Use of a Wellness Coaching Model Among Urban-Dwelling, Low-Income Older Adults

Older adults, age 65 years or over, currently represent 14.5% of the United States (U.S.) population. This value is projected to more than double to 98 million by 2060 (AoA, 2015) as ann increasing number of older adults, both rich and poor, are living longer in the presence of chronic disease and illness symptoms (National Center for Health Statistics (US) & National Center for Health Services Research, 2012). Compared to younger individual, older adults are more likely to experience repeated hospitalizations and/or unplanned visits to their health care provider, and face increased costs to manage their health (Lehnert et al., 2011). Prolonged life, desired by many, brings new challenges. Older adults often struggle to maintain quality of life and independence in the presence of complex, chronic diseases and prevailing illness symptoms; for low-income elders with limited access to a resourceful, supportive environment, these challenges are even more profound (Huguet, Kaplan, & Feeny, 2008).

Partnering with the Boston Housing Authority (BHA), this pilot project implemented a wellness coaching model consisting of a comprehensive, geriatric assessment, an individualized healthy aging plan, and continued coach contacts to increase health self-management. Troutman’s theory of successful aging, that supports individual determination of successful aging and an action plan to achieve life goals provided the theoretical foundation. Troutman’s theory of successful aging involves three coping processes: 1. functional performance mechanisms, 2. intra-psychic factors, and 3. spirituality (Topaz, Troutman-Jordan, MacKenzie, 2014). Functional performance mechanisms refer to the use of conscious awareness and choice as an adaptive response to physiologic and physical aging. Intrapsychic factors are the innate features that contribute to the person’s ability to adapt to change and solve problems. Spirituality consists of the person’s beliefs and views that relates to something greater than self. Each of the three processes contribute to the complex process of gero-transcendence and, ultimately, successful aging.

The primary purpose of this study was to determine if low-income older adults who participate in a personalized wellness coaching model will have increased self-management behaviors (i.e. physical activity) as compared to a wait-list control group. The study sample included minority older adults residing in one of two BHA sites. Fifteen participants (5 females and 10 males, mean age 77.4 ± 7.9 years) were assigned to the intervention group and 13 older adults (7 females and 6 males, mean age 75.8 ± 9.1 years) from another BHA site made up the control group, crossing over to the intervention six months later. Assessment tools used were interRAI’s Health & Social Check-up and the Lifestyle Survey.

Independent and paired t-tests (p<0.05) were calculated to compare baseline and follow-up results. There was statistical improvement of physical activity in both Amory Groups 1 (p<0.02) and 2 (p<0.016) and the PAM score (p<0.05) in Amory Group 2. Self-reported quality of life statistically decreased in the control group at Holgate.