Adapting a successful health enhancing program for use with low-income men and women
Masterpiece Living (ML), an action program based primarily on MacArthur research on successful aging, has demonstrated positive effects on well-being among older men and women (see Appendix, Section I). The evaluative research was conducted in two communities, both with relatively high income residents. The program, made available by the non-profit Masterpiece Alliance Foundation, has been adopted by more than 40 Continuing Care Retirement Communities (CCRC). The research we now propose will adapt the ML program for use in affordable housing communities and assess its effectiveness in such communities. This research builds on and, we believe, will contribute to two important but seldom integrated bodies of research. The first is the laboratory and epidemiological studies that link social and environmental factors to health, well-being and productive behavior. The second body of research is based mainly in organizations and factors that create positive change in organizations.
The core conceptual content of the ML program consists of three concepts: access, information, and connectedness. Access to exercise facilities, to health-promotive food choices, etc, is made easy and convenient. Information about the relevance of such choices is provided and, more important, information about each person’s own activities and progress is given. Connectedness is emphasized by means of group feedback sessions in which progress and problems are discussed and plans are shared. The formation of “buddy” pairs to strengthen good intentions about diet, exercise, and voluntary activity is enabled and encouraged. Four hypotheses predict that this program, in comparison to the control community, will produce (1) gains in self-reported well-being, (2) gains in mobility and balance, (3) reductions in medical risk factors, and (4) increases in voluntary activity. A fifth hypothesis, at the community level, predicts a reduction in the demand (need) for medical care, nursing, and assisted living. The methods for this experiment have two sources: the experience of introducing the ML program in more than 40 Continuing Care Retirement Communities, and the extensive experience of the Principal Investigators in designing and conducting large-scale surveys. As stated in our hypotheses, the expected outcomes of this research will be the demonstration of potential improvements in health and productive behavior among older men and women of low income. If the results are more modest, they will at least clarify the needs of this often overlooked population and offer some guidance for policy as well as future research.
Like other developed countries the United States is an aging society, a society in which older men and women are increasing in numbers and proportion. Our policies and institutions have not yet adapted to these demographic changes. Relevant research, if it is brought to the attention of policy makers, can provide evidence upon which to base policy that will optimize life quality and reduce costs. At the Congressional level, the relevant committees in the House are Budget and Education and Work Force. In the Senate, the Special Committee on Health, Education, Labor and Pension as well as the Committee on Aging are both concerned with the well-being of elders. Our scientific findings should also be brought to the Department of Housing and Urban Development as well as to state governments, where many of the policies affecting low-income families are formed. We cannot work directly with 50 states but we can reach them by working with agencies that do so, like the Center for State Innovation and the Administration on Aging.