Why Frail Seniors are Important?
Why Frail Seniors are Important?

Why Frail Seniors are Important? - PowerPoint Presentation

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Why Frail Seniors are Important? - Description

A Presentation to the NL Public Sector Pensioners Association Oct 7 th 2015 Capital Hotel Dr Roger Butler Associate Professor of Family Medicine MUN My Mom Objectives 1The attendee will be introduced to a model of frailty taking into account the entire population of seniors ID: 541356 Download Presentation

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Presentation on theme: "Why Frail Seniors are Important?"— Presentation transcript


Why Frail Seniors are Important? A Presentation to the NL Public Sector Pensioners’ AssociationOct 7th 2015 Capital Hotel

Dr. Roger Butler

Associate Professor of Family Medicine

MUN Slide2

My MomSlide3

Objectives1.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.Slide5

Frailty 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 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.Slide8

Prevalence and co-occurrence of the three frailty phenotypes.

Josep Garre-Olmo et al. Age Ageing 2013;42:46-51

© Slide9

Robust VS Frail older adults Frailty Phenotype ≥3 of unintentional weight loss, exhaustion ,weakness, slow walking , low physical activity and accumulation of medical, functional or social deficits


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 .Slide10

Average Life Expectancy tables USA 1997 (Walters) Males


Managing Aggressive Behavior in DementiaDr. Roger ButlerSlide14

Risks of Medicines in Frail Older Adults1.ADR’s


3.Functional impairment

4.Geriatic syndromes


.Impaired hepatic and/or renal function


.Drugs with anticholinergic and sedative properties


.Antiplatelet ,anticoagulants and hypoglycemic agents.Slide15

Can we reverse frailty?Physical frailty can potentially be prevented or treated with specific modalities:Exercise

Protein calorie supplementation



Reduction of Polypharmacy



14, issue 6 ,June 2013 ,pages 392-397Slide16

Fact or Fiction Seniors are costing the health care system too much money?Slide17

Do diet and exercise trump medications in the elderly?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


medicine .org

2.Comparative effectiveness of exercise and drug interventions on mortality outcomes :



2013 BMJ


Naci , John PA loannidis director ( London School of Economics) Slide18

Combined Impact of Health Behaviours and Mortality in Men and Women : The EPIC –Norfolk Prospective Population Study20,244 men and women aged 45-79No 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 Slide19

ResultsIf you have all 4 behaviours you have a 4 fold difference in total mortality in men and womenEquivalent to 14 years chronological ageTrends strongest for cardiovascular causes. Slide20

Comparative effectiveness of exercise and drug interventions on mortality outcomes : metaepidemiolgical study16 meta-analyses

305 randomized controlled trials

339274 participants…..14716 exercise group


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 diabetesSlide21

ResultsNo statistically detectable differences were evident between exercise and drug interventions in the secondary prevention of

coronary artery disease




Physical activity interventions


more effective


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 EuropeSlide22

United Kingdom 14% of adults exercise regularly with only 1/3 meeting recommended levels of physical activityUtilization rates for prescription drugs continue to rise :

2000 – 11.2


for every person



for every personSlide23

Newfoundland and Labrador Senior DemographicsTotal population 2015 = 527,756Population >65=97,269

% >65=18.4%


Males >85 =3221

Females >85=6221

Conservative frailty estimate >85 =2500 to 5000

>85= I/3 are demented = 3000

Stats Canada 2015Slide24

1978-Present NL 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



NH age 86 /Dementia # 1 diagnosis/90% DVA

2017 ….oldest proportion over 65 in Canada

2030 …oldest proportion over 65 in the worldSlide27

ChallengesDevelop 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 organizationsSlide28

ChallengesPoverty/HousingNutritionIncome support


Allied health support

Medical home model

Palliative Care

Advance Care Directives