Dr. Keren Brown Wilson:
Oregon is a very rural state. You just have to drive across the mountains or go to the coast or get outside the Willamette Valley and you realize Oregon is really rural. One of the issues facing rural areas everywhere in the world, not just Oregon is the out-migration of young people. So when young people finish school, they need a job, or they go away to another school and often they don’t go back. And when the young people are gone, it becomes even more difficult to provide support services to the older people left behind. Pretty soon what you have left are a bunch of isolated older adults who have to drive three, four, or five hours to the doctor or to get groceries and that becomes really, really difficult. It’s not just a matter of knowing what you ought to do or being willing to do what you ought to do.

It’s also a matter of having the opportunity to do what you ought to do. We really focus on helping communities identify the priorities that they have around aging. And the top ones are always transportation, housing, access to health services. And so we work with them on an individual basis, community basis, to decide what kinds of strategies can they implement to strengthen their ability to support their older population. An EMT is a good example of that. EMTs are well-trained, they have a good health knowledge, and they’re there. And so they’re always sort of on-call to, to, to respond to a problem. But there’s no reason why an EMT can’t have a regular route to check on people.

So it’s really, let’s take stock of what we got and let’s figure out what’s underutilized. And let’s sort of leverage that underutilization in an organized systematic way. People are always surprised with how many assets they have, mostly their people, because human resources are always the greatest asset. And when you could systematically organize them around an issue, they can accomplish remarkable things.

Renee Moseley:
Many of our elders, particularly once they retire, don’t have meaning and purpose. They don’t have a place to belong. So, they’re oftentimes in places where they’re alone, which then leaves them susceptible to health challenges. Having difficulty following up with their medication, having access to food, needing supports around accessing services.

Joy Murray:
I had gotten to the point where it was really not possible for me to maintain a full time job or even a part time job, so it was pretty depressing, and pretty hard to feel that I was going to be able to contribute much to life anymore.

Renee Moseley:
Affordable housing is a huge challenge for older adults. That is such a barrier for elders to be able to live a full life.

Joy Murray:
We just couldn’t afford it. We were looking at basements and things like that that didn’t really have a kitchen or enough room for two people and it was quite bleak. Then we looked at this place, which is wonderful. They have these nice big energy efficient apartments. We wanted to be a part of what they were doing, but also it offered affordable rent.

Renee Moseley:
The idea is that the community is a form of intervention, so it’s a community that comes together to support one another. The elders are required to participate 100 hours per quarter. They can mentor, they can tutor, they can support a parent, they can walk kids to school, they can take each other to medical appointments. So, that’s how they start to have meaning and purpose and, at the same time, reduce their isolation.

Joy Murray:
You’re always talked about in terms of not doing things, or being a burden, or a problem to society. To be somewhere where I feel like I’m contributing every day by being here, it’s so good for me. It just has made a whole huge difference in my life. It’s tapped into inner resources that I didn’t know I had.

Renee Moseley:
The ability for them to actively participate in somebody else’s lives affords them the place to show up in life in a different way. There’s a vibrancy that we see here that we don’t see oftentimes in other older communities, particularly if you’re living by yourself. There’s a Dr. Susan Pinker, who wrote a book called The Village Effect: How Face-to-Face Contact Can Make You Happier, Healthier and Smarter. When you have a place that you connect to, and you know that you belong, that you know that you have a reason to take care of your health.

Joy Murray:
This is not a program. This is a life. We are really involved with real people. We are really important. We are really integrated. It’s not some abstract idea to keep us safe. It’s a way of life.

Speaker 1:
What if you were a senior and you use a walker, you don’t drive anymore. So to keep your body and mind active, you ride the bus to a book club at the library, but walking to the bus stop is difficult and scary along a busy road. What would you do? What should we do?

Bandana Shrestha:
Today, we have one in eight people who are people 65 and over. In the next 15 years that will grow to one in five. Our communities are not ready for that growth. We know people want to remain in their own home and community as long as possible and having a livable community really is a great way of doing that because that means people can age in place, they can be with their friends and family and have the support systems that enable them to maintain quality of life and contribute to the community at large.

We want to look at both the built environment but also the social environment. So if you’re thinking about how do you really prepare as a community for the changing demographics, you should also be looking at things like what sort of support services do we have. We know that 80 to 90% of all longterm care support and services that are provided in the United States is provided by unpaid family caregivers. Employers for instance, that’s one of the things in an age friendly community, employers would support caregivers. You could be providing incentives for people to be able to balance both their responsibilities at home, but also continue to be really contributing members of your workforce.

There are many things that prevent us from having livable communities. Some of the key barriers are the kind of transportation that we currently have. Not having walkable streets, not having the right type of housing options in communities. There is a real connection between the built environment and health outcomes for people. There was a research that Stanford did, which showed that where you live really has an impact on your longevity. One of the things they found out is even if you’re a low income person, but you live in a place that’s very livable, which has great access to parks and walkable environment, your health outcomes are much better than somebody who is higher income but lives in not a very livable place, like maybe a very car centric place.

Age friendly communities doesn’t just benefit people who are old today. It really is about investing in the future. As you grow older, what do you want? You want to be able to do the same things you do as a younger person. You want to be able to contribute. You want to be able to continue to volunteer. You want to remain independent. Aging successfully means living successfully.

Patricia Schoonmaker:
All right. Good afternoon. Welcome to the Data Within Reach webinar. This webinar’s hosted by the Health Promotion and Chronic Disease Prevention Section of the Public Health Division at the Oregon Health Authority.

Patricia Schoonmaker:
Thanks so much for joining us. My name is Patricia Schoonmaker, and I am a health policy specialist in the Health Promotion and Chronic Disease Prevention Section. And I’m joined by my colleague, Sharon Coryell, who is a research analyst, and she will be sharing some information in the second part of the webinar.

Patricia Schoonmaker:
Just as we get started today, I just want to remind everyone of a few webinar courtesies. Please mute your phone when you’re not speaking, and that keeps the amount of feedback and distracting background noise and helps us hear everyone who’s sharing. And if you do speak, please say your name, where you’re from, before asking a question or sharing your feedback and comments. And that helps us all follow along with the conversation.

Patricia Schoonmaker:
So today’s webinar is being recorded, and it will be posted on the Health Within Reach blog following today’s event. And finally we ask that you hold your questions until the end of the data sharing portion of today’s webinar. We are planning to have 10 to 15 minutes at the end of the webinar for questions. And please keep in mind, also you’re welcome to send questions using the chat function of the webinar.

Patricia Schoonmaker:
And you can send these questions at any time throughout the presentation, and we’ll be checking that chat box as we continue our presentation and get to the Q and a part of the presentation.

Patricia Schoonmaker:
Welcome. Today the title is Healthy Aging and Brain Health. And we’re really pleased to share some information with you today, because healthy aging really has become an emerging part of our work that started about five years ago at the Public Health Division. And it’s really based on the fact that in public health, we’re looking at improving the lifelong health of all people in Oregon.

Patricia Schoonmaker:
So as you see before you, we’re going to be talking about the what, what is our goal in talking about healthy aging. And our end goal is to integrate healthy aging into state and local public health programs and plans.

Patricia Schoonmaker:
And a little bit about the so what, we will be talking about some healthy aging data that we have reviewed, and how we’ve come to this point now that we are about five years into our work.

Patricia Schoonmaker:
And then there will be a summary of now what, what does this mean? And we’re really looking at this healthy aging focus from a chronic disease prevention, early detection, self-management focus. So we will sort of see, get a glimpse of our tagline, which is what’s good for your heart, is good for your brain. Keep that in mind.

Patricia Schoonmaker:
So this slide shows, it’s probably not surprising to most of you that Oregon’s population is aging, just as it is within everywhere in the country. And this is the result of longterm trends, our increase in success with chronic disease prevention and management, and healthier lifestyles, change of access to food, many things.

Patricia Schoonmaker:
And so the key point here is keep in mind that this is not a temporary change with the baby boom generation that we have, but this is something that we’re seeing as a permanent change. And it’s worldwide and in Oregon. And the number that we hear referenced, is that by 2030, one in five people are expected to be age 65 and above. And that includes myself, and we have to plan for this.

Patricia Schoonmaker:
All right, so this slide explains that we really are wanting to include and broaden the acceptance of healthy aging as a public health priority. We know that there are many partners who have been working on healthy aging issues for years. And actually public health is one of the newer groups to come to the table.

Patricia Schoonmaker:
So we are working with groups like the area agencies on aging, the Department of Human Services, Aging and Disability Resource Connection of Oregon, the Portland State University Institute on Aging, as well as the OHSU Layton Institute on Aging.

Patricia Schoonmaker:
So we have community partners and other academic partners. Also, the Alzheimer’s Association and the American Association of Retired Persons are very heavily involved in working on what we call age friendly cities and communities. And Portland was one of the first cities to be designated a World Health Organization age friendly city.

Patricia Schoonmaker:
So we also, in public health, as the second bullet shows, it’s very important for us to review data and look at what we know and really define our actions as data-driven actions. And we looked at data from the behavioral risk factor surveillance, as well as other data, and this is with a group of partners that we’re linking with.

Patricia Schoonmaker:
Also along with that, we drafted an Oregon Healthy Aging Index, and we just wanted to share that. It is drafted right now, but it has a lot of data from the Behavioral Risk Factors Surveillance System. So looking at physical health, chronic conditions, stress, functional status and caregiver health, different components that we’re looking together to look at how we can track and monitor and where we have the ability to make some change.

Patricia Schoonmaker:
So again, this is very much data-driven, and our intent is to work towards finding ways to integrate healthy aging into all of our public health plans and programs. And so what Sharon is going to share with you is an example of data that we use, because in order to get towards developing messages, we’re very interested in knowing about public health perception about aging.

Patricia Schoonmaker:
And I think I forgot to mention one thing, this is related to is when we looked at the data, the sixth leading cause of death in Oregon, and nationally is Alzheimer’s. So there is concern and fear. We used to think of cancer and heart disease, but we wanted to test out what are Oregonians thinking about this issue of brain health and changes in your memory. Sharon, I will turn it over to you.

Sharon Coryell:
Thanks, Patricia. Like, Patricia said, in 2015 our section, the Health Promotion and Chronic Disease Prevention Section conducted a panel survey really to better understand what Oregonians thought and knew about the health of their brain.

Sharon Coryell:
So we asked Oregonians how concerned they were about their overall general health and their brain health within the next 20 years from now. And you can see from this slide here, that Oregonians are just as concerned for their brain health, as they are compared to their overall general health.

Sharon Coryell:
We also asked respondents which of the following diseases they were most afraid of getting including Alzheimer’s, cancer, heart disease, diabetes, depression and influenza. The labels got removed from this chart, I apologize. But those are the diseases that we looked at. And that top one, the orange, is 37% of respondents actually said they were most afraid of getting Alzheimer’s, compared to all the other diseases. And this is really consistent with international data across the globe.

Sharon Coryell:
Next we asked respondents about what behaviors they believe to be effective in reducing Alzheimer’s disease. While there seems to be a general understanding that community engagement and social interactions, on this chart you can see that it is generally good for your overall healthy active aging. We really did identify several areas for opportunity for further education.

Sharon Coryell:
And you can see that the behavior ranked the highest or the most for the very or somewhat effective was mental stimulation. And because we know, like Patricia said, that what is good for your heart is good for your brain, this doesn’t necessarily include mental stimulation activities, like puzzles and problem solving type.

Sharon Coryell:
We also, if you would shift down to the bottom of the chart, you can see there are some larger gray areas. And these really represent the, I don’t knows, the areas where further increase in awareness we could focus our efforts, and those were specific to reduction in tobacco use, looking at whether or not taking prescription medications and over the counter medications, as well.

Sharon Coryell:
Additionally, there’s a lot of concern, because for low income individuals and groups, Alzheimer concern is low, overall. This is important because research has found that low income groups are at a greater risk for Alzheimer’s disease, when compared to other higher income groups.

Sharon Coryell:
So we found in our panel survey, that one in five believed that they are not at all likely to get Alzheimer’s, and were twice as likely to believe that their family members would not at all likely to get Alzheimer’s disease, as well. Another point to look at are those low income respondents who were more likely to view mental stimulation and taking medication as very effective in reducing Alzheimer’s. So some of the things that we’re trying to increase in public awareness as well, with our efforts.

Sharon Coryell:
So, now what? While research is still evolving on this topic, early science is telling us that there is a strong connection between brain health and your heart’s health. We see this in national studies that indicate one in three cases of Alzheimer’s may be attributable to a modified risk factors and behaviors, such as physical inactivity, smoking, hypertension, obesity and diabetes.

Sharon Coryell:
If we saw a 20% reduction in these risk factors, each decade through 2050, this has the potential to decrease the cases of Alzheimer’s by 1.5 million cases.

Sharon Coryell:
For this to happen, more work continues to be done working with partners, getting more data, and integrating healthy aging into public health messages. I’m going to pass it back to Patricia to talk about the, now what.

Patricia Schoonmaker:
This is the focus for looking at the opportunities for public health at the state and local level, to work with their community organizations, their researchers, and to really get messages out, and include that information about, as Sharon said, the the whole issue with brain health and heart health, is the need for aerobic exercise and vascular health.

Patricia Schoonmaker:
So you’re really getting oxygen, and she mentioned doing the games is a different kind of stimulation, not increasing the oxygen and blood flow. We need to continue to look at more data collection so that we, as we said, working on, we’ll be finalizing our healthy aging index, and look at areas where we can take action, things such as looking at the health conditions, smoking rates, the issues about poor mental health days, issues about cognition and caregiver health. Many, many areas that influence how someone is aging and if they’re aging well.

Patricia Schoonmaker:
We’ve also heard from some of the researchers, the things about social isolation and how individuals have access to transportation, or things within their community environment are very important. We’re asking all of our public health partners to basically join the action for increasing healthy aging, as we know we’re living longer, and to continue this work on prevention, getting the messages out of what’s livable. Communities, healthy communities have the impact to influence the health of moms and youth and babies, as well as grandmothers and all ages to do more and be active.

Patricia Schoonmaker:
And these are the kinds of things that you see supported on the Place Matters Oregon website with all of our focus on physical activity and nutrition and tobacco free living. So we’re real excited to link with beyond our section, where we’re working with the Oral Health Program and other groups in public health who are a part of this process.

Patricia Schoonmaker:
So we are now opening this up to questions or comments from any of you. Anything in the chat box? Oh, so specifically, our pose, our questions. I forgot I didn’t turn my page. Thank you, Sharon.

Patricia Schoonmaker:
Do you have any specific, aside from your questions about what you heard, you have any examples of how you have integrated healthy aging into your work, or what do you see as opportunities to integrate healthy aging into your current work?

Sharon Coryell:
Also, if you have a question on the conference line, to take yourself off of mute. Oh Patricia, there’s a question. The question is, “I am a physical therapist. So the talk about using physical activity to help decrease or mitigate Alzheimer’s is right up my alley.”

Patricia Schoonmaker:
Fabulous. Yeah, everything from walking, all kinds of physical activity are beneficial. As we hear from the Alzheimer’s Association, you actually get like little, you can think of it similar in your brain to the cholesterol that clogs your arteries, and they call it plaques and tangles, though it really is about helping that increased circulation and oxygen.

Patricia Schoonmaker:
So, that’s great. And Selena, do you have any specific examples that you can share as to how you’re doing that and or any resources that you use or refer people to?

Patricia Schoonmaker:
And Selena’s response is, “I work in a geriatric community, and we have very active wellness program.” That’s great. “We include physical as well as mental programs.”

Patricia Schoonmaker:
Like I said before, the data are really early on, but they’re still evolving and there’s a lot of potential for further research to identify those, and further solidify those modifiable risks connected to heart and brain health.

Patricia Schoonmaker:
We include physical, as well as mental programs. Yes, ahead. Yes.

Speaker 3:
It was very well received. And so as I’m sitting here listening to you folks, and you probably have said the quickest way in public health for me to integrate any of this, is to start out with our County employees, and actually just getting the word out about the data that you’ve shared with us today amongst our employee population and maybe trying to come up with more physical activity for the County Wellness Program.

Patricia Schoonmaker:
That sounds great. And modeling that behavior is an excellent way to start. And then, looking at how to integrate physical activity into your different activities, everything from in meetings, and then looking at what you have in your community, exactly as you said, the Walk with Ease.

Patricia Schoonmaker:
And that’s a program, if you’re not familiar with it, started from the Arthritis Foundation as a focus on folks to try to overcome some of their pain. And they could be, you don’t have to be aging to have joint pain, but that was the focus.

Patricia Schoonmaker:
But it really can be used by anybody, and then you get that group participation, which in many cases just builds on itself. Thank you for sharing that. You said Crook County, good for you all.

Sharon Coryell:
Talani also said, “My goal is to educate older adults about the benefits of physical activity for brain health.” How have you been doing that?

Patricia Schoonmaker:
Tell them they can still do their puzzles, but then they get up and take an activity break, and move around and go outside or walk around or something, if they really love their puzzles. It’s not to say that they couldn’t or shouldn’t do them.

Sharon Coryell:
“Patient by patient, as well as providing educational talks on a regular activity, and coaching people to integrate movement into their normal routine.” That’s great.

Patricia Schoonmaker:
Great, great.

Sharon Coryell:
Are there any questions about the data that I presented, or some of the pieces that Patricia talked about around the healthy aging index?

Sharon Coryell:
Hello, yes?

Speaker 4:
[inaudible 00:21:19].

Patricia Schoonmaker:
Yes, it’s in a draft form right now. We have a committee internally in the Public Health Division working on it, and then we’ll be sharing it with some of our outside partners from OHSU and Portland State, AARP, some other groups. So we look forward to sharing that in the near future. And I thank you for asking for that.

Patricia Schoonmaker:
And I can say that we have reviewed data from the America’s health rankings from United Health Foundation Senior Report. We’ve looked at the Older Americans 2016 Key Indicators of Wellbeing, a profile for older Americans. So the committee has really looked at different sources, as we have been drafting this.

Patricia Schoonmaker:
And so we will share that, and it should, to public health folks look pretty familiar. But we really were careful to make sure that indicators were selected, where there was ongoing data. So on an annual basis or every other year, you could get data. We wanted to make sure that we would have access to that.

Sharon Coryell:
And as for the other part of your question, the webinar was recorded, or is being recorded and we will be posting that on the Data Within Reach blog.

Patricia Schoonmaker:
Yes?

Sharon Coryell:
Okay. Our communications person in the room is nodding.

Speaker 4:
Thank you.

Sharon Coryell:
Welcome.

Patricia Schoonmaker:
This is Patricia again. Just as you’re thinking, one data point that I find interesting when we think about how community oriented Oregon is, only 3% of Oregonians are in institutionalized facilities.

Patricia Schoonmaker:
So there is very much a focus on living within your community, and it may be assisted living or something, but not in nursing homes or facilities where in some areas of the country there’s a higher percentage. And that is a very low percentage compared to the rest of the country.

Patricia Schoonmaker:
And I think that speaks to the opportunity of different groups working together, community-based organizations and having a network of supportive services for care for the aging, all the way through to hospice care, which I remember when I heard it said that Oregon was the best place in the country to die. And I felt like, “Aw,” but then I thought, “Oh no, let me think about what that means.” It means there are resources that are available to individuals and families.

Patricia Schoonmaker:
Any other questions or comments?

Sharon Coryell:
All right, well if there are no other questions or comments, I want to thank you all for the discussion during this Data Within Reach webinar on this bright Thursday. It’s pretty cloudy in Portland, actually.

Sharon Coryell:
You are welcome to send any remaining questions to [email protected] and we’d be happy to continue the learning with you. After this webinar, please take a moment to complete the feedback survey, as your comments support our quality improvement process.

Sharon Coryell:
Again, on behalf of the Health Promotion and Chronic Disease Prevention Section at the Oregon Public Health Division, thank you for joining you.

Patricia Schoonmaker:
Thank you.