The community-based LIVE WELL Initiative: Improving the lives of older adults.

A collaborative partnership among community-based organizations (CBOs) could strengthen local services and enhance the capacity of a community to provide services as well as meet the diverse needs of older adults. The United Way of Tarrant County developed the LIVE WELL Initiative, partnering with six CBOs to provide nine evidence-based or evidence-informed health interventions to improve the health and lower healthcare costs of vulnerable individuals at risk for poor health. The nine programs include specific target areas, such as falls prevention, chronic disease self-management, medication management, and diabetes screening and education. A total of 63,102 clients, nearly 70% of whom were older adults, were served through the Initiative. Significant improvements in self-reported health status were observed among served clients. The percentage of clients reporting self-rated health as good, very good, and excellent increased from 47.5% at baseline to 61.1% at follow-up assessment. The mean healthy days improved from 16.9 days at baseline to 20.6 days at follow-up assessment. Additional improvements in program-specific outcomes demonstrated significant impacts of targeted intervention focus among served clients by program. The findings of this study emphasize that the impact of a collaborative partnership with multiple CBOs could promote health and well-being for older adults.

Effect of Obesity on Bone Healing After Foot and Ankle Long Bone Fractures.

As obesity has become more common, fractures in the obese population have become more frequent. Concern exists regarding alterations in bone health and healing in obese patients. A matched case-control study was performed at 1 institution to evaluate whether an association exists between nonunion and a high body mass index in metatarsal and ankle fractures. A total of 48 patients with nonunion were identified, and control patients matched 2 to 1 (n = 96) were selected. The control patients were matched for age, sex, and fracture type. No association was identified between nonunion and the continuous body mass index (p = .23) or morbid obesity, with a body mass index of ≥40 kg/m2 (p = .51). However, the results from both univariate and multivariate analysis suggested that patients with a current alcohol problem or a history of an alcohol problem might have a greater risk of nonunion. The odds ratio of a patient with a history of alcohol use experiencing nonunion was 2.7 (95% confidence interval 1.2 to 6.2). Further studies are warranted to confirm these findings.

Increasing the Availability of Physical Activity Programs for Older Adults: Lessons Learned From Texercise Stakeholders.

Many initiatives have been developed to facilitate older adults' engagement in physical activity (PA) and document its benefits. One example is Texercise, a 12-week program with a focus on increasing participants' self-efficacy. The goal of this paper is to augment the knowledgebase of PA program implementation and dissemination by elucidating the experience of Texercise implementation as perceived by multiple stakeholders. We conducted 28 semistructured stakeholder interviews and categorized the responses into four preset themes: (1) program delivery and advocacy; (2) value/merit of the program; (3) successes/challenges of offering and sustaining the program; and (4) recommendations for enhancing implementation and delivery. We identified emergent subthemes through further analysis. Many perceptions that are broadly applicable to community organizations emerged. Our findings highlight the importance of stakeholder support when embedding PA programs in communities. Furthermore, the findings are crucial to understanding underlying processes that support widespread program dissemination and sustainability.

A Model Program of Community-Based Supports for Older Adults at Risk of Nursing Facility Placement.

Transitioning an older adult into a nursing facility is a major life event for older adults (care recipients, CRs) and their family caregivers (CGs). This article describes the implementation of a community living program and presents findings on important health and well-being indicators. One hundred ninety-one participants aged 60 and older not eligible for or currently enrolled in Medicaid and meeting four risk domains (functional, health, cognitive/emotional, informal support system) were enrolled for the 10-month program. Two evidence-based interventions were blended into a comprehensive community-based approach to long-term care that included $750 per month for home care services. Measures were conducted at baseline and 6 and 12 months. Nine (6%) participants did not complete the program because of nursing facility admission. CRs had fewer physician visits (4.1 vs 7.3, P < .001), emergency department visits (0.3 vs 1.4, P < .001), hospital stays (0.4 vs 0.9, P < .001), and total nights in the hospital (0.8 vs 5.1, P < .001) at 12 months than at baseline. Center for Epidemiologic Studies Depression Scale (CES-D) scores also improved significantly (6.8 vs 9.4, P < .001). CGs had improvements in CES-D scores (5.9 vs 3.9, P < .001) and CG burden (14.7 s 12.6, P = .01) from baseline to 12 months. This multicomponent program improved the physical and mental health of CGs and CRs at risk of nursing facility placement. Future studies are needed to compare the overall placement rate to determine the success of diverting nursing facility placement in this population of older adults.

A Model Home-Delivered Meals Program to Support Transitions from Hospital to Home.

Meals On Wheels, Inc. of Tarrant County (MOWI) collaborated with local community-based organizations and hospitals to provide home-delivered meals and an evidence-based medication management intervention as a care transition service. The model program was designed to address risk factors commonly associated with preventable hospital readmissions. MOWI staff provided meals to 121 patients recently discharged from an inpatient hospitalization or emergency department visit from March 2013 through March 2014. A total of 18,010 meals were delivered to the 121 clients. On average, clients received 6.25 meals per week with meal delivery starting, on average, 8.95 days postdischarge. Ninety-three of the 121 clients also elected to receive the HomeMeds program. Client self-report of health care utilization (e.g., hospital readmission) at three months and six months was lower than expected given client characteristics. Positive changes in the Emergent Care Assessment and resolution of medication alerts provide additional evidence of a positive effect of the home-delivered meals program. More research is needed to document the benefits of home-based care supports following hospitalization.