The population of Americans aged 65 years or older will double during the next 25 years to about one-fifth of the population. Moreover, a major shift has occurred in the leading causes of death from infectious diseases and acute illnesses to chronic diseases, with two out of three older adults having more than one chronic disease. Poor lifestyle choices are linked to many chronic illnesses that plague older adults. Thus, chronic conditions like cardiovascular disease and diabetes provide a strong incentive for action among older adults, with treatment for this population accounting for a majority of the U.S. healthcare budget.
Risk factors for cardiovascular disease include obesity, poor nutrition, decreased physical activity, social isolation, and older age. Disparities in cardiovascular health are prominent among members of socioeconomically-disadvantaged communities. In a study funded by the Aeta Foundation and published in Family and Community Health, we evaluated a community-based health promotion intervention to improve nutrition and exercise in older adults.
Our interdisciplinary team of investigators at Duquesne University School of Nursing, reasoned that our nurse-run Community-Based Health and Wellness Centers, located in disadvantaged neighborhoods, would be the ideal place to reach vulnerable older adults. Our Centers began in 1994 with a mission to provide wellness-oriented health care services to vulnerable populations by delivering holistic and culturally-competent care. From one site in 1994, the Centers have expanded to 10 sites serving older adults within the lower-income, ethnically-diverse neighborhoods of the greater Pittsburgh area.
Our team implemented a 12-week group behavioral intervention to improve eating and physical activity, “Wise Choices,” for 118 racially diverse older adults at 6 community-based senior centers. The weekly, 45-minute group sessions focused on the following dietary and physical activity areas over the course of 12 weeks:
- getting started / using pedometers to track daily steps
- eating 5 fruits and vegetables daily / setting a new goal for daily steps
- eating a variety of colorful fruits and vegetables / incorporating stretching
- including calcium-rich dairy products / increasing the walking pace
- eating three calcium-rich dairy products daily / benefits of walking for bone health
- health benefits of dietary fiber / walking in different weather conditions
- adding more fiber to your diet / activity for gastrointestinal health
- eating sensible portion sizes / proper posture during physical activity
- identifying portions / activity for controlling weight and diabetes
- healthy food choices / physical activities in addition to walking
- celebrating success / planning for the continuation of changes
We provided healthy tip sheets, pedometers, and multiple opportunities for tracking diet, physical activity, and body weight. Each session began with a weigh-in and ended with a group walk. Each participant received a t-shirt and was entered into two drawings to win a gift basket during the course of the program. Participants reported that they found the guidance and group support to be very engaging. The faculty, staff and students involved in the program found it to be rewarding and motivating too.
Assessment of outcomes was completed pre- and post-intervention. In our publication, we documented increases in fruit, vegetable, and whole grain intake; pace of walking; number of city blocks walked; daily steps walked; functional mobility; and self-rated general health, including bodily pain and physical functioning. Additionally, we had excellent retention of participants through the end of the program. These findings suggest that a relatively low-intensity lifestyle intervention can effectively be implemented for community-dwelling older adults to promote healthy lifestyle behaviors.
Development and dissemination of similar approaches is warranted in wellness or community centers. Creative partnerships among key stakeholders are needed to move this work forward and have a major public health impact. Ultimately, providing accessible services in the community can facilitate healthy aging in place and preventing transition to a higher level of care.
For sound information on healthy lifestyles among older adults, see:
The Wise Choices project was supported by The Aetna Foundation, a national foundation that supports projects to promote wellness, health and access to high quality health care for everyone. The views presented here are those of the authors and not necessarily those of The Aetna Foundation, its directors, officers, or staff.
Turk M, Kalarchian M, Resick L, Elci O. Wise choices: Nutrition and exercise for older adults—A community-based health promotion intervention. Family & Community Health. 2016;39(4):263-272. PMID: 27536931