Welcome to the 3rd and final newsletter of the EHLE project!
The end of 2009 is approaching and so is the end of the EHLE project… The four partners have worked very hard on the project during the last 1.5 years. At the 12th of November, we organised an international convention in Venice to present the results of the project. In this newsletter, we will provide a summary of the presentations performed at this convention. Finally, we will give you information on the main product of this project: the multimedia training toolbox.

Final International Convention – 12 November 2009 – Venice, Italy
The final international convention was organised by the project leader of the EHLE project, Italy, in close cooperation with The Veneto Region and Azienda ULSS 16. The project partners were invited to the convention, accompanied by delegates from their country, and Italian politicians, health workers and policy makers were invited. The invited speaker was Dr. Jack Guralnik of the National Institute on Aging, Bethesda, Maryland, USA, who performed a key note lecture on social and behavioural factors predicting healthy aging: the roles of education and physical activity. Almost 200 people attended the convention in beautiful Venice. The purposes of the convention were:
- contribute to the training of those who work with elderly people, creating innovative training models. These are valid across Europe and cover the area of health education and, in particular, physical activity, nutrition, use of medicines, and use of tobacco.
- present participants with a multimedia training toolbox which was developed over the course of the project.
- promote the dissemination of teaching and explanatory materials across the region.
- share knowledge and experience in order to obtain innovative results valid across Europe in the field of continuing education for elderly people.

In the following paragraphs, each country will give you a summary of what they have presented at the convention. In addition, a summary of the key note lecture of Dr. Jack Guralnik is given.

Italy
EHLE project - Health education as the empowerment of elderly people
Dr. Corti gave a broad introduction to the EHLE project lifecycle. She summarized the background and the motivation that gave ground to the project. She also presented the development and the progression of the project during the two years of multilayer collaboration among the four partners and gave emphasis to the findings of the perception analysis. From there, the project entered the phase of creating and testing the training instruments during the 4 pilot trainings. Finally the conceptual framework for the training concept was developed and the final training toolbox was produced.

The project has been successful in the production of a final product that can be used by health professional and lay persons working with older persons. The project was also successful in enhancing the collaboration among the four partners and in finalizing all the project activities on time.




Spain
From a perception analysis of 1,200 European over-55s to the development of a training  toolbox for professionals.
Starting from the base of the initial objectives set in the project, the elaboration and design of a questionnaire are considered. From this questionnaire a perception analysis is extracted in order to know about the health perception of elderly people in the four countries participating in the project. The questionnaire has the following characteristics: Cover the essential aspects in order to evaluate the elderly persons’ health perception; It should be objective; Include and respect the cultural differences; Easy to understand for the survey participants; Accessible to the language of each country; Easy to use for the different partners with their respective work; With results that should be easy to be exploited and exported to different types of analyses and different uses during the development of the materials and the training tool.
Of the four countries and 300 surveys in each one, we obtained a total of 1,200 polled persons, who contribute general features of the target group in each country. The questionnaire insists in the integral health concept and includes the following aspects: general, personal and socio-demographic data in the diverse areas and sections of the questionnaire: daily habits, nutrition, sleep, physical activity, alcohol and tobacco consumption, drug consumption, emotional health and memory.
From the results of the questionnaire and an online application that allows the four partners to work simultaneously and in five languages, diverse types of analysis a) univariate and b) bivariate have been carried out and a large field was opened for further exploitation. The main results are reflected in a report of more than 300 pages, where the diverse areas have carried out a detailed study in order to give a base to the contents of the training modules, tools and materials.   


    FIRST CONCLUSIONS PERCEPTION ANALYSIS
As some first conclusions, which will be increased with the later analysis, we can point out that even within the variety of the studied populations, the obtained data have shown that health is perceived as an important issue by grown-ups and elderly people, who have formed part of this study.
Following a healthy lifestyle is associated with a recognizable and permanent emotional well-being in each of the four countries in spite of the different starting levels, which could be due to the geographical and cultural differences.
The direct relation between the perceived health level and the educational level among the survey group has been proven by the collected data. This should encourage us to continue with this task promoting initiatives to improve elderly persons’ lifestyles and habits among seniors.
From the results obtained from the perception analysis and the training concepts, the training toolbox has been elaborated. 

France
Health learning  process through social and health services
UNCCAS as French partner of the EHLE project works at national and local level in the field of social services. It has a strong development of its activities among the elderly, which is in fact an important part of the French population (21,26 % of elderly people aged 60 years old and more). Answer the needs of an ageing population is a priority in France but also in Europe. By elderly person we mean seniors, elderly persons whatever their health status (disabled, vulnerable, self sufficient or not and also healthy ones), but before all this, persons has individuals with a personal history, opinions, decisions and so on. Local members provide social services (home care services, services in daily life activities,  meals on wheels, and so on) but also cultural activities that will give to the elderly a place in the local communities, and also some prevention action in the field of health. Social and health services are both part of the process of the wellbeing of elderly people. By  joining their efforts, by improving the skills of social and health professionals, the EHLE project will give them keys and skills to promote healthy lifestyles and healthy ageing among the elderly population. The EHLE project will provide them scientific knowledge, ways to improve their communication with the elderly, and ways to improve the elderly health and wellbeing on a daily basis, with concrete possible implementations.
“Ageing is not a disease, ageing is a chance, getting the means to an healthy ageing is an opportunity”.


The Netherlands
Preliminary results of the perception analysis
 

Dr. Laura Welschen from the Netherlands

With the help of the analysis that Spain already performed some additional analyses were performed with the data of 1200 questionnaires (300 per country), based on a scientific research question: ‘What are the differences in reported health behaviour between the northern and southern European countries’.


The idea was that we have different lifestyles in the countries that might explain the differences in, for example, the prevalence of type 2 diabetes, cancer and cardiovascular diseases.
It was found that there were indeed differences between the 4 countries:

• Physical activity: Italy and France perform less physical activity than the other 2 countries.
• Smoking: France has less smokers than the other countries.
• Nutrition: Spain eats more fruit, France eats less vegetables, The Netherlands eats more bread, Spain and the Netherlands use more dairy products, Spain prefers fish above meat.
• Alcohol: Spain and the Netherlands are beer drinkers, Italy and France are wine drinkers

However, there was no north – south effect as Spain and the Netherlands, the most southern and northern country, respectively, were very similar. Effects have been adjusted for confounding (age, sex. Level of education, living situation) but these variables did not influence the results. However, we have to pay attention to the selection bias of the collection of the questionnaires because this was performed very differently in each country and that might have affected the results.

The development of the training concept
The EHLE project is based on the idea of empowering people to adopt a healthy lifestyle. Empowering = helping people to discover and use their own ability to gain mastery over their own health. This can be done by means of 3 strategies, which are all incorporated in all materials of the training toolbox:

1. Risk communication: we have to inform people on their health risks as people are often unaware of these risks and therefore not encouraged to change lifestyle.
2. Motivation: by means of techniques of ‘Motivational Interviewing’ people can be motivate to change before actually move on to the next step of goal setting.
3. Goal setting: we have to help people how to set goals in order to change their lifestyle.

The idea that these 3 strategies might empower people lies in our training concept which was based on 3 theories:

1. The Theory of Planned Behaviour. According to this theory, we have to give people information on health risks to give them the opportunity to change their attitude concerning behavioural change.
2. The Self-regulation theory. This theories says that people use feedback of their cognitions to make action plans to change behaviour. The most important cognitions are the controllability of the health/disease and consequences of certain behaviours. We have to learn people that the consequences of a bad lifestyle are a higher risk of developing severe disease and we have to learn them that they can control their health by means of lifestyle changes.
3. The social network theory, which assumes that we have to pay attention to the social network of a person and take this into consideration when he/she is trying to change lifestyle.

Lecture Dr. Jack Guralnik
Dr. Jack Guralnik works at the National Institute on Aging, Bethesda, Maryland, USA, and performed a key note lecture on “Social and behavioural factors predicting healthy aging: the roles of education and physical activity”.
    He started with some background literature on mortality rates and showed that the life expectancy is greatly dependent of the level of education of a person. Life expectancy consist of 2 parts: active and disabled life expectancy.
Active life expectancy is the average number of years of remaining life which is disability-free for an individual who is a specific age. The disabled life expectancy is the average number of years of remaining life with disability for an individual at a specific age.
 

Dr. Guralnik then focussed on this last part: the disabled life expectancy. He showed that the risk factors for disability are: low physical activity, smoking, high and low body mass index, weight loss, heavy and no alcohol consumption, high medication use, poor self-rated health, reduced social contacts. Therefore, the need to prevent people from becoming disabled is high. That was a important reason for him to start a study on this topic.
In the LIFE (Lifestyle Interventions and Independence For Elders) study he assessed whether exercise can prevent disability. The study was designed as a randomised controlled trial and started with a pilot study.




The intervention group received a physical exercise program and the control group an educational program on successful aging. The physical exercise program consisted of 5 elements: 1) aerobic (walking), 2) strength (lower extremities), 3) balance 4) flexibility stretching, 5) behavioural counselling (group and telephone). After a follow-up of one year, people in the intervention group improved the primary outcome measure: the mobility, measured by means of the speed on a 400 meter walk and the ability to balance on different standing positions on two feet. The pilot study was also successful on other aspects: there was a high number of people (>400 in 9 months) recruited to participate in the study and a minimal loss to follow, showing that the intervention was practical and safe and easy to perform and therefore probably easy to implement in daily practice. Currently, the definitive trial is being conducted a 8 study sites in the USA. The plan is to include 1,600 sedentary persons in the age of 70-89 years.
Dr. Guralnik finished with showing the American guidelines for physical activity. For all adults, the guidelines recommend to avoid inactivity, do a medium amount of aerobic physical activity (150 min moderate-intensity or 75 min vigorous intensity), more exercise will have more benefit, do muscle strengthening 2 days/week. In addition, for older adults the guidelines say to do balance training in order to prevent fall risk, to monitor the level of effort using relative intensity, to be as active as you abilities and conditions allow and to try to understand how chronic conditions affect ability to be active. 

Multimedia Training Toolbox:
The Training Toolbox is finished! The Training Toolbox is designed to give concrete and practical support to those who work or volunteer with elderly people. All the scientific, methodological and communicative materials developed during the course of the project and refined during the Pilot Training make part of the Training Toolbox.
The materials and tools have been elaborated by collecting the main aspects of the perceived health. They aim to give answers to main messages based in scientific evidences and the training concept, and to reach the target group directly and easily. In this sense, these two parts that will be carried out with the support of the handbook, should be highlighted:  A- training health professionals; B- teaching elderly people to live healthy lifestyles

The toolbox contains the following items:

• a project poster
• 5 project brochures on Nutrition, Memory, Tobacco, Pharmaceutical consumption, and Physical activity.
• the handbook that explains the purpose of the EHLE project, how to use the project materials (powerpoints and brochures) and how you can empower elderly people.
• a DVD with all the materials and also a digital handbook with hyperlinks to specific parts of the toolbox

If you are interested in receiving a toolbox, please contact:

• Italy: Laura Bracconeri laura.bracconeri@sanita.padova.it
• France: Kristine Stempien kstempien@unccas.org
• Spain: Concepción Bru Ronda direccion.upua@ua.es
• The Netherlands: Laura Welschen: l.welschen@vumc.nl

You can also download many of these materials from our website:
http://www.ehle-project.eu/en/project-tools.html

Project agenda:
The project will finish at the end of 2009. This means that in the next few months we will finish all project tasks. So please check our website www.ehle-project.eu every now and then to follow our progress.