Future trends in human resources for health care : a scenario analysis

[Contents] 1. Introduction and scope of this scenario analysis. 2. Demography of health care professionals. 3. Demographic changes in the health workforce. 4. Regulating the demography of health care professionals. 5. Regulating human resources productivity. 6. Scenario analysis. 7. Summary and conclusion. References

NUTRITION AND HEALTH IN A COHORT REPRESENTATIVE OF THE GENERAL COMMUNITY-DWELLING POPULATION OF LAUSANNE AGED 65 AND OVER

The objective was to study the links between health characteristics, frailty criteria, lifestyles, adiposity and disability in a population-based cohort of non-institutionalized adults aged 65 to 70 years at baseline (N= 1,260 to 1,293). At baseline, frailty was rare (2%), while pre-frailty was common (26%). Pre-frail participants had significantly more comorbidity and disability (defined as help received for activities of daily living, ADL) than non-frail participants. Weakness was the most frequent frailty criterion and was associated with cardio-vascular diseases (CVD). The prevalence of overweight (body mass index (BMI) 25.0-29.9 kg/m2), obesity (BMI ≥30.0 kg/m2), and abdominal obesity (waist circumference (WC) ≥102 cm in men, WC ≥88 cm in women) was 53%, 24%, and 45% in men; 35%, 23%, and 45% in women. Walking and using stairs in daily life was associated with lower adiposity values than doing sports at least once/week. Eating fruit and vegetables at least twice/day, walking and using stairs in daily life, and doing sports ≥once/week were significantly negatively associated with financial difficulties and positively with educational level. In longitudinal analyses, 130 persons died over a median follow-up of 8.47 years. In fully adjusted Cox models, mortality was significantly associated with neither BMI nor WC, but there were trends toward non- significant J curves across both BMI and WC quintiles. Disability (defined as difficulty with BADL or institutionalization, 231 cases) tended to increase monotonically across both BMI and WC quintiles and was significantly associated with BMI quintile 5 (HR=2.44, 95% CI [1.65-3.63]), and WC quintiles 4 (HR=1.81 [1.15-2.85]) and 5 (HR=2.58, [1.67-4.00]). Almost half of the population had a substantially increased HR of disability, as compared to the reference BMI/WC categories. In conclusion, studies with larger sample sizes and longer follow-up should assess the roles of BMI and WC trajectories since midlife and further clarify the shapes of their associations with disability. These findings, together with the literature review, emphasize the need for life-long strategies aimed at preventing excess weight, muscle loss and functional decline through adequate nutrition and regular physical activity, starting at early age and extending throughout life. -- Nutrition et santé à l'âge de 65 ans et plus : une étude dans la population de Lausanne ne vivant pas en institution L'objectif de ce doctorat était d'étudier les liens entre l'état de santé, le degré de fragilité, le style de vie, le surpoids et le développement d'une dépendance dans les activités de la vie quotidienne en analysant les données fournies par environ 1300 adultes initialement âgés de 65 à 70 ans. Ces personnes ont été suivies sur une durée de plus de 8 ans; elles ont rempli des questionnaires et passé des tests régulièrement. La fragilité a été définie sur la base de 5 critères (perte de poids involontaire, vitesse de marche lente, force de préhension au niveau de la main faible, fatigue ressentie et activité physique basse) dont 3 au moins doivent être remplis pour être considéré comme fragile. Au démarrage de l’étude, la fragilité était rare (2% des participants), mais la pré-fragilité (1 ou 2 critères remplis) fréquente (26%). Les participants pré-fragiles avaient plus souvent des maladies chroniques ou recevaient de l'aide pour effectuer les activités de la vie quotidienne (s’habiller, manger, se doucher, etc.) que les personnes n’ayant aucun des 5 critères de fragilité. La faiblesse de la préhension au niveau de la main était le signe de fragilité le plus fréquent et il était plus souvent observé parmi les personnes souffrant de maladies cardio- vasculaires. L’indice de masse corporelle (IMC) est une mesure de la corpulence. Il s’agit du poids (en kg) divisé par la taille au carré (en m2). La fréquence du surpoids (IMC entre 25.0 et 29.9 kg/m2) était de 53% chez les hommes et de 35% chez les femmes. Celle de l’obésité (IMC ≥30.0 kg/m2) était de 24% chez les hommes et de 23% chez les femmes. L’obésité abdominale (définie par un tour de taille supérieur ou égal à 102 cm chez les hommes, 88 cm chez les femmes) touchait 45% des hommes et des femmes. Les personnes marchant au quotidien et prenant les escaliers étaient plus minces que celles qui évitaient les escaliers mais faisaient du sport au moins 1x/semaine. Les habitudes nutritionnelles favorables à la santé étaient par ailleurs liées aux facteurs socio-économiques: les personnes mangeant des fruits et légumes au moins 2x/jour, utilisant les escaliers au quotidien et faisant du sport au moins une fois par semaine ont moins souvent rapporté des difficultés financières et bénéficiaient d'un niveau d’éducation plus élevé. Lors du suivi de 8 ans, 130 personnes sont décédées. En tenant compte de certains facteurs dans les analyses (sexe, âge, difficultés financières, éducation, tabagisme, perte de poids), il n’y avait pas de lien statistiquement significatif entre l’IMC ou le tour de taille et le risque de décès; cependant la mortalité tendait à être plus élevée aux deux extrêmes, parmi les personnes de très faible corpulence ainsi que parmi les personnes obèses. Au cours du suivi, 231 personnes ont développé des difficultés durables dans les activités de la vie quotidienne. Leur nombre augmentait progressivement dans les catégories d’IMC ou de tour de taille plus élevé. En particulier, parmi les 20% des personnes ayant l’IMC le plus élevé, ou les 40% des personnes ayant le tour de taille le plus élevé, la survenue de ces difficultés était significativement plus fréquente. En conclusion, il faudrait effectuer des études avec plus de participants et un suivi plus long pour mieux connaître le rôle de l’IMC et du tour de taille depuis l’âge de 40-50 ans, et clarifier leurs liens avec les difficultés dans les activités de la vie quotidienne. La littérature suggère qu’il faut prévenir le surpoids, la perte de masse musculaire et le déclin fonctionnel depuis un jeune âge et tout u long de la vie par le biais d’une alimentation équilibrée et d’une activité physique régulière

Prefrailty and chronic morbidity in the youngest old: an insight from the Lausanne Cohort Lc65+.

OBJECTIVES: To estimate the prevalence of prefrailty, frailty, comorbidity, and disability in the youngest old and to identify chronic diseases associated with individual frailty criteria. DESIGN: Population-based cohort study of noninstitutionalized elderly adults at baseline; cross-sectional analysis. SETTING: Lausanne, Switzerland. PARTICIPANTS: One thousand two hundred eighty-three individuals with complete data on frailty, aged 65 to 70 (58.5% women). MEASUREMENTS: Frailty was assessed according to an adaptation of Fried's criteria (shrinking, weakness, exhaustion, slowness, and low activity, three criteria needed for the diagnosis of frailty, 1 to 2 for prefrailty). Other outcomes were diseases diagnosed by a doctor (≥ 2 chronic diseases: comorbidity) and limitations in activities of daily living (ADLs, basic and instrumental). RESULTS: At baseline, of 1,283 participants 71.1% were classified as nonfrail, 26.4% as prefrail, and 2.5% as frail. The proportion of women increased across these three groups (56.5%, 62.8%, and 71.9%, respectively; P = .01), as did the proportion of individuals with one or more chronic diseases (68.0%, 82.8%, and 90.6%, respectively; P < .001) and the proportion with basic or instrumental ADL disability (1.6%, 10.3%, and 59.4%, respectively; P < .001). Weakness (low grip strength) was the most frequent criterion (14.3%). Prefrail participants had significantly more comorbidity and ADL disability than nonfrail participants (P < .001). When present in isolation, weakness was associated with two to three times greater prevalence of coronary heart disease, other heart diseases, diabetes mellitus, and arthritis. Similarly, a significant association was identified between exhaustion and depression. CONCLUSION: Prefrailty is common in the youngest old. The most prevalent frailty criterion is weakness, which is associated with cardiovascular diseases. Longitudinal studies of the evolution of prefrailty should explore the role of potential interactions between individual frailty criteria and specific chronic diseases

Prevalence, awareness, treatment and control of hypertension in a Swiss general population: the CoLaus Study

Objective: To assess the prevalence levels of awareness, treatment and control of hypertension and associated factors in Switzerland. Methods: Population-based cross-sectional study of 6,182 subjects (52.5% women) aged 35-75 years living in Lausanne, Switzerland. Hypertension was defined as blood pressure ≥140/90 mm Hg or current antihypertensive medication. Results: The overall prevalence of hypertension was 36% (95% CI: 35-38%). Among hypertensive participants, 63% were aware of having hypertension. Among aware hypertensives, 78% were treated, and among treated hypertensives 48% were controlled (BP <140/90 mmHg). In multivariate analysis, prevalence of hypertension was associated with older age, male gender, low educational level, high alcohol intake, awareness of diabetes, awareness of dyslipidaemia, obesity and parental history of myocardial infarction (MI). Awareness of hypertension was associated with older age, female gender, awareness of diabetes, awareness of dyslipidaemia, obesity and parental history of MI. Control was associated with younger age, higher educational level and no alcohol intake. Alone or in combination, sartans were the most often prescribed antihypertensive medication category (41%), followed by diuretics, beta-blockers, ACE inhibitors and calcium channel blockers. Only 31% of treated hypertensives were taking ≥2 antihypertensive medications. Conclusion: Although more than half of the participants with hypertension were aware of being hypertensive and more than three quarters of them received a pharmacological treatment, less than half of those treated were adequately controlled. Treated hypertensive subjects should be followed up more closely

Prevalence, awareness, treatment and control of high blood pressure in a Swiss city general population: the CoLaus study.

BACKGROUND: This study is aimed to assess the prevalence of awareness, treatment and control of high blood pressure (HBP) and associated factors in a Swiss city. DESIGN: Population-based cross-sectional study of 6182 participants (52.5% women) aged 35-75 years living in Lausanne, Switzerland. METHODS: HBP was defined as blood pressure >/=140/90 mmHg or current antihypertensive medication. RESULTS: The overall prevalence of HBP was 36% (95% confidence interval: 35-38%). Among participants with HBP, 63% were aware of it. Among participants aware of HBP, 78% were treated, and among those treated, 48% were controlled (BP <140/90 mmHg). In multivariate analysis, HBP prevalence was associated with older age, male sex, low educational level, high alcohol intake, awareness of diabetes or dyslipidaemia, obesity and parental history of myocardial infarction. HBP awareness was associated with older age, female sex, awareness of diabetes or dyslipidaemia, obesity and parental history of myocardial infarction. HBP control was associated with younger age, higher educational level and no alcohol intake. Alone or in combination, sartans were the most often prescribed antihypertensive medication category (41%), followed by diuretics, beta-blockers, angiotensin converting enzyme inhibitors and calcium channel blockers. Only 31% of participants treated for HBP were taking >/=2 antihypertensive medications. CONCLUSION: Although more than half of all participants with HBP were aware and more than three-quarters of them received a pharmacological treatment, less than half of those treated were adequately controlled