The community-based LIVE WELL Initiative: Improving the lives of older adults

Figures & data

Figure 1. LIVE WELL Initiative evaluation model.

Table 1. LIVE WELL Initiative programs and characteristics.

Program	Priority population characteristics	Length of intervention	Partner organization	Intervention activities
A Matter of Balance (AMOB)	Adults age 60 years and older in Tarrant County who have a fear of falling or who have suffered previous falls	Eight 2-hour sessions	Sixty and Better, Inc.	Facilitated by certified coaches. Clients learn to view falls as controllable, employ simple exercises for strength and balance, manage fears and risk of falling. Program offers brainstorming and problem-solving activities, application of practical coping strategies, peer encouragement.
Chronic Disease Self-Management Program (CDSMP)	Adults age 60 years and older in Tarrant County who have chronic diseases.	Six 2.5-hour sessions	Sixty and Better, Inc.	Two trained lay leaders, one or both of whom have chronic diseases themselves, provide sessions. Participants make weekly action plans, share experiences, and help each other solve problems they encounter in creating and carrying out their self-management program.
HomeMeds	Clients enrolled in SCS services or MOW living in Tarrant County	30 days	Sixty and Better, Inc.	Case manager collects medication information, including drug name, dosage, and frequency as well as other information regarding fall history and symptoms of dizziness and confusion. Pharmacist reviews the medication information, generates alerts for potential medication issues, and recommends adjustments, if needed.
			MOW, Inc. of Tarrant County
DiabetesSalud!	Adults with diabetes living in Tarrant County	6 months (three 60- to 90-minute visits)	NTACHC	Diabetes Health Promotor assesses and conducts different activities related to the management of diabetes, including developing participants’ behavioral goals and educating participants on various diabetes-related topics.
Community Health Navigation (CHN)	Adults age 35 years and older living in Tarrant County who have extreme difficulty in managing their own health or the healthcare system	6 months	MOW, Inc. of Tarrant County	Trained community health professionals provide in-home counseling to improve or maintain clients’ health by connecting with services in the community
REACH-TX	Family caregivers providing at least 8 hours of care per week and are identified as being at risk for placing their loved ones with dementia into a nursing home	6 months	Alzheimer’s Association North Centeral Texas Chapter	Dementia care specialist provides a multicomponent of support that can help Alzheimer’s and dementia caregivers reduce stress and depression and improve their capacity for self-care.
In-home Respite	Adults who have mid-stage Alzheimer’s disease or other types of dementia and their caregivers, who are residents of Tarrant County and have been determined to be at-risk for nursing home placement	6 months (up to 6 hours per week)	Easterseals North Texas	Easterseals North Texas care provider engages care recipients in various activities and assists them with personal care, meal preparation, and light housekeeping duties.
Diabetes-Nutrition Counseling	Home-bound men or women with diabetes or at nutritional risk or both	6 months	MOW, Inc. of Tarrant County	Registered or licensed dietitians provide in home, one-on-one nutrition and diabetes assessment with individualized education and counseling, including management of diet, physical activity, blood glucose, and medication
Health Literacy	Library staff, community organization representatives, clinicians	Continuous when funded	University of North Texas Health Science Center	System-level program to ensure that librarians, CBO representatives, and clinicians can help patrons meet their health literacy needs

MOW: meals on wheels; NTACHC: North Texas Area Community Health Center; CBO: community-based organization.

Table 2. Outcome measures by program.

Programs	Outcome measures	Assessments
All	CDC Healthy Days Measures (Centers for Disease Control and Prevention, 2000)	Baseline; follow-up (varies by program)
AMOB	Falls Efficacy Scale (Tennstedt et al., 2001)	Baseline; completion
CDSMP	Stanford Self-Efficacy for Managing Chronic Disease (Lorig et al., 2001)	Baseline; completion
HomeMeds (Sixty and Better, Inc.)	Morisky Medication Adherence Scale (Morisky et al., 1986)	Baseline; 30 days follow-up
HomeMeds (MOW, Inc. of Tarrant County)	Use or plan to use updated medication list	75‒90 days follow-up
DiabetesSalud!	HbA1c	Baseline; 6 months follow-up
CHN	PAM (Hibbard et al., 2005)	Baseline; 6 months follow-up
REACH-TX	REACH II Quality of Life for caregivers (Belle et al., 2006)	Baseline; 6 months follow-up
	Nursing home placement for care recipients	6 months follow-up
In-home respite	Zarit Caregiver Burden Interview (Zarit et al., 1980)	Baseline; 6 months follow-up
	Nursing home placement for care recipients	6 months follow-up
Diabetes Nutrition Counseling	Goal Attainment	6 months follow-up
Health Literacy	Health literacy knowledge and impacts	Baseline; completion

AMOB: A Matter of Balance; CDSMP: Chronic Disease Self-Management Program; CHN: Community Health Navigator; HbA1c: hemoglobin A1c; REACH: Resources for Enhancing Alzheimer’s Caregiver Health; PAM: Patient Activation Measure.

Table 3. Number of clients enrolled in the programs of LIVE WELL Initiative.

Organizations	Program	Number served^a
Sixty and Better, Inc.	A Matter of Balance (AMOB)	3,675
	Chronic Disease Self-Management (CDSM)	2,888
	HomeMeds	753
	Screening for diabetes and nutritional risk	12,313
Meals on Wheels, Inc. of Tarrant County	HomeMeds	15,427
	Community Health Navigation	1,144
	Diabetes Nutrition Counseling	9,993
	Screening for diabetes and nutritional risk	29,923
North Texas Area Community Health Center	DiabetesSalud!	2,642
Alzheimer’s Association North Central Texas Chapter	REACH-TX	2,381^b
Easterseals North Texas	In-home respite	1,273^b
UNT Health Science Center	Universal Precautions Toolkit Training (Health Literacy)	1,050

^aDuplicate clients across programs and years are included.

^bCaregivers and care recipients are included.

Each program has a different funding period.

Table 4. Change in proportion in clients who rated their health good, very good, and excellent from baseline to follow-up by program.

Program	N (%^A)	Baseline	Follow-up	z^a
AMOB	1,762 (47.9%)	80.6%	87.0%	–8.09***
CDSMP	546 (18.9%)	66.8%	78.9%	–6.18***
HomeMeds (MOWI)	7,201 (46.7%)	36.3%	49.8%	–21.23***
DiabetesSalud!	1,218 (46.1%)	54.0%	91.9%	–20.43***
CHN	175 (18.8%)	42.9%	52.0%	–2.26*
REACH-TX	613 (33.2%)	72.9%	84.3%	–6.61***
In-home respite (CG)	242 (46.5%)	74.4%	74.8%	–.28
In-home respite (CR)	360 (28.3%)	42.8%	38.6%	–3.64***
Nutrition counseling	2,620 (26.2%)	37.9%	53.2%	–10.39***

*p < .05, ***p < .001, AMOB: A Matter of Balance; CDSMP: Chronic Disease Self-Management Program; MOWI: Meals on Wheels, Inc. of Tarrant County; CHN: Community Health Navigator; CG: caregivers; CR: care recipients.

^ARate of data collection.

^aWilcoxon signed-ranks test.

Table 5. Change in the average number of healthy days from baseline to follow-up by program.

Program	N (%^a)	Baseline (SD)	Follow-up (SD)	t
AMOB	1,718 (46.7%)	25.48 (8.98)	27.12 (6.64)	7.85***
CDSMP	507 (17.6%)	22.73 (10.49)	22.70 (9.65)	–.07
HomeMeds (MOWI)	6,959 (45.1%)	13.59 (13.43)	17.72 (13.26)	25.56***
DiabetesSalud!	1,195 (45.2%)	27.16 (7.50)	29.34 (4.09)	9.52***
CHN	170 (18.3%)	13.19 (13.27)	16.38 (12.83)	3.04**
REACH-TX	559 (30.3%)	16.68 (11.63)	22.93 (9.84)	12.93***
In-home respite (CG)	236 (45.4%)	19.37 (11.31)	22.22 (9.41)	7.22***
In-home respite (CR)	348 (27.3%)	10.96 (11.78)	10.49 (11.56)	–1.21
Nutrition counseling	2,341 (23.4%)	14.72 (13.66)	20.67 (12.25)	18.44***

*p < .05, **p < .01, ***p < .001, AMOB: A Matter of Balance; CDSMP: Chronic Disease Self-Management Program; MOWI: Meals on Wheels, Inc. of Tarrant County; CHN: Community Health Navigator; CG: caregivers; CR: care recipients.

^aRate of data collection.

Table 6. Changes in program-specific outcomes from baseline to follow-up by program.

Program	Outcome measures	N (%^A)	Baseline M (SD)/N (%)	Follow-up M (SD)/N (%)	t/z
AMOB	Falls efficacy	2,118 (57.6%)	2.72 (.74)	3.21 (.63)	33.28***
CDSMP	Self-efficacy	508 (17.6%)	7.41 (2.08)	8.18 (1.38)	9.71***
HomeMeds (MOW)	Use or Plan to use updated medication list	6,616 (42.9%)	–	88.8%	–
HomeMeds (SB)	Medication Adherence level	125 (16.6%)			22.30***^a
	High adherence		29 (23.2%)	30 (24.0%)
	Medium adherence		43 (34.4%)	59 (47.2%)
	Low adherence		53 (42.4%)	36 (28.8%)
DiabetesSalud!	HbA1c	1,443 (54.6%)	8.80 (2.50)	7.20 (1.81)	–27.79***
CHN		465 (50.0%)			–7.72*** ^a
Patient Activation Measure	Believing activation is important		129 (27.7%)	78 (16.8%)
	Having knowledge and confidence to take action		100 (21.5%)	79 (17.0%)
	Taking action		128 (27.5%)	141 (30.3%)
	Ability to stay the course		108 (23.2%)	167 (35.9%)
REACH-TX	Quality of Life
	Depression	867 (46.9%)	9.57 (6.49)	7.34 (5.96)	–10.18***
	Caregiving Burden	809 (43.6%)	21.02 (9.07)	16.55 (8.92)	–13.39***
	Social Support	864 (46.8%)	18.52 (6.92)	20.26 (6.82)	7.98***
	Self-care	864 (46.8%)	6.41 (1.98)	6.53 (1.86)	1.86^+
	Problem Behavior	766 (41.5%)	.54 (.92)	.69 (1.05)	3.42**
	Nursing home placement	1,522 (82.4%)	–	114 (7.49%)
In-home Respite	Caregiving Burden	274 (52.7%)	31.69 (8.90)	29.42 (8.12)	–10.04***
	Nursing home placement	1,193 (93.7%)	–	89 (7.46%)
Nutrition Counseling	Goal Attainment
	Met all the time	5,777 (57.8%)		1,898 (32.9%)
Health Literacy	Health Literacy Knowledge	310 (42.0%)	20.76 (4.92)	27.29 (3.51)	23.12***
	Plan to implement	421 (57.0%)	15.66 (6.85)	18.29 (6.78)	13.28***
	Communication practice	305 (41.3%)	17.64 (9.16)	19.97 (11.16)	9.25***

⁺p < .10, *p < .05, **p < .01, and ***p < .001.

^ARate of data collection.

^aWilcoxon signed-ranks test.

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