CIBER FRAGILIDAD Y ENVEJECIMIENTO SALUDABLE

LEOCADIO RODRIGUEZ MAÑAS

Disability

“Failure to thrive”

Func

tiona

l Cap

acity

Death

Usual

Successful

Accelerated

DEATH

0

5

10

15

20

25

EU (2

7 co

untr

ies)

Bulg

aria

Denm

ark

Esto

nia

Gree

ce

Fran

ce

Cypr

us

Lith

uani

a

Hung

ary

Net

herla

nds

Pola

nd

Rom

ania

Slov

akia

Swed

en

Icel

and

Switz

erla

nd

Life expectancy at 50 y

Free-of-disability life expectancy at 50 y

LONGEVITY (AMOUNT OF LIFE)

QUALITY OF LIFE (FUNCTION)

CHRONIC DISEASE

HEALTH SYSTEMS

+ SOCIAL

SYSTEMS

Prevention Risk manag. Empowerment

Integrated Coordinated. Continued

FUNCTION

Nature, October 2016

LONGEVITY

Aging is not a disease: AGE ASSOCIATED CHANGES

Biological Aging Is No Longer an Unsolved Problem Ann NY Acad Sci 2007; 1100: 1-13

LEONARD HAYFLICK DISEASE

C. Age-related Frailty

Entropic Forces

Risk accumulation and homeostatic mechanisms dysfunction

Disability Clinical Detection

Studenski S. J Nutr Health Aging 2009;13:729-32

Decreased biological reserves and reduced physiologic function underlies frailty Aging process → Significative lost of Functional Reserve and Functional Capacity

• Decrease of Functional reserve with age → plausible association with decrease of functional capacity and performance of activities of daily living

• Because functional level is one of the best indicators of health status, Focus should be on functionality and not on the diagnosis of disease when facing older frail patients

0 0

60

80

100

40

20

20

40

60

80

100 FUNCTIONAL

RESERVE

80 years 20 Years

FUNCTIONAL RESERVE FUNCTIONAL CAPACITY

ADL

% Maximal strength to sit to stand from a chair

USUAL TIME

Frailty: a Complex Syndrome of Increased Vulnerability

Age

Life-course Determinants: Biological (including genetic) Psychological Social, Societal Environment

Chronic Disease

Decline in physiologic reserve

Adverse outcomes •Disability •Morbidity •Hospitalization •Institutionalization •Death

Candidate markers

•Nutrition •Mobility •Activity •Strength •Endurance •Cognition •Mood

REVERSIBILITY

Age

APPROPRIATE TIME

CHRONIC DISEASES

Lancet, November 2014

CONTRIBUCION ANUAL RETICEF

Los objetivos principales del CIBER sobre Fragilidad y Envejecimiento Saludable son:

1. Evitar la discapacidad en las personas mayores, mediante el conocimiento de sus causas, mecanismos y de la efectividad de las intervenciones terapéuticas y preventivas, con especial atención a las etapas precoces de la discapacidad (fragilidad), sus factores de riesgos y sus consecuencias. 2. Proveer de evidencia experimental a la toma de decisiones sobre modelos preventivos y asistenciales

Para el logro de estos objetivos principales, se desarrollarán 3 líneas estratégicas, Mecanismos biológicos del envejecimiento saludable orientado al mantenimiento de la autonomía funcional y de los mecanismos que conducen a la fragilidad y la discapacidad.

Trayectorias funcionales y factores moduladores. Estudios de cohortes. interacción enfermedad crónica-envejecimiento-deterioro funcional

Intervenciones preventivas y terapéuticas de la fragilidad y el deterioro funcional. análisis de eficacia, eficiencia y efectividad.

Garcia-Valles et al., 2013

144 C57BL/6J

72 72

Wheel-runners Sedentary

ESTUDIOS LONGITUDINALES

Our team We are a multidisciplinary team focused on research on older people focused on frailty, functional decline and chronic conditions (e.g. diabetes, heart failure) through observational and interventional studies on diagnostic procedures, biomarkers, models of care and new therapeutic approaches. • 12 Geriatricians • 2 Clinical Pharmacologists • 2 Biomedical engineers • 2 Biologists • 1 Mathematician and statistician • 1 Epidemiologist • 1 Nutritionist • 1 Physiotherapist • 1 Economist (health economics) • 1 Neuropsychologist • 1 Occupational Therapist • 3 Research Nurses • 1 Lab technician

Circadian Healthy Aging

Cronolab University of

Murcia

Wearable Devices for Circadian

(temperature, activity, light exposure) and

Sleep monitoring Kronowise & Kronobed

Circadian remodelling

strategies

Automatic Report of Circadian

rhythms Frailty On-line plaftorm

Kronowizard

New frailty score including Circadian

and sleep frailty

Circadian and sleep dsiruption in pathological

states

Animal models: Short living fish

& Diurnal rodent

Development of frailty animal models

Extreme longevity human models,

centenarians

Population and clinical

cohort studies on frailty

Prognostic and pathogenic role

of frailty in chronic

disease, falls, cancer and

major surgery.

Physical activity,

sedentary lifestyle Identification

of frailty’s risk, diagnosis and prognosis

biomarkers

Assessment of tools for

the diagnosis of frailty in healthcare

delivery centres

Use of technologies

in the detection,

approach and monitoring of

frail elderly

Design and implementation of Clinical trials in frail patients

Treatment of chronic

disease and comorbidity

in frail patients

Cronolab in the CIBER Network

Sun light exposure and osteoporosis

Prof. Leocadio Rodríguez Mañas Sº de Geriatría Hospital Universitario de Getafe

Envejecimiento y fragilidad. Un nicho para la innovación tecnológica

Months 1-6

Months 1-12 M13-15 Months 16-28 M29-

31 Months 32-

36

State of the Art WP leader /Co-leaders Task leaders

Local status WP leader /Co-leaders Local partners Local institutions

(1)

(2) (3)

Collection of Preferences WP leader /Co-leaders Local partners Local institut.

Road-maps WP leader /Co-leaders Task leaders

(4)

Comments from the MSs WP leader /Co-leaders Local partners Local institut.

(5) (6)

Road-maps WP leader /Co-leaders Task leaders

Working documents at the end of each period (1) State of the Art (2) Local status and category of development (3) MSs Preferences for the road-map (4) Road-maps for each category and preferences (5) Local comments to the road-map (6) Final documents to be launched to MSs and EU parliament

DG-SANTE JOINT ACTION ON FRAILTY

• UAM • UPM • UPNA • UV • KAROLINSKA INSTITUTE • KINGS COLLEGE (LONDON) • BEDS/HART UNIVERSITY • U. TOULOUSE • U. BORDEAUX • UCSC (ROMA) • U. BRUSSELS • U. NAPOLES-2 • U. S CARLOS (PRAGA) • JAGELLONIAN U. (CRACOVIA) • BETHESDA HOSP. (STTUTGART) • HOSP. S. RAFFAELLE (ROMA) • WHO • CARDIFF UNIVERSITY • CARDIFF METROPOLITAN U.

PARTNERS

• GERMAN INST. NUTRITION • FRIEDRICH SCHILLER U (JENA) • AUSTRIAN ACADEMY OF SCI. • GHENT UNIVERSITY • INRCA (ITALY) • LIFELENGTH • GENOMIC SYSTEMS • INGEN • IDETRA • CLASE10 • DIFRAIL (UK) • YOUHEALTH • EVERCYTE • MOSAIQUES • SIEMENS • ATOS • CREATE-NET • AUSTRIAN INSTIT. OF TECHNOLOGY • INTERDIGITAL

23

Partners of FRAILOMIC

Use of Minimal model and Toledo cohort information variables in diagnosis (Q1) by PCA a

26

“Developing innovative therapeutic interventions against physical frailty and sarcopenia (ITI-PF&S) as a prototype geriatric indication”

IMI Call n.9 (call for interest) published on July 9th, 2013

27

Physical activity intervention Structured exercise and physical activity (LIFE study

protocol), mainly aerobic Nutritional assessment and dietary intervention Personalised dietary recommendations Health technology intervention Remote monitoring of daily physical activity, walk speed, reinforcement of intervention adherence

Multi-component intervention (MCI)

15 clinical sites (+ 1) 9 European countries

The SPRINTT randomised clinical trial

ACANTO Consortium

09/03/2017 29

Envitel HuG ATOS

University of Norhumbria

SIEMENS AG

Telecom Italia

Universitá di Siena

Universitá di Trento

INRIA

FORTH

ACANTO is a continuation of a recently finished project: DALI: Devices for Assisted Living

09/03/2017 30

WP1. ACANTO Clinical Validation

Caracteristicas del Paciente

Rodríguez-Mañas; 2001

ENFOCADOS EN LA ENFERMEDAD

ENFOCADOS EN LA FUNCION

Caracteristicas de los Sistemas de Salud

PACIENTE “CLASICO” (siglo XX)

Una enfermedad Sin impacto sobre la función Sin secuelas funcionales

PACIENTE MODERNO (siglo XXI)

Varias enfermedades crónicas, con reagudizaciones frecuentes Con impacto sobre la función Con secuelas funcionales

ESQUEMA GENERAL DE ASISTENCIA GERIATRICA SECTORIZADA Y COORDINADA

ATENCION PRIMARIA

ATENCION ESPECIALIZADA

SERVICIOS SOCIALES

SEVICIO DE GERIATRIA OTROS SERVICIOS HOSPITALARIOS

- UGA - UGRF - HDG - C. Externa

- AGD Gestión de casos

- Interconsultas

AGD: asistencia geriátrica domiciliaria; UGA: Unidad Geriátrica de Agudos; UGRF: Unidad Geriátrica de Recuperación Funcional; HDG: Hospital de Día Geriátrico;

Node regions

Catalunya Madrid

Industry

CLC

València

● EIT Health Spanish co-location center

The Spanish node is formed by three regions (Catalunya, Madrid and Valencia) involving strong partners in the three areas of the innovation triangle: research, education and business

Confidential, EIT HEALTH – WG, MARCH 2015

PIPELINE OF PROJECTS LISTED (WORK IN PROGRESS 2015)

MemSleep Enhancing ageing

memeory loss UPM TRL6

BeyondSILOS ICT integrated care

UPV

TRL7

echoBUTLER Disease mnagemt. models assesment

BIOCAT

TRL3-9

VISUALAID Enhanced reality for

visually impaired UPM TRL6

AD CARE caregivers support CAIXA FUND

TRL (ND)

FRAILTY (PREHEE) prescriptive health for

the elderly

GMV TRL8

BREATHE Manage stress and

depressions UPV TRL7

HMD_LOVI aids for low

vission patients UPM TRL6

ReAAL Open platform for independan living

UPV TRL8

ACTIVATE managing

dependant people at home UPV TR6

FRAILTY (MUSCLE LOSS)

ABBOT Nutrition

TR9

AD-DIAGNOSTIC

UPM TR5-8

SMARTCARE Integrated care

platforms UPV TR7

FRAILTY (ALTARI-

HomeCare) GMV

HOME monitoring TRL8

MATURITY

FRAILTY ATOS

TR9

FRAILTY

UPM

TR6-8

FRAILTY

SERMAS

TR6-8

Magic-AD UPM

TRL (ND)

Now-a-days there are not in the market applications to attend the specific needs of elderly people with comorbidities in risk of developing dependency

INNOVACIÓN: FUNCTION vs DISEASE

Historical Databases

from Co-

morbidities Patients

EN CONCLUSION

¿PREGUNTAS?