Demographic change – challenges to society & economy Ageing Health society workforce shortage Chronic conditions Financial unsustainability HLY vs LE Health inequalities
EPIDEMIOLOGIC TRANSITION DEMOGRAPHIC TRANSITION 400 Cardiop. Isquémica 350 Cancer Tuberculosis 300 Disentería Neumonía 250 200 150 100 50 0 1900 1920 1950 40 20 0 When the facts change, I change -20 my mind. What do you -40 do, sir? Cardiop. Isquémica -60 ACVA Mortalidad no CV John Maynard Keynes -80 1950 1960 1975 1995
I have been vaccinated against polio and mumps. I have been vaccinated BE AWARE ABOUT against chicken pox, whooping cough THE TRUE FOCUS: and measles. Then I fell down the stairs. IT IS FUNCTION!!! Charlie Brown - Charles M. Schulz REVERSIBILITY APPROPRIATE FRAILTY TIME Candidate Life-course Adverse outcomes markers Chronic Determinants: • Disability Disease • Nutrition Biological • Morbidity • Mobility (including • Activity • Hospitalization genetic) Decline in • Strength Psychological • Institutionalization physiologic • Endurance Social, Societal • Death reserve • Cognition Environment • Mood
Frailty as a dynamic functional state CARE Preventing Preventing Preventing Preventing Managing FOCUSED frailty Disability Disabilty Dependency Dependency Treating Treating Treating ON Frailty Functional Disability Decline Potential reversibility of functional decline Robust Frail Functional Disability Dependency Limitation Definition Interventions to What What What What What improve quality How How How How How and outcomes - Where Where Where Where Where and prevent or delay further ? ? ? ? ? functional decline
Frailty conceptual models B) Frailty phenotype A) Deficit accumulation Fried et al. J Gerontol Med Sci. 2001;56A:M146-M156 Rockwood K. J Am Geriat Soc. 2006;54:975-979 Rodriguez-Mañas L & Walston JD Rev Esp Geriatr Gerontol 2017
The functional continuum Isolated Physiological Multiple MULTYSYSTEMIC Non-reversible Vulnerability conditions IMPAIRMENT DISABILITY-DEPENDENCY SEVERE DEPENDENCY ROBUSTNESS DEATH FUNCTIONAL RESERVE LOW CURRENT TOOLS: DICHOTOMIC (FRAIL vs NON-FRAIL)
IS IT POSSIBLE TO DESIGN SUCH A FLOWCHART FOR FRAILTY AT RISK NO YE S SCREENING NO YE S DIAGNOSIS NO YE S PROGNOSIS TREATMENT
Is it necessary to modulate the prevention strategy according to the level of frailty? Yes INTUITIVE NOT EVIDENCE-BASED How should it be modulated Clinical Phenotypes By severity GREAT OPPORTUNITIES FOR RESEARCH By comorbidity By setting With which approaches OBSERVATIONAL STUDIES Improving diet RCT S Physical exercise Managing cardiovascular risk Others
Key Action Areas Alignment of Health Systems Provision of LTC Age-friendly environment Improve measuring, monitori and understanding
PRIMARY COMMUNITY CARE INTEGRATED COORDINATION CARE Patient-centred SOCIAL SERVICES management HOSPITAL CARE - CCU GERIATRICS DEPARTMENT OTHER HOSPITAL-BASED DEPARTMENTS - FRPAC - ACU COORDINATION - FOU - GDH - OC - LT CONTINUED COORDINATION CARE ACU: Acue Care Unit ; FRPAC: Functional Recovery Post-Acute Care; FOU: Falls and Orthogeriatric Unit; GDH: Geriatric Day Hospital; LT: Liaision Team; OC: Outpatien Clinic; CCU: Community Care Unit
JOINT ACTION ADVANTAGE ON FRAILTY 4 ideas to consider Work will consider: Frailty is a public MS individualities • Work should be health problem and EC funded • progress from: societal challenge in projects EIP on AHA AG • Europe that can be The EC supports MS to 2014 Council • Frailty prevented & will work on a EU policy to Conclusions Scientific evidence • benefit from a prevent frailty 2014 SPC LTC • European approach report Building a European approach to tackle frailty at national level
JOINT ACTION ADVANTAGE ON FRAILTY Working on frailty prevention by Intervention Implementing Prevention results • Diagnosis • Analysis Awareness • Treatment • National • Understanding frailty • Clinical pathways • structures/plans Framing the concept • Services organization • Capacity building • Facilitators/barriers • to change "Frailty prevention approach" at EU level
Objectives 1. To promote important sustainable changes in the organization and implementation of care in the Health and Social Systems ; ADVANTAGE JA aims at building a common understanding on frailty 2. To prepare a common to be used in all the Member European framework on States, by policy makers and other screening, early diagnosis, stakeholders, which should be the prevention, assessment and base for a common management management of frailty ; both at individual and population level of older people who are frail or at risk of developing frailty 3. To develop a common throughout the European Union. strategy on frailty prevention and management, including raising awareness and advocacy among stakeholders, especially policy and decision makers.
TARGET GROUPS 1. Policy makers and stakeholders , both from the public and private sectors. 2. Health and Social care professionals 3. Frail older people and their carers, those at risk of frailty, and the EU population at large .
EXPECTED OUTCOMES /RESULTS A GENERAL EUROPEAN FRAMEWORK A SPECIFIC MS PERSPECTIVE which will be aligned with the European one, but implemented according to the local capability and context.
IMPLEMENTATION PHASES Phase I (2017) - State of the Art - Phase II (2018) - background developing and testing Phase III (2019) - information collection, the draft version of drafting final analysis and rational the common European documents, debating discussion and model to approach these with participant drafting of preliminary frailty (frailty MSs, and drafting the documents. prevention approach – final framework, the FPA document). FPA document and policy recommendations. STATE OF THE ART MS PRIORITIES STATUS OF MS CONSULTATION ROAD-MAP DRAFTS FINAL ROAD-MAPS
Mahon, Spain, EAB and SC meeting September 2017
THE THIRD TRANSITION BREAKING THE INERTIA CARE CURE FUNCTION DISEASE QUALITY OF LIFE SURVIVAL RISK TO BENEFIT RATIO TO DO TIMELY INTERVENTIONS LONG-TERM PREVENT REACT INTEGRATED/CONTINUED EPISODES Rodriguez-Mañas et al., JAMDA 2017 Rodriguez-Mañas et al, ADVANTAGE proposal, 2016
FACING THE CHALLENGE OF HEALTHY AGING AVOIDING DISABILITY IMPROVING SUSTAINABILITY BY FIGHTING AGAINST FRAILTY
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