International Association Of Gerontology And Geriatrics Research Articles

A novel online training programme for healthcare professionals caring for older adults

The proportion of older people in the world population is growing rapidly. Training and retaining healthcare professionals in sufficient numbers in the field of ageing represents a major challenge for the future, to deal with the healthcare needs of this ageing population. The COVID pandemic has unfortunately compounded shortages of healthcare workers worldwide. There is therefore a pressing need to scale-up the education of healthcare professionals in geriatrics and gerontology. Over the last 30 years, a group of motivated geriatrics physicians from Europe have been striving to educate healthcare professionals in geriatrics and gerontology through various initiatives, and using innovative pedagogic approaches to train physicians, nurses and other healthcare professionals around the world. The COVID-19 pandemic unfortunately put a stop to presence-based training programmes, but prompted the development of the online International Association of Gerontology and Geriatrics (IAGG) eTRIGGER (e-Training In Geriatrics and GERontology) course, a new training course in geriatrics and gerontology for healthcare professionals from a wide range of backgrounds. We outline here the history of the educational initiatives that have culminated in the roll-out of this new programme, and the perspectives for the future.

Role of Microbes in the Development of Alzheimer's Disease: State of the Art - An International Symposium Presented at the 2017 IAGG Congress in San Francisco.

This article reviews research results and ideas presented at a special symposium at the International Association of Gerontology and Geriatrics (IAGG) Congress held in July 2017 in San Francisco. Five researchers presented their results related to infection and Alzheimer’s disease (AD). Prof. Itzhaki presented her work on the role of viruses, specifically HSV-1, in the pathogenesis of AD. She maintains that although it is true that most people harbor HSV-1 infection, either latent or active, nonetheless aspects of herpes infection can play a role in the pathogenesis of AD, based on extensive experimental evidence from AD brains and infected cell cultures. Dr. Miklossy presented research on the high prevalence of bacterial infections that correlate with AD, specifically spirochete infections, which have been known for a century to be a significant cause of dementia (e.g., in syphilis). She demonstrated how spirochetes drive senile plaque formation, which are in fact biofilms. Prof. Balin then described the involvement of brain tissue infection by the Chlamydia pneumoniae bacterium, with its potential to use the innate immune system in its spread, and its initiation of tissue damage characteristic of AD. Prof. Fülöp described the role of AD-associated amyloid beta (Aβ) peptide as an antibacterial, antifungal and antiviral innate immune effector produced in reaction to microorganisms that attack the brain. Prof. Barron put forward the novel hypothesis that, according to her experiments, there is strong sequence-specific binding between the AD-associated Aβ and another ubiquitous and important human innate immune effector, the cathelicidin peptide LL-37. Given this binding, LL-37 expression in the brain will decrease Aβ deposition via formation of non-toxic, soluble Aβ/LL-37 complexes. Therefore, a chronic underexpression of LL-37 could be the factor that simultaneously permits chronic infections in brain tissue and allows for pathological accumulation of Aβ. This first-of-its-kind symposium opened the way for a paradigm shift in studying the pathogenesis of AD, from the “amyloid cascade hypothesis,” which so far has been quite unsuccessful, to a new “infection hypothesis,” or perhaps more broadly, “innate immune system dysregulation hypothesis,” which may well permit and lead to the discovery of new treatments for AD patients.

Academic Activities of the Korean Gerontological Society for Four Decades: An Analysis Related to Trends in Aging Policy and Activities of the International Association of Gerontology and Geriatrics

본 연구의 목적은 한국노년학회의 40년간 주요 학술활동을 한국노인정책의 변화와 세계노년학ㆍ노인의학회(IAGG)의 학술동향에 맞춰 분석해 보고, 향후 노년학회의 학술발전 방향을 제시하는 것이다. 연구방법은 먼저 한국노년학회의 주요학술활동을 각 연도별 학술대회자료집과 문헌을 중심으로 개괄적으로 살펴본 후 한국노인정책의 변화를 통한 한국노년학회의 학술활동은 조선일보, 한겨레 신문검색과 한국언론진흥재단의 빅카인즈 검색을 통해 찾은 각 제도별 자료를 연도별로 비교하여 분석하였다. 다음으로 IAGG의 학술활동을 통한 한국노년학회의 학술활동은 학술대회 개최연도를 중심으로 국제기구의 노인관련 주요 아젠다를 포함하여 비교분석하였다. 분석결과 지난 40년간 한국노년학회는 다양한 학술활동을 국내외의 노인정책 변화에 민감하게 대응하면서 다학제적으로 혹은 국제적으로 활발하게 진행해 온 것으로 나타났다. 그럼에도 노년학회 구성원의 다양성 결여로 다루어지지 못했던 중요한 주제도 있었으며, 하나의 주제를 심도있게 지속적으로 논의하지 못했던 점도 지적될 수 있다. 향후 한국노년학회는 한국의 대표적 노인관련 학회로서 다학제적 학문적 특성을 살려 한국의 노인정책을 선도함은 물론 국제학회 및 기구들과의 연대를 통해 활발한 학술활동을 해 나가야 할 것이다.The purpose of this study is to examine the major academic activities of the Korean Gerontological Society (KGS) during the last 40 years in comparison to changes in elderly policies in Korea and also academic trends in gerontology worldwide and the academic activities of the International Association of Gerontology and Geriatrics (IAGG); based on this analysis, this study aims to propose future directions for the academic progress of the KGS. We examined the major academic activities of the KGS by analyzing the contents of biannual conferences, international conferences, and irregular seminars and policy meetings, using conference booklets, KGS websites, and literature on KGS history. Second, we analyzed the academic activities of the KGS in comparison to changes in elderly policies in Korea, using databases of major newspapers and also the BigKinds search offered by the Korea Press Foundation. Third, the academic activities of the KGS were reviewed in comparison to those of the IAGG and the major aging policy agendas of key international organizations. The study results demonstrate that the KGS has been proactive in conducting diverse multi-disciplinary and international academic activities while promptly responding to both domestic and international changes in elderly policies. But some issues were not properly addressed due to the lack of diversity in its members, and it also should be noted that some issues were not discussed in depth for a sufficient length of time. Henceforth, as the leading academic organization in gerontology with a multi-disciplinary orientation in Korea, the KGS should continue to lead the development and evaluation of aging policies and also actively carry out diverse academic activities in collaboration with international academic societies and organizations.

Program Abstracts from the 21st International Association of Gerontology and Geriatrics (IAGG) World Congress.

Program Abstracts from the 21st International Association of Gerontology and Geriatrics (IAGG) World Congress.

RAPID GERIATRIC ASSESSMENT

Since the article by Rubenstein and colleagues, in 19841 at the Sepulveda Veterans Affairs Medical Center, demonstrated the ability of a Comprehensive Geriatric Evaluation and Management Unit (GEMU) to improve outcomes for frail older persons, numerous studies have duplicated these findings.2,3 Meta-analyses have confirmed the value of GEMUs.4 Unfortunately, despite their success, they are not widely available in the private sector andwith themarked decline in geriatricians, there are a limited number of geriatricians available in the United States to manage these units.5 For these reasons, it has become essential to increase the knowledge of primary care providers concerning the care of older persons and to develop a brief geriatric assessment that can guide primary care providers to provide quality care for the growing aging population. At Saint Louis University, we have developed a simple Rapid Geriatric Assessment (RGA) that can be completed by the patients and/or their caregiver. The basic screen takes less than 4 minutes to complete (Figure 1). Frailty and sarcopenia have become the new giants of geriatrics.6e19 Although there is much overlap between these 2 syndromes, approximately 30% of persons have one or other of the syndromes, without any overlap.20 To screen for these 2 conditions we have used the well-validated, FRAIL21e26 and SARC-F scales.27e32 We have also included the Simplified Nutritional Assessment Scale (SNAQ),33e35 as anorexia and weight loss have important negative outcomes in older persons.36e42 The International Association of Gerontology and Geriatrics (IAGG) consensus conference has stressed the need for early detection of cognitive impairment.43e45 Many physicians find it difficult to detect cognitive impairment in their patients.46e49 The IAGG has suggested that both objective as well as subjective cognitive impairment should be tested for. The rapid Cognitive Screen (RCS),46,50 which is derived from the St Louis University Mental Status (SLUMS) examination51 has been included in the battery as an objective measure of cognition. It adds 2.5 minutes to the assessment, which can be done by any trained individual in the physician’s office. In addition to the RCS, we believe that the AD-8, developed at Washington University in St Louis, is an

Managing older people with diabetes in care homes

This paper discusses some of key issues that need to be considered when caring for older people with diabetes living in care homes. It refers to but does not reproduce diabetes management information available in diabetes clinical guidelines such as Sinclair et al. [Diabetes mellitus in older people position statement on behalf of the International Association of Gerontology and Geriatrics (IAGG) and the European Diabetes Working Party for Older People (EDWOP) and the International Task force Experts in Diabetes. J Am Med Dir Assoc. 2012;13:497–502], International Diabetes Federation (IDF) [Global guideline for managing older people with type 2 diabetes. 2013. Available from www.idf.org] and Dunning et al. [2013. Available from http://www.adma.org.au/clearinghouse/doc_details/133-the-mckellar-guidelines-for-managing-older-people-with-diabetes-in-residential-and-other-care-settings_9dec2013.html] guidelines. It does address care issues such as sexual health and wellbeing and companion animals that are rare...

Nursing Home Research: The First International Association of Gerontology and Geriatrics (IAGG) Research Conference

The International Association of Gerontology and Geriatrics held its first conference on nursing home research in St Louis, MO, in November 2013. This article provides a summary of the presentations.

Cognitive frailty: frontiers and challenges.

An international consensus group comprised of investigators from the International Academy of Nutrition and Aging (IANA) and the International Association of Gerontology and Geriatrics (IAGG) recently convened in Toulouse, France to establish a definition for cognitive frailty in older adults. This effort was motivated by growing awareness that many people with physical frailty are also prone to cognitive problems. In “Cognitive Frailty: Rationale and Definition” [1], an initial working definition was developed, and a framework proposed for future studies of cognitive frailty.

Promoting access to innovation for frail old persons. IAGG (International Association of Gerontology and Geriatrics), WHO (World Health Organization) and SFGG (Société Française de Gériatrie et de Gérontologie) Workshop--Athens January 20-21, 2012.

Frailty tends to be considered as a major risk for adverse outcomes in older persons, but some important aspects remain matter of debate. The purpose of this paper is to present expert's positions on the main aspects of the frailty syndrome in the older persons. Workshop organized by International Association of Gerontology and Geriatrics (IAGG), World Health Organization (WHO) and Société Française de Gériatrie et de Gérontologie (SFGG). Frailty is widely recognized as an important risk factor for adverse health outcomes in older persons. This can be of particular value in evaluating non-disabled older persons with chronic diseases but today no operational definition has been established. Nutritional status, mobility, activity, strength, endurance, cognition, and mood have been proposed as markers of frailty. Another approach calculates a multidimensional score ranging from "very fit" to "severely frail", but it is difficult to apply into the medical practice. Frailty appears to be secondary to multiple conditions using multiple pathways leading to a vulnerability to a stressor. Biological (inflammation, loss of hormones), clinical (sarcopenia, osteoporosis etc.), as well as social factors (isolation, financial situation) are involved in the vulnerability process. In clinical practice, detection of frailty is of major interest in oncology because of the high prevalence of cancer in older persons and the bad tolerance of the drug therapies. Presence of frailty should also be taken into account in the definition of the cardiovascular risks in the older population. The experts of the workshop have listed the points reached an agreement and those must to be a priority for improving understanding and use of frailty syndrome in practice. Frailty in older adults is a syndrome corresponding to a vulnerability to a stressor. Diagnostic tools have been developed but none can integrate at the same time the large spectrum of factors and the simplicity asked by the clinical practice. An agreement with an international common definition is necessary to develop screening and to reduce the morbidity in older persons.

Response Letter to Gazzaruso and Colleagues

We’d like to thank Dr Gazzaruso and colleagues for their thought-provoking letter which suggests that our conclusion, that a HbA1c target of 8.0% may be lower than necessary for maintaining function in nursing home eligible elders, may be premature for 2 reasons. (1) First, they note that our study results run counter to previous studies where hyperglycemia was associated with disability. However, both of the cited studies were cross-sectional, raising the possibility that the observed association was due to reverse causation. Specifically, providers may have appropriately decreased the intensity of glycemic treatments for disabled patients, since these patients are often older with a higher burden of comorbidities putting them at higher risk for hypoglycemia. (2, 3) Thus, we believe our longitudinal study is an important advance from previous studies. Second, Dr Gazzaruso and colleagues note that our studies occurred before the widespread use of dipeptidyl peptidase 4 (DPP-4) inhibitors and glucagon-like peptide 1 (GLP-1) agonists. We acknowledge that newer agents hold the promise of tighter glycemic control in older adults with less hypoglycemia. However, there is currently little data to suggest that these newer medications lead to improved patient outcomes such as decreased functional decline. Since these newer medications cost many times more than older medications and long-term safety is unknown, we believe that older medications should be tried first in the vast majority of older patients with diabetes. For healthier elders with an extended life expectancy, we agree with Dr Gazzaruso that a reasonable HbA1c target would be 7.0 – 7.5%, as recommended by the International Association of Gerontology and Geriatrics (IAGG). (4) However, our study and conclusions focused on nursing home eligible elders for whom consensus statements recommend less stringent glycemic targets. The IAGG panel states that “in cases of functional dependence, care home residence…and other high dependency states, [HbA1c target] may need to be adjusted to reduce the risk of hypoglycemia and enhance patient safety.” (4) Further, a recent American Diabetes Association and European Association for the Study of Diabetes consensus statement recommended that “…less stringent goals—e.g. 7.5 – 8.0% or even slightly higher—are appropriate for patients with…a limited life expectancy [or] extensive comorbid conditions.” (5) Thus, for elders with functional limitations and limited life expectancy, expert consensus statements appear to support our conclusion that a HbA1c target of 8.0% may be lower than necessary to maintain function.

A survey of physicians who care for older persons in Southwest China.

The aim of this survey is to determine the main barriers of geriatric health care from the physicians' point of view and compare the improvement before and after the Continue Medical Education (CME) provided by International Association of Gerontology and Geriatrics (IAGG). Cross-sectional survey. Five hundred samples were generated using systematic random sampling from the address lists of physicians in Southwest China who had received the IAGG CME or been trained in Sichuan Association of Geriatrics (SAG) CME. The interview instrument examined demographics and information on geriatric education. Of the 500 physician sampled, 461(92.2 percent) responded. 34.3 percent of the respondents reported that over 70 percent of their patients were older persons. 76.8 percent of the respondents felt that they lacked geriatric knowledge. Only 15.6 percent of the respondents had geriatric curriculum before graduation, and 26.0 percent received geriatric trainings after graduation. Most physicians felt that "Language barrier" and "Insufficient geriatric education in undergraduate medical school and postgraduate education" were the main challenges in practicing geriatric medicine. Geriatric training and knowledge are inadequate due to the lack of geriatric curriculums in medical schools and CME for physicians who practice geriatrics. With the help of IAGG, CME in Southwest China provided more workshops on geriatric progress in year 2011 than in year 2007-2010. Eighty percent of the physicians acknowledged that the IAGG CME was helpful for their clinical practice. The physicians paid more attention to geriatric syndromes rather than age-related pathophysiology alone. CME provided by geriatric associations is helpful. Collaboration between different geriatric societies such as IAGG and SAG may be a good model for spreading geriatric knowledge and should be considered by medical educational administration.

Am I a Gerontologist or Geriatrician?

Am I a Gerontologist or Geriatrician?

Diabetes Mellitus in Older People: Position Statement on behalf of the International Association of Gerontology and Geriatrics (IAGG), the European Diabetes Working Party for Older People (EDWPOP), and the International Task Force of Experts in Diabetes

Diabetes mellitus is a highly prevalent metabolic condition in ageing societies associated with high levels of morbidity, multiple therapies, and functional deterioration that challenges even the best of health care systems to deliver high-quality, individualized care. Most international clinical guidelines have ignored the often-unique issues of frailty, functional limitation, changes in mental health, and increasing dependency that characterize many aged patients with diabetes. A collaborative Expert Group of the IAGG and EDWPOP and an International Task Force have explored the key issues that affect diabetes in older people using a robust method comprising a Delphi process and an evidence-based review of the literature. Eight domains of interest were initially agreed and discussed: hypoglycemia, therapy, care home diabetes, influence of comorbidities, glucose targets, family/carer perspectives, diabetes education, and patient safety. A set of "consensus" statements was produced in each domain of interest. These form a foundation for future policy development in this area and should influence the clinical behavior and approach of all health professionals engaged in delivering diabetes care to older people.

A Research Agenda for Nursing Homes

At the last International Association of Gerontology and Geriatrics (IAGG) World Congress, the IAGG Executive Committee underlined the need to develop a research agenda for nursing homes. In the past several decades, the fields of geriatrics and gerontology have focused on creating, organizing, and coordinating geriatrics facilities, and little attention has been given to research that would improve clinical practice. Now it is time to broaden our scope to ensure that high-quality research becomes a priority.