What is the Optimal Duration of Participation in a Community-Based Health Promotion Program for Older Adults?

Optimizing duration of participation in health promotion programs has important implications for program reach and costs. We examined data from 355 participants in EnhanceWellness (EW) to determine whether improvements in disability risk factors (depression, physical inactivity) occurred early or late in the enrollment period. Participants had a mean age of 74 years; 76% were women, and 16% were non-white. The percent depressed declined from enrollment to six months (35% to 28%, p = .001) and from six to 12 months (28% to 22%, p = .03). The percent physically inactive declined over the first six months, without substantial change thereafter (47%, 29%, and 29%). Those remaining inactive at six months had worse self-rated health and more depressive symptoms initially; a subset of those increased their physical activity by 12 months. These data suggest that enrollment could be reduced from 12 to six months without compromising favorable effects of EW participation, although additional benefits may accrue beyond six months.

Community-based "powerful tools" intervention enhances health of caregivers.

Family caregiving is prevalent and may have adverse impacts on health, particularly for elder caregivers who tend to have chronic health conditions which need ongoing self-management. Interventions that empower family caregivers to take care of themselves are needed. This study examined the impact on caregivers of participation in a self-care skill-building, self-efficacy enhancing, community-based program called powerful tools for caregiving (PTC). We assessed health-risk behaviors, self-care, and psychological well-being among 118 adult caregivers who participated in PTC in western Washington state between July 2001 and June 2004, about half of whom were aged 65 or older. Health-risk behaviors were reduced and self-care and psychological well-being improved significantly, overall and for each stratum of age (> or =65 years of age versus <65).

A five state dissemination of a community-based disability prevention program for older adults.

OBJECTIVE: To describe challenges in disseminating the Health Enhancement Program (HEP), a community-based disability prevention program for community dwelling elders, and to examine program effectiveness in geographically dispersed sites. METHODS: Within-group, pre-test-post-test comparisons of disability risk factors, health and functional status, and hospitalizations for 115 participants completing one year in HEP, and primary care provider awareness and perceptions of the program. RESULTS: Most (77%) participants were women, with an average age of 73 years and an average of 3.5 chronic conditions. At one-year follow-up, compared with enrollment, fewer participants were depressed (8.8% vs 15.9%), physically inactive (15.8% vs 38.6%), at high nutritional risk (24.3% vs 44.1%), or experiencing restricted activity days (35% vs 48%). Severity scores on most measures also improved significantly. The proportion hospitalized was unchanged from the year prior to HEP, although risk factors predicted an increase in hospitalizations as for the control group in the randomized trial. CONCLUSIONS: HEP reduced participants' disability risk factors. Sites varied on numbers enrolled and time to implement the program, likely due to differing referral bases, degree of physician awareness of HEP, and site readiness. However, the benefits of HEP participation were comparable with those reported previously.