Strong Bones, Strong Body A Program for Older Adults 1. The targeted nutrition need that will be the focus of this program is the importance of calcium, vitamin D, and physical activity for osteoporosis prevention. The target population is older adults aged 65+ living in Mountain Top, Pennsylvania. 2. The goal for Strong Bones, Strong Body (the name of the program) is to increase knowledge and consumption of calcium-and vitamin D-rich food sources, as well as knowledge of and participation in physical activity to prevent osteoporosis development in adults aged 65+ in the Mountain Top, PA community. 3. Outcome Objectives: a. To increase consumption of calcium-rich foods among adults aged 65+ in the Mountain Top, PA community so that 75% of participants consume at least 2 servings of calcium-rich foods daily within the month following the completion of the 5 week program. b. To increase consumption of vitamin D-rich foods among adults aged 65+ in the Mountain Top, PA community, so that 75% of participants consume at least 2 servings of vitamin D-rich foods daily within the month following the completion of the 5 week program. c. To increase weekly physical activity participation in adults aged 65+ in the Mountain Top, PA community, so that 50% of the participants report to participating in physical activity at least three times each week, for at least 20 minutes per day within the month following the completion of the 5 week program. 4. Learning and Educational Needs of the Target Population a. Learning Needs of Adults Aged 65+ i. Empathize and relate to concerns and needs: It will be important that the program s curriculum empathizes with those who may have physical disabilities when developing the physical activity component potentially by providing a variety of exercises for adults of all abilities. When, developing the diet-related component of my program (calcium-and vitamin D-related), it will be important to address concerns such as health benefits, cost, and fiber content of the foods. When developing the physical activity related component, it will be important to consider concerns such as moving independently, staying active with grandchildren, preventing a fall (many negative implications arise from an older adult falling). ii. Considering disabilities: The program will have to focus not only on accommodating for physical disabilities, as listed above, but also disabilities related to vision and hearing. The printed/powerpoint materials must have font and images that accommodate for conditions such as presbyopia and slower processing of visual information. The volume at which the instructor(s) conduct the lesson must also be fitting for those who may suffer from impaired hearing.
iii. Considering living situation and economic status: Participants may be retired, living on Medicare, and/or living on very small incomes. When suggesting calcium-or vitamin D-rich foods, it is important to include reasonably priced items. For participants that live in the senior center, foods that are served to them from the center s kitchen need to be observed and documented in order to give examples of calcium-and vitamin D-rich foods that are available within the senior center s menu. Also, for participants living in the senior center, the available space/facilities available for them to practice physical activity need to be taken into account when developing the lesson focused on increasing physical activity. b. Educational Needs of Adults Aged 65+ i. Calcium and Vitamin D Educational Needs: 1. Explanation of their roles in bone health and osteoporosis prevention 2. Their value as critical providers of strong bone health and osteoporosis prevention 3. Specific sources of foods high in each, and the proper serving of these sources 4. How many servings to get of the sources each day ii. Exercise Educational Needs: 1. Explanation of the role of physical activity in strong bone maintenance and osteoporosis prevention 2. The value of exercise as a provider of strong bone health and osteoporosis prevention 3. Safe ways to exercise, accommodations made for any existing disabilities 4. Duration to exercise for each day 5. How many times to exercise each week 5. Overview of the program: Levels I, III, and II a. Level I: Building Awareness: Church announcements: I, as the instructor of the program, will visit parishes in the Mountain Top area and announce the start date and details of the program at the end of the parishes mass times. Brochures containing information about osteoporosis prevention and the program s launch will be handed out by two local university nutrition students (recruited by me to help implement the lessons of the program). b. Level III: Supportive Environment: One way to create a supportive environment for those living in the nursing home is by developing a partnership with the senior center staff (foodservice workers, nursing staff who deliver food) to ensure that some of the foods they serve are rich in calcium and vitamin D. I would also ask that the nurses who deliver the food inform participants which delivered foods presented are high in calcium or vitamin D, and remind them of their importance in bone health. Program s promoting the poster would be placed in locations commonly visited by older adults (restaurants, supermarkets, etc.).
c. Level II: Change Lifestyles the Program: i. Where: Mountain Top Senior Care and Rehab Center in Mountain Top, PA in the large group meeting room ii. Participants: Older adults age 65+, either living in the senior center or elsewhere in the community iii. Duration: Five consecutive weeks, one 45 minute lessons each week (aside from first lesson, which will be 30 minutes) iv. When: Tuesday of each week, at 11:00 A.M. v. By Whom: Myself (present at each lesson), or by pairs of nutrition students at Wilkes University who were previously recruited vi. Lessons: 1. Lesson 1: Osteoporosis Overview 2. Lesson 2: Calcium and Bone Health 3. Lesson 3: Vitamin D and Bone Health 4. Lesson 4: Physical Activity and Bone Health 5. Lesson 5: Review of Calcium, Vitamin D, and Physical Activity and Bone Health (in the form of a party ). 6. Lesson Plan: a. Title: Calcium and Bone Health b. Definition of Target Audience: Older adults age 65+ living in the Mountain Top, PA community c. Duration: 45 minutes d. Lesson Goal: The goal of this lesson is to increase participant s knowledge of calcium s role in bone health, calcium-rich food sources, and serving sizes of calcium-rich foods. e. Objectives for lesson: i. To increase participant s awareness of calcium s role in bone health, so that 75% express a gain of knowledge on this topic through an administered quiz. ii. To increase participant s knowledge of calcium-rich food sources, so that 75% are able to recall 3 food sources mentioned in the lesson through an administered quiz. iii. To increase participant s knowledge of the number of calcium-rich food servings they should be consuming each day, so that 90% of participants can recall the number of servings they should be consuming each day through an administered quiz. f. Procedure: i. When: Tuesday at 11:00 AM ii. Where: Mountain Top Senior Care and Rehab Center, located on South Main Boulevard in Mountain Top, PA
iii. How: Forty-five minute lesson presentations, administered by either myself or a pair of nutrition students from Wilkes University. g. Learning Experiences and Activities: i. Instructor Introduction (5 minutes): Oral question-and-answer review of the previous week s lesson ii. PowerPoint Presentation (10 minutes) 1. Slide 1: Title of lesson, Calcium and Bone Health 2. Slide 2: Bullet point list of lesson s objectives 3. Slide 3-4: Calcium s Role in Bone Health Slides contain information regarding why calcium is needed for strong bones iii. Activity: Visual Identification of Calcium-Rich Foods and their Respective Serving Sizes (15 minutes): Five examples of calcium-rich foods will be brought in, and measured to show the correct serving size (foods listed in materials). This activity will include a handout Getting your Calcium from Every Food Group, with foods listed from each of the five food groups (grains, fruits, vegetables, dairy, meat and protein) that are rich in calcium, along with the serving size of each of the listed foods. iv. PowerPoint: Lesson on Servings per Day (5 minutes) 1. Slide 5: How Many Servings Should I Be Getting? This slide will contain information on how many calcium servings older adults should be getting each day. v. Handout: Review Quiz (5 minutes): Participants will be given 5 minutes to take a review quiz covering knowledge about concepts mentioned in the lesson s objectives. Grading will be done the by instructor(s) within the week before the next lesson. vi. Questions/Comments (5 minutes): It will be announced that the floor is open for further questions/comments from participants. Instructor(s) will thank participants for attending. vii. On their way out, participants will be provided with pre-prepared Calcium Goodie Bags (contents listed in Materials needed ), along with an evaluation sheet about the lesson. The evaluation sheet will include a list of questions about each part of the day s lesson, each followed by a series of numbers 1-5 for the participants to rate the listed components, with 1 being not at all effective or enjoyable and 5 being extremely effective and enjoyable. The bottom of the evaluation sheet will ask that the participant write their own comments or concerns about the lesson, followed by several blank lines for their answer. h. Evaluation i. An evaluation sheet will be distributed to all participants at the end of the lesson to be returned by participants at the next week s lesson.
ii. The end-of-class quiz will evaluate if lesson s objectives were met. iii. A five-minute review session in the following week s lesson with a question and answer session will be held to evaluate how much information was retained. i. Materials needed: PowerPoint presentation (slides 1-5), computer, projector, foods for demonstration (6 oz. Yoplait Fruit Flavored Yogurt, 1 quart Tropicana orange juice, 1 box Whole Wheat Total cereal,1.5 oz. container of vanilla ice cream); Calcium goodie bag: 1 small orange, 1 Kraft cheese stick, and 1 Emerald 100 calorie pack of raw almonds; Handouts: Getting Your Calcium from Every Food Group, Review Quiz, Evaluation Sheet 7. Evaluation: a. Impact/outcome: Beginning one month after completion of the 5 week program, follow-up evaluation sheets will be sent to the home addresses (and provided at the senior center) of participants to provide a written evaluation of behavior changes. The instructions would read: Listed below are a set of health and fitness choices that some people do agree with and some people do not. As a result of participating in some or the entire Strong Bones, Strong Body program, please circle your response to the following. Answer choices would be frequency-based ( Never, Rarely, Sometimes, Often, or Always ). b. Process: The primary form of process evaluation will be provided through the evaluation sheets handed out to participants at the end of each lesson. Attendance will also be taken with a sign-in sheet to keep record of how many participants there were total, how many completed the entire program, and if any/how many stopped coming after a certain amount of lessons. c. Fiscal/Efficiency: The budget would be set at $1,000 for the program s promotion materials and the materials for the initial run of the five weeks of lessons. The budget would go toward 3 categories: foods, promotion materials, and other lesson materials. I would keep careful documentation of the money spent in each category, as well as the amount/cost of foods and other materials donated from the program s partner organizations. Staffing for the program consists only of volunteerism, so no budget amount need be set aside for payment to the program s staff. As stated before, careful documentation will be kept regarding the number of participants involved in the program. The documented total cost can be divided by the number of participants to generate the cost of the program per participant, which can be used to decide on budget and related fiscal decisions if the program were to continue for another five-week run of lessons. 8. Marketing the Program a. Program Slogan: Bone Strong, Body Strong, Senior Strong
b. Delivery: At level I (building awareness), the slogan would be printed on the brochures handed out, as well as verbally mentioned in the after-mass announcements and announcements made through other local platforms where adults aged 65+ are likely to visit (restaurants, supermarkets during the day, fitness centers). Through the program s partnership with Carone s local supermarket, a small stand will be set up in the month before the program s launch for a few days a week. The student volunteers will sit outside of the supermarket handing out various calcium-and vitamin D-rich food sources in the form of goodie bags. The table will bear the slogan on the front side, and brochures with information about the program would be present at the table. At level II (lifestyle changes), the slogan would be incorporated on the PowerPoint slides shown during lessons, as well as written on the bottom of any handouts distributed during the lessons. At level III (supportive environment), I will have posters posted throughout the senior center, as well as in supermarkets, restaurants, fitness centers and other local facilities that don the slogan. Student volunteers will continue promotion of the program through the promotion table (used in stage I to build awareness) to create a supportive environment. Through my partnership with the local fitness center, I would potentially request the staff of the center host a Bone Strong, Body Strong, Senior Strong fitness program (named after the program s slogan) focused on teaching older adults ways to safely work out using the fitness center s facilities. 9. Challenges a. Impaired vision in older adults present the challenge of making sure reading materials are appropriately designed as easily readable. All handouts will be in a larger and easily read font (one with serifs). The PowerPoint text would also be very large and in an easily read font. b. Older adults can have a tendency to be set in their habits. Because of this, I will incorporate common food source examples that adults would be likely to already have included in their diets, and avoid excessive use of trendy foods that they may be opposed to trying. For those who do not have a habit of exercising, I will brainstorm exercises that are simple and can be incorporated into everyday activities. 10. Partnerships a. Student Nutrition Association at Wilkes University: The student instructors involved in this program can help promote the program, administer the lessons, grade the quizzes, and analyze and document evaluation data. The students will also design several small fund raisers to aid in some of the program s funding. b. Carone s Local Supermarket: The supermarket could help with program promotion (placement of brochures, flyers, and posters in the market) as well as
provide some of the foods provided as examples/rewards in the individual lessons, such as the foods for the Calcium Goodie Bags mentioned in the lesson plan. c. Local Restaurants: Local restaurants can serve as a platform for brochures, flyers, and posters for promotion of the program. d. Mountain Top Senior Care and Rehab Center (staff): Partnering with them provides a facility for the program to be carried out. Potential collaborations with foodservice staff and nurses can ensure proper calcium-and vitamin D-rich foods are delivered to participants living in the center. The staff will also be involved in evaluating if changes are being made in the behaviors of live-in participants after the program has ended. e. Local parishes: They will serve as platform for promotion of the program in a setting where the target population is likely to be in attendance (verbal announcements, handing out flyers at the door). f. Northeast Sports and Fitness Center: The fitness center will be another platform for poster, flyer, and brochure promotion. As mentioned previously, a fitness program for older adults named after the program s slogan can be facilitated through the partnership with the fitness center. 11. Management: a. Organizational Structure i. I, as a hypothetical registered dietitian in this situation, would be responsible for the oversight of all volunteers involved in this program. I would recruit students studying nutrition from the local university (Wilkes University), with their incentives for volunteering being an excellent addition to a resume, as well as a letter of recommendation. Ten students would be recruited making five pairs of nutrition students to help instruct each of the program s five lessons. The students would also be involved in the promotion of the program (designing and handing out flyers, making announcements, etc.). The student volunteers and I would be the primary personified management of the program. b. Data Systems i. All participant names, phone numbers, and addresses would be gathered at the first lesson and kept in a binder in case the need to contact a participant was to arise. ii. The results of the evaluation sheets that will be sent to residencies mentioned in section 7 (impact/outcome evaluation) will be analyzed by the nutrition student volunteers and I to generate statistics about the frequencies of the self-reported behavior changes. iii. The staff of the senior center will be provided with guidelines to monitor behavior changes potentially related to the program involving dietary changes (with calcium and vitamin D consumption) and participation of
physical activity. The staff can then report any changes observed, providing data to analyze the successes or failures of the program.