Prevention of Geriatric Syndrome

Transcription

1 National Center for Geriatrics and Gerontology 1 Healthy Ageing -A Life without Comobidity- Prevention of Geriatric Syndrome Takao Suzuki, Research Institute, National Center for Geriatrics and Gerontology What will happen in the Super-aged Society 1) Rapid increase of the number and proportion of old-old people with age 75 and over; 23% in 2010 to 32% in ) Rapid increase of care-needed elderly person; 4.0 million in 2010 to 7.5 million in ) Rapid increase of demented elderly person ; 3.6 million in 2010 to 6.5 million in ) Rapid increase of number of death in a year ; 1.1 million in 2010 to 1.7 million in ) Rapid increase of single and married couple household with member age 65 years old and over; 54 % in 2010 to 70 % in /10/16

2 Japanese Elderly People Today Young-old (65-74 yrs.) Very healthy Very active Good social tie and network Hoping to work as possible The new generation of young-old is capable of actively contributing to the society and many desire to do so. About 30 % on the elderly are willing to work over life-time. More than half of older people expect themselves to retire at age 65 and over. In fact, almost 30 % of men aged 65 and over are in the laborforce, much higher than in European countries and even USA. Japanese womenalso lead the world in labor force participation. Japanese Elderly People Today Young-old (65-74 yrs.) Very healthy Very active Good social tie and network Hoping to work as possible Old-old (75 + yrs.) Geriatric Syndrome Long-term care state Frail & Sarcopenia Dementia (Cognitive function )

3 People Needing Long-term Care by Sex and Age Group(1,000 people, %) % (1,000 people) (1,000 people) (%) (%) years old Ministry of Health, Labour and Welfare, Actual Condition Survey of long-term Care Insurance Beneficiaries, 2008 LONG-TERM CARE INSURANCE SYSTEM LTCI started in April, LTCI is for sharing nursing care costs for the elderly among the general public, and allows users to select the prevention and nursing care services which they hope to use. LTCI was reformed in April, 2006 to be more prevention-oriented system for the elderly whose daily life become less active. 2012/10/16

4 Causes of care requiring condition 100% 50% Others Parkinsonism Dementia Fraility Joint disease Fall and Fracture Stroke 0% SN C-1 C-2 C-3 C-4 C-5 SN : support need C : Care level ) :Underlying disease mainly related to geriatric syndrome or family 2012/10/16 Geriatric Syndrome Physical frailty Sarcopenia Fall Incontinence Undernutrition Oral Dysfunction Cognitive Decline Characteristics of Geriatric Syndrome slowly progressive and non-fatal not necessarily caused by diseases leave untreated, QOL becomes worse preventable with proper intervention 2012/10/16

5 Current Concepts of Sarcopenia Sarcopenia, from the Greek for poverty of flesh, is a term coined by Rosenberg in 1989 to denote the decline in muscle mass and strength that occurs with aging Loss of Muscle Mass 1 Muscle weakness 2 Slow walking speed 3 Self-reported exhaustion 4 Low physical activity 5 Unintentional weight loss Disability Mobility Falls Hospitalization Fractures Death Flow chart of participants in the RCT Sarcopenia=304 (21.7%) Non-participants =149 Exercise + Amino acid 39 Randomization =155 (51.0%) RCT and Cross over Exercise 39 Amino acid 39 Control 38 Post test in July (n=34) Post test in July (n=36) Post test in July (n=37) Post test in July (n=37)

6 Intervention Program (1) Exercise 1) Exercise period: 3-month 2) Frequency: 2 days per week 3) Time: 60 minutes 4) Exercise Program (1) Muscle strengthen training (thigh, abdominal) Chair, band, ankle weight, and ball exercise (2) Balance and walking training Intervention Program (2) Amino acid 1) Supplement period: 3-month 2) Frequency: 3g supplement 2 times per day (total 6g) Phe 7.0% Water Milk Thr 10.5% Ile 10.5% Leucine 42.0% Val 10.5% Lys 14.0% Supplementation a day 3) Compliance: To accurately monitor the amino acid ingestion during the trial, a recording sheets were distributed to the subjects, who were instructed to record the time and amount of amino acid ingestion at home everyday.

7 注 ) Ex+AAS :Exercise and Amino acid Supplement Ex :Exercise AAS :Amino acid Supplement HS :Health Education (Cont) RCT for Improvement of Sarcopenic Condition in the elderly women (Kim H, Suzuki T. et al. JAGS,2011) RCT for Prevention of Decline of Cognitive Function among the MCI Community Elderly Three Factors in Daily Life (Life style) 運動習慣と認知症発症との関係 3 か月間の運動による脳賦活効果 週 3 回以上の運動習慣 /3 回未満ハザード比 0.62 (95% CI, 0.44 to 0.86) Larson EB, et al. Ann Intern Med, /10/16

8 2012/10/16 Brain Image MRI FDG PET fnirs

9 Exercise Intervention ( 80 sessions in 6 months) Task 1 Health Check Warming- up Task 3 Game, Fun Exercise, Activation of Brain Function Task 2 Aerobic exercise Task 4 Communication and relax A B C D A:Mini mental state exam., B:Wechsler memory scale-logical memory total score, C:word fluency test-category, D:word fluency test-letter. Blue-exercise, Red-control

10 All-MCI am-mci a b MRI 指標による脳萎縮の割合 (Rate of atrophy in the brain volume by MRI) a:all MCI subjects ( Not significant ) b:amnestic MCI subject (Significant p< 0.05 ) Integrated Community Care System Local community (within 30 minutes distance) In order to establish Integrated Community Care System, comprehensive and continuous provision of five types of care is needed within the local community. 20

11 21 Thank you for your kind attention