ENCONTRO COM A CIÊNCIA E TECNOLOGIA EM PORTUGAL Promoting independent living in frail older adults by improving cognition and gait ability and using assistive products João Apóstolo Unidade de Investigação em Ciências da Saúde: Enfermagem

INTRODUCTION - SOCIODEMOGRAPHIC TRENDS OLD-AGE DEPENDENCY

INTRODUCTION - SOCIODEMOGRAPHIC TRENDS Ageing indicators, Portugal, 1961-2016 (source: PORDATA) Current expenditure on healthcare per capita, Portugal, 2000-2016 (source: PORDATA)

COSTS INTRODUCTION - FRAILTY frailty: 4-17% / pre-frailty: 19-53% ! Prevalence in community-dwelling adults aged ≥ 65Y: frailty: 4-17% / pre-frailty: 19-53% - is an age-related state of high vulnerability to adverse health outcomes after a stressor event - predisposes the individuals to progressive decline in different functional domains - contributes to the onset of geriatric syndromes (Clegg et al., 2013; Fried et al., 2004) COSTS

INTRODUCTION – NEEDS AND SOLUTIONS SOCIO-DEMOGRAPHIC CONTEXT Aged and frail population Increased ratio of falls and old-age dependency Increased morbidity and prevalence of dementia ARISING NEED Integrated, creative and dynamic strategy to prevent frailty in older adults PROPOSED SOLUTION Promotion of independent living in frail older adults by improving cognition and gait ability by provision of specific equipment

INTRODUCTION – INTERVENTIONS ON FRAILTY The recent systematic review by Apóstolo et al. have shown that the favorable effects on frailty indicators may be observed after the interventions based on: physical exercise (mainly conducted in group) physical exercise with nutritional supplementation nutritional supplementation alone cognitive training combined treatment. The interventions need to be adapted to the personal characteristics and contexts.

MIND&GAIT PROJECT Project accepted for funding in the IC & DT Projects Competition in Polytechnic Institutes and Schools AVISO N.º 02/SAICT/2016

MIND&GAIT PROJECT OBJECTIVE STRATEGY To develop innovative initiatives and systems to facilitate an early intervention in the health condition of frail older adults STRATEGY 1. Development of a structured and integrated combined intervention consisting of (I) Computer-Based Cognitive Stimulation Program (ii) Physical Activity Program 2. Development of auto-blocking mechanism for rolling walkers (ABMRW) 3. Use of a web platform as a repository and for dissemination of results and resources

MIND&GAIT ACTIVITIES Update and test the cognitive stimulation program (1-7M) Develop and test the physical activity program (1-7M) Upgrade the ABMRW (1-4M) Develop a web platform to support the material and disseminate the intervention materials (9-18M) Assess the effectiveness of the combined intervention in old adults with frailty (9-14M) Analyze participant perception of the interventions (3-18M) Test the ABMRW (5-8M) Promote scalability Project reports Identification of barriers and opportunities, monitoring and review of milestones and deliverables and review of objectives achievement (3-18M)

MIND&GAIT IMPACT KNOWLEDGE TRANSFER INTO CLINICAL PRACTICE PRACTICE-BASED RESEARCH EDUCATION AND INNOVATION Innovate applications to be implemented as a response to societal challenges: 1. Health, demographic change, and wellbeing 6. Europe in a changing world - Inclusive, innovative and reflective societies RIS 3 Action Lines - NUTS II Center region Technologies for QL: - Development of innovative actions and systems that promote active and healthy aging and lead to independent living that cross the different care networks - Development of new treatments and therapies

MIND&GAIT MERIT SCIENTIFIC-TECHNICAL MERIT OF THE PROJECT QUALITY OF THE PROJECT TEAM INTERDISCIPLINARITY INTERDISCIPLINARITY exercise science specialists, nurses, occupational therapists, mechanics and computer engineers ORIGINALITY TECHNICAL AND SCIENTIFIC EXPERIENCE RESEARCH AWARDS PATENTS SUBMITTED BASED ON CLINICAL DAILY PRACTICE RESEARCHERS HEALTH- PROFESSIONALS TESTED IN CLINICAL DAILY PRACTICE COMMUNITY STUDENTS

REFERENCES Apóstolo, J., Cooke, R., Bobrowicz-Campos, E., et al. Predicting risk and outcomes for frail older adults: an umbrella review of frailty screening tools. JBI Database of Systematic Reviews & Implementation Reports 2017; 15(4):1154-1208. Apóstolo, J., et al. Effectiveness of the interventions to prevent progression of pre-frailty and frailty in older adults: a systematic review. JBI Database of Systematic Reviews & Implementation Reports. Submitted. Clegg A, Young J, Iliffe S, et al. Frailty in elderly people. Lancet 2013; 381:752-762. Fried LP, Ferrucci L, Darer J, et al. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci 2004;59:255-263. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J GerontolBiol Med Sci 2001;5 6:M146–M156. Lang PO, Michel JP, Zekry D. Frailty Syndrome: A transitional State in a Dynamic Process. Gerontology 2009;55:539-549. Rodriguez-Manas L, Feart C, Mann G, et al. Searching for an operational definition of frailty: a Delphi method based consensus statement: the frailty operative definition-consensus conference project. J Gerontol A Biol Sci Med Sci 2013; 68(1):62–7. Rockwood K, Hogan D, Macknigth C. Conceptualisation and measurement of frailty in elderly people. Drugs Aging 2000;17(4):295-302.