Preventive home visits and healthy ageing

European Year of Active Ageing and Solidarity between Generations Copenhagen, January 19, 2012
Carsten Hendriksen, Dr.Med.Sc., Associate prof. Bispebjerg University Hospital Center for Healthy Aging, University of Copenhagen Cahen@sund.ku.dk

Next 15 seconds

Imagine yourself as an old person

Next 15 minutes
1) Health promotion and preventive possibilities - evidence

2) Preventive home visits as an example

Evidence

Never have so many old people had so many years with so high functional ability as old people to day why?

Because of
Improved - Social conditions - Education - Life style - Technical possibilities - Medical treatment - Integrated health care and rehabilitation

Evidence

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

Health promotion and Prevention

What can you do yourself? Have good genes Be graduated Be employed Avoid chronic diseases Have a close social network

The most important in old age

Good functional ability in everyday life

- physical - mental - social

- despite chronic diseases

Prevention - Evidence Examples

Physical activities
Medical treatment Fall prevention

Physical activities
If I have to choose only one preventive strategy in old age Physical activities

Sedentary life style is dangerous

Medical treatment

Never have so many old people had so many years with so high functional ability as old people to day - also because of medical treatment But -

Medication in old age

Evidence often based on trials where included participants had no comorbidity and people aged 75 years and over are rarely represented two-edged-sword?

Medication in old age

Polypharmacy
Effect Side effects

Symptoms because of disease or because of side-effects?

Falls substantial burden?

Falls are the most frequent accident among older people More than 1/3 of persons aged 65+ and 50% aged 80+have a least one fall per year But falls can be prevented!

Reason for the reduction in hip fractures in Denmark?

More attention to physical activities among older people More attention to falls and fall prevention among older people More attention to fall prevention among health professionals Prevention of osteoporosis medical treatment More healthy old people - cohort effect

Prevention in Denmark
- has been a part of the policy in relation to older people during 30 years Primary secondary tertiary prevention From primary care to hospitals From groups to individuals

Social and health care in Denmark

General practitioner Old person

Primary care sector

Hospital

Prevention and older people

No prevention without interdisciplinary and cross-sectional collaboration Macro level - organisation Meso level - professionals Micro level person/patient

Preventive home visits

Micro level:
Preventive home visits in Denmark have been an important example when translating the scientific evidence about health promotion and prevention to daily practice

Preventive home visits

The aim: To support older peoples self-caring and to aid them utilizing their own resources optimally. Counselling and guidance on activities and support options communicated in time can postpone functional decline and maintain social relations

Preventive home visits

In Denmark all municipalities from 1996 are obliged to offer preventive home visits to citizents above 75 years from 2010 at least one annual visit. The local municipalities must organize the visits according to need and may opt exempt those who are receiving both personal and practical help from the municipalities.

Preventive home visits - Do they really work?

21 randomised controlled trials Outcomes (OR) death 0.92 (0.801.05) nursing home admission 0.86 (0.681.10) functional status decline 0.89 (0.771.03) Significant heterogeneity
Huss A et al. JGMS 2008

Preventive Home Visits

The studies suggest that comprehensive assessment in the homes of older persons followed up in a well functioning interdisciplinary culture can be a valuable strategy to prevent or postpone functional decline.

Preventive home visits - the content

Structured conversation life situation, health, social network, resources Objective examintion cognition, muscle strength, early signs of disability

Attention to possible risk situations fatigue, loss of weight, loneliness, loss of spouse
Action proposals

Follow up

Summary
Prevention of disability is the main topic among older people Enhancing physical activity is the most important strategy for preventing disability Preventive medication can provide enhanced functional ability but is a two-edge-sword Prevention of falls is possible Communication and coordination is necessary between the primary and secundary health care sector

I hope you will grow old - the alternative is so much worse for you

Thank you for your attention