The aim of the A3 Action group "Functional Increase" is maintaining, restoring and improving functional capacity.
We need to generate knowledge on how to prevent or reverse age-related functional decline by:
In order to prevent and even reverse the functional decline that occurs with age and thereby increase the Healthy Life Years within a few years throughout Europe, we think that the focus should be on generating knowledge of long term health effects, both from from existing data and by testing hypotheses. The spread of that knowledge will then directly allow citizens and health care providers to increase the healthspan.
To generate such knowledge ("knowledge of long term health effects") we are pursuing the following objectives:
There was some consensus that the generation of such knowledge should require the creation of a toolbox to assemble these four axis together (The 4th axis arrived quite late in the discussion).
The toolbox and the conceptional framework should rely on four axis:
To prevent or even reverse the functional decline that occurs with age, the goal is to develop knowledge for long term health that can be both estimated from existing data and tested. Optimally, the different approaches should synergize around those 4 pillars.
To achieve putting that framework in place, skills on various topics are required, such as:
To achieve this aim we are creating a toolbox which includes a web framework for exchanging information and gathering data, methodologies for conducting questionairs/surveys, and array of biomarkers to measure physical decline or increase as well as defined interventions.
This toolbox includes biomarkers that can be used prelaminary and during interventions. Such biomakers should be preferentially non-invasive markers like
Ideally we would have a list of biomarkers of aging and the corresponding methods for their evaluation. We should have a bunch of biomarkers that are easy to measure, cheap and scalable to many individuals as well as cover a wide range of functional capacities from molecular level to whole physiology.
We can measure telomere length either in blood or saliva using the genomics DNA obtained from these sources. The price for telomere length measurement is around 30€ each sample and the techique used Q-PCR. This is very easy, not that cheap but still affordable if we can have financial help.
For achieving a functional increase, functional assessments are important too. So in a toolbox we should take in to account gaitspeed, step-to-step variability, balance, muscle strength (hand-grip strength), functional mobility (for example the Timed Up and Go) and endurance capacity (VO2 max). Furthermore we have to look into all the domains of frailty like nutritional state and intake, cognition, social participation, etc. Although frailty by itself is not a focus, but to search for pre-frail signs and risk-factors is advised.
The interventions to test will be of educational, dietary (e.g. supplements, nutrients), molecular (drugs), social (to feel useful, to have fun, to learn), and physical nature. Those interventions may include:
Interventions (applications of new solutions on target populations). The read out for interventions would be questionnaires and biomarkers as well as functional assessments (gaitspeed, step-by-step variability, balance, muscle strength), functional mobility (for example the Timed Up and Go)
The perceived quality of life and other contextual, sociological and psychological issues need to be considered in the conceptional framework.
It was said that good practices should be sent by the end of July. So in addition to the summary above, I would like to suggest that we link the 4 axis and the skills to some good practices. On my personal side I see the following 4 good practices where I am particularly active; If some of you share such practices or want to develop other ones do not hesitate to let us know, it could allow us to spread the workload more easily and know each other better :
Collection of functional assessment tools and instruments for single domains
D1.1. Inventory of main assessment tools
Collection of Comprehensive assessment tools
D2.1: main instruments for acute care, post-acute care, home care, nursing homes etc.
D2.2: simple screening assessment tools to measure functional deficit and fraility for primary care
Standardization of geriatric assessment
D3.1 List of priorities and selection of the best products and instruments
Functional deficit and ICT
D4.1: Technologies/softwares to counteract functional deficit
Functional deficit and domotics
D5.1: models and specific assisted living technologies
Functional decline and biomarkers
D6.1: list of Biomarkers
D6.2: correlation of physical performance scores with biomarkers
D6.3: sensibility and specificity of biomarkers
Functional decline and use fo diagnostic measurements
D7.1 list of specific invasive/non-invasive technique, apparatus and equipment
Frailty vs functional decline and their inter-relationship
D8.1: definition of main characteristics of such a grey area
Functional decline and RCTs
D9.1 methodology to run RCT on mutlimorbid patients using functional decline as core inclusion criteria