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
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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 MomSlide3Slide4
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
Slide6Slide7
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
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 .Slide10Slide11Slide12
Average Life Expectancy tables USA 1997 (Walters) Males
FemaleSlide13
Managing Aggressive Behavior in DementiaDr. Roger ButlerSlide14
Risks of Medicines in Frail Older Adults1.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.Slide15
Can we reverse frailty?Physical frailty can potentially be prevented or treated with specific modalities:Exercise
Protein calorie supplementation
Vit
D
Reduction of Polypharmacy
Jama
vol
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
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) 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
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 diabetesSlide21
ResultsNo 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 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
perscriptions
for every person
2010-17.7
perscriptions
for every personSlide23
Newfoundland and Labrador Senior DemographicsTotal population 2015 = 527,756Population >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 2015Slide24Slide25Slide26
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
2014
avg
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
Transportation
Allied health support
Medical home model
Palliative Care
Advance Care Directives