Interview with Angélica Ugarte - Health care professional in Osakidetza

Interviewer
In the light of your political experience in the field of frailty in older people, how would you define frailty considering its multidimensional nature (for example, health, social, economic, ethical, legal)?

Interviewee
In my opinion, frailty is a syndrome suffered by older people, due to their lack of activity, advanced age and different nutrition.

How would I define a frail elderly person? Well, it is a person who has reduced capacities, physiological reserves and functional capabilities. This then leads to the possibility of suffering effects, adverse health situations and possible negative consequences of these adverse situations. Frail people are more vulnerable to the negative consequences of these situations, and are susceptible to these situations, which can lead to a situation of disability and dependency.
Frailty has to be measured by functional capacity, which is the most important part of the definition itself, in that a frail person has reduced functional capacity.

Interviewer
From your point of view, what are the needs related to frailty? Are they changing over time?

Interviewee
The basic need now is to detect frailty in a systemic way (which is what the national health system also recommends) in order to be able to act to reverse the situation of functional difficulty and be able to avoid or delay disability or dependency.

Interviewer
How does frailty affect and is affected by many different aspects of a person's life? (including the person´s physical health, immobility, mental health, loneliness, cognitive function and their social and family environment)

Interviewee
Since functional capacity is affected, people become sedentary which strongly influences their health. They burn fewer calories, reduce muscle mass, their bones are weakened, their metabolism for synthesising fats and sugars can be affected, their immune system may not work well, they may have poor circulation, their bodies may experience more inflammations or they can develop hormonal imbalances. In other words, there are a number of factors that can lead to a sedentary lifestyle. What can cause this? Well, heart disease, blood pressure, strokes, diabetes, obesity, social isolation, even anxiety problems, depression, many diseases that can be avoided.

Interviewer
How does the extent of a person's frailty change over time and how can it be influenced by lifestyle or other factors?

Interviewee
The most important way to change a person's frailty is through physical activity, and this has already been proven.
By ceasing to be sedentary and doing age-appropriate physical activity, not only by working on endurance and strength, but also balance and flexibility, we are able to improve people's physical and mental capacity. We need to prevent and reduce life-threatening illnesses and improve our social response. They are the most fundamental aspects to act against it.

Interviewer
What national policies, strategies and initiatives are put in place for addressing the needs of older people who live with frailty? How are current policies suggesting the multidimensional nature of old–age frailty?

Interviewee
Through the consensus document of “Prevention of frailty and failures of the national health system”, published in 2014. I find it interesting because it recommends the systematic detection of frailty. Especially in people over 70, because it is a prevalent problem in people of this age. And it really creates a risk of dependency. Above all, there are reasonably reliable detection methods and potentially beneficial interventions. This for us is the basis of our local approach as well as everything published by the WHO on ageing and health.

Interviewer
On 13th December 2018, in Madrid, the ADVANTAGE JA coordinator presented the ‘Frailty Prevention Approach’, which is a common approach to frailty to be used in Europe to overcome differences between countries. In 2019 the Frailty Prevention Approach document will be widely disseminated, and member states will be contacted to understand, at a governmental and regional level how they plan to implement this document in practice. In this context, are there any policies, strategies, experts´ groups, national and international initiatives, that you consider valid and that we should consider and take as best practices?

Interviewee
At the Advantage meeting, it was mentioned the homogeneity, homogeneity to develop ageing tools at a European level. It was highlighted how physical exercise decreases frailty, how its effectiveness is proven, how it increases the health of frail individuals but it further highlighted the preventive side of frailty. It is always considered that the sooner we act on frailty, the more effective it is. The important thing about the work of prevention in terms of the risk of falls, nutrition, a healthy diet reducing frailty, polypharmacy... All these things were highlighted and what was more to be highlighted was the homogeneity in cultures as different as there were at the European forum and the social problem that this generated. That was the general concern. With these policies and these initiatives, it is the right thing to do, to act at a local level.

Interviewer
Do you think frailty should be addressed through the synergy and joint work of policy makers and stakeholders? If yes, what would you say, is the situation in your country regarding this issue?

Interviewee
Of course, as long as there is no political decision and as long as we operate on government-driven trajectories, we cannot do anything. I believe it is necessary to work and raise awareness from above, from governments. Healthcare systems need to be adapted to the ageing population we currently serve. Long-term care systems must be created. Elderly-friendly environments need to be created and measurement, monitoring and understanding need to be improved.
I know the situation at Osakidetza [Basque Health Service], and I can say that a great deal of effort is being put into following a strategic direction in order to improve the health and well-being of the population over 70, trying to work from early detection and care in risk situations. So, we are also working at a grass-roots level with local health networks.

Interviewer
From your experience, what are the barriers encountered in health and social care settings for managing frailty in older people? What are the possible effective solutions to overcome such barriers?

Interviewee
I think the most important thing is the lack of awareness, both among the population and among health workers themselves. I believe that it is not difficult to deal with frailty, but to do so it is necessary to be aware of it and know that something must be done.

Interviewer
In your opinion, what new services or strategies are needed for meeting the multidimensional needs of an ageing population? Shall the role of the healthcare system change or evolve in this respect?

Interviewee
Yeah, I think so. I think it's already changing. As for what we are doing in Osakidetza, I think we are a bit ahead in planning for services that are improving or will bring improvements. On the one hand, in Osakidetza we are working with the Mayor's Care Plan (PAM), which helps us stratify the population. We can identify people in pre-fragmentation because they are already becoming sedentary and at the same time fragile. And we are already working with this frality in order to be able to treat it, even prevent it and/or reverse it. To this end, we are working through the local health network with the aim of, in addition to raising awareness, knowing the determinants of health with which we work. We want to identify the assets that the older population has in order to be able to use them and work in the community, and what is essential is the participation of older people, their empowerment. Therefore, we are carrying out a field study, an identification of health assets, in which the population identifies its strengths so that they can be used within the community.
For this, we need political and governmental participation and citizen participation. Not only is it an instrument, the local health network, the collection and recognition of data and that's it. Its purpose is to weave a network of relationships and mutual support. All this improves the quality of life, promotes health and is not only aimed at solving individual problems, but also at facilitating social and environmental change.

Interviewer
In your country, where can advice, support and information be obtained for people with frailty, families and carers?

Interviewee
Well, Osakidetza is a means of access, but another very important one is social services. We relate and communicate a lot with social services and well, since the patient or citizen is an individual and the problems are often social and health problems, we approach from both areas. In addition, social workers deal not only with the projects of the town councils, but also with the projects of the provincial town councils, among which they cover the social aspect. From the point of view of health, I believe that the access points for the population are these two. Here I believe that we are working on projects that can affect the population and that they have enough information to be advised.