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

Elizabeth A Phelan¹, Barbara Williams², Susan J Snyder³, Sally Sizer Fitts¹, James P LoGerfo⁴

¹Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, WA, USA; ²Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, WA, USA; ³Senior Services of Seattle/King County, Seattle, WA, USA; ⁴Department of Medicine, Division of General Medicine, University of Washington, Seattle, WA, USA

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.

Keywords: aged, risk factors, outcome and process assessment (healthcare), chronic disease self-management, diffusion of innovation, program evaluation