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Persistent chronic conditions are among the top leading causes of death in the U.S. The majority of older adults live with two or more chronic conditions. When poorly managed, chronic conditions can result in negative psychosocial and health outcomes such as low quality of life, diminished mood, workforce withdrawal, high healthcare utilization, and disability. Fortunately, chronic disease self-management interventions show promise in reducing the negative impact of chronic conditions on health status. This symposium will highlight formative work and recent findings of community-based interventions that promote successful self-management. To start, presenter one will describe findings from four studies that constitute the formative work necessary to inform implementation of self-management interventions in community and healthcare settings. Next, presenter two will report findings from an effectiveness trial of a technology-based intervention to support hypertension self-management. Then, presenter three will describe findings on the feasibility of a Health Passport tool to promote self-health management among individuals with physical limitations. Finally, presenter four will describe factors affecting attendance among African Americans with arthritis who participated in a national dissemination of Chronic Disease Self-Management Education programs. Collectively, these presentations will provide practical evidence and science-based recommendations for ways to increase successful chronic disease self-management and ultimately improve population health among older adults.

Between 70% and 90% of Americans aged 65 and older have experienced at least one traumatic event such as a sexual or physical assault, disaster, illness, or terrorism. Trauma exposure in older adult populations is linked to physical, mental, and cognitive decline. A new approach to improve outcomes of trauma-affected older adults is Person-Centered, Trauma-Informed (PCTI) Care, which promotes the dignity, strength, and empowerment of trauma-affected individuals by incorporating knowledge about trauma into agency programs, policies, and procedures. The Administration for Community Living/Administration on Aging has awarded The Jewish Federations of North America (JFNA) a grant to develop innovative PCTI interventions for Holocaust survivors. This includes a community-based intervention whereby local leadership councils are developed to identify Holocaust survivor needs, distribute grant funding, train caregivers in PCTI care, and forge partnerships to advance community-led Holocaust survivor care. This program has been implemented in eight major US cities where 168 community leaders dispersed 25 grants serving approximately 500 Holocaust survivors. JFNA conducted an evaluation of the first six of the eight cities to determine the impact of this community-based model on participants and Holocaust survivors and investigate the process by which a community-based model can be replicated. This evaluation used surveys and semi-structured interviews to collect data on variables including understanding of PCTI care, awareness of Holocaust survivor needs, strength of community partnerships, and leadership council sustainability. This session will review evaluation findings including best practices for community-based models of PCTI care, and applicability of findings to other older populations.

Living Life to the Full 55+ (LLTTF) was an 8-week, 12-hour, community educational program based on CBT principles. The program aim was to teach participant skills and techniques to cope effectively with life stress. Participants self-referred to the program by responding to advertisements or were otherwise referred to the program by local community centres. Following the promising results of the pilot study, a follow-up empirical study was conducted to assess the impact of the program on clinical measures and other notable measures over time. Study participants (N = 514) were recruited at partner sites hosting the program. Demographic and other data was collected to assess the impact of the program. Measures collected to assess the impact of the program were the Beck Depression Inventory (BDI-II), Beck Anxiety Inventory (BAI), Warwick-Edinburgh Mental Well-being Scale (WEMWBS), and a brief measure of loneliness/social connectedness. Participant data was collected pre/post-intervention, and at post-course follow-up periods (3/6/9-months). Preliminary repeated-measures ANOVA analyses found statistically significant changes in depression, anxiety, mental well-being, and loneliness scores, from pre- to post-intervention. Participant’ depression, anxiety, and loneliness scores significantly reduced from pre- to post-course. Participants also experienced a significant improvement in mental well-being from pre- to post-course. Observed decreases in loneliness and depression did not significantly change from post-course to any of the follow-up periods. Results suggest the viability of a nonclinical program for addressing depression and loneliness in older individuals, and have implications for community-based strategies attempting to address mental health issues in older Canadians

Research suggests that social isolation in Appalachian older adults may be associated with reduced cognitive function. Despite this, few interventions for these individuals incorporate both social and cognitive components in a community-based setting. The “Memory Masterclass” program was developed to address this care challenge, and implemented through an Adult Day Services Center. With 29 community-dwelling older adult participants from western Virginia, the six-week pilot program focused on strategies and practices associated with improving long-term memory or executive function. In addition to the lifestyle-focused curricula, the course included group activities focused on connecting participants to community networks of resources that might enable them to successfully implement lifestyle changes. Findings support the feasibility of implementation with a wider group of rural Appalachian older adults and suggest that individual differences in self-reported memory may be closely tied to improvements following the program.

In the United States, Asian American and Pacific Islanders (AAPI) are the fastest growing segments of the older adult population. According to the Center for Disease Control (2010), heart disease and stroke are the leading causes of deaths for the AAPI population. A well-balanced nutrition and low salt diet can reduce the risk of heart disease; however, it is difficult to find a nutrition education program tailored for AAPI cultural traditions and provided in-language. Healthy Eating Healthy Aging (HEHA) was developed for AAPIs ages 55 and older using train-the-trainer model and tested its impact on fruit and vegetable consumption and salt intake monitoring. The HEHA was translated into 7 different AAPI languages and delivered through 19 community-based organizations (CBOs) in 9 states. The training focused on three components: Nutrition education, nutrition label reading and heart health. Using a pre- and post-test design, CBOs reached a combined 906 participants. Participants’ mean age was 71.91 years (+9.5); many were female (69%), and reported not speaking English well (78%). Participants reported high blood pressure (46%), diabetes (28%), arthritis (32%), and heart disease (16%). Participants reported eating more servings of fruits (5.74 to 5.92) and vegetables (5.77 to 6.0) for the past 7 days, increasing their salt intake monitoring (6.45 to 7.12) and increase in nutrition label readings from 47% to 63% after intervention. HEHA, culturally and linguistically adapted for AAPIs, can impact nutrition among older AAPIs. The train-the-trainer model with CBOs can serve as a potential tool to disseminate the HEHA nationally.

Effective new strategies are needed to address multiple problems encountered by community-based older adults. Problems such as depression and anxiety are among the most common mental health challenges experienced among older adults and are associated with higher rates of cognitive issues and medical service use. Depression and anxiety also are among the most successfully treated mental health problems. Additionally, older adults are at the highest risk for experiencing medication problems and adverse medication events arising from drug interactions as well as physical and psychological challenges in managing medications. Social isolation and loneliness are reported in over a third of older adults and these conditions rival standard biomedical factors in predicting morbidity and mortality in later life. Despite these myriad challenges, there are few resources available to support older adults experiencing these conditions in the community. This session presents three innovative models and emerging evidence of their effectiveness to support at-risk older adults living in the community. Carbajal-Madrid and colleagues will report on the mental health benefits of the Insights in-home psychotherapy program. Meyer and colleagues will discuss findings from a study of the C-MEDS in-home medication management program. Gruenewald and associates will share results of a literature review to inform the design and implementation of a new intervention to address social isolation and loneliness and preliminary implementation evaluation findings. Each highlighted intervention is delivered as a component of Independence at Home (IAH), a free, community-based service program designed to facilitate psychosocial and physical well-being while aging in place.