Ageing and frailty Facts and myths. Finn Rønholt MD. Ph.d. MPA.

Transcription

1 Ageing and frailty Facts and myths Finn Rønholt MD. Ph.d. MPA.

2 Ageing and frailty Facts and myths Ageing Ageing and disease Ageing and frailty Risk scores Physical activity and rehabilitation

3 Most common risk-factors for disease

4 Centenarians in Denmark

5 Centenarians in Denmark (771 women 153 men)

6 Hypertension and age

7 Cancer and age Men Women

8 Dementia and age ,28 mill. EU citisens År

9 Use of medication and age

10 Aortic stenosis and age Iung, B. & Vahanian, A. (2011) Epidemiology of valvular heart disease in the adult Nat. Rev. Cardiol. doi: /nrcardio

11 Advanced treatment and age % Kilde: Dansk Hjerteregister PCI among elderly patients aged 80+ in Danmark

12 The olympic syndrom Immobility (stroke, fracture, arthrosis) Instability (Vertigo, dissiness, falls) Intellektual reduction (delirium) Incontinence (urine, stool) Iatrogenesis (caused by treatment)

13 102 years old

14 78 years old

15 Disability What and worry being you dependent most about on getting others old? help

16 Expected lifetime at age 65 in 1994, 2000, 2005 and 2011 with and without longstanding illness Men 14, ,3 Women 17, ,1 7, , Without longstanding illness With longstanding illness 16 Health data from SILC 2011 Jeune et al. Eur J Ageing 2008

17 Expected lifetime at age 65 in 1994, 2000, 2005 and 2011 with and without mobility limitations Men ,3 1,9 15,4 Women ,1 1,9 18, Without mobility limitations With mobility limitations 17 Health data from SILC 2011 Jeune et al. Eur J Ageing 2008

18 The elderly have become younger

19 Ageing is more than age Physical Psycological Social Mental

20 The elements of functional capacity Functional capacity Physical function Mental function Cognitive function Emotionel function

21 Models of functional decline

22 p Reduced homeostasis Immune defence Neurotransmitters Hormones Reg. of temperature Acidity Oxidation Osmotc pressure

23 Frailty A clinically recognizable state of increased vulnerability resulting from aging-associated decline in reserve and function across multiple physiologic systems such that the ability to cope with everyday or acute stressors is comprised. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146-M156.

24 Age CHA2DS2-VASc Congestive heart disease Hypertension Age > 65år Diabetes Stroke Vaskular disease Sex (women) HAS-BLED Hypertension Abnorm lever/kindey function Stroke Former bleeding Labile INR Age > 65år Drug abuse

25 Frailty CHA2DS2-VASc Congestive heart disease Hypertension Age > 65år Diabetes Stroke Vaskular disease Sex (women) HAS-BLED Hypertension Abnorm lever/kindey function Stroke Former bleeding Labile INR Age > 65år Drug abuse

26 The pathway towards frailty

27 Fried s frailty phenotype Weight loss (>= 10 pounds last year) Exhaustion (2 spg fra CDS-D) Grip strength Slow walk (6 min walk < 210 m) Low physical activity Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146-M156. Solvejg Henneberg Pedersen 2011

28 Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146-M156.

29 How to measure frailty?

30 Frailty as a Predictor of Surgical Outcomes in Older Patients 0-1: Non-frail 2-3: Intermediate Frail 4-5: Frail Frailty independently predicts postoperative complications, length of stay, and discharge to a skilled or assisted-living facility in older surgical patients and enhances conventional risk models. Makary A J Am Coll Surg; 2010:

31 A simple test for frailty: Gaitspeed 5 meters cut off 6 sec.

32 Gait Speed as an Incremental Predictor of Mortality and Major Morbidity in Elderly Patients Undergoing Cardiac Surgery Afilalo J. J Am Coll Cardiol. 2010;56:

33 Gait Speed as an Incremental Predictor of Mortality and Major Morbidity in Elderly Patients Undergoing Cardiac Surgery Afilalo J. J Am Coll Cardiol. 2010;56:

34 Physical activity Sarcopeni Frailty

35 Physical activity and muscle strength Twice per week in 5 years

36 Physical activity and muscle strength Training among elderly aged 70.

37 And it is never too late Femur. 92-years old man living in a nursighome - before and after 12 weeks of intense training.

38 The elderly have become younger

39 - but something happens when you get older