Donnerstag, 28.09.2017

15:45 - 17:15

Hörsaal 12

S213

Gebrechlichkeit, Multimorbidität, und Funktionalität - Drei Seiten derselben Medaille?

Moderation: D. Dallmeier, Ulm

Altern, als physiologischer Prozess, ist per se mit einem progressiven Funktionsabbau unterschiedlicher Systeme assoziiert, was gleichzeitig in manchen Fällen das Auftreten von Krankheiten wie Niereninsuffizienz, arterielle Hypertonie usw. begünstigen, und zu einer Verschlechterung der homöostatischen Reserven und der Resilienz führen kann. Der Begriff Gebrechlichkeit, in English Frailty, wurde 1991, als ein Versuch die Komplexität dieser Veränderungen zu erfassen, eingeführt. Allerdings ist die Benennung ihrer Attribute je nach Vertreter sehr unterschiedlich. So wird unter den Geriatern u.a. Mangelernährung, Hilfsbedürftigkeit, Gleichgewichtsstörungen, Schwäche, Anorexia, Demenz, und Polypharmazie genannt. Patienten und Betreuer heben zusätzlich die soziale Interaktion sowie die emotionale Stimmung hervor. Die Operationalisierung von Gebrechlichkeit ist sehr divers und wird daher immer wieder kontrovers diskutiert. So variiert die Prävalenz von Gebrechlichkeit in einer Population stark in Abhängigkeit der verwendeten Instrumente. In diesem Kontext möchten wir in unserem Symposium darüber diskutieren 1) ob Gebrechlichkeit und Multimorbidität zwei unterschiedliche Entitäten sind, oder nicht; 2) ob man Instrumente zur Evaluierung von Funktionalität und körperlicher Behinderung als Surrogate für die Identifizierung von gebrechlichen Individuen in klinischen Studien anwenden kann; 3) was für eine Bedeutung Gebrechlichkeit in der geriatrischen Onkologie hat oder haben kann; und 4) wie die Akkumulation von Defiziten uns dafür helfen kann, eine ältere Studienpopulation bezüglich Gebrechlichkeit zu charakterisieren.

15:45
Frailty and multi-morbidity - Two different entities or just two expressions for the same condition
S213-01 

J. M. Bauer; Heidelberg

Frailty has been defined as a geriatric syndrome characterized by declining reserves and increased vulnerability. While aging triggers the development of frailty and affects the overall functional status of an older person, individual comorbidity is of equal or even of greater importance in this regard. Major disease entities like chronic kidney disease or heart failure interfere with physiological systems that are also involved in the aging process. On a molecular and cellular level the effects of aging and those of chronic diseases often involve similar mechanisms. As with increasing age the simultaneous presence of multiple chronic diseases becomes more frequent, from a clinical perspective the effects of aging and multimorbidity on the development of frailty can rarely be distinguished. Although frailty and multimorbidity are conceptually different, they are closely interrelated as the frailty assessment integrates the combined effects of aging and multimorbidity on individual reserve and vulnerability in higher age.

16:05
Evaluating scores of functionality and disability for the characterization of frail older persons within clinical studies - explorations and recommendations of the Medication and Quality of Life in frail older persons (MedQoL) Research Group*
S213-02 

S. Brefka, D. Dallmeier, V. Mühlbauer, J. M. Bauer, W. Haefeli, S. Voigt-Radloff, M. Denkinger; Ulm, Heidelberg, Freiburg

Background: Although underrepresentation of older adults in clinical trials is decreasing, information about frailty is still lacking. We aimed to identify functionality and disability assessments and evaluate their usability as surrogates for frailty in observational and randomized controlled trials on geriatric pharmacotherapy.

Methods: An expert group including geriatricians, clinical pharmacologists, and epidemiologists reached a consensus on a list of assessments of frailty, functionality, and disability frequently applied in older people. If available, standardized cut-off points for frailty were extracted. For instruments without established frailty cut-off, the expert group agreed on proposed cut-off points by assessing (i) the number and weight of items, (ii) the used score system and its clinical interpretation, and (iii) the question “Which score would a patient in a given frailty category most likely obtain?”.

Results: Fourteen of the identified 33 instruments had established frailty cut-offs. The other 19 instruments are commonly used to measure functionality addressing mobility and activities of daily living among others. For each of these 19 instruments cut-off values for the following frailty levels: very frail, frail, pre-frail, and not frail were defined.

Conclusion: To characterize frail older people in clinical trials and observational studies, we propose cut-off points for 33 existing assessments on functionality and frailty. These approximations may help to support the search, analysis, synthesis, and interpretation of evidence in older people not just based on the chronological age but according to their functional and frailty status. Next steps should evaluate the sensitivity of these proposed cut-offs for the identification of frail older people.

16:25
Die Bedeutung von Frailty-Aspekten in der geriatrischen Onkologie
S213-03 

H. Burkhardt; Mannheim

Um vor anspruchsvollen und belastenden Therapiestrategien ein möglichst individuelle Risiko-Nutzen Relation abbilden zu können wird die Integration geriatrischer Aspekte in die Diagnostik empfohlen. Hier spielt das altersbedingte Phänomen der Frailty (Gebrechlichkeit) eine bedeutsame Rolle und wurde bereits in den Anfängen der geriatrischen Onkologie zwar nicht explizit aber indirekt aufgegriffen.

Der Vortrag stellt aktuelle Entwicklungen in der geriatrischen Onkologie vor und zeigt auf welche Aspekte hier dominant sind. Er versucht auch die Bezüge zwischen altersbedingtem Verlust der Muskelmasse und –funktion (Sarkopenie) und Effekten durch Tumoraktivität (Kachexie) hinsichtlich ihrer Bedeutung für therapeutischen Entscheidungsprozesse darzustellen. Ferner wird ein Ausblick gegeben, wie eine Implementierung geriatrisch fundierter diagnostischer Prozesse in onkologische Therapiealgorithmen gelingen kann.

16:45
High deficit accumulation in a large cohort of fit older Swabians - results from the ActiFE Study
S213-04 

D. Dallmeier, U. Braisch, J. Klenk, D. Rothenbacher, M. Denkinger; Ulm

Background: Deficit accumulation is a well acknowledged approach to determine frailty in older adults. The Activity and Function in the Elderly (ActiFE Ulm) Study is a longitudinal cohort study among adults ≥65 years, which started in 2009. We intended to study whether deficit accumulation was associated with six-year mortality in community dwelling older adults.

Methods: A frailty index (FI) was built according to the model proposed by Rockwood. We identified 38 items at baseline representing following domains: basic and instrumental activities of daily living, comorbidities, number of medications, fall risk, psychosocial anamnesis, cognitive function, physical activity, fitness and self-awareness. Each variable had a score from 0 (no deficit) to 1 (presence of deficit). FI represents the sum of all scores divided by 38. Cox-proportional hazards models evaluated the association of the estimated FI and six-year mortality stratified by sex, adjusted for age, smoking and education.

Results: A total of 948 subjects were considered for this analysis (mean age 75.3±6.3, 57.5% men). Median FI was 0.11 (interquartile range (IQR) [0.07, 0.17]) in men, and 0.12 (IQR [0.07, 0.19]) in women, 16.2% men and 21.6% women had a FI ≥0.2. We observed a total of 128 deaths (median FU 2434 days). A 10% increment of FI was associated with an adjusted hazard ratio (HR) of 2.28 [95% CI 1.79, 2.89] in men and a HR of 1.81 [95% CI 1.40, 2.35] in women for death during six-year follow-up. As categorical, those with FI ≥0.2 had a HR of 3.40 [95% CI 2.26, 5.11] in men, and a HR of 3.18 [95% CI 1.59, 6.33] in women.

Conclusions: Using a deficit accumulation approach for frailty requires a thorough assessment of older people, which may not be easily accomplished in the clinical settings. In this relatively healthy population-based cohort, ca. 20% were categorized as frail (FI ≥0.2). FI, both as continuous and categorical measure, was clearly associated with six-year mortality in men and women.

 

 

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