European Union Geriatric Medicine Society Research Articles

Editorial introductions.

Editorial introductions.

Editorial introductions

Editorial introductions

Editorial introductions

Editorial introductions

2018 ESC Guidelines for the diagnosis and management of syncope

The Task Force for the diagnosis and management of syncope of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) Endorsed by: European Academy of Neurology (EAN), European Federation of Autonomic Societies (EFAS), European Federation of Internal Medicine (EFIM), European Union Geriatric Medicine Society (EUGMS), European Society of Emergency Medicine (EuSEM) (text is available in electronic version doi:10.15829/1560-4071-2019-7-130-194)

Translation and Validation of the Spanish Version of the SARC-F Questionnaire to Assess Sarcopenia in Older People.

The revised European consensus on sarcopenia definition and diagnosis (EWGSOP2) includes the SARC-F questionnaire, the most valid and consistent sarcopenia screening tool, as the mandatory first step. Our aim was the translation, cross-cultural adaptation, and validation of the SARC-F questionnaire as a culturally-responsive Spanish-language version for the European population. Cross-sectional descriptive study, applying the two-step WHO methodology for translation and cross-cultural adaptation of health questionnaires, and harmonization with the Mexican-Spanish version. European Union Geriatric Medicine Society recommendations for SARC-F validation in European languages were considered. Outpatient clinics of a university hospital. stable, ambulatory (including aids), community-dwelling population ≥65 years old. The self-reported 5-item SARC-F questionnaire was administered; scores ≥4 indicated sarcopenia. Sensitivity, specificity, accuracy-likelihood ratios, predictive values, and kappa statistics were calculated and consecutively compared with European Working Group on Sarcopenia in Older People (EWGSOP) and EWGSOP2 criteria. This Spanish version, administered in an average 70s, has adequate internal consistency (Cronbach alpha=0.779). For the validation study, 90 (43.3%) of 208 potentially eligible subjects (81.4 ± 5.9 years old, 75.6% women) were included. SARC-F identified 51 (56.7%) subjects with sarcopenia and 39 (43.3%) without the disease. Prevalence was 17.8% per EWGSOP and 25.6% per EWGSOP2 (58% accuracy and fair agreement: sensitivity, 78.3%; specificity, 50.8%). SARC-F is a feasible tool, suitable for bedside assessment in community-dwelling older patients. Wide diffusion of this culturally-responsible SARC-F Spanish version is expected as EWGSOP2 is adopted and sarcopenia assessment is broadly implemented in Spain.

Editorial introductions

Editorial introductions

Cross-cultural adaptation and validation of the SARC-F to assess sarcopenia: methodological report from European Union Geriatric Medicine Society Sarcopenia Special Interest Group.

Sarcopenia is a well-identified process of aging known to cause functional deterioration, falls, fractures, frailty and mortality. Considering the global aging population, sarcopenia assessment has become a public health priority because its early detection is expected to prevent or decrease adverse outcomes through commencement of therapeutic measures. Therefore, the diagnosis of sarcopenia mediated by effective screening is expected to become particularly important. Being very practical with clearly demonstrated value to predict sarcopenia-related adverse outcomes, SARC-F questionnaire stands as one of the best tools to evaluate sarcopenia in every day practice. SARC-F has originally been created in English. Considering the variety of languages in Europe, it seems very valid to adapt and validate this tool in different European languages. This report is written to explain the details of the final consensus methodology suggested for SARC-F validation, thereby guiding and helping the research teams in their studies.

An International Perspective on Chronic Multimorbidity: Approaching the Elephant in the Room.

Multimorbidity is a common and burdensome condition that may affect quality of life, increase medical needs, and make people live more years of life with disability. Negative outcomes related to multimorbidity occur beyond what we would expect from the summed effect of single conditions, as chronic diseases interact with each other, mutually enhancing their negative effects, and eventually leading to new clinical phenotypes. Moreover, multimorbidity mirrors an accelerated global susceptibility and a loss of resilience, which are both hallmarks of aging. Due to the complexity of its assessment and definition, and the lack of clear evidence steering its management, multimorbidity represents one of the main current challenges for clinicians, researchers, and policymakers. The authors of this article recently reflected on these issues during two twin international symposia at the 2016 European Union Geriatric Medicine Society (EUGMS) meeting in Lisbon, Portugal, and the 2016 Gerontological Society of America (GSA) meeting in New Orleans, USA. The present work summarizes the most relevant aspects related to multimorbidity, with the ultimate goal to identify knowledge gaps and suggest future directions to approach this condition.

How clinical practitioners assess frailty in their daily practice: an international survey

IntroductionVarious operational definitions have been proposed to assess the frailty condition among older individuals. Our objective was to assess how practitioners measure the geriatric syndrome of frailty in their daily routine.MethodsAn online survey was sent to national geriatric societies affiliated to the European Union Geriatric Medicine Society (EUGMS) and to members of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO).ResultsA total of 388 clinicians from 44 countries answered to the survey. Most of them were medical doctors (93%), and their primary field of practice was geriatrics (83%). Two hundred and five clinicians (52.8%) always assessed frailty in their daily practice, 38.1% reported to “sometimes” measure it, and 9.1% never assess it. A substantial proportion of clinicians (64.9%) diagnose frailty using more than one instrument. The most widely used tool was the gait speed test, adopted by 43.8% of the clinicians, followed by clinical frailty scale (34.3%), the SPPB test (30.2%), the frailty phenotype (26.8%) and the frailty index (16.8%).ConclusionA variety of tools is used to assess frailty of older patients in clinical practice highlighting the need for standardisation and guidelines.

Erratum to: Can We Identify Patients with High Risk of Osteoarthritis Progression Who Will Respond to Treatment? A Focus on Epidemiology and Phenotype of Osteoarthritis.

Osteoarthritis is a syndrome affecting a variety of patient profiles. A European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis and the European Union Geriatric Medicine Society working meeting explored the possibility of identifying different patient profiles in osteoarthritis. The risk factors for the development of osteoarthritis include systemic factors (e.g., age, sex, obesity, genetics, race, and bone density) and local biomechanical factors (e.g., obesity, sport, joint injury, and muscle weakness); most also predict disease progression, particularly joint injury, malalignment, and synovitis/effusion. The characterization of patient profiles should help to better orientate research, facilitate trial design, and define which patients are the most likely to benefit from treatment. There are a number of profile candidates. Generalized, polyarticular osteoarthritis and local, monoarticular osteoarthritis appear to be two different profiles; the former is a feature of osteoarthritis co-morbid with inflammation or the metabolic syndrome, while the latter is more typical of post-trauma osteoarthritis, especially in cases with severe malalignment. Other biomechanical factors may also define profiles, such as joint malalignment, loss of meniscal function, and ligament injury. Early- and late-stage osteoarthritis appear as separate profiles, notably in terms of treatment response. Finally, there is evidence that there are two separate profiles related to lesions in the subchondral bone, which may determine benefit from bone-active treatments. Decisions on appropriate therapy should be made considering clinical presentation, underlying pathophysiology, and stage of disease. Identification of patient profiles may lead to more personalized healthcare, with more targeted treatment for osteoarthritis.

Editorial introductions

Editorial introductions

Cross-sectoral collaboration by telehealth for prevention of acute admissions in elderly

Introduction: High age is associated with an increased risk of hospital-demanding disease. In only 20 years, the number of 80+ in Denmark will double from approximately 238,000 in 2015 to 470,000 in 2035. Despite the increasing number of aged persons, the number of hospital beds in Denmark are being reduced as new ‘super-hospitals’ are built across the country. In response, health care delivery organisations and authorities have focused their efforts on avoiding acute short-term ( Description of care practice: Consequently, there is a demanding need for rethinking current practices and finding alternative ways by which it is possible to diagnose potentially acute patients quickly and initiate proper treatment. Building on the existing collaboration and practises in the Danish healthcare system between general practices, home care delivered by the municipalities and secondary care (hospitals) and the technological infrastructure available in Region of Southern Denmark, PAATH (Prevention of Acute Admissions by Telehealth) will facilitate new cross-sectoral procedures that strengthen the collaboration for the benefit of patients (70+). PAATH’s aim is to demonstrate if by utilising existing technological solutions, we can develop and demonstrate a complete process from home-monitoring of patient’s vital signs to remote specialist consultation that can ultimately prevent acute admissions to hospital. Acute team nurses in Svendborg Municipality are equipped with a “GERI-suitcase” containing a range of devices to measure vital signs, blood tests, bladder scan etc. The data from the devices are automatically transferred via a tablet (which also enables real-time video consultation) to a joint IT platform, where the GP, hospital, home care and the patient all have access and are able to see the data. The treating doctor will thus have immediate access to the data and a much clearer picture of the patient’s current situation and thereby a qualified foundation for deciding the treatment and next steps, i.e. if the patient can be treated at home, at the geriatric outpatient clinic or admissions is required. The GERI-suitcase concept is tested for an eight-month period between July 2016 and February 2017. Conclusion and discussion: With the intention of demonstrating the potential in new cross-sectoral work procedures and telehealth supported home-monitoring by acute team for the prevention of acute admissions of elderly medical patients, PAATH began in January 2016 and is in the process of testing the GERI-suitcase in real-life settings. The purpose of PAATH is to demonstrate if it is technically, medically, organisationally and culturally feasible. Effectiveness (reduction in acute admissions, contacts to GP and home care services) will be far more scientifically and rigorously evaluated in further studies that are planned to succeed PAATH.

European Society for Swallowing Disorders - European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome.

This position document has been developed by the Dysphagia Working Group, a committee of members from the European Society for Swallowing Disorders and the European Union Geriatric Medicine Society, and invited experts. It consists of 12 sections that cover all aspects of clinical management of oropharyngeal dysphagia (OD) related to geriatric medicine and discusses prevalence, quality of life, and legal and ethical issues, as well as health economics and social burden. OD constitutes impaired or uncomfortable transit of food or liquids from the oral cavity to the esophagus, and it is included in the World Health Organization’s classification of diseases. It can cause severe complications such as malnutrition, dehydration, respiratory infections, aspiration pneumonia, and increased readmissions, institutionalization, and morbimortality. OD is a prevalent and serious problem among all phenotypes of older patients as oropharyngeal swallow response is impaired in older people and can cause aspiration. Despite its prevalence and severity, OD is still underdiagnosed and untreated in many medical centers. There are several validated clinical and instrumental methods (videofluoroscopy and fiberoptic endoscopic evaluation of swallowing) to diagnose OD, and treatment is mainly based on compensatory measures, although new treatments to stimulate the oropharyngeal swallow response are under research. OD matches the definition of a geriatric syndrome as it is highly prevalent among older people, is caused by multiple factors, is associated with several comorbidities and poor prognosis, and needs a multidimensional approach to be treated. OD should be given more importance and attention and thus be included in all standard screening protocols, treated, and regularly monitored to prevent its main complications. More research is needed to develop and standardize new treatments and management protocols for older patients with OD, which is a challenging mission for our societies.

A comprehensive fracture prevention strategy in older adults: the European Union Geriatric Medicine Society (EUGMS) statement.

Prevention of fragility fractures in older people has become a public health priority, although the most appropriate and cost-effective strategy remains unclear. In the present statement, the Interest Group on Falls and Fracture Prevention of the European Union Geriatric Medicine Society, in collaboration with the International Association of Gerontology and Geriatrics for the European Region, the European Union of Medical Specialists, and the International Osteoporosis Foundation-European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis, outlines its views on the main points in the current debate in relation to the primary and secondary prevention of falls, the diagnosis and treatment of bone fragility, and the place of combined falls and fracture liaison services for fracture prevention in older people.

A Comprehensive Fracture Prevention Strategy in Older Adults: The European Union Geriatric Medicine Society (EUGMS) Statement.

Prevention of fragility fractures in older people has become a public health priority, although the most appropriate and cost-effective strategy remains unclear. In the present statement, the Interest Group on Falls and Fracture Prevention of the European Union Geriatric Medicine Society (EUGMS), in collaboration with the International Association of Gerontology and Geriatrics for the European Region (IAGG-ER), the European Union of Medical Specialists (EUMS), the International Osteoporosis Foundation - European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis, outlines its views on the main points in the current debate in relation to the primary and secondary prevention of falls, the diagnosis and treatment of bone fragility, and the place of combined falls and fracture liaison services for fracture prevention in older people.

A comprehensive fracture prevention strategy in older adults: The European union geriatric medicine society (EUGMS) statement

Prevention of fragility fractures in older people has become a public health priority, although the most appropriate and cost-effective strategy remains unclear. In the present statement, the Interest group on falls and fracture prevention of the European union geriatric medicine society (EUGMS), in collaboration with the International association of gerontology and geriatrics for the European region (IAGG-ER), the European union of medical specialists (EUMS), the Fragility fracture network (FFN), the International osteoporosis foundation (IOF) – European society for clinical and economic aspects of osteoporosis and osteoarthritis (ECCEO), outlines its views on the main points in the current debate in relation to the primary and secondary prevention of falls, the diagnosis and treatment of bone fragility, and the place of combined falls and fracture liaison services for fracture prevention in older people.

Priority topics for European multidisciplinary guidelines on the management of chronic kidney disease in older adults.

To identify and prioritize potential topics to be addressed in the development of European multidisciplinary guidelines on the management of chronic kidney disease stage 3b-5 in older patients. We composed a list of 47 potential guideline topics by reviewing the literature, consulting online 461 nephrologists and 107 geriatricians, and obtaining expert input. A multidisciplinary panel of twelve experts then prioritized the topics during a face-to-face consensus meeting, following a nominal group technique structure with two voting rounds. Topics were rated on a 9-point scale ranging from 1 ('not at all important') to 9 ('critically important'). The highest rating (median; range) was assigned to 'Screening and referral' (8.5; 2.0). Eight topics shared the second highest rating with a median priority score of 8.0 (2.0) and included 'Starting dialysis or not' and 'Accurate assessment of renal function.' 'Targets for and treatment of diabetes' received the lowest rating with (3.0; 6.0). This joint initiative of the European Renal Association-European Dialysis Transplant Association (ERA-EDTA) and the European Union Geriatric Medicine Society (EUGMS) prioritized the development of guidance on interdisciplinary referral of older patients with chronic kidney disease stage 3b-5. Future guidance will therefore focus on identifying prognostic scores to predict death and progression to end-stage renal disease, as well as accurate tests for assessment of renal function in older kidney patients. This will contribute to more informed treatment decision making in this growing patient population.

Healthy brain ageing and cognition: Nutritional factors

Nutritional factors can influence the risk of Alzheimer's disease and its rate of clinical progression, suggesting that the association between diet, nutrient status and cognitive function deserves more attention. The European Union Geriatric Medicine Society (EUGMS) working group “Healthy Brain Ageing and Cognition” supports the development of practical recommendations for nutritional strategy, focused predominantly on the preventive aspects of diet and nutrition on cognitive decline. Adopting a healthy lifestyle and avoiding nutritional deficiencies in young or midlife adults is essential and there is compelling evidence to justify recommending a Mediterranean diet as a way of achieving these goals. There is currently insufficient evidence to endorse the use of specific nutrients to promote healthy brain ageing. In addition, currently there is no generally applicable evidence to recommend the use of single-agent micronutrient supplementation at any stage of dementia or for prevention. Omega-3 fatty acids or specific medical foods may be considered for selected patients with early dementia. When signs of malnutrition are detected, correction of specific deficiencies is necessary to improve nutritional status. Individuals at risk of malnutrition should be advised to improve nutritional intake from dietary food sources and should avoid taking high doses of specific nutrients as supplements. Nutritional awareness, advice and intervention are important in the general management and follow-up of people with cognitive problems.

Relationship between the Gérontopôle Frailty Screening Tool and the frailty phenotype in primary care

IntroductionFrailty is characterized by increased vulnerability to stressors that poses the older subject at risk of adverse health-related outcomes, including hospitalization, disability and mortality. Early identification of community-dwelling frail older subjects is important in order to implement preventive strategies against negative health-related outcomes, in particular disability. Validated brief screening tools are needed to detect frail community-dwelling elders. Materials and methodsThe aim of the present study, promoted by the European Union Geriatric Medicine Society (EUGMS) working group on “Frailty in older persons”, is to determine the agreement between the Gérontopôle Frailty Screening Tool (GFST) (administered by the general practitioner) and the Fried’ criteria for frailty phenotype as reference measure (administered by a blinded assessor). The study is performed in older primary care patients in nine European countries after translation of the GFST into eight languages. ResultsThe sample (n=109 older patients,) included 37.6%, 56.9%, and 5.5% robust, pre-frail or frail, and disabled individuals, respectively. The GFST showed a sensitivity of 71.0%, a specificity of 70.2%, a positive predictive value of 75.9% and a negative predictive value of 64.7% at the identification of non-disabled frail elders. The positive and negative likelihood ratios were 2.38 and 0.41, respectively. In logistic regression models only slow gait speed (odds ratio [OR]: 19.65, 95% confidence interval [95% CI]: 4.69–82.35) and mobility issues (OR: 18.04, 95% CI: 3.11–104.78) were significantly associated with the condition of frailty in the absence of disability. ConclusionsOur findings demonstrate an overall moderate agreement between the GFST and the frailty phenotype.

P-273: Body mass index, nutrition and rehabilitation outcome in elderly patients with cognitive impairment

This journal suppl. entitled: Abstracts of the 11th International Congress of the European Union Geriatric Medicine Society - Geriatric medicine for future Europeans - Successful aging creates new challenges