Functional Increase

Created on July 28, 2013, 4:30 p.m. by Hevok & updated by Hevok on Oct. 24, 2013, 9:51 p.m.

Project: Functional Increase

The aim of the A3 Action group "Functional Increase" is maintaining, restoring and improving functional capacity.

High Level Summary

.. that could be on a slide

We need to generate knowledge on how to prevent or reverse age-related functional decline by:

  • Listening to the needs of people
  • Conducting interventions on people to test proposed solutions
  • Have a toolbox to gather data and generate evidence
  • Proposing new solutions to be tested

Detailed Summary

.. that could be on a document

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:

  • the definition of a TOOLBOX including biomarkers tests, informaton communication technology for monitoring, procedures to validate interventions and questionnaires (to detect frailty, to investigate perceived quality of life, etc.)
  • the definition of a GENERAL CONCEPTIONAL FRAMEWORK able to justify and represent in an integrated conceptual/theoretical view the tools in the box

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:

  1. Listen to the needs of people, considering their perceived quality of life. Get data from people, in the form of surveys for example; their needs, expressed or not.
  2. Existing interventions: filter out some interventions and test them to see if they allow to prevent and reverse functional decline. Connected podometers [http://fitbit.com/flex] is an example, advice for healthier lifestyles or functional foods or medicines are other examples.
  3. Generate evidence, draw statistics and reason on it.
  4. Identify new solutions*: we must not forget the potential of forthcoming interventions

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:

  • questionnaires (an online form was discussed that dynamically adds questions depending on what the user previously entered; a general questionnaire could have new questions arise depending on what the person answers)) in addition to getting data automatically through connected devices
  • biomarkers (to assess and predict functional decline)
  • statistics (and other ways to put data together)
  • target populations (patients, and citizens in general)

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.

Functional assessments:

  • Gaitspeed
  • Step-to-step variability
  • Balance
  • Functional mobility (Timed Up and Go)
  • Endurance capacity (VO2 max)
  • Nutritional state/intake
  • Cognition
  • Social participation
  • happiness degree (this could be a function of several factors that can be integrated in a formula)

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:

  • Education on lifestyle choices (e.g. stop smoking)
  • A vegetarian/vegan balanced diet
  • Physical/activity exercise
  • Natural compounds supplementation/functional food
  • Nanoparticle targeting senescence-cells [22996839]

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)

.. Collection of natural compounds

The perceived quality of life and other contextual, sociological and psychological issues need to be considered in the conceptional framework.

Good Practices

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 :

  • biology of aging (I personally think that a lot is to except from there, but it is a matter of time and/or focus)
  • connected podometers (I personally think that it is the low hanging fruit for long health; it is generally termed “quantitative self for health” but the choice of a friend who coaches you is empirically more important than the quantification; I mentioned fitbit because it has some good consensus currently, but I have no royalties on such things ;-)
  • health statistics/ontologies (we need them to decipher non-short-term effects on health)
  • citizen data (in particular through cities and associations not specific to patients)

.. A toolbox: to help coordinate data/people and generate evidence draw statistics and reason on it.

.. We can also measure telomerase activity in saliva or blood samples.

Tasks

  1. Collection of functional assessment tools and instruments for single domains

D1.1. Inventory of main assessment tools

  1. 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

  1. Standardization of geriatric assessment

D3.1 List of priorities and selection of the best products and instruments

  1. Functional deficit and ICT

D4.1: Technologies/softwares to counteract functional deficit

  1. Functional deficit and domotics

D5.1: models and specific assisted living technologies

  1. 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

  1. Functional decline and use fo diagnostic measurements

D7.1 list of specific invasive/non-invasive technique, apparatus and equipment

  1. Frailty vs functional decline and their inter-relationship

D8.1: definition of main characteristics of such a grey area

  1. Functional decline and RCTs

D9.1 methodology to run RCT on mutlimorbid patients using functional decline as core inclusion criteria

functional_increase.gif

Tags: prevention, aging, guideline, summary, Aging, health
Categories: News, Article

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