Hvordan kan tidlig opsporing og træning gavne ældre, som har risiko for funktionsnedsættelser? V. Jenny Havn Leder af forebyggende hjemmebesøg ÆHF Odense Kommune Paolo Caserotti, PhD Department of Sports Science and Clinical Biomechanics, University of Southern Denmark (SDU) Center for Active and Healthy Ageing (CAHA) National Institutes of Health (NIH) - National Institute on Ageing (NIA), Bethesda USA SUFO 2016 OUTLINE Hvad er HANC? (Paolo) Forebyggende hjemmebesøg i Odense behov for differentiering (Jenny) HANC results: home visit + active-life style intervention (Paolo) Videreførelse af resultater fra HANC til ny målgruppe sårbare ældre (Jenny) Sårbare Ældre: foreløbige resultater (Paolo) Vision 1
INTERREG 4 A Syddanmark-Schleswig-K.E.R.N. 2007-2013 HANC Healthy Ageing Network of Competence in Southern Denmark - Northern Schleswig-Holstein (HANC) (1,5 mio Euro) Lead partner: Department of Sports Science and Clinical Biomechanics, University of Southern Denmark Principal Investigator: Paolo Caserotti HANC partners What is HANC? HANC is a platform for cooperation between researchers, users, health care providers and companies. Together they find better solutions to serve the needs of older adults for Active and Healthy Ageing through optimizing opportunities for physical, social and mental health. HANC is more than a project: it is a platform to develop new best practice models 4 2
Why HANC? Raise awareness for Healthy Ageing in term of societal challenges and needs, new solutions and markets. Show opportunities and success stories. Trigger and facilitate horizontal, vertical and cross-border cooperation in the HANC region between academia, economy, society and policy. Access to competences and markets across the border. 5 Function as a key concept Functionality is a broad concept referring to various dimensions such as physical, medical, biological, mental or social functions. The functions level of a person determines the specific and individual need for support of Active and Healthy Ageing. We use ICF model as a frame 6 3
7 Healthy Ageing Network of Competence in Southern Denmark - Northern Schleswig-Holstein (HANC) (Interreg 4A program) Shift the focus: from care to earlier prevention in the disability process Early identification of older people at severe risk of functional loss, dependency, disability: implementation of a new screening model within the municipality health-care framework. Implementation of sustainable active life-style intervention model for older citizens at risk of severe functional loss to reverse risk factors. 4
9 Toolbox: identification Identification of early of marker early markers Collaboration with ODENSE Municipality - Forebyggende hjemmebesøg: 75+ year older citizen HOME VISITS -Stage 1: Preventive home visit: 11,500 potential home visits in Odense in 2013 14 key domains associated with risk of functional loss, dependency, disability First home visit (Elderly consultants Odense municipality) Cognitive function Physical function Fatigue Quality of life Life-style (free-living physical activity) Sleep quality Activities of Daily living Second home visit (SDU) Pain Body composition Muscle function Anthropometrics Motor& cognitive skills Fear of falling/falls history Depression 5
VI HAR LÆNGE LEDT EFTER EN ALARM KLOKKE Kirsten Avlunds træthedsscore Systematik i samtaleguiden ICF baseret tilgang MANGE ÆLDRE ER FRISKE Har overskud: tid penge- godt helbred Kan selv mestre og tage ansvar for egen sundhed Har mulighed for at hjælpe andre frivilligt arbejde? 6
HVORDAN KAN VI FINDE DE SÅRBARE ÆLDRE? Kronisk sygdom Faldepisode Dårligt selvoplevet helbred Lav eller faldende funktionsevne Flytning Tab af nærtstående Ægtefælle til kronisk syg Udskrivelse fra sygehus Depression Demens Flere andre problemstillinger ORGANISERING EFTER LOVÆNDRING Alle + 80 årige i Odense Nye +75 Friske ældre Sårbare ældre Enker/enkemænd +65 Døve ældre + 65 Etnisk minoritet +65 Behov for pleje 7
SPÆNDENDE - MEN DET HER GÅR ALDRIG! Medarbejderne siger nej! Borgerne siger nej! Barrieren var hos mig selv Klaksvik Færøerne ODENSE KOMMUNE: FOREBYGGENDE HJEMMEBESØG 8
3 meters (time) 17 3 meters (time) Slow walkers are more inactive and sleep worse than fast walkers: consequences? 18 9
Forebyggende hjemmebesøg: resultater Risk profile: Cognitive function and quality of life by walking speed groups Digit symbol substitution test (DSST) Neuropsychological test sensitive to brain damage, dementia, age and depression Quality of life a: significantly different from Fast b: significantly different from Moderate Forebyggende hjemmebesøg: resultater Risk profile: Cognitive function and quality of life by walking speed groups Digit symbol substitution test (DSST) Neuropsychological test sensitive to brain damage, dementia, age and depression Quality of life Slow walkers have reduced cognitive function and lower quality of life than fast and moderate walkers: consequences? a: significantly different from Fast b: significantly different from Moderate 10
21 What have we done? 1. Home test during HANC visit 2. Waited for 28 months 3. Collected data for personlipleje as following: 2009 Home visit (2012-13) 2016 4. Analysed data using the SPPB and compared the group of people with low SPPB (0-8) and high SPPB (9-12) 5. Evaluated the probability of receiving one (or more) "personlig pleje-ydelser" during the follow-up period in the group with low SPPB versus high SPPB 22 11
Personlig pleje-ydelser provided by the municipality of Odense: Antal personer som har modtaget ydelsen mindst én gang efter første hjemmebesøg Ydelse I alt (n=554) SPPB 0-8 SPPB 9-12 Personlig pleje 144/554 (26%) 106/325 (32,3%) 38/229 (16,6%) Praktisk bistand Sygepleje Article in preparation not for reproduction 23 24 12
Risk of having personlig pleje for older citizen with SPPB score of 0-8 compared to 9-12 After 2.8 years About 25 % of citizens with a SPPB between 9-12 at the first visit had a probability of having one (or more) "personlig pleje-ydelser" About 48 % of those with SPPB between 0-8 visit had a probability of having one (or more) "personlig pleje-ydelser" This is nearly double Hazard ratio is about 2. SPPB seems to be a very sensitive test! 25 Can we reverse risk factors? Implementation of a sustainable active life-style intervention within primary prevention framework to reverse risk factors. Implementation of sustainable active life-style intervention model for old and very old people at risk of severe functional loss: target mobility-limited older adults with good cognitive function and low physical function (gait speed <0,9m/s) 13
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Changes after exercise: key indicators for fall, functional loss and disability Muscle strength and power declines by 1.5 to 3.5 % per year Effect of 12-week training POTENTIAL REJUVENATION of 7-10 years HANC Sustainable active life-style intervention SAMTALEGUIDE ICF BASERET Kroppen Alarm Personlige faktorer Borgerens helbredstilstand Omgivelser Aktivitet og deltagelse 15
DE GODE ERFARINGER FRA HANC PROJEKTET VIDEREFØRES TIL MÅLGRUPPEN AF UDSATTE + 65 ÅRIGE: Evidensbaseret tidlig opsporing Evidensbaseret forebyggende indsats Tidlig opsporing og forebyggelse af funktionstab hos udsatte +65 årige Der er stadig stor ulighed i sundhed i Danmark Udsatte borgere har en markant dårligere sundhedstilstand. Rapport om ulighed i sundhed 2011: Kort eller ingen uddannelse Har gennem livet haft ringe eller ingen tilknytning til arbejdsmarkedet Lever alene ( fx skilsmisse, enke/enkemand) Ikke-vestlig baggrund Mænd er mere udsat end kvinder 16
FOKUS PÅ BORGERE MED SPINKELT NETVÆRK: Lever alene Har ingen børn Har ikke været tilknyttet arbejdsmarked de seneste 5 år inden de blev 65 år 34 17
Physical activity (a v e ra g e in t e n s it y ) 09-03-2016 Forebyggende målrettet identification : opsporing of early af + 65 marker årige udsatte ældre borgere Forebyggende hjemmebesøg- Early identification of 65+ vulnerable older citizens Odense Kommune - Ældrepulje 2014 Community-dwelling older citizen 65-74 year-old living in Odense selected from Municipality database 1. Alone 2. Without children HOME VISITS -Stage 1: Preventive home visit: ~2,500 letters sent 65-74 year old 180 older citizen tested during home visit (Elderly consultants Odense municipality) Cognitive function Physical function Fatigue Quality of life Life-style (free-living physical activity) Sleep quality Activities of Daily living Depression + 65 årige udsatte ældre borgere Physical activity: Sårbare Ældre vs HANC 2 5 0 0 D a y 0 6 :0 0-2 3 :0 0 2 2 5 0 * 2 0 0 0 * 1 7 5 0 1 5 0 0 0 S lo w M o d e r a te F a s t R is k G r o u p The risk group is highly inactive and similar to the slow walkers who are more than 10 years older. Simple selection criteria allows to identify a sub-group of older citizen at very high risk and develop tailored interventions 36 18
UDSATTE ÆLDRE + 65 ÅRIGE FORELØBIGE RESULTATER ( FORBEHOLD FOR RELATIVT LILLE GRUPPE BORGERE) Er mere inaktive end de dårligste i HANC Har lavere intensitet i deres aktiviteter Ser ud til at have dårligere søvnkvalitet Kvinder har større aktivitetsniveau end mænd. (mænd laver 60 % af hvad kvinderne gør) Kvinderne scorer markant bedre end mænd i fysisk og kognitiv funktion OPSPORET OG HVAD SÅ? Forebyggelse på ældreområdet Håndbog til kommunerne. Sundhedsstyrelsen Forebyggelsespakkerne Sundhedsstyrelsen Paletten.dk viser muligheder i civilsamfund HANC forebyggende træning med kvalificeret instruktør Transport er en barriere Kvalificerede instruktører Sårbare ældre nervøse for at komme ud 19
EN GOD MOTOR Frivillighed SDU Odense Kommune MASKINRUM: SDU Evidens Tidlig opsporing Aktiv Livsstil Frivillige Det levede liv Bæredygtigt Odense Kommune Erfaring gerontologi og geriatri Hverdagen for de ældre i Odense Kommune 20
VISION HANC II Stille skarpt på tidlig opsporing Optimere potentialet i tidlig opsporing Nye bæredygtige og langsigtede interventionsmuligheder Storskala implementering i Region Syddanmark og Tyskland 42 21
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