Alumno: Dr. Odín Edgar Vázquez Valdez Tutor: Dr. Clemente Zúñiga Gil

Presentación del tema: "Alumno: Dr. Odín Edgar Vázquez Valdez Tutor: Dr. Clemente Zúñiga Gil"— Transcripción de la presentación:

1 XIV CURSO ALMA 2015 Programas de prevención de la Fragilidad: Evidencias de éxito
Alumno: Dr. Odín Edgar Vázquez Valdez Tutor: Dr. Clemente Zúñiga Gil 11-Septiembre-2015

2 Prevención de Fragilidad
Su prevalencia tiene relación directa a la edad. La fragilidad se asocia a desenlaces adversos como caídas, hospitalizaciones, institucionalización, discapacidad y muerte. Espectro continuo de estados intermedios que pueden modificarse. La prevalencia de fragilidad es directamente proporcional a la edad, y con mayor incidencia a partir de los 65 años. La prevención de fragilidad es importante debido a que se asocia a diversos desenlaces adversos, entre ellos, caídas, discapacidad, hospitalizaciones, institucionalización y muerte. McMillan GJ and Hubbard RE. Frailty in older inpatients: what physicians need to know. Q J Med 2012; 105:1059–1065. Michel JP. Frailty: Successful clínical practice implementation. The Journal of Nutrition, Health & Aging 2014; 18 (5):470.

3 Two different parts compose the instrument, the first one appears as a questionnaire, its main objective is to attract the general practitioner’s attention to very general signs and/or symptoms potentially indicating the presence of an underlying frailty status, and the second part in which the general practitioner expresses his/her own view about the frailty status of the individual. Vellas B, et al. Looking for frailty in community-dwelling older persons: THE GERONTOPOLE FRAILTY SCREENING TOOL (GFST). The Journal of Nutrition, Health & Aging 2013;17(7):

4 Geriatric Frailty Clinic (G.F.C)
2011 “Geriatric Frailty Clinic (G.F.C) for Assessment of Frailty and Prevention of Disability” Plan de prevención personalizado, conducido por el médico de primer contacto Educación del paciente/familia respecto a sus factores de riesgo y enfermedades Intervención específica Seguimiento: A los 15 días, visita con médico de primer contacto Al mes y a los 3 meses, vía telefónica por enfermera The G.F.C began in october 2011 as a separate activity of the geriatric day hospital unit of the Toulouse Gérontopôle, France. The G.F.C currently accommodates up to five patients per day, five days per week. The comprehensive evaluation of frailty leads to the identification of potential risk factors for negative health-related events in different domains: physical activities, nutrition, cognition, mood, vision and hearing, urinary incontinence, oral care and social relations. On the same day of the evaluation, the geriatrician contacts the general practitioner to explain briefly the results of the multidisciplinary assessment, the proposed Plan de Prevención Personalizado (PPP) and discuss possible therapeutic changes. it includes behavioral and therapeutic suggestions to correct the specific risk factors, according to the clinical priorities given by the physician. One year after the first evaluation, a reassessment at the G.F.C is offered routinely to all patients except those who have been integrated into the Toulouse Gerontopole standard geriatric network, are deceased or those who have become dependent. Tavassoli N, Guyonnet S, Abellan van Kan G, et al. Description of 1,108 older patients referred by their physician to the “Geriatric Frailty Clinic (G.F.C) for assessment of frailty and prevention of disability” at the Gerontopole. The Journal of Nutrition, Health & Aging 2014;18(5):

5 Geriatric Frailty Clinic (G.F.C)
Tavassoli N, Guyonnet S, Abellan van Kan G, et al. Description of 1,108 older patients referred by their physician to the “Geriatric Frailty Clinic (G.F.C) for assessment of frailty and prevention of disability” at the Gerontopole. The Journal of Nutrition, Health & Aging 2014;18(5): Tavassoli N, Guyonnet S, Abellan van Kan G, et al. Description of 1,108 older patients referred by their physician to the “Geriatric Frailty Clinic (G.F.C) for assessment of frailty and prevention of disability” at the Gerontopole. The Journal of Nutrition, Health & Aging 2014;18(5):

6 Geriatric Frailty Clinic (G.F.C)
Población Edad m 82.9 años No Frágil 69 (6.4%) Pre-Frágil (39.1%) Frágil 590 (54.5%) Al año, reevaluación en G.F.C 520 (46.9%) Toulouse Gérontopôle standard geriatric network 131 (25.2%) Discapacidad 41 (7.9%) Muertes (4.0%) Completaron reevaluación 139 (26.7%) 93.6% de los pacientes evaluados cumplieron criterios para pre-fragilidad o fragilidad según el fenotipo de Fried, lo que refleja la utilidad como herramienta de escrutinino del Gerontopole Frailty Screening Tool (GFST) The G.F.C began in october 2011 as a separate activity of the geriatric day hospital unit of the Toulouse Gérontopôle, France. The G.F.C currently accommodates up to five patients per day, five days per week. The comprehensive evaluation of frailty leads to the identification of potential risk factors for negative health-related events in different domains: physical activities, nutrition, cognition, mood, vision and hearing, urinary incontinence, oral care and social relations. On the same day of the evaluation, the geriatrician contacts the general practitioner to explain briefly the results of the multidisciplinary assessment, the proposed Plan de Prevención Personalizado (PPP) and discuss possible therapeutic changes. it includes behavioral and therapeutic suggestions to correct the specific risk factors, according to the clinical priorities given by the physician. One year after the first evaluation, a reassessment at the G.F.C is offered routinely to all patients except those who have been integrated into the Toulouse Gerontopole standard geriatric network, are deceased or those who have become dependent. Tavassoli N, Guyonnet S, Abellan van Kan G, et al. Description of 1,108 older patients referred by their physician to the “Geriatric Frailty Clinic (G.F.C) for assessment of frailty and prevention of disability” at the Gerontopole. The Journal of Nutrition, Health & Aging 2014;18(5):

7 El ejercicio de resistencia y la suplementación nutricional aumentan fuerza y masa muscular
Fueron 100 sujetos, edad media 87.1 años. Intervención: ejercicio de resistencia 3 veces a la semana durante 10 semanas, músculos extensores de cadera y rodilla. El ejercicio de resistencia aumentó la fuerza y masa muscular, independe a las variables de edad, género, diagnóstico médico y nivel funcional. N Engl J M 1994;330:

8 The Health ABC study is a longitudinal, prospective cohort study, 2,964 participants for these analyses. At the end of the follow-up period of 5 years, 563 participants died (18% of the original cohort). Hubo evalución basal, a 3 años y a 5 años.

9 El número de comorbilidades fue el predictor más fuerte
The strongest and most consistent predictor of incident frailty in all the fully adjusted models was baseline number of diagnoses, with an approximate doubling of odds for frailty with each diagnosis reported (adjusted OR = 1.90; 95% CI: 1.55 – 2.34; not shown in Table 4 ). This suggests that the presence of multiple health conditions places an older individual at increased risk for frailty and that this risk is independent of exercise or lifestyle activity levels. J Gerontol A Biol Sci Med Sci 2009;64A(1):61-68

10 Estatinas en prevención de Fragilidad
Mujeres postmenopáusicas ≥ 65 años 25,378 Seguimiento a 3 años At baseline, 8.4% of women (n 2122) were current users of statin medications, and 3.6% of women were current users of >3 years duration (n 800). In this prospective study of more than 25,000 women 65 years old or older who were initially free of frailty, current use of statin medications was not significantly related to the development of frailty at 3-year follow-up. Among the 25,378 women who were free of frailty at baseline, 3453 had developed frailty (13.6%) by the 3-year follow-up contact. Current statin use had no association with incident frailty (OR =1.00; 95% CI, 0.85–1.16; Table 2). LaCroix AZ, Gray SL,Aragaki A, et al. Statin Use and Incident Frailty in Women Aged 65 Years or Older: Prospective Findings From the Women’s Health Initiative Observational Study. Journal of Gerontology: MEDICAL SCIENCES. 2008; 63A(4):369–75

11 Estudio observacional, con evaluación basal y a los 3 años, alrededor de 600 sujetos. Medición basal de 25-hidroxi Vitamina D, y luego sólo seguimiento de los criterios de fragilidad. Los sujetos con deficiencia de vitamina D fueron en mayor frecuencia mujeres y de mayor edad. J Am Geriatr Soc 2012;60:256–264.

12 Prevención de Fragilidad
La fragilidad está asociada con: Sedentarismo Desnutrición Obesidad Enfermedad cerebrovascular Enfermedad cardiovascular Enfermedad renal crónica Osteoartritis Frailty is associated with co-morbidities, particularly cerebrovascular, chronic kidney and cardiovascular disease, and primary prevention of these conditions could reduce the prevalence of frailty in old age. Actuar de forma oportuna, dirigir la intervención a los adultos jóvenes, cuando los factores clínicos de riesgo pueden ser modificados. Apoyándonos en médicos de primer contacto y otros especialistas para detectar a pacientes en el espectro de la fragilidad mediante herramientas sencillas y útiles. McMillan GJ and Hubbard RE. Frailty in older inpatients: what physicians need to know. Q J Med 2012; 105:1059–1065. Michel JP. Frailty: Successful clínical practice implementation. The Journal of Nutrition, Health & Aging 2014; 18 (5):470.

13 G. Zuliani et al. / European Geriatric Medicine (2015)

14 Mujeres y personas con menor escolaridad se benefician de programas de prevención
Seguimiento a 2 años J Epidemiol Community Health 2012;66:1116–1121

15 Prevención de Fragilidad
Se requiere una intervención más temprana, incidir en adultos jóvenes. “Geriatrizar” a médicos de primer contacto y otros especialistas Establecer herramienta de detección Manejo de comorbilidades para disminuir factores de riesgo ya identificados Frailty is associated with co-morbidities, particularly cerebrovascular, chronic kidney and cardiovascular disease, and primary prevention of these conditions could reduce the prevalence of frailty in old age. Actuar de forma oportuna, dirigir la intervención a los adultos jóvenes, cuando los factores clínicos de riesgo pueden ser modificados. Apoyándonos en médicos de primer contacto y otros especialistas para detectar a pacientes en el espectro de la fragilidad mediante herramientas sencillas y útiles. McMillan GJ and Hubbard RE. Frailty in older inpatients: what physicians need to know. Q J Med 2012; 105:1059–1065. Michel JP. Frailty: Successful clínical practice implementation. The Journal of Nutrition, Health & Aging 2014; 18 (5):470.

16 Prevención de Fragilidad