EA PHELAN, B. WILLIMS, S. LEVEILLE, S. SNYDER, EH WAGNER, JP LoGERFO : Outcomes of a community-based dissemination of the health enhancement program.

By Phelan EA, Williams B, Leveille S, Snyder S, Wagner EH, LoGerfo JP. Department of Medicine, Division of Gerontology and Geriatric Medicine, School of Public Health and Community Medicine, Seatle, Washington 98104, USA.

Published in the Journal of American Geriatrics Society. 2002 Sep ;50(9):1519-24.

OBJECTIVES : We previously found in an efficacy trial that a health promotion program prevented functional decline and reduced hospitalizations in community-dwelling older people with chronic conditions. We sought to evaluate the effectiveness of the program in its dissemination phase. DESIGN : Outcome evaluation using a within-group, pretest-posttest design. SETTING : Fourteen senior centers located throughout western Washington. PARTICIPANTS : Three hundred four community-dwelling men and women aged 65 and older. INTERVENTION : A disability-prevention, chronic disease-self-management program. MEASUREMENTS : Participant characteristics, risk factors for disability, change in health and functional status, and healthcare use over 1 year of enrollment ; participant satisfaction. RESULTS : Participants were 71% female, had a mean age of 76, and reported three chronic health conditions on average. The percentage of participants found to be depressed decreased (28% at time of enrollment vs 17% at 1-year follow-up, P =.005). The percentage of physically inactive participants decreased (56% vs 38%, P =.001). Physical activity level and exercise readiness improved (Physician-based Assessment and Counseling for Exercise mean score 4.3 vs 5.1, P =.001). At follow-up, 83% rated their health the same as or better than a year ago, compared with 73% at time of enrollment. The proportion with impaired functional status, as measured by bed days and restricted activity days, stayed the same. The proportion hospitalized remained stable (23% at enrollment and follow-up, P = 1.0). CONCLUSIONS : Under real world conditions, the Health Enhancement Program reaches older people at risk of functional decline. Those enrolled for 1 year experience a reduction in disability risk factors, improvement in health status, no decrements in functional status, and no increase in self-reported healthcare use.

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