Epidemiologic characteristics Participation barriers-and frailty related items in a cohort of older people in rural Crete with low MMSE

Transcription

1 Epidemiologic characteristics Participation barriers-and frailty related items in a cohort of older people in rural Crete with low MMSE University of Crete (a partner in the MISTRAL COMMITMENT of the A3 group of the EPI AHA) Program Thales-Multidisciplinary Network for the Study of Alzheimer's Disease in Rural Areas

2 Disclosure LAGOUTA, HERAKLION, CRETE, GREECE

3 VILLAGES : Heraklion

4 Overall Aims of the study At the Clinical level: Establishment of a multidisciplinary network (Center of Excellence at the University of Crete) of experts (geriatricians-neurologistspsychiatrists-general practitioners-psychologists) in dementia diagnosis and treatment At the Educational level: Development of a Comprehensive geriatric method for assessment of older people with cognitive impairment and implementation of educational programs for primary health care providers

5 Overall Aims of the study At the Research level: Create a longitudinal cohort of elders in rural areas of Crete and develop a clinical and genetic information database of well characterized individuals with cognitive impairment linked to a DNA bank in order to Detect factors associated with healthy aging Evaluate risk factors for frailty and cognitive decline Dietary habits Stress, depression Alcohol, smoking Sleep patterns Physical activity Social connectivity Genetic and epigenetic factors

6 Figure 1: Overall participants N=3579 persons asked to participate Phase A N=3220 (90%) accepted & participated Phase A N=359 (10%) refused to participate Phase A N=667 (20.7%) met criteria to participate Phase B N=2553 (79.3%) did not meet criteria to participate Phase B N=402 (60.3%) accepted & participated Phase B N=265 (39,7%) refused to participated Phase B

7 Phase A: Reasons of refusal to Participate Phase B Presented in order of frequency (rough estimation) 1. I am ok, I do not need any further tests 2. I am tired of doctors and I do not like the system 3. I have other more important problems to deal with (family problems or other medical issues) 4. Inconvenience, no way to get to the clinic and I don't want the doctor to come to my house Participation rates were similar between males and females (60%) Mean age of participants was 77.6 years and of non participants 78.6

8 u1 Higher education, greater number of comorbidities and a surviving spouse predict higher likelihood for phase B participation Logistic regression predicting the odds of an eligible person to participate inthesecondphaseoftheprogram(n=643includedinthemodel) Variable Odds ratio 95% CI p-value Male gender Age(years) MMSE score Number of chronic conditions > Widowed or divorced Less than 6 years of education Katz index 4/

9 Diapositive 8 u1 Garyfalia: is it write? I think that lower number of morbidities predicts participation user; 11/05/2015

10 Phase B : Significantly higher rates of exhaustion, physical slowness and stationary life style among participants with dementia (SHARE * Frailty items) 39,7 Exhaustion 23,3 p = ,3 Reduced Appetite 10, ,6 % p =.6 Physical Slowness p =.006 Stationary Life Style ,3 p = Dementia MCI Non-Impaired * SHARE Instrument for Primary Care from the Survey of Health, Ageing and Retirement in Europe

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12 ACTIONABLE LESSONS & NEXT STEPS TRAINNING OF PRIMARY CARE HEALTH PERSONNEL CREATE MOBILE UNITS FOR ACCESABILITY USE OF e HEALTH TOOLS CITIZEN TRAINING IN USE OF SOCIALBE MEDIA FOR CONNECTIVITY, KNOWLEDGE, LITERACY COMMUNITY INVOLVENT IN MEANGFUL ACTIVITIES [environment, creative arts, spirituality] REGIONAL AUTHRORITY INVOLVEMENT

13 Many thanks Participants from the villages Primary Healthcare practitioners All the members of Thales Team CharikliaTziraki-Segal, Director of MelabevResearch and Evaluation Unit and HEBREW U, Israel, & ALLILEGI NGO, Heraklion, Crete, Greece

14 Thales Team SymeonPanagiotakis 1, SimosPanagiotis 2, BertsiasΑntonios 3, Fountoulakis Nick 1, GiakkaMaria 1, ZaganasIoannis 4, KapetanakiStefania 3, BastaMaria 5, KoutentakiEirini 5, ΤzirakiSophia 2, DuijkerGeorge 3, ManassakiCynthia 3, LionisChristos 3, PlaitakisAndreas 4, Tziraki-Segal Chariklia 6, Boumpas Dimitrios 7, VgontzasAlexandros 4 1. Department of Internal Medicine University General Hospital of Heraklion, Crete, 1. Department of Internal Medicine University General Hospital of Heraklion, Crete, Greece 2. Department of Clinical Psychiatry Medical School University of Heraklion Crete, Greece 3. Clinic of Social and Family Medicine Faculty of Medicine University of Crete, Greece 4. Department of Neurology University General Hospital of Heraklion Crete, Greece 5. Department of Psychiatry University General Hospital of Heraklion Crete, Greece 6. ALLILEGI, NGO, HERAKLION, CRETE, GREECE & Melabev Research and Evaluation Unit and Hebrew University, Israel. 7. 4th Department of Medicine Medical School University of Athens, Greece

15 Primary healthcare clinic in rural Crete The Program has been cofinanced by the European Union (European Social Fund - ESF) and Greek national funds through the Operational Program Education and Lifelong Learning of the National Strategic Reference Framework ( ) Cretan Medical School