Health Promotion 2 7 07

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Health Promotion Activities of Urban Dwelling Older Adults: 

Health Promotion Activities of Urban Dwelling Older Adults Eileen Sullivan-Marx, PhD, CRNP, FAAN

Health Promotion Activities of Older Adults Cindy Lou Cuesta, E. Sullivan-Marx, Yu-Ru Lin, & S. Ratcliffe: 

Health Promotion Activities of Older Adults Cindy Lou Cuesta, E. Sullivan-Marx, Yu-Ru Lin, andamp; S. Ratcliffe Funded by Penn Institute for Urban Research, CPLN 528/URBS 428, Undergraduate Urban Research Course

Research Aims: 

Research Aims Describe the health promotion and disease prevention activities of adults over the age of 75 living in West Philadelphia zip codes Describe potential barriers to health promotion and disease prevention activities of adults over the age of 75 living in West Philadelphia Evaluate the utility of the Philadelphia Health Management Corporation (PHMC) database to address aims 1 and 2 to inform further research.

What is Health?: 

What is Health? Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. (WHO, 1948)

Leading Health Indicators: 

Leading Health Indicators Physical Activity  Overweight and Obesity  Tobacco Use  Substance Abuse  Responsible Sexual Behavior  Mental Health  Injury and Violence  Environmental Quality  Immunization  Access to Health Care (According to Healthy People 2010)

The Health Belief Model(Becker, Haefner, Kasl et al., 1997, Medical Care): 

The Health Belief Model (Becker, Haefner, Kasl et al., 1997, Medical Care) Individual Perceptions Modifying Factors Likelihood of Action

Study Framework: 

Study Framework Individual Perceptions Perceived seriousness of high blood pressure Modifying Factors Knowledge, demographics, perceived threat of disease, reference group, cues to action Likelihood of Action Perceived benefits of action, barriers to preventive action

West/Southwest Philadelphia: 

West/Southwest Philadelphia Pennsylvania is one of the states with the highest percentage of older adults Top Health problems for individuals living in the West/Southwest Philadelphia community : High blood pressure Weight Problems Diabetes Heart problems Back Pain

Philadelphia Health Management Corporation (PHMC) Database: 

Philadelphia Health Management Corporation (PHMC) Database Based on longitudinal telephone surveys Includes elderly supplement for those 60 years of age and older Phila – 1248 individuals over age 60

SampleN= 112: 

Sample N= 112 Eight zip codes in LIFE catchment area 75 or older

Demographic VariablesN= 112: 

Demographic Variables N= 112

Ages 75+ in LIFE Codes: 

Ages 75+ in LIFE Codes

Gender: 

Gender

Marital Status: 

Marital Status

Race: 

Race

Medicaid Status: 

Medicaid Status

Education Level: 

Education Level

Number People in HH: 

Number People in HH

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Federal Poverty Guidelines for Family Unit of 2 = $12, 830

Research Methodology: 

Research Methodology Health variables

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Median BMI = 26.453

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IADL Activities: 

IADL Activities

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ADL Activities: 

ADL Activities

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Obesity and Gender: 

Obesity and Gender

# IADL limitations and Obesity: 

# IADL limitations and Obesity

# ADL limitations and Obesity: 

# ADL limitations and Obesity

# IADL limitations and Exercise talk with Doctor: 

# IADL limitations and Exercise talk with Doctor

#ADL limitations and Exercise Talk with Doctor: 

#ADL limitations and Exercise Talk with Doctor

Race and Obesity: 

Race and Obesity

Income Level and Obesity: 

Income Level and Obesity

Obesity Level and View of Health: 

Obesity Level and View of Health

Research Gaps and how this Project Fills Them: 

Research Gaps and how this Project Fills Them Health promotion knowledge Access to health promotion services limited Barriers/Advantages in urban environments for health promotion Racial/ethnic/economic disparities

Variables: 

Variables Individual Perceptions Perceived susceptibility to disease Modifying Factors Demo Knowledge about prevention Knowledge about disease Sociopsychologic variables Functional status

Variables: 

Variables Likelihood of Action Transportation Ease of access to healthy food Advice given by health provider Lack of health coverage or Rx coverage

Research Methodology and Limitations: 

Research Methodology and Limitations Secondary Data Analysis Descriptive Study Cross Section Bias sample – those able to answer a phone survey

Limitations: 

Limitations PHMC purpose vs. Health Beliefs Model Limited # of 60+ Bias sample – those able to answer a phone survey

IOM – Unequal Treatment Report (Smedley et al, 2002): 

IOM – Unequal Treatment Report (Smedley et al, 2002) Avoid fragmentation Refuse treatment Increase awareness of racial and ethnic disparities among public Increase health provider awareness of health disparities Evidence based guidelines

Refocusing the Interdisciplinary: Toward Elder-Friendly Urban Environments : 

Refocusing the Interdisciplinary: Toward Elder-Friendly Urban Environments Eileen Sullivan-Marx, School of Nursing Joan Davitt, Social Policy andamp; Practice Harris Steinberg, School of Design Dina Schlossberg, Law School Lucy Kerman, Fels School of Government

Toward Elder Friendly Environments: 

Toward Elder Friendly Environments Aim – To develop interdisciplinary research regarding challenges facing older adults who live in urban environments with a particular focus on West Philadelphia

Goals: 

Goals Development of new interdisciplinary research collaborations to examine challenges of older adults in urban environments. Exploration of rigorous community-based participatory research methodologies that can be used to address issues of older adults living in urban environments. Develop and implement civic engagement in West Philadelphia that will foster community-based participatory action research to inform policy makers and sustain elder-friendly urban communities.

West Philadelphia Community Assessment: 

West Philadelphia Community Assessment Strong community identity and history Chronic illness and behavioral health risks Physical disabilities prevalent Need for functional home adjustments Financial vulnerabilities and need for estate planning Exposure to crime and violence Generation gap in civic leadership Access to available community amenities limited (shopping, banking, transportation) Diminishing capacity of the extended family to support vulnerable family members

Strategies: 

Strategies Create academic, professional and student collaborations among Schools of Nursing, Social Policy andamp; Planning, Medicine, Design, Law, Wharton and Engineering Host two seminars per semester Develop working groups considering research collaborations Initiate community-based projects and education.

Penn CompactAmy Gutmann, President, University of Pennsylvania: 

Penn Compact Amy Gutmann, President, University of Pennsylvania Increasing Access Integrating Knowledge Engaging Locally and Globally Penn Boosting Civic Capacity Penn Improving Public Education Penn Improving Public Health Penn Improving Quality of Life Penn Driving the Economy

Suggested Research : 

Suggested Research Development of indicators of healthy urban/elder-friendly neighborhoods. Associations between physical and behavioral health, access to care, victims of crime, and worsened financial risk (predatory lending). Impact of race and class on housing choices and neighborhood stability, drawing on lessons from the Gulf Coast and nationally. Impact of cultural and spiritual traditions on the stability of the African American elderly community.

Community Engagement: 

Community Engagement Identify complex needs of the vulnerable elderly community that require solutions which cross disciplines and engage the community to develop priorities, hypotheses testing, and advising methodology Evaluation of community education and projects on such topics as predatory lending, estate planning , and home repairs

Community Based-Participatory Research: 

Community Based- Participatory Research Provide the community a voice that informs andamp; receives the benefit of academic research Engage the community as partners in research and teaching Establish research priorities with the community Create sensitivity to research priorities within disenfranchised populations 

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Map of West Phila population

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Map of West Phila population

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Map of West Phila homeownernship

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Forum Focus Group Findings: 

Forum Focus Group Findings Housing Repairs Second Story Barriers Financial Consumer Education Resources for Advocacy

Outcomes of an Exercise Program for Older African American Women in a PACE Model: 

Outcomes of an Exercise Program for Older African American Women in a PACE Model PI – E. Sullivan-Marx; Co-I S. Volpe CBPR Model Determine the relative effects of a 16 week, three times a week, strength and endurance exercise program for nursing home eligible African American women enrolled in a PACE Physical andamp; Cognitive Function Strength andamp; Endurance Satisfaction

Fitness among Older Urban Dwelling MenAnn B. Mitchell, MSN, PhD candidate: 

Fitness among Older Urban Dwelling Men Ann B. Mitchell, MSN, PhD candidate Identify specific beliefs and attitudes about the behavior and physical activity of older African American urban dwelling men Engaged in work with relevant community and faith based organizations that represent the community interest of West and Southwest Philadelphia.

Resource Center for Minority Aging Research (submitted): 

Resource Center for Minority Aging Research (submitted) J. Johnson andamp; N. Strumpf PI C. Hughes-Halbert andamp; E. Sullivan-Marx, Co Community Core Leaders Improve health outcomes, reduce health disparities, train new investigators, prepare community organizations and stakeholders to participate in design, conduct, and dissemination of research