‫حضرت رسول اكرم (ص)‬
‫وجود سالمندان در بين شما باعث بركت و نعمت هاي الهي ميشود‬
‫‪1‬‬
‫(بحاراالنوار)‬
Frailty
Reza Fadayevatan,
MD, MPH, PhD
The University of Social Welfare and Rehabilitation Sciences
2
(USWR)
Topics of Lecture
What is Ageing?
Where we are?
Frailty
Prevention of frailty
Mutual responsibilities
3
‫?‪1- What is Ageing‬‬
‫جوانی چنين گفت روزی به پيری‬
‫که چون است با پيريت زندگانی؟‬
‫بگفت اندرين نامه حرفی است مبهم‬
‫(پروین)‬
‫‪4‬‬
‫که معنيش جز وقت پيری ندانی‬
‫‪what goes around comes around‬‬
‫تازه جوانی ز ره نيشخند‬
‫پير بخنديد و بگفت ای جوان‬
‫‪5‬‬
‫گفت به پيری که کمانت به چند؟‬
‫چرخ تورا نيز دهد رايگان‬
What is Ageing?
•Progressive loss of adaptability
•Increased risk of acquiring disease
•Increased risk of dying
•Starts age 12
6
The Story of Life: a Postcard
from 19th Century Germany
*Courtesy of Elizabeth Barrett-Connor
7
Why Ageing? The force of mortality
Age specific mortality
(per thousand)
1000
100
10
1870
1920
1950
1990
1
0.1
0
20
40
60
80
100
Age (years)
9
Why Ageing? Increased life expectancy
life expectancy at birth in the 20th century
90
life expectancy (years)
80
70
60
50
40
male
30
female
20
10
0
1890
1910
1930
1950
year
1970
1990
10
Why Ageing? Trends in birth rates
• Fewer births
• More survivors of infancy
• Decreased mortality in adult
• Health improvement
11
‫?‪2- Where we are‬‬
‫‪ ‬جمعيت كل كشور در سال ‪70,495,782 :85‬‬
‫‪ ‬جمعيت سالمند كشور در سال ‪5,121,043 : 85‬‬
‫‪ ‬درصد سالمندي كشور‪ 26/7 :‬درصد‬
‫‪ ‬تعداد افراد داراي يك معلوليت يا بيشتر در استان تهران‪ 151899 :‬نفر‬
‫‪ ‬تعداد افراد ‪ 100‬ساله و بيشتر در استان تهران‪ 1891 :‬نفر‬
‫‪ ‬تعداد افراد ‪ 100‬ساله و بيشتر در شهر تهران‪ 1138 :‬نفر‬
‫‪12‬‬
‫‪Tehran Province‬‬
‫‪ ‬استان تهران‪:‬‬
‫‪ ‬كل جمعیت‪13,422,366 :‬‬
‫‪ ‬جمعیت سالمند‪973,183 :‬‬
‫‪ ‬جمعیت سالمند داراى درآمد بدون كار‪385,200 :‬‬
‫‪ ‬شهر تهران‪:‬‬
‫‪ ‬كل جمعیت‪7,975,679 :‬‬
‫‪ ‬جمعیت سالمند‪686,431:‬‬
‫‪ ‬درصد سالمندی‪8.6 :‬‬
‫‪ ‬جمعیت سالمند داراى درآمد بدون كار‪293,815 :‬‬
‫‪13‬‬
‫گروههاي سني سالمندان تهراني كه به صورت‬
‫انفرادي زندگي مي كنند‬
‫گروههاي سني‬
‫‪60-64‬‬
‫‪65-69‬‬
‫‪70-74‬‬
‫‪ 75‬به باال‬
‫جمع‬
‫‪14‬‬
‫تعداد سالمندان‬
‫‪14561‬‬
‫‪18217‬‬
‫‪22043‬‬
‫‪34685‬‬
‫‪89506‬‬
‫میزان سالخوردگی در مناطق مختلف شهر تهران‬
‫‪15‬‬
‫میانگین هزینه سالمت در مناطق مختلف شهر‬
‫تهران‬
‫‪16‬‬
‫هزینه تشخیص پزشکی در مناطق مختلف شهر‬
‫تهران‬
‫‪17‬‬
‫روند تغییر جمعیت در ایران‬
‫‪1385‬‬
‫‪18‬‬
‫‪1375‬‬
‫‪1365‬‬
‫سال سرشماری‬
‫‪%25.08‬‬
‫‪%39.5‬‬
‫‪%45.45‬‬
‫جمعیت زیر ‪ 15‬سال‬
‫‪%7.27‬‬
‫‪%6.62‬‬
‫‪%5.43‬‬
‫جمعیت باالی ‪60‬‬
‫سال‬
‫ضریب سالمندي‬
‫‪ ‬نسبت جمعیت باالي ‪ 65‬سال به جمعیت زیر ‪ 15‬سال‬
‫‪ ‬ضریب سالمندي در سال ‪1365‬‬
‫‪ ‬ضریب سالمندي در سال ‪1375‬‬
‫ضریب سالمندي در سال ‪1385‬‬
‫‪19‬‬
‫‪% 6.68‬‬
‫‪%10.93‬‬
‫‪%20.68‬‬
3- Frailty:
Frailty is defined as:
 Persons with a high probability of
dependency on others for daily care
within the next 12 months
 The World Health Oranization has
described frailty as the state when
“awareness” of a problem arises
20
What is Frailty? (1)
 Elderly people are Frail when they have
multiple interacting medical and psychosocial problems
 Frailty represents increased vulnerability
which is associated with ageing
 These patients do not have a common
pathology
21
What is Frailty? (2)
 Frailty may not be a disease, but there is no
question that certain diseases and medical
problems play a large role in it
 Frailty is the beginning of a
cascade that leads to functional deterioration,
hospitalization,
institutionalization, and death
22
What is Frailty? (3)
23
Prevalence


10-25% over 65 y/o
30-45% over 85 y/o

The proportion is increasing with ageing society
24
Frailty
 Keywords: (Frailty, Fragility, Vulnerability)
 Frailty in our literature
 Frailty in the religious context
 Frailty in the health sciences
25
Frailty is not disability
 Similarities
 More common with advanced age, both increase
morbidity and mortality
 Differences
 Frailty always means multisystem failure; disability may
be due to failure of one or more systems
 Frailty always unstable; disability may be stable
 Thus, frailty often described as “subclinical” or
“preclinical” disability
26
‫حدیقة الحقیقه و شریعه سنایي غزنوي‬
‫عمر دادم بجملگي بر باد‬
‫‪27‬‬
‫بر من آمد ز شصت صد بیداد ‪‬‬
‫كشكول شیخ بهائي‬
‫پس از پنجه نباشد تن درستي ‪‬‬
‫بصر كندي پذیرد پاي سستي‬
‫چو شصت آمد نشست آمد پدیدار ‪‬‬
‫‪‬‬
‫به هشتاد و نود چون در رسیدي ‪‬‬
‫بسا سختي كه از گیتي كشیدي‬
‫از آن جا گر به صد منزل رساني ‪‬‬
‫بود مرگي بصورت زندگاني‬
‫‪28‬‬
‫شکایت گفتن پیرمردی به طبیب از رنجوریها و جواب گفتن طبیب او را‬
‫گفت پیری مر طبیبی را که من‬
‫گفت از پیری است آن ضعف دماغ‬
‫گفت از پیری است ای شیخ قدیم‬
‫گفت از پیری است ای شیخ نزار‬
‫گفت ضعف معده هم از پیری است‬
‫گفت آری انقطاع دم بود‬
‫گفت کم شد شهوتم یکبارگی‬
‫گفت پایم سست شد از ره بماند‬
‫گفت پشتم چون کمانی شد دوتا‬
‫گفت تاریک است چشمم ای حکیم‬
‫گفت ای احمق براین بر دوختی‬
‫ای مدمغ عقلت این دانش نداد‬
‫تو خر احمق ز اندک مایگی‬
‫پس طبیبش گفت کای عمر تو شصت‬
‫چون همه اجزا و اعضا شد نحیف‬
‫‪29‬‬
‫در زحیرم از دماغ خویشتن‬
‫گفت بر چشمم ز ظلمت هست داغ‬
‫گفت پشتم درد میآید عظیم‬
‫گفت هر چه میخورم نبود گوار‬
‫گفت وقت دم مرا دمگیری است‬
‫چون رسد پیری دو صد علت شود‬
‫گفت از پیری است این بیچارگی‬
‫گفت کز پیری است در کنجت نشاند‬
‫گفت از پیری است این رنج و عنا‬
‫گفت از پیری است ای مرد حلیم‬
‫از طبیبی تو همین آموختی‬
‫که خدا هر درد را درمان نهاد‬
‫بر زمین ماندی ز کوته پایگی‬
‫این غضب وین خشم هم از پیری است‬
‫خویشتنداری و صبرت شد ضعیف‬
‫قانون ابن سینا‬
‫مراحل عمر‪ ،‬ازديدگاه ابن سينا‪:‬‬
‫‪‬‬
‫‪‬‬
‫‪‬‬
‫‪‬‬
‫‪‬‬
‫‪‬‬
‫‪30‬‬
‫اول‪ ،‬سن نمو‪ :‬كه آنرا سن آغازي مي نامند و این مرحله تا نزدیك سي‬
‫سالگي است و شامل پنج مرحله‪ ،‬مي باشد‪:‬‬
‫‪ )1‬سن نوباوگي و آن زماني است كه شیرخوار‪ ،‬هنوز قدرت‬
‫برخاستن و حركت دادن اندام را ندارد‪.‬‬
‫‪ )2‬سن خردسالي كه در آن طفل‪ ،‬پا مي گیرد ولي هنوز استوار‬
‫نیست و آن زماني است كه هنوز افتادن دندان هاي شیري و روئیدن دندان‬
‫هاي دائمي‪ ،‬شروع نشده است‪.‬‬
‫‪ )3‬سن نشوونما كه مرحله اي است بعد از نیرو گرفتن و رویش‬
‫دندان هاي دائمي و پیش از بلوغ‪.‬‬
‫‪ )4‬سن نوجواني و آن تا زماني است كه جوش در صورت‬
‫ظاهر مي شود‪.‬‬
‫‪ )5‬سن جواني كه بعد از نوجواني است تا زماني كه نمو متوقف‬
‫مي گردد‪.‬‬
‫مراحل عمر‪ ،‬ازديدگاه ابن سينا‬
‫‪ ‬دوم‪ ،‬سن وقوف یا ركود‪ :‬كه آنرا سن جواني‪ ،‬خوانند و تا مرز‬
‫سي و پنج تا چهل سالگي ادامه دارد‪.‬‬
‫‪ ‬سوم‪ ،‬سن فرازي‪ :‬كه با بقاء قوه‪ ،‬قرین است و آن سن نوپیران‬
‫است و تا مرز شصت سالگي دوام دارد‪.‬‬
‫‪ ‬چهارم‪ ،‬سن فرودي‪ :‬كه با پیدایش ناتواني قرین است و آن سن‬
‫پیري است تا پایان زندگي‬
‫‪31‬‬
Co-morbid conditions by age
percentage of women with:
No illnesses
1 llness
80
2 or more illnesses
70
60
50
40
30
20
10
0
60-69 years
70-79 years
80+ years
32
Atypical disease presentations
 Their history:
 “giants”
 “silent”
 “atypical”
This is determined by change in function, not by change in
parameters such as cardiac index, serum level of creatinine
33
Atypical disease presentations
Delirium
Falls
Immobility
Incontinence
Pressure ulcers
Social breakdown
34
Risk Factors of frailty
Aging
Psycho
Social
Diseases
Environment
Reserve
capacity
Adaptability
Familial
physical capacity
cognition
nutrition
sensory
affective
Frailty
factors that
are essential for
interaction
with environment
Risk factors
Functional decline
35
How does Frailty happen?
• Virtually before our eyes.
• Family care givers are so concerned about
the “Big Staff”-cancer, MI, Stroke- and
overlook the less obvious: loss of appetite,
ADL, Depression.
• Since Frailty is not a disease, it can slip
through the cracks.
36
Approach to Illness in the Older
Patient
• In older adults, the
presenting problem is just
the “tip of the iceberg” of
a pathological process,
which takes careful
diagnostic assessment to
uncover.
• For example, a certain
elderly patient is having
recurrent falls. Why?
37
Approach to Illness in the Older
Patient
•
After some history taking and some
simple laboratory tests, you find this
patient has exercise induced hypoxia.
•
And why the hypoxia? Because of the
true but hidden diagnosis of Congestive
Heart Failure that had not been
diagnosed by anyone previously and,
now requires treatment.
•
And just where did that ice-berg come
from (i.e.. Why are they in failure now?
How much is reversible?)?
38
Atypical disease presentations
• Their history:
– “giants”
– “silent”
– “atypical”
Illness in old age often presents atypically, or is often
masked. This is determined by change in function, not by
change in parameters such as cardiac index, serum level
of creatinine. For example:
Silent MI or Urinary Tract Infection presenting as confusion
39
Who do we see?
Geriatric Syndromes
•
•
•
•
•
•
•
•
•
•
•
Confusion
Falls
Delirium
Immobility
Incontinence
Pressure ulcers
Social breakdown
Loss of independence
Depression
Multiple medical problems and medications
Elder abuse
40
40
The Giants of Geriatrics
The Big Three ‘I’s
• Intellectual failure
• Instability and immobility
• Incontinence
42
Use of hospitals in the final 15 years of life
Himsworth R L,
Goldacre M J.
BMJ
1999;319:1338-9
43
Survival Rates by Age Group (65- 69 Yrs)
100%
90%
80%
Percent
70%
60%
Frail
Non-Frail
50%
40%
30%
20%
10%
0%
1
2
3
4
5
Years
6
7
8
9
44
Survival Rates by Age Group (70 - 74 Yrs)
100%
90%
80%
Percent
70%
60%
Frail
Non-Frail
50%
40%
30%
20%
10%
0%
1
2
3
4
5
Years
6
7
8
9
45
Survival Rates by Age Group (70 - 74 Yrs)
100%
90%
80%
Percent
70%
60%
Frail
Non-Frail
50%
40%
30%
20%
10%
0%
1
2
3
4
5
Years
6
7
8
9
46
Survival Rates by Age Group (80 - 84 Yrs)
100%
90%
80%
Percent
70%
60%
50%
40%
Frail
Non-Frail
30%
20%
10%
0%
1
2
3
4
5
Years
6
7
8
9
47
Survival Rates by Age Group (85 Yrs & Older)
100%
90%
80%
Percent
70%
60%
Frail
Non-Frail
50%
40%
30%
20%
10%
0%
1
2
3
4
5
Years
6
7
8
9
48
Age is just a number
“How old would you be if
you didn’t know how old
Satchel Paige
you were?”
Age is just a number
49
Fitness and Frailty
BA=Biological Age
CA
Fitness
Frailty
BA
CA=Chronological Age
50
Fitness and Frailty
Frail Elderly
BA
CA
BA (Biological Age) > CA (Chronological Age)
51
Fitness and Frailty
Fit Elderly
CA
BA
BA (Biological Age) < CA (Chronological Age)
52
54
55
Can Frailty Be Treated or Prevented?
While some aspects of frailty are age-related and
irreversible, others are not. Frailty should be seen
as treatable, and as an important stage on the road
to disability and serious illness.
it is important to consider which therapies make
sense for a frail elderly person and which are to
improve the quality of life.
57
Governors’ Responsibility
 It is mutual
Growing up gracefully
59
Growing up disgracefully
60
Aspects of responsibilities
 1- Public education
 2- Public facilities )work, leisure, …(
 3- Public access for elderly and disabled
 4- lawful community
 5- Social support )family economy…(
 6- Using their invaluable experience
 …Age friendly city
61
Lawful environment
62
63
Socially engaged
64
Age friendly city
65
Summary
•Ageing is a (the) major human
achievement of the 20th century
•Age in just a number
•Mutual responsibility of people
and governing
66
Thank you for listening
67