ESPEN Congress Lisbon 2015 KEEP FIT FOR LIFE – … · ESPEN Congress Lisbon 2015 Economic impact...

32
ESPEN Congress Lisbon 2015 Economic impact of Healthy Ageing C. Sieber (DE) KEEP FIT FOR LIFE – NUTRITIONAL AND FUNCTIONAL ENHANCEMENT OF OLDER ADULTS

Transcript of ESPEN Congress Lisbon 2015 KEEP FIT FOR LIFE – … · ESPEN Congress Lisbon 2015 Economic impact...

ESPEN Congress Lisbon 2015

Economic impact of Healthy AgeingC. Sieber (DE)

KEEP FIT FOR LIFE – NUTRITIONALAND FUNCTIONAL ENHANCEMENT OF OLDER ADULTS

ESPEN-Congress 2015 in Lisbon

Economic impact of Healthy Ageing

- personal perspective -

Cornel Christian SieberLehrstuhl Innere Medizin-Geriatrie

Friedrich-Alexander Universität Erlangen-NürnbergChefarzt Klinik für Allgemeine Innere Medizin und Geriatrie

Krankenhaus Barmherzige Brüder Regensburg

Healthy AgeingEU Project Definition

Healthy ageing is the process ofoptimising opportunities for physical, social and mental health to enableolder people to take an active part in society without discrimination and toenjoy an independent and good qualityof life.

Dimensions of Ageing

Normal Ageing

Successful AgeingHealthy Ageing

Demographic change andEconomy

• Labour• Health• Family economics• Social security• Income distribution• Social mobility• Immigration• Productivity• Structural change• Economic growth• Development

Menue

• Healthy Ageing – the framework• Costs to promote Healthy Ageing• Costs of loss of Healthy Ageing• Healthy Ageing and QALY‘s• Choosing Wisely Initiative• THM

Menue

• Healthy Ageing – the framework• Costs to promote Healthy Ageing• Costs of loss of Healthy Ageing• Healthy Ageing and QALY‘s• Choosing Wisely Initiative• THM

Taxonomy

• Normal ageing exists

– Challenged by Aubrey de Grey

• Then, normal ageing must equal healthy ageing• Successful ageing then means mainly healthy

ageing• Intervention: To preserve healthy ageing or to

treat „unhealthy ageing or „abnormal ageing“

Adult Disability Dependency Ratio (ADDR)

• Classically, the age-quotient is given as: 65 vs 15-64 (years)

• Caveat: – Older adults today are longer healthy, take

over jobs more often and care for family, neighbours...

• ADDR takes instead of age per se the health status into acount

Sanderson and Scherbov. Science 2010;329:1287

Adult Disability Dependency Ratio (ADDR)

Classical age-quotient:• 2010: 33 (for 100 working persons, 33 are

retired)• 2050: 63ADDR:• 2010: 12 (for 100 persons, 12 are disabled)• 2050: 15

Sanderson and Scherbov. Science 2010:329;1287

Menue

• Healthy Ageing – the framework• Costs to promote Healthy Ageing• Costs of loss of Healthy Ageing• Healthy Ageing and QALY‘s• Choosing Wisely Initiative• THM

Healthy AgeingEU Project Definition

Is health promotion for older people worthwhile?The usual cost-benefit model with consumption versus production discriminates against people with low incomes, such as pensioners. Including “senior production” (care of grand children, voluntary work etc) makes cost-effectiveness analyses fairer. Cost-benefit analyses of programmes relevant to older people indicate that the programmes lead to improved quality of life and decreased health care consumption. The potential health gains of a prevention programme are greater in the older population than among young people.

Healthy AgeingEU Project Definition

NutritionConsiderable gains in terms of mortality andfunction could be achieved if older peopleadopted a healthier lifestyle with healthyeating habits. Obesity and overweight areassociated with unhealthy dietary habits andlack of physical activity

Changes in life-expectancies - 1

• Age 65, year 2012:– 18.6 y for men– 21.1 y for women

• Age 65, year 2050:– 20.1 for men– 24.6 for women

The older you are, the older you

get

Changes in life-expectancies - 2

• When associated with improvement in underlying health, additional life expectancy gains only have a limited effect on expenditure growth.

• Elderly „healthy“ persons are a substantial driver for investments and production of healthcare goods.

Modeling health and health careexpenditures

• Population ageing is partly result of rise in life expectancy

• Time-to-death studies take this intoaccount, and find a slower increase in healthcare costs increase (mortalityfunctions as proxy to health)

• So, expenditures seem only to bepostponed later in life

Der SPIEGEL

Menue

• Healthy Ageing – the framework• Costs to promote Healthy Ageing• Costs of loss of Healthy Ageing• Healthy Ageing and QALY‘s• Choosing Wisely Initiative• THM

Modeling health and health careexpenditures

Expansion of Morbidity scenario

versus

Compression of Morbidity scenario

Compression of Morbidity

Fries JF. NEJM 1980;303:130-135

0

0,1

0,2

0,3

0,4

0,5

0,6

0,7

0,8

0,9

1

0 1 2 3 4

No disability - no comorbidityNo disability - comorbidity (2 diseases)No disability - comorbidity (3+ diseases)Disability - no comorbidityDisability - comorbidity (2 diseases)Disability - comorbidity (3+ diseases)

Years

Surv

ival

rate

No disabilityDisability

Disability – more than multimorbidity – determines mortality in persons >80 years of age

Landi F et al. J Clin Epidemiol 2010;63:752-758

Menue

• Healthy Ageing – the framework• Costs to promote Healthy Ageing• Costs of loss of Healthy Ageing• Healthy Ageing and QALY‘s• Choosing Wisely Initiative• THM

Cost-efffectiveness and QALY

Success: Gain in quality-adjustedlife-years

Calculation of one life-year in relation to health:

–QALY of 1 equals oneyear in completephysical andpsychological health–1 year with a QoL of50% means: 1 x 0.5 = 0.5 QALY

QALY = Lifetime x Quality of Life

herkömmliche oder keine

Behandlung

Cost-effectiveness of a 3-months oral Supplement in N=120 malnourished persons with a non-malignant disease

3 months intervention with protein- and

energy-rich supplement

+ 0.045 QALYs = 16 days 100% Quality

of Life

Norman K et al. Eur J Clin Nutr 2011;65(6):735-42

Economics of proteinsupplementation

• The available economic evidenceindicates that protein and energysupplementation in treatment orprevention of malnutrition providesan opportunity to improve patientwellbeing and lower health systemcosts.

Milte RK et al. Eur J Clin Nutr 2013;67:1243-1250

Menue

• Healthy Ageing – the framework• Costs to promote Healthy Ageing• Costs of loss of Healthy Ageing• Healthy Ageing and QALY‘s• Choosing Wisely Initiative• THM

Choosing Wisely

• In 2012 the ABIM Foundation launched Choosing Wisely® with a goal of advancing a national dialogue on avoiding wasteful or unnecessary medical tests, treatments and procedures.

• Germany (German Society of Internal Medicine = DGIM): Also „underuse“

(ABIM = American Board of Internal Medicine)

Choosing Wisely Geriatrics(American Geriatrics Society)

• Don’t recommend percutaneous feeding tubes in patients with advanced dementia; instead offer oral assisted feeding.– O.k. with our guidelines

• Avoid using prescription appetite stimulants or high-calorie supplements for treatment of anorexia or cachexia in older adults; instead, optimize social supports, discontinue medications that may interfere with eating, provide appealing food and feeding assistance, and clarify patient goals and expectations.– Not o.k. with our guidelines

Choosing Wisely and economics

If we would not treat healthy persons, but instead really would treat thosewho need it (not healthy), we would

make a real economic change in healthcare expenditures

Menue

• Healthy Ageing – the framework• Costs to promote Healthy Ageing• Costs of loss of Healthy Ageing• Healthy Ageing and QALY‘s• Choosing Wisely Initiative• THM

THM

• Economics of Healthy Ageing have to balanceexpenditures with income/investments, independent of QoL

• Demographic change does not per per se increase health economics

• Out of the trias to promote Healthy Ageing andthereby longevity, nutrition seems to be theeasiest one to tackle (compared to physicalactivity and social contacts)

For more...

The Journal of the Economics ofAgeing

(Elsevier)

There are always different ways to look at a situation, including Economics of Healthy Ageing