13-carsten hendriksen - preventive home visits and healthy ageing

8/13/2019 13-Carsten Hendriksen - Preventive Home Visits and Healthy Ageing

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Preventive home visits and healthy

ageing

European Year of Active Ageing and Solidarity

between GenerationsCopenhagen, January 19, 2012

Carsten Hendriksen, Dr.Med.Sc., Associate prof.

Bispebjerg University Hospital

Center for Healthy Aging, University of Copenhagen

[email protected]


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Next 15 seconds

Imagine yourself as an old person


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Next 15 minutes

1) Health promotion and preventive possibilities- evidence

2) Preventive home visits as an example


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Evidence

Never have so many old people had so many yearswith so high functional ability as old people today

why?


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Because of

Improved

- Social conditions

- Education- Life style

- Technical possibilities

- Medical treatment- Integrated health care and

rehabilitation


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Evidence

To grow old is a much more dynamic process thanwe thought for 30 years ago


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Health promotion and Prevention

What can you do yourself?

Have good genes

Be graduated

Be employed

Avoid chronic diseases

Have a close social network


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The most important in old age

Good functional ability in everyday life

- physical

- mental

- social

- despite chronic diseases


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Prevention - Evidence -

Examples

Physical activities

Medical treatment

Fall prevention


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Physical activities

If I have to choose only one preventive strategy inold age

Physical activities

Sedentary life style is dangerous


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Medical treatment

Never have so many old people had so many yearswith so high functional ability as old people today

- also because of medical treatment

But -


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Medication in old age

Evidence often based on trials where includedparticipants had no comorbidity and peopleaged 75 years and over are rarely represented

two-edged-sword?


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Medication in old age

Polypharmacy

Effect Side effects

Symptoms

because of disease or because of side-effects?


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Fallssubstantial burden?

Falls are the most frequent accident among olderpeople

More than 1/3 of persons aged 65+ and 50% aged80+have a least one fall per year

But falls can be prevented!


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Reason for the reduction in hip

fractures in Denmark?

More attention to physical activities among olderpeople

More attention to falls and fall prevention among

older peopleMore attention to fall prevention among health

professionals

Prevention of osteoporosis

medical treatmentMore healthy old people - cohort effect


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Prevention in Denmark

- has been a part of the policy in relation to olderpeople during 30 years

Primarysecondarytertiary prevention

From primary care to hospitalsFrom groups to individuals


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Social and health care in Denmark

Generalpractitioner

Primary caresector

Hospital

Old person


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Prevention and older people

No prevention without interdisciplinary and cross-sectionalcollaboration

Macro level - organisation

Meso level - professionals

Micro levelperson/patient


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Preventive home visits

Micro level:

Preventive home visits in Denmark have been animportant example when translating the

scientific evidence about health promotion andprevention to daily practice


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The aim:

To support older peoples self-caring and to aidthem utilizing their own resources optimally.Counselling and guidance on activities andsupport options communicated in time canpostpone functional decline and maintain socialrelations


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In Denmark all municipalities from 1996 areobliged to offer preventive home visits tocitizents above 75 yearsfrom 2010 at least one

annual visit.

The local municipalities must organize the visitsaccording to need and may opt exempt those

who are receiving both personal and practicalhelp from the municipalities.


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Preventive home visits - Do

they really work?21 randomised controlled trials

Outcomes (OR)

death 0.92 (0.80

1.05)nursing home admission 0.86 (0.681.10)

functional status decline 0.89 (0.771.03)

Significant heterogeneity

Huss A et al. JGMS 2008


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Preventive Home Visits

The studies suggest that comprehensiveassessment in the homes of older personsfollowed up in a well functioning

interdisciplinary culture can be a valuablestrategy to prevent or postpone functionaldecline.


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Preventive home visits - the content

Structured conversation

life situation, health, social network,resources

Objective examintioncognition, muscle strength, early signs of

disability

Attention to possible risk situationsfatigue, loss of weight,loneliness, loss of spouse

Action proposals

Follow up


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Summary

Prevention of disability is the main topic among olderpeople

Enhancing physical activity is the most important strategyfor preventing disability

Preventive medication can provide enhanced functionalability but is a two-edge-sword

Prevention of falls is possible

Communication and coordination is necessary betweenthe primary and secundary health care sector


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I hope you will grow old

- the alternative is so much worse for you


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Thank you for your attention

13-carsten hendriksen - preventive home visits and healthy ageing

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