Longevity - loneliness, dependency, malnutrition and geriatric giants in 12,210 elderly hospitalized people

Transcription

1 Longevity - loneliness, dependency, malnutrition and geriatric giants in 12,210 elderly hospitalized people Pavel Weber, Hana Meluzínová, Hana Matějovská-Kubešová, Vlasta Polcarová, Dana Weberová, Katarina Bieláková Dept. of Internal Medicine, Geriatrics and Practical Medicine; Faculty Hospital and Masaryk University; Brno; Czech Republic 1

2 The Characteristic of Ageing Ageing is an irreversible, universal and species specific process, which can not be defined explicitly It affects with diverse rapidity every organ, which loses its functional provision Gradual physical and mental powers 2

3 Ageing Notices Inevitable physiological process, which is actually a way to ontogenetic age as the last period of human life. AIM of NEW GERONTOLOGY: years of active life extension and maintenance of functional capacity as long as possible

4 Homeostenosis (Cassel: Geriatric Medicine, 2003, NY) 4

5 Old Age and Illness 1. risk of chronical and degenerative illnesses and death 2. An old organism adapts badly to varying conditions of internal and external environment 5

6 European Population Age Structure (Baltes: Gerontology 2003;49:123) 100% 80% 60% 40% % 0% Year 6

7 Population CR

8 What is due to increase LE? 1. Improved sanitation 2. Better hygiene 3. Reduced infant mortality 4. Development of antibiotics and vaccines 5. Better health care 8

9 Live expectancy at birth - Europe 9

10 Greying Europe Share of seniors in European countries 14-20% Expected growth over 30 years: 25 30% 10

11 Age Categories New Division y. young seniors y. old seniors adaptability vulnerability 85 + y. oldest old frailty dependence 11

12 Functional cathegorization of seniors 1. robust (fit) seniors 2. independent only fail under load (illness, injury, surgery, etc.) 3. frail risk as well as in standard conditions (falls, mental and mobility disorders, etc.) 4. fully dependent immobile Weber P.: Vnitřní Lék., 49, 2003, č. 3, s

13 Difficulties of modern medicine in the care of seniors Atomization of medicine Absence of holistic approach Multi-morbidity seemingly doesn t belong anywhere socialization of health problems Weber P., Svačinová J.: Chapter X, s In: Reece, Steve M.; NOVA Publisher, New York USA, 2005, 233s. ISBN:

14 Who is a geriatric patient? Biologically older patient - suffering from chronic diseases, disabled and functionally limited. Is multi-morbid. Needs rehabilitative, somatic, psychological and social assistance.

15 Health and social situation - interactions Every illness in old age can change the social situation essentially. A not-fully self-sufficient senior becomes risk and depends on various types of social assistance. 15

16 Illnesses and Age vs. frailty DEMENTIA DEPRESSION Muscle strenght Physical activity THYREOPAT. CVD MULTI- MORBIDITY SENSORY ORGANS OSTEOPOR. Frailty Falls Sarcopenia TUMORS DM Disability 16

17 Understanding of age Ageing and its manifestation as currently understood such as frailty, functional disorders and decreasing mental abilities are not standard symptoms of ageing process but they are mostly consequences of simultaneously on-going diseases. Weber P.: Vnitřní Lék., 49, 2003, č. 3, s

18 Transition to frailty (Tinetti, Wolf) < 80y. sight cognition regular exercise FRAILTY sight disorders weakness LE ROBUSTNESS > 80y. standing and walk disorders depression sedatives TRANSITION ZD: <2F a >3Z REVERSIBILITY? FR: >4F a <1Z 18

19 Geriatric giants 1. Instability 2. Immobility 3. Incontinence 4. Intellectual disorders 5. Iatrogenia? Weber P.: Postgraduální medicína, 6, 2004, č. 3, příloha, s

20 Characteristics sy 5 I Multicausality Chronical process Decline of independence Impossibility of ordinary treatment Weber P.: Euro J Ger, 4, 2002, č. 4, s

21 Other geriatric syndroms Sy decondition and hypomobility (sarcopenia) Sy anorexia and malnutrition, dehydratation Sy of dual deficit (sight, hearing) Geriatric maladaptive sy Sy of mistreatment, neglect and elder abuse Sy of the terminal geriatric deterioration - FTT Weber P.: Euro J Ger, 4, 2002, č. 4, s

22 Minimum geriatric tests for seniors examination patient > 75 yrs. admitted to hospital > 70 yrs. ambulatory investigated at GP s or somewhere else MMSE - test ADL - test, in ambulatory IADL GP: each 1-2 years repeat! 22

23 Algorithm of acute hospital stay of the elderly Cassel: Geriatric Medicine, 2003, 23 NY

24 PRESENTATION OF RESULTS AND EXPERIENCES GERIATRIC SYNDROMS

25 Seniors treated KIGPL 65 y ,495 pat. ( y.) from 65 to 103 y % % Weber P et al.: Geriatrics Today, 5, 2002, No 1, pp

26 KIGPL social characteristic of seniors according to gender AGE 79,3 ± 9,0 y. LONELINESS 35% AFTER-CARE 19,4% NH/RH 2,4% AGE 81,1 ± 7,0 y. LONELINESS 44% AFTER-CARE 25% NH/RH 3,8% 26

27 Categorization of treated seniors according to age y y. 85+ y. 31% 21% patients 48% 27

28 Geriatric syndroms giants according to age 60% 50% 40% y y. 85+ y. 30% 20% 10% 0% FALLS IMMOBILITY INCONTINENCE DEMENTIA Weber P.: Vnitřní Lék., 49, 2003, č. 3, s

29 Relation between falls and age * p<0.05 ** p<

30 Relation between immobility and age 100% 80% Female OR (+10 y): (1.458; 1.666) Male OR (+10 y): (1.110; 1.335) * p<0.05 ** p< % 40% * 20% 0%

31 Relation between urinary incontinence and age 100% 80% 60% 40% 20% * Female OR (+10 y): (1.962; 2.239) Male OR (+10 y): (1.537; 1.837) ** ** * p<0.05 ** p<0.01 0%

32 Relation between dementia and age 100% 80% Female OR (+10 y): (1.995; 2.315) Male OR (+10 y): (1.609; 1.980) * p<0.05 ** p< % 40% ** 20% ** 0%

33 MMSE and ADL-test at admission KIGPL (severe decrease of cognition and limited self-sufficiency) 60% 50% 40% y y. 85+ y. 30% 20% 10% 0% MMSE-test <20p. ADL-test <65p. Weber P et al.: Euro J Ger, 9, 2007, No 4, pp

34 Relation between occurrence 1 GS and age 100% 80% Female OR (+10 y): (2.082; 2.405) Male OR (+10 y): (1.500; 1.809) ** ** 60% 40% * * p<0.05 ** p< % 0%

35 Relation between occurrence at least 2 GS and age 100% 80% 60% Female OR (+10 y): (2.051; 2.342) Male OR (+10 y): (1.460; 1.744) ** * 40% * p<0.05 ** p< % 0%

36 Relation between occurrence at least 3 GS and age 100% 80% Female OR (+10 y): (2.044; 2.382) Male OR (+10 y): (1.717; 2.130) * p<0.05 ** p< % 40% ** 20% 0%

37 Relation between occurrence at least 4 GS and age 50% 40% Female OR (+10 y): (2.129; 2.746) Male OR (+10 y): (2.058; 3.056) * p<0.05 ** p< % 20% 10% * 0%

38 Relation between loneliness and age 100% 80% 60% ** ** ** ** ** ** 40% * p<0.05 ** p< % 0% Female OR (+10 y): (1.662; 1.924) Male OR (+10 y): (1.478; 1.766)

39 Relation between need of aftercare and age 50% 40% Female OR (+10 y): (1.245; 1.452) Male OR (+10 y): (1.141; 1.440) * p<0.05 ** p< % ** 20% 10% 0%

40 Relation between nursing home admission and age 50% 40% Female OR (+10 y): (1.905; 2.627) Male OR (+10 y): (1.200; 2.071) * p<0.05 ** p< % 20% 10% ** ** 0%

41 Relation between dependency at admission and age 100% 80% Female OR (+10 y): (1.583; 1.796) Male OR (+10 y): (1.243; 1.479) 60% 40% * * p<0.05 ** p< % 0%

42 Relation between dependency at discharge and age 100% 80% Female OR (+10 y): (1.549; 1.765) Male OR (+10 y): (1.271; 1.525) 60% 40% 20% * p<0.05 ** p<0.01 0%

43 Relation between malnutrition and age 50% 40% Female OR (+10 y): (1.715; 2.066) Male OR (+10 y): (1.369; 1.756) 30% 20% 10% * p<0.05 ** p<0.01 0%

44 How about healthy aging? PRESCRIPTION Motion activity Mental activity Nutrition Social activity Training 30min. / D The optimal BMI prevention of osteoporosis prevention of sarcopenia Gymnastics brain reminiscence therapy Sat.fats, chol. Na Fruits, vegetables, proteins cal. Vitamins, trace elements Loneliness Socialization (contacts) ) Weber P.: Euro Rehab, 12, 2002, č. 2, s

45 New approach to older patients 1. New diagnostic methods and therapeutic algorithms are used in acute geriatric wards together. 2. These make possible also the treatment (including recovery) and protect selfsufficiency in the elderly being acutely ill. Weber P.: Vnitřní Lék., 49, 2003, č. 3, s

46 Conclusion Geriatric patients (including long-livers) are permanently threatened with de-compensation of their functional state and require specific modification of the specialist s approach when deciding on regimen and treatment measures. 46

47 THM Continuous assessment of somatic, mental and social status incl. self-sufficiency is therefore crucial in the elderly (especially in longevity). 47

48 add life to years, not years to life 48