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Newcastle 2007, April 23
AGEACTION
Jean-Pierre MICH= EL,
Geneva medical school and university hospitals - Switzerland
3D"EUGMS
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The medical challenges
for a longer life
?????
Very
heterogeneous
LIFE CYCLES ! =
Prevention of  fra= ilty
and
age-related disability
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Targeting the near future
medical care challenges
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CHRONIC DISEASES &
DISABILITIES
Pre= vention of  frailty
and
age-related disability
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Aging successfully until death<= /span>
Study of predictors of dying without disability
= in 1’097 US citizens who died in late old age with known disability = ;
&#= 13;
&#= 13;
&#= 13;
&#= 13;
LEVEILLE SG  et al Am J Epidemiol   1999; 149: 654-64
18%
26%
= and being NON-disabled befor= e death was
85 y.o.
80 y.o.
= the probability of = surviving to age of
Woman
Man
For a 
NO= N-disabled 65 y.o.
<= /span>
=
<= span lang=3DEN-US style=3D'font-family:"Comic Sans MS";font-size:156%;color:#33= 3399; mso-color-index:5;mso-special-format:lastCR;display:none'>
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INCREASING AGE
(dysfunctions in
activities of daily living) =
Significant explanatory variables
= for functional disabilities
Major causes of DISABILITY
HOGAN DB et al   J Gerontol A Biol Sci Med Sci  1999; 54: M77-82
FRAILTY
2 x functional disabilities in 85+ = than in the youngest
In the 85+
In the 65-84 y.o.
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« A transitional state »        = ;            &n= bsp;     
   <= /span>
RO= BUSTNESS
FRAIL= TY
DEPENDENCE
in Activities of Daily
Living (ADL)
FRAILTY \ life long proce= ss
&= #13;
time =
DEATH = ;
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INC= REASING AGE
(dysfunctions in
activities of daily living) =
Significant explanatory variables
= for functional disabilities
Major causes of DISABILITY
HOGAN DB et al   J Gerontol A Biol Sci Med Sci  1999; 54: M77-82
= Modifiable risk factors:
Malnutrition, low exercise level, slow gait and depression !
SARKISIAN CA et al  J Am Geriatr Soc  2000; 48: 170-8=
FRAILTY
2 x functional disabilities in 85+ than in the youngest
In the 85+
In the 65-84 y.o.
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VANITALLIE TB   Metabolism  2003; 52(10 Suppl 2): 22-6= 3;
 AGE= ING a= nd/or FRAILTY ?
One
characteristic
of the
FRAILTY SYNDROME
that distinguishes it from =
the effects of <= u>ageing per se
is the
 POTENTIAL REVERSIBILITY<= span lang=3DEN-US style=3D'font-size:156%;color:blue'>
of many of its features
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DISEASES=
<= /div>
INC= REASING AGE
(dysfunctions in
activities of daily living) =
Significant explanatory variables
= for functional disabilities
Major causes of DISABILITY
HOGAN DB et al   J Gerontol A Biol Sci Med Sci  1999; 54: M77-82
= Modifiable risk factors:
Malnutrition, low exercise level, slow gait and depression !
SARKISIAN CA et al  J Am Geriatr Soc  2000; 48: 170-8=
FRAILTY
2 x functional disabilities in 85+ than in the youngest
In the 85+
In the 65-84 y.o.
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=
=
Targeting the near future
medical care challenges
=
=
CHRONIC DISEASES &
DISABILITIES
=
=
CLINICAL ONSET
of
DISEASES
Pre= vention of  frailty
and
age-related disability
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=
ADULT
diseases
= &Yac= ute;        = ;          Ý Mortality
        = ;      or Ý Disability
<= span style=3D'color:blue'>=  Diabetes
<= span style=3D'color:blue'>=  Stroke
= =  Coronary heart        dis= ease
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<= ![endif]>
&icir= c; CVD mortality rates
ì Disab= ility linked to CVD
<= span lang=3DES-TRAD style=3D'font-family:"Arial Black";font-size:178%;color:red= '>The “paradox” of
Cardio Vascular Diseases (CVD)
Villar , Banegas, Donado, Rodríguez Artalejo. SEA Report 2003
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=
ADULT
diseases
&Yac= ute; Ý Mortality
&Yac= ute;         or Ý Disability
<= span style=3D'color:blue'>=  Diabetes
<= span style=3D'color:blue'>=  Stroke
= =  Coronary heart        dis= ease
R= 26;GERIATRIC diseases   
Û Mortality
Ý  Disability
<= span style=3D'color:blue'>=  Sensory impairments
=  Locomotor disorders
<= b> Dementias
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Dementia a= nd
Physical dependence
Dementia
 increases by 14
inabilities in activities of daily living
Dementia
is a
strong predictor of disability !

SAUVAGET C et al<= span style=3D'mso-spacerun:yes'>   Gerontol   2002; 48: 226-33=
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Clinical diagnosis
Alzheimer&a= cute;s Disease (A.D.): 
a life long commitment
40        = ;            &n= bsp;        50     &n= bsp;            = ;            &n= bsp;   60     &n= bsp;            = ;            &n= bsp; 70        = ;            &n= bsp;             80
Asymptomatic            = ;            &n= bsp;   Clinical  phase
     phase
<= b>
0
25
50
75
100
3D"Text=
% of end-stage AD <= /b>
 Age (years)
Estimated start of neuropathological changes
Modified from P= J VISSER 2000 and M KIPIVELTO 2005
?
?
?
1st complaints<= /b>
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text/html; charset="us-ascii" Newcastle 2007, April 23
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Targeting the near future
medical care challenges
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CHRONIC DISEASES &
DISABILITIES
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WELL-KNOWN
RISKY CONDITIONS
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CLINICAL ONSET
of
DISEASES
Pre= vention of  frailty
and
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Clinical diagnosis
Alzheimer&a= cute;s Disease (A.D.): 
a life long commitment
40        = ;            &n= bsp;        50     &n= bsp;            = ;            &n= bsp;   60     &n= bsp;            = ;            &n= bsp; 70        = ;            &n= bsp;             80
Asymptomatic            = ;            &n= bsp;   Clinical  phase
     phase
<= b>
0
25
50
75
100
3D"Text=
% of end-stage AD <= /b>
 Age (years)
Est= imated start of neuropathological changes
Modified from P= J VISSER 2000 and M KIPIVELTO 2005
Risk factors
ß
Prevention
1st complaints<= /b>
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Newcastle 2007, April 23
Dementia risk
=3D
Smoking (yes)
ì 1.9 fold
Cholesterol
> 6.5 mmol/l
ì 2.0 fold
Systolic Blood
Presure
SPB
> 140 mmHg
ì 2.1 fold
= Body Mass Index
BMI
 > 30 kg/m2
Combined effect of
MIDLIFE vascular = risk factors
on late-life dementia
The combination of
BMI > 30 kg/m2 =
+ SBP > 14= 0mmHg
+ Cholesterol
> 6.5 mmol/l
ß
DEMENTIA RISK 
 æ  6.2 fold
KIVIPELTO M et al
Arch Neurol   2005; 62 : 1556-60
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«&nbs= p;Periods of life »
vs.
« a life course perspective »Death
=
   Ageing
   Adulthood
        = ;       20 years
        = ;         10 years
         5 years
       1 y= ear
Pregnancy
Birth
Death
=
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Missing
Rates per 100.000&#= 13;
SANS  S et al   Eur Heart J   1997;18: 1231-48=
Age-standardized mortality from
CORONARY HEART DISEASE
in European regions in 1990-91
(men of all ages)
 Red:
more than 700 / 100’000  =
Ligth yellow:
l= ess than 80 / 100’000
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438.8=
276.0=
189.4=
127.3=
94.9&= #13;
87.7&= #13;
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38.4<= /span>
Missing
Rates per 100.000
Age-standardized mortality from
STROKE
in European regions in 1990-91
(men= of all ages)= 3;
SANS S et al   Eur Heart J   199= 7;18: 1231-48
 Red:
more than 400 / 100’000  =
Ligth yellow:
l= ess than 80 / 100’000
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RISK FACTORS for DISABILITY
=
=
=
Risk factors
for
functional status decline
= = LIFE STYLE
. Smoking
. Low level of physical acti= vity
. Malnutrition<= br> (under or over weight)
Burden of diseases
Mental disorders<= i>
= Low
social contacts
<= span lang=3DEN-US style=3D'font-size:133%;color:#333399;mso-color-index:5'><= i>Poor
self-perceived
health
STUCK AE et al   Soc Sci Med   1999; 48: 445-69  and   JAGGER C   Personal communication   Beijing  2001&#= 13;
Large meta-analysis