Term Paper: Successful Aging for Over the Age of 50

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TTM

Improving Healthy Aging and Longevity Through the Transtheoretical Model

As human beings age, negative health behaviors cannot only be compounded in their impact, but the habits and patterns leading to these behaviors can become increasingly difficult to break away from. For many older adults, ingrained behaviors such as smoking, poor diet and a lack of exercise can be especially challenging to reverse, even in spite of recommendations from doctors and other healthcare professionals. Evidence suggests that adults over the age of 60 comprise a population that is both vulnerable to the permanent retention of these deleterious health behavior and, increasingly, susceptible to the negative health consequences that these behaviors can produce. In particular, the threats of obesity, heart disease, stroke and other potentially fatal health events become exponentially greater as adults reach this age. However, for many adults, this age also represents an opportunity for lifestyle improvement that will become increasingly difficult to attain as aging continues. This is the rationale for the intervention called for by the present study. Using the Transtheoretical Model (TTM), the discussion hereafter will rationalize and detail a health behavior promotion-based intervention for individuals over the age of 60 with the intention of helping them institute meaningful and lasting health behavior changes. The intention is to help the subjects of this intervention achieve better health outcomes as they advance in age.

Theoretical Model:

The selected intervention approach is based on the Transtheoretical Model. This calls for behavior change through a sequence of steps by which the subject can begin to first accept the need for said change and subsequently achieve lasting behavior improvements. According to Lach et al. (2004), this intervention model "was developed to help explain how people change their behavior. The main organizing concept of the TTM is that people go through change as a process over time. First, individuals work through cognitive and affective processes leading to adoption of a new behavior or cessation of an unhealthy behavior, and then they move to using behavioral strategies to establish a new patter of behavior." (Lach et al., p. 88-89)

Lach et al. describe the Transtheoretical Model as requiring six separate stages of progressive behavior change signaling first a cognitive recognition of the need for change and, subsequently, an active effort to actually effect said change. Lach et al. identify the six stages of change as Precontemplation, Contemplation, Preparation, Action, Maintenance and, ultimately, Termination. These stages implication a progression which arcs from the moment of a subject's relative ignorance to the need for or total unwillingness to engage in change until the individual reaches a point at which the negative behaviors have been eliminated and in which permanent change in behavior has occurred. The end result of this process will be a lasting set of improvements in health behaviors and, therefore, in both health outcomes and individual longevity.

Influencing Factors:

One of the most significant factors influencing the parameters of the intervention in question is the set of cultural conditions impacting the lifestyles of the aging and elderly. Often, after the age of 60, sedentary lifestyle habits may either be formulated or solidified such that physical activity and exercise are seen as undesirable or even unattainable. Indeed, for many in this age bracket, there is a sense that physical activity may lead to negative health events such as coronary, stroke or injurious accident. In many ways, the culture of aging is seen as incompatible with regular, healthy exercise in spite of the elevated risks to this age group which make such exercise absolutely imperative. According to Burbank et al. (2002), the Transtheoretical Model is constructed to reverse such cultural predilections. Indeed, the research by Burbank et al. argues that "even in advanced old age, one can improve strength, decrease the risk of falls, improve cardiorespiratory fitness, and improve ability to live independently. The Transtheoretical Model (TTM) of behavior change is an internationally recognized model that holds much promise for health behavior changes of all types." (Burbank et al., p. 51)

There are also major social factors to consider in altering lifestyles for the aging or elderly. Quite often, there is a direct connection between an individual's commitment to regular, healthy physical activity and one's partnership with others in the achievement of this pattern. That is to say that support from friends and exercise partners can be a determinant in one's commitment to an exercise regiment and, ultimately, an active lifestyle. Such exercise partnership and social support can be increasingly difficult for older adults to find. This social need is critical when considering an intervention such as the present one. As the intervention proceeds, it will be with recognition of the value in creating strong social support networks amongst intervention subjects and between said subjects and the various health professionals who will be dispatched for their support. The fostering of a positive and collaborative relationship between these parties may substantially improve individual subject abilities to maintain the positive lifestyle changes achieved through the TTM intervention.

Health Promotion Plan:

Literature Summary:

In developing an actionable Health Promotion Plan, it is useful first to consider some of the pertinent literature on the subject. For this, we consider the article by Velicer et al. (1998), which contends that the TTM approach incorporates multiple dimensions of the individual health-belief complex into a strategy for self-driven change. This denotes that with the proper social, medical and professional support, the individual is expected to be an active director of his or her own intervention. According to the text by Velicer et al., "the model involves emotions, cognitions, and behavior. This involves a reliance on self-report. For example, in smoking cessation, self-report has been demonstrated to be very accurate (Velicer, Prochaska, Rossi, & Snow 1992). Accurate measurement requires a series of unambiguous items that the individual can respond to accurately with little opportunity for distortion." (Velicer et al., p. 1)

The study by Lach et al. (2004) offers a report on some of the successes achieved through the use of the TTM approach. This study reports on a series of successful efforts engaged in a variety of geographical settings within the United States and in direct concert with existing medical research organizations. According to Lach et al., a trial program was "Developed in collaboration with health professionals at Washington University School of Medi- cine, HealthStages was initiated and piloted in three cities where OASIS centers are located: St. Louis, Missouri; Portland, Oregon; and Tucson, Arizona." (p. 88) the study's findings indicated that the program helped to fill gaps in the health promotion practices of the respective contexts and that older adults were generally positive and receptive to the program's parameters.

Intervention Objectives:

This literature speaks to the primary objective of the intervention, which is to effectively promote health behavior change for adults over 60 and, consequently, to help bring lifestyle improvement, healthier aging and better health outcomes such as greater longevity.

A secondary objective is to improve awareness of the need for healthy lifestyle adaptations among the elderly. This will be underscored by the distribution of information aimed at fostering greater awareness of the needs of the elderly. This denotes the need both for clearly communicated information and knowledge directly via intervention channels and more generally-directed outreach efforts aimed at improving public awareness of the need for lifestyle improvements among the aging.

Population Appropriateness:

The population selected, adults over the age of 60, was identified as fitting the need for intervention due to the age group's heightened vulnerability to many of the health risks described here throughout. Indeed, as adults age, the risks of fall down injuries, of heart disease and of a host of other age-related maladies will increase substantially. According to Burbank et al. (2002), this makes the selected population especially suited for the TTM approach. The gradual induction of this process as well as the stated goal specific to this project-improving lifestyle habits amongst adults -- are especially pertinent for those advanced past the age of 60. On this point, the study by Burbank et al. "outlines the effects of exercise on age-related changes in the musculoskeletal system and describes the TTM as a model useful to help older adults change their exercise behavior" (p. 51)

Implementation Approach:

Strategies:

The primary strategy for execution of this intervention will be the use of monthly meetings. Here, we will gather in a selected conference room or local library with a selected group of intervention subjects in order to discuss behavior changes. This collective engagement would be supplemented by individualized intervention plans. At each meeting, one or more interdisciplinary consultants such as dieticians, cardiologists, physical trainers, social workers and nurses will meet with the group and with inquiring individual subjects in order to assist in their change. Lach et al. provide endorsement to this approach, recognizing the importance of a dialogue-based (rather than activity-based) initiation to the intervention. According to Lach et al., "the general exercise classes are appropriate for helping peo- ple who are exercising to maintain that behavior, but… [END OF PREVIEW]

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