doctors’ and older patients’ health …...introduction the present study generated data for the...

DOCTORS’ AND OLDER PATIENTS’ HEALTH LITERACY OF FUNCTIONAL DECLINE AND

FRAILTY

Results from Latvia and Romania

EU Policy Recommendations Executive summary

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LIST OF CONTRIBUTORS (in alphabetical order)

. Dr Gunta Ancane – Latvian Medical Association; the Stradins University, Riga

. Assist. Prof. Dr. Ana Capisizu – Romanian College of Physicians; WG Healthy for and Active Ageing; University of Medicine and Pharmacy ”Carol Davila” and ”St. Luca” Hospital for Chronic Diseases, Bucharest

. Univ. Assist. Dr. Monica Haras – Romanian College of Physicians; WG Healthy for and Active Ageing; University of Medicine and Pharmacy ”Carol Davila” and Teaching Emergency Hospital "Bagdasar-Arseni", Bucharest

. Prof. Dr Gelu Onose – Chair CPME WG for Healthy and Active Ageing; Romanian College of Physicians; University of Medicine and Pharmacy ”Carol Davila” and Teaching Emergency Hospital "Bagdasar-Arseni", Bucharest – coordinating editor

. Dr Olga Rostowska, Immediate President of the European Medical Students’ Association

. Prof Kristine Sorensen – Maastricht University, Consortium partner of HLS-EU

. Prof. Dr. Tiberiu Spircu (statistics expert) – University of Medicine and Pharmacy ”Carol Davila”, Bucharest

. Dr Jacques van der Vliet, CPME expert EIPAHA CPME Secretariat: . Anamaria Corca, CPME EU Policy Advisor . Henry Kizito, CPME Maastricht University Intern . Daria Zygmunt, CPME EU Policy Intern

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EU Policy Recommendations

Introduction The present study generated data for the first time on the levels of health literacy of functional decline and frailty for doctors and older patients (60+ years old) in Latvia and Romania. Furthermore, the study tackles not only the lack of data on the topic but it provides insight from two EU member states, a Central-Eastern and a Baltic member state, that (also) struggle with the fall in fertility 1 coupled with high percentage of outward migration predominantly within the early working age population. Projections on the aging of the population in Latvia and Romania are particularly worrying as the fall in fertility, migration and life expectancy that is below that of the EU-15 member states accelerate the impact of the projected demographic challenges at an unprecedented rate.

Figure 1: Source – What’s Next in Aging Europe: Aging with Growth in Central Europe and the Baltics, p. 38, Based on United Nations Population Division (2013)

The framework of the present study is the European Innovation Partnership on Active and Healthy Ageing (EIPAHA) at EU level. The study is part of a commitment of the Standing Committee of European Doctors (CPME) and the partners in the present study to understand the health literacy of functional decline and frailty and raise awareness on prevention of frailty and functional decline.

CPME was actively contributing to the Strategic Implementation Plan of the EIPAHA2, identifying the need for action on Prevention of Frailty and Functional Decline as a European public health priority with significant scope for innovation and positive contribution to demographic challenges3.

1 A World Bank report from March 2015 situate the fertility levels to be lower than those in the EU-15. Please see page 38 for further information. 2 CPME Press release, 7 November 2011: The Strategic Implementation Plan for Active and Healthy Ageing: CPME Welcomes Adoption and Urges to Immediate Action.

http://ec.europa.eu/health/ageing/innovation/index_en.htm

http://ec.europa.eu/health/ageing/innovation/index_en.htm

http://ec.europa.eu/research/innovation-union/pdf/active-healthy-ageing/steering-group/operational_plan.pdf#view=fit&pagemode=none

http://www.worldbank.org/content/dam/Worldbank/Publications/ECA/aging%20europe.pdf

http://www.cpme.eu/the_strategic_implementation_plan_for_active_and_healthy_ageing_cpme_welcomes_adoption_and_urges_to_immediate_action/

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RECCOMENDATION 1: The novel data from Latvia and Romania contributes to the general health data in the two countries providing new insights to health literacy on functional decline and frailty. This study is further supported by the World Bank recommendation of March 2015 “What's Next in Aging Europe: Aging with Growth in Central Europe and the Baltics” insofar as it meets the call concerning the need for further action in countries such as Latvia and Romania.

Chapter VI, pt. 26 of the Council of Europe Recommendation (CM/Rec(2014)2) on the promotion of human rights of older persons of 19 February 2014 encourages “appropriate measures at national level, including preventive measures, to promote, maintain and improve the health and well-being of older persons as well as health care and long-term quality care that is available and accessible”; pt. 34 also states “Care givers should receive sufficient training and support to adequately ensure the quality of the services provided. Where older persons are being cared for at home by informal carers, the latter should likewise receive sufficient training and support to ensure that they are able to deliver the care needed”.

With many international initiatives around the topic and efforts to improve health literacy, the present study should be expanded to understand the precise level of health literacy for frailty and functional decline at a European scale. Furthermore, such a wider scale study would also provide a better understanding behind mechanisms to promote patient empowerment and support self-care.

RECCOMENDATION 2: Preliminary results from Latvia and Romania show data that complements the results from the European Citizens' Digital Health Literacy Eurobarometer Study as well as the HLS-EU survey findings. The European Citizens’ Digital Health Literacy Eurobarometer report aims to assess the extent and use of the internet to manage health. It also tries to identify and understand which are the sources of health information citizens prefer other than the internet. The study finds that 79% of respondents ask their doctor when searching for information elsewhere than the internet (European Citizens' Digital Health Literacy Eurobarometer Study, p. 64). In Romania the percentage is 77% and in Latvia 84%. In the present study that looks at the age group of 60+ year old persons from Latvia and Romania, the results are similar and doctors are the main source of information with regard to both functional decline (54.8%) and frailty (50.8%). However, when comparing the results from the Eurobarometer study with the present study for a similar age group (the older population), 26% above 55 years old indicate to have never used the internet and 20% state not to have access to the internet. Furthermore, patients in Latvia and Romania indicated to prefer TV and radio broadcasts as a means to improve awareness of functional decline and frailty. This correlates to the decreased digital access and preferences of the older population. Of the older age group using the internet for health information and who indicated that were not satisfied with the health information found, they did so primarily because they felt the information was commercially oriented (47%). Another interesting finding of the Eurobarometer study that underlines the need to improve health literacy refers to the immediate actions older people took after searching the internet for health information: 1 spoke to friends or relatives (43%); 2.made a doctor’s appointment (37%) and 3. took the necessary measures to treat oneself (self-medication) or change lifestyle (30%).

3 CPME Press release, 6 November 2012: CPME Supports and Contributes to the Action Plan on Prevention of Frailty and Functional Decline. For the composition of the Steering Group of the EIPAHA members, please see the Strategic Implementation Plan – page 42, Annex I.

https://wcd.coe.int/ViewDoc.jsp?id=2162283&

http://ec.europa.eu/public_opinion/flash/fl_404_en.pdf


http://cpme.dyndns.org:591/adopted/2015/Info.2015-095.Final_report_Executive_summary_of_HLS-EU.pdf


http://cpme.dyndns.org:591/adopted/2012/PR_EIPAHA_26102012_AC_kr_bb.pdf



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With regard to the HLS-EU study, results of the levels of general health literacy in Bulgaria and Greece decrease with the age group (Comparative report on Health Literacy on Eight EU Member States, page 47). The present study shows similar results for this age group.

RECCOMENDATION 3: While the health literacy levels are higher in Latvia and Romania than shown in the HLS-EU study of 8 EU member states, patients have most difficulty understanding the concepts of functional decline and frailty when considering the competences to find, understand, access and apply information related to functional decline and frailty.4. Furthermore a high percentage of patients considered necessary actions on prevention of functional decline and frailty. It is recommended to replicate this research in other EU member states as increased knowledge concerning functional decline and frailty will have added value at EU level in support of healthy ageing.

RECCOMENDATION 4: While some of the doctors responding to the questionnaire were well aware, understood and applied concepts on functional decline and frailty, when questioned about specific scales of measurement or in-depth information about functional decline and frailty, generally other doctors could not point towards specific scales (reference questions) or how much doctors focus on these areas in daily practice. Hence it is recommended that the health literacy concerning functional decline and frailty among doctors should be part of curricula for general practitioners and other medical specialties working with older patients.

RECCOMENDATION 5: While this survey faces limitations in terms of sample size and geographical representativeness, a wider population that includes, for the doctors, more specialties could potentially offer more in-depth insights and more precise indications on the levels of health literacy related to functional decline and frailty.

The surveys on functional decline and frailty, which included separate questionnaires to patients as well as health professionals were carried out between April and October 2014. The responses were collected, analyzed and joined together with the present recommendations and respective summary between October and April 2015.

Valuable feedback was also received from:

. Michelle Glekin, Israeli Medical Association,

. Prof Dr Tomasz Kostka, Medical University Lodz,

. Dr Konstanty Radziwiłł, CPME Immediate Past President,

. Dr Itzhak Siev-Ner, Israeli Medical Association,

. Dr Anthony Woolf, the Bone and Joint Decade Association.

4 Pelikan, J, Rothlin, F, Ganahl, K., Comparative report on Health Literacy on Eight EU Member States, 2012. HLS-EU Consortium main partners:Prof Kristine Sorensen, Helmut Brand, Maastricht University, the Netherlands.

http://cpme.dyndns.org:591/adopted/2015/Comparative_report_on_health_literacy_in_eight_EU_member_states.pdf

http://cpme.dyndns.org:591/adopted/2015/Comparative_report_on_health_literacy_in_eight_EU_member_states.pdf

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Summary of results:

Analysis of patient responses concerning functional decline and frailty

The study analysed 301 responses from 60+ older patients living in Latvia and Romania. Most respondents were aged between 65 and 74 years (38.2%), 65% live with their family, 73.4% were fully retired whereas only 8.3% were not retired. 12.6% declared that family and home were their work. A very high number of patients declared to be aware of age-related functional decline, 76.4%. The main source of information on functional decline is represented by doctors (54.8%), health broadcasts (22.9%), relatives, friends (20.3%) and journals (19.9%). Concerning frailty the responses were similar, 50.8% saw doctors as a main source of information and instead of journals, magazines were 4th in terms of source of information (20.3% of respondents indicated magazines). A rather significant percentage of patients found it difficult to access information on functional decline (18.6%). Most respondents however found it easy to access information (46.18%). Concerning frailty the responses were similar ranging from easy (46.51%) to very easy (10.96%) and 18.27%, again, a rather significant percentage that indicated it is difficult to access information. The most trusted sources of information were: doctors, health broadcasts, nurses, pharmacists and magazines. 44.2% of respondents indicated that TV and radio programs, a hotline where the public can call, an increase in physicians awareness and an increase in the awareness of the young generation, are measures that should be implemented to prevent functional decline and frailty. The levels of health literacy both on functional decline and frailty are high in both countries. The questionnaires included in the study adapted the conceptual HLS-EU model linking health literacy to include the competencies to access, understand, appraise and apply information on functional decline and frailty. Table 1 below summarizes the main results.

TABLE 1. Summary of responses

Health literacy Functional decline Frailty Awareness 76.4% of respondents are aware of functional decline 75.75% (aware of frailty) Access Source 10.3% do not know or access information on

functional decline 10.6% do not know or access information on frailty

Type 18.6% difficult access and 14.62% did not know or cared

18.2% difficult access and 10.3% did not know or cared

Understand 21.93% found it difficult to understand the concept 19.93% found it difficult to understand the concept Appraise Look for information 44.85% of respondents seek information frequently but also a significant percentage never seeks information

(11.63%) or rarely seek information (37.54%). Trusted sources A very high percentage indicate the doctor as the most trusted source of health information (79.4%), followed by

health broadcasts, a more traditional source of digital information (31.2%), nurses (21.9%), pharmacists (20.6%) and magazines (18.6%).

Judge relevance 41.6% indicated functional decline is very relevant for their health condition and 35.55% judged it as important. This is a very high importance attached to the condition.

81.73%, a slightly higher percentage of respondents, of respondents gave judged frailty important and very important to their health condition.

Gain knowledge 69.76% respondents gave high and very high priority to gain knowledge on functional decline.

66.77% respondents gave high and very high priority to gain knowledge on frailty

Reversibility 37.54% considered pre-frailty reversible, in line with the preferences to seek information on the condition. 35.55% did not consider frailty reversible.

Apply General knowledge Patients most often communicated about functional decline and frailty with family (59.5% - 179 respondents), then with doctors (50.2% - 151), and then with relatives/friends/neighbours (34.9% - 105).

Healthcare Regular physical activity or exercise

Most respondents stated they did walk for 30 minutes more than three times a week (28.6% - 86 respondents).Yet an alarming percentage (15% - 45 respondents) answered “no” to this question. It should be noted that 40.2% of the interviewed respondents failed to answer this question. Most respondents did not walk 60 minutes at all (24.6% - 74 respondents). 23.9% (72) stated they did walk 60 minutes at least three times a week. It should be noted that 23.9% of the respondents did not answer this question. 32.9% (190) of the respondents stated their daily routine included some form of physical exercise more than three times a week. It should be noted that 36.9% (111) respondents did not check this answer.

Increased weakness Most respondents responded they did feel weaker (23.59% - 71 respondents) or they thought they might have become more weak (29.57% - 89). Only 59 (19.6%) responded “no” and other 18 (6%) failed to give an answer.

Consult doctor Most respondents had consulted a doctor regarding their weakness (81.4% - 149 respondents). 4.4% (8

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respondents) did not respond to this question. Recurring tiredness Most respondents declared they felt more tired in general (31.56% - 95 respondents) or they thought they felt

more fatigue (30.56% - 92 respondents). Physical pattern changes

Most respondents (33.6% - 101) did not feel a change in their balance. The percentage of respondents feeling a negative change in their mobility was slightly higher (25.2% - 76) than that of respondents who felt that nothing had changed in their mobility (23.9% - 72) or were unsure (23.3% - 70). Most respondents stated they felt stiffness, especially in the morning (34.9 % - 105 respondents). Most respondents declared they did not drop objects (40.9% - 123). Most respondents declared the time they needed for their daily activities was not prolonged (26.9% - 81 respondents). Most respondents stated they did not need a prolonged time to cross the street (34.2%).

Psycho-cognitive intellectual patterns

Most respondents stated it was more difficult for them to recall certain information (34.9%). Most respondents declared they did not find it difficult to find their way to a destination (58.8%). Most respondents felt there was nothing changed in their laughing or smiling pattern (52.8% - 159). Most respondents stated they were not crying more easily (44.9% - 135). Most respondents felt that nothing had changed in their performance of regular intellectual tasks (46.2% - 139). Most respondents felt that nothing had changed in their understanding of instructions/ directions (46.8% - 141). Most respondents felt that nothing had changed in their performance of mathematical tasks (40.5% - 122).

Weight loss that patient cannot explain

Most respondents did not notice any weight loss (69.77% - 210 respondents).

Disease prevention and health promotion

Measures to prevent functional decline related to ageing

Most respondents considered that all the listed measures should be taken to prevent age-related functional decline and frailty (44.2% - 133). Of course, TV and radio programs are preferred. The listed measures in the options for response were: a)TV and radio programs on the issue to increase awareness on the subject matter and education for healthy lifestyle b) Hotline where the public can call to ask questions about different resources available (e.g. where to get transportation to different services, access to buildings, what health and social services are available for the elderly, etc.) c) Increase physicians’ awareness and knowledge with regards to available screening and treatment approaches d) Increase awareness of the younger generation to help them recognise, be sensitive

Based on the conceptual model of health literacy and the results summarized in Table 1, patients are perceived to have a low level of health literacy. While the levels of access may be improved, the understanding of functional decline and frailty is even a bigger problem with around 20% of the respondents having difficulty understanding and only around 10% having difficulty accessing information.

*NB: Within the answers to the questionnaire for 60+older patients, there were free answers to questions which, unfortunately have not been translated from Latvian into English. Therefore, a list of frequent answers could not be compiled.

Analysis of doctor responses concerning functional decline and frailty

300 doctors responded to the questionnaire: 148 doctors practicing in Romania and 150 in Latvia. 1 doctor indicated Andorra was his main place of practice and another Romanian doctor indicated Nigeria as his main country of practice. All Latvian respondents were over 44 years old. The Romanian sample is clearly skewed in favour of “young” ages. This reflects the increasing number of physicians in the new generations. Concerning the doctors’ specialties we registered a disproportionate number of psychiatrists in the Latvian sample, and of neurosurgeons in the Romanian sample. While 88.5% of Romanian doctors declared a single specialty, only 48.7% of Latvian respondents declared a single specialty and 38.7% did not state any specialty. Fortunately for our study, most of respondents (82.2%) treat/see at least weekly elderly patients. Most Romanian doctors (78.4%) see elderly patients on a daily basis, while nearly half of the Latvian doctors (46.7%) see elderly patients weekly. 82.43% of respondents were aware of the functional decline concept. It is notable that all Latvian doctors stated they were aware of the concept of functional decline. Slightly fewer respondents declared awareness of “Frailty” (78.9%). Interestingly, all Latvian Doctors declared they were aware of the concept of frailty. All Latvian doctors declared that functional decline assessment “does not apply to their field of practice”. Most Romanian respondents stated they did not know any scales (35.46%).

Overall doctors present low levels of health literacy on both functional decline related to ageing and frailty. Table 2 below presents a summary based on the conceptual distinctions of health literacy.

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TABLE 2. Summary of responses

Health literacy Functional decline Frailty Awareness General knowledge Overall, 82.43% of respondents were aware of

the functional decline concept. It is notable that all Latvian doctors stated they were aware of the concept of functional decline.

Slightly fewer respondents declared awareness of “Frailty” (78.9%). Interestingly, all Latvian Doctors declared they were aware of the concept of frailty.

Scales All Latvian doctors declared that functional decline assessment “does not apply to their field of practice”. Most Romanian respondents stated they did not know any scales (35.46%). Overall, only 53 respondents (17.79%) were aware of at least 1 scale for assessing functional decline, and they were all Romanian. Only 37.25% of respondents were at least to some extent, familiar with FAM. 11 Romanian respondents did not check this answer. The familiarity with other scales relevant for functional decline was below 50%.

All Latvian responders answered “does not apply”. Overall, only 48 respondents (16.11%) were aware of at least 1 scale for assessing frailty, and they were all Romanian.

Access Source The internet (54.7%) and professional training (51.7%) appear to be the main sources for information on functional decline.

Professional training (69.1%) and Internet (65.1%) seem to be the main sources of information.

Easiness of access Most respondents (53.36%) declared it is easy or very easy for them to access information on age-related functional decline.

Most respondents (177 – 59.40%) found it easy or very easy to access information on age-related frailty

Understand Own declaration most respondents (177 – 59.40%) found it easy or very easy to access information on age-related frailty

Most respondents (201 out of 298 valid answers – 67.45%) found it easy or very easy to understand the concept of age-related frailty.

Define The most common view among the interviewed doctors was that functional decline corresponds to “all the above” definitions (58.38%) which, as

The most common view among the interviewed doctors was that frailty corresponds to “all the above” definitions (64.09%) which, as well, reflect

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well, reflect a correct knowledge on the subject matter.

a correct knowledge on the subject matter.

Understand already accessed information

Most respondents (176 out of 294 valid answers – 59.86%) found it easy or very easy to understand information they have accessed on functional decline related to ageing.

Most respondents (172 out of 294 valid answers – 58.50%) found it “easy” or “very easy” to understand information they have accessed on frailty

Appraise Reversibility The majority of the answers asserted that pre-frailty and frailty are not reversible conditions (38.23%), which reveals a rather low knowledge on the subject matter. Out of 226 subjects who gave an opinion on the reversibility of pre-frailty/frailty (other than “I do not know”), a number of 33 (14.60%) had declared they were not aware of the concept!!

Judge relevance Out of 293 respondents, 225 (76.79%) considered age-related functional decline and its assessment relevant in their practice. Out of the 223 doctors who considered age-related functional decline and its assessment relevant in their practice, 28 (12.44%) had stated they were not aware of the concept! Most of the respondents (166 out of 298, i.e. 55.70%) found functional decline and its assessment “relevant” or “very relevant” for their practice. We found that out of the 255 who gave an opinion on the relevance of functional decline for their practice, 29 (11.37%) had stated they were not aware of the concept of functional decline!

Most respondents (160 out of 298, i.e. 53.69%) found frailty and its assessing “relevant” or “very relevant” for their practice. Out of 257 respondents who gave a definite opinion on the relevance of frailty, 37 (14.40%) had declared they were not aware of the concept of frailty!

Gain knowledge Most respondents (147 out of 294 – 50.00%) gave “high” or “very high” priority to gaining knowledge on age-related functional decline.

Most respondents (208 out of 293 – 70.99%) gave “low” or “very low” priority to gaining knowledge about frailty, in opposition to the trend emphasized in the answers to the same (above) question, concerning the age related functional decline (?). In fact, this “low priority” option was the choice of

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all Latvian respondents! Usefulness of measurement tools

Apply General knowledge Overall, the answers revealed that the great (60–80%) majority of the elders are accompanied to the medical visit by their family (117 such answers = 61.90% of the respondents).

Healthcare Signs or symptoms Age-group: Respondents declared the most frequent answers to this question were: 60-70 years (38.10%) and 50-60 years (27.89%).

Most respondents selected the option “50-60 years” age group (35.47%) and “60-70 years” age group (35.14%). We consider these answers reflect a low level of literacy on the subject.

Criteria observed: Self-reported exhaustion was considered by most respondents (64.1%) as the basic criterion for frailty.

Assessment The overwhelming majority (240, i.e. 82.76%) of respondents stated they do not assess functional decline and frailty.

Most frequent conditions assessed

According to the answers provided by our respondents, the most frequent health problems in elderly (80-100%) were: cardio-vascular disorders (59.73%), mental/psycho-cognitive disorders (52.01%) and metabolic ones (52.01%). Surprisingly the neuro-/locomotor problems are placed, according to the collected answers on the penultimate place as frequency. In fact, no Latvian respondent indicated any neuro-/locomotor problem at all.

Disease prevention and health promotion

Measures to prevent functional decline and frailty related to ageing

The most frequent answer was that all mentioned measures were adequate (61.1%), which reflects reliable good level of literacy on the subject matter. The mentioned measures were:

• Intake of nutritional supplements and/or drugs with different anti-abiotrophy/ anti-ageing properties

• Practicing physical activity regularly • Having/adopting good nutrition habits (healthy diet - Mediterranean type) • Staying active in the social environment • Prevent and/or fight against di-stress

Health promotion

measures. How often do you

The most frequent answer was “once every 6 months” (183 out of 296 – 61.82%). It is notable that all Latvian doctors responded “once every 6 months”.

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experience patients having/adopting and promoting a healthy lifestyle to prevent/delay the onset of the functional decline and frailty and/or mitigate its consequences?

Adherence to treatment of patients

Respondents generally characterized their patients’ adherence to treatment as moderate (31.40%) or quite high (37.20%). After the cross-tabulation, the most frequent answers were overall the same, but reversed as the order of frequency: quite high and moderate.

Factors to increase adherence

The most common opinions were that psycho-cognitive problems (253 answers, 84.9%) and very severe physical disability (249 answers, 83.6%) decrease adherence to therapy, while education (250 answers, 83.9%) and trust in the health systems (223 answers,74.8%) increase adherence to therapy – which is correct, thus revealing a very good level of literacy on the subject matter.

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Health Literacy on Functional decline and Frailty Related to Ageing

Pilot Survey based on the Questionnaire for 60+ older Patients

– preliminary results –

.

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I. General personal information on the respondent 1. Gender?

a) Female b) Male

Total Latvia Romania

Frequency Percent Frequency Percent Frequency Percent

Valid Female Male

212 70.4 104 68.9 108 72.0

86 28.6 44 29.1 42 28.0

Total 298 99.0 148 98.0 150 100.0

Missing System 3 1.0 3 2.0

Total 301 100.0 151 100.0 150 100.0

A total of 301 respondents responded to our questionnaire (212 = 70.4% women, 86 = 28.6% men). Three respondents (1%) from Latvia did not specify their gender. Most respondents were women in both countries.

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2. Marital state a) married b) not married c) widowed d) divorced

Total Latvia Romania Frequency Percent Frequency Percent Frequency Percent

Valid

married

not married

widowed

divorced

(Other)

136 45.2 60 39.7 76 50.7

6 2.0 4 2.6 2 1.3

114 37.9 48 31.8 66 44.0

39 13.0 34 22.5 5 3.3

2 0.7 2 1.3 0 99.3

Total 297 99.7 148 98.0 149 0.7

Missing System 4 1.3 3 2.0 1 50.7

Total 301 100.0 151 100.0 150 100.0

Most respondents were either married (136 – 45.2% of answers, 60 - 39.7% from the Latvian sample and 76 – 50.6% from the Romanian sample) or widowed (114 – 37.9% of answers, 48 – 31.8% of the Latvian respondents and 66 – 44% of the Romanian respondents). Two Latvian respondents (0.7%) specified having other status (no details). Four (1.3%, 3 from Latvia and 1 from Romania) of the respondents failed to answer this question.

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3. Age? a) 60 to 65 b) 65 to 74 c) 75 to 84 d) 85 or older



Valid 60 to 65 65 to 74 75 to 84 85 or older

79 26.2 32 21.2 47 31.3

115 38.2 72 47.7 43 28.7

83 27.6 35 23.2 48 32.0

20 6.6 8 5.3 12 8.0

Total 297 98.7 147 97.4 150 100.0

Missing System 4 1.3 4 2.6 0 0

Total 301 100.0 151 100.0 150 100.0

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Most respondents (115 – 38.7%) were aged between 65-74 years. 47.7% of the Latvian respondents were

in this age group. The group age over 85 years comprised the smallest patient number (20 – 6.7%).

Romanian respondents had more uniform ages (47 - 31.3% were aged between 60-65 years, 43 - 28.7%

were between 65-74 years, 48 – 32% were between 75-84%). Four respondents (1.3%) from Latvia failed

to answer to this question.

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4. Live with: a) family b) alone c) friends d) in social housing e) in a sheltered accommodation f) nursing home g) other care institution (please specify)


Valid

family alone friends

in social housing in a sheltered accommodation

nursing home other care institution...

193 64.8 81 53.6 112 74.7

95 31.9 63 41.7 32 21.3

3 1.0 2 1.3 1 0.7

2 0.7 2 1.3

4 1.3 4 2.7

Total 297 99.7 148 98.0 149 99.3

Missing System 4 1.3 3 2.0 1 0.7

Total 301 100.0 151 100.0 150 100.0

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Most interviewed respondents lived with family (193 – 65%), other lived alone (95 – 32%). Very few stated they were living with friends (3 – 1%), in social housings (2 – 0.7%) or in a sheltered accommodations (4 – 1.3%). Four respondents – 1.3% (3 from Latvia and 1 from Romania) failed to give an answer to this question.

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5. In which country do you reside most of the time? • Albania • Andorra • Armenia • Austria • Belgium • Bosnia & Herzegovina • Bulgaria • Croatia • Cyprus • Czech republic • Denmark • Estonia • Finland • France • Germany

• Georgia • Greece • Hungary • Iceland • Ireland • Israel • Italy • Kosovo • Latvia • Lichtenstein • Lithuania • Luxembourg • Malta • Macedonia (former Yugoslav Republic of) • Moldova (Republic of) • Monaco

• Montenegro • Netherlands • Norway • Poland • Portugal • Romania • San Marino • Serbia • Slovak Republic • Slovenia • Spain • Sweden • Switzerland • Turkey • Ukraine • United Kingdom

Country residence Frequency Percent

Valid Latvia Romania

151

50.2

150

49.8

Total

301

100.0

The declared countries of residence were Romania (49.8%) and Latvia (50.2%).

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6. Do you still work? a) I am fully retired and do not work b) I work full time/ not retired c) I still work full time despite having reached retirement age d) I work part time or on special request or projects e) I do voluntary work on a regular basis f) Family and home are now my “work” g) I work on other activities (please specify):

Frequency of “yes”

(% of Total)

First 3 positions

Valid I am fully retired

I work full time / not retired

Full time despite...

I work part time

I do voluntary work

Family and home are...

I work on other activities

221 73.4 1

25 8.3 3

13 4.3 17 5.6 16 5.3 38 12.6 2

3 1.0 (Total) 301 100.0

Most respondents were fully retired (73.4% - 221 respondents). 12.6 % responded “family and home are now my work”, 8.3% (25 respondents) were not retired.

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II.A. Awareness about the concept of functional decline and frailty related to ageing - in conceptual connection mainly with general knowledge on the subject matter

7. I am aware of "functional decline"

a) Yes b) No


Valid

Yes No

230 76.4 118 78.1 112 74.7

56 18.6 21 13.9 35 23.3 Total 286 95.0 139 92.1 147 98.0

Missing System 15 5.0 12 7.9 3 2.0

Total 301 100.0 151 100.0 150 100.0

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Most respondents stated they were aware of the concept of age related functional decline (76.4 – 230). 5%

(15 respondents) did not provide an answer to this question (12 Latvian respondents and 3 Romanian

respondents).

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8. I am aware of "frailty" a) Yes b) No


Frequency Percent Frequency Percent Frequency Percent Valid

Yes No

228

75.7

117

77.5

111

74.0

54

17.9

19

12.6

35

23.3

Total

282

93.7

136

90.1

146

97.3

Missing System

19

6.3

15

9.9

4

2.7

Total 301 100.0 151 100.0 150 100.0

Most of the respondents declared they were aware of the concept of frailty (75.75% - 228 respondents). 6.3% (19 respondents: 15 from Latvia and 4 from Romania) failed to give an answer to this question.

13

II.B. Access information on functional decline and frailty related to ageing - in conceptual connection mainly with general knowledge on the subject matter

9. How did you learn about age-related functional decline?

a) Doctors b) Pharmacists c) Nurses d) Social workers/Community center workers e) Relatives/ Friends/Neighbours f) Other Patients g) Journals h) Internet i) Health broadcasts j) I don't really know much about functional decline k) Other (please specify):

Frequency of “yes” (% of Total) First 5 positions Valid Doctors 165 54.8 1

Pharmacists 43 14.3 Nurses 52 17.3 5 Social workers 19 6.3 Relatives/Friends 61 20.3 3 Other respondents 26 8.6 Journals 60 19.9 4 Internet 28 9.3 Health broadcasts 69 22.9 2 I don't really know much about... 31 10.3 Other sources 16 5.3

(Total) 301 100.0 Most respondents named doctors as their main source of information on functional decline (54.8% - 165 respondents). Other important sources were health broadcasts (22.9% - 69), relatives/friends (20.3% - 61) and journals (19.9% - 60).

14

10. How did you learn about age-related frailty? a) Doctors b) Pharmacists c) Nurses d) Social workers/Community center workers e) Relatives/ Friends/Neighbours f) Other Patients g) Magazines h) Internet i) Health broadcasts j) I don't really know much about frailty k) Other (please specify):

Frequency of “yes” (% of Total) First 5 positions Valid Doctors 153 50.8 1

Pharmacists 45 15.0

Nurses 48 15.9 5 Social workers 18 6.0

Relatives/Friends 68 22.6 3 Other respondents 29 9.6

Magazines 61 20.3 4 Internet 26 8.6

Health broadcasts 71 23.6 2 I don't really know much about... 32 10.6

Other sources 16 5.3

(Total) 301 100.0 Similarly, the main source of information on frailty were doctors (50.8% - 153 respondents). Other frequently declared resources were: health broadcasts (23.6% - 71), relatives/friends (22.6% - 68) and magazines (20.3% - 61).

15

11. How easy or difficult is it for you to access information on functional decline related to ageing? a) Very difficult b) Difficult c) Easy d) Very easy e) I don’t know /care

Frequency Percent Valid

Very difficult

Difficult

Easy

Very easy

I don’t know /care

23 7.6

56 18.6

139 46.2

22 7.3

44 14.6

Total 284 94.4 Missing System 17 5.6

Total 301 100.0 Most respondents appreciated they had easy access to information about age related functional decline (46.18% - 139 respondents). Yet, a significant percentage of the respondents found it difficult to access this information (18.60% - 56 respondents) or even very difficult (7.60%). Also, the percentages of respondents responding “I don’t know/care” was alarmingly high (14.62% - 44 respondents).

16

12. How easy or difficult is it for you to access information on frailty related to ageing? a) Very difficult b) Difficult c) Easy d) Very easy e) I don’t know /care


Very difficult

Difficult

Easy

Very easy


28 9.3

55 18.3

140 46.5

33 11.0

31 10.3


Total 301 100.0 Again, most respondents appreciated they had easy access to information about age related functional decline (46.51% - 140 respondents) or very easy access (10.96% - 33). A significant percentage of the respondents though found it difficult to access this information (18.27 % - 55 respondents). Also, the percentages of respondents responding “I don’t know/care” was alarmingly high (10.30% - 31 respondents).

17

II.C. Understand information on functional decline related to ageing 13. How easy or difficult is it for you to understand the concept of functional decline related to ageing?

a) Very difficult b) Difficult c) Easy d) Very easy e) I don’t know /care


Very difficult

Difficult

Easy

Very easy


21 7.0

66 21.9

153 50.8

27 9.0

22 7.3


Total 301 100.0 Most respondents, more than half (more precisely 50.83% - 153 respondents) found it easy, and

additionally 27 respondents (8.97%) found it very easy to understand information on functional decline.

An alarming percentage though declared they found it difficult (21.93% - 66 respondents).

18

Distribution by age-groups:

Age category

60 to 65 65 to 74 75 to 84 85 or older Total Understand age-related functional decline

Very difficult Difficult Easy

Very easy I don’t know /care

4 4 5 8 21

22 22 18 4 66 38 63 47 3 151

8 14 4 1 27

5

8

7

2

22

Total 77 111 81 18 287 It should be noted that while in all other age groups the most frequent answer to this question was easy to understand”, most respondents aged over 85 years stated it was very difficult for them to understand (44.44% - 8 respondents), probably due to age-related cognitive decline.

19

14. How easy or difficult is it for you to understand the concept of frailty related to ageing? a) Very difficult b) Difficult c) Easy d) Very easy e) I don’t know /care


Very difficult

Difficult

Easy

Very easy


22 7.3

60 19.9

156 51.8

33 11.0

18 6.0


Total 301 100.0 Again, most respondents found it easy (51.83% - 156 respondents) and very easy (10.96% - 33) to

understand information on frailty. An alarming percent though declared they found it difficult (19.93% - 60

respondents).

20

By age-groups: Age category

60 to 65 65 to 74 75 to 84 85 or older Total

Understand age-related frailty Very difficult Difficult Easy Very easy I don’t know /care

6

4

8

4

22

17 18 19 6 60

45 60 46 3 154

6 20 4 3 33

3 9 4 2 18

Total 77 111 81 18 287

It should be noted that while in all other age groups the most frequent answer to this question was “easy to

understand”, most respondents aged over 85 years stated it was difficult for them to understand (33.33% - 6

respondents), probably due to age-related cognitive decline.

21

II.D. Appraise information on functional decline and frailty related to ageing

15. Which of the following applies to your situation – as regards looking for information about your own health, including problems generated by ageing: a) I frequently seek information on my own health b) I rarely seek specific information on my own health c) I never seek information on my own health

Frequency Percent

Valid

I frequently seek information

I rarely seek information

I never seek information

135 44.9

113 37.5

35 11.6


Total 301 100.0 The percentage of respondents who stated they frequently seek information on their health (44.85% - 135 respondents) was slightly higher compared to the percentage who stated they rarely seek this information (37.54% - 113). 5.98% (18 respondents) failed to answer this question.

22

16. Which health information sources do you trust? a) Doctors b) Pharmacists c) Nurses d) Social workers/Community center workers e) Relatives/ Friends/Neighbours f) Other Patients g) Magazines h) Internet i) Health broadcasts j) I don't really know much about functional decline k) Other (please specify):


(% of Total)

First 5 positions

Valid Doctors 239 79.4 1 Pharmacists 62 20.6 4 Nurses 66 21.9 3 Social workers 12 4.0 Relatives/Friends 36 12.0 Other respondents 28 9.3 Magazines 56 18.6 5 Internet 23 7.6 Health broadcasts 94 31.2 2 I don't really know much about... 9 3.0 Other sources 4 1.3 (Total) 301 100.0

The most trusted sources of health information were, in order: the doctors (79.4% - 239 respondents), health broadcasts (31.2% - 94), nurses (21.9% - 66), pharmacists (20.6% - 62) and magazines (18.6% - 56).

23

17. How do you judge the relevance, for your health condition, to know/get up-dated about age-related functional decline?

a) Very important b) Important c) Not very important d) Not at all important e) I don’t know /care


Very important

Important

Not very important

Not at all important


126 41.9

107 35.5

29 9.6

16 5.3

10 3.3


Total 301 100.0 Most respondents very found it very important (41.86% - 126 respondents) and important (35.55% – 107 respondents) for their health to keep up-dated about age-related functional decline. 4.32% (13 respondents) failed to answer this question.

24

18. How much priority do you give to gain knowledge on age-related functional decline? a) Very high priority b) High priority c) Low priority d) Very low priority e) No priority at all


Very high priority

High priority

Low priority

Very low priority

No priority at all

101 33.6

109 36.2

43 14.3

4 1.3

26 8.6


Total 301 100.0 Most respondents gave very high (33.55% – 101 respondents) and high priority (36.21% - 109) to gaining knowledge about functional decline. 5.98% (18 respondents) failed to give an answer.

25

19. How do you judge the relevance, for your health condition, to know/ get up-dated about age-related frailty?

a) Very important b) Important c) Not very important d) Not at all important e) I don’t know /care


Very important

Important

Not very important

Not at all important


121 40.2

125 41.5

31 10.3

15 5.0

2 0.7


Total 301 100.0 Most respondents found it very important (42.20% - 122 respondents) and important (41.53% – 125 respondents) for their health to keep up-dated about age-related frailty. 4.98% (15 respondents) failed to answer this question.

26

20. How much priority do you give to gain knowledge on age-related frailty? a) Very high priority b) High priority c) Low priority d) Very low priority e) No priority at all


Very high priority

High priority

Low priority

Very low priority

No priority at all

92 30.6

109 36.2

39 13.0

17 5.6

26 8.6


Total 301 100.0 Most respondents gave very high (30.56% – 92 respondents) and high priority (36.21% - 109) to gaining knowledge about frailty. 5.98% (18 respondents) failed to give an answer.

27

21. Do you think prefrailty and frailty are reversible conditions? a) Yes b) No c) I don’t know

Pre-frailty Frequency Percent Valid

Yes

No

I don't know

113 37.5

72 23.9

63 20.9


Total 301 100.0

Frailty Frequency Percent Valid

Yes

No

I don't know

53 17.6

107 35.5

55 18.3


Total 301 100.0

Most respondents considered pre-frailty a reversible condition (37.54% - 113 respondents). 17.61% (53 respondents) did not answer this question, which is consistent with clinical reality. This matches with the answers given to the questions about the relevance of keeping up to date with information and the priority of gaining information on the subject.

28

Most respondents considered frailty not reversible (35.55% - 107 respondents). 28.57% (86) respondents failed to give an answer to this question.

29

22. Do the other employers treat you differently because of your age? a) I am self-employed b) Yes, there are positive changes (please provide examples) c) Yes, there are negative changes (please provide examples) d) I don't know e) No, nothing changed f) Other (please specify)


(% of Total)

First 2 positions

Valid I am self-employed 60 19.9 1 Yes, there are positive changes 18 6.0 Yes, there are negative changes 7 2.3 I don't know 26 8.6 No, nothing changed 36 12.0 2 Other... 35 11.7 3 (Total) 301

Most respondents declared they were self-employed (19.9% - 60 respondents). Other frequent answers were that nothing changed with age (12.0% - 36) or some other specified changes had occurred (11.7% - 35 respondents).

30

23. Would you consider helpful some of your working conditions to be modified because of your age (e.g. working hours/ schedule, opportunities to take some rest during the work program and/or help for visiting doctor/s or other medical institution)?

a) That would be of significant help b) I already experienced such changes in my work place c) I don’t know d) No, this is not necessary in my situation e) Not applicable

Frequency

Percent First 2 positions

Valid That would be of significant help

28

9.3

2

I already experienced such changes

12

4.0

I don’t know 10 3.3 No, this is not necessary 27 9.0 Not applicable 206 68.4 1

Missing System 18 6.0

(Total) 301 100.0 Most respondents (68.4% - 206) responded this question was not applicable to them (probably due to the fact they were retired). 9.3% (28) of the respondents considered that adapting working conditions according to their age would be beneficial. Only 6% (18 respondents) did not respond.

31

24. Do you feel the management of your organization allows you to contribute to your professional ability/ performance, including permanent education, tailored to your age?

a) Yes, my management takes this into account b) Yes, to a certain extent c) No, there is no such policy d) Not applicable

Frequency

Percent First 2 positions

Valid Yes, my management takes this into account Yes, to a certain extent No, there is no such policy

Not applicable

19

6.3

22 7.3 23 7.6 2

213 70.8 1

Total 281 93.4


Total 301 100.0 Most respondents (70.8% - 281) responded this question was not applicable to them (probably due to the fact they were retired). 7.6% stated there was no such policy (of permanent education, tailored to the age). 8% (24) of respondents did not answer this question.

32

25. Do you feel your professional experience is considered useful/valued at your workplace? a) Yes b) Partially c) No d) Not applicable

Frequency Percent Valid Yes

Partially No Not applicable

38 12.6

28 9.3 7 2.3

156 51.8

Total 229 76.0


Total 301 100.0 Again, most respondents (51.8% - 229) responded this question was not applicable to them (probably due to the fact they were retired). 12.6% stated their professional experience was valued at their workplace. 24% (72) of respondents did not answer this question.

33

26. Do you feel that your professional experience is adequately transmitted to the next generation of workers/ colleagues?

a) Yes, this is part of the company’s policy b) Yes, to a certain extent c) No, there is no such policy d) Not applicable

Frequency Percent Valid Yes, this is part of the company’s

policy Yes, to a certain extent No, there is no such policy Not applicable

23

7.6

36 12.0 34 11.3

191 63.5

Total 284 94.4


Total 301 100.0 Again, most respondents (63.46% - 191) responded this question was not applicable to them (probably due to the fact they were retired). 11.96% stated their professional experience was, to a certain extent, adequately transmitted to the next generation. 5.6% (17) of respondents did not answer this question.

34

II.E. Apply information on functional decline and frailty related to ageing - (a) in conceptual connection mainly with general knowledge

27. With whom are you usually communicating about functional decline and frailty related to ageing?

a) Family b) Relatives/Friends/Neighbors c) Doctors d) Pharmacists e) Nurses f) Someone paid to help me g) Nobody h) Others, please specify...


(% of Total)

First 2 positions

Valid Family 179 59.5 1 Relatives/Friends/Neighbors 105 34.9 3 Doctors 151 50.2 2 Pharmacists 49 16.3 Nurses 57 18.9 Someone paid to help me 6 2.0 Nobody 30 10.0 Others 4 1.3 Total 301

Patients most often communicated about functional decline and frailty with family (59.5% - 179 respondents), then with doctors (50.2% - 151), and then with relatives/friends/neighbours (34.9% - 105).

35

II.E. Apply information on functional decline and frailty related to ageing - (b) in conceptual connection mainly with health care

28. Are you engaged in any form of regular physical activity or exercise? (Walk 30, 60 minutes; Use the bike for 30 minutes)?

a) No b) Yes, once a week c) Yes, twice a week d) Yes, three times a week e) Yes, more than three times a week

Walk 30 minutes Frequency Percent Valid No

Yes, once a week Yes, twice a week Yes, three times a week Yes, more than three times a week

45 15.0 17 5.6 18 6.0 14 4.7

86

28.6

Total 180 59.8 Missing System 121 40.2 Total 301 100.0

Most respondents stated they did walk for 30 minutes more than three times a week (28.6% - 86 respondents). Yet an alarming percentage (15% - 45 respondents) answered “no” to this question. It should be noted that 40.2% of the interviewed respondents failed to answer this question.

Walk 60 minutes Frequency Percent Valid No


74 24.6 7 2.3 8 2.7 8 2.7

72

23.9


Most respondents did not walk 60 minutes at all (24.6% - 74 respondents). 23.9% (72) stated they did walk 60 minutes at least three times a week. It should be noted that 23.9% of the respondents did not answer this question.

Use the bike for 30 minutes Frequency Percent Valid No


79 26.2 17 5.6 12 4.0

6 2.0

21

7.0


36

Most respondents did not use the bike at all (26.2% - 79 respondents). 7% (21 respondents) stated they did use the bike at least three times a week. It should be noted that more than half (55.1%) of the respondents did not answer this question.

No, I am not engaged in any intended form of physical exercise but part of my daily routine includes physical exercise

Frequency

Percent

Valid No Yes, once a week Yes, twice a week Yes, three times a week Yes, more than three times a week

75 24.9 5 1.7 2 .7 9 3.0

99 32.9 Total 190 63.1

Missing System 111 36.9 Total 301 100.0

32.9% (190) of the respondents stated their daily routine included some form of physical exercise more than three times a week. It should be noted that 36.9% (111) respondents did not check this answer.

37

29. Have you recently noticed increased weakness (decrease of grip strength)? a) Yes, I do feel more weak (including with grip strength decrease), without changing diet and/or habits b) Yes, I think I might have become more weak (including with grip strength decrease)/ fatigued recently c) Yes, but I have changed diet and/or habits significantly d) I don’t know for sure e) No, I haven’t noticed increased weakness (including with grip strength decrease)/ fatigue tiredness recently

Frequency Percent Valid Yes, I do feel more weak

Yes, I think I might have become more weak Yes, but I have changed diet I don’t know for sure No, I haven’t noticed increased weakness

71 23.6

89

29.6

23 7.6 41 13.6

59

19.6


Most respondents responded they did feel weaker (23.59% - 71 respondents) or they thought they might have become more weak (29.57% - 89). Only 59 (19.6%) responded “no” and other 18 (6%) failed to give an answer.

38

30. If yes, have you considered consulting your doctor? a) Yes b) No

Frequency Percent

Valid Yes

No 149 81.4

26 14.2 Total 175 95.6


Most respondents had consulted a doctor regarding their weakness (81.4% - 149 respondents). 4.4% (8 respondents) did not respond to this question.

31. If no, what are the reasons not to? (free answers)*

39

32. Have you recently noticed increased recurring tiredness/ (even) exhaustion and/or the need to rest more than usual?

a) Yes, I do feel more tired in general/ (even) exhausted, without changing diet and or habits b) Yes, I think I might feel more fatigue/ exhaustion recently c) Yes, but I have changed diet and/or habits significantly d) I don’t know for sure e) No, I haven’t noticed increased tiredness/ exhaustion recently

Frequency Percent Valid Yes, I do feel more tired in general

Yes, I think I might feel more fatigue Yes, but I have changed diet I don’t know for sure No, I haven’t noticed increased tiredness

95 31.6 92 30.6 20 6.6 27 9.0 47 15.6


Most respondents declared they felt more tired in general (31.56% - 95 respondents) or they thought they felt more fatigue (30.56% - 92 respondents)

40

33. Have you recently noticed changes to any of the following physical patterns? • Keeping balance; • General mobility; • Stiffness/'rusty sensation, especially in the morning; • Dropping objects; • Time needed for daily activities; • Time needed to cross the street?

Keeping balance Frequency Percent

Valid Yes, it’s more difficult Maybe Nothing changed

95 31.6

41 13.6 101 33.6


Most respondents (33.6% - 101) did not feel a change in their balance. 21.3% of the interviewed respondents did not respond to this question.

General mobility Frequency Percent


76 25.2

70 23.3 72 23.9


The percentage of respondents feeling a negative change in their mobility was slightly higher (25.2% - 76) than that of respondents who felt that nothing had changed in their mobility (23.9% - 72) or were unsure (23.3% - 70).

Stiffness/rusty sensation Frequency Percent


105 34.9

60 19.9 60 19.9


Most respondents stated they felt stiffness, especially in the morning (34.9 % - 105 respondents).

Dropping objects Frequency Percent


48 15.9

41 13.6 123 40.9


Most respondents declared they did not drop objects (40.9% - 123).

41

Time needed for daily activities Frequency Percent


68 22.6

69 22.9 81 26.9


Most respondents declared the time they needed for their daily activities was not prolonged (26.9% - 81 respondents).

Time needed to cross the street Frequency Percent


52 17.3

42 14.0 103 34.2


Most respondents stated they did not need a prolonged time to cross the street (34.2% - 103 respondents).

42

34. If yes, for which or any of these changes have you consulted your doctor about? a) All of these changes b) Some of these changes c) None

Frequency Percent Valid All of these changes

Some of these changes

None

26 51.0

19 37.3

5 9.8 Total 50 98.0


It is fortunate to observe that most respondents stated they did consult a doctor for their physical performance changes (51% - 26 of 51 respondents who felt there were some changes).

43

35. Have you recently noticed changes to any of the following psycho-cognitive intellectual patterns? • Recalling certain information, e.g. names, numbers; • Finding your way to a certain destination; • Laughing and or smiling less/ more than you used to; • Crying more easily than you used to; • Performing regular intellectual tasks; • Understanding instructions/directions; • Performing mathematical tasks.

Recalling certain information Frequency Percent


105 34.9

68 22.6 91 30.2


Most respondents stated it was more difficult for them to recall certain information (34.9% - 105 respondents).

Finding way to destination Frequency Percent


24 8.0

24 8.0 177 58.8


Most respondents declared they did not find it difficult to find their way to a destination (58.8% - 177).

Laughing or smiling less/more Frequency Percent


28 9.3

44 14.6 159 52.8


Most respondents felt there was nothing changed in their laughing or smiling pattern (52.8% - 159).

Crying more easily Frequency Percent


47 15.6

60 19.9 135 44.9


Most respondents stated they were not crying more easily (44.9% - 135).

44

Performing regular intellectual tasks Frequency Percent


39 13.0

53 17.6 139 46.2


Most respondents felt that nothing had changed in their performance of regular intellectual tasks (46.2% - 139).

Understanding instructions/ directions Frequency Percent


33 11.0

50 16.6 141 46.8


Most respondents felt that nothing had changed in their understanding of instructions/ directions (46.8% - 141).

Performing mathematical tasks Frequency Percent


45 15.0

58 19.3 122 40.5

Total 225 74.8 Missing System 76 25.2 Total 301

Most respondents felt that nothing had changed in their performance of mathematical tasks (40.5% - 122).

45

36. Which of these changes have you consulted your doctor about? : • Recalling certain information; • Finding your way to a certain destination; • Laughing and or smiling less/ more than you used to do; • Crying more easily; • Performing regular intellectual tasks; • Understanding instructions; • Performing mathematical tasks?

(Only those responding “Yes,...” or “Maybe” at the analogous point in Q35 above)

Recalling certain information Frequency Percent

Valid No Yes

78 45.1

63 36.4 Total 141 81.5


Finding way to destination Frequency Percent

Valid No Yes

20 41.7

22 45.8 Total 42 87.5


Laughing or smiling less/more Frequency Percent

Valid No Yes

34 47.2

28 38.9


Crying more easily Frequency Percent

Valid No Yes

48 44.9

35 32.7 Total 83 77.6


Performing regular intellectual tasks Frequency Percent

Valid No Yes

51 55.4

23 25.0 Total 74 80.4


Understanding instructions/ directions Frequency Percent

Valid No Yes

49 59.0

17 20.5 Total 66 79.5


46

Performing mathematical tasks Frequency Percent

Valid No Yes

54 52.4

24 23.3 Total 78 75.7


Sadly, for most of these psycho-intellectual changes, the percentage of respondents who had consulted a doctor was not much larger than the percentage of respondents who had not consulted a doctor.

47

37. Have you noticed recent weight loss which you cannot explain? a) Yes, I have lost some weight without changing diet and/or lifestyle b) Yes, but this is due to a change in diet and/or lifestyle c) No d) I don’t know

Frequency Percent

Valid Yes, I have lost some weight Yes, but this is due to a change in diet No I don’t know

41 13.6

17 5.6 210 69.8

14 4.7 Total 282 93.7


Most respondents did not notice any weight loss (69.77% - 210 respondents).

48

38. If you replied yes to the previous question (or chose options a) or b)) have you considered consulting your doctor? ? (Only those responding “Yes,...” at the Q37 above)

a) Yes b) No

Frequency Percent

Valid Yes No

44 75.9

4 6.9 Total 48 82.8


Of the respondents who had experienced some weight loss, most considered consulting a doctor (75.9% - 44 respondents out of 58).

39. If no, what are the reasons not to: (free answers)*

49

40. Have you consulted a doctor of any specialty in the last year about a specific problem or ailment? (all respondents)

a) Yes, more than once (please indicate how often) b) Yes, once c) No

Frequency Percent

Valid Yes, more than once Yes, once No

143 47.5

73 24.3 50 16.6


Fortunately, most respondents stated they had consulted a doctor once (24.3% - 73 respondents) or more than once (47.5% - 143) over the last year.

41. If you have consulted a doctor, what kind and why? (free answers)*

50

42. Have you been hospitalized in the last year? (all respondents)

a) Yes, more than once (please indicate how often) b) Yes, once c) No

Frequency Percent

Valid Yes, more than once Yes, once No

56 18.6

60 19.9 170 56.5


Most of our respondents had not been hospitalized over the last year (56.5% - 170 respondents).

51

43. Is your GP/FAMILY PHYSICIAN aware of your chronic conditions? (all respondents)

a) Yes b) No

Frequency Percent

Valid Yes No

244 75.9

14 6.9 Total 258 82.8


The overwelming majority of the interviewed respondents stated their GP/ family physician was aware of their chronic conditions (75.9% - 244 respondents). 17.2% (43 respondents) failed to answer this question.

52

44. If yes, about how many of the following such conditions: • neuro/locomotor, • cardiovascular, • mental/psychocognitive (depression, dementia), • metabolic (diabetes mellitus, obesity,hyperuricemia), • respiratory, • digestive, • urinary, • hormonal, • hematological, • dermatological

do you know to have?

(Frequencies) One Two Three Four More than four Missing (position)

Neuro/loco-motor 71 16 4 3 4 146 2 Cardiovascular 105 25 9 4 8 93 1 Mental/psycho- cognitive

38

6

3

2

195 6

Metabolic 56 3 2 183 3-4 Respiratory 29 4 2 1 208 7 Digestive 47 4 2 4 4 183 3-4 Urinary 41 3 4 4 5 187 5 Hormonal 17 1 2 222 9 Hematological 18 4 2 220 8 Dermatological 13 5 1 225 10

As expected, most answers pointed to one chronic cardio-vascular condition (105), followed in the order of frequency by neuro-locomotor conditions.

53

45. Have you recently considered or has someone from your close environment advised you to get help in carrying out daily tasks?

a) Yes, I agree I need some help on a daily basis b) I might need some help from time to time c) Someone suggested I should need help but I am not sure it’s necessary d) No, I don’t need help at present – I can take care of myself adequately e) I don’t know

Frequency Percent

Valid Yes, I agree I need some help on a daily basis I might need some help from time to time Someone suggested I should need help but I am not sure No, I don’t need help at present I don’t know

35 11.6

66 21.9 6 2.0

171 56.8 6 2.0


The majority of our respondents did not need any help for daily activities (56.8% - 171 respondents). 5.6% of respondents did not give an answer to this question.

54

46. If yes, to which of the following daily self-management tasks do you need help with? (Only those responding “Yes,...” or “I might need...” at the Q45 above)


(% of Total)

First 5 positions

Valid Washing hands

Taking a shower

Brushing teeth

Getting dressed in the upper part of the body

Getting dressed in the lower part of the body

Taking medication Transfers (e.g. wheelchair to bed, bed to wheelchair, wheelchair to car, car to wheelchair)

Preparing food for myself My house keeping

Lifting heavy objects

Shopping

Driving Using the computer

Electronic payment instruments

My own money administration My own medication administration

Other basic and/or instrumental activities of daily living (ADLs/ IADLs) (please specify):

7 6.9

17 16.8 8 7.9

11 10.9

10 9.9

15 14.9

14

13.9

29 28.7 4 50 49.5 2 67 66.3 1 45 44.6 3 17 16.8 16 15.8 19 18.8 15 14.9 23 22.8 5

9

8.9

Total 101 100.0 67 out of 101 respondents considered they needed help for lifting heavy objects. 50 respondents out of 101 thought they needed help in housekeeping. Only 7 respondents (6.9%) considered they needed help washing their hands.

55

47. How do you participate in the society/community? a) Elected missions/responsibilities (including of institutional kind) b) I participate in different activities related to caring for others, including volunteering c) Socialization such as within: clubs, going to watch cultural and/or sports events, parties, d) Yes, occasionally e) No active participation f) Other (please specify):

Frequency of “yes” (% of Total) Valid Elected missions/responsibilities

Different activities related to caring Socialization such as clubs, concerts, going to watch cultural and/or sports events, parties Yes, occasionally No active participation

Other...

10 3.3

13 4.3

60

19.9

78 25.9 125 41.5

5 1.7

Total 301 100.0 Unfortunately, most of our respondents stated they did not actively participate in the society/community (41.5% - 125 respondents).

56

II.E. Apply information on functional decline and frailty related to ageing – (c) in conceptual connection mainly with disease prevention and (d) health promotion

48. What, based on your knowledge, should be done to prevent functional decline and frailty related to ageing?

a) TV and radio programs on the issue to increase awareness on the subject matter and education for healthy lifestyle

b) Hotline where the public can call to ask questions about different resources available (e.g. where to get transportation to different services, access to buildings, what health and social services are available for the elderly, etc.)

c) Increase physicians’ awareness and knowledge with regards to available screening and treatment approaches d) Increase awareness of the younger generation to help them recognise, be sensitive to and support ageing relatives e) All of the above f) None of the above g) Other (please specify):

Frequency of “yes” (% of Total) Valid TV and radio programs...

Hotline where the public can call... Increase physicians’ awareness... Increase awareness of the younger generation... All of the above None of the above Other...

88 29.2

22 7.3 58 19.3 69 22.9

133 44.2 10 3.3

10 3.3

Total 301 100.0 Most respondents considered that all the listed measures should be taken to prevent age-related functional decline and frailty (44.2% - 133). Of course, TV and radio programs are preferred.

*NB: The text in red refers to free answer questions, which unfortunately have not been translated into English. Therefore, a list of frequent answers could not been compiled.

1

Health Literacy on Functional decline and Frailty

Related to Ageing

Pilot Survey based on Questionnaire for Doctors

– preliminary results –

2

Preliminary selection

5. In which country do you practice most of the time?

Albania

Andorra

Armenia

Austria

Belgium

Bosnia & Herzegovina

Bulgaria

Croatia

Cyprus

Czech republic

Denmark

Estonia

Finland

France

Germany

Georgia

Greece

Hungary

Iceland

Ireland

Israel

Italy

Kosovo

Latvia

Lichtenstein

Lithuania

Luxembourg

Malta

Macedonia (former Yugoslav Republic of)

Moldova (Republic of)

Monaco

Montenegro

Netherlands

Norway

Poland

Portugal

Romania

San Marino

Serbia

Slovak Republic

Slovenia

Spain

Sweden

Switzerland

Turkey

Ukraine

United Kingdom

Frequency Percent

Valid Andorra 1 0.3

Latvia 150 50.0

Romania 148 49.3

Total EU 299 99.7

Other Nigeria 1 0.3

We received 300 filled in questionnaires.

Of course, almost all respondents mainly practiced in Romania (148) or Latvia (150).

Only one doctor indicated Andorra as main practice setting.

A single respondent among the Romanian interviewed doctors indicated Nigeria as his/hers main practice

country.

The current statistical analysis was performed on the answers provided by Romanian and Latvian doctors.

I. General personal information on the respondent

1. What is your gender? a) Female

b) Male



Valid Female 145 48.7 77 51.3 68 45.9

Male 151 50.7 73 48.7 78 52.7

Total 296 99.3 150 100.0 146 98.6


Total 298 100.0 150 100 148 100

3

The Latvian sample is relatively well calibrated between the two genders. The Romanian sample is not so

well calibrated, in favour of men.

4

2. What is your age group? a) 27 to 34

b) 35 to 44

c) 45 to 54

d) 55 to 64

e) 65 to 74

f) 75 or older



Valid 27 to 34 54 18.1 0 0 54 36.5

35 to 44 37 12.4 0 0 37 25.0

45 to 54 92 30.9 61 40.7 31 20.9

55 to 64 78 26.2 58 38.7 20 13.5

65 to 74 35 11.7 31 20.7 4 2.7

75 or older 0 0 0 0 0 0

Total 296 99.3 150 100.0 146 98.6


Total 298 100.0 150 148 100

5

None of the respondents was 75 years or older.

All Latvian respondents were over 44 years old

The Romanian sample is clearly skewed in favour of “young” ages. This reflects the increasing number of

physicians in the new generations.

3. What is your medical specialty or specialties?

Speciality

Total Latvia Romania Number of

“yes”

answers

Frequency (%

of total)

Number of

“yes”

answers

Freq. Number of

“yes”

answers

Freq.

1) General practitioner 9 3.0 9 6.1

2) Family medicine 45 15.1 32 21.3 13 8.8

3) Rheumatologist 1 0.3 1 0.7

4) Orthopaedic surgeon 10 3.4 10 6.8

5) Physical and rehabilitation medicine 16 5.4 16 10.8

6) Occupational medicine 0 0.0

7) Neurologist 4 1.3 4 2.7

8) Psychiatrist 64 21.5 63 42.0 1 0.7

9) Internal medicine 6 2.0 6 4.1

10) Cardiologist 16 5.4 9 6.0 7 4.7

11) Geriatrician 2 0.7 2 1.4

12) Gynaecologist 2 0.7 2 1.4

13) emergency med. 1 0.3 1 0.7

14) e-n-t 1 0.3 1 0.7

15) epidemiology 1 0.3 1 0.7

16) forensics 1 0.3 1 0.7

17) gastroenterology 1 0.3 1 0.7

18) general surgery 11 3.7 11 7.4

19) haematology 1 0.3 1 0.7

20) hygiene med. 1 0.3 1 0.7

21) infectious diseases 2 0.7 2 1.4

6

22) intensive care 9 3.0 9 6.1

23) laboratory med. 1 0.3 1 0.7

24) morphopathology 1 0.3 1 0.7

25) neurosurgery 30 10.1 30 20.3

26) oncology 3 1.0 3 2.0

27) ophthalmology 1 0.3 1 0.7

28) paediatrics 9 3.0 8 5.3 1 0.7

29) plastic surgery 8 2.7 8 5.4

30) pneumology 1 0.3 1 0.7

31) radiology 2 0.7 2 1.4

32) urology 1 0.3 1 0.7

Disproportionate number of psychiatrists in the Latvian sample, and of neurosurgeons in the Romanian sample.

Note: specialties starting in lower-case were indicated by respondents.

7

Single vs. multiple specialities

A number of respondents avoided to select a listed speciality or to indicate a non-listed one.

Moreover, more than half of respondents selected two and even three medical specialities from the list, as

follows:



Valid None declared 66 22,1 58 38,7 8 5,4

Single 204 68,5 73 48,7 131 88,5

Double 27 9,1 18 12,0 9 6,1

Three (or more) 1 0,3 1 0,7

Total 298 100.0 150 100 148 100

While 88.5% of Romanian doctors declared a single specialty, only 48.7% of Latvian respondents declared

a single specialty and 38.7% did not state any specialty.

8

4. When did you start your medical practice? a) Before 1970

b) 70s

c) 80s

d) 90s

e) After 2000



Valid Before 1970 57 19.1 53 35.3 4 2.7

70s 35 11.7 28 18.7 7 4.7

80s 67 22.5 44 29.3 23 15.5

90s 53 17.8 25 16.7 28 18.9

After 2000 85 28.5 0 0 85 57.4

Total 297 99.7 150 100.0 147 99.3

Missing System 1 0.3 0 0 1 0.7

Total 298 100.0 150 0 148

The answers reflect the same phenomenon as in Q2 (see also the cross-table below). A total of 77% of

respondents started their medical practice in the 90’s or later.

Count What is your age group? Total

27 to 34 35 to 44 45 to 54 55 to 64 65 to 74

When did you start your

medical practice?

Before 1970 0 0 17 24 15 56

70s 0 0 13 13 9 35

80s 0 0 28 31 7 66

90s 0 8 32 9 4 53

After 2000 54 29 2 0 0 85

Total 54 37 92 77 35 295

9

6. How often do you see elderly patients (60 years or older)? a) Daily

b) Weekly

c) Monthly

d) Quarterly

e) Occasionally



Valid Daily 152 51.0 36 24.0 116 78.4

Weekly 93 31.2 70 46.7 23 15.5

Monthly 48 16.1 44 29.3 4 2.7

Quarterly

Occasionally 4 1.3 4 2.7

Total 297 99.7 150 100.0 147 99.3


Total 298 100.0 150 100 148 100

Fortunately for our study, most of respondents (82.2%) treat/see at least weekly elderly patients.

Most Romanian doctors (78.4%) see elderly patients on a daily basis, while nearly half of the Latvian

doctors (46.7%) see elderly patients weekly.

10

II.A. Awareness about the concept of functional decline and frailty related

to ageing – in conceptual connection with general knowledge on the subject

matter

7. Are you aware of this concept: Yes No

Functional decline



Valid Yes 244 81.9 150 100.0 94 63.5

No 51 17.1 0 0 51 34.5

Total 295 99.0 150 100 145 98.0


Total 298 100.0 150 100 148 100.0

Three respondents from the Romanian sample avoided to give a clear answer...

Overall, 82.43% of respondents were aware of the functional decline concept. It is notable that all Latvian

doctors stated they were aware of the concept of functional decline.

11

8. Are you aware of the concept:

Yes No

Frailty



Valid Yes 235 78.9 150 100.0 85 57.4

No 59 19.8 0 0 59 39.9

Total 294 98.7 150 100 144 97.3


Total 298 100.0 150 100 148

Slightly fewer respondents declared awareness of “Frailty”... (78.9%). Interestingly, all Latvian Doctors

declared they were aware of the concept of frailty.

12

9. How many scales for assessing functional decline in the elderly do you know? a) 3 or more

b) 2

c) 1

d) I don’t know any

e) Does not apply to my field of practice



Valid 3 or more 31 10.4 0 0 31 20.9

2 20 6.7 0 0 20 13.5

1 3 1.0 0 0 3 2.0

I don't know any 50 16.8 0 0 50 33.8

Does not apply to

my field of

practice

187 62.8 150 100.0 37 25.0

Total 291 97.7 150 100.0 141 95.3


Total 298 100.0 150 100 148 100

All Latvian doctors declared that functional decline assessment “does not apply to their field of practice”.

Most Romanian respondents stated they did not know any scales (35.46%).

13

Overall, only 53 respondents (17.79%) were aware of at least 1 scale for assessing functional decline, and

they were all Romanian.

14

10. How many scales for assessing frailty in the elderly do you know? a) 3 or more

b) 2

c) 1

d) I don’t know any

e) Does not apply to my field of practice



Valid 3 or more 28 9.4 0 0 28 18.9

2 18 6.0 0 0 18 12.2

1 3 1.0 0 0 3 2.0

I don't know any 53 17.8 0 0 53 35.8

Does not apply to

my field of

practice 187 62.8 150 100.0 37 25.0

Total 289 97.0 150 100.0 139 93.9


Total 298 100.0 150 100 148 100

All Latvian responders answered “does not apply”.

Overall, only 48 respondents (16.11%) were aware of at least 1 scale for assessing frailty, and they were

all Romanian.

15

11. Which of the following measurements are you familiar with and use to assess functional performance

– including its decline – and age-related frailty?

(You can tick more than one option)

Not familiar at all. do

not use

Familiar to some

extent

Yes. I am familiar

and use

a) Functional Independence Measure (FIM) 110 78 99

b) Functional Assessment Measure (FAM) 130 127 17

c) Barthel Index 121 139 16

d) Cumulative Illness Rating Scale (CIRS / mCIRS /

CIRS-G)

87 131 50

e) Clinical Global Impression of Change in Physical

Frailty (CGICPF)

145 109 16

f) Canadian Study of Health and Ageing (CSHA) /

Clinical Frailty Scale (CFS)

169 84 16

g) Frailty (L. Fried) phenotype 155 84 29

h) Short Physical Performance Battery (SPPB) 137 100 34

i) Vulnerable Elders Survey (VES-13) 145 109 14

j) 6 Minutes Walking Test (6-MWT) 134 97 42

k) Canadian Study of Health and Ageing Frailty Index 156 99 13

l) Model InterRAI 143 109 16

m) SHARE-FI 144 107 15

n) The Gereontopole Frailty Screening Tool (GFST) 105 12 117

o) Other (please specify):

Only one respondent (from the Romanian group) indicated another known measure (i.e. MMSE).

16

Familiarized with Functional Independence Measure FIM?

In which country do you practice

most of the time?

Total

Latvia Romania

Familiarized with Functional

Independence Measure FIM

Not familiar at all, do not use 37 73 110

Familiar to some extent 48 30 78

Yes, I am familiar and use 65 34 99

Total 150 137 287

Only 37.25% of respondents were at least to some extent, familiar with FAM. 11 Romanian respondents

did not check this answer.

17

Familiarized with Functional Assessment Measure FAM?


most of the time?

Total

Latvia Romania

Familiarized with Functional

Assessment Measure FAM




Total 150 124 274

Only 42.38% (144 respondents) were, at least to some extent, familiar with FAM. 24 (8.1%) Romanian

doctors failed to check an answer to this question.

18

Familiarized with Barthel Index?

In which country do you practice most

of the time?

Total

Latvia Romania

Familiarized with Barthel

Index




Total 150 126 276

42.47% of respondents were familiar with this scale. 22 Romanian respondents did not check this answer.

Familiarized with Cumulative illness Rating Scale CIRS/mCIRS/CIRS-G?

Count


of the time? Total

Latvia Romania

Familiarized with Cumulative

illness Rating Scale

CIRS/mCIRS/CIRS-G




Total 150 118 268

19

Familiarized with Clinical Global Impression of Change in Physical Frailty CGICPF?


of the time? Total

Latvia Romania

Familiarized with Clinical

Global Impression of Change in

Physical Frailty CGICPF




Total 150 120 270

20

Familiarized with Canadian Study of Health and Ageing CSHA/ Clinical Frailty Scale CFS?


of the time?

Total

Latvia Romania

Familiarized with Canadian

Study of Health and Ageing

CSHA/ Clinical Frailty Scale

CFS




Total 150 119 269

21

Familiarized with Frailty (L. Fried) phenotype?


of the time?

Total

Latvia Romania

Familiarized with Frailty (L.

Fried) phenotype




Total 150 118 268

Familiarized with Short Physical Performance Battery SPPB?


of the time?

Total

Latvia Romania

Familiarized with Short Physical

Performance Battery SPPB




Total 150 121 271

22

Familiarized with Vulnerable Elders Survey VES-13?


of the time?

Total

Latvia Romania

Familiarized with Vulnerable

Elders Survey VES-13




Total 150 118 268

23

Familiarized with 6 Minutes Walking Test 6-MWT?


of the time?

Total

Latvia Romania

Familiarized with 6 Minutes

Walking Test 6-MWT




Total 150 123 273

Familiarized with Canadian Study of Health and Ageing Frailty Index CSHAFI?


of the time?

Total

Latvia Romania

Familiarized with Canadian

Study of Health and Ageing

Frailty Index CSHAFI




Total 150 118 268

24

Familiarized with Model InterRAI?


of the time?

Total

Latvia Romania

Familiarized with Model

InterRAI




Total 150 118 268

25

Familiarized with SHARE-FI?


of the time?

Total

Latvia Romania

Familiarized with SHARE-FI




Total 150 116 266

Familiarized with The Gereontopole Frailty Screening Tool GFST?

In which country

do you practice

most of the time?

Total

Romania

Familiarized with The

Gereontopole Frailty Screening

Tool GFST

Not familiar at all, do not use 105 105

Familiar to some extent 12 12

Total 117 117

All Latvian doctors failed to check the answer about the GFST. No respondent declared using this tool.

26

This question 11 referred to 8 scales applicable to functional decline and 11 scales applicable to frailty. We

analyzed the number of functional decline and frailty scales that were familiar to our respondents.

Compute total number of known functional decline scales

Known FD scales Frequency Percent

Valid 0 73 24.5

1 22 7.4

2 46 15.4

3 27 9.1

4 11 3.7

5 23 7.7

6 96 32.2

Total 298 100.0

Known FD scales Frequency Percent

Valid None 73 24.5

1 or 2 68 22.8

3 or more 157 52.7

Total 298 100.0

Compute total number of known Frailty scales

Known Fr. scales Frequency Percent

Valid 0 95 31.9

1 56 18.8

2 4 1.3

3 3 1.0

4 5 1.7

5 12 4.0

6 1 0.3

7 13 4.4

8 30 10.1

10 72 24.2

11 7 2.3

Total 298 100.0

Known Fr. scales Frequency Percent

Valid None 95 31.9

1 or 2 60 20.1

3 or more 143 48.0

Total 150 100.0

Comments: 24.5% of respondents were not familiar with any of the functional decline scales; 31.9% of respondents

were not familiar with any of the frailty scales.

28

II.B. Access information on functional decline related to ageing - in conceptual connection mainly with

general knowledge on the subject matter

12. How did you learn about age-related functional decline? (you can tick more than one option)

Romania Latvia Total

a) Professional training 65 89 154

b) Scientific journals 51 51 102

c) Internet 49 114 163

d) Colleagues 38 95 133

e) Patients 17 107 124

f) Health broadcasts 22 63 85

g) I don’t really know much about

functional decline/ I don’t understand 30 53 83

h) Other sources 0 79 79

Comments: The internet (54.7%) and professional training (51.7%) appear to be the main sources for

information on functional decline.

13. How did you learn about age-related frailty? (you can tick more than one option)


a) Professional training 65 141 206

b) Scientific journals 48 8 56

c) Internet 44 150 194

d) Colleagues 31 150 181

e) Patients 22 111 133

f) Health broadcasts 13 42 55

g) I don’t really know much about

functional decline/ I don’t understand 36 77 113

h) Other sources 0 82 82

Again, professional training (69.1%) and Internet (65.1%) seem to be the main sources of information.

29

14. How easy or difficult is it for you to access information on age-related functional decline? a) Very easy

b) Easy

c) Difficult

d) Very difficult

e) I don’t know/ I don’t understand


most of the time?

Total

Latvia Romania

How easy or difficult is it for

you to access information on

age-related FUNCTIONAL

DECLINE?

Very easy 14 15 29

Easy 71 59 130

Difficult 41 23 64

Very difficult 20 7 27

I don’t know / I don’t understand 4 44 48

Total 150 148 298

Most respondents (53.36%) declared it is easy or very easy for them to access information on age-related

functional decline.

30

We cross-check these answers with the ones given at question 7 (Q7), and we consider valid only

those answering Yes at Q7:

Are you aware of this concept:

functional decline?

Total

Yes No



age-related FUNCTIONAL

DECLINE?

Very easy 26 3 29

Easy 120 9 129

Difficult 58 6 64


I don’t know / I don’t understand 16 30 46

Total 244 51 295

Comment: When we look at the data, we find that of the 159 respondents who found it easy/very easy to

access information on functional decline, 1 had not answered to Q7 and 12 (7.55%) answered they were

not aware of such a concept (see bar-chart below)!!

That’s why a “confidence” evaluation of answers is necessary!

31

15. How easy or difficult is it for you to access information on age-related frailty? a) Very easy

b) Easy

c) Difficult

d) Very difficult



most of the time? Total

Latvia Romania



age-related FRAILTY?

Very easy 7 15 22

Easy 97 58 155

Difficult 30 24 54


I don’t know / I don’t

understand 1 43 44

Total 150 148 298

Again, most respondents (177 – 59.40%) found it easy or very easy to access information on age-related

frailty.

We cross-check these answers with the ones given at question 8 (Q8), and we consider valid only



frailty? Total

Yes No



age-related FRAILTY?

Very easy 15 7 22

Easy 141 11 152

Difficult 46 8 54



understand 13 30 43

Total 235 59 294

32

Comment: When we look at the data, we find that of the 177 respondents who found it easy/very easy to

access information on frailty, 18 (10.17%) also answered they were not aware of such a concept!!

33

II.C. Understand information on functional decline and frailty related to ageing

16. How easy or difficult is it for you to understand the concept of age-related functional decline? a) Very easy

b) Easy

c) Difficult

d) Very difficult



most of the time?

Total

Latvia Romania


you to understand the concept

of agerelated FUNCTIONAL

DECLINE?

Very easy 12 14 26

Easy 79 74 153

Difficult 37 19 56



understand 5 34 39

Total 150 147 297

Most respondents (179 out of 297 valid answers – 60.27%) found it easy or very easy to understand the

concept of agerelated functional decline.

34

17. How easy or difficult is it for you to understand the concept of age-related frailty? a) Very easy

b) Easy

c) Difficult

d) Very difficult



most of the time?

Total

Latvia Romania


you to understand the concept

of age-related FRAILTY?

Very easy 12 14 26

Easy 101 74 175

Difficult 23 21 44



understand 4 33 37

Total 150 148 298

Most respondents (201 out of 298 valid answers – 67.45%) found it easy or very easy to understand the

concept of age-related frailty.

35

18. How would you define age-related functional decline? (You can tick more than one option)


a) Functional capacity is considered to be quantitatively described by the aerobic

power 14 79 93

b) Functionality. especially in the elderly. is mainly related to the current

capabilities of an individual to carry out basic activities of daily living

(B/ADLs) (I/ADLs); their normal level of fulfilment represents the hallmark

of personal autonomy and the basis for self-management and quality of life.

78 86 164

c) Functional decline in the elderly refers to the global natural. age-related

involution that tends progressively to alter (impair) his/her intrinsic.

biological independence performances. 81 86 167

d) It is a decline in physical performance and ability to undertake everyday

activities of daily living. 56 118 174

e) Clinical-functional state(us) is a dialectical balance between the capability

theoretically existing/declared by the elderly in standard functional disability

assessments and their actual performance in daily life (‘enacted’).

41 88 129

f) None of the above 9 94 103

g) All of the above 30 144 174

h) Other (please specify): 0 0 0

The most common view among the interviewed doctors was that functional decline corresponds to “all the

above” definitions (58.38%) which, as well, reflect a correct knowledge on the subject matter. However, there are discrepancies among the Latvian and Romanian respondents.

19. How would you define age-related frailty? (You can tick more than one option)


a) Status meeting three out of five phenotypic criteria indicating compromised

energetic 25 80 105

b) Geriatric syndrome 34 109 143

c) State of increased (‘secondary’) vulnerability 34 103 137

d) Particular abnormality. in older adults. with multiple impairments and

consequent decline in physiological reserves and functional capacity 42 126 168

e) Precursor of disability 26 107 133

f) Mental. physical. functional capacity and/or performance decline 50 120 170

g) A state of risk of loss of independence/morbidity/premature mortality 40 141 181

h) None of the above 11 0 11

i) All of the above 41 150 191 j) Other (please specify): 0 0 0

The most common view among the interviewed doctors was that frailty corresponds to “all the above”

definitions (64.09%) which, as well, reflect a correct knowledge on the subject matter. However, as above, there are discrepancies among the Latvian and Romanian respondents.

36

20. How easy or difficult is it for you to understand information you have accessed on functional

decline related to ageing? a) Very easy

b) Easy

c) Difficult

d) Very difficult



most of the time?

Total

Latvia Romania


you to understand information

you have accessed on

FUNCTIONAL DECLINE

related to ageing?

Very easy 42 12 54

Easy 43 79 122

Difficult 43 28 71



understand 2 24 26

Total 150 144 294

Most respondents (176 out of 294 valid answers – 59.86%) found it easy or very easy to understand

information they have accessed on functional decline related to ageing.

We cross-checked these answers with the ones given at question 7, and we considered valid only


37


functional decline?

Total

Yes No


you to understand information

you have accessed on

FUNCTIONAL DECLINE

related to ageing?

Very easy 52 2 54

Easy 99 21 120

Difficult 61 10 71



understand 9 17 26

Total 241 51 292

We found that out of the 176 respondents (with answers “easy”/”very easy”), 2 had not answered Q7, and

23 (13.07%) had answered that they were not aware of the concept of functional decline!

Since questions 16 and 20 are overlapping in content, we cross-referenced them, to assess the consistency

of the answers:

How easy or difficult is it for you to access information

on age-related FUNCTIONAL DECLINE? Total

Very

easy

Easy Difficult Very

difficult

I don’t know / I

don’t understand

How easy or difficult is it for you to understand

information you have accessed on FUNCTIONAL

DECLINE related to ageing?

Very easy 13 19 12 6 4 54

Easy 14 68 20 8 12 122

Difficult 1 29 28 7 6 71

Very difficult 0 13 4 4 0 21

I don’t know / I

don’t understand 1 1 0 1 23 26

Total 29 130 64 26 45 294

The answers are weakly concordant (Somers’ d = 0.342).

38

21. How easy or difficult is it for you to understand information you have accessed on frailty related

to ageing? a) Very easy

b) Easy

c) Difficult

d) Very difficult



most of the time?

Total

Latvia Romania

How easy or difficult is for do

you is to understand

information you have accessed

on FRAILTY related to

ageing?

Very easy 35 12 47

Easy 47 78 125

Difficult 44 29 73



understand 0 24 24

Total 150 144 294

Most respondents (172 out of 294 valid answers – 58.50%) found it “easy” or “very easy” to understand

information they have accessed on frailty.

We cross-checked these answers with the ones given at question 8, and we considered valid only


39

How easy or difficult is for do you is to understand information you have accessed on

FRAILTY related to ageing?

Total

Very easy Easy Difficult Very difficult I don’t know / I don’t understand

Are you aware of this

concept: frailty?

Yes 44 97 60 24 7 232

No 3 25 13 1 17 59

Total 47 122 73 25 24 291

We found that out of the 172 respondents (with answers “easy”/”very easy”), 3 did not answer about

awareness and 28 (10.23%) had answered that they were not aware of the concept of frailty!

Since questions 17 and 21 are overlapping in content, we cross-referenced them, to see assess the

consistency of the answers:

How easy or difficult is it for you to understand the concept

of age-related FRAILTY?

Total

Very

easy

Easy Difficult Very

difficult

I don’t know / I

don’t understand

How easy or difficult is for do you is to

understand information you have accessed on

FRAILTY related to ageing?

Very easy 13 28 5 0 1 47

Easy 8 94 9 7 7 125

Difficult 1 36 24 6 6 73

Very difficult 4 13 5 2 1 25

I don’t know / I

don’t understand 0 3 0 1 20 24

Total 26 174 43 16 35 294

Again, the answers are weakly concordant (Somers’ d = 0.386).

40

II.D. Appraise information on functional decline and frailty related to

ageing

22. Do you think pre-frailty and frailty are reversible conditions? a) Yes. both are reversible

b) No. none of them is reversible

c) Only pre-frailty is a reversible condition

d) I don’t know


most of the time?

Total

Latvia Romania

Do you think PREFRAILTY

and FRAILTY are reversible

conditions?

Yes, both are reversible 39 14 53

No, none of them is reversible 58 54 112

Only pre-frailty is a reversible

condition 31 33 64

I don’t know 22 42 64

Total 150 143 293

41

The majority of the answers asserted that pre-frailty and frailty are not reversible conditions (38.23%),

which reveals a rather low knowledge on the subject matter.

We cross-checked these answers with the ones given at question 8:


frailty?

Total

Yes No

Do you think PREFRAILTY

and FRAILTY are reversible

conditions?

Yes, both are reversible 48 5 53

No, none of them is reversible 89 21 110

Only pre-frailty is a reversible

condition 56 7 63


Total 231 58 289

Out of 226 subjects who gave an opinion on the reversibility of pre-frailty/frailty (other than “I do not

know”), a number of 33 (14.60%) had declared they were not aware of the concept!!

42

23. How do you find the relevance of age-related functional decline and its assessment in your

practice? Not relevant Somehow relevant Very relevant I don’t know

Age-related functional

decline


most of the time?

Total

Latvia Romania

How do you find the relevance

of age-related FUNCTIONAL

DECLINE and its assessment

in your practice?

Not relevant 35 4 39

Somehow relevant 75 46 121

Very relevant 40 64 104


Total 150 143 293

Out of 293 respondents, 225 (76.79%) considered age-related functional decline and its assessment

relevant in their practice.

We cross-tabulated these answers with the ones given to question 7.


functional decline?

Total

Yes No

How do you find the relevance

of age-related FUNCTIONAL

DECLINE and its assessment

in your practice?


Somehow relevant 109 12 121



Total 242 49 291

43

Out of the 223 doctors who considered age-related functional decline and its assessment relevant in their

practice, 28 (12.44%) had stated they were not aware of the concept!

44

24. How much priority do you give to gain knowledge about age-related functional

decline?

a) Very high priority

b) High priority

c) Low priority

d) Very low priority

e) No priority at all


most of the time?

Total

Latvia Romania

How much priority do you give

to gain knowledge about

agerelated FUNCTIONAL

DECLINE?

Very high priority 32 7 39

High priority 56 52 108

Low priority 34 41 75

Very low priority 28 14 42

No priority at all 0 30 30

Total 150 144 294

Most respondents (147 out of 294 – 50.00%) gave “high” or “very high” priority to gaining knowledge on

age-related functional decline.

45

25. How much priority do you give to gain knowledge about age-related frailty? a) Very high priority

b) High priority

c) Low priority

d) Very low priority

e) No priority at all


most of the time?

Total

Latvia Romania

How much priority do you give

to gain knowledge about

agerelated FRAILTY?

Very high priority 0 8 8

High priority 0 54 54

Low priority 150 40 190

Very low priority 0 18 18

No priority at all 0 23 23

Total 150 143 293

Most respondents (208 out of 293 – 70.99%) gave “low” or “very low” priority to gaining knowledge about

frailty, in opposition to the trend emphasized in the answers to the same (above) question, concerning the

age related functional decline (?).

In fact, this “low priority” option was the choice of all Latvian respondents!

46

26. How do you find the measurement tools available to assess functional decline related to ageing? a) Very useful

b) Useful

c) Less useful

d) Not useful

e) I don’t have an opinion


most of the time?

Total

Latvia Romania

How do you find the

measurement tools available to

assess FUNCTIONAL


Very useful 22 9 31

Useful 56 70 126

Less useful 38 16 54

Not useful 34 1 35

I don’t have an opinion 0 52 52

Total 150 148 298

Most respondents (157 out of 298 – 52.68%) found such measurement tools “useful” or “very useful”.

We cross-tabulated these answers with the ones given to question 7:


functional decline?

Total

Yes No

How do you find the


assess FUNCTIONAL


Very useful 29 1 30

Useful 111 15 126

Less useful 46 8 54

Not useful 34 1 35


Total 244 51 295

We found that out of 246 subjects who had an opinion on functional decline measurement tools, 25

(10.16%) had stated that they were not aware of the concept of functional decline!

47

27. How do you find the measurement tools available to assess frailty related to ageing? a) Very useful

b) Useful

c) Less useful

d) Not useful



most of the time?

Total

Latvia Romania

How do you find the


assess FRAILTY related to

ageing?

Very useful 33 8 41

Useful 70 71 141

Less useful 47 14 61

Not useful 0 1 1


Total 150 148 298

Most of the respondents (182 out of 298, i.e. 61.07%) found measurement tools “useful” or “very useful”.

We cross-tabulated these answers with the ones given to question 8:

Count


frailty?

Total

Yes No

How do you find the


assess FRAILTY related to

ageing?

Very useful 37 3 40

Useful 120 20 140

Less useful 54 7 61

Not useful 1 0 1


Total 235 59 294

Out of the 244 respondents who expressed an opinion on frailty measurement tools, 30 (12.29%) had

declared that they were not aware of the frailty concept!!

48

28. How do you judge the relevance of functional decline and its assessing for practicing your work? a) Very relevant

b) Relevant

c) Less relevant

d) Not relevant



most of the time?

Total

Latvia Romania

How do you judge the

relevance of FUNCTIONAL

DECLINE and its assessing for

practicing your work?


Relevant 71 64 135

Less relevant 25 27 52



Total 150 148 298

Most of the respondents (166 out of 298, i.e. 55.70%) found functional decline and its assessment

“relevant” or “very relevant” for their practice.

We cross-referenced these answers with the ones given to question 7:


functional decline?

Total

Yes No


relevance of FUNCTIONAL

DECLINE and its assessing for

practicing your work?


Relevant 121 14 135




Total 244 51 295

We found that out of the 255 who gave an opinion on the relevance of functional decline for their practice,

29 (11.37%) had stated they were not aware of the concept of functional decline!

(If there will found necessary we shall fulfill, based on the same related standardized formula, cross-

tabulations (with the respective Somer’s d coefficient values), including to all question pairs to which we

observed quantitatively consistent conflicting answers.)

49

Crosstabulation of Q28 and Q24

How much priority do you give to gain knowledge about

agerelated FUNCTIONAL DECLINE?

Total

Very high

priority

High

priority

Low

priority

Very low

priority

No priority at

all

How do you judge the relevance

of FUNCTIONAL DECLINE and

its assessing for practicing your

work?

Very relevant 11 13 3 4 0 31

Relevant 15 71 34 11 2 133

Less relevant 5 10 21 11 4 51

Not relevant 8 11 6 8 4 37

I don’t have

an opinion 0 3 11 8 20 42

Total 39 108 75 42 30 294

The answers given are weakly concordant (Somers’ delta = 0.386).

29. How do you judge the relevance of frailty and its assessing for practicing your work? a) Very relevant

b) Relevant

c) Less relevant

d) Not relevant



most of the time?

Total

Latvia Romania


relevance of FRAILTY and its

assessing for practicing your

work?


Relevant 75 61 136




Total 150 148 298

Most respondents (160 out of 298, i.e. 53.69%) found frailty and its assessing “relevant” or “very relevant”

for their practice.

We cross tabulated these answers with the ones given to question 8:


frailty?

Total

Yes No


relevance of FRAILTY and its

assessing for practicing your

work?


Relevant 118 17 135




Total 235 59 294

Out of 257 respondents who gave a definite opinion on the relevance of frailty, 37 (14.40%) had declared

they were not aware of the concept of frailty!

50

Crosstabulation of Q29 and Q25:

How much priority do you give to gain knowledge about

agerelated FRAILTY?

Total

Very high

priority

High

priority

Low

priority

Very low

priority

No priority

at all

How do you judge the relevance of

FRAILTY and its assessing for practicing

your work?

Very relevant 5 3 15 1 0 24

Relevant 2 41 86 3 1 133

Less relevant 1 7 51 3 2 64

Not relevant 0 0 26 3 4 33

I don’t have an

opinion 0 3 12 8 16 39

Total 8 54 190 18 23 293

Weak concordance (Somers’ delta = 0.411)

30. In your opinion. how much do you know about assessing age-related functional decline? a) Very much

b) Much

c) Little

d) Very little

e) Nothing


most of the time?

Total

Latvia Romania

In your opinion, how much do

you know about assessing age-

related FUNCTIONAL

DECLINE?

Very much 23 3 26

Much 43 17 60

Little 42 62 104

Very little 42 45 87

Nothing 0 21 21

Total 150 148 298

Most of the respondents (191 out of 298, i.e. 64.09%) declared they knew little or very little about

assessing age-related functional decline – thus emphasizing a low level of specific literacy.

Cross-tabulation of Q30 and number of functional decline scales known:

Total number of known FD scales Total

None 1 or 2 3 or more


you know about assessing age-

related FUNCTIONAL

DECLINE?

Very much 1 8 17 26

Much 5 14 41 60

Little 15 27 62 104

Very little 33 17 37 87

Nothing 19 2 0 21

Total 73 68 157 298

Results were weakly concordant: Somers’d=-0.332.

51

31. In your opinion. how much do you know about assessing age-related frailty? a) Very much

b) Much

c) Little

d) Very little

e) Nothing


most of the time?

Total

Latvia Romania


you know about assessing

agerelated FRAILTY?

Very much 19 3 22

Much 37 14 51

Little 64 64 128

Very little 30 46 76

Nothing 0 21 21

Total 150 148 298

Most respondents (204 out of 298, i.e. 68.46%) stated they knew little or very little about assessing frailty –

thus emphasizing a low level of specific literacy.

52

Crosstabulation of Q31 and number of frailty scales known:

Total number of known frailty scales Total

None 1 or 2 3 or more


you know about assessing

agerelated FRAILTY?

Very much 1 6 15 22

Much 7 9 35 51

Little 27 35 66 128

Very little 39 10 27 76

Nothing 21 0 0 21

Total 95 60 143 298

The results were weakly concordant (Somers’d =-0.370)

32. How much knowledge do you have concerning the categories and sub-domains of frailty? a) A lot of knowledge

b) Some knowledge

c) Little knowledge

d) No knowledge


most of the time?

Total

Latvia Romania

How much knowledge do you

have concerning the categories

and subdomains of

FRAILTY?

A lot of knowledge 0 3 3

Some knowledge 0 27 27

Little knowledge 150 55 205

No knowledge 0 61 61

Total 150 146 296

Most respondents (205 out of 296 – 69.26%) declared they knew little about the categories and sub-

domains of frailty. All Latvian doctors stated they knew little about this subject. These results emphasize

an overall low level of literacy in this respect.

We cross referenced these answers with the answers received to question 8:


frailty?

Total

Yes No

How much knowledge do you

have concerning the categories

and subdomains of

FRAILTY?

A lot of knowledge 1 2 3

Some knowledge 22 4 26

Little knowledge 186 18 204

No knowledge 25 34 59

Total 234 58 292

Out of the 235 subjects who declared they had knowledge about the categories and sub-domains of frailty,

24 (10.21%) had previously stated they were not familiar with the concept of frailty.

53

33. How often should functional decline be measured in the elderly patients? a) Monthly

b) Quarterly

c) Once every 6 months

d) Once a year

e) Less frequently


most of the time?

Total

Latvia Romania

How often should

FUNCTIONAL DECLINE be

measured in the elderly

patients?

Monthly 39 11 50

Quarterly 45 24 69

Once every 6 months 56 40 96

Once a year 10 52 62

Less frequently 0 15 15

Total 150 142 292

Most respondents opinion was that functional decline should be measured every 6 months (32.88%) or

quarterly (23.63%), which is quite correct.

We cross-tabulated these answers with the ones received to question 7:


functional decline?

Total

Yes No

How often should

FUNCTIONAL DECLINE be

measured in the elderly

patients?

Monthly 49 1 50

Quarterly 60 8 68




Total 242 48 290

The results were weakly concordant: Somers’s d=0.260.

54

The data shows that many of the subjects responding that functional decline should be measured once a year or

less frequently also stated they were not familiar with the concept of functional decline.

55

34. How often should frailty be measured in the elderly patients? a) Monthly

b) Quarterly


d) Once a year

e) Less frequently


most of the time?

Total

Latvia Romania

How often should FRAILTY

be measured in the elderly

patients?

Monthly 33 10 43

Quarterly 29 19 48




Total 150 138 288

Most responders considered that frailty should be assessed once every 6 months (35.41%) or yearly

(28.82%), which is partly correct.



frailty?

Total

Yes No

How often should FRAILTY

be measured in the elderly

patients?

Monthly 40 3 43

Quarterly 41 6 47




Total 232 52 284

56

II.E. Apply information on functional decline and frailty related to ageing -

(a) in conceptual connection with general knowledge

35. Who is accompanying patients aged 60 and over to the medical visit?

0-20% of the

elderly 20-40% of the




elderly

Family 35 34 61 117 43

Paid carers 97 44 45 50 0

Friends or

neighbours 1 53 30 15 4

Others 50 17 5 1 0

Nobody 189 15 13 6 2

Overall, the answers revealed that the great (60–80%) majority of the elders are accompanied to the

medical visit by their family (117 such answers = 61.90% of the respondents).

To perform the statistical analysis ONLY ON RELIABLE ANSWERS, we created two reliability filters,

one for the literacy on the functional decline and the other for the literacy on frailty – based on

comparisons between questions with logically connected content – related to ageing.

The functional decline “reliability” filter selected only respondents who answered “yes” to question 7, did

not answer “I don’t know” or “does not apply to my field” to question 9, were familiar with (as knowledge

degree threshold) at least one functional scale in question 11 and did not answer “I don’t know” to question

16.

There are two degrees of “reliable” answers: “low” res. “high”. High reliable are those familiar with at

least two functional scales (Q11).

The frailty filter was created in a similar fashion, using the answers to the questions 8, 10, 11, 17.

It is our intent to use these filters in the final analysis, to process the questions 22-47, with few exceptions.

Who is accompanying patients aged 60 and over to the medical visit? Family:

Frequency Percent

Valid

0-20% of the elderly 35 11.7





Total 290 97.3


Total 298 100.0

57

Who is accompanying patients aged 60 and over to the medical visit? Paid carers:

Frequency Percent

Valid





Total 236 79.2


Total 298 100.0

Who is accompanying patients aged 60 and over to the medical visit? Friends or neighbors:

Frequency Percent

Valid

0-20% of the elderly 1 .3





Total 103 34.6


Total 298 100.0

Who is accompanying patients aged 60 and over to the medical visit? Others:

Frequency Percent

Valid





Total 73 24.5


Total 298 100.0

Who is accompanying patients aged 60 and over to the medical visit? Nobody:

Frequency Percent

Valid






Total 225 75.5


Total 298 100.0

58

II.E. Apply information on functional decline and frailty related to ageing –

(b) in conceptual connection with health care

36. In which age group do you first observe signs and/or symptoms of age-related functional decline?

a) 40-50 years

b) 50-60 years

c) 60-70 years

d) 70-80 years

e) Over 80 years old

f) I don't know


most of the time?

Total

Latvia Romania

In which age group do you first

observe signs and/or symptoms


DECLINE?

40-50 years 21 7 28

50-60 years 53 29 82

60-70 years 30 82 112

70-80 years 28 19 47

Over 80 years old 18 0 18

I don't know 0 7 7

Total 150 144 294

The most frequent answers to this question were: 60-70 years (38.10%) and 50-60 years (27.89%).



functional decline?

Total

Yes No




DECLINE?

40-50 years 27 1 28

50-60 years 70 11 81

60-70 years 86 25 111

70-80 years 36 10 46


I don't know 4 3 7

Total 241 50 291

Of the 287 subjects who gave an opinion to this question (other than “I don’t know”), 50 (17.42%) had

previously declared they were not familiar with the concept of functional decline!!

Overall, we consider these answers reflect an acceptable level of literacy on this subject matter.

59

37. In which age group do you first observe signs and/or symptoms of age-related frailty? a) 40-50 years

b) 50-60 years

c) 60-70 years

d) 70-80 years

e) Over 80 years old

f) I don't know


most of the time?

Total

Latvia Romania



of agerelated FRAILTY?

40-50 years 15 7 22

50-60 years 80 25 105

60-70 years 20 84 104

70-80 years 20 20 40


I don't know 0 8 8

Total 150 146 296

Most respondents selected the option “50-60 years” age group (35.47%) and “60-70 years” age group

(35.14%).

We consider these answers reflect a low level of literacy on the subject.



frailty?

Total

Yes No



of agerelated FRAILTY?

40-50 years 19 3 22

50-60 years 94 11 105

60-70 years 74 28 102

70-80 years 27 12 39


I don't know 5 3 8

Total 234 59 293

Out of 288 respondents who gave a definite opinion to this question, 59 (20.49%) had previously stated

they were not familiar with the concept of frailty!!! This is consistent with our above mentioned related

assertion.

60

38. Which of the basic criteria of frailty is the earliest that you come across most often?


a) Weakness (especially objectified by reporting/ examining his/her grip strength)

b) Unintentional weight loss

c) Self-reported exhaustion

d) Slow walking speed

e) Low physical activity

f) Other

Frequency Percent

a) Weakness (especially objectified by

reporting/ examining his/her grip

strength)

180 60.4

b) Unintentional weight loss 43 14.4

c) Self-reported exhaustion 191 64.1

d) Slow walking speed 70 23.5

e) Low physical activity 169 56.7

f) Other 35 11.7

Self-reported exhaustion was considered by most respondents (64.1%) as the basic criterion for frailty.

61

39. How do you assess functional decline and respectively. frailty. in a patient?

(you can tick more than one option) a) I use scales such as: FIM. FAM. CIRS/mCIRS. Barthel index. CGICPF. CSHACFS. T10MWT.

6MWT

b) I use other scales and measurements

c) I don't assess it


most of the time?

Total

Latvia Romania

How do you assess

FUNCTIONAL DECLINE and

respectively, FRAILTY, in a

patient?

I use scales such as: FIM,

FAM, CIRS/mCIRS, Barthel

index, CGICPF, CSHACFS,

T10MWT, 6MWT

6 30 36

I use other scales and

measurements 0 14 14

I don't assess it 144 96 240

Total 150 140 290

The overwhelming majority (240, i.e. 82.76%) of respondents stated they do not assess functional decline

and frailty.

62

40. In the elderly patients, how frequently do you encounter the following problems: (You can tick more than one option)

0-20% of

the elderly

20-40& of

the elderly

40-60% of

the elderly

60-80% of

the elderly

80-100% of

the elderly

a) Neuro‐/ loco‐motor 6 26 46 39 10

b) Cardiovascular 1 9 35 51 178

c) Mental/

psycho‐cognitive

(depression. dementia) 21 33 35 33 155

d) Metabolic (diabetes

mellitus. obesity.

hyperuricemia) 8 25 56 32 155

e) Respiratory 14 48 34 15 151

f) Digestive 23 42 32 14 149

g) Urinary 17 47 29 21 148

h) Hormonal 46 33 20 4 149

i) Haematological 39 39 23 5 2

j) Dermatological 40 39 24 8 149

k) Other 0 0 0 0 0

According to the answers provided by our respondents, the most frequent health problems in elderly (80-

100%) were: cardio-vascular disorders (59.73%), mental/psycho-cognitive disorders (52.01%) and

metabolic ones (52.01%).

Surprisingly (?!) the neuro-/locomotor problems are placed, according to the collected answers on the last

but one place as frequency. In fact, no Latvian respondent indicated any neuro-/locomotor problem at all.

63


(c) in conceptual connection mainly with disease prevention

41. What, based on your knowledge, should be done to support patients’ function and prevent/delay

the onset of its age-related decline and/or mitigate its consequences? (You can tick more than one option)

a) Intake of nutritional supplements and/or drugs with different anti-abiotrophy/ anti-ageing properties

b) Practicing physical activity regularly

c) Having/adopting good nutrition habits (healthy diet - Mediterranean type)

d) Staying active in the social environment

e) Prevent and/or fight against di-stress

f) None of the above

g) All of the above

h) Other (please specify):

Only took into consideration the answers belonging to those who responded Yes at Q7 or at Q8:

Frequency Percent

a) Intake of nutritional supplements and/or

drugs with different anti-abiotrophy/ anti-

ageing properties

14 32.6

b) Practicing physical activity regularly 20 46.5

c) Having/adopting good nutrition habits

(healthy diet - Mediterranean type)

17 39.5

d) Staying active in the social environment 17 39.5

e) Prevent and/or fight against di-stress 10 23.3

f) None of the above 1 2.3

g) All of the above 28 65.1

h) Other 0 0.0

Total 43 100.0

The most frequent answer was that all the mentioned measures were adequate (61.1%), which reflects

reliable good level of literacy on the subject matter.

42. How often do you discuss preventive measures for age-related functional decline with your

patients? a) Monthly or more frequently

b) Quarterly


d) Once a year

e) Less frequently


most of the time?

Total

Latvia Romania

How often do you discuss

preventive measures for

agerelated FUNCTIONAL

DECLINE with your patients?

Monthly or more frequently 79 30 109

Quarterly 71 17 88


Once a year 0 16 16


Total 150 145 295

64

The majority of the Latvian doctors chose “monthly or more frequently” counseling as an answer.

We selected only the answers belonging to those who responded yes to question 7:

Frequency Percent

Monthly or more frequently 18 42,9

Quarterly 4 9,5

Once every 6 months 8 19,0

Once a year 8 19,0

Less frequently 4 9,5

Total 42 100,0

Most doctors answered “monthly or more frequently” (42.9%).

43. How often do you discuss preventive measures for age-related frailty with your patients? a) Monthly or more frequently

b) Quarterly


d) Once a year

e) Less frequently


most of the time?

Total

Latvia Romania

How often do you discuss

preventive measures for age-

related FRAILTY with your

patients?


Quarterly 124 11 135


Once a year 0 15 15


Total 150 142 292

In should be noted that the great majority of Latvian doctors (82.67%) answered “quarterly”.

65


(d) in conceptual connection mainly with health promotion

44. How often do you experience patients having/adopting and promoting a healthy lifestyle to

prevent/delay the onset of the functional decline and frailty and/or mitigate its consequences? a) Every few days or more frequently

b) Between once a week and once every 4 weeks

c) Between once a month and quarterly

d) 2‐3 times per year

e) Less frequently or never


most of the time?

Total

Latvia Romania

How often do you experience

patients having/adopting and

promoting a healthy lifestyle to

prevent/delay the onset of the

functional decline and frailty

and/or mitigate its consequences?


Quarterly 0 23 23


Once a year 0 34 34


Total 150 146 296

The most frequent answer was “once every 6 months” (183 out of 296 – 61.82%).

It is notable that all Latvian doctors responded “once every 6 months”.

45. How would you characterize your elderly patients’ adherence to treatment for functional decline

and/or frailty? a) Very high

b) Quite high

c) Moderate. satisfactory

d) Low. not satisfactory

e) Very low


most of the time?

Total

Latvia Romania

How would you characterize

your elderly patients’

adherence to treatment for

functional decline and/or

frailty?

Very high 4 5 9

Quite high 80 29 109

Moderate, satisfactory 52 40 92

Low, not satisfactory 14 42 56

Very low 0 27 27

Total 150 143 293

Respondents generally characterized their patients’ adherence to treatment as moderate (31.40%) or quite

high (37.20%).

66

We selected only the answers belonging to those who responded yes to questions 7 and 8:

Frequency Percent

Valid

Very high 2 4,7

Quite high 16 37,2

Moderate, satisfactory 14 32,6

Low, not satisfactory 10 23,3

Very low 1 2,3

Total 43 100,0

The most frequent answers were overall the same, but reversed as the order of frequency: quite high and

moderate.

46. Can you specify factors that tend to reduce or increase related therapy adherence in the elderly

(60 years or above)? (You can tick more than one option)

Reduce Increase

a) Education level – including of health literacy 29 (9.7%) 250 (83.9%)

b) Psycho-cognitive problems (depression/ negativism. dementia) 253 (84.9%) 19 (6.4%)

c) Very severe physical disability 249 (83.6%) 21 (7.0%) d) Socio-economic state 232 (77.9%) 35 (11.7%) e) Spiritual/ religious beliefs 211 (70.8%) 43 (14.4%)

f) Trust in the health system 33 (11.1%) 223 (74.8%) g) Lack of trust in the health system 237 (79.5%) 5 (1.7%) h) None of the above 3 (1.0%) 2 (0.7%) i) All of the above 11 (3.7%) 1 (0.3%) j) Other 0 0

The most common opinions were that psycho-cognitive problems (253 answers, 84.9%) and very severe

physical disability (249 answers, 83.6%) decrease adherence to therapy, while education (250 answers,

83.9%) and trust in the health systems (223 answers,74.8%) increase adherence to therapy – which is

correct, thus revealing a very good level of literacy on the subject matter.

47. What can you do to manage functional decline and/or frailty in your patients?


a) Prescribe nutritional supplements and/or drugs with different anti-abiotrophy/ anti-ageing properties

b) Advise on regular physical activity

c) Advise on having/adopting good nutrition habits (healthy diet - Mediterranean type)

d) Advise on staying active in the social environment

e) Advise on preventing and/or fighting against di-stress

f) All of the above

g) None of the above

h) Other (please specify):

67

Only those answering Yes at Q7 and Q8:

Frequency Percent

a) Prescribe nutritional supplements

and/or drugs with different anti-

abiotrophy/ anti-ageing properties 12 44.4

b) Advise on regular physical activity 12 44.4

c) Advise on having/adopting good

nutrition habits (healthy diet -

Mediterranean type) 12 44.4

d) Advise on staying active in the social

environment 12 44.4

e) Advise on preventing and/or fighting

against di-stress 10 37.0

f) All of the above 19 70.4

g) None of the above 0 0

h) Other 0 0

Total valid answers 27 100.0

The most frequent answer was “all of the above” (70.4 %), which is correct, thus revealing a very good

level of literacy on the subject matter.

Statistical analysis was done using SPSS V22.0, last accessed 06.11.2014, 14.00.

General discussion: the data from the Latvian respondent doctors to this survey contained

identical answers in all the 150 questionnaires to questions 7, 8, 9, 10, 37, 44 (?)

Conclusions:

1. The idea - emerging from the stringent/obvious necessity of determining the level of

literacy on functional decline and frailty, related to ageing, through the European

(and not only) population – that backed up the onset of our two related international

surveys proved, including as emphasized by the data we have collected and

preliminary processed, extremely useful and welcome.

2. Unfortunately the low adherence to effectively contribute within the Consortium we

have constituted in this purpose resulted in specific data available for processing,

only from two national participants: Romania and Latvia. Although emphasizing

some interesting aspects, it is questionable whether the current related results could

be extrapolated to all the European citizens.

3. Therefore, as we have repeatedly emphasized and kindly asked to all the members

within in the related Consortium and respectively, to the ones of the CPME’s WG on

Healthy and Active Ageing, these two surveys need, for fully reaching their goal, to

be continued – also with further refinement of their two underpinning customized

questionnaires – and especially enlarged by data collection from more countries.

doctors’ and older patients’ health …...introduction the present study generated data for the...

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