29Oct14 - ILC Global Alliance Ageing and Mobility Symposium

Ageing and Mobility: ILC Global Alliance Symposium

Wednesday 29th October 2014

This event is kindly supported by Alliance Boots and hosted by the LGA

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Welcome

Louise PlouffeILC-Brazil


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Cllr Marianne Overton MBEElected Leader of the LGA Independent Group and

Vice Chair of the LGA, Lincolnshire County Council and North Kesteven District Council

Welcome from the Local Government Association


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Andrew BonserDirector of Public Policy

Alliance Boots

Welcome from Alliance Boots


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Rosy PereyraPresident

ILC-Dominican Republic

Sarcopenia: A forgotten cause of mobility problems in old age


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Sarcopenia: A Forgotten Cause of Mobility Problems in Old Age

Rosy Pereyra, M.D.

President ILC-DR

ILC-GA Symposium.- London. England October 29th, 2014

7

Sarcopenia a Forgotten Cause of Mobility Problems in Old Age

Introduction and Definition

Syndrome characterized by a progressive and generalized diminution of muscle mass and strength with the risk of adverse effects such as physical disability, poor quality of life and death.

It is perhaps the most serious threat to health and longevity and it is believed to play a role in the pathogenesis of fragility and the functional problems that accompany ageing.

-1 DE

-2 DE

Media

• Lean mass of extremities (kg)/estature (m)2

• Total lean mass(kg)/body weight (kg)

The Classical Definition of Sarcopenia is Based in Muscle Mass

Baumgartner RN, et al. Am J Epidemiol. 1998;147:755-763.Janssen I, et al. J Am Geriatr Soc. 2002;50:889-896.

Body muscle mass

NormalRisk of sarcopenia

Severe sarcopenia

Dis

trib

uci

ón

en

ad

ult

os

jóve

nes

9

Sarcopenia. A Forgotten Cause of Mobility Problems in Old Age

Prevalence

It is estimated that approximately 5-13% of people between 60-70 years are affected by sarcopenia.

There is an estimated loss of 0.5-1% per year after the age of 25 and this accelerates after the age of 60, doubling in each decade specially in inactive people.

10

Muscle strength and potency diminish with ageing

Lauretani F, et al. J Appl Physiol. 2003;95:1851-1860.

(N/d

m)

Years of age

0

250

500

750

1000

0

(kg

)

Years of age

00

(wat

ios)

Years of age

0

80

160

240

320

400

600 100

(cm

2 )

Years of age

0

20

40

60

80

20

40

60

80

100

8020 40 60 1008020 40

60 1008020 40 60 1008020 40

Varones MujeresVarones Mujeres

Varones MujeresVarones Mujeres

Three measures of muscular function and one of muscle mass in men and women

Strength of knee extension

Muscle strength Calf muscle

Manual pressure

11


Phisiopathological Changes

Ageing is associated to changes not only in muscular mass but also in muscle compositión its properties and contractility.

Changes in muscle fibers affectStrength and Potency

Lang T, et al. Osteoporosis Int. 2010;21:543-559.

Qualitativechanges in muscle

Type 1 fibers Type II fibers Motorneurone Denervatión

Ageing SarcopeniaReinervatión

Disminutionl in ttransversal area

• Increase in type I fibers

• Diminution in type II fibers

Senil miosteatosis

Miosteatosis• Increase in

intermuscular and intramuscular fat

Transversal cut of the thigh through resonance

Transversal cut of the thigh through tomography

* Significativamente diferente respecto al momento basal,p < 0,01

Intramuscular fat increase even with a stable body weight

Delmonico MJ, et al. Am J Clin Nutr. 2009;90:1579-1585.

Five years longitudinal study

Varones Mujeres

Muscle Intermuscular adipose tissue Succutaneous adipose tissue

Eva

luat

ion

res

pec

t to

b

asal

mo

men

t (%

)

8

4

0

-4

-6

-2

2

6

-10

-12

*

*

*

*

15

Sarcopenia. A forgotten Cause of Mobility Problems in Old Age

Causal Mechanisms

Loss of ability of satellite cells to self multiply

Loss of ability of muscle to respond to anabolic stimuli such as that of Insulin, growth hormone and amino acids.

Insufficient protein in the diet.

Lack of frequent exercise.

16


Effects of Sarcopenia

Diminution of physical function

Increased disability

Increased dependency

Mobility problems

Increase in health costs

0 2 4 6 8 10

Activities of daily living

Make their own meals

Hability to take care of themselves

Get up 5 times from a chair

Walk 2,5 meters

Lift 4,5 kg

Climb 10 steps

Walk 400 meters

Janssen I, et al. J Am Geriatr Soc. 2002;50:889-896.

Sarcopenia Diminishes Function and Increases disability

Men Women

Normal Moderate Sarcopenia

Severe sarcopenia

Normal Moderate Sarcopenia

Severe sarcopenia

Prevalence 36% 53% 11% 69% 22% 9%

Relative risk of disability,

%1.00 3.48 4.60 1.00 1.46 3.15

Cost in US thousand millions

- 7.18 3.63 - 2.7 4.96

Janssen I, et al. J Am Geriatr Soc. 2004;52:80-85.

Sarcopenia has an ElevatedHealth Cost

The direct health cost attributed to sarcopenia in The US in the year 2000 was 18.500 million dollars (nearly 1,5% of the total health cost of that year).

19

Sarcopenia. A Forgotten Cause of Mobility Problems in Old age

Diagnosis

Should be stablished when two out of three criteria are met:

1. That there is a reduction in muscle mass.

2. That there is a reduction in muscle strength and/or low exercise tolerance.

20


Diagnosis

Muscle mass is 2 standard deviations below a population of reference.

Diminution of the walking speed below 0.8 mts/sec in a 4 meters walking trial.

CAT scan, MRI, anthropometry and the valuation of creatinine excretion are also used.

21


Treatment

Since sarcopenia is due to multiple factors, its prevention and treatment require an integrated approach that should include:

Diet

Hormonal replacement therapy

Nutritional supplements including Vitamin D and

Exercise

Paddon-Jones D, et al. Am J Clin Nutr. 2008;87:1562S-1566S.

Protein Synthesis and Muscle Mass

• Proteins in the diet stimulate protein synthesis in older people

• An increase in the intake of protein > 0,8 g/kg/day

- Increase the anabolism of proteins in muscles

- Can help to avoid the senile decrease in muscle mass

Design

• n = 63 women and 37 men, 87,1 ± 0,6 years (interval: 72-98)

• The strength was measured as a maximal repetition of extensor muscles of the hip and knees after a 10 weeks intervention.

RESULTS

• In fragile old people you get better results when you associate exercise with oral nutritional supplements.

Oral Nutritional Supplements plus Resistance Exercises Increase Muscle Strength

Fiatarone M, et al. N Engl J Med. 1994;330:1769-1775.

Experimental Group

Exercise Control

Var

iati

on

in

str

eng

th (

%)

500

300

100

-100

0

200

400

-200Exercise plus supplements

Supplements

**

*

24


Hormonal Replacement Therapy

Growth hormone

Mechano growth factor and insulin like growth factor

Testosterone

25


Exercise

26


Finally

Ageing produces a diminution of muscle mass, strength, and muscular function.

Sarcopenia is defined mainly by the degree of diminution of muscle mass.

Sarcopenia is due to a complex interaction between many factors among those, nutrition.

The diminution of muscle mass in sarcopenia, increases the risk of fragility, mobility problems, disability and has an elevated health cost.

It can be avoided by having a good nutrition and exercising during your life time. These are probably the more efficient public health interventions for this condition.

27

Sarcopenia. A forgotten Cause of Mobility Problems in Old Age

!!!!!!!!!! Thank you and let’s start!!!!!!!!!!!

Contacts to the presenter:

Rosy Pereyra, M.D.

President ILC-DR

(809) 449-9551

[email protected]

Susana Concordo HardingDirector

ILC-Singapore

Are we living longer and healthier? Exploring gender differences in health

expectancy among older Singaporeans


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For more information about this presentation, please contact Susana Concordo Harding at [email protected]


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mailto:[email protected]

Dr Sebastiana KalulaDirector

ILC-South Africa

Prevalence and risks factors for falls, and the impact on mobility in later life:

The Cape Town study


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Ageing and mobility:Impact of falls –

the Cape Town study

Sebastiana Kalula

ILC South AfricaUniversity of Cape Town

Falls are a major cause of morbidity and mortality, and contributor to impaired functioning and mobility in older people

Long lie (>1 hour)• Pneumonia• Dehydration• Pressure sores

Social• Social withdrawal• Institutionalization

Functional• Immobility• Deconditioning• Decreased righting reflex

Psychological• Fear of falls• Loss of confidence• Depression• Increased dependency

Physical injuries• Bruises• Head injury• Fractures

Source: Grimm and Mion 2011; Lord et al., 2001, Donald and Bulpitt 1999, Tinetti and Williams 1997

Impact of a fall

Impact of hip fractures

• 2 % of falls result in hip fracture

• 25 % die within 6 months

• 60 % have restricted mobility

• Management and social costs are high

Sources: Chu et al., 2006; O’Loughlin et al., 1993; Tinetti et al., 1988.

Although prevalence and incidence rates of falls are well established in high income countries, little is known on falls in low to middle income countries, particularly in sub-Saharan Africa

South Africa is listed as a middle income country, but has a large poor population

Information on falls in older persons in Africa is sparse

• Single study in Rwanda (Ntagungira, 2005) focused on older persons who had fallen; recurrent fallers constituted 23.3 %

• Single retrospective study in Nigeria (Bekibele and Gureje, 2010) established a fall prevalence rate of 23 %

• Until now, no information in South Africa

Africa region studies

Surveyed 837 community-dwelling older persons with a 12-month follow-up

Sample size 837 aged ≥ 65 years• Gugulethu n=231 (black Africans)• Plumstead n=145 (whites)• Wynberg n=264 (coloureds (mixed

ancestry))

Follow up sample n=632

Cape Town study on falls

Kalula, 2012

Prevalence of falls: Cape Town study

• At baseline: 26.4 % Recurrent falls: 11 %

• At follow-up: 22 % Recurrent falls: 6.3%

• Incidence rate: 367 per 1000 person years– 236 per 1000 person years for men – 405.7 per 1000 person years for women

• Recurrent falls more common in women: 82.5 %

Fall prevalence by ethnic group: Cape Town study

Whites

n

140

%

42.9

Coloureds 392 34.4

Black Africans 283 6.4

Independent risk factors for a fall were mainly self-reported conditions:• Medical conditions (poor mobility, poor vision, poor urine control, depression, Parkinson’s disease)

• Self-rated poor health status

• Medication use (antidepressants, anti- inflammatory drugs)

Risk factors for falls: Cape Town study

Occupation category (%)

ReferenceBlack African

n = 283Whitesn = 140

OR (95% CI)

Unskilled 221 (78.1) 12 (8.6) 1

Skilled 58 (20.5) 94 (67.1) 30 (15–58)*

Managerial 4 (1.4) 34 (24.3) 157 (47–513)*Health compared to a year ago (%) ‒ Worse 15 (5.3) 9 (6.4) 2.17 (0.85 – 5.58)Mobility ‒ With difficulty 47 (16.6) 20 (14.3) 0.84 (0.47 – 1.48)

Total number in household (median, IQR))

7 (5-8.5) 2 (1-3) 0.32 (0.26 – 0.38)*

Ethnic differences in risk factors

*P value = <0.001

CharacteristicReference

Black Africann = 283

Whiten = 140 OR (95% CI)

Age in years (median, (IQR)) 74 (69-78) 76.5 (70-

81)

1.04 (1.01–1.08)#

Comorbidities (median, (IQR)) 3 (2-4) 4 (2-5) 1.39 (1.18 – 1.52)*

Number of drugs (median, (IQR)) 3 (1-4) 4.5 (2-7) 1.36 (1.25 – 1.49)*

Self-reported depression (%) Yes 23 (8.1) 21 (15.0) 2.00 (1.06 – 3.75)*

Geriatric Depression Scale score 1 (1-6) 2 (1-3) 0.89 (0.83 – 0.97)$

Use of psycholeptics (%) Yes 1 (0.4) 13 (9.3) 28.87 (3.74–223.0)*

Self-rated health (%) Poor 228 (80.6) 25 (17.9) 0.05 (0.03 – 0.09)*p value: * < 0.001, # =0.006, $= 0 005

Occupation category (%)

ReferenceBlack African

n = 283White

n = 140 OR (95% CI)

SES Index score 6 (5 – 6) 8 (8 – 8) 5.23 (3.94 – 6.94)*

Cognitive score 8 (4 – 12) 2 (0 – 5.7) 0.83 (0.79 – 0.87)*

Hand grip strength (kg) 14 (10.5–19) 16 (11 – 22) 1.04 (1.01 – 1.06)*

One leg stand eyes open (seconds)

3 (1 – 7) 13 (6 – 26) 1.14 (1.11 – 1.17)*

One leg stand eyes shut (seconds)

1 (0.0 – 4.0) 3 (2.0 – 6) 1.13 (1.07 – 1.19)*

Up & Go test (seconds) 20 (18 – 23) 12 (10 – 16) 0.89 (0.86 – 0.92)*

Chair stands (seconds) 20 (19 – 22) 12. (10 – 15) 0.79 (0.73 – 0.82)*

SES= Socio-economic Status index; score of 8 items in household; * p value: < 0.001

Falls and medical help: Cape Town study

• At baseline, 72 per cent reported injury resulting from a fall and 42 per cent sought medical help for the injury

• At follow-up, 70 per cent reported injury and 38 per cent sought medical help

Consequences of a fall: Cape Town study

Baseline Follow-up %

%•Injuries

- soft tissue 69.7

68.1- fractures 14.4

5.7

• Fear of falls 53.9 60.1

• Not fully recovered 41.7 39.4

Surveyed 837 older personsOutdoors N (%) Indoors N (%)

Stairs/steps 293 (35) Slippery floor 221 (26.4)

Road (uneven surface, potholes, stones, road works, slippery)

86 (10.3) Mats/loose carpet 189 (22.6)

Ground (stones, sand, uneven) 53 ( 6.3) Children/pets/toys 54 (6.5)

Garden (furniture, toys, plants, hose, washing line)

21 (2.5) Stairs/steps 52 (6.2)

Veranda (slippery, uneven, holes) 20 (2.4 Furniture 37 (4.4)

Pavement (people, uneven, rubble, banana peels, cracks)

19 (2.3) Getting out of a bath 31 (3.7)

Environmental hazards for falls: Cape Town study

Findings and questions• Finding of marked ethnic differences in fall

prevalence was unexpected and raises questions

• Speculated that life-time manual labour preserves gait and balance in the relatively deprived black African sub-sample, hence a low fall rate

• Far lower fall rate in black Africans despite high poverty levels and more environmental hazards in their residential area

• Design and implement falls intervention programmes to sustain mobility

• History taking, rather than tests, is a more reliable tool for clinicians to identify those at risk of a fall who could benefit from intervention

• Educate and train health professionals in screening for falls, and management of risk factors and consequences of a fall

Recommendations

Thank you

Dr Didier HalimiILC-France

MOBILAGE


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MOBILAGE

D. HALIMI (ILC-France) on behalf of

BROCA Hospital, CEREMH, RATP and ILC-France

ILC Gobal Alliance Mobility Symposium London 10.29.14 52

MOBILAGE: MOBILITY FOR ALL !


MOBILAGEThe situation

• Outdoor mobility of older people is – a matter of freedom , preservation of autonomy, psychological

& social wellbeing– essential for prevention of dependency

• Loss of mobility has negative consequences– depressive symptoms after cessation of driving (Marottoli,

1997) • Driving remains the favourite mode of transportation

– for > 50% of people 75 + (Sofres 1990-2000)– driving ability should to be assessed

• potentially impacted by physical, sensory or cognitive deficits• to ensure secure driving as long as possible

– Alternatives should be proposed if ability to drive is impaired


MOBILAGEThe project

• To evaluate outdoor mobility of pre-frail and frail elderly and their caregivers through workshops and training focusing on mobility

• Objectives • Identify the risks of decreased mobility1

• Analyze participants’ mobility1 • Propose tailored training

• Walking in public area ,• Driving, cycling, public transportation1

• Inform on alternative outdoor mobility aids • support patients and their families in their implementation2,3

• This pilot project will include – 100 pre-frail and frail subjects 75 or older– re-evaluated after 6 months.

1: BROCA Hospital; 2: CEREMH ; 3: RATP ILC Gobal Alliance Mobility Symposium

London 10.29.14 55

MOBILAGEWhy should I participate?

• I am embarrassed by certain movements• I reduced the frequency of my outings • I am concerned about my mobility • I find it hard to get around • I do not feel confident while driving • I am curious to test new devices • I do not feel confident in public transport and I use

them less


MOBILAGEWho will benefit ?

• Patients, relatives and professionals in gerontology will directly or indirectly benefit from this program

• Communication of results will help educate the public about the issue of elder’s mobility


First step Mobility evaluation and needs assessment of pre-frail and frail persons or their caregivers after medical evaluation and sensory testing ( BROCA Hospital)

Second step if the person is eager to learn more about the potential benefits of the MOBILAGE program

• Awareness and testing session• Theoretical training: traffic laws and road signalling• Practical training: driving assessment with a driving

instructor (and a psychomotor therapist if needed), bicycles, tricycles, adapted scooters, use of public transportation …

MOBILAGEIn practice


MOBILAGEWhere are we?

• 72 pre-frail and frail people or their caregivers have accepted the mobility screening (first step)

• 16 have attended the mobility workshops ( second step ) to get – additionnal information on new mobility aids and to test

them – And/or driving support

• Limitations – Fear of taking the plunge – Availability for the workshops – Budget and technical maintenance for the new mobility

aids ILC Gobal Alliance Mobility Symposium London 10.29.14 59

MOBILAGE The Partners


CEntre of REsources & Innovation Mobility & HandicapNon profit organisation National Centre of Expertise for technical aids for Mobility by the CNSA

Paris Public Transportation Network

BROCA Hospital

Draisine (draisienne) a walking aid that allows you to move while sitting upright


Awareness and discovery of new mobility solutions

Adapted Scooters

For people who walk and want solution to increase their mobility perimeter



Different adapted cycles: bicycles, tricycles, and electrical cycles



Balance learning to ...

... Control the bike, or simply regain confidence.


Individual or small group sessions to learn safe city traffic


Theoretical training: Refresh regulation and signalling


Driving school: driving sessions with practical advice to regain confidence.


Support to use Public Transportation

Albertine takes the bus!


CONCLUSION

• Outdoor mobility is key for the wellbeing and the preservation of autonomy

• MOBILAGE is a valuable experiment, stressing – The importance of a correct evaluation of the

mobility and needs of the pre-frail and frail persons and their caregivers

– The need for some support services to increase the adherence of the persons to the proposed solutions


This presentation has been made possible thanks to: • Broca Hospital: Marie-Laure SEUX, Laure CAILLARD, Mélanie

CORNUET • CEREMH: Claude DUMAS, Antoine VERNIER, Elisabeth

JOSEPH• RATP: Jean-Pierre TEXIER

70ILC Gobal Alliance Mobility Symposium

London 10.29.14

ILC-France

• Françoise Forette, MD• Marie-Anne Brieu, MD• Philippe Guillet, MD• Jean-Claude Salord, MD• Didier Halimi, MD


Short Comfort Break


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Kunio MizutaPresident

ILC-Japan

Maintaining Older People’s Mobility: What Do We Need?


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Maintaining Older People’s Mobility: What Do We Need?To Promote Older People’s Independence

“Aging and Mobility,” ILC- Global Alliance Conference October 29, 2014

London

Kunio MIZUTAPresident, ILC-Japan

74

1. Demographic Trends in Japan

75

27.2 18.5 16.4 13.2 9.4

75.8 86.2 79.0 70.8

50.0

6.0 13.0 16.3

14.8

13.8

2.8 9.0 15.6

21.8

23.9

0

20

40

60

80

100

120

140

1975 2000 2013 2025 2050

75-

65-74

15-64

0-14

Total: 111.9% of 65+: 7.9%

million people

126.917.4%

97.138.8%

120.730.3%

127.325.1%

Population Aging: Estimates & Projections

% of the elderly: 7.9% (1975) ⇒ 25.1% (2013) ⇒ 30.3% (2025) # of the old-old: 2.8mil.(1975) ⇒ 15.5mil.(2013) ⇒ 21.8mil. (2025)

Cabinet Office (2014). Annual Report on the Aging Society

2. Significance of Mobility among Older People, Research Supporting “LTC Prevention” Programs

Cerebro-vascular disease (Stroke)

Joint disorder, fracture,

fall

Demen-tia

Age-related frailty

Cardiac (heart) disease

Other, unknown

Total 21.5 21.1 15.3 13.7 3.9 24.5

Male 32.9 11.3 10.9 10.5 4.5 29.9Femal

e 15.9 25.8 17.5 15.3 3.7 21.8

76

Reasons for needing care by sex (%)

Many people start needing care due to locomotor disabilities

Reasons for Needing Care

Ministry of Health, Labour and Welfare (2012). Comprehensive Survey of Living Conditions.

◆ First sign of disability: Loss of ability to walk. Then problems with toileting and eating.

◆ A longitudinal study (5 year follow-up study) shows that the groups with slower walking speed are at higher risk for IADL decline (slowest group: 23%, fastest group: 5%).

◆ An exercise intervention study for older people proves that 　 a program to increase motor function improves physical function (walking speed, MCS) and mental health (WHO-5).

Suzuki, T. (2012). The Basics on a Hyper-Aged Society (pp.42-43). Kodansha Gendai Shinsho.

Ohbuchi, S., et al. (2010). Research on comprehensive evaluation and analyses regarding long-term care prevention. In T. Suzuki et al. (eds), Report on a Comprehensive Research Project Regarding Long-Term Care Prevention (p.33). Japan Public Health Association.

77

Older People’s Walking & IADLWalking speed is an important health indicator. Programs to increase motor function can be effective.

◆ A longitudinal study shows:

Frequency of going out: 3 groups“1+/day” “1/every few days” “<1/week”

(Odds ratios at the 2-yr. follow-up study)

Problem w/ walking　1.00　　　　　　 1.78　　　　　　 4.02

Problem w/ cognitive function1.00 1.58 3.49

78

Frequency of Going Out & Older People’s Health

Fujita, K., et al. (2006). Frequency of going outdoors as a good predictor for incident disability of physical function as well as disability recovery in community-dwelling older adults in rural Japan. Journal of Epidemiology, 16 (1), 261-270.

Lower frequency of going out is an independent risk factor for problems w/ walking and cognitive function

◆A longitudinal study examined what effects the total hours of productive activities have on older people’s health(3 year follow-up study)

Significant differences in ADL (going out, standing up from a chair/bed, going to the toilet, etc.) and cognitive impairments (SPMSQ score)

Shibata, H., Sugihara, Y., & Sugisawa, H. (2012). Social contribution by middle-aged and older Japanese: Its contributing factors and effects on physical and emotional well-being. Analyses of 2 representative panel data. Applied Gerontology, 6, 21-38.

79

Hours of Activities & Levels of ADL Cognitive

ImpairmentsProductive activities can prevent ADL and cognitive impairments

Summary of Existing Studies

1. A significant number of people start needing care due to locomotor disabilities. 2. Speed of walking is an important health indicator among older people.3. Lower frequency of going out is a risk factor for problems with walking and cognitive function.4. Programs to increase motor function can be effective. 5. Productive activities can prevent ADL and cognitive impairments.

80

3. Comprehensive Community Care & Long-Term Care Prevention

Comprehensive Community Care (providing integrated community support, including housing, health care, LTC, preventive care and assistance w/ daily living, so that people can stay in a familiar environment)

◆Within the frame of CCC, municipalities are urged and supported to make efforts to prevent frailty by maintaining and restoring older people's motor function through evidence-based way of exercise. ◆Active participation by residents, especially older people and community as a whole is essential. 81

Long-term care prevention service, Sakai city, Fukui prefecture

4. Other Measures to Promote Locomotor Health & LTC Prevention

Basic Health Check List for Those Over 65years Old is distributed to about 50% of the elderly population by local municipalities, and about 30% of older people fill it out. 　　

82

Health Checkups for LTC Prevention

Questionnaires1 daily life 　Do you normally travel by bus or train by yourself?Do you go out and buy daily necessities by yourself?Do you manage your own deposits and savings at the bank?Do you often go out to visit your friends?Do you consult with your family or friends about their problems?

2 physical abilityAre you able to go upstairs without holding rail or wall?Are you able to stand up from the chair without any aids?Are you able to keep walking for about 15 minutes?Do you worry about falling down?…… ©AMDA International Medical Information Center 2008

Prevention of “Locomotive Syndrome”

83

Bones

Muscles

Joints

Bone strength

Fall/fracture

Sarcopenia

Burden on joint/inflammation

Mobility

Limited activities/soci

al participation

Needing care

“Health Japan 21” Campaign (Ministry of Health, Labour and Welfare)

“The Locomotive Challenge! Council”

(The Japanese Orthopaedic Association + private enterprises)

◆ Promoting barrier-free design: Streets, parks, buildings, public transportation, etc.

◆ Focused efforts to promote barrier-free design: Around stations and areas frequently used by older people and those w/ disabilities

84

Measures to Build a Better Environment to Improve Mobility

Barrier-Free Act (Enacted in 2000, revised in 2006)Ensuring independent living for older people & those w/ disabilities

Mobility Support Project

85Ubiquitous Tanba Sasayama

Internet(WiFi service)

Reading QR codes +Providing WiFi positional info

QR Code

System configuration & available contents

Routing assistance

Bus timetables

Info on restrooms

Info on facilities

Providing contents

(content server)

Walking space network data

Conclusion

◆ Maintaining and improving older people’s mobility are tools to promote their social participation. Programs to maintain and improve mobility cannot be effective without older people’s positive attitude toward a society. ◆ That is, we can pave the way for a hyper-aged society based on the concept of Productive Aging.

86

Lia DaichmanPresident

ILC-Argentina

Loss of mobility, loss of Autonomy, loss of quality of life


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LIA SUSANA DAICHMAN MD CYNTHIA MARIÑANSKY MD MAG. SOFÍA APTEKMAN SW ROSANA SILBERMAN SW

-ARGENTINA

“LOSS OF MOBILITY,

LOSS OF AUTONOMY,

LOSS OF QUALITY OF LIFE”

London, Oct. 2014

INTRODUCTION

Life-space scales have been developed

to assess movement of individuals

from home to beyond town or region

in contrast with classic measures of mobility

that do not take into account

the interaction with the living environment.

-ARGENTINA

-Argentinean total population: 40.117.096 persons corresponding 5.725.838 to people 60 years and older

DEMOGRAPHY

- People over 65 years of age represent 10.2% 14.3% are 60 years old and over.

•The proportion of seniors in Argentina is the third highest in the Latin American Region after Uruguay and Cuba.

- Middle life expectancy at birth is around 75.5 years, 72.5% for males and 80% for females.

[1]

-ARGENTINA

Gender: 82% females

Average age: 77.1 years, (77.5 (F) and 75.4(M)

Education: 54% high school; 7% university; Income: 80% believed “sufficient”

Health: 76% perceived themselves to be in a good health

Marital status: 44% widows; 36% married; 6% divorced;

14% single (exceed the rate of the City of BsAs)

Living arrangements: 66% with other people; 44% living alone.

GROUP PROFILE: ANALYSISN = 50

-ARGENTINA

RESULTS

Cognitive functioning: 84% normal; 16% had some difficulties.

Depressive symptoms: 70% showed no depressive symptoms; 30 % presented depressive symptoms.

Physical limitations: 58 % had no difficulty with the Chair Test; 20 % had some difficulties; 22% could not perform the test at all.

ADL: 84% had no difficulty; 16% require assistance

Space Life: 52% were above 87 points; 32% between 56 and 87 points and 16% below the 56 point line which is considered risk (highest 120 points)

-ARGENTINA

HIGHLIGHTSDiffered according to previous personalities and coping mechanisms through their life cycles.Nearly 70% expressed that their lives would be highly impaired in the case they should have to remain at home:

- “I would commit suicide because I love my home and activities”- “I cannot even think about it” - “I really never thought about it”- “I would lose my freedom, I would become a slave” - “I would be depressed, I wouldn´t like to live like that”- “I would lose my job, the one I depend on.”-“I would adapt myself, I would look for company and help” – -“I expect it won’t happen, it would be very hard”

-ARGENTINA

-“I would share part of my home as a way to get somebody to be with me”

- “There are always other options. If I would have company, it will be much easier”

-“I would program a new environment; try to keep up my best according to my limitations, read, design, paint, care for my plants and my place... And be careful so that HELP does not increase my

limitations…”

-ARGENTINA

DISCUSSION- A high percentage of our population expressed that a situation like this would influence on their emotional state by means of depression, sadness, anguish, anxiety about the future and helplessness…

-The vast majority of people admitted that they would need help. (It seems that FAMILY would be the first answer).

- Nevertheless, a fair number of people, who would accept help, do not mention family as their first resource. More than that, they explicit would feel pretty bad about having to rely on their children or grandchildren for informal care.

-ARGENTINA

- Older sons and daughters, more than often take care of their own - grandchildren and when they have to look after their older parents,

even if they privilege the little ones, they find themselves in a difficult position which they cannot escape and have little choice… .

RECOMMENDATIONS

•Inform and prepare older person, their families and the community in general about what to do and how to deal with gradual or sudden loss of autonomy’ situations.

•Work with Focus groups or special courses for older persons addressing risk factors related to this age group and generate alternative projects that extend and strengthen existing and new networks of support.

•Create specialized public and private centers for advice and support to older persons and their families to be used as required.

•Promote programs and awareness workshops on intergenerational solidarity to facilitate inclusion of older adults in need of care

-ARGENTINA

RECOMMENDATIONS

• Stimulate more public and private policies to build or improve and adapt homes for older people for present and future needs.

• Sensitize the population about the importance of home safety to prevent accidents.

• Promote within the community the importance of physical activity, health care and active ageing to prevent deterioration and disability.

• Encourage individual, intergenerational and community social, exchange, including older persons, to promote the consolidation of support networks at a useful level when necessary.

• Work individually or in groups, in terms of medical and social services, to avoid, prevent, and support sensory deprivations as well as all types of MOBILITY’s loss.

-ARGENTINA

Thank you very much from Buenos Aires!.. [email protected]

-ARGENTINA

Dr Iva HolmerováPresident

ILC-Czech Republic

Local and national initiatives to support active ageing and improve quality of

long-term care in the Czech Republic


#ilcglobalalliance

Local and national initiatives to support active ageing and

improve quality of long-term care in the Czech Republic

Iva Holmerová, Petr Wija ILC-Czech Republic

Healthy Life Expectancy (Wija 2012)

2011 ženy mužihly 63,6 62,2le 80,7 74,7% hly 78,8% 83,3%

rozdíl muži ženy: 6 let (LE), 1,4 let (HLY)

P. Wija, 2013

Future need of long-term care will depend on (EC 2013):•

– Numbers of persons 80+•

– Health status of population, healthy life expectancy, chronic diseases and multimorbidity

– Ability to live in home environment despite disability

Enabling model of geriatric care(P.Millard, 1994)

Acute care – dg and treatment

Rehabilitation

Long-term care

Functional improvement

Disabling model of geriatric care (P.Millard, 1994)

Dg and th

RHB

Long-term care

Underestimation of geriatric care needs – fixation of disability

BEDEKRGuide on Active Ageing

orHow to find the way in the landscape of active

ageing and long-term careHolmerová I., Starostová O., Vepřková R., Wija P.

BEDEKR

Support of active ageing on the community level Participation and communication with local authorities Independent living Environment and mobility

BEDEKR

Intergenerational activities Voluntary work Education ICT literacy and internet Social activities Physical activity and sports

BEDEKR

Mobility:

- Important aspect of quality of life- Necessary for self-maintenance

Individual level (rehabilitation, support, aids)Community level – no barriers, transportSocietal level - enabling environment

CELLO – ILC – CZ

• Thanks to:• Dana Hradcová – GOS Project and CELLO

Coordinator• Marcela Janečková – FRAM Project• Olga Starostová – FRAM Project• Radka Vepřková – FRAM Project• Hana Vaňková – IGA and GOS Project• Petr Veleta – GOS Project

Marieke van der WaalDirector, ILC-Netherlands

Jayant UmranikarILC-India

Panel Response


#ilcglobalalliance

Ageing and Mobility: ILC Global Alliance Symposium

Wednesday 29th October 2014


#ilcglobalalliance

Presentations & Public Speaking

29Oct14 - ILC Global Alliance Ageing and Mobility Symposium