In my July 7 column, "Sharing learning opportunities has come full circle," I mentioned that I couldn't fit into that column all the information I had learned at the Maryland Gerontological Association's spring conference. One of the topics I didn't have room to discuss concerns medical-religious partnerships as a model of caring and how these connections can address the health needs of an aging society.

I decided that this subject matter is worth two columns; this one will provide background and details on this model of caring from an expert, Dr. W. Daniel Hale, a psychologist and national leader in health ministries; and the next column will cover the practical application of this care model through health care ministries at Howard County churches.

At the MGA conference, Hale was part of a panel addressing the topic "Reaching Out to the Community." As the conference agenda stated, "creative community collaborations are necessary in the current economic climate and outreach programs that incorporate innovation and outside the box thinking to effectively meet the needs of older adults were discussed. Hale's presentation was on "New Models of Caring." The information in this article is based on his conference presentation and my phone interview with him.

As of June 27, Hale is a special adviser in the Office of the President at Johns Hopkins Bayview Medical Center, in Baltimore. He is on leave from his position as professor of psychology at Stetson University, in DeLand, Fla., and expects to be in Baltimore for at least two years to further the work he started in Florida. He is also an adjunct associate professor of medicine at Johns Hopkins School of Medicine.

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Health care solutions

Hale's work in Florida centered on solutions to deal with the health care challenges that need to be addressed in our aging society, and especially the high incidence of chronic conditions in that population. In the United States population in 1992 the percentage of people 65 years of age or older was 12-13 percent. It is projected that in 2030, the year that the baby boomers reach Medicare age, the percentage will grow to 19-20 percent.

Not only is the aging population increasing, but chronic illnesses in the adult population are increasing. Hale cited in his presentation that 87 percent of people, age 65 and older, has at least one chronic condition and 67 percent of that population has two or more chronic conditions. These statistics translate to the fact that more than 133 million Americans live with at least one chronic condition and approximately half of these have multiple chronic conditions.

These numbers are expected to grow to 160 million by 2020 and 170 million by 2030. Hale said that we are facing a major health care crisis around the challenge of chronic illness. Hale further explained that people with chronic conditions account for 90 percent of all prescription drugs used; 80 percent of all inpatient hospital stays; 75 percent of all visits to physicians; and 85 percent of all health care expenditures. Chronic conditions are also the leading cause of mortality, accounting for seven out of every 10 deaths.

Glaucoma and diabetes

I was surprised to find out from Hale that health care for chronic conditions is mostly provided in the home by the patients themselves and their family members. He cited two examples: glaucoma and diabetes mellitus.

For glaucoma, he said that a patient with this eye disease goes to the ophthalmologist every four months for a pressure check, a visual field exam, or a complete eye exam, but most of the time, the patient is managing the disease by applying eye drops to reduce the eye pressure. It is the same with a person who has diabetes mellitus.

The patient monitors blood sugar levels and injects insulin, or takes the appropriate medication, thus the majority of the care management is in the patient's hands, and the patient only goes to the doctor for regular checkups or if a special need arises.

According to Hale, data suggest "care provided in the current acute, episodic model is not cost-effective and often leads to poor outcomes for patients with chronic conditions; that these conditions require continuous care and coordination across health care settings and providers. We can find solutions by developing better connections between supportive and clinical care delivery systems and by encouraging and supporting patient self-management and family caregiving."

One solution is for medical leaders to partner with religious congregations of all denominations. In his book, "Bowling Alone: The Collapse and Revival of American Community," Dr. Robert Putnam states, "Faith communities in which people worship together are arguably the single most important repository of social capital in America."

Putnam goes on to say "In one survey of 22 types of voluntary associations, from hobby groups to professional associations to veterans groups to self-help groups to sports clubs to service clubs, it was membership in religious groups that was most closely associated with other forms of civic involvement, like voting, jury service, community projects, talking with neighbors, and giving to charity.

Religiously involved people seem simply to know more people." He cited a survey that found that "religious attendance was the most powerful predictor of the number of one's daily personal encounters," and that "regular church attendees reported talking with 40 percent more people in the course of the day."

In 1992 the population of Volusia County, Fla., was 375,000, of which 20 percent of that population was already 65 years of age or older. Based on the fact that this was 50 percent higher than the rest of the country, Hale and his associates, Drs. Richard Bennett, Neil Oslos and C. Dwaine Cochran, started researching and developing a project to help address the medical needs of this aging population.

Project REACH

After consulting at length in Baltimore and Florida with Dr. John Burton, then professor of medicine and director of the Division of Geriatric Medicine and Gerontology at Johns Hopkins, Hale and his associates got the green light to pursue Project REACH: A program to train community-based lay health educators. From the beginning, he had 'buy-in' from the local community hospitals and physicians. Clergy welcomed congregation-based health education. The program required committed, energetic lay leaders who could be identified and trained.

The plan for Project REACH was to train 12 lay health educators, starting with 20 to 25 people because of projected attrition. The volunteers would be recruited from religious congregations. Medical professionals would provide instruction and materials. Then lay health educators and medical professionals would conduct subsequent programs.