EuGMS Newsletter February 2019
WELCOME ADDRESS by EuGMS PRESIDENT Prof Finbarr Martin
Dear friends and colleagues,
New Year greetings to you all. Now, with renewed energy is the time to think about what you and we all can achieve this year. A great EuGMS Congress must be high on the list. The planning is going well for this main event in the beautiful and historic Polish city of Krakow on September 25th to 27th. Check the Congress website for full information.
It looks like this will be a turbulent year for Europe. So much political change: so much uncertainty. The values underpinning our shared mission - for an age-friendly Europe with health services to match - will be as important as ever. What are these values? Collaboration, solidarity across our borders, sharing knowledge and experience, and of course promoting better health and care for our older populations. In practice this means developing and spreading our work on the principles and practice of geriatrics. Let me update you on some of our activities.
In Spring 2018, we launched the “Global Europe Initiative” with a team including members from South and Eastern Europe. This is clarifying what different countries or regions need from EuGMS. There was a successful “pre-2020” academic meeting in Athens in November which raised the profile of the multidisciplinary Hellenic Consortium for Geriatric Medicine: more events are planned for late 2019 and perhaps in early 2020 in partnership with the Fragility Fracture Network. We will hold our summer Executive board meeting in Prague in combination with an academic event: we hope to attract colleagues from neighbouring countries.
During discussions in 2017/18, the full board asked us to develop a campaign to promote geriatric principles and evidence that could be used by member societies in their own countries, as well as at the European level. We now have firm plans to produce this “Manifesto” in collaboration with civic partners and with support from the WHO Europe region office. It will be a team effort drawing on the contributions of academics, EAMA graduates, and national experience and achievements of full board members. We hope to have an early draft this Spring and launch at our Congress in September.
This last year we have spent time improving our organisation with great help from our new secretariat at Aristea (Rome and Genoa). For example, agreeing rules for acceptance of commercial support for projects, strengthening and developing new SIGs and getting legal protection for our logo. Each and every member of the Executive board have made significant contributions but I hope the others forgive me for singling out Sofia Duque, our Communications and Web Director, for getting more of you in touch through social media, improved website (still much more to come there) and Newsletter. Thanks to all of them.
Finally, continue supporting our growing journal, European Geriatric Medicine, as it starts its second year with the energetic editor, Alfonso Cruz Jentoft and the new publisher, Springer. (http://www.eugms.org/publications/egm.html)
See you in Krakow.
Finbarr C Martin, President 2018-19.
WELCOME ADDRESS by EuGMS ACADEMIC DIRECTOR Prof Mirko Petrovic
Dear colleagues and friends,
Let me take this opportunity to wish all of you and your families a very happy, prosperous and healthy New Year. It has been a year of significant achievements for the EuGMS, and I believe that we are starting 2019 with greater collective purpose as we work together to create a better future for geriatric medicine across Europe.
Our Special Interest Groups (SIGs) and Task and Finish (T&F) Groups have recently been reorganised within a new structure and are now focused around big geriatrics syndromes and relevant topics both from medical and societal point of view. Some of the SIGs are new and some have already been active for many years with clearly visible and relevant output. The activity of each SIG is coordinated by two co-leaders who together with group members have the autonomy to organise the activity of the SIG (thereby liaising with the AB) in the way the SIG finds is most effective and helpful and to involve colleagues with expertise who are keen to contribute, excel and promote both the SIG and the EuGMS. For each SIG we have collected an update about the composition and future initiatives. The Academic board stimulates and promotes collaboration and interactivity between different SIGs in order to increase scientific output and visibility of our society. In that sense, our intention in the coming period would be to attract not only young and promising new members from the countries with a long and rich tradition of geriatric medicine but, in close collaboration with our Global Europe Initiative, also members from countries in which geriatrics medicine has not yet been established as an independent specialty. Based on the principles of scientific curiosity, open-mindedness and solidarity we strive not only for the highest level of professionalism and scientific excellence but also for a progressively increasing number of congress participants, visitors of our website and readers of our journal European Geriatric Medicine. By intensifying interactions and collaboration between our members and by enlarging the already strong network of professionals and academicians in the field of geriatric medicine we try to make geographical distances and borders of any type irrelevant.
The preparations for our annual congress to be held in the beautiful city of Krakow this year are progressing very successfully. Together with our dear and distinguished colleagues from the local organising committee led by Tomas Grodzicki, Jerzy Gasowski and Karolina Piotrowicz the Academic Board is composing an attractive and well-balanced program. Besides the traditionally well represented countries at the congress, this year we very much hope to attract more participants from countries of Eastern and Central Europe. Sinds last year in Berlin the congress lasts three days and several new session formats have been introduced (i.e. key note lectures with opinion leaders, and interactive workshops) in addition to already established invited and submitted symposia, core curriculum session, jointly organized with the European Academy for Medicine of Ageing and oral and poster sessions. Since last year we also have introduced EuGMS Community booth where colleagues from different countries and regions from Europe can meet each other and exchange experience and expertise and brainstorm about collaboration opportunities. At the same time the Academic Board has alredy successfully undertaken first preparatory steps and contacts with representatives of the organising committees of our forthcoming congresses in Athens 2020 and London 2021 respectively. There is a lot of enthusiasm, goodwill and energy with one common goal: to go swifter, higher and stronger when it comes to promotion and spreading of professional and academic excellence in the field of geriatric medicine across Europe.
EuGMS is becoming an attractive and preferred partner of many scientific societies and organisations that also deal with problems affecting older population. This increased interest results in numerous memorandums of understanding and consecutively in joint activities during our yearly congresses.
Thanks to an efficient mutual collaboration between the Academic and Executive board and support of our secretariat and our PCO Aristea we today have a well-organised and transparent structure of the society which promises further growth and increased societal impact in order to develop geriatric medicine across the whole European continent and encourage the provision of geriatric medical services to all older citizens across Europe.
Do zobaczenia w Krakowie!
Mirko Petrovic, Academic Director 2018-2021
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EGM AT GLANCE
Suggested reading by the EGM Editor, Prof Alfonso Cruz Jentoft
- Sarcopenia diagnostic criteria update by EWGSOP: what has been changed?
This is an editorial pointing out the launch of EWGSOP2, published in Age Ageing and presented in a keynote in Berlin, which is one of the most important initiatives of EuGMS. In the updated consensus paper on sarcopenia, EWGSOP focuses on low muscle strength as a key characteristic of sarcopenia, uses low muscle quantity and quality to confirm the sarcopenia diagnosis, and defines severe sarcopenia when poor physical performance is present. They also provide cut-off points for measurements of variables for the diagnosis of sarcopenia.
Arai, H. Eur Geriatr Med (2018) 9: 733
- Application of ultrasound for muscle assessment in sarcopenia: towards standardized measurements.
This is a consensus document of the Sarcopenia SIG of EuGMS on the use of ultrasounds. The results of this review provide thus an evidence base for an ultrasound protocol in the assessment of skeletal muscle. This standardization of measurements is the first step in creating conditions to further test the applicability of US for use on a large scale as a routine assessment and follow-up tool for appendicular muscle.
Perkisas, S., Baudry, S., Bauer, J. et al. Eur Geriatr Med (2018) 9: 739
- Effect of caffeine on sleep and behaviour in nursing home residents with dementia.
This pre-post pilot study found a significant positive effect of caffeine reduction on sleep and apathy. They studied 21 nursing home residents with dementia living in 1 dementia special care unit, in whom caffeine was gradually eliminated in the afternoon and evening.
de Pooter-Stijnman, L.M.M., Vrijkotte, S. & Smalbrugge, M. Eur Geriatr Med (2018) 9: 829
YOUNG GERIATRICIANS CORNER
Suggested reading by the EuGMS Academic Board
- Drug-eluting stents (DES) in elderly patients with coronary artery disease (SENIOR): a randomised single-blind trial.
This study concluded that among elderly patients who have PCI, a DES and a short duration of DAPT (Dual Anti Platelet Therapy) are better than BMS (Bare Metal Stents) and a similar duration of DAPT with respect to the occurrence of all-cause mortality, myocardial infarction, stroke, and ischaemia-driven target lesion revascularisation. A strategy of combination of a DES to reduce the risk of subsequent repeat revascularisations with a short BMS-like DAPT regimen to reduce the risk of bleeding event is an attractive option for elderly patients who have PCI.
Varenne O et al.. Lancet. 2018 Jan 6;391(10115):41-50
- Trial of Solanezumab for Mild Dementia Due to Alzheimer’s disease.
This study examined the humanized monoclonal antibody solanezumab, which was designed to increase the clearance from the brain of soluble Aβ, peptides that may lead to toxic effects in the synapses and precede the deposition of fibrillary amyloid. It found that Solanezumab at a dose of 400 mg administered every 4 weeks in patients with mild Alzheimer's disease did not significantly affect cognitive decline.
Honig L et al.. N Engl J Med 2018; 378: 321-330
- What Is Known About Preventing, Detecting, and Reversing Prescribing Cascades: A Scoping Review.
This study found that prescribing cascades are a recognized problem internationally. By learning from the range of resources to prevent, detect, and reverse prescribing cascades, this review contributes to improving drug prescribing, especially in older adults.
Brath H et al.. JAGS 2018; 66:2079–2085.
MEET THE EXPERT
Prof NICOLA VERONESE
After obtaining his Medical Degree in 2008, Dr Veronese did the school of Geriatric Medicine at the University of Padova, becoming a Board-Certified Geriatrician in 2014. Dr Veronese is author of more than 250 manuscripts in international, peer-reviewed journals, dealing with epidemiology of chronic diseases in the elderly. His main topics of interest are: osteoporosis, osteoarthritis, frailty, nutritional problems of older people, systematic reviews and meta-analyses. In 2016 he won the prestigious Fellowship of the International Osteoporosis Foundation and European Society for Clinical and Economical Aspects of Osteoporosis, Osteoarthritis and Musculo-Skeletal Diseases for his outstanding quality in osteoporosis and osteoarthritis. From 2018, he is the leader of the SIG of the EuGMS entitled “Systematic Reviews and meta-analyses in Healthy Ageing”, a group interested in how to improve meta-research in geriatric medicine.
I AM A GERIATRICIAN IN… POLAND
The practice of geriatrics in Poland – a Kraków perspective
Currently in Poland, geriatrics is a well established specialty of its own right. The level of popular and professional awareness of the peculiarity of medical issues in older persons increased considerably over the past three decades. The change in the perception of the ‘geriatric’ issues, and the fact that the older patient differs biologically and pathophysiologically form a younger one, has been greatest in recent years. Both at the societal and professional levels, the appreciation of the fact that Polish society is speedily ageing caught its roots. As a result growing numbers of medical school graduates as well as clinicians already practicing in the fields such as internal medicine, family medicine or neurology started to specialize in geriatrics. Geriatricians are now considered as fully fledged, independent, and equal players in the field of healthcare, and geriatrics entered a group of ‘basic’ specialties, rather than being a mere subspecialty to internal medicine, although it is still possible, or even advisable from our perspective as internists-geriatricans, to specialize in geriatrics after obtaining specialty in internal medicine, family medicine and neurology.
This, however, had not always been like so. Geriatrics as a subspecialty to internal medicine was introduced in Poland only in 1982. The first geriatric hospital ward in Poland was established in Upper Silesia. For a long time, few of the many medical schools in Poland, including the Faculty of Medicine of the Jagiellonian University in Kraków, included geriatrics as an obligatory part of an undergraduate medical curriculum, at first as single (sic!) day of geriatrics during internal medicine. Likewise the Kraków Universty Hospital was the second academic tertiary care medical centre to be furnished with a department of geriatrics, which due to a premature shutting of the first such department in Warsaw, is now the oldest academic geriatric department in the country. In those early years in mid-eighties, which were the gloomy years of the martial law imposed by the then communist regime, when shortages of anything starting from toilet utensils through medications to equipment were the daily bread of the patient and the doctor alike, the idea to create a geriatric department might seem extravagant. However, it fell on a fertile ground, as the department was created in close liaison with the largest LTC institution in Poland, the Kraków Nursing Hospital (ZOL). With time, the ideas of geriatrics per se, the need for a network of geriatric inpatient and outpatient services, and most of all of the training of the clinicians begun to be self evident.
With the political change, stable economic growth, and stepwise, sometimes staggering, emergence from stagnation imposed by oppressiveness of the so-called ‘real socialism’ which was a shared experience from Berlin to Moscow and from Tallin to Sofia, the daily practice of geriatrics in Poland started to be little-by-little easier and ingratiating.
Currently, there are approximately five hundred doctors in Poland holding the specialty of geriatrics, and the numbers are growing. Many strong academic and clinical geriatric centres are currently active in Poland including Łódź, Białystok, Warsaw, Wrocław, Poznań, Bydgoszcz, Katowice and Kraków, to name but a few. At the time when one of us (JG) was starting his medical career in mid nineties, there were about a hundred-and-fifty geriatricians. By the time when the younger of us (KP) passed her specialty in geriatrics after she specialized in internal medicine, the number had grown threefold. With the advent of the Horizon 2020 funds, the funding at the local governmental, and the national level, the needs of older persons started to be better addressed. From research, through digital participation, through growing network of long-term-care institutions to improvements in availability of medical care directed at the needs of the older patient, the practice of geriatrics in Poland is a part of a much better milieu. True, in order further to improve the situation, a lot of issues still need addressing. From shortages of nursing personnel, through salaries, through continuation to educate the public and the political class, the challenges are still great. But we try as best as we can to do our job, for the betterment of health of the ageing Polish population.
Daily practice of geriatrics in Poland depends on a setting. Geriatrician working in a geriatric ward (there are still relatively few purely geriatric wards in Poland) or a general medical ward accepting acute medical inpatients, usually tries to balance the attitude between those of an acute doctor and those of a doctor aware of the peculiarities of old age in health and disease. While the ward-routines do not differ from general medical ones, the approaches to the patient, including comprehensive geriatric assessment (CGA), closer collaboration with other members of the team such as psychologist, physiotherapists, social worker, dietitians, do require more time and thus put a little more work-load. A geriatrician working in an outpatient department, must dedicate about 1-1.5 hours per each new patient, and approximately 30-60 minutes per each follow-up visit of an older patient. This contrasts with a doctor working in any other subspecialty where time allotted per patient is usually a fraction of the time mentioned above. This at times does cause tensions, however, older patient requires considerably more time and attention. On the other hand, the more workload is not reflected by greater financial coverage by the National Health Fund. The difficulties include sheer impossibility to perform full CGA in all our hospitalized patients, even if we limit the target population to those scoring 3 or more points in VES-13, an inventory designated by National Health Fund to check the eligibility of an older patient to undergo full CGA. Problems include shortages of mid-tier and lower personnel. Not only do we lack nursing staff in general, but there are shortages in staff (nursing, nurse-assistants) who would be trained in rudiments of geriatric approaches. There is no real post-acute care, the awareness on the part of caregivers, that some issues would be better addressed by the geriatrician, and, finally, the fact that as a player within the system, geriatrician has limited legal capability to issue orders for certain aides such as prostheses etc. are major setbacks.
Karolina Piotrowicz, MD, PhD
Jerzy Gąsowski, MD, PhD
NEW TOOLS FOR CLINICAL PRACTICE
Domínguez-Rodríguez A et al. Utility of the Identification of Seniors at Risk Score to Predict In-Hospital Mortality in Older Patients with Heart Failure. JAMDA 2018; Volume 19, Issue 12: 1137–113. https://www.jamda.com/article/S1525-8610(18)30385-2/fulltext
Kemp G et al. Towards a toolkit for the assessment and monitoring of musculoskeletal ageing. Age and Ageing 2018; Volume 47, Issue 6: 774–777, https://doi.org/10.1093/ageing/afy078
GERIATRICS CME ACROSS EUROPE
15th EuGMS International Congress of the European Geriatric Medicine Society EVIDENCE BASED MEDICINE IN GERIATRICS, 25 – 27 September 2019, Krakow, Poland
II Workshop SEMEG March 22, Madrid, Spain
14th International Conference on Alzheimer's and Parkinson's Diseases, AD/PD™ March 26, Lisbon, Portugal
British Geriatrics Society Spring Meeting 2019, April 10-12 2019, Cardiff, UK
SIOG 2019 advanced course in Geriatric Oncology, June 26-29 2019, Lorenzon Study Centre of the Università Cattolica del Sacro Cuore in Treviso, Italy
5th EAN Congress June 29, Oslo, Norway
Summer Course on Ethics in Dementia Care July 2, Leuven, Belgium
8th FFN Global Congress 2019, August 28-30 2019, Oxford, UK
BGS 20th International Conference on Falls and Postural Stability, September 20, London. UK
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