Targeting Frailty to Prevent Disability: Insights from The Irish Longitudinal Study on Ageing (TILDA)

Transcription

1 Targeting Frailty to Prevent Disability: Insights from The Irish Longitudinal Study on Ageing (TILDA) Aisling M. O Halloran PhD TILDA, Medical Gerontology, Trinity College Dublin. National disability Authority Annual Conference Croke Park, Dublin, 25 th September 2018

2 Overview Lifespan and Healthspan Introduction to TILDA What is Frailty Measuring Frailty and Disability in TILDA Frailty and Disability in Ireland Research findings from TILDA Informing Policy and Practice o The National Frailty Education Programme The Language of Frailty

3 Lifespan and Healthspan People are living longer and the population is ageing. 65 years 2011: 8% 12% 2021: 10% 15% 2050: 20% 25% (US Census Bureau An Aging World, 2015; UN World Populaton Ageing Report, 2015)

4 Lifespan and Healthspan

5 Lifespan and Healthspan

6 Lifespan and Healthspan

7 Lifespan and Healthspan

8 Lifespan and Healthspan The disparity between lifespan and healthspan has lead to a mushrooming in research activity under the umbrella of Healthy Ageing

9 TILDA The Irish Longitudinal Study on Ageing (TILDA)

10 TILDA Cohort The Irish Longitudinal Study on Ageing (TILDA) Sample: Baseline Sample : Data: Collected Data collection: Population representative, longitudinal cohort study of community-living adults aged 50+ years in ROI 8,175 respondents. Health, economic and social circumstances Every 2 years Health Assessment:Every 4 years

11 TILDA Data Collection The Irish Longitudinal Study on Ageing (TILDA)

12 TILDA Study Design

13

14 What is Frailty?

15 What is Frailty? Advancing age adverse health outcomes + increased health services use BUT Same Age Same Risk (Chronological) (Biological) Frailty captures this difference in susceptibility or risk

16 Clegg et al, 2013; Fried et al, 2001) What is Frailty? Frailty is: A distinct health condition related to the ageing process Frailty can present differently in different people - heterogeneity

17 What is Frailty? Frailty is: A transition phase between healthy ageing and disability. Clegg et al, 2013; Morley et al, 2012; Rockwood et al, 2007; Wlaston et al, 2006; Fried et al, 2001)

18 What is Frailty? Frailty is: Prevalent in older adults at between 4-59% among 65+ aggroup. (Santos-Eggiman et al, 2009)

19 What is Frailty? Frailty is: A risk factor for adverse outcomes Falls Disability Dementia Healthcare Use Long-term Residential Care Clegg et al, 2013; Morley et al, 2012; Rockwood et al, 2007; Wlaston et al, 2006; Fried et al, 2001, 2004)

20 What is Frailty? Frailty is: A dynamic process, it can be changed or reversed Robust Non-frail Pre-frail Frail Disability

21 Frailty Prevalence and Incidence Interventions for Frailty Healthy Diet Exercise Social connections Brain training Stress Reduction Review medications Manage chronic conditions

22 Frailty How to measure it?

23 Frailty in TILDA Frailty Index Model

24 Research Findings from TILDA Frailty Prevalence and Incidence

25 Frailty Prevalence and Incidence Prevalence of Frailty and Disability Frailty Disabilities

26 Frailty Prevalence and Incidence Prevalence of Frailty and Disability by Age Frailty Disabilities

27 % Prevalence Frailty Prevalence and Incidence Prevalence of Frailty and Disability by Gender Frailty Disabilities Male Disability Female

28 Frailty Prevalence and Incidence Incidence of Frailty and Disability Robust at Wave 1 No Disabilities at Wave 1

29 Frailty Prevalence and Incidence Incidence of Frailty and Disability Disability Status at Wave 1 Frailty Status at Wave 1

30 Summary of findings from TILDA Prevalence of frailty 14% among adults aged 50+ years Frailty is higher among women and increases with age Prevalence of disability is 13% among adults aged 50+ years Disability is higher among women and increases with age 1 in 20 people without frailty will develop frailty over 5 years 1 in 11 people without disabilities will develop a disability over 5 years People with a disability are 4 times more likely to develop frailty over 5 years People with frailty are 8 times more likely to develop a disability over 5 years

31 Informing Policy and Practice

32 Informing Policy TILDA data has informed over 53 policy and strategy documents in Ireland

33 Informing Practice The National Frailty Education Programme A partnership between TILDA and the National Clinical Programme for Older People (NCPOP)

34 Informing Practice The National Frailty Education Programme FRAILTY: we need to think about it, understand and recognise it and plan for how we will support and care for those living with frailty in our community and in our hospital. We need to future proof delivery of our health care services for the people who will be using it!

35 Informing Practice The National Frailty Education Programme

36 Recognising Frailty: Insights from TILDA Defining frailty Frailty as a loss of physiological reserve Non-frail Frail...a state of increased vulnerability to a stressor event, which increases the risk of adverse outcomes.. 1. Understanding & Recognising Frailty: definitions, models, interventions and prevention Clegg et al. 2013; Morley et al. 2012; Rockwood et al.2007; Fried et al TILDA: an overview of the study design and data collection & Health Centre tour TILDA Research: relevant to frailty 3. Frailty Assessment Tools: an Interactive workshop session: Cognitive (MoCA) and Depression tests (CES-D), Grip strength test & Timed Up and Go (TUG) test

37 Informing Practice The National Frailty Education Programme Interprofessionals Numbers completed Percent completed Physiotherapists 29 21% Nurses(DON/CNM/Nurse specialists/anp) 29 21% Occupational Therapists 27 20% Medical Social Workers 11 8% Nurse Lecturers/education co-ordinator 9 7% Speech & Language Therapist 8 6% Dietitians 6 4% Pharmacists 6 4% Medical 4 3% Clerical/reception staff 2 2% Therapy lead 3 2% Psychologist 1 1% Nurses % Total % 1,300 Healthcare professionals Countrywide

38 Informing Practice The National Frailty Education Programme By increasing the understanding of frailty, we can improve the detection, prevention, management and therefore outcomes for these older adults.

39 The Language of Frailty

40 The Language of Frailty How would you define the term frail?

41 The Language of Frailty - A Word of Caution Frail is when someone is weak, and can t do anything much. It is that stage where you become dependent on people for most things No, I m definitely not frail. Frail means you re doddery and shaky. You can t do anything at all. Do I look frail to you?! I m not frail. That s someone who can t do anything, who s wasting away. Thin and skinny. AGE UK & BGS 2015

42 The Language of Frailty WHO Clinical Consortium on Healthy Ageing Topic focus: frailty and intrinsic capacity (2016) health care professionals and researchers in geriatrics should move away from focusing on disease towards Intrinsic capacity (IC) and functional ability (FA) IC is the combination of the individual s physical and mental, including psychological, capacities FA is the combination and interaction of IC with the environment a person inhabits.

43 Funders

44 Thank you For more information: