Highlights EUGMS 2017 Jean-Baptiste Beuscart (France) Dhayana - - PowerPoint PPT Presentation

Highlights EUGMS 2017

Jean-Baptiste Beuscart (France) Dhayana Dallmeier (Germany) Miguel Toscano Rico (Portugal)

• on behalf of EAMA -

Conflict of Interest Disclosure:

• we like to listen to our friends presentations
• we like the food sponsors offered
• we enjoy visiting Nice

81 hours of presentations 717 abstracts

Breaking news:

• European Union Geriatric Medicine Society is

dead

• God save the EUropean Geriatric Medicine

Society

Developing preventive actions in geriatrics: have we been able to change the picture of geriatrics?

Prevent

Cognitive decline Malnutrition Hospital readmission CV disease Delirium ADR

Primary Secondary Tertiary

• For those ≥ 80 y.o. and frail

 SBP target of 150 mmHg (robust older people 130 mmHg – 150 mmHg)

• A special subgroup - patients with history of cancer

Cardiovascular disease

• Anti-inflammatory

therapy with 150 mg Canakinumab for atherosclerotic disease showed a reduction of recurrent CVE Cannabis

Thrombotic disease

• Status post arterial thrombosis   risk VTE/PE
• Secondary Prevention for VTE: 2016 guidelines  aspirin
• HF with Preserved EF is the most common form seen in >70 y.o.
• Please consider HF by any new atypical symptom such as

weakness, exhaustion, somnolence, delirium, decline in oral intake or general condition

• Frailty and Malnutrition are associated with poor outcomes

Cardiac decompensation

Delirium

In the clinical settings In nursing homes In the emergency room Non-pharmacological prevention Effective but difficult to achieve Requires a team work with nurses and Public Health administration Pharmacological prevention Complex pathophysiology 17 RCTs in the past 2 years– most in surgical patients Alpha2-receptor agonist: Dexmedetomidine !?

• Validation of

instruments to identify high risk patients needed Geriatric-friendly ER

Track changes / fluctuations in alertness

Cognitive Decline

Mild cognitive impairment (MCI)

• Promote cognitive training and physical activity
• Multimodal interventions could be benefitial
• Insufficient evidence to prescribe antidementia drugs

Dementia stage

• Cholinesterase inhibitors have modest effect on cognition

If not tolerated  Memantine in those with moderate to severe dementia

• Cognitive stimulation therapy improves cognitive function in mild to moderate

dementia

• Physical activity shows a trend towards cognitive benefit

Normal cognitive stage

• Hypertension treatment and physical activity may prevent cognitive decline
• Other modifiable risk factors: Education, obesity, Smoking, Depression
• A consensus with respect to the definition of cognitive decline is urgently needed

• Functional decline relates to  of physical fitness due to physiological

changes and concomitant diseases

• 67 screening instruments for Frailty
• Prevention

Physical activity / Nutrition / Preventing diseases

• Sarcopenia has a low Positive Predictive Value to predict frailty, but it

does modify the effect of frailty on different outcomes such as mortality

• Depending on the definition used frailty

may involve the disability threshold or not Fitness… Frailty… Disability

Frailty

Iatrogenic risk

• High risk of ADR in older patients
• Benefit – Risk ratio evaluation

– Based on best evidence: real-life studies, not only RCTs – Assess functionality and frailty (CGA) – Close follow-up

• Lack of discussion with patients

Malnutrition

• If you focus on nutrition, you have to pay attention to

physical activity

– High protein intake may not be effective on nutritional status without physical exercise – Bad appetite may be related to physical activity – Relationship between protein-energy malnutrition and diet quality is not so straightforward

• Not only how much people eat but what people eat

Malnutrition

• If you focus on nutrition, you have to pay attention to

physical activity

– High protein intake may not be effective on nutritional status without physical exercise – Bad appetite may be related to physical activity – Relationship between protein-energy malnutrition and diet quality is not so straightforward

• Not only how much people eat but what people eat

Unplanned hospital readmissions

• It is possible to reduce early and unplanned hospital

readmission

– Acute care, post-acute care, nursing homes

• Similar strategies

– New model and new (non-linear) organization – Assess functional status during whole hospitalization – Increase internal and external communication – Reinforce partnership

Unplanned hospital readmissions

• It is possible to reduce early and unplanned hospital

readmission

– Acute care, post-acute care, nursing homes

• Similar strategies

– New model and new (non-linear) organization – Assess functional status during whole hospitalization – Increase internal and external communication – Reinforce partnership

Developing preventive actions in geriatrics: have we been able to change the picture of geriatrics?

Prevent

Cognitive decline Malnutrition Hospital readmission CV disease Delirium ADR

Improve

Physical activity Screening Research Assessment Healthcare

• rganization

Nutrition

Primary Secondary Tertiary

Screening for Frailty:

• Multidimentional

Prognostic Index (MPI) accurately predicts mortality and other important parameters in daily practice

• MPI-Age study is expected to improve cost-effectiveness
• f interventions in frail older persons (free access on EUGMS

website)

• Future trends: targeting biological and phenotypical

markers of aging, before function decline emerges

Screening for sarcopenia

• SARC-F is a valid tool for screening sarcopenia
• Muscle-US remains controverse, but might evolve as

a useful tool for bedside muscle mass evaluation (after standardized protocols)

Nutrition:

• Malnutrition screening is a must (high prevalence, worse
• utcomes)
• Mediterranean Diet ≠ Mediterranean Food
• Muscle loss and functional decline starts soon after

hospital admission: nutritional and physiotherapy support should start asap

• Adequate nutritional status is crucial for the success of

rehabilitation programs

Physical activity:

• Geriatricians must achieve expertise in exercise

prescription

• Optimal exercise recommendations confers the best
• utcomes. Nevertheless, sub-optimal exercise goals also

reduces mortality (to lesser extent)

• To gain muscle mass: resistance exercise (+adequate protein

intake 1.2g/Kg/d)

She got a plastic surgery, nevertheless…

Cancer screening

• Screening is a choice, not a public health imperative
• Screening for cancer should be personalized

– Screening can be harmful

• Life expectancy should be more than 10 years:

– Recommendation in most guidelines for most cancers in

• lder patients
• In the older patients with cancer

– Screening tools exist to better identify those who need CGA, at risk of chemotoxicity, or death

Assessment of preventive strategies

• Ideal study design is Holy grail Quest

– Selection bias in RCTs / Imbalance in Real life studies

• It is not possible to translate directly results from fit

to frail older people

• Life course approach:

– Focus on function in complex clinical context: may be more appropriate for preventive strategies

Assessment of preventive strategies

• Ideal study design is Holy grail Quest

– Selection bias in RCTs / Imbalance in Real life studies

• It is not possible to translate directly results from fit

to frail older people

• Life course approach:

– What happened during whole life? (before birth!) – Important messages for early prevention

The geriatrician & clinical research

Integrated Care for Older People

WHO Clinical consortium on healthy ageing – with collaboration of EUGMS The goal is „Function“ The Ambition is to collect function measurements globally Functional ability – Combination of intrinsic capacity and the environmental settings Intrinsic Capacity

• Vitality
• Locomotion
• Cognitive
• Sensory
• Psychosocial

Common care and treatment goals across different providers

Developing preventive actions in geriatrics: have we been able to change the picture of geriatrics?

Prevent

Cognitive decline Malnutrition Hospital readmission CV disease Delirium ADR

Improve

Physical activity Screening Research Assessment Healthcare

• rganization

Nutrition

Primary Secondary Tertiary

Keywords Functionality Physical activity Communication Nutrition Organization Social integration Evidence

Thanks To EAMA and EUGMS for giving us this opportunity to go from Learning  Sharing  Acting We just say Au revoir Nice…. See you in

Berlin