Why geriatric knowledge AND infrastructure should be implemented into the out-patient sector: Findings and innovative interventions from the Hamburg Longitudinal Urban Cohort Ageing Study (LUCAS)

Abstract

Aim & methods The LUCAS study design (individual trajectories [ Fig. 1 ] since 2000 with embedded RCTs) revealed unexpected findings leading to appropriate preventative interventions (BMBF01ET1002A). Results Geriatric syndromes start with pre-clinical loss of health resources followed by accumulation of risk-factors resulting in frailty as a leading cause of disability and premature death. This process covered at least 1000 days in initially robust community-dwelling older persons. Therefore, simple but highly predictive self-screening tools were developed and implemented in general practices. Then, identified pre-frail persons underwent an extended geriatric-gerontological assessment (instruments to avoid ceiling effects, technical supported gait analyses). We identified underlying causes (i.e. impact disease, post traumatic distress syndrome) of the frailty cascade and derived therapeutic strategies. Conclusion LUCAS showed a population-based approach was effective in selecting different target groups for interventions preventing frailty and functional decline in pre-clinical stages. We conclude that the outpatient sector in many European countries is inadequately prepared to provide comprehensive medical care to older persons. We recommend implementing not only geriatric knowledge but also appropriate infrastructure like outpatient assessment units planned since 2013 by the German Government. We invite the EAMA-Community to participate in further analyses and interpretation of the extensive LUCAS-database.