PHYSICAL FRAILTY & SARCOPENIA IN SPRINTT

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1 CONFLICT OF INTEREST DISCLOSURE PHYSICAL FRAILTY & SARCOPENIA IN SPRINTT Emanuele Marzetti, MD, PhD Dept. of Geriatrics, Neurosciences and Orthopaedics Orthogeriatric Unit Teaching Hospital Agostino Gemelli Catholic University of the Sacred Heart School of Medicine Rome, Italy Consultant for Novartis Consultant for Huron Consulting Group Consultant for Genactis Co-Leader of Work-Package 8 (analysis of results) of the SPRINTT Project (IMI JU ) Napoli, 23 settembre 2016 FROM THE DISEASE-CENTRED PARADIGM TO A HOLISTIC APPROACH FOR THE CARE OF OLDER PEOPLE Healthcare systems, based on the standalone-disease medicine paradigm, are unsuitable to cope with a growing population of older adults characterised by the co-existence of multiple, chronic disabling conditions. This scenario results in inappropriate use of resources and escalating healthcare expenditures. A transition is needed from the disease-centred model of care to a "holistic approach, in which the functional status is at the core of medical management. The geriatric syndromes of frailty and sarcopenia are paradigmatic conditions on which to lever for reshaping the current medical paradigms. 1

2 (..) a state of vulnerability to poor resolution of homeostasis following a stress and is a consequence of cumulative decline in multiple physiological systems over a lifespan. This cumulative decline erodes homeostatic reserve until relatively minor stressor events trigger disproportionate changes in health status ( ) Sarcopenia is a syndrome characterised by progressive and generalised loss of skeletal muscle mass and strength with a risk of adverse outcomes such as physical disability, poor quality of life and death. FROM THEORY TO PRACTICE... Gotta pick my choice 2

3 The higher the number of deficits in an index, the higher the estimates for adverse outcomes, independent of the type of deficit added. 3

4 POPULAR DEFINITIONS OF SARCOPENIA Cesari et al., J Frailty Aging 2012 YET ANOTHER (FINAL?) DEFINITION FNIH CONSENSUS DEFINITION OF CLINICALLY IMPORTANT SARCOPENIA THE FRAILTY PHENOTYPE AND SARCOPENIA Dam et al., J Gerontol A Biol Sci Med Sci 2014 Fried et al., J Gerontol A Biol Sci Med Sci

5 PHYSICAL FUNCTION IMPAIRMENT: AT THE CORE OF SARCOPENIA AND PHYSICAL FRAILTY The PF&S condition involves: Target organ damage (low muscle mass) Specific clinical phenotype Impaired physical performance 5

6 SETTING THE SPPB RANGE Four-hundred-metre walk baseline completion by SPPB score. Older people with SPPB < 3 are unable to complete the test Older adults scoring 10+ on the SPPB are commonly considered high-functioning (Guralnik et al., J Gerontol 1994) A cut-off of 9 in the SPPB has good sensitivity and specificity in discriminating frail from non-frail older adults (da Câmara et al., Geriat Gerontol Int 2013) Screening in primary care for nondisabled, older persons with SPPB 9 yields individuals with substantial morbidity, impairments and functional limitations (Bandinelli et al., Aging Clin Exp Res. 2006) Vasunilashorn et al., J Gerontol A Biol Sci Med Sci 2009 SETTING THE SPPB RANGE Age- and sex-adjusted proportion of participants who completed the 400-m walk test at baseline and were able to perform the test at 3-year. Loss of ability to walk 400 metres was greatest (66%) among participants with baseline SPPB scores of 7 or less. High risk Moderate risk Low risk Vasunilashorn et al., J Gerontol A Biol Sci Med Sci

7 Cesari,, Marzetti, Aging Clin Exp Med (submitted) Cesari,, Marzetti, Aging Clin Exp Med (submitted) ( ) To solve the duality between reductionism and the medical complexity of our aging societies, a substantial modification of current paradigms is required, shifting from traditional, disease-centered models of care to more comprehensive and person-tailored approaches. An unavoidable, yet desirable step in such a transition would entail the widespread implementation of integrated models of care in which a geriatrician (or an internist versed in geriatric medicine) may support clinical decisions for complex older patients ( ). 7

8 Key points The ongoing demographic transition is accompanied by substantial changes in medical needs and nosographic scenarios, which imposes the development of counteractions against highly prevalent disabling conditions. The operationalisation of PF&S surpasses the traditional medical paradigm of healing through treating a single disease by focusing on the functional domain. All of the components defining PF&S are objectively measurable, which will facilitate its incorporation into standard practice. The recognition of a precise biological substratum for PF&S (i.e., skeletal muscle decline) opens new venues for the development of preventive and therapeutic interventions. FUNDING Innovative Medicines Initiative Joint Undertaking (IMI JU ) Italian Ministry of Education and Research (linea D ) Achille and Linda Lorenzon Study Centre Fondazione Roma (call for proposals NCDs 2013) Dept. of Geriatrics, Rome emarzetti@live.com 8