Transcript Why Frail Seniors are Important? - NL Public Sector Pensioners

Why Frail Seniors are Important?
A Presentation to the NL Public
Sector Pensioners’ Association
Oct 7th 2015 Capital Hotel
Dr. Roger Butler
Associate Professor of Family Medicine
MUN
My Mom
1.The attendee will be introduced to a model
of frailty taking into account the entire
population of seniors.
2. The attendee will be introduced to the
evidence supporting diet and exercise vs
drug therapy for the senior age group .
3.The attendee will be introduced to some of
the demographic challenges facing the frail
seniors in our province .
4.The attendee will be introduced to some of
the important determinants of health in this
age group.
Objectives
Frailty is a clinical state in which there is an
increase in an individual’s vulnerability for
developing increased dependency and /or
mortality when exposed to a stressor.
JAMA Vol 14 ,issue 6, June 2013 pages 392-397
Frailty
Frailty develops as a consequence
of age-related decline in many
physiological systems. Between a
quarter and half of people older
than 85 years are estimated to be
frail, and these people have a
substantially increased risk of falls,
disability, long-term care, and
death.
Prevalence and co-occurrence of the three frailty phenotypes.
©
Josep Garre-Olmo et al. Age Ageing 2013;42:46-51
Frailty Phenotype ≥3 of unintentional weight loss,
exhaustion ,weakness, slow walking , low physical activity
and accumulation of medical, functional or social deficits
Robust mobile and functionally independent
Robust patients have a medication focus on prevention,
treatment ,and to alleviate symptoms and delay functional
decline and mortality .
Frail patients who are approaching end of life need to take a
more palliative approach and often one can stop preventative
therapies .
Robust VS Frail older adults
Males
Female
20
25
15
top
25%
10
Mid25%
Bottom
25%
5
0
20
Top25%
15
Mid
50%
10
Bottom
25%
5
0
70 75 80 85 90
70 75 80 85 90
Average Life Expectancy tables USA
1997 (Walters)
Managing Aggressive
Behavior in Dementia
Dr. Roger Butler
1.ADR’s
2.Hospitalisation
3.Functional impairment
4.Geriatic syndromes
5.Impaired hepatic and/or renal function
6.Drugs with anticholinergic and sedative properties
7.Antiplatelet ,anticoagulants and hypoglycemic agents.
Risks of Medicines in Frail Older
Adults
Physical frailty can potentially be prevented or treated with
specific modalities:
1. Exercise
2. Protein calorie supplementation
3. Vit D
4. Reduction of Polypharmacy
Jama vol 14, issue 6 ,June 2013 ,pages 392-397
Can we reverse frailty?
Seniors are costing the health care system
too much money?
Fact or Fiction
It depends…..
1.Combined Impact of Health Behaviours and
Mortality in Men and Women : The EPIC –Norfolk
Prospective Population Study
Jan 2008 Kay –Tee Shaw et al www.plos medicine .org
2.Comparative effectiveness of exercise and drug
interventions on mortality outcomes
:metaepidemiological study
2013 BMJ Huseyin Naci , John PA loannidis director ( London School of Economics)
Do diet and exercise trump
medications in the elderly?
20,244 men and women aged 45-79
No cardiovascular or cancer at baseline 1993-1997
Followed until 2006
Scored 1 point for each of 4 health behaviours:
Current non smoking = 1 point
Moderate Alcohol intake = 1 point
Fruit and vegetable 5 servings per day = 1 point
Not physically inactive = 1 point
Combined Impact of Health Behaviours and Mortality in
Men and Women : The EPIC –Norfolk Prospective
Population Study
If you have all 4 behaviours you have a 4
fold difference in total mortality in men
and women
 Equivalent to 14 years chronological age
 Trends strongest for cardiovascular
causes.
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Results
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16 meta-analyses
305 randomized controlled trials
339274 participants…..14716 exercise group remainer drug
trials
Four disease processes examined:
1.Effectiveness of exercise on the secondary prevention of
coronary heart disease
2.Rehabilitation of stroke
3.Treatment of heart failure
4.Prevention of diabetes
Comparative effectiveness of exercise and drug
interventions on mortality outcomes :
metaepidemiolgical study
No statistically detectable differences were evident between
exercise and drug interventions in the secondary prevention
of coronary artery disease and prediabetes.
Physical activity interventions were more effective than
drug treatment among patients with stroke ( exercise
more effective than antiplatelets and exercise more effective
than anticoagulants.)
Diuretics were more effective then exercise in heart
failure.
Physical inactivity has been ranked as the
fifth leading cause of disease burden in
Western Europe
Results
14% of adults exercise regularly with only
1/3 meeting recommended levels of
physical activity
Utilization rates for prescription drugs
continue to rise :
2000 – 11.2 perscriptions for every person
2010-17.7 perscriptions for every person
United Kingdom
Total population 2015 = 527,756
Population >65=97,269
% >65=18.4%
>85=9442
Males >85 =3221
Females >85=6221
Conservative frailty estimate >85 =2500 to
5000
>85= I/3 are demented = 3000
Stats Canada 2015
Newfoundland and Labrador
Senior Demographics
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Staffing reallocation in Nursing Homes (80% of
budget salaries…. MDS)
2005 -2007 Have status with have not
infrastructure(10 year)
Rising Tide Report Alzheimer’s Canada 2010
Alzheimer’s International 2012 Public Health
Priority
2014 avg NH age 86 /Dementia # 1
diagnosis/90% DVA
2017 ….oldest proportion over 65 in Canada
2030 …oldest proportion over 65 in the world
1978-Present NL
Develop a provincial strategy not just for
well but for frail elderly
Develop a consistent home first approach
Develop age friendly communities
Develop standards for training of home
support workers to meet the needs of
todays clients
Develop standards of care for personal care
homes
Develop sustainability of community
support organizations
Challenges
Poverty/Housing
Nutrition
Income support
Transportation
Allied health support
Medical home model
Palliative Care
Advance Care Directives
Challenges