Room
Paternot salle n°40 ( à côté de l'auditoire PATERNOT )
Theme
Aging - Promotion of healthy aging
Chair
Laurence Seematter-Bagnoux
Title
Faut-il dépister régulièrement la fragilité liée à l’âge ? Une analyse longitudinale dans l’étude Lc65+
Name
Yves Henchoz
Affiliation
Unisanté, Centre universitaire de médecine générale et santé publique
Abstract
CONTEXTELe dépistage de la fragilité est une priorité de santé publique qui vise à proposer à un stade précoce des stratégies de prise en charge afin de prolonger l’indépendance et allonger l’espérance de vie en bonne santé. Un suivi régulier renseigne sur la trajectoire de fragilité au fil des années, mais il reste à vérifier que la trajectoire est un meilleur prédicteur du déclin fonctionnel qu’une mesure ponctuelle de la fragilité. Cette étude vise à tester cette hypothèse dans une population de personnes âgées vivant dans la communauté.
MÉTHODES
Les données proviennent de 1564 seniors lausannois suivis depuis 2004 dans le cadre de l’étude Lausanne cohorte 65+ (Lc65+). L’analyse utilise les cinq critères du phénotype de fragilité en 2005 (66-71 ans) et en 2014 (75-80 ans), ainsi que les trajectoires de fragilité sur dix ans (2005, 2008, 2011, 2014) construites à l’aide d’un modèle mixte semi-paramétrique. La survenue d’une dépendance fonctionnelle a été relevée sur les 6 années suivantes (2015-2020). L’association entre la (pré-)fragilité (au moins 1 critère rempli) et l’incidence de dépendance fonctionnelle a été évaluée par un modèle de survie en temps discret. L’aire sous la courbe ROC (AUC) a permis de comparer la capacité prédictive des modèles.
RÉSULTATS
La (pré-)fragilité concerne 25.2% des participant-e-s à 66-71 ans, et 45.9% à 75-80 ans. Trois trajectoires de fragilité ont été identifiées : favorable (56%), intermédiaire (36%) et défavorable (7%). Le risque de dépendance fonctionnelle à l’âge avancé est plus élevé chez les personnes (pré-)fragiles à 66-71 ans (HR=1.69, IC95% 1.19-2.40) ou à 75-80 ans (HR=2.35, IC95% 1.74-3.17). Par rapport à la trajectoire favorable, le risque de dépendance fonctionnelle est plus élevé dans les trajectoires intermédiaire (HR=2.05, IC95% 1.52-2.78) et défavorable (HR = 2.65, IC95% 0.97-7.24). L'AUC indique une capacité discriminante acceptable de la fragilité à 75-80 ans (0.64) et des trajectoires (0.62, p[75-80vs.traj.]=.216), et une capacité discriminante légèrement moins bonne de la fragilité à 66-71 ans (0.58, p[66-71vs.75-80]=.007 et p[66-71vs.traj.]=.027).
CONCLUSION
Une mesure des trajectoires de fragilité n’apporte une prédiction que marginalement meilleure par rapport à une mesure à la fin de la soixantaine. Ces résultats soulignent l’utilité d’un dépistage précoce de la fragilité pour prévenir le déclin fonctionnel, mais aussi l’utilité croissante à l’approche des 80 ans.
Title
Importance of Health Literacy and Knowledge Regarding Advance Care Planning Among Older Adults
Name
Clément Meier
Affiliation
University of Lausanne
Abstract
Background:
Individuals’ attitudes toward advance care planning (ACP) can be influenced by their health literacy and knowledge of the topic. Health literacy skills influence how people perceive their health difficulties, communicate with healthcare providers, and make medical decisions. Knowledge regarding end-of-life medical situations is likely to shape individuals’ decisions to engage in ACP. This study investigates the associations between individuals’ health literacy and knowledge of ACP and their attitudes toward end-of-life care planning among a representative sample of adults aged 58+ in Switzerland.
Method:
We used data from 1,369 respondents from wave 8 (2019/2020) of the Survey on Health, Ageing, and Retirement in Europe. Subjective ACP health literacy was measured with questions on the competencies in understanding medical interventions, finding information, communicating, and making decisions about end-of-life care options. Respondents’ knowledge was assessed using test-based questions on 11 end-of-life medical situations. Engagement in end-of-life care planning was measured by having advance directives (ADs) and/or having designated a healthcare proxy and approving to have ADs in the future. Associations were estimated using separate probit regressions, controlling for social, health, and regional characteristics.
Results:
We found that respondents with higher ACP health literacy tended to have higher end-of-life knowledge. Individuals with higher ACP health literacy were also more likely to approve and have ADs. Individuals with higher knowledge scores were more likely to have completed ADs. Finally, when we simultaneously included both variables in the model, only the positive association of ACP health literacy with approval and completion of ADs remained statistically significant.
Conclusions:
Our findings show that ACP health literacy seems to play a preponderant role in ADs approval and completion. Thus, encouraging the writing of ADs should not be based exclusively on informing individuals but should focus on strengthening their competencies to complete ADs by providing them with adequate support.
Title
Influence of case characteristics on use and costs of home care services
Name
Flurina Meier
Affiliation
ZHAW, Winterthur Institute of Health Economics AND SwissTPH -Swiss Tropical and Public Health Institute PH
Abstract
The number of home-dwelling persons with care needs, using home care services, has increased substantially in the past years in Switzerland, amongst others due to earlier hospital discharges and later admissions to nursing homes. These developments are likely to have increased the complexity of home care situations and home care needs of clients. However, little is known about the case and context characteristics of home care situations that are linked to higher service use or higher costs. In this study we provide new insights into the relationship between case and environment characteristics, and service use and costs.
Methods
This cross-sectional, observational study was carried out with eight home care service organisations (Spitex) throughout Switzerland. The study included all home care service clients undergoing routine assessments or re-assessments mandatory for insurance reimbursement (interRAI Home-Care) during an inclusion phase. InterRAI Home-Care assessment data was linked to administrative data on service use in the three months following the inclusion of the case. Corresponding costs will be calculated.
In literature no model of complex care situations for the out-patient care sector with a focus on remuneration existed. We, therefore, developed such a complexity model based on the literature and expert’s opinion. For each factor of the complexity model we will determine how strongly it is associated with service use and costs in univariate regression models. Multivariate regression analyses will be used to predict home care service use and costs for care situations considered to be particularly demanding by Spitex experts, such as clients with cognitive impairment/dementia, instable and palliative care situations. A lack of, or overwhelmed, informal caregivers will be considered as effect modifiers, relevant confounders will be accounted for.
Results
The inclusion phase started in Mai 2022 and finished in November 2022, resulting in 1’144 home care service clients included in the study. Data collection will finish in March 2023. By autumn 2023 we will present final results from this study.
Discussion
Insights on case and context characteristics influencing service use and costs of home care services is sparse. Our study is the first addressing this question for Switzerland in a systematic way using a large and rich data set on home care clients and their service use and costs.
Title
Older adults' medical preferences for the end of life: a cross-sectional population-based survey in Switzerland
Name
Sarah Vilpert
Affiliation
HEC, University of Lausanne
Abstract
Objectives: Medical decision-making at the end of life is common and should be as patient-centered as possible. Our study investigates older adults’ preferences toward three medical treatments that are frequently included in advance directive forms and their association with social, regional, and health characteristics.
Setting: A cross-sectional study using population-based data of wave 8 (2019/20) of the Swiss component of the Survey of Health, Ageing, and Retirement in Europe (SHARE).
Participants: 1,430 adults aged 58 years and older living in Switzerland.
Primary and secondary outcome measures: Three questions on the preferences regarding cardiopulmonary resuscitation (CPR); life-prolonging treatment in case of high risk of permanent mental incapacity; reduced awareness (sedation) to relieve unbearable pain and symptoms. Their associations with individuals’ social, regional and health characteristics.
Results: Most older adults expressed a wish to receive CPR (58.6%) and to forgo life-prolonging treatment in case of permanent mental incapacity (90.7%). Most older adults also indicated that they would accept reduced awareness if necessary to receive effective treatment for pain and distressing symptoms (60.8%). Older adults' treatment preferences for CPR and life-prolonging treatment differed according to sex, age, partnership status, linguistic region and health status, while willingness to accept reduced awareness for effective symptom treatment was more similarly distributed across population groups.
Conclusions: Simultaneous preferences for CPR and refusal of life-prolonging treatment might appear to be conflicting treatment goals. Considering individuals’ values and motivations can help clarify ambivalent treatment decisions. Structured ACP processes with trained professionals allows for exploring individuals' motivations and values and helps to identify congruent care and treatment goals.
Title
Frühzeitige Erkennung chronischer Krankheiten – am Beispiel von COPD
Name
Diederik Eijsvogel
Affiliation
Die Präsentation wird freundlicherweise unterstützt von AstraZeneca AG
Abstract
Burden of COPD
Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung condition characterized by chronic dyspnea, cough and sputum production.1 COPD stands as the third leading cause of death worldwide.2 The Global Initiative for Chronic Obstructive Lung Disease (GOLD) defines COPD as a “common, preventable, and treatable disease”.1 The global burden of COPD affects an estimated 384 million individuals1, with Switzerland harboring between 200’000 to 300’000 patients .3,4 The burden of COPD is projected to escalate due to an aging population and sustained exposure to COPD risk factors.12
COPD exacerbations, also known as “lung attacks” and experienced by a majority of patients, contribute significantly to irreversible lung damage, decreased lung function, and elevated risk of future cardiopulmonary events (exacerbations, cardiovascular complications) and mortality.5-9 The prevalence of exacerbations and hence the progression of the disease can be avoided and reduced by diligent follow-up and therapeutic optimization in the primary care setting .5,10-11
Accurate diagnosis and effective therapy are pivotal in preventing exacerbations and hospitalisation. Diagnosis of COPD is done via spirometry at the primary care setting. But 36% of Swiss patients did not have any spirometry results available at hospital admission.4 Challenges stem from time constraints, limited capacity, and ability to perform the spirometry.
Recent surveys reveal a substantial gap in public awareness of the disease, both among the general publication (approximately 45%) and health policy makers (roughly 30%) across 14 countries, including but not limited to Germany, Italy, France, Spain and Belgium).13 Misconceptions persist, including that COPD is solely a smoker’s disease, which contributes to individuals not seeking timely help for symptoms resulting in under-diagnosis and under-recognition of the disease.14 The good news is: COPD is treatable and patient empowerment ist possible, yet not all evidence-based solutions are widely recognized by all the important stakeholders.13
In conclusion, to improve COPD management, we need to start to invest into holistic approaches with several different stakeholders, starting with primary care, speciality care, patient organisations, pharma industry, insurances, societies and more. Simultaneously, increased public awareness is vital for facilitating early diagnosis and management of COPD.
References:
- Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for prevention, diagnosis and management of COPD. 2023
- World Health Organization. The top 10 causes of death. https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death. Accessed October 14, 2021.
- Russi EW, Karrer W, Brutsche M, Eich C, Fitting JW, Frey M, Geiser T, Kuhn M, Nicod L, Quadri F, et al: Diagnosis and management of chronic obstructive pulmonary disease: the Swiss guidelines. Official guidelines of the Swiss Respiratory Society. Respiration 2013; 85: 160–174.
- Buess M, Schilter D, Schneider T, Maurer M, Borer H, Thurnheer R, Köhler E, Junker L, Jahn K, Grob M, Rüdiger J, Geiser T, Helfenstein E, Solèr M, Fiechter R, Sigrist T, Brun P, Barandun J, Koltai E, López-Campos JL, Hartl S, Roberts M, Schumann DM, Tamm M, Stolz D. Treatment of COPD Exacerbation in Switzerland: Results and Recommendations of the European COPD Audit. Respiration. 2017;94(4):355-365.
- Gouveia A, Mauron C, Marques-Vidal P. Potentially Avoidable Hospitalizations by Asthma and COPD in Switzerland from 1998 to 2018: A Cross-Sectional Study. Healthcare (Basel). 2023 Apr 26;11(9):1229.
- Miravitlles M, Bhutani M, Hurst JR, Franssen FME, van Boven JFM, Khoo EM, Zhang J, Brunton S, Stolz D, Winders T, Asai K, Scullion JE. Implementing an Evidence-Based COPD Hospital Discharge Protocol: A Narrative Review and Expert Recommendations. Adv Ther. 2023 Aug 4
- Suissa S, Dell’Aniello S, Ernst P. Long-term natural history of chronic obstructive pulmonary disease: severe exacerbations and mortality. Thorax. 2012;67:957–63
- Suissa S, Dell’Aniello S, Ernst P. Long-term natural history of chronic obstructive pulmonary disease: severe exacerbations and mortality. Thorax. 2012;67:957–63
- Watz H, Tetzlaff K, Magnussen H, Mueller A, Rodriguez-Roisin R, Wouters EF, et al. Spirometric changes during exacerbations of COPD: a post hoc analysis of the WISDOM trial. Respir Res. 2018;19:251.
- Criner R.N., Han M.K. COPD Care in the 21st Century: A Public Health Priority. Respir. Care. 2018;63:591–600. doi: 10.4187/respcare.06276
- Singh D., Agusti A., Anzueto A., Barnes P.J., Bourbeau J., Celli B.R., Criner G.J., Frith P., Halpin D.M.G., Han M., et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease: The GOLD science committee report 2019. Eur. Respir. J. 2019;53:1900164
- Bloom, D.E., et al. (2011). The Global Economic Burden of Noncommunicable Diseases. Geneva: World Economic Forum.
- Act on COPD. Common, Preventable, Treatable: Has COPD been underprioritised? (2022) Accessible at: https://qrcgcustomers.s3-eu-west-1.amazonaws.com/account21372441/30986798_2.pdf?0.16088484869497655 [last accessed July 2023]
- Mathioudakis et al. Stigma: an unmet public health priority in COPD. The Lancet Respiratory Medicine. (2021) 955-956