Interventi proattivi per le persone fragili: conoscenze e prospettive. Proactive Interventions for frail elderly: Knowledge and perspectives

Transcription

1 Interventi proattivi per le persone fragili: conoscenze e prospettive Proactive Interventions for frail elderly: Knowledge and perspectives Ernesto Palummeri, MD Senior Research Scientist for frailty and aging Galliera Hospital Genoa, Italy Regione Liguria

2 Aging Clin Exp Res Jun;22(3): Improving health for elderly people: an international health promotion and disease prevention agenda. RW Besdine, TF Wetle The Warren Alpert Medical School of Brown University, Providence, RI 02912, USA. Abstract Across the world, there are substantial but missed opportunities for promoting health of older persons and extending the healthy life span. Current approaches to health care rely on late detection and treatment of disease, and some of the most expensive systems of care have population health outcomes that are poor to mediocre. A majority of deaths and disability result from progression of preventable chronic diseases for which human behaviors are major contributing factors. An organized and aggressive agenda in health promotion and disease prevention emerges as an important part of the strategy to both promote health and control costs. After reviewing data on determinants of health and contribution of behavioral factors to morbidity and mortality, this paper presents the evidence for efficacy and effectiveness of specific behavioral and clinical interventions to reduce risk for many of the problems accounting for death and disability among elders. We address tobacco use, lack of exercise, inadequate nutrition, hypertension, delirium, obesity, falls, cancer screening, poor oral health, osteoporosis, immunizations and medication safety. Strategies for implementation of effective interventions present an international challenge.

3 Ageing index in Europe (Source: Eurostat 2012) Ranking Country name Ageing index 1. Germany 157,1 2. Italy 150,0 3. Bulgaria 140,9 4. Greece 135,8 5. Latvia 129,9 6. Portugal 129,4 7. Austria 123,7 8. Lithuania 123,3 9. Croatia 120,0 10. Slovenia 117,7 LIGURIA 238,0 EU ,4

4 Chronological age is not a precise indicator of functional decline (Bergman,H.,Ferrucci,L.,Guralnik,et al. 2007, Frailty: an emerging research and clinical paradigm: issues and controversies. J.Gerontol.A Biol.Sci.Med.Sci. 62, )

5 The changes that accompany aging depend on genetic and environmental factors, and are lifestyle and life event related (WHO, 1999). Therefore, while some may remain healthy and resilient in later life, others may become increasingly vulnerable to internal and external stressors. J.Bousquet et al, Int J Nutr Ageing, in press The latter refers to a state of frailty. Tiago Coelho et al.front. Aging Neurosci. 7:56. doi: /fnagi , e pub 21 Apr 2015

6 Centro Nazionale di Epidemiologia, Prevenzione e Promozione della Salute Ufficio di Statistica ISTITUTO SUPERIORE DI SANITA Mortalità nel periodo 1 giugno - 31 agosto Death rate in Italy from Differenze tra 2003 e st June per fasce to 31di th etàaugust anni years 3% 3% anni 5% years 5% > 74 years 92% 75 anni e oltre 92% No. deaths in Genoa population in August

7 HEALTHCARE AREA 1. Washing Y N 2. Dressing Y N 3. Continence Y N 4. Feeding Y N 5. Toileting Y N Social Monitor Project Highlighting Form (GPs) 6. Transferring Y N 7. No ischaemic heart disease Y (A) N (C) 8. No COPD Y (X) N (Y) 9. Oriented Y (D) N (F) 10. No pressure sores Y (G) N (H) SOCIAL AREA 1 She/He lives in family or benefits from any support network Y N 2 She/He lives with an autonomous relative Y N 3 Adequate family unit (no psychiatric diseases, no addiction, Y N

8 Social Monitor Project CLASSES OF INTERVENTION CHECK LIST 1. Maximum risk = 1 visit/day + 1 phone call/day 2. High risk = 1 visit altern.day + 1 pc/day 3. Intermediate risk = 1 visit twice a week + 1 phone call on the other dd 4. Low risk = 1 visit a week + 1 phone call altern.day 5. Very low risk= 1 phone call monthly Electrical system Water system Food reserves Water reserves Personal care Domestic Hygiene Airing the house Adequate dressing in relation with climate Orientation Continence, diarrhoea, constipation It was needed to activate: 113 (police) 118 (health emergency) General pract Social-health district 115 (firemen) Other (spec.)

9 Social Monitor Project RESULTS Deaths summer 2005 No. No. % Gen. Populat. over ,42 Intervention ,74 Hospital Admissions Summer 2005 No. No. % Gen. Populat. over ,87 Intervention ,88

10 Andamento Trend ofdella over 74 popolazione years old population fragile in in Liguria in Region rapporto in the next alle 10 years stime and ISTAT estimated nei prossimi needs in Nursing 15 anni home beds e fabbisogno stimato di pl di RSA No Over 74 x No Frail (18%)x NH Beds (30%) x ,2 13,8 14,4

11 Handgrip

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13 Domain Main item 9. Have you recently experienced any worsening of your mobility due to physical state? Social domain 1. In case of need, can you count on someone close to you? 2. Which is your highest education degree? (below secondary level) 3. Do you feel lonely most of the time? Healthcare access 4. Which is your past or current working activity? (compilative to be scored) 5. Have you been evaluted by a healthcare professional during the past 12 months? Cognitive domain Bio-clinical domain 6. Have you experienced a memory decline during the past 12 months? 7. Do you take 5 or more medications per day? 8. Have you recently lost weigth such that your clothing has become looser?

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15 Ellen Freiberger et al, Wien Med Wochenschr, 2011, 161: Frailty is a dynamic condition and frail elderly people can transit to non-frail but can also become definitely frail if no specific interventions are implemented THE I.A.N.A. TASK FORCE ON FRAILTY ASSESSMENT OF OLDER PEOPLE, 2008

16 Trend of over 74 years old population in Liguria Region in the next 10 years and estimated needs in Nursing home beds With a 1%/5 years decrease in frailty prevalence Nr. Over 74 x Nr. Over 74 x Nr. Frail x (18%) 43(17%) 42(16%) Nr. Frail x (18%) 46(18%) 48(18%) Nr. NH (30%) x ,2 12,9 12,4 Nr. NH (30%) x ,2 13,8 14,4