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Firman J.,National Council on Aging
Generations | Year: 2014

People with mild or early-stage Alzheimer's disease consider sacred relationships to be at the heart of adjusting to and coping with this disease. Spiritual advisors and the community must play an active role in preserving this relationship in people with Alzheimer's. This article explores findings on the importance of sacred relationships from the perspective of 28 people with mild Alzheimer's. Copyright © 2014 American Society on Aging; all rights reserved.

Ory M.G.,Texas A&M University | Ahn S.,Texas A&M University | Ahn S.,University of Memphis | Jiang L.,Texas A&M University | And 5 more authors.
Medical Care | Year: 2013

Background: Emerging health care reform initiatives are of growing importance amidst concerns about providing care to increasing numbers of adults with multiple chronic conditions. Evidence-based self-management strategies are recognized as central to managing a variety of chronic diseases by improving the medical, emotional, and social role management demands of chronic conditions. Objectives: To examine the effectiveness of the Chronic Disease Self-Management Program (CDSMP) among a national sample of participants organized around the Triple Aim goals of better health, better health care, and better value in terms of reduced health care utilization. Research Design: Utilizing data collected from small-group CDSMP workshops, baseline, 6-month, and 12-month assessments were examined using 3 types of mixed-effects models to provide unbiased estimates of intervention effects. Subjects: Data were analyzed from 1170 community-dwelling CDSMP participants. Measures: Triple Aim-related outcome measures: better health (eg, self-reported health, pain, fatigue, depression), better health care (eg, patient-physician communication, medication compliance, confidence completing medical forms), and better value [eg, reductions in emergency room (ER) visits and hospitalizations in the past 6 mo]. Results: Significant improvements for all better health and better health care outcome measures were observed from baseline to 12-month follow-up. The odds of ER visits significantly reduced from baseline to 12-month follow-up, whereas significant reductions in hospitalization were only observed from baseline to 6-month follow-up. Conclusions: This National Study of CDSMP (National Study) demonstrates the successful translation of CDSMP into widespread practice and its potential for helping the nation achieve the triple aims of health care reform. © 2013 by Lippincott Williams and Wilkins.

Lorig K.,Stanford University | Laurent D.D.,Stanford University | Plant K.,National Council on Aging | Krishnan E.,Stanford University | Ritter P.L.,Stanford University
Chronic Illness | Year: 2014

Background: Based on the works of Kiesler and Bandura, action plans have become important tools in patient self-management programs. One such program, shown effective in randomized trials, is the Internet Chronic Disease Self-Management Program. An implementation of this program, Healthy Living Canada, included detailed information on action plans and health-related outcome measures. Methods: Action plans were coded by type, and associations between action plans, confidence in completion and completion were examined. Numbers of Action Plans attempted and competed and completion rates were calculated for participants and compared to six-month changes in outcomes using regression models. Results: Five of seven outcome measures significantly improved at six-months. A total of 1136 action plans were posted by 254 participants in 12 workshops (mean 3.9 out of 5 possible); 59% of action plans involved exercise, 16% food, and 14% role management. Confidence of completion was associated with completion. Action plan completion measures were associated with improvements in activity limitation, aerobic exercise, and self-efficacy. Baseline self-efficacy was associated with at least partial completion of action plans. Discussion: Action planning appears to be an important component of self-management interventions, with successful completion associated with improved health and self-efficacy outcomes. © The Author(s) 2013.

Ory M.G.,Texas A&M University | Smith M.L.,University of Memphis | Ahn S.,University of Georgia | Jiang L.,Texas A&M University | And 2 more authors.
Health education & behavior : the official publication of the Society for Public Health Education | Year: 2014

INTRODUCTION: The adult population is increasingly experiencing one or more chronic illnesses and living with such conditions longer. The Chronic Disease Self-Management Program (CDSMP) helps participants cope with chronic disease-related symptomatology and improve their health-related quality of life. Nevertheless, the long-term effectiveness of this evidence-based program on older adults as compared to the middle-aged populations has not been examined in a large-scale, national rollout.METHOD: We identified baseline characteristics of CDSMP participants aged 65 years or older (n = 687, M = 74.8 years) in the National Study of CDSMP from 2010 to 2012. Comparisons were made to middle-aged participants aged 50 to 64 (n = 325, M = 58.3 years). Assessments were conducted at baseline and 12-month follow-up. Linear and generalized linear mixed models were performed to assess changes in primary and secondary outcomes, controlling the key sociodemographics and number of chronic conditions.RESULTS: All primary outcomes (i.e., social/role activities limitation, depression, communication with doctors) significantly improved in both the older and middle-aged cohorts. Although improvements in illness symptomatology (e.g., fatigue, pain, shortness of breath, and sleep problems) were similar across both cohorts, only the middle-aged cohort benefitted significantly in terms of overall quality of life and unhealthy mental health days. Effect sizes were larger among the middle-aged population who were also more likely to enter the program in poorer health and be from minority backgrounds.CONCLUSIONS: The current study documented improved health outcomes but more so among the middle-aged population. Findings suggest the importance of examining how age and interacting life circumstances may affect chronic disease self-management. © 2014 Society for Public Health Education.

Lorig K.,Stanford Patient Education Research Center | Ritter P.L.,Stanford Patient Education Research Center | Ory M.G.,Texas A&M University | Whitelaw N.,National Council on Aging
Diabetes Educator | Year: 2013

Purpose: The purpose of the study was to determine the feasibility and efficacy of a generic chronic disease self-management program for people with type 2 diabetes. Methods: English-speaking adults with type 2 diabetes who were part of a larger US national translation study of the Stanford Chronic Disease Self-Management Program (CDSMP) were invited to be part of the current study. In addition to completing self-report questionnaires, participants submitted blood samples at baseline, 6 months, and 12 months. Of the 114 participants, half had A1C values between 6% and 6.9% and half had values of 7.0% or more. Results: Adults with diabetes successfully participated in CDSMP workshops in a community health setting. Participants demonstrated statistically significant improvements in health indicators and behaviors but no reductions in health care utilization. Participants with A1C of 7% and above had A1C reductions at 6 months, with smaller reductions at 12 months. Those with baseline A1C less than 7% had no changes in A1C at 6 or 12 months. Conclusions: The results suggest that the CDSMP is a useful and appropriate program for lowering A1C among those with A1C above 7% and for improving health status for people with diabetes, regardless of their A1C. © 2013 The Author(s).

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