Written by Taylor R. Patskanick, master’s research fellow in aging, Harvey A. Friedman Center for Aging at the Institute for Public Health
Evidence-based public health includes the use of proven approaches to improve population health. Historically, public health interventions were not always scientifically-based. And in today’s increasingly connected, yet resource-scarce world, public health practice has become more dynamic, intricate, and transdisciplinary than ever before.
An evidence-based approach to public health ensures decision-making is grounded in scientific research that is effective, up-to-date, and the best of what can be offered. This approach, along with taking into account the values and interests of the stakeholders and target community, means we can more effectively establish goals, measure success, and promote healthy outcomes that address important community and population needs.
Aging service providers, practitioners, researchers, policymakers, and more have long been working together to better understand how older adults can achieve optimal health and wellbeing. Concerns about policy reform, including how to lower healthcare costs while promoting ideal health outcomes, have largely dominated the discourse about growing older in the U.S. Perhaps it comes as no surprise then, that the most common evidence-based programs for older adults are health promotion programs that endorse healthy self-management behaviors to increase coping capacity, reduce healthcare utilization, and improve overall wellbeing.
But what does it actually mean to put evidence-based public health into practice with aging societies and older adults?
Evidence-based programming for older adults have the same elements of any other kind of evidence-based public health practice. These programs engage stakeholders, are based on data and systemic peer-reviewed evidence, utilize program planning frameworks, include implementation and evaluation plans, and are effectively disseminated to the larger public. A brief summary of a few well-known evidence-based programs focused primarily on adults in mid-life and older are below:
The Centers for Disease Control and Prevention Healthy Aging Program and Healthy Brain Initiative have developed web-based tools and resources including reports, journal articles, issue briefs, podcasts, and a health information portal for older adults, caregivers, public health service providers, the general public, and for partnerships with other federal agencies. The Healthy Aging program and Healthy Brain Initiative have also created a healthy aging data portal, offering the most up-to-date CDC data and surveillance on health behaviors, health promotion engagement, and cognition. The program offers concrete materials and steps older adults and caregivers can take to address emergency preparedness, advance care planning, and any needs for clinical preventive services.
The Self-Management Resource Center at Stanford University has over 30 years of experience creating and testing evidence-based health education programs dedicated to helping older adults better their manage chronic health conditions. The SMRC began as an arthritis education program funded by the U.S. National Institutes of Health and gradually developed into the Chronic Disease Self-Management Program which was also adapted for use during the HIV/AIDS crisis and with Spanish-speaking populations. The Arthritis Self-Management Program has served as the program template for other health promotion programs at the SMRC including those focused on chronic pain, diabetes self-management, caregiving, and for cancer survivors. SMRC conducts vigorous evaluation of their programs and offers extensive training and licenses for service providers seeking to deliver these programs.
Healthy IDEAS (Identifying Depression, Empowering Activities for Seniors) is an evidence-based program integrating depression awareness into case management services for older adults. Healthy IDEAS was founded in the Baylor College of Medicine in partnership with Care for Elders. The program aims to improve the quality of life of older adults through screening and assessing for depression, educating older adults and caregivers about depression, linking them to primary and mental health care providers, and empowering older adults to manage their depression through a behavioral-activation approach with involvement in meaningful activities. The program is delivered over a 3-6 month period with at least three face-to-face visits and three telephone calls.
Respecting Choices® (RC) is a comprehensive and evidence-based program focused on person-centered advance care planning for individuals at all stages of health across healthcare settings. RC utilizes non-physician Advanced Care Planning Facilitators to assist patients to make decisions that align with their goals and values. RC was founded in 1985 under the direction of Dr. Bud Hammes in response to the moral distress patient’s families and care providers often face when making critical choices about treatment for patients who lack decision-making capacity. RC is now a certification program for facilitators and includes an array of consultation and educational services as well as ongoing evaluation and quality improvement efforts to ensure the efficacy of the program when implemented.
Evidence-based public health practice and policy matters in work with older adults and their communities. These programs and ideas are backed by research, have been rigorously tested, and are more likely to produce positive changes for those who participate. You may be wondering what other resources are out there to guide practitioners towards a planning and implementation framework that puts evidence first:
The American Occupational Therapy Association offers evidence-based practice resources and reports around productive aging.
Healthy People 2020 of the Office of Disease Prevention and Health Promotion within the U.S. Department of Health and Human Services provides objectives and evidence-based interventions and resources that target adults aged 65+.
The Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services has provided a webpage with links to the National Guideline Clearinghouse, U.S. Preventive Services Task Force (USPSTF), and archive of current and past Guides to Clinical Preventive Services. These resources may serve as a starting point, particularly for healthcare professionals, for shaping meaningful evidence into programmatic action.
The National Association of County & City Health Officials (NACCHO)and Prevention Research Center in St. Louis, among others, connect public health practitioners with online evidence-based programming, guidelines, toolkits, and resources.
When we think about establishing goals, measuring success, and making do with the resources that we have, evidence-based public health creates the backbone to address important community and population needs. There are many challenges to evidence-based public health, but as the United States age demographic becomes older, rigorous evidence-based programs serving older adults will need to be embedded within our long-term systems and infrastructures in order to make an impact and promote healthy outcomes for all.