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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
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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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Preventive home visits
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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Preventive home visits
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