Upload
others
View
7
Download
0
Embed Size (px)
Citation preview
Targeting Frailty to Prevent Disability: Insights from The Irish Longitudinal Study
on Ageing (TILDA)
Aisling M. O’Halloran PhDTILDA, Medical Gerontology, Trinity College Dublin.
National disability Authority Annual ConferenceCroke Park, Dublin, 25th September 2018
Overview
• Lifespan and Healthspan
• Introduction to TILDA
• What is Frailty
• Measuring Frailty and Disability in TILDA
• Frailty and Disability in Ireland – Research findings from TILDA
• Informing Policy and Practice
o The National Frailty Education Programme
• The Language of Frailty
Lifespan and Healthspan
People are living longer and the population is ageing.
(US Census Bureau An Aging World, 2015; UN World Populaton Ageing Report, 2015)
≥65 years
2011: 8% 12%
2021: 10% 15%
2050: 20% 25%
Lifespan and Healthspan
Lifespan and Healthspan
Lifespan and Healthspan
Lifespan and Healthspan
Lifespan and Healthspan
The disparity between lifespan and healthspan has lead to a
mushrooming in research activity under the umbrella of
“Healthy Ageing”
TILDA
The Irish Longitudinal Study on Ageing (TILDA)
TILDA Cohort
The Irish Longitudinal Study on Ageing (TILDA)
www.tilda.ie
Sample: Population representative, longitudinal cohort study of community-living adults aged 50+ years in ROI
Baseline Sample : 8,175 respondents.
Data: Collected Health, economic and social circumstances
Data collection: Every 2 years
Health Assessment:Every 4 years
TILDA Data Collection
The Irish Longitudinal Study on Ageing (TILDA)
TILDA Study Design
2006
1992
1998
1989
2000
1981
2002
2002
19911958
2009
1993
2001
1987
2006
1957
20062007
2011
2010
2012
19991996
1999
1987 20172013
19791993
2006
19851991
19911989
2002
19791988
19921963
1985
1986
1959
2006
2016
2015
What is Frailty?
What is Frailty?
Advancing age → adverse health outcomes +
increased health services use
BUT
Same Age ≠ Same Risk(Chronological) (Biological)
Frailty captures this difference in susceptibility or risk
What is Frailty?
Clegg et al, 2013; Fried et al, 2001)
Frailty is:
• A distinct health condition related to the ageing process
• Frailty can present differently in different people - heterogeneity
What is Frailty?
Clegg et al, 2013; Morley et al, 2012; Rockwood et al, 2007; Wlaston et al, 2006; Fried et al, 2001)
Frailty is:
• A transition phase between healthy ageing and disability.
What is Frailty?
(Santos-Eggiman et al, 2009)
Frailty is:
• Prevalent in older adults at between 4-59% among 65+ ag-group.
What is Frailty?
Clegg et al, 2013; Morley et al, 2012; Rockwood et al, 2007; Wlaston et al, 2006; Fried et al, 2001, 2004)
Frailty is:
• A risk factor for adverse outcomes
Falls Disability Dementia
Healthcare Use Long-term Residential Care
What is Frailty?
Frailty is:
• A dynamic process, it can be changed or reversed
RobustNon-frail
Pre-frail Frail Disability
Frailty Prevalence and Incidence
Interventions for FrailtyHealthy Diet Exercise Social connections
Stress
ReductionManage chronic
conditions
Review
medicationsBrain training
Frailty
How to measure it?
Frailty Index Model
Frailty in TILDA
Frailty
Prevalence and Incidence
Research Findings from TILDA
Frailty Prevalence and Incidence
Prevalence of Frailty and Disability
DisabilitiesFrailty
Frailty Prevalence and Incidence
Prevalence of Frailty and Disability by Age
DisabilitiesFrailty
Frailty Prevalence and Incidence
Prevalence of Frailty and Disability by Gender
11
14
0
5
10
15
Male Female%
Pre
va
len
ce
Disability
DisabilitiesFrailty
Frailty Prevalence and Incidence
Incidence of Frailty and Disability
No Disabilities at Wave 1Robust at Wave 1
Frailty Prevalence and Incidence
Incidence of Frailty and Disability
Disability Status at Wave 1 Frailty Status at Wave 1
Summary of findings from TILDA
Prevalence of frailty 14% among adults aged 50+ years
Frailty is higher among women and increases with age
1 in 20 people without frailty will develop frailty over 5 years
1 in 11 people without disabilities will develop a disability over 5 years
Prevalence of disability is 13% among adults aged 50+ years
Disability is higher among women and increases with age
People with a disability are 4 times more likely to develop frailty over 5 years
People with frailty are 8 times more likely to develop a disability over 5 years
Informing Policy and Practice
Informing Policy
• TILDA data has informed over 53 policy and strategy documents in Ireland
Informing Practice
The National Frailty Education Programme
A partnership between TILDAand the National Clinical Programme for Older
People (NCPOP)
The National Frailty Education Programme
FRAILTY: we need to think about it, understand and recognise it and plan for how we will support and care for those living with frailty in our community and in our hospital.
We need to future proof delivery of our health care services for the people who will be using it!
Informing Practice
The National Frailty Education Programme
Informing Practice
Definingfrailty
Frailtyasalossofphysiologicalreserve
Cleggetal.2013;Morleyetal.2012;Rockwoodetal.2007;Friedetal.2001
...astateofincreasedvulnerabilitytoa
stressorevent,whichincreasestherisk
ofadverseoutcomes…..
Non-frail
Frail
Recognising Frailty: Insights from TILDA
1. Understanding & RecognisingFrailty: definitions, models, interventions and prevention
2. TILDA: an overview of the study design and data collection & Health Centre tour
TILDA Research: relevant to frailty
3. Frailty Assessment Tools: an Interactive workshop session: Cognitive (MoCA) and Depression tests (CES-D), Grip strength test & Timed Up and Go (TUG) test
The National Frailty Education ProgrammeInterprofessionals Numbers
completedPercent completed
Physiotherapists 2921%
Nurses(DON/CNM/Nurse specialists/ANP) 29 21%
Occupational Therapists 27 20%
Medical Social Workers 11 8%
Nurse Lecturers/education co-ordinator 9 7%
Speech & Language Therapist 8 6%
Dietitians 6 4%
Pharmacists 6 4%
Medical 4 3%
Clerical/reception staff 2 2%
Therapy lead 3 2%
Psychologist 1 1%
Nurses 135 57%
Total 235 100%
1,300Healthcare professionals
Countrywide
Informing Practice
The National Frailty Education Programme
By increasing the understanding of frailty, we can improve the detection, prevention, management and therefore outcomes for these older adults.
Informing Practice
The Language of Frailty
The Language of Frailty
How would you define the term “frail”?
The Language of Frailty - A Word of Caution
‘’Frail is when someone is weak, and can’t do anything much. It is
that stage where you become dependent on people for most
things’’
“No, I’m definitely not frail. Frail means you’re doddery
and shaky. You can’t do anything at all.”
“Do I look frail to you?! I’m notfrail. That’s someone who can’tdo anything, who’s wasting away.Thin and skinny.”
AGE UK & BGS 2015 https://www.england.nhs.uk/blog/be-careful-using-the-f-word-with-frail-patients/
The Language of Frailty
WHO Clinical Consortium on Healthy AgeingTopic focus: frailty and intrinsic capacity (2016)
“…health care professionals and researchers in geriatrics should move away from focusing on disease towards
Intrinsic capacity (IC) and functional ability (FA)”
IC is the combination of the individual’s physicaland mental, including psychological, capacities
FA is the combination and interaction of IC with the environment a person inhabits.
Funders
Thank you
For more information:www.tilda.ie