This document summarizes a presentation given at an event on ageing and mobility. The presentation was given by Dr. Rosy Pereyra on sarcopenia, which is a loss of skeletal muscle mass and strength associated with ageing. Some key points from the presentation include: - Sarcopenia is estimated to affect 5-13% of people aged 60-70 and prevalence increases with age. It can lead to physical disability, poor quality of life, and increased risk of death. - Diagnosis of sarcopenia requires low muscle mass plus either low muscle strength or poor physical performance. It can be assessed through muscle mass measurements, grip strength tests, or walking speed tests. -

1. Ageing and Mobility: ILC Global
Alliance Symposium
Wednesday 29th October 2014
This event is kindly supported by Alliance Boots and hosted by the LGA
#ilcglobalalliance

2. Welcome
Louise Plouffe
ILC-Brazil
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3. Welcome from the Local
Government Association
Cllr Marianne Overton MBE
Elected Leader of the LGA Independent Group and
Vice Chair of the LGA, Lincolnshire County Council and
North Kesteven District Council
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4. Welcome from Alliance Boots
Andrew Bonser
Director of Public Policy
Alliance Boots
This event is kindly supported by Alliance Boots and hosted by the LGA
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5. Sarcopenia: A forgotten cause of
mobility problems in old age
Rosy Pereyra
President
ILC-Dominican Republic
This event is kindly supported by Alliance Boots and hosted by the LGA
#ilcglobalalliance

6. Sarcopenia: A Forgotten Cause of Mobility
Problems in Old Age
Rosy Pereyra, M.D.
President ILC-DR
ILC-GA Symposium.- London. England October 29th, 2014

7. 7
Sarcopenia a Forgotten Cause of Mobility Problems in Old Age
Introduction and Definition
Syndrome characterized by a progressive and generalized diminution of
muscle mass and strength with the risk of adverse effects such as
physical disability, poor quality of life and death.
 It is perhaps the most serious threat to health and longevity and it is
believed to play a role in the pathogenesis of fragility and the functional
problems that accompany ageing.

8. The Classical Definition of Sarcopenia is
Based in Muscle Mass
-1
DE
Severe
sarcopenia
-2
DE
Risk of Normal
sarcopenia
Media
• Lean mass of
extremities
(kg)/estature (m)2
• Total lean mass
(kg)/body weight (kg)
Body muscle mass
Baumgartner RN, et al. Am J Epidemiol. 1998;147:755-763.
Janssen I, et al. J Am Geriatr Soc. 2002;50:889-896.
Distribución en adultos jóvenes

9. 9
Sarcopenia. A Forgotten Cause of Mobility Problems in Old Age
Prevalence
 It is estimated that approximately 5-13% of people between 60-70 years
are affected by sarcopenia.
 There is an estimated loss of 0.5-1% per year after the age of 25 and this
accelerates after the age of 60, doubling in each decade specially in
inactive people.

10. Three measures of muscular function and one of muscle mass in men and women
10
Muscle strength and potency diminish
with ageing
Strength of knee extension
Manual pressure
Varones Mujeres Varones Mujeres
20 40 60 80 100 20 40 60 80 100
Muscle strength Calf muscle
Varones Mujeres Varones Mujeres
Lauretani F, et al. J Appl Physiol. 2003;95:1851-1860.
(N/dm)
Years of age
1000
750
500
250
0
0
(kg)
Years of age
80
60
40
0
0
(watios)
Years of age
400
320
240
160
80
0
0 60 100
(cm2)
Years of age
0
20
100
80
60
40
20
20 40 80 20 40 60 80 100

11. 11
Sarcopenia. A Forgotten Cause of Mobility Problems in Old Age
Phisiopathological Changes
 Ageing is associated to changes not only in muscular mass but also in
muscle compositión its properties and contractility.

12. Changes in muscle fibers affect
Strength and Potency
Reinervatión
Lang T, et al. Osteoporosis Int. 2010;21:543-559.
Qualitative
changes in
muscle
Type 1 fibers Type II fibers Motorneurone Denervatión
Ageing Sarcopenia
• Increase in
type I fibers
• Diminution in
type II fibers
Disminutionl in
ttransversal area

13. Senil miosteatosis
Miosteatosis
• Increase in
intermuscular and
intramuscular fat
Transversal cut of the thigh through resonance
Transversal cut of the thigh through tomography

14. Intramuscular fat increase even with a
stable body weight
Muscle Intermuscular adipose tissue Succutaneous adipose tissue
6
2
-2
* Significativamente diferente respecto al
momento basal,p < 0,01
Delmonico MJ, et al. Am J Clin Nutr. 2009;90:1579-1585.
Five years longitudinal study
Varones Mujeres
Evaluation respect to
basal moment (%)
8
4
0
-4
-6
-10
-12
*
*
*
*

15. 15
Sarcopenia. A forgotten Cause of Mobility Problems in Old Age
Causal Mechanisms
 Loss of ability of satellite cells to self multiply
 Loss of ability of muscle to respond to anabolic stimuli such as that of
Insulin, growth hormone and amino acids.
 Insufficient protein in the diet.
 Lack of frequent exercise.

16. 16
Sarcopenia. A Forgotten Cause of Mobility Problems in Old Age
Effects of Sarcopenia
 Diminution of physical function
 Increased disability
 Increased dependency
 Mobility problems
 Increase in health costs

17. Sarcopenia Diminishes Function
and Increases disability
0 2 4 6 8 10
Walk 400
meters
Climb 10 steps
Lift 4,5 kg
Walk 2,5
meters
Get up 5 times
from a chair
Hability to take care of
themselves
Make their own
meals
Activities of daily
living
Janssen I, et al. J Am Geriatr Soc. 2002;50:889-896.

18. Sarcopenia has an Elevated
Health Cost
Men Women
Normal Moderate
Sarcopenia
Severe
sarcopenia
Normal Moderate
Sarcopenia
Severe
sarcopenia
Prevalence 36% 53% 11% 69% 22% 9%
Relative risk
of disability,
%
1.00 3.48 4.60 1.00 1.46 3.15
Cost in US
thousand
millions
- 7.18 3.63 - 2.7 4.96
The direct health cost attributed to sarcopenia in The US in the year 2000 was
18.500 million dollars (nearly 1,5% of the total health cost of that year).
Janssen I, et al. J Am Geriatr Soc. 2004;52:80-85.

19. 19
Sarcopenia. A Forgotten Cause of Mobility Problems in Old age
Diagnosis
Should be stablished when two out of three criteria are met:
1. That there is a reduction in muscle mass.
2. That there is a reduction in muscle strength and/or low exercise
tolerance.

20. 20
Sarcopenia. A Forgotten Cause of Mobility Problems in Old Age
Diagnosis
 Muscle mass is 2 standard deviations below a population of reference.
 Diminution of the walking speed below 0.8 mts/sec in a 4 meters
walking trial.
 CAT scan, MRI, anthropometry and the valuation of creatinine excretion
are also used.

21. 21
Sarcopenia. A Forgotten Cause of Mobility Problems in Old Age
Treatment
 Since sarcopenia is due to multiple factors, its prevention and treatment
require an integrated approach that should include:
 Diet
 Hormonal replacement therapy
 Nutritional supplements including Vitamin D and
 Exercise

22. Protein Synthesis and Muscle Mass
• Proteins in the diet stimulate protein
synthesis in older people
• An increase in the intake of protein
> 0,8 g/kg/day
- Increase the anabolism of proteins in
muscles
- Can help to avoid the senile decrease in
muscle mass
Paddon-Jones D, et al. Am J Clin Nutr. 2008;87:1562S-1566S.

23. Oral Nutritional Supplements plus
Resistance Exercises Increase Muscle
Strength
Design
• n = 63 women and 37 men,
87,1 ± 0,6 years (interval: 72-98)
• The strength was measured as a
maximal repetition of extensor
muscles of the hip and knees
after a 10 weeks intervention.
RESULTS
• In fragile old people you get
better results when you associate
exercise with oral nutritional
supplements.
Exercise Control
Experimental Group
Fiatarone M, et al. N Engl J Med. 1994;330:1769-1775.
Variation in strength (%)
500
400
300
200
100
0
-100
-200
Exercise plus
supplements
Supplements
**
*

24. 24
Sarcopenia. A Forgotten Cause of Mobility Problems in Old Age
Hormonal Replacement Therapy
 Growth hormone
 Mechano growth factor and insulin like growth factor
 Testosterone

25. 25
Sarcopenia. A Forgotten Cause of Mobility Problems in Old Age
Exercise

26. 26
Sarcopenia. A Forgotten Cause of Mobility Problems in Old Age
Finally
 Ageing produces a diminution of muscle mass, strength, and muscular
function.
 Sarcopenia is defined mainly by the degree of diminution of muscle
mass.
 Sarcopenia is due to a complex interaction between many factors
among those, nutrition.
 The diminution of muscle mass in sarcopenia, increases the risk of
fragility, mobility problems, disability and has an elevated health cost.
 It can be avoided by having a good nutrition and exercising during your
life time. These are probably the more efficient public health
interventions for this condition.

27. 27
Sarcopenia. A forgotten Cause of Mobility
Problems in Old Age
!!!!!!!!!! Thank you and let’s start!!!!!!!!!!!

28. Contacts to the presenter:
Rosy Pereyra, M.D.
President ILC-DR
(809) 449-9551
rosy.pereyra@gmail.com

29. Are we living longer and healthier?
Exploring gender differences in health
expectancy among older Singaporeans
Susana Concordo Harding
Director
ILC-Singapore
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30. For more information about this presentation, please
contact Susana Concordo Harding at
susanaharding@tsaofoundation.org
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31. Prevalence and risks factors for falls,
and the impact on mobility in later life:
The Cape Town study
Dr Sebastiana Kalula
Director
ILC-South Africa
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#ilcglobalalliance

32. Ageing and mobility:
Impact of falls –
the Cape Town study
Sebastiana Kalula
ILC South Africa
University of Cape Town

33. Falls are a major cause of morbidity and
mortality, and contributor to impaired functioning
and mobility in older people

34. Long lie (>1 hour)
• Pneumonia
• Dehydration
• Pressure sores
Social
• Social withdrawal
• Institutionalization
Impact of a fall
Functional
• Immobility
• Deconditioning
• Decreased righting reflex
Psychological
• Fear of falls
• Loss of confidence
• Depression
• Increased dependency
Physical injuries
• Bruises
• Head injury
• Fractures
Source: Grimm and Mion 2011; Lord et al., 2001, Donald and Bulpitt 1999, Tinetti and Williams 1997

35. Impact of hip fractures
• 2 % of falls result in hip fracture
• 25 % die within 6 months
• 60 % have restricted mobility
• Management and social costs
are high
Sources: Chu et al., 2006; O’Loughlin et al., 1993;
Tinetti et al., 1988.

36. Although prevalence and incidence rates of
falls are well established in high income
countries, little is known on falls in low to
middle income countries, particularly in
sub-Saharan Africa
South Africa is listed as a middle income
country, but has a large poor population

37. Africa region studies
Information on falls in older persons in Africa is
sparse
• Single study in Rwanda (Ntagungira, 2005)
focused on older persons who had fallen;
recurrent fallers constituted 23.3 %
• Single retrospective study in Nigeria (Bekibele
and Gureje, 2010) established a fall prevalence
rate of 23 %
• Until now, no information in South Africa

38. Cape Town study on falls
Surveyed 837 community-dwelling older persons with a
12-month follow-up
Sample size 837 aged ≥ 65 years
• Gugulethu n=231 (black Africans)
• Plumstead n=145 (whites)
• Wynberg n=264 (coloureds (mixed ancestry))
Follow up sample n=632
Kalula, 2012

39. Prevalence of falls: Cape Town study
• At baseline: 26.4 %
Recurrent falls: 11 %
• At follow-up: 22 %
Recurrent falls: 6.3%
• Incidence rate: 367 per 1000 person years
– 236 per 1000 person years for men
– 405.7 per 1000 person years for women
• Recurrent falls more common in women: 82.5 %

40. Fall prevalence by ethnic group:
Cape Town study
Whites
n
140
%
42.9
Coloureds 392 34.4
Black Africans 283 6.4

41. Risk factors for falls: Cape Town study
Independent risk factors for a fall were mainly self-reported
conditions:
• Medical conditions (poor mobility, poor
vision, poor urine control, depression,
Parkinson’s disease)
• Self-rated poor health status
• Medication use (antidepressants, anti-inflammatory
drugs)

42. Ethnic differences in risk factors
Occupation category
(%)
Reference
Black African
n = 283
Whites
n = 140
OR (95% CI)
Unskilled 221 (78.1) 12 (8.6) 1
Skilled 58 (20.5) 94 (67.1) 30 (15–58)*
Managerial 4 (1.4) 34 (24.3) 157 (47–513)*
Health compared to a
year ago (%) ‒ Worse 15 (5.3) 9 (6.4) 2.17 (0.85 – 5.58)
Mobility ‒ With
difficulty 47 (16.6) 20 (14.3) 0.84 (0.47 – 1.48)
Total number in
household (median,
IQR))
7 (5-8.5) 2 (1-3) 0.32 (0.26 – 0.38)*
*P value = <0.001

43. Characteristic
Reference
Black
African
n = 283
White
n = 140 OR (95% CI)
Age in years (median, (IQR)) 74 (69-78) 76.5 (70-81) 1.04 (1.01–1.08)#
Comorbidities (median, (IQR)) 3 (2-4) 4 (2-5) 1.39 (1.18 – 1.52)*
Number of drugs (median, (IQR)) 3 (1-4) 4.5 (2-7) 1.36 (1.25 – 1.49)*
Self-reported depression (%) Yes 23 (8.1) 21 (15.0) 2.00 (1.06 – 3.75)*
Geriatric Depression Scale score 1 (1-6) 2 (1-3) 0.89 (0.83 – 0.97)$
Use of psycholeptics (%) Yes 1 (0.4) 13 (9.3) 28.87 (3.74–223.0)*
Self-rated health (%) Poor 228 (80.6) 25 (17.9) 0.05 (0.03 – 0.09)*
p value: * < 0.001, # =0.006, $= 0 005

44. Occupation category
(%)
Reference
Black African
n = 283
White
n = 140 OR (95% CI)
SES Index score 6 (5 – 6) 8 (8 – 8) 5.23 (3.94 – 6.94)*
Cognitive score 8 (4 – 12) 2 (0 – 5.7) 0.83 (0.79 – 0.87)*
Hand grip strength (kg) 14 (10.5–19) 16 (11 – 22) 1.04 (1.01 – 1.06)*
One leg stand eyes
3 (1 – 7) 13 (6 – 26) 1.14 (1.11 – 1.17)*
open (seconds)
One leg stand eyes shut
(seconds)
1 (0.0 – 4.0) 3 (2.0 – 6) 1.13 (1.07 – 1.19)*
Up & Go test (seconds) 20 (18 – 23) 12 (10 – 16) 0.89 (0.86 – 0.92)*
Chair stands (seconds) 20 (19 – 22) 12. (10 – 15) 0.79 (0.73 – 0.82)*
SES= Socio-economic Status index; score of 8 items in household; * p value: < 0.001

45. Falls and medical help: Cape Town study
• At baseline, 72 per cent reported injury resulting
from a fall and 42 per cent sought medical help
for the injury
• At follow-up, 70 per cent reported injury and 38
per cent sought medical help

46. Consequences of a fall: Cape Town study
Baseline Follow-up
% %
• Injuries
- soft tissue 69.7 68.1
- fractures 14.4 5.7
• Fear of falls 53.9 60.1
• Not fully recovered 41.7 39.4

47. Environmental hazards for falls: Cape Town study
Surveyed 837 older persons
Outdoors N (%) Indoors N (%)
Stairs/steps 293 (35) Slippery floor 221 (26.4)
Road (uneven surface,
86 (10.3) Mats/loose carpet 189 (22.6)
potholes, stones, road works,
slippery)
Ground (stones, sand, uneven) 53 ( 6.3) Children/pets/toys 54 (6.5)
Garden (furniture, toys, plants,
hose, washing line)
21 (2.5) Stairs/steps 52 (6.2)
Veranda (slippery, uneven, holes) 20 (2.4 Furniture 37 (4.4)
Pavement (people, uneven,
rubble, banana peels, cracks)
19 (2.3) Getting out of a bath 31 (3.7)

48. Findings and questions
• Finding of marked ethnic differences in fall
prevalence was unexpected and raises questions
• Speculated that life-time manual labour preserves
gait and balance in the relatively deprived black
African sub-sample, hence a low fall rate
• Far lower fall rate in black Africans despite high
poverty levels and more environmental hazards in
their residential area

49. Recommendations
• Design and implement falls intervention
programmes to sustain mobility
• History taking, rather than tests, is a more
reliable tool for clinicians to identify those at risk
of a fall who could benefit from intervention
• Educate and train health professionals in
screening for falls, and management of risk
factors and consequences of a fall

50. Thank you

51. MOBILAGE
Dr Didier Halimi
ILC-France
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52. MOBILAGE
D. HALIMI (ILC-France) on behalf of
BROCA Hospital, CEREMH, RATP and ILC-France
ILC Gobal Alliance Mobility Symposium
London 10.29.14
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53. MOBILAGE: MOBILITY FOR ALL !
ILC Gobal Alliance Mobility Symposium
London 10.29.14
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54. MOBILAGE
The situation
• Outdoor mobility of older people is
– a matter of freedom , preservation of autonomy, psychological &
social wellbeing
– essential for prevention of dependency
• Loss of mobility has negative consequences
– depressive symptoms after cessation of driving (Marottoli, 1997)
• Driving remains the favourite mode of transportation
– for > 50% of people 75 + (Sofres 1990-2000)
– driving ability should to be assessed
• potentially impacted by physical, sensory or cognitive deficits
• to ensure secure driving as long as possible
– Alternatives should be proposed if ability to drive is impaired
ILC Gobal Alliance Mobility Symposium
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55. MOBILAGE
The project
• To evaluate outdoor mobility of pre-frail and frail elderly and their
caregivers through workshops and training focusing on mobility
• Objectives
• Identify the risks of decreased mobility1
• Analyze participants’ mobility1
• Propose tailored training
• Walking in public area ,
• Driving, cycling, public transportation1
• Inform on alternative outdoor mobility aids
• support patients and their families in their implementation2,3
• This pilot project will include
– 100 pre-frail and frail subjects 75 or older
– re-evaluated after 6 months.
1: BROCA Hospital; 2: CEREMH ; 3: RATP
ILC Gobal Alliance Mobility Symposium
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56. MOBILAGE
Why should I participate?
• I am embarrassed by certain movements
• I reduced the frequency of my outings
• I am concerned about my mobility
• I find it hard to get around
• I do not feel confident while driving
• I am curious to test new devices
• I do not feel confident in public transport and I use
them less
ILC Gobal Alliance Mobility Symposium
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57. MOBILAGE
Who will benefit ?
• Patients, relatives and professionals in gerontology will
directly or indirectly benefit from this program
• Communication of results will help educate the public about
the issue of elder’s mobility
ILC Gobal Alliance Mobility Symposium
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58. MOBILAGE
In practice
First step
Mobility evaluation and needs assessment of pre-frail and frail
persons or their caregivers after medical evaluation and sensory
testing ( BROCA Hospital)
Second step
if the person is eager to learn more about the potential benefits of
the MOBILAGE program
• Awareness and testing session
• Theoretical training: traffic laws and road signalling
• Practical training: driving assessment with a driving
instructor (and a psychomotor therapist if needed), bicycles,
tricycles, adapted scooters, use of public transportation …
ILC Gobal Alliance Mobility Symposium
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59. MOBILAGE
Where are we?
• 72 pre-frail and frail people or their caregivers have
accepted the mobility screening (first step)
• 16 have attended the mobility workshops ( second
step ) to get
– additionnal information on new mobility aids and to test
them
– And/or driving support
• Limitations
– Fear of taking the plunge
– Availability for the workshops
– Budget and technical maintenance for the new mobility
aids
ILC Gobal Alliance Mobility Symposium
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60. MOBILAGE
The Partners
ILC Gobal Alliance Mobility Symposium
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CEntre of REsources & Innovation Mobility &
Handicap
Non profit organisation
National Centre of Expertise for technical aids for
Mobility by the CNSA
Paris Public Transportation Network
BROCA Hospital

61. Draisine (draisienne) a walking aid that allows you to move
while sitting upright
ILC Gobal Alliance Mobility Symposium
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Awareness and discovery of
new mobility solutions

62. Adapted Scooters
For people who walk and want solution to increase their
mobility perimeter
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Awareness and discovery of
new mobility solutions

63. Different adapted cycles: bicycles,
tricycles, and electrical cycles
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Awareness and discovery of
new mobility solutions

64. Balance learning to ...
... Control the bike, or
simply regain confidence.
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65. Individual or small group sessions to learn
safe city traffic
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66. Theoretical training:
Refresh regulation and signalling
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67. Driving school: driving sessions with
practical advice to regain confidence.
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68. Support to use Public
Transportation
Albertine takes the bus!
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69. CONCLUSION
• Outdoor mobility is key for the wellbeing and
the preservation of autonomy
• MOBILAGE is a valuable experiment, stressing
– The importance of a correct evaluation of the
mobility and needs of the pre-frail and frail
persons and their caregivers
– The need for some support services to increase
the adherence of the persons to the proposed
solutions
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70. This presentation has been made possible thanks to:
• Broca Hospital: Marie-Laure SEUX, Laure CAILLARD, Mélanie
CORNUET
• CEREMH: Claude DUMAS, Antoine VERNIER, Elisabeth JOSEPH
• RATP: Jean-Pierre TEXIER
70
ILC Gobal Alliance Mobility Symposium
London 10.29.14

71. ILC-France
• Françoise Forette, MD
• Marie-Anne Brieu, MD
• Philippe Guillet, MD
• Jean-Claude Salord, MD
• Didier Halimi, MD
ILC Gobal Alliance Mobility Symposium
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72. Short Comfort Break
This event is kindly supported by Alliance Boots and hosted by the LGA
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73. Maintaining Older People’s
Mobility: What Do We Need?
Kunio Mizuta
President
ILC-Japan
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74. Maintaining Older
People’s Mobility:
What Do We Need?
To Promote Older People’s Independence
“Aging and Mobility,” ILC- Global Alliance Conference
October 29, 2014
London
Kunio MIZUTA
President, ILC-Japan
74

75. 1. Demographic Trends in Japan
Population Aging: Estimates & Projections
75
% of the elderly: 7.9% (1975) ⇒ 25.1% (2013) ⇒ 30.3% (2025)
# of the old-old: 2.8mil.(1975) ⇒ 15.5mil.(2013) ⇒ 21.8mil. (2025)
9.0 15.6
6.0 2.8
13.0
75.8 86.2
16.3
79.0
21.8
14.8
70.8
23.9
13.8
50.0
27.2 18.5 16.4 13.2 9.4
140
120
100
80
60
40
20
0
1975 2000 2013 2025 2050
75-
65-74
15-64
0-14
Total: 111.9
% of 65+: 7.9%
million
people
126.9
17.4%
97.1
38.8%
120.7
30.3%
127.3
25.1%
Cabinet Office (2014). Annual Report on the Aging Society

76. 2. Significance of Mobility among
Older People, Research Supporting
“LTC Prevention” Programs
Reasons for Needing Care
Many people start needing care due to locomotor
disabilities
Cerebro-vascular
disease
(Stroke)
Joint
disorder,
fracture,
fall
Demen-tia
Age-related
frailty
Cardiac
(heart)
disease
Other,
unknown
Total 21.5 21.1 15.3 13.7 3.9 24.5
Male 32.9 11.3 10.9 10.5 4.5 29.9
Female 15.9 25.8 17.5 15.3 3.7 21.8
76
Reasons for needing care by sex (%)
Ministry of Health, Labour and Welfare (2012). Comprehensive Survey of Living Conditions.

77. Older People’s Walking & IADL
Walking speed is an important health indicator.
Programs to increase motor function can be effective.
◆ First sign of disability: Loss of ability to walk. Then
problems with toileting and eating.
◆ A longitudinal study (5 year follow-up study) shows that
the groups with slower walking speed are at higher risk for
IADL decline (slowest group: 23%, fastest group: 5%).
◆ An exercise intervention study for older people proves that
a program to increase motor function improves physical
function (walking speed, MCS) and mental health (WHO-5).
Suzuki, T. (2012). The Basics on a Hyper-Aged Society (pp.42-43). Kodansha Gendai Shinsho.
Ohbuchi, S., et al. (2010). Research on comprehensive evaluation and analyses regarding long-term care prevention. In T.
Suzuki et al. (eds), Report on a Comprehensive Research Project Regarding Long-Term Care Prevention (p.33). Japan Public
Health Association.
77

78. Lower frequency of going out is an independent risk
factor for problems w/ walking and cognitive function
◆ A longitudinal study shows:
Frequency of going out: 3 groups
“1+/day” “1/every few days” “<1/week”
(Odds ratios at the 2-yr. follow-up study)
Problem w/ walking
1.00 1.78 4.02
Problem w/ cognitive function
1.00 1.58 3.49
78
Frequency of Going Out &
Older People’s Health
Fujita, K., et al. (2006). Frequency of going outdoors as a good predictor for incident disability of physical
function as well as disability recovery in community-dwelling older adults in rural Japan. Journal of
Epidemiology, 16 (1), 261-270.

79. ◆A longitudinal study examined what effects the
total hours of productive activities have on older
people’s health
(3 year follow-up study)
Significant differences in ADL (going out, standing
up from a chair/bed, going to the toilet, etc.) and
cognitive impairments (SPMSQ score)
Shibata, H., Sugihara, Y., & Sugisawa, H. (2012). Social contribution by middle-aged and older Japanese: Its contributing
factors and effects on physical and emotional well-being. Analyses of 2 representative panel data. Applied Gerontology,
6, 21-38.
79
Hours of Activities &
Levels of ADL Cognitive
Productive acImtivpitaieirsm caenn tpsrevent ADL
and cognitive impairments

80. Summary of Existing Studies
1. A significant number of people start
needing care due to locomotor disabilities.
2. Speed of walking is an important health
indicator among older people.
3. Lower frequency of going out is a risk
factor for problems with walking and
cognitive function.
4. Programs to increase motor function can
be effective.
5. Productive activities can prevent ADL and
cognitive impairments.
80

81. 3. Comprehensive Community Care &
Long-Term Care Prevention
Comprehensive Community Care
(providing integrated community support, including housing, health care, LTC,
preventive care and assistance w/ daily living, so that people can stay in a familiar
environment)
◆Within the frame of CCC, municipalities are urged and
supported to make efforts to prevent frailty by maintaining
and restoring older people's
motor function through
evidence-based way of
exercise.
◆Active participation by
residents, especially older
people and community
as a whole is essential.
81
Long-term care prevention service, Sakai city, Fukui
prefecture

82. 4. Other Measures to Promote
Locomotor Health & LTC Prevention
Basic Health Check List for Those Over 65years Old is
distributed to about 50% of the elderly population by
local municipalities, and about 30% of older people fill it
out.
82
Health Checkups for LTC
Prevention
Questionnaires
1 daily life
Do you normally travel by bus or train by yourself?
Do you go out and buy daily necessities by yourself?
Do you manage your own deposits and savings at the bank?
Do you often go out to visit your friends?
Do you consult with your family or friends about their problems?
2 physical ability
Are you able to go upstairs without holding rail or wall?
Are you able to stand up from the chair without any aids?
Are you able to keep walking for about 15 minutes?
Do you worry about falling down?
…
… ©AMDA International Medical Information Center 2008

83. Prevention of
“Locomotive Syndrome”
83
“Health Japan 21” Campaign
(Ministry of Health, Labour and Welfare)
“The Locomotive Challenge! Council”
(The Japanese Orthopaedic Association + private enterprises)
Bones
Muscles
Joints
Bone strength
Fall/fracture
Sarcopenia
Burden on
joint/inflammation
Mobility
Limited
activities/social
participation
Needing care

84. Measures to Build a Better Environment to Improve Mobility
Barrier-Free Act (Enacted in 2000, revised in 2006)
Ensuring independent living for older
people & those w/ disabilities
◆ Promoting barrier-free design: Streets,
parks, buildings, public transportation, etc.
◆ Focused efforts to promote barrier-free
design: Around stations and areas
frequently used by older people and those
w/ disabilities
84

85. Mobility Support Project
85
Ubiquitous Tanba Sasayama
Reading QR codes +
Providing WiFi positional
info
Internet
(WiFi service)
QR Code
System configuration & available
contents
Routing assistance
Info on
facilities
Info on
restrooms
Bus timetables
Providing contents
(content server)
Walking space network data

86. Conclusion
◆ Maintaining and improving older
people’s mobility are tools to promote
their social participation. Programs to
maintain and improve mobility cannot be
effective without older people’s positive
attitude toward a society.
◆ That is, we can pave the way for a
hyper-aged society based on the concept
of Productive Aging.
86

87. Loss of mobility, loss of Autonomy,
loss of quality of life
Lia Daichman
President
ILC-Argentina
This event is kindly supported by Alliance Boots and hosted by the LGA
#ilcglobalalliance

88. -ARGENTINA
“LOSS OF MOBILITY,
LOSS OF AUTONOMY,
LOSS OF QUALITY OF LIFE”
LIA SUSANA DAICHMAN MD
CYNTHIA MARIÑANSKY MD
MAG. SOFÍA APTEKMAN SW
ROSANA SILBERMAN SW
London, Oct. 2014

89. INTRODUCTION
-ARGENTINA
Life-space scales have been developed
to assess movement of individuals
from home to beyond town or region
in contrast with classic measures of mobility
that do not take into account
the interaction with the living environment.

90. DEMOGRAPHY
-Argentinean total population:
40.117.096 persons
corresponding 5.725.838 to people
60 years and older
- People over 65 years of age
represent 10.2%
14.3% are 60 years old and over.
- Middle life expectancy at birth is
around 75.5 years,
72.5% for males and 80% for
females.
•The proportion of seniors in Argentina is the
third [1]
highest in the Latin American Region
after Uruguay and Cuba.
-ARGENTINA

91. GROUP PROFILE: ANALYSIS
Gender: 82% females
N = 50
 Average age: 77.1 years, (77.5 (F) and 75.4(M)
 Education: 54% high school; 7% university;
Income: 80% believed “sufficient”
 Health: 76% perceived themselves to be in a good health
 Marital status: 44% widows; 36% married; 6% divorced;
14% single (exceed the rate of the City of BsAs)
-ARGENTINA
 Living arrangements: 66% with other people; 44% living alone.

92. RESULTS
-ARGENTINA
 Cognitive functioning: 84% normal; 16% had some difficulties.
 Depressive symptoms: 70% showed no depressive symptoms;
30 % presented depressive symptoms.
 Physical limitations: 58 % had no difficulty with the Chair Test;
20 % had some difficulties;
22% could not perform the test at all.
 ADL: 84% had no difficulty; 16% require assistance
 Space Life: 52% were above 87 points; 32% between 56 and
87 points and 16% below the 56 point line
which is considered risk (highest 120 points)

93. -ARGENTINA
HIGHLIGHTS
Differed according to previous personalities and coping mechanisms
through their life cycles.
Nearly 70% expressed that their lives would be highly impaired in the case
they should have to remain at home:
- “I would commit suicide because I love my home and activities”
- “I cannot even think about it”
- “I really never thought about it”
- “I would lose my freedom, I would become a slave”
- “I would be depressed, I wouldn´t like to live like that”
- “I would lose my job, the one I depend on.”
-“I would adapt myself, I would look for company and help” –
-“I expect it won’t happen, it would be very hard”

94. -ARGENTINA

95. -ARGENTINA
DISCUSSION
- A high percentage of our population expressed that a situation like
this would influence on their emotional state by means of
depression, sadness, anguish, anxiety about the future and
helplessness…
-The vast majority of people admitted that they would need help.
(It seems that FAMILY would be the first answer).
- Nevertheless, a fair number of people, who would accept help, do not
mention family as their first resource. More than that, they explicit
would feel pretty bad about having to rely on their children or
grandchildren for informal care.
- Older sons and daughters, more than often take care of their own
- grandchildren and when they have to look after their older parents,
even if they privilege the little ones, they find themselves in a difficult
position which they cannot escape and have little choice… .

96. RECOMMENDATIONS
-ARGENTINA
•Inform and prepare older person, their families and the
community in general about what to do and how to deal with
gradual or sudden loss of autonomy’ situations.
•Work with Focus groups or special courses for older persons
addressing risk factors related to this age group and generate
alternative projects that extend and strengthen existing and new
networks of support.
•Create specialized public and private centers for advice and
support to older persons and their families to be used as
required.
•Promote programs and awareness workshops on
intergenerational solidarity to facilitate inclusion of older adults
in need of care

97. RECOMMENDATIONS
-ARGENTINA
• Stimulate more public and private policies to build or improve and
adapt homes for older people for present and future needs.
• Sensitize the population about the importance of home safety to

prevent accidents.
• Promote within the community the importance of physical activity,
health care and active ageing to prevent deterioration and disability.
• Encourage individual, intergenerational and community social,
exchange, including older persons, to promote the consolidation
of support networks at a useful level when necessary.
• Work individually or in groups, in terms of medical and social
services, to avoid, prevent, and support sensory deprivations as
well as all types of MOBILITY’s loss.

98. Thank you very much from
Buenos Aires!..
-ARGENTINA
liadaichman@fibertel.com.ar

99. Local and national initiatives to support
active ageing and improve quality of
long-term care in the Czech Republic
Dr Iva Holmerová
President
ILC-Czech Republic
This event is kindly supported by Alliance Boots and hosted by the LGA
#ilcglobalalliance

100. Local and national initiatives to
support active ageing and improve
quality of long-term care in the
Czech Republic
Iva Holmerová, Petr Wija
ILC-Czech Republic

101. Healthy Life Expectancy (Wija 2012)
2011 ženy muži
hly 63,6 62,2
le 80,7 74,7
% hly 78,8% 83,3%
rozdíl muži ženy: 6 let (LE), 1,4 let (HLY)

102. P. Wija, 2013

103. Future need of long-term care will depend on
(EC 2013):
•
– Numbers of persons 80+
•
– Health status of population, healthy life expectancy,
chronic diseases and multimorbidity
– Ability to live in home environment despite
disability

104. Enabling model of geriatric care
(P.Millard, 1994)
Acute care – dg and treatment
Rehabilitation
Long-term care
Functional
improvement

105. Disabling model of geriatric care
(P.Millard, 1994)
Dg and th
RHB
Long-term care
Underestimation
of geriatric care
needs – fixation
of disability

106. BEDEKR
Guide on Active Ageing
or
How to find the way in the landscape of active
ageing and long-term care
Holmerová I., Starostová O., Vepřková R., Wija P.

107. BEDEKR
 Support of active ageing on the community level
 Participation and communication with local authorities
 Independent living
 Environment and mobility

108. BEDEKR
 Intergenerational activities
 Voluntary work
 Education
 ICT literacy and internet
 Social activities
 Physical activity and sports

109. BEDEKR
Mobility:
- Important aspect of quality of life
- Necessary for self-maintenance
Individual level (rehabilitation, support,
aids)
Community level – no barriers, transport
Societal level - enabling environment

115. CELLO – ILC – CZ
• Thanks to:
• Dana Hradcová – GOS Project and CELLO
Coordinator
• Marcela Janečková – FRAM Project
• Olga Starostová – FRAM Project
• Radka Vepřková – FRAM Project
• Hana Vaňková – IGA and GOS Project
• Petr Veleta – GOS Project

116. Panel Response
Marieke van der Waal
Director, ILC-Netherlands
Jayant Umranikar
ILC-India
This event is kindly supported by Alliance Boots and hosted by the LGA
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117. Ageing and Mobility: ILC Global
Alliance Symposium
Wednesday 29th October 2014
This event is kindly supported by Alliance Boots and hosted by the LGA
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