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CIBER FRAGILIDAD Y ENVEJECIMIENTO SALUDABLE
LEOCADIO RODRIGUEZ MAÑAS
Disability
“Failure to thrive”
Func
tiona
l Cap
acity
Death
Usual
Successful
Accelerated
DEATH
0
5
10
15
20
25
EU (2
7 co
untr
ies)
Bulg
aria
Denm
ark
Esto
nia
Gree
ce
Fran
ce
Cypr
us
Lith
uani
a
Hung
ary
Net
herla
nds
Pola
nd
Rom
ania
Slov
akia
Swed
en
Icel
and
Switz
erla
nd
Life expectancy at 50 y
Free-of-disability life expectancy at 50 y
LONGEVITY (AMOUNT OF LIFE)
QUALITY OF LIFE (FUNCTION)
CHRONIC DISEASE
HEALTH SYSTEMS
+ SOCIAL
SYSTEMS
Prevention Risk manag. Empowerment
Integrated Coordinated. Continued
FUNCTION
Nature, October 2016
LONGEVITY
Aging is not a disease: AGE ASSOCIATED CHANGES
Biological Aging Is No Longer an Unsolved Problem Ann NY Acad Sci 2007; 1100: 1-13
LEONARD HAYFLICK DISEASE
C. Age-related Frailty
Entropic Forces
Risk accumulation and homeostatic mechanisms dysfunction
Disability Clinical Detection
Studenski S. J Nutr Health Aging 2009;13:729-32
Decreased biological reserves and reduced physiologic function underlies frailty Aging process → Significative lost of Functional Reserve and Functional Capacity
• Decrease of Functional reserve with age → plausible association with decrease of functional capacity and performance of activities of daily living
• Because functional level is one of the best indicators of health status, Focus should be on functionality and not on the diagnosis of disease when facing older frail patients
0 0
60
80
100
40
20
20
40
60
80
100 FUNCTIONAL
RESERVE
80 years 20 Years
FUNCTIONAL RESERVE FUNCTIONAL CAPACITY
ADL
% Maximal strength to sit to stand from a chair
USUAL TIME
Frailty: a Complex Syndrome of Increased Vulnerability
Age
Life-course Determinants: Biological (including genetic) Psychological Social, Societal Environment
Chronic Disease
Decline in physiologic reserve
Adverse outcomes •Disability •Morbidity •Hospitalization •Institutionalization •Death
Candidate markers
•Nutrition •Mobility •Activity •Strength •Endurance •Cognition •Mood
REVERSIBILITY
Age
APPROPRIATE TIME
CHRONIC DISEASES
Lancet, November 2014
CONTRIBUCION ANUAL RETICEF
Los objetivos principales del CIBER sobre Fragilidad y Envejecimiento Saludable son:
1. Evitar la discapacidad en las personas mayores, mediante el conocimiento de sus causas, mecanismos y de la efectividad de las intervenciones terapéuticas y preventivas, con especial atención a las etapas precoces de la discapacidad (fragilidad), sus factores de riesgos y sus consecuencias. 2. Proveer de evidencia experimental a la toma de decisiones sobre modelos preventivos y asistenciales
Para el logro de estos objetivos principales, se desarrollarán 3 líneas estratégicas, Mecanismos biológicos del envejecimiento saludable orientado al mantenimiento de la autonomía funcional y de los mecanismos que conducen a la fragilidad y la discapacidad.
Trayectorias funcionales y factores moduladores. Estudios de cohortes. interacción enfermedad crónica-envejecimiento-deterioro funcional
Intervenciones preventivas y terapéuticas de la fragilidad y el deterioro funcional. análisis de eficacia, eficiencia y efectividad.
Garcia-Valles et al., 2013
144 C57BL/6J
72 72
Wheel-runners Sedentary
ESTUDIOS LONGITUDINALES
Our team We are a multidisciplinary team focused on research on older people focused on frailty, functional decline and chronic conditions (e.g. diabetes, heart failure) through observational and interventional studies on diagnostic procedures, biomarkers, models of care and new therapeutic approaches. • 12 Geriatricians • 2 Clinical Pharmacologists • 2 Biomedical engineers • 2 Biologists • 1 Mathematician and statistician • 1 Epidemiologist • 1 Nutritionist • 1 Physiotherapist • 1 Economist (health economics) • 1 Neuropsychologist • 1 Occupational Therapist • 3 Research Nurses • 1 Lab technician
Circadian Healthy Aging
Cronolab University of
Murcia
Wearable Devices for Circadian
(temperature, activity, light exposure) and
Sleep monitoring Kronowise & Kronobed
Circadian remodelling
strategies
Automatic Report of Circadian
rhythms Frailty On-line plaftorm
Kronowizard
New frailty score including Circadian
and sleep frailty
Circadian and sleep dsiruption in pathological
states
Animal models: Short living fish
& Diurnal rodent
Development of frailty animal models
Extreme longevity human models,
centenarians
Population and clinical
cohort studies on frailty
Prognostic and pathogenic role
of frailty in chronic
disease, falls, cancer and
major surgery.
Physical activity,
sedentary lifestyle Identification
of frailty’s risk, diagnosis and prognosis
biomarkers
Assessment of tools for
the diagnosis of frailty in healthcare
delivery centres
Use of technologies
in the detection,
approach and monitoring of
frail elderly
Design and implementation of Clinical trials in frail patients
Treatment of chronic
disease and comorbidity
in frail patients
Cronolab in the CIBER Network
Sun light exposure and osteoporosis
Prof. Leocadio Rodríguez Mañas Sº de Geriatría Hospital Universitario de Getafe
Envejecimiento y fragilidad. Un nicho para la innovación tecnológica
Months 1-6
Months 1-12 M13-15 Months 16-28 M29-
31 Months 32-
36
State of the Art WP leader /Co-leaders Task leaders
Local status WP leader /Co-leaders Local partners Local institutions
(1)
(2) (3)
Collection of Preferences WP leader /Co-leaders Local partners Local institut.
Road-maps WP leader /Co-leaders Task leaders
(4)
Comments from the MSs WP leader /Co-leaders Local partners Local institut.
(5) (6)
Road-maps WP leader /Co-leaders Task leaders
Working documents at the end of each period (1) State of the Art (2) Local status and category of development (3) MSs Preferences for the road-map (4) Road-maps for each category and preferences (5) Local comments to the road-map (6) Final documents to be launched to MSs and EU parliament
DG-SANTE JOINT ACTION ON FRAILTY
• UAM • UPM • UPNA • UV • KAROLINSKA INSTITUTE • KINGS COLLEGE (LONDON) • BEDS/HART UNIVERSITY • U. TOULOUSE • U. BORDEAUX • UCSC (ROMA) • U. BRUSSELS • U. NAPOLES-2 • U. S CARLOS (PRAGA) • JAGELLONIAN U. (CRACOVIA) • BETHESDA HOSP. (STTUTGART) • HOSP. S. RAFFAELLE (ROMA) • WHO • CARDIFF UNIVERSITY • CARDIFF METROPOLITAN U.
PARTNERS
• GERMAN INST. NUTRITION • FRIEDRICH SCHILLER U (JENA) • AUSTRIAN ACADEMY OF SCI. • GHENT UNIVERSITY • INRCA (ITALY) • LIFELENGTH • GENOMIC SYSTEMS • INGEN • IDETRA • CLASE10 • DIFRAIL (UK) • YOUHEALTH • EVERCYTE • MOSAIQUES • SIEMENS • ATOS • CREATE-NET • AUSTRIAN INSTIT. OF TECHNOLOGY • INTERDIGITAL
23
Partners of FRAILOMIC
Use of Minimal model and Toledo cohort information variables in diagnosis (Q1) by PCA a
26
“Developing innovative therapeutic interventions against physical frailty and sarcopenia (ITI-PF&S) as a prototype geriatric indication”
IMI Call n.9 (call for interest) published on July 9th, 2013
27
Physical activity intervention Structured exercise and physical activity (LIFE study
protocol), mainly aerobic Nutritional assessment and dietary intervention Personalised dietary recommendations Health technology intervention Remote monitoring of daily physical activity, walk speed, reinforcement of intervention adherence
Multi-component intervention (MCI)
15 clinical sites (+ 1) 9 European countries
The SPRINTT randomised clinical trial
ACANTO Consortium
09/03/2017 29
Envitel HuG ATOS
University of Norhumbria
SIEMENS AG
Telecom Italia
Universitá di Siena
Universitá di Trento
INRIA
FORTH
ACANTO is a continuation of a recently finished project: DALI: Devices for Assisted Living
09/03/2017 30
WP1. ACANTO Clinical Validation
Caracteristicas del Paciente
Rodríguez-Mañas; 2001
ENFOCADOS EN LA ENFERMEDAD
ENFOCADOS EN LA FUNCION
Caracteristicas de los Sistemas de Salud
PACIENTE “CLASICO” (siglo XX)
Una enfermedad Sin impacto sobre la función Sin secuelas funcionales
PACIENTE MODERNO (siglo XXI)
Varias enfermedades crónicas, con reagudizaciones frecuentes Con impacto sobre la función Con secuelas funcionales
ESQUEMA GENERAL DE ASISTENCIA GERIATRICA SECTORIZADA Y COORDINADA
ATENCION PRIMARIA
ATENCION ESPECIALIZADA
SERVICIOS SOCIALES
SEVICIO DE GERIATRIA OTROS SERVICIOS HOSPITALARIOS
- UGA - UGRF - HDG - C. Externa
- AGD Gestión de casos
- Interconsultas
AGD: asistencia geriátrica domiciliaria; UGA: Unidad Geriátrica de Agudos; UGRF: Unidad Geriátrica de Recuperación Funcional; HDG: Hospital de Día Geriátrico;
Node regions
Catalunya Madrid
Industry
CLC
València
● EIT Health Spanish co-location center
The Spanish node is formed by three regions (Catalunya, Madrid and Valencia) involving strong partners in the three areas of the innovation triangle: research, education and business
Confidential, EIT HEALTH – WG, MARCH 2015
PIPELINE OF PROJECTS LISTED (WORK IN PROGRESS 2015)
MemSleep Enhancing ageing
memeory loss UPM TRL6
BeyondSILOS ICT integrated care
UPV
TRL7
echoBUTLER Disease mnagemt. models assesment
BIOCAT
TRL3-9
VISUALAID Enhanced reality for
visually impaired UPM TRL6
AD CARE caregivers support CAIXA FUND
TRL (ND)
FRAILTY (PREHEE) prescriptive health for
the elderly
GMV TRL8
BREATHE Manage stress and
depressions UPV TRL7
HMD_LOVI aids for low
vission patients UPM TRL6
ReAAL Open platform for independan living
UPV TRL8
ACTIVATE managing
dependant people at home UPV TR6
FRAILTY (MUSCLE LOSS)
ABBOT Nutrition
TR9
AD-DIAGNOSTIC
UPM TR5-8
SMARTCARE Integrated care
platforms UPV TR7
FRAILTY (ALTARI-
HomeCare) GMV
HOME monitoring TRL8
MATURITY
FRAILTY ATOS
TR9
FRAILTY
UPM
TR6-8
FRAILTY
SERMAS
TR6-8
Magic-AD UPM
TRL (ND)
Now-a-days there are not in the market applications to attend the specific needs of elderly people with comorbidities in risk of developing dependency
INNOVACIÓN: FUNCTION vs DISEASE
Historical Databases
from Co-
morbidities Patients
EN CONCLUSION
¿PREGUNTAS?
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