Creating a Senior Health Group

America's senior citizen population is a population that has largely been ignored by mainstream society and the media. It is no secret that the size of this population is going to explode over the next couple decades with the addition of the baby boomers. With this massive increase of population in terms of both sheer numbers and percentage of the total population, this group will become increasingly difficult to ignore.

If one examines data available from the United States Census Bureau, one will find that currently, persons age sixty-five and over are 40.2 million in number. This amount is projected to grow to 63.9 million in 2025 and 88.5 million in 2050. If one calculates these numbers in relation as a percentage of our nation's projected total population, it will be found that currently persons age sixty-five and over account for 12.9% of our total population; in 2025, that percentage will increase to 17.8%, and finally in 2050 that percentage will peak at 20.1%. Of the given ages and populations studied at the U.S Census Bureau, this is by far the most dramatic increase (U.S. Census Bureau, 2008).

There are many different ways which could be used to help this group. The purpose of this particular group will be to help educate senior citizens on the benefits of eating healthier, the importance of identifying healthy and unhealthy foods, and how their lives and the lives of others can be improved through nutrition. The reason I am interested in forming this type of group is based on experience in the Outagamie Red Cross's Shopping & Errand program, which I have been participating in for the last couple months. I have performed shopping services for several different clients, and much of the food I have purchased is loaded with salt (salt causes the body to retain water and therefore gain weight, and also raises blood pressure), sugar, and fat. Many buy prepared boxed meals, which seem healthy, but are usually loaded with salt and fat. Another common thing that is not known is that deli meat is also loaded with salt, and this item is purchased fairly often. However, the more subtle foods that are harmful to one's health are not so much the problem; the problem is that a person will buy fruit bars, diet soda, candy, and apples; the majority of the diet is sugar, fat, and salt, which can cause a range of poor health conditions when not eaten in moderation. This suggests a personal lack of awareness of the benefits of healthy nutrition, something that has become more mainstream since the 1990's.

The theoretical framework to be used is Bandura's social learning theory. Basically, this theory holds that group members learn to behave in a particular way based on reinforcement or punishment by other group members. If group members praise a person's behavior, that person will be more likely to engage in that behavior in the future, whereas if a person engages in behavior disapproved by the group, that person will be less likely to engage in that behavior due to the scorn of other group members (Toseland & Rivas, 2005, p. 60). Harris and Grootjans (2006), in their research on aging, feel that the following attitude is the best method to work with aging:

Health care workers need to orchestrate a shift in the way that we view ageing and health. This shift requires a greater emphasis on the promotion of well-being rather than the present focus on reducing or treating disease and minimizing the impact of disablement on individuals. Such a shift in perspective challenges us to see older people not as a burden upon the health care system but as active participants and contributors within the community (p. 277).

The group will be a treatment group and will focus on member ability to grow in personal knowledge of healthy eating and ability to take action and implement it into his or her life. The group will have a round-robin format and democratic leadership style. It is presumed that seniors who join this group will have varying levels of knowledge of healthy eating; the group leader is presumed to be the "expert," the one who will know the answer or find it for the group. The group rules that would be employed would be that 1) no one is allowed to start talking until someone is finished, 2) to give advice, one must first obtain consent from the person to which they would like to give advice, 3) no negative or demeaning talk about another person or their diet is allowed, 4) each person must open his or her turn to speak by stating his or her first name. The purpose of these rules is to keep conversation structured so that there is a minimum of crosstalk and random chatter, which can cause impairments in group functioning. It also keeps a minimum amount of information being presented, which will allow seniors to increase their focus and have a better chance of remembering the information presented. Anticipated group norms include resistance to change, an emphasis on tradition, and desire for a consistent routine. One structured activity that will be employed is having group participants write down all the different foods they eat for a week, and then bringing that information to the group. Each group member will be asked to share one day's worth of food he/she has eaten in the past week. Many people do not realize how unhealthy their diets are until they share them with others; the group will also have to safeguard against embarrassing the member to the point where he/she feels returning to the group is not an option. The member will then be asked to describe the benefits of eating the healthy food and the drawbacks of eating the unhealthy food, and what change could be made to improve his/her diet. If the member feels comfortable, he/she will be given the option to hear feedback from other group members or the group leader. This is a pretty concrete method of educating seniors on nutrition, and the success of the group depends on how much members follow-through with their newly-acquired knowledge.

At the Outagamie Red Cross, the Shopping & Errand program is an already excellent way of reaching homebound seniors and the disabled. These services are provided to individuals wherever they are located-their apartment, house, or retirement home. Information about this program has been disbursed by delivering brochures to community centers and retirement homes, performing presentations at senior meal sites and retirement homes, and by recommendation of current clients to potential future ones. The Shopping & Errand program has grown from eight clients and one volunteer to 168 clients and twenty-five volunteers in a period of nineteen years; the same method of information disbursement, coupled with a rough estimate of the senior population in Outagamie county doubling from 17,000 to 34,000 in the next couple decades, and the fact that this group is open to all seniors, not just the homebound or disabled, means that there is huge potential for the nutrition group to grow. The manager of the Shopping & Errand program, and most certainly the volunteers, are aware of the poor nutrition habits of many seniors. Mobilizing support through this auspice does not seem as though it would be difficult.

The mission statement of the Red Cross is as follows:

The American Red Cross - Outagamie Chapter is a humanitarian organization, led by volunteers, that provides relief to victims of disasters and helps people prevent, prepare for and respond to emergencies. It does this through services that are consistent with its congressional charter and the fundamental principles of the International Red Cross and Red Crescent movement (American Red Cross..., 2008).

Admittedly, Tony Gonzalez, director of the Outagamie Red Cross, noted that the Shopping & Errand program was a bit of a stretch, but then again, the Red Cross is a "humanitarian organization" and poor health can lead to personal health emergencies-heart attacks, diabetes, and death. While it may be a stretch, there is no way to deny the usefulness and positive impact this program could have.

The prospective group members are all citizens aged fifty-five and above. The primary target is persons who are disabled and/or homebound, as they are in most need of improved health, and the secondary target is all other senior citizens. This group will be run by volunteers, and volunteers will be trained to be sensitive to any group member issues that may arise, keeping in mind that the needs of the client and the ability for the client to participate in any way that he or she can is of the highest importance. Group membership is open and members are allowed to come and go as their need determines. Disruptive members will be warned about their behavior once, and if the behavior continues, the member will be removed from the group. Members who engage in disruptive behavior on a consistent basis will be permanently removed from the group. Group attrition will be dealt with in a whatever-means-are-necessary type of mentality. Groups that are too small can potentially be combined. Recruitment will occur through the means of distribution of information through existing chains of communication in the Shopping & Errand program. Another possibility is door-to-door distribution of brochures, or bulk mailings.

Group meetings will occur once per week for a duration of an hour on an indefinite basis. This is based on the findings of Kwon and Read, who studied four senior communities: "...[b]oth social and physical connectivity are essential to creating communities that allow seniors to age in place and that are easier and more fun to live in for people of all ages and abilities" (2008, p. 35). This group will hopefully accomplish its purpose of helping seniors to improve their nutrition, but even if it fails to do so, another important function this group serves is as a social outlet. The reason it has an indefinite time frame is that there will always be group members in need of improving their nutrition. In regard to the lifespan of senior citizens, LaViest, Sellers, Brown, and Nickerson state:

...[T]he risk for 5-year mortality is roughly three times higher for those who are socially isolated relative to those who are not socially isolated controlling for the effects of age, income, number of health problems, and level of education (1997, p. 726).

So, not only does this group have the potential to lead to improved nutrition, but also it can lead to an increased life span due to the increased opportunity seniors have for social support. Besides this, there will always be new persons entering retirement homes, or people who do not join the group for whatever reason, so therefore making the time span indefinite allows access for the most people.

I would lead the initial groups while the group was beginning to take its hold throughout the community, but the long-term plan would be to train other people to be group leaders. A co-leader is unnecessary, but could become so if group membership rises to more than ten people; having a co-leader would then allow this large group to split into two smaller groups, which would enhance the group's effectiveness and functioning. The group leader will be responsible for being the final expert on what good nutrition is; it is the leader's responsibility to answer the question, or research it and provide the answer at a later time. The leadership style, as mentioned before, will be democratic. This is based on the premise that while the leader is ultimately the expert, there are some situations and sets of knowledge held only by those with certain life experiences; therefore, it may also be sometimes necessary to use feedback or advice from other group members. Another main responsibility of the group leader is for the leader to keep the group working within its open-sharing format, and to stop any cross-talk or negative communication trends as quickly as possible. As the group continues to grow in numbers throughout the community, the leader will be responsible for recruiting and training additional group leaders. Anyone will be accepted as a group leader, however, the ideal group leaders would be senior citizens themselves. It is easiest for a group member to take advice from someone who is most like him or her self. Perhaps, some persons at the retirement homes will increase in personal functioning enough or have enough awareness to talk about nutrition. Realistically, the best candidates will be those seniors who are still able to live independently.

The costs of the group will be minimal. The initial leader will develop a very basic curriculum utilizing the previously mentioned structured task of writing down all the foods one eats in a week and then discussing what changes can be made. This can be done easily voluntarily in one's spare time. Many of the groups will be held in local retirement homes, apartment buildings, or other public places such as libraries that people can congregate for no or a low fee. Guest speakers may be used on occasion, so perhaps setting aside a small amount of money may need to be set aside for that. The biggest expense will be transportation; one goal of this group would be to bus people to a location where they would be able to participate in the group, as some seniors may live alone in a location that does not have access to this group. Typically, it is my personal experience that volunteers often do not request reimbursement for travel expenses. In regard to group leaders, this may be the case, but some money will need to be set aside in the event that group leaders are unable or unwilling to travel on their own expense.

Since this is an open group, new members will come about often. Prior to each meeting, introductions and/or an icebreaker will be used to help each new person to get to know the other people in the group. Members may become anxious when having to discuss a part of their diet in front of a group of strangers, but when they see other members of the group openly sharing without fear and that others are not criticizing them, they will be more likely to open up to the group. In addition, group members will be reminded of the group rules at the beginning of every meeting so that they know what kind of talk is acceptable. Encouraging full participation will primarily be the responsibility of the group leader; the leader will have to realize when it is necessary to move on from more talkative members and maybe ask the more quiet members for some input. Every group develops its own norms as it meets on a regular basis, and as long as none of the norms are harmful to any of the members progress and ensure healthy group functioning, the norms will be tolerated. Any norm that violates this principle must be quickly extinguished and reframed to a healthy functioning behavior. The most important norm is probably to read the rules prior to the beginning of every meeting so that each member knows acceptable forms of conduct. The second most important norm to instill is to have each group member state his or her first name before sharing with the group; this avoids issues of crosstalk, which can be devastating to a group's functioning.

Several potential obstacles exist that could threaten the existence of the group. The primary obstacle will be the issue of group member attrition. This will be especially so with seniors in retirement homes because of the fragile nature of their health. The best solution seems to be to continue advertising the group through the previously-stated means in order to gain new members to replace those who leave. Another possible barrier to the group could be funding. Even though the group only requires very minimal funds for operating, who would want to supply the funds for a senior nutrition group? Seniors are a forgotten population, and are not as favored by the media as other populations, so raising even minimal funds may prove difficult. The best way to provide funds may be to hold fundraiser cookouts in front of local stores. A third obstacle could be too much crosstalk detracting from the group's main purpose of personal nutrition. Seniors suffer from high levels of social isolation, and as a result, often engage in talk that is not pertinent to the current topic. While they do need their social outlets, they will be reminded that they need to stick to the topic and that they are welcome to stay after the meeting and talk with other group members as they please.

Ideally, this group will continue to perpetually exist, and no termination will be needed. The group's placement in retirement homes means that people will be coming and going on a regular basis, and there should always be at least a handful of people interested in the group. However, it may happen that the group has to disband because of one of the potential barriers listed before. In that case, a final wrap-up session would be held. Any group members in continuing need of the group's services would be provided with the necessary information to attend our groups in the area, or similar ones. Another idea behind this group was to provide transportation for members if necessary, so those arrangements would be made as well. During the final wrap-up session, group members would be praised for the progress they have made. Keeping in mind that they are doing weekly (ideally) tracking of their diet, their most recent sheets will be compared to their first sheets, and any positive changes will be noted. However, it is also important to note that any regularly-attending seniors are able to lead the group should they choose to do so, so any time a group is facing termination, an excellent opportunity is presented for seniors to step up and contribute.

The group evaluation method will be formative. At the last meeting of every month, the group leader will ask for verbal feedback about the group and any member concerns. For any members not comfortable sharing in front of the group, suggestions may also be written down. At the end of every quarter, the group leader will hand out a written evaluation tool where group members rate the group and the leader in several different areas; group members again have the opportunity to provide any other suggestions they may have noted throughout the course of the group. The reason for such intensive feedback is that, to my knowledge, not much data exists on this type of group, and I am assuming this to be the first year of the group, so intensive feedback will be necessary to help the group properly address member concerns and keep from falling apart.

Overall, this group has the potential to succeed, especially given the high amount of projected growth in the senior population. Not only does the group allow for the opportunity to serve a vulnerable population, but it also gives seniors the opportunity to make a contribution within their own communities. They have the opportunity to lead the group, or provide valuable guidance to other members. Ideally, this leads to improvements in personal physical and emotional health, and this means that seniors have increased ability to make contributions to their own family, as well as other places in the community. Finally, one author strongly believes that civic engagement greatly improves the lives of senior citizens. He believes that older adults have the power to change the world, should be treated respectfully and empowered to shape their own lives, and that all older adults should be able to engage in civic duties regardless of physical or financial ability. This author sums up the benefits of civic engagement when he states "The benefits of civic involvement for elders include sustaining meaning in their lives, increasing social engagement and decreasing isolation...and breaking down stereotypes and barriers to a meaningful old age" (Cullinane, 2008, p. 58). This group does an excellent job of reflecting these core values, so what are we waiting for?

References

American Red Cross - Outagamie Chapter. (2008). About us. Retrieved from www.redcrossoutagamie.org

Cullinane, P. (2008). Purposeful lives, civic engagement, and Tikkun Olam.

Generations, 32(2), 57-59. Retrieved from http://newfirstsearch.oclc.org

Harris, N., & Grootjans, J. (2006). The potential role of ecological health promotion in progressing healthy ageing. Ageing International, 31(4), 276-282. Retrieved from www.ebscohost.com

Kwon, J., & Read, A. (2008, September). Livable communities are working for senior citizens. Public Management, 90(8), 34-35. Retrieved from www.wilsonweb.com

LaVeist, T.A., Sellers, R.M., Elliot Brown, K.A., & Nickerson, K.J. (1997). Extreme social isolation, use of community-based support services, and mortality among African-American elderly women. American Journal of Community Psychology, 25(5), 721-732. Retrieved from www.wilsonweb.com

Toseland, R.W., & Rivas, R.F. (2005). An Introduction to Group Work Practice. Boston:

Allyn & Bacon.

United States Census Bureau. (2008). Projections of the population by selected age groups and sex for the United States: 2010 to 2050 [Data file]. Retrieved from http://www.census.gov/population/www/projections/files/nation/summary/

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