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Health Plans Find That Senior Fitness Programs Improve Both Physical Health and Mental Health
By Brigita M. Fody-Urias and Steven H. Nelson
While behavioral health research has shown time and again that the risk of developing depression remains high among the elderly, diagnosis and treatment rates remain frustratingly low. To improve the mental health of their senior members, some health plans are turning to physical health programs and reaping mental health dividends. In this issue of Perspectives, we'll look at the success one senior health and fitness program has had in tackling depression.
HealthCare Dimensions, Inc. (HCD) based in Tempe, Ariz. was founded in 1992 and is based on the concept that the health care industry and the fitness industry should team together to create evidence- based interventions that prevent illness and improve health. Toward that end, HCD has developed a senior health and fitness program called SilverSneakers®. The SilverSneakers Fitness Program is an evidence-based program designed to improve the physical and mental health of all of its participants. SilverSneakers is offered by a variety of health plans across the country including Group Health Cooperative, Kaiser, Ochsner Health plan, PacifiCare/Secure Horizons, HAP (Henry Ford Health System), Intergroup of Arizona, Foundation Health of Florida and NYLCare 65 (Aetna/US Healthcare). The SilverSneakers Fitness Program has been shown to improve the health of health plans by reducing medical costs up to 66%, reducing voluntary disenrollment by 30%, boosting growth by 10-25% through market differentiation and improving public relations.
Use Exercise to Improve the Health of Seniors
The benefits of targeted exercise on the senior population are well documented in the literature. Seniors who exercise are shown to have improved mental and physical health. In 1989, the Surgeon General stated that physical health improvements for seniors who exercise include:
(1) Decreased incidence of both fatal and non-fatal coronary heart disease;
(2) Reductions in hypertension; and
(3) Reductions in rates of obesity. The Surgeon General stated that mental health benefits of exercise for seniors include decreases in depression and anxiety.
Keeping a positive outlook, maintaining meaningful friendships and relationships, staying active and involved, eating properly and exercising regularly can make a dramatic difference in the health and life of seniors. However, there are many barriers to those activities and social interactions among the elderly.
The SilverSneakers program reduces those barriers in several ways:
-- Free full memberships at local fitness and health facilities. HCD organizes networks of accredited fitness facilities for health plans that are close to where their members live. HCD closely monitors the facilities over time to insure quality.
-- Senior-specific fitness programming. SilverSneakers fitness classes are offered at each facility at least two times per week. The classes are offered at three different levels throughout the network. The classes are designed to service seniors at all fitness levels, from seniors with limited mobility to the most active seniors. Moreover, all instructors receive advanced training in senior needs.
-- Aggressive education and promotion. Many seniors have never exercised regularly, let alone attended a health club. To reduce the intimidation and fear of the unknown, HCD uses its knowledge and research about communicating with the senior population to help partnering health plans educate their members about the program.
-- Motivation and encouragement. HCD has developed several effective ways to help seniors stay motivated. It is not uncommon for a senior who has missed class a few times to receive a "missed you" phone call, card or letter from the senior advisor and the rest of the SilverSneakers class.
-- Social activity. A sufficient challenge to maintaining good mental health in the senior population is the lack of social interaction and meaningful friendships. Social interaction is a specific goal of the SilverSneakers program. Parties, excursions, dances and lunches are all common activities of SilverSneakers participants. Several health plans have even reported marriages among their members as a result of the fitness program.
Improve the Mental Health of Seniors
According to the National Institute of Mental Health, more than 2 million, or approximately 1% to 8% of senior Americans suffer from depression. Furthermore, other studies noted that depressed seniors consume approximately 50% more medical health services. Therefore, it is essential that health plans continue to study alternative interventions such as SilverSneakers that reduce the risks associated with mental illness in the elderly. Toward that end, an observational study was conducted by HCD on a Medicare population in the Northwest.
The data suggest that the SilverSneakers Fitness Program may help improve the mental health of its participants. SilverSneakers respondents who scored positive for depression showed 67% average improvement over a one-year period, compared to only 11% average improvement during the one-year time period in the comparison group. Those improvements translate into substantial reduction in health plan claims costs.
Study Gauges Effectiveness
To measure the impact of the fitness program on the mental health of its participants, an observational study was initiated with baseline SF-36 data obtained in January 1997 and follow-up data gathered in March 1998. The scores of SilverSneakers Fitness Program participants were compared to the results from the Medical Outcomes Study (MOS) as outlined in the SF-36 user's manual.
The MOS patients were adults sampled from various systems of care. The MOS results are used as "norms" for expected scores and changes in populations with specified chronic conditions. The MOS results for expected mental health changes were derived from a screened sample of 4,335 patients of formally trained mental health providers.
A total of 445 program participants were included in that study. At baseline, the SilverSneakers population was 55% female, 98.6% were 65 years of age or older, and the mean age was 71 years.
In comparison the MOS population screened for clinical depression included 4,335 subjects. The total MOS population was 54% female, and had a mean age of 58 years.
SilverSneakers Shows Results
The SF-36 user's manual demonstrates that the mental component summary score (MCS) may be used as a screening tool for clinical depression. A score of less than or equal to 42 on the MCS scale positively screens a respondent for clinical depression, with sensitivity and specificity equal to 73.7% and 80.6%, respectively. A total of 279 MOS patients met study inclusion criteria for depression.<F128M>
The mean baseline MCS score for all MOS patients with clinical depression was 34.84. The MOS patients were identified for depression via a written clinical diagnostic screener as well as a telephone-administered diagnostic interview. In the group of 279 MOS patients, the average improvement shown was 11%, or 3.86 points.
In comparison, a total of 27 respondents in the SilverSneakers population screened met inclusion criteria for depression. The mean baseline MCS score for the 27 respondents was 30.35. The mean follow-up MCS score for the respondents was 50.70.
The average improvement shown in the MCS scores for the SilverSneakers group was 67%, or 20.35 points. Moreover, of the 27 SilverSneakers respondents, 21 no longer had MCS scores below the depression cut-off at follow-up (see graph below).
Limitations to the study include:
(1) Study not case-controlled;
(2) No baseline data regarding comorbidity status were available for the SilverSneakers fitness program's participants; and
(3) Different depression screening tools identified the populations in this study. A further factor that influences all depression studies is that depressed patients are expected to rebound from depression.
Despite the limitations of the study, the data indicate that SilverSneakers positively impacts the mental health of seniors. Finally, programs like SilverSneakers may be the key to allowing seniors' golden years to be more rewarding while helping health plans find a way to provide for seniors given today's shrinking Medicare reimbursement.
For more information, please contact Mark Mosebrook, HealthCare Dimensions, Inc., Tempe, Ariz.
Article published in Managed Behavioral Health News 9/16/99
Copyright © 1999 by Atlantic Information Services, Inc.
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