Increasing our disability free years

Irish people could increase their disability free years by reducing their risk factors for cardiovascular disease, dementia and falls/syncope, Prof. Rose Anne Kenny, Chair of Medical Gerontology and Director of Falls and Syncope Unit, St. James’s Hospital and Trinity College, Dublin, told the conference.

Prof. Rose Anne Kenny
Prof. Rose Anne Kenny

Speaking on “Best place to care – innovative solutions,” she said that in Ireland the lived life years after 65 were 18 for man and 21 for women. Of those years, 61% would be disability free for men and 57% for women.

Two big health factors in Ireland were cardiovascular disease, which was the commonest cause of death in this country and in Europe and dementia, which was our biggest cost challenge. The cost of dementia care was more than stroke, heart and cancer costs combined and it was going to escalate year on year.

Advertisement
RCSI Leadership

Prof. Kenny said the biggest risk factors for cardiovascular disease and brain health were hypertension, diabetes, high cholesterol, atrial fibrillation, obesity/metabolic syndrome and hypotension. A major issue was how to identify hypertension in people over the age of 50.
The TILDA study which had focussed on a nationally representative sample of 8,504 Irish people aged 50 and over was producing valuable information. People who had participated in the study were re-assessed every two years, to see if they had developed diseases and if they had any prior risk factors which could have been modified, so it was providing real time information.

The cost of dementia care was more than stroke, heart and cancer costs combined and it was going to escalate year on year.

Prof. Kenny said blood pressure was a huge risk factor for stroke, cardiac disease and dementia. “In Ireland there is a big gap between what people think they have and what they actually have. In Ireland almost 65% of people over 50 have high blood pressure and nearly half of them are unaware of it. Our research has shown that of those with hypertension only 55% were aware of their hypertension. Of those with hypertension and on treatment, 48% were not controlled.

“Of those with undiagnosed high blood pressure, 56% were older, poorer, living alone and less educated.”

Hypertension was an easily modified risk factor. Data could help target limited resources at those most in need and in 2016 a new scheme was introduced to reimburse GPs for ambulatory blood pressure measurement.

Prof. Kenny said that of those with known cardiovascular disease, 68.8% were using statins and of those with diabetes 57.4% were using statins.

Atrial fibrillation (AF) which was a common cardiac rhythm disturbance and increased in prevalence with age particularly the population 65 years and over was associated with a five-fold increased risk of stroke, a three-fold risk of heart failure and two-fold increased risk of both dementia and mortality.

One third of those with atrial fibrillation were aware of their condition and on correct treatment, one third were aware and were not on correct treatment, while one third were unaware they had atrial fibrillation.

Prof. Kenny said that at the moment Ireland was one of the fattest nations in the world “And I don’t think it is appreciated the difference obesity will make down the road to brain health. Estimates are that we could reduce alzheimer’s by 30% – 40% by controlling obesity.

She said that one way in which we could deliver low lying fruit and which was not being properly addressed was falls.

When she had worked in Newcastle-upon-Tyne in the UK they did a lot of studies on falls and blackouts in EDs. “The ED had 71,000 adults aged 50 or over and a third were there because of falls or blackouts. Twenty five per cent of those who came in with falls had cognitive impairment at that time. Forty five per cent of those over 65 came in because of falls/syncope.

“We found that four or more risk factors for falls were present. The risk factors were balance, gait, medication, home hazards and over a third had underlying cardiovascular disease which could be modified. Thirty four per cent had had a fall in the previous 12 months.  Of those aged 50 – 64, 29% had had a fall in the previous 12 months, as had 33 % of the 65- 74 age group and 41% of those aged 75 and over.

“Falls and blackouts are a big issue in Ireland. In 2014, falls and collapse were the third to fourth commonest cause for admission and the second to third commonest diagnosis at discharge in those over 50 in Galway, St. James’s, Tallaght and Sligo Hospitals.

We want to provide care for these common symptoms and obviate the need for admission.
“If you were over 80 there is a high prospect of admission to hospital following a fall. In Newcastle we started a dedicated ambulatory falls and syncope unit and a dedicated falls and blackout service in the hospital. To evaluate patients. The result was that we only admitted one third of those who came and of those who were admitted their length of stay was reduced from 19.9 to 2.4 days.