For more information about the final programme, speakers or the EHFG conference please contact us directly!

Transcription

1 For more information about the final programme, speakers or the EHFG conference please contact us directly! SAVE THE DATE! 18th EHFG: 30 September 02 October 2015

2 Approaching frailty in older adults A story of a successful scaling up and a second try Leocadio Rodríguez Mañas Coordinator Group on Frailty A3 Action Group (Frailty and functional decline) EIP-AHA

3 EIP AHA TOPICS A) The issue B) The challenge C) The approach: proof of concept D) The implementation: scaling-up

4 Functional Capacity EVOLUTION OF POPULATION STRUCTURE IN SPAIN (Data from INE) Disability D E A T H Successful LONGEVITY Failure to thrive Usual Death Accelerated

5 Functional Capacity LONGEVITY (AMOUNT OF LIFE) Disability Failure to thrive Death Accelerated D E A T H Successful Usual QUALITY OF LIFE (FUNCTION)

6 Characteristics of the Patient CLASSIC PATIENT (XXth Century) One acute/chronic disease Without functional impact Without functional sequelae MODERN PATIENT (XXIth Century) Several chronic diseases, with usual acute episodes With functional impact With functional sequelae WE MUST CHANGE OUR MINDS Rodríguez-Mañas; 2001

7 EIP AHA TOPICS A) The issue B) The challenge C) The approach: proof of concept D) The implementation: scaling-up

8 EIP AHA After centuries of trying to live longer, the time for living better has come Rodriguez-Mañas L & Fried LP Lancet 2014

9 I have been vaccinated against polio and mumps. I have been vaccinated against chicken pox, whooping cough and measles. Then I fell down the stairs. Charlie Brown - Charles M. Schulz BE AWARE ABOUT THE TRUE FOCUS: IT IS FUNCTION!!!

10 CUÁL ES EL MEJOR MOMENTO PARA INTERVENIR SOBRE LA DISCAPACIDAD? EIP AHA Only 30% of older patients experiencing a Funcional lost duirng hospitalisation recover to their basal functional status BUT FUNCTIONAL LOST IS PREVENTABLE Basal IMPAIRED Basal IMPAIRED Basal IMPAIRED Basal IMPAIRED 1 month 3 months 6 months 12 months Rate of recovery in older patients after hospitalisation due to a acute medical condition Boyd et al., JAGS 2008

11 EIP AHA OPTIONS Prolong the management of failure... or aim for success?

12 EIP AHA TOPICS A) The issue B) The challenge C) The approach: proof of concept D) The implementation: scaling-up

13 Frailty: a Complex Syndrome of Increased Vulnerability Age REVERSIBILITY FRAILTY Life-course Determinants: Biological (including genetic) Psychological Social, Societal Environment Chronic Disease Decline in physiologic reserve Candidate markers Nutrition Mobility Activity Strength Endurance Cognition Mood Adverse outcomes Disability Morbidity Hospitalization Institutionalization Death Modified from Bergman H, 2008 Biological, Psychological, Social, societal modifiers/assets and deficits, Health and Care systems

14 Frailty: a Complex Syndrome of Increased Vulnerability Prevent/Delay Frailty Health Promotion and Prevention Life-course Determinants: Biological (including genetic) Psychological Social, Societal Environment Delay Onset Chronic Disease Decline in physiologic reserve APPROPRIATE TIME Delay/Prevent adverse outcomes, care FRAILTY Candidate markers Nutrition Mobility Activity Strength Endurance Cognition Mood USUAL TIME Age Adverse outcomes Disability Morbidity Hospitalization Institutionalization Death Modified from Bergman H, 2008 Biological, Psychological, Social, societal modifiers/assets and deficits, Health and Care systems

15 IF WE WAIT UNTIL THE VASE IS BROKEN (UNTIL THE DISABILITY IS PRESENT).IT WILL NEVER BE AS BEFORE. WE WILL COME LATE.

16 WHAT IS THIS THING CALLED FRAILTY? MULTIPLE + DISEASES CONDITIONS

17 EIP AHA A step in the right direction: Jonathan Afilalo (right) clocks a patient's performance on the gait speed test.

18 EIP AHA TOPICS A) The issue B) The challenge C) The approach: proof of concept D) The implementation and scaling-up

19

20 Study Beds CGA Interdisciplin. meetings/week Standard Assessment Tools Protocols Structural adaptations Discharge planning Collard (1985) 10y10 2 Harris (1991) 14 Landefeld (1995) 14 diaria Counsell (2000) 34 diaria Asplund (2000) 11 1 Study Geriatrician Trained Nurse Social Worker Ocupational Therapist Physiotherapist Collard Harris Landefeld Counsell Asplund Baztán, Suárez-García, López-Arrieta, Rodríguez-Mañas, Rodriguez-Artalejo, BMJ 2009

21 GENERAL ORGANIZATION OF THE CONTINUED, COORDINATED AND INTEGRATED MODEL OF CARE FOR OLDER ADULTS PRIMARY CARE - CCU CASE MANAGEMENT SOCIAL SERVICES SPECIALIZED CARE (HOSPITAL) GERIATRIC SERVICE - Liaison Team - ACU - FRU - GHD - Outpatients Office OTHER HOSPITAL SERVICES CCU: Continued Care Unit; ACU: Acute Care Unit; FRU: Functional Recovery Unit; GHD: Geriatric Day Hospital

22 For the first time, frailty and falls are recognised as relevant health issues in older people It provides a joint algorithm for detection and management of both entities to be implemented In Primary care, but with the support of Geriatric facilities, promotinga coordinated and integrated model of care

23 KEY POINTS FOR SUCCESS The issues represent a true challenge for the sustainability of the Health & Social System The program embraces in a joint effort two relevant issues Multidisciplinary approach Participation of different stakeholders Political support Frailty was declared one of the five priorities to be tackled in the Spanish National Program against chronic diseases and conditions; Time until its aproval by the political authority: 6 months Time since the launching of the working group until the approval of the document: 6 months)

24 REASONS FOR OPTIMISM TO EXPAND THE PROGRAMS 1) Our strategy of combining efforts has been succesful at a National level 2) Regional authorities strongly supported the effort to become a Reference Site 3) Madrid is the Region with the largest development of Geriatric Services and facilities in Spain, with well-established programs on frailty in different Hospitals that are coordinated with Primary Care and Social resources 4) Regional stakeholders have shown their interest 5) Madrid is now finishing its own Strategic Plan against Chronic Diseases that should be in line with the National Program 6) We have met the Regional Health authorities and they have received our proposals favorably

25 REASONS FOR PESIMISM 1) With the economic crisis, the problem of older people is not now in the political agenda 2) In less than one year we will have elections

26 FACING THE RISKS FOR DISABILITY Disability is the main factor impairing the Quality of Life Fortunately many older people develop frailty previous to disability, allowing us to assess frailty in order to - Detect people at risk - Intervene on them to prevent disability We have succesful models to fight against frailty and now is the time to use strategies of scaling-up to disseminate those models

27 EIP AHA Thank so much and.questions?