The Fountain of Health Initiative for Optimal Aging – A Unique Canadian

Strategy to Promote Brain Health & Resilience

Linda Gobessi MD FRCPC

Toronto, January 27, 2017

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Objectives

1. Learn about the Fountain of Health (FoH) Initiative for Optimal Aging

2. Appreciate the evidence-base behind FoH

3. Be aware of range of FoH tools available to public & to clinicians

4. Summarize the evidence currently available regarding use and impact thus far

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What is the Fountain of Health?

• National initiative to translate science of healthy aging, brain neuroplasticity and resilience

• Promotes optimal aging by examining outlook on aging & modifying health behaviours using Cognitive Behaviour Therapy tools

• Build a movement for optimal aging

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Population Pyramid Ontario

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Global Population Column

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BackgroundCultural Stereotypes About Aging

“Senior years are dominated by loss of productivity, creativity and cognitive decline”

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3.59.4

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Maman

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Wabi Sabi

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Resilience

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FoH National Leadership Team

Canadian Medical Association

AlzheimerSociety

Canadian Mental Health

Association

Canadian Geriatrics Society

International Longevity Centre Canada

FoH National Team: Goals

• Build a movement for optimal aging:

– Disseminate evidence-base FoH resources through key organizations

– Speakers’ Bureau: Knowledge transfer

– Work together for funding & policy influence

– Best-evidence resource & research

– Develop new tools

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Fountain of Health Partners

EVIDENCE

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World Aging & Brain Health Institute(W.A.B.H.I)

• In alignment with Positive Psychiatry of Aging

• Fosters international research collaboration in:

– Brain Neuroplasticity and Resilience

– Beliefs on aging

– Cognitive behavioural therapy

– Health behaviour change

• WABHI research: Translated in:

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Human Longevity: Epigenetics• Genes account for only about 25% of

what determines human longevity– Heritability of Human Longevity Twin Studies

Coefficient of heritability

• McGue et al (1993) 0.22

• Herskind et al (1996) 0.25

• Ljungquist et al (1998) <0.33

• Much more determined by epigenetic factors including outlook & lifestyle

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25%

Attitude to Aging Affects Longevity

Levy (2002): 660 50+ y Ohio Longitudinal Study of Ageing & Retirement Longevity associated with positive self-perceptions of aging, measured up to 23 years earlierIncreased longevity by 7.5 years– Controlled for other health factors

– Greater impact than low systolic blood pressure, cholesterol, BMI (1-3 years); no history of smoking, tendency to exercise (1-4 years)

Levy B et al Longevity increased by positive self-perceptions of aging J Pers Soc Psych 2002

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Positive Views & Walking

Physical Activity

• Best promoter of brain neuroplasticity across lifespan is physical activity

• All forms of physical activity help:–Mild to vigorous– Strength or cardiovascular–Avoidance of sedentary behaviors

• Exercise of significant benefit esp. in mild - moderate depression

Bogdan Draganski et al. Neuroplasticity: Changes in grey matter induced by training. Nature 427, January 2004.Becca Levy et al. Longevity Increased by Positive Self-Perceptions of Aging. Journal of Personality and Social Psychology, 2002.Nagamatsu LS, et al. Resistance training promotes cognitive and functional brain plasticity in seniors with probable mild cognitive impairment. Arch Intern Med 2012.Rockwood K, et al. Physical activity and the maintenance of cognitive function. Alzheimers Dementia 2007.

Physical Activity for Dementia Prevention

Neuroplasticity: Cognitive Activity

• Cognitive activity promotes plasticity

• Higher education lowers risk of dementia

• Complex, novel activities most helpful

Can cognitive activity treat MCI?...

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Attachment, Social Contact & Resilience

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Harvard Resilience Study

• 724 subjects followed over 75 years

• 60 of original subjects still alive and participating in their 90’s

• 2 groups: Harvard sophomores and young adults from poorest Boston neighborhoods

• At age 50, secure relationships were the single most predictive variable related to well-being over 25 years regardless of socioeconomic background Robert Waldinger et al, 2015 J Psych of Aging

Bridging the Gap

PRACTICE

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FoH in Practice

FoH Tools: CBT BasedI am over the hill now – it is all downhill from here, so why bother?

Sedentary

5 FoH Clinician Tools for Health Behaviour Change

Interactive website www.fountainofhealth.ca

1) 30 sec: Share FoH website; tear-off pamphlet

2) 3 min: FoH Quiz, FoH Video

3) 5-10 min: FoH Healthy Living Handbook

4) 10-15 min x 2-3 Visits: FoH Clinician’s Guide

– L.I.N.K. model

– SMART goals

– Follow Up/ Goal attainment

5) 2 hours x 9 weeks:

– Enhanced CBT Group for Depressed/ Anxious Seniors

Assess Baseline Outlook & Behaviours

FoH Healthy Aging Questionnaire:1. How socially connected do you feel?

2. How physically active are you?

3. How interested are you in learning new things?

4. How likely are you to seek mental health help if you need it?

5. How successfully (in your own definition) do you feel you are aging?

(10 pt scale for each Q. Total score out of 50)34

Set Health Behaviour Change Goals

FoH Clinician’s Guide:

CBT EXPRESS!

Engage 5 Healthy Aging Messagesin the office with L.I.N.K.

L.I.N.K. Into Healthy Aging Discussion

L: Listen empathically to presenting concern

I: Identify patient as Ideal for FoH Intervention(Healthy Aging Self-Assessment Questionnaire to identify areas of strength/weakness))

N: Navigate one small behavioral change in physical activity, social contact or brain challenge

K: Keep a record of the goal set. F/u 1-2 months

Sample Script Using L.I.N.K.I. “ Your depression dx makes you an ideal candidate for a new brain health program. Would you like to hear more about it ?....”

“ Lets start with a baseline to see where you feel your overall health is now....(Give FOH Quiz)....”

“Based on your questionnaire results, it looks like being (physically active) is an area you could do more in to improve your health.”

N. “Would you like to set one small goal in that area to work on for next time?”

Evidence For Change

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FoH Knowledge Transfer Study FoH Handbook

Knowledge: 74 clinicians had FoH education: Sign. difference pre-post knowledge

Transfer to practice: 23 given FoH Handbooks:

– QA Questionnaire at 2 mo follow up: 19/ 23 (83% return rate): 100% recommended to colleague

– Tracking sheets: 11/23 (50% return rate) reached 102 patients; 60 (60%) patients set specific goal

Thoo, V, Freer J & Cassidy K “The FoH: Bringing Seniors’ Mental Health Promotion into Clinical Practice.” Canadian Geriatrics Journal Vol 8 No 4 (2015)

Knowledge Translation StudyFoH Clinician Guide Pilot

Knowledge Translation to Practice:

Clinicians (N=7) reported improvement in application of FoH information

– All rated FoH tools somewhat- very useful (used FoHHandbook most) & all recommended to colleague

Used Guide to reach 71 patients:

– Most goals (N=34; 47.8%) related to physical activity

– Over half of patients completely reached (N=34; 47.8%) or exceeded (N=11; 15.5%) goal

FoH Community Series

• FoH 6 weeks community workshop series: • Run by senior peer- leaders • Powerpoints with speakers’ notes

• Dovetails with CMHA’s “Living Life to the Full”• Can also be run by allied health/ other professionals

• 6 groups (N=51)• Quality assurance measures:

• Statistically significant improvements in awareness, knowledge and application of knowledge in daily life.

• Self-perceptions of aging scores increased

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Next Steps

• What we’re up to:

– Baycrest’s CC-ABHI SPARK grant: 50,000 (Feb 2017-Jan 2018)

– Scale up FoH in Nova Scotia and pilot the FoH App

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Next Steps

• What you can do:– Explore FoH website, try taking the FoH quiz for

yourself

– Sign up for FoH Newsletter & literature updates (just follow us on Twitter or Like us on Facebook)

– Contact our FoH Speakers’ Bureau to request a talk in your area

– Order FoH materials; Poster, handbooks

– Email us with your ideas/feedback: infoatfountainofhealth.ca

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