North Carolina Evidence-Based Healthy Aging Programs Department of Health & Human Services Division of Aging & Adult Services Spring 2014

North Carolina Evidence-Based Healthy Aging Programs Department of Health & Human Services Division of Aging & Adult Services Spring 2014 Nicolle Miller, MS, MPH, RD, LDN nicolle.miller@dhhs.nc.gov (919) 855-3423

A profile of North Carolinians NC is Aging! # Retirees # Foreign-born population (Immigrant and refugees) # Life expectancy # Baby boomers # Lower birth rates

NC Population Projections 2012 2032 # % # % Total population 9,765,229 11,928,509 60+ 1,908,472 19.5% 3,030,092 25.4% 65+ 1,345,905 13.8% 2,338,400 19.6% 85+ 159,887 1.6% 289,387 2.4% Baby Boomers 2,367,352 24.2% 1,757,944 14.7% Baby boomers: 2012 (48-66 years) 2032 (68-86 years) Source: NC State Data Center

Counties with more people 60 years old+ than age 0-17, 2012 Graham Cherokee Clay Pasquotank Currituck Camden Alleghany Stokes Ashe Surry Rockingham Caswell Person Warren Northampton Vance Gates Watauga Wilkes Granville Halifax Hertford Perquimans Forsyth Yadkin Guilford Franklin Alamance Orange Chowan Mitchell Avery Bertie Durham Nash Yancey Caldwell Alexander Davie Edgecombe Madison Davidson Wake Martin Washington Iredell Burke Randolph Chatham Wilson Tyrrell Catawba Buncombe McDowell Rowan Pitt Beaufort Haywood Johnston Lee Swain Greene Hyde Rutherford Lincoln Henderson Cabarrus Harnett Stanly Moore Wayne Jackson Polk Cleveland Gaston Montgomery Lenoir Macon Transylvania Mecklenburg Craven Cumberland Pamlico Richmond Hoke Sampson Jones Union Anson Duplin Scotland Onslow Carteret Robeson Bladen Pender Columbus New Hanover Counties with more 60+ than 0-17 (59) Brunswick Dare Counties with more 0-17 than 60+ (41) Source: NC State Data Center, 10/1/2013

Counties with more people 60 years old+ than 0-17, 2025 Graham Cherokee Clay Pasquotank Currituck Camden Alleghany Ashe Surry Stokes Rockingham Caswell Person Warren Northampton Vance Gates Watauga Wilkes Granville Halifax Hertford Perquimans Yadkin Forsyth Mitchell Avery Guilford Franklin Alamance Orange Chowan Bertie Yancey Caldwell Alexander Davie Durham Nash Madison Edgecombe Iredell Burke Davidson Wake Martin Washington Catawba Randolph Chatham Buncombe McDowell Rowan Wilson Tyrrell Dare Haywood Pitt Beaufort Johnston Swain Rutherford Lincoln Lee Greene Hyde Henderson Cabarrus Harnett Jackson Polk Cleveland Gaston Stanly Moore Wayne Montgomery Macon Transylvania Mecklenburg Lenoir Craven Cumberland Pamlico Hoke Union Richmond Sampson Jones Anson Duplin Scotland Onslow Carteret Robeson Bladen Pender Columbus New Counties with more 60+ than 0-17 (89) Hanover Brunswick Counties with more 0-17 than 60+ (11) Source: NC State Data Center, 10/1/2013

% of population 65 and over, 2012 Graham Cherokee Clay Pasquotank Currituck Camden Alleghany Ashe Surry Stokes Rockingham Caswell Person Warren Northampton Vance Gates Watauga Wilkes Granville Halifax Hertford Perquimans Yadkin Forsyth Mitchell Avery Guilford Franklin Alamance Orange Chowan Bertie Yancey Caldwell Alexander Davie Durham Nash Madison Edgecombe Iredell Burke Davidson Wake Martin Washington Catawba Randolph Chatham Buncombe McDowell Rowan Wilson Tyrrell Dare Haywood Pitt Beaufort Johnston Swain Rutherford Lincoln Lee Greene Hyde Henderson Cabarrus Harnett Jackson Polk Cleveland Gaston Stanly Moore Wayne Montgomery Macon Transylvania Mecklenburg Lenoir Craven Cumberland Pamlico Hoke Union Richmond Sampson Jones Anson Duplin Scotland Onslow Carteret Robeson Bladen Pender 10% or less (6) 11% to 20% (75) 21% to 30% (19) *Number of counties in parenthesis Columbus New Hanover Brunswick North Carolina 14% Range: 7.8%-27.7% Source: NC State Data Center, 10/1/2013

% of population 65 and over, 2032 Graham Cherokee Clay Pasquotank Currituck Camden Alleghany Ashe Surry Stokes Rockingham Caswell Person Warren Northampton Vance Gates Watauga Wilkes Granville Halifax Hertford Perquimans Yadkin Forsyth Mitchell Avery Guilford Franklin Alamance Orange Chowan Bertie Yancey Caldwell Alexander Davie Durham Nash Madison Edgecombe Iredell Burke Davidson Wake Martin Washington Catawba Randolph Chatham Buncombe McDowell Rowan Wilson Tyrrell Dare Haywood Pitt Beaufort Johnston Swain Rutherford Lincoln Lee Greene Hyde Henderson Cabarrus Harnett Jackson Polk Cleveland Gaston Stanly Moore Wayne Montgomery Macon Transylvania Mecklenburg Lenoir Craven Cumberland Pamlico Hoke Union Richmond Sampson Jones Anson Duplin Scotland Onslow Carteret Robeson Bladen Pender 11% to 20% (22) Columbus New Hanover 21% to 30% (70) Brunswick 31% or more (8) *Number of counties in parenthesis North Carolina 20% Range: 10.6%-32.6% Source: NC State Data Center, 10/1/2013

Most older adults 65+ years live in the community Community 33.4 M; 93.5% Nursing Homes 1.5 M; 4.5% Assisted Living 1.0 M; 2.0% US Census Bureau; Centers for Medicare & Medicaid, Medicare Current Beneficiary Survey

Nationally, NC Ranks 10th in the size of the total population 9th in the size of population 60y/o+ 9th in the size of the population 65y/o+ 11th in the size of the population 85y/o 6th in grandparents responsible for grandchildren under 18 y/o Source: 2012 ACS one year estimates

NC Poverty rate increases in older age Unmarried women have higher poverty rates People living in poverty are at risk of having inadequate resources for housing, food, health care and other needs

Leading Causes of Death for 65+, 2011 Rank Cause Number % 1 Diseases of heart 12,949 22.9 2 Cancer 12,118 21.4 3 Chronic lower respiratory diseases 3,942 7.0 4 Cerebrovascular disease 3,598 6.4 5 Alzheimer's disease 2,783 4.9 Source: NC State Center for Heath Statistics

The Burden of Chronic Disease Treating chronic disease accounts for 75% of U.S. health care spending By 2030 U.S. Boomers More than 6 of every 10 will be managing more than one chronic condition 14 million (1 out of 4) will be living with diabetes >21 million (1 out of 3) will be considered obese 26 million (1 out of 2) will have arthritis When I m 64: How Boomers Will Change Health Care, American Hospital Association, May 2007 ¹Centers for Disease Control and Prevention. Chronic Disease Overview page. Available at: http://www.cdc.gov/nccdphp/overview.htm. Accessed April 6, 2007.

Our Challenges Rapidly growing older adult population Chronic disease Food insecurity Expensive - More money spent on health, social security, shortage of labor force

NC Division of Aging and Adult Services Senior Nutrition Programs (Congregate, Home Delivered Meals) Adult Day Services Family Caregiver Services and Respite Care In-Home Aide Information and Case Management Senior Center Operations Transportation Housing and Home Improvement Adult Protective Services Other Services (Health Promotion, Ombudsman Advocacy Program, State Prescription Drug Program, etc.)

Evidence-Based Healthy Aging Programs Offered Through Local Area Agencies on Aging (AAAs) A B C E D F G M K J L P Q R N O http://www.ncdhhs.gov/aging/ http://www.ncdhhs.gov/aging/livinghealthy/livinghealthy.htm

Evidence-Based Healthy Aging Programs EBPs translate tested program models or interventions into practical, effective community programs that can provide proven health benefits to participants. National Support for EBPs: Administration on Aging Centers for Disease Control and Prevention Centers for Medicare and Medicaid Services

NC Evidence-Based Healthy Aging Programs Chronic Disease Self- Management Education Programs (CDSME) Called Living Healthy in NC *CDSMP (Chronic Disease) *Tomando Control de su Salud (Spanish CDSMP) *DSMP (Diabetes) *PSMP ( Positive SMP - HIV/AIDS) CPSMP (Chronic Pain) ASMP (Arthritis) A Matter of Balance (MOB) Arthritis Foundation Exercise Program Aquatics Program Tai Chi Program Walk With Ease Fit and Strong! Healthy IDEAS Laughter Yoga *Indicates offered through AAAs

Self-Management Class Logistics Highly Interactive and Engaging Lay Leader Model of Implementation Appropriate for those with medical conditions, those at risk, and caregivers CDSME Classes 6 classes, 2.5 hours/class, 10-12 participants MOB Classes 8 classes, 2 hours/class, up to 20 participants

North Carolina Infrastructure Many Partner Organizations (Aging, Public Health, CBOs, Clinical, CCNC, etc.) Statewide Director (Aging) 16 AAA Living Healthy Regional Coordinators DAAS Living Healthy Website: http://www.ncdhhs.gov/aging/li vinghealthy/livinghealthy.htm Since 2008 Living Healthy Over 800 leaders 659 classes offered A Matter of Balance 423 leaders 388 classes offered Arthritis Foundation and Walk With Ease 626 leaders 246 sites offering classes

% Participants Chronic Conditions Reported in NC Living Healthy 60 50 40 30 20 10 0 Hypertension Arthritis Diabetes Other Anxiety/Depression Heart Disease Breathing/Lung Di... Osteoporosis Cancer Stroke North Carolina National Level Note: 73% of participants indicate having more than 1 chronic illness. The average number of conditions is 2.76 (range 1-6). 71% of DSMP participants have DM.

% of Participants NC Living Healthy Outcomes 2011 100 90 80 70 60 50 40 30 20 10 0 General Health Physician Communication Symptom Management Daily Activities Before Workshop 1-Year Follow-up Participants who attended a NC Living Healthy CDSMP workshop from November 2009 March 2010 were asked a series of questions regarding their current health status. Approximately one year after the workshops were held (November 2010 March 2011), those participants that completed the health-related information were contacted by a member of the DAAS evaluation team. Those contacted were then asked the same health status questions that were administered one year prior.

Return on Investment 2013 CDSMP National Study Institute of Healthcare Improvement s Triple Aims Better Health Feel healthier More active lives Less depression Better quality of life Fewer Sick Days Better Care Communication Medication compliance Health literacy Lower Cost $714 per person savings in emergency room visits and hospital utilization $364 per person net savings after considering program costs ($350) Potential savings of $6.6 billion by reaching 10% of Americans with one or more chronic conditions

Return on Investment 2013 CMS Report to Congress Participation in A Matter of Balance (MOB) $938 decrease in total medical cost savings per year Reductions in unplanned hospitalizations Associated with increased PT and occupational therapy (OT) use

Return on Investment Potential for North Carolina Falls: $32 million per year 30% of Older Adults fall each year MOB programs cost $137/participant in the state ($801 cost savings per person after program costs) Reaching 10% of those at risk of a fall Chronic Disease: $60 million per year 80% of Older Adults have at least 1 chronic condition CDSME programs cost $161/participant in the state ($553 cost savings per person after program costs) Reaching 10% of these older adults with a chronic condition

Sustaining Evidence Based Healthy Aging Programs Area Agencies on Aging are required to use AoA health promotion funding for Evidence-Based Programs $500,000+ statewide Living Healthy embedded into: Grant proposals (Division of Public Health s (DPH) Community Transformation (CTG) Grants and Office of Minority Health and Health Disparities (OMHHD) Grants) Programs & Policies DAAS & DPH (NC Stroke Plan) Local Grants Partner Organizations and Use of Business Plans Division of Public Health Local Health Departments Primary care clinics Hospitals Community Care of NC networks Cooperative Extension AARP Faith-based groups

How can you get involved in Bring workshops and/or trainings to your community Serve as a partner with the EBPs Regional Coordinator/Area Agency on Aging Assist in recruiting participants, signing people up for the class, offering classes in your facility, etc. Share program costs Living Healthy? Be a program champion and generate interest Refer your colleagues, family members, and friends to the program

Referrals for Healthy Living Congratulations on your decision to better manage your health! To begin, I recommend you enroll in one of the following FREE programs: Living Healthy Self Management Living Healthy with Diabetes Self Management Today s Date Patient s Name Lists of interested individuals maintained by Regional Coordinators http://www.ncdhhs.gov/aging/livinghealth y/livinghealthy_regions.htm#lay Health Care Provider Signature For a listing of available classes in your area, please call the Western Piedmont Area Agency on Aging at 828-485-4216 or visit www.wpcogaaa.org

How can you get involved in Living Healthy? Become a Lay Leader or identify Lay Leaders in your community Training for CDSMP is 4 full days (8:30a-4pm typically) DSMP cross training is 2 full days MUST be willing to teach 2 classes per year MUST be able to stick to the curriculum and NOT offer professional expertise Help us connect with people, groups, organizations, etc. that may be interested

Contact Information Nicolle Miller, MS, MPH, RD Aging Specialist NC Division of Aging & Adult Services nicolle.miller@dhhs.nc.gov (919) 855-3423 Living Healthy website available at: http://www.ncdhhs.gov/aging/livinghealthy/livinghealthy.htm