Ageing and frailty Facts and myths Finn Rønholt MD. Ph.d. MPA.
Ageing and frailty Facts and myths Ageing Ageing and disease Ageing and frailty Risk scores Physical activity and rehabilitation
Most common risk-factors for disease
Centenarians in Denmark 1870-2000 2000 450
Centenarians in Denmark 1870-2012 2012 924 (771 women 153 men)
Hypertension and age
Cancer and age Men Women
Dementia and age 35 30 25 20 15 10 5 0 65-69 70-74 75-79 80-84 85-89 90 3,28 mill. EU citisens År
Use of medication and age
Aortic stenosis and age Iung, B. & Vahanian, A. (2011) Epidemiology of valvular heart disease in the adult Nat. Rev. Cardiol. doi:10.1038/nrcardio.2010.202
Advanced treatment and age % 10 9 8 7 6 5 4 3 2 1 0 2000 2002 2004 2006 2008 2010 Kilde: Dansk Hjerteregister PCI among elderly patients aged 80+ in Danmark
The olympic syndrom Immobility (stroke, fracture, arthrosis) Instability (Vertigo, dissiness, falls) Intellektual reduction (delirium) Incontinence (urine, stool) Iatrogenesis (caused by treatment)
102 years old
78 years old
Disability What and worry being you dependent most about on getting others old? help
Expected lifetime at age 65 in 1994, 2000, 2005 and 2011 with and without longstanding illness Men 14,1 15.0 16.0 17,3 Women 17,6 18.1 19.0 20,1 7,4 8.7 8.2 11.1 11.1 10.5 6.8 6.4 7.8 6,5 7.0 8.4 1994 2000 2005 2011 1994 2000 2005 2011 Without longstanding illness With longstanding illness 16 Health data from SILC 2011 Jeune et al. Eur J Ageing 2008
Expected lifetime at age 65 in 1994, 2000, 2005 and 2011 with and without mobility limitations Men 14.1 3.4 10.7 15.0 2.6 12.4 16.0 2.7 13.3 17,3 1,9 15,4 Women 17.6 7.1 10.5 18.1 6.2 11.9 19.0 5.8 13.1 20,1 1,9 18,2 1994 2000 2005 2011 1994 2000 2005 2011 Without mobility limitations With mobility limitations 17 Health data from SILC 2011 Jeune et al. Eur J Ageing 2008
The elderly have become younger
Ageing is more than age Physical Psycological Social Mental
The elements of functional capacity Functional capacity Physical function Mental function Cognitive function Emotionel function
Models of functional decline
p Reduced homeostasis Immune defence Neurotransmitters Hormones Reg. of temperature Acidity Oxidation Osmotc pressure
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.
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
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
The pathway towards frailty
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
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.
How to measure frailty?
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: 901-908
A simple test for frailty: Gaitspeed 5 meters cut off 6 sec.
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: 1668-76
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: 1668-76
Physical activity Sarcopeni Frailty
Physical activity and muscle strength Twice per week in 5 years
Physical activity and muscle strength Training among elderly aged 70.
And it is never too late Femur. 92-years old man living in a nursighome - before and after 12 weeks of intense training.
The elderly have become younger
- but something happens when you get older