Centre for Gerontology & Rehabilitation COLLAGE University College Cork, Ireland. Eileen O Herlihy 3 rd July 2014

Transcription

1 Centre for Gerontology & Rehabilitation COLLAGE University College Cork, Ireland. Eileen O Herlihy 3 rd July 2014

2 Centre for Gerontology and Rehabilitation (CGR) - Established in 2010 Atlantic Phil. & HSE - School of Medicine at University College Cork - St Finbarr's Hospital in Cork City - Led by Prof William Molloy - Dr. Suzanne Timmons (PI) - 15 research staff and 2 admin staff

3 CGR - Research Areas -Advance care planning (ACP) - Advance care directives (ACDs) - Palliative care - Dev frailty assessment & treatment strategies - Neurodegenerative disease (Dementia, Alzheimer's disease, PD) - INAD - Training & Education - Gerontology, Rehabilitation & End of Life Care - Postgraduate programme in Older Person Rehabilitation - FP7: NILVAD: A clinical study for a new treatment in Alzheimer's disease ( PERSSILAA: PERsonalised ICT Supported Services for Independent Living and Active Ageing (

4 CGR - COLLAGE & EIP AHA Activities in 2 actions groups: A1: Prescription and adherence to treatment - Empowerment subgroup of the A1 - Let Me Decide (ACD) Prof Molloy - Advance care planning (ACP) - Palliative care education programme

5 ACP & Palliative Care - More control over your future care if ever incapable - Promotes respect for patient s wishes - Evidence it improves end of life care - Reduces Family stress, anxiety & depression - Easier end of life decision making - 91% HCPs think it s a good idea & 75% would recommend it - Reduces transfer of dying patients to hospital - 25% of all deaths are in LTC - Empower staff to provide good palliative care - Education - End of life/quality of death - Healthcare utilisation and costs

6 CGR - COLLAGE & EIP AHA A3: Prevention of functional decline and frailty - Co-ordination of Caregivers & Dependency subgroup - CARTS:Community Assessment of Risk & Treatment Strategies Who is at risk? What is the greatest risk?, What is the most appropriate response?, Should this person stay at home...should that person go to a nursing home?. Possible to identify risk but no one knows how to quantify it.

7 CARTS: - Community Assessment of Risk for three adverse outcomes (AO): hospitalization, institutionalization and death - RISC: Risk Instrument for Screening in the Community - Short screening tool used by community nurses in older adults to detect those at risk of AO, frailty & functional decline - Predict adverse outcomes (AO) - Help develop integrated management strategies

8

9 RISC Screening Baseline Screened 803 March-August 2013 Follow up August 2013 to March 2014

10 Risk and Actual Rate (%) of Institutionalisation

11 Risk and Actual Rate (%) of Hospitalisation 30,00 25,00 20,00 15,00 10,00 Risk of Hospitalisation: Low risk (n=687) Risk of Hospitalisation: Medium risk (n=172) Risk of Hospitalisation: High risk (n=86) 5,00 0,00

12 Risk and Actual Rate (%) of Death

13 RISC: n= 783 of 803 patients with complete data Global Risk Score (Institutionalisation) 1-2 (Low) 3 (Moderate) 4-5 (High) No. of Patients at Baseline (T0) Institutionalised by T6 months 10 (1%) 6 (11%) 3 (9%) Institutionalised by T12 months 21 (3%) 9 (14%) 4 (12%) Institutionalised by T21 months 57 (8%) 21 (33%) 10 (30%) Global Risk Score (Death) No. of Patients at Baseline (T0) Deaths by T6 months 23 (4%) 15 (10%) 7 (30%) Deaths by T12 months 41 (7%) 26 (19%) 12 (57%) Deaths by T21 months 67 (11%) 38 (27%) 14 (67%) Global Risk Score (Hospitalisation) No. of Patients at Baseline (T0) Hospitalised by T6 months 29 (5.5%) 26 (15%) 7 (8%) Hospitalised by T12 months 54 (10%) 35 (20%) 19 (22%) Hospitalised by T21 months 61 (12%) 38 (22%) 21 (24%)

14 RISC: n= 778 of 803 patients with complete data Institutionalisation Rate Frail (> 6 CFS) (n=494) Not Frail (< 6 CFS) (n=384) T6 months 10 (2%) 9 (2%) T12 months 18 (4%) 17 (4%) T21 months 41 (8%) 41 (11%) Death Rate T6 months 32 (6.5%) 14(4%) T12 months 52 (10.5%) 28 (7%) T21 months 69 (14%) 52 (13.5%) Hospitalisation Rate Frail (> 6 CFS) (n=494) Not Frail (< 6 CFS) (n=384) T6 months 32 (6.5%) 14(4%) T12 months 52 (10.5%) 28 (7%) T21 months 69 (14%) 52 (13.5%)

15 Summary - easy to use tool - predicts AO in a community cohort of older - more sensitive than CFS - those at high-risk were 30 times more likely to be institutionalized or die at follow-up than those in lower risk categories - proactive approach - inform healthcare systems - Pilot across Europe - Horizon RCT & Interventions

16