Targeting Frailty to Prevent Disability: Insights from The Irish Longitudinal Study

on Ageing (TILDA)

Aisling M. O’Halloran PhDTILDA, Medical Gerontology, Trinity College Dublin.

National disability Authority Annual ConferenceCroke Park, Dublin, 25th September 2018

Overview

• Lifespan and Healthspan

• Introduction to TILDA

• What is Frailty

• Measuring Frailty and Disability in TILDA

• Frailty and Disability in Ireland – Research findings from TILDA

• Informing Policy and Practice

o The National Frailty Education Programme

• The Language of Frailty

Lifespan and Healthspan

People are living longer and the population is ageing.

(US Census Bureau An Aging World, 2015; UN World Populaton Ageing Report, 2015)

≥65 years

2011: 8% 12%

2021: 10% 15%

2050: 20% 25%

Lifespan and Healthspan

Lifespan and Healthspan

Lifespan and Healthspan

Lifespan and Healthspan

Lifespan and Healthspan

The disparity between lifespan and healthspan has lead to a

mushrooming in research activity under the umbrella of

“Healthy Ageing”

TILDA

The Irish Longitudinal Study on Ageing (TILDA)

TILDA Cohort

The Irish Longitudinal Study on Ageing (TILDA)

www.tilda.ie

Sample: Population representative, longitudinal cohort study of community-living adults aged 50+ years in ROI

Baseline Sample : 8,175 respondents.

Data: Collected Health, economic and social circumstances

Data collection: Every 2 years

Health Assessment:Every 4 years

TILDA Data Collection

The Irish Longitudinal Study on Ageing (TILDA)

TILDA Study Design

2006

1992

1998

1989

2000

1981

2002

2002

19911958

2009

1993

2001

1987

2006

1957

20062007

2011

2010

2012

19991996

1999

1987 20172013

19791993

2006

19851991

19911989

2002

19791988

19921963

1985

1986

1959

2006

2016

2015

What is Frailty?

What is Frailty?

Advancing age → adverse health outcomes +

increased health services use

BUT

Same Age ≠ Same Risk(Chronological) (Biological)

Frailty captures this difference in susceptibility or risk

What is Frailty?

Clegg et al, 2013; Fried et al, 2001)

Frailty is:

• A distinct health condition related to the ageing process

• Frailty can present differently in different people - heterogeneity

What is Frailty?

Clegg et al, 2013; Morley et al, 2012; Rockwood et al, 2007; Wlaston et al, 2006; Fried et al, 2001)

Frailty is:

• A transition phase between healthy ageing and disability.

What is Frailty?

(Santos-Eggiman et al, 2009)

Frailty is:

• Prevalent in older adults at between 4-59% among 65+ ag-group.

What is Frailty?

Clegg et al, 2013; Morley et al, 2012; Rockwood et al, 2007; Wlaston et al, 2006; Fried et al, 2001, 2004)

Frailty is:

• A risk factor for adverse outcomes

Falls Disability Dementia

Healthcare Use Long-term Residential Care

What is Frailty?

Frailty is:

• A dynamic process, it can be changed or reversed

RobustNon-frail

Pre-frail Frail Disability

Frailty Prevalence and Incidence

Interventions for FrailtyHealthy Diet Exercise Social connections

Stress

ReductionManage chronic

conditions

Review

medicationsBrain training

Frailty

How to measure it?

Frailty Index Model

Frailty in TILDA

Frailty

Prevalence and Incidence

Research Findings from TILDA

Frailty Prevalence and Incidence

Prevalence of Frailty and Disability

DisabilitiesFrailty

Frailty Prevalence and Incidence

Prevalence of Frailty and Disability by Age

DisabilitiesFrailty

Frailty Prevalence and Incidence

Prevalence of Frailty and Disability by Gender

11

14

0

5

10

15

Male Female%

Pre

va

len

ce

Disability

DisabilitiesFrailty

Frailty Prevalence and Incidence

Incidence of Frailty and Disability

No Disabilities at Wave 1Robust at Wave 1

Frailty Prevalence and Incidence

Incidence of Frailty and Disability

Disability Status at Wave 1 Frailty Status at Wave 1

Summary of findings from TILDA

Prevalence of frailty 14% among adults aged 50+ years

Frailty is higher among women and increases with age

1 in 20 people without frailty will develop frailty over 5 years

1 in 11 people without disabilities will develop a disability over 5 years

Prevalence of disability is 13% among adults aged 50+ years

Disability is higher among women and increases with age

People with a disability are 4 times more likely to develop frailty over 5 years

People with frailty are 8 times more likely to develop a disability over 5 years

Informing Policy and Practice

Informing Policy

• TILDA data has informed over 53 policy and strategy documents in Ireland

Informing Practice

The National Frailty Education Programme

A partnership between TILDAand the National Clinical Programme for Older

People (NCPOP)

The National Frailty Education Programme

FRAILTY: we need to think about it, understand and recognise it and plan for how we will support and care for those living with frailty in our community and in our hospital.

We need to future proof delivery of our health care services for the people who will be using it!

Informing Practice

The National Frailty Education Programme

Informing Practice

Definingfrailty

Frailtyasalossofphysiologicalreserve

Cleggetal.2013;Morleyetal.2012;Rockwoodetal.2007;Friedetal.2001

...astateofincreasedvulnerabilitytoa

stressorevent,whichincreasestherisk

ofadverseoutcomes…..

Non-frail

Frail

Recognising Frailty: Insights from TILDA

1. Understanding & RecognisingFrailty: definitions, models, interventions and prevention

2. TILDA: an overview of the study design and data collection & Health Centre tour

TILDA Research: relevant to frailty

3. Frailty Assessment Tools: an Interactive workshop session: Cognitive (MoCA) and Depression tests (CES-D), Grip strength test & Timed Up and Go (TUG) test

The National Frailty Education ProgrammeInterprofessionals Numbers

completedPercent completed

Physiotherapists 2921%

Nurses(DON/CNM/Nurse specialists/ANP) 29 21%

Occupational Therapists 27 20%

Medical Social Workers 11 8%

Nurse Lecturers/education co-ordinator 9 7%

Speech & Language Therapist 8 6%

Dietitians 6 4%

Pharmacists 6 4%

Medical 4 3%

Clerical/reception staff 2 2%

Therapy lead 3 2%

Psychologist 1 1%

Nurses 135 57%

Total 235 100%

1,300Healthcare professionals

Countrywide

Informing Practice

The National Frailty Education Programme

By increasing the understanding of frailty, we can improve the detection, prevention, management and therefore outcomes for these older adults.

Informing Practice

The Language of Frailty

The Language of Frailty

How would you define the term “frail”?

The Language of Frailty - A Word of Caution

‘’Frail is when someone is weak, and can’t do anything much. It is

that stage where you become dependent on people for most

things’’

“No, I’m definitely not frail. Frail means you’re doddery

and shaky. You can’t do anything at all.”

“Do I look frail to you?! I’m notfrail. That’s someone who can’tdo anything, who’s wasting away.Thin and skinny.”

AGE UK & BGS 2015 https://www.england.nhs.uk/blog/be-careful-using-the-f-word-with-frail-patients/

The Language of Frailty

WHO Clinical Consortium on Healthy AgeingTopic focus: frailty and intrinsic capacity (2016)

“…health care professionals and researchers in geriatrics should move away from focusing on disease towards

Intrinsic capacity (IC) and functional ability (FA)”

IC is the combination of the individual’s physicaland mental, including psychological, capacities

FA is the combination and interaction of IC with the environment a person inhabits.

Funders

Thank you

For more information:www.tilda.ie