HPS 4600 Health Promotion Program Name(s): Ash Parker and Dana Toledo Date: November 15, 2009

Program Title/Topic: Target Group/Setting: Seniors ages 65+ Program (200 Pts)

Dr. J. Petrillo 200 Points Total

1) Title Page and Table of Contents (5) The Pursuit of Happiness Ash Parker and Dana Toledo Kennesaw State University HPS 4600 Health Promotion Applications Dr. Jane Petrillo

2) Title of Program (5) The Pursuit of Happiness

3) Mission Statement (5) The Pursuit of Happiness provides older adults ages 65 an up at Heritage at Walton Reserve with strategies for detecting symptoms of depression, coping with depression, and effective treatment reducing the prevalence of depression by using specifically designed tools and intervention activities which will increase physical activity, increase social interaction, and improve the overall environment conducive to good health that the seniors reside in.

4) Program Goals and Objectives (25) - To reduce the cases of further physical complications caused by depression - To encourage and make available effective treatments for depression - To help participants recognize symptoms of depression in an effort to be able to cope with depression - To encourage a more positive environment for mental health among older adults ages 65+ in assisted living facilities - To provide effective tools designed to stimulate skills and interests specifically for older adults to reduce the onset of depression - To increase social support and relationships among participants

5) Rationale for the Program (25) The Pursuit of Happiness Ash Parker and Dana Toledo Exercise & Health Science Kennesaw State University

Target Population: Adults 65+ Health Problem: Depression Program Setting: Nursing home/senior facility

Depression is among the leading causes of disability worldwide (World Health Organization, 2009). Approximately 121 million people worldwide currently suffer from depression (World Health Organization, 2009). Eighteen million American adults have depression and about 2 million adults ages 65 and over have some form of depressive illness (National Institute of Mental Health, 2007). Older adults have an increased risk for experiencing depression (Center for Disease Control, 2007). Estimates of major depression among older people living in any given community range from less than 1% to approximately 5%. However, rates of depression rise to 13.5% in those who require home healthcare and to 11.5% in older hospital patients (Center for Disease Control, 2007). Treatment programs for depressed elderly patients suffering from cardiovascular disease and other major illnesses usually take longer than normal and are less successful (American Psychological Association, 2007). The feelings of hopelessness and isolation that often spur thoughts of suicide are more prevalent among older adults, especially those with disabilities or confined to nursing homes (American Psychological Association, 2007). Mental Health America conducted a survey to compare depression levels and suicide rates in all 50 states and the District of Columbia based on these four measures: 1) The percentage of the adult population experiencing at least one major depressive episode in the past year; 2) the percentage of the adolescent

population experiencing at least one major depressive episode in the past year; 3) the percentage of the adult population experiencing serious psychological distress; 4) and the average number of days in the past 30 days in which the population reported that their mental health was not good (Mental Health America, 2009). Survey results indicate that the State of Georgia ranks 11th in depression and 19th in suicide rates. Also, depression is the main cause of about 900 suicides every year (Georgia Department of Behavioral Health and Developmental Disabilities, 2007). According to the American College of Cardiology (2009), depression was associated with 15% to 53% increases in 5-year cardiovascular costs for women, showing an estimated $1,500 to $3,300 higher health care cost than nondepressed groups. Days lost from work resulting from depression exceed all other disorders and the economic burden on family members and society accounts for 60-85% of the total cost of the illness and represents a significant proportion of the Gross National Product (World Health Organization, 2001). Depression and anxiety are two major causes of illness and death in the United States and are associated with reduced quality of life, social functioning, and excess disability (Centers for Disease Control and Prevention, 2009). In 2006, the CDCs Behavioral Risk Factor Surveillance System (BRFSS) conducted a survey to measure anxiety and depression among U.S. citizens in thirty-five states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands. The BRFSS stated the following: Persons with current depression and a lifetime diagnosis of depression or anxiety were significantly more likely than persons without these conditions to have cardiovascular disease, diabetes, asthma, and obesity and to be a current smoker, to be physically inactive, and to drink heavily. (CDC, para. 3) Data shows that 15.1% of people diagnosed with cardiovascular disease have current depression and 12.4% have a lifetime diagnosis of depression. Among those diagnosed with diabetes, 12.9% have current depression and 11.6% have a lifetime diagnosis of depression. The higher rates of current depression are

often those diagnosed with asthma (24.3%), obesity (35.2%), smoking (37.9%), and physical inactivity (43.0%). Asthma (22.3%), obesity (32.8%), smoking (30.8%), and physical inactivity (30.6%) are also correlated with the lifetime diagnosis of depression (CDC, 2006). One specific strategy to reduce the incidence and prevalence of depression and depression-related illness among older adults is through a depression prevention and awareness program entitled The Pursuit of Happiness. The program consists of three sessions for sixty minutes, focusing on approximately ten to twelve older adults ages 65 and over in a senior assisted living home. The program will inform participants about depression via agerelevant educational materials, activities, and discussions. The program will also use effective and valid diagnostic tools for identifying depressive tendencies in older adults. The program educates participants on how to recognize depression symptoms as well as address the many contributing factors that may lead to depression. The program will employ intervention activities designed specifically for older adults based on their skills, interests, and abilities. The benefits of The Pursuit of Happiness Program are to improve quality of life among older adults by using proper detection techniques. By improving the mental health of older adults and reducing the physical problems related to disease associated with depression, the symptoms of depression can be significantly reduced. Chronic depression has both physical and mental consequences that may complicate an older adults existing health condition and trigger new concerns (American Psychological Association, 2007). Some of these concerns can include cardiovascular disease, diabetes, asthma, obesity, smoking, physical inactivity, and heavy drinking. Participation in this program will allow participants to continue to engage in activities they enjoy while coping with depression and at the same time preventing potential depressive tendencies. The Pursuit of Happiness Program is similar to several successful community depression programs. Healthy IDEAS (Identifying Depression, Empowering Activities for Seniors) is a community depression program implemented by Care of Elders in Houston, TX that takes place in the participants place of residence.

Healthy Ideas is designed to detect and reduce the severity of depressive symptoms in older adults with chronic health conditions and functional limitations through existing community-based case management services (CDC, 2009). This program resulted in reductions in depression severity and self-reported pain, increased knowledge of how to get help for depression, increased activity levels, and knowledge of how to manage depressive symptoms. The Pursuit of Happiness Program will utilize a similar standardized depression assessment tool to screen for symptoms of depression. The Pursuit of Happiness Program is similar to the IMPACT (Improving Mood-Promoting Access To Collaborative Treatment) program that the IMPACT Implementation Center in Seattle, Washington offers in that it engages older adults in physical activity and is implemented in the primary care setting of the participant (CDC, 2009). The Pursuit of Happiness also utilizes components of PEARLS (Program to Encourage Active Rewarding Lives for Seniors) program by the University of Washington School of Public Health, which is implemented in the participants place of residence. PEARLS teaches participants to identify symptoms of depression, problems that may play a part in depression, and how to devise steps to solve these problems (CDC, 2009). Using appropriate depressionreducing techniques and engaging individuals in a healthy experience to improve mental health, the Pursuit of Happiness Program will be successful because it will provide the target population with effective tools in preventing, identifying, and reducing the symptoms and problems related to depression.

6) Priority Health Problem and Priority/Target Population (10) - Depression in older adults, adults ages 65+ 7) Planning Group and Program Stakeholders (10) Ash Parker and Dana Toledo Program Director: Dr. Jane Petrillo Stakeholder(s): Ms. Tina Edward, family and friends of participants

8) Program Setting/Location/Time (10) Heritage at Walton Reserve

1675 Walton Reserve Blvd. Austell, GA 30168-2537 (678) 255-2700 November 19 and 24 @ 1PM

9) Resources Needed and Funding Sources and Itemized Budget (15)

10) Marketing Strategies and Materials (15) - Marketing flyer

11) Intervention Activities (40) - Powerpoint review of statistics of the prevalence of depression - Itinerary of interventions - Powerpoint during lunch on risks of depression - Geriatric Depression Scale - Making greeting cards for friends or family members - Document accomplished activities - Powerpoint on how to recognize depression and depressive tendencies - Zookinesis video - Fun and interactive trivial game called the Sticky Head Game - Encourage participants to share a favorite song, poem, or story - Review accomplishments and newly learned behaviors and receive incentives

12) Evaluation and Assessment (25) - Geriatric Depression Scale - Checklist

13) References (5) American Psychiatric Association (2000, February). Economic grand rounds: patterns of hospital costs for depression in general hospital wards and specialized psychiatric settings. American Psychological Association (2007). Aging and depression. http://www.apahelpcenter.org/articles/article.php?id=121.

American Psychological Association (2003, September). Facts about depression in older adults. http://www.apa.org/ppo/issues/olderdepressfact.html. Centers for Disease Control and Prevention (2007). Depression is not a part of growing older. http://www.cdc.gov/features/HealthyAging/. Centers for Disease Control and Prevention (2009). CDC features: anxiety and depression. http://www.cdc.gov/Features/dsBRFSSDepressionAnxiety/. Cobb County Senior Services (2009). http://seniors.cobbcountyga.gov/services.htm Georgia Department of Behavioral Health and Developmental Disabilities (2007, July). Clinical depression not a normal part of aging. http://dbhdd.georgia.gov/portal/site/DBHDD/menuitem.5f0f430d0b5cf94b5 0c8798dd03036a0/?vgnextoid=f9c1955129204110VgnVCM100000bf0101 0aRCRD&vgnextchannel=38cc5afcc63e9110VgnVCM100000bf01010aR CRD. Mental Health America (2009), Ranking Americas mental health: an analysis of depression across the states. http://www.mentalhealthamerica.net/go/state-ranking. Richman, V.V. (2000). Economic grand rounds: patterns of hospital costs for depression in general hospital wards and specialized psychiatric setting. Economic Grand Rounds, 51(2), http://psychservices.psychiatryonline.org/cgi/content/full/51/2/179. Royal Australian College of General Practitioners (2005). Medical care of older persons in residential aged facilities. http://www.racgp.org.au/silverbookonline/4-4.asp Rutledge, T., et al., Depression and cardiovascular health care costs among women with suspected myocardial ischemia. Journal of the American College of Cardiology, 53. http://content.onlinejacc.org/cgi/content/abstract/53/2/176. National Institute of Mental Health (2007). Depression. http://www.nimh.nih.gov/health/publications/depression/completeindex.shtml.

World Health Organization (2009). Depression. http://www.who.int/mental_health/management/depression/definition/en/.

14) Appendix (5)