Four different frailty models predict health outcomes in older patients with stable chronic obstructive pulmonary disease

Background Frail patients with chronic obstructive pulmonary disease (COPD) face a higher risk of adverse outcomes, but there is no clear consensus on which frailty measures are most suitable for COPD patients. Herein we evaluated the ability of frailty measurements in predicting 1-year acute exacerbation, hospitalization, and mortality in older patients with COPD. Methods A total of 302 patients [median age: 86 years (IQR: 80–90), 22.2% female] were admitted to the Department of Geriatric Medicine were prospectively enrolled in this study. Frailty status was assessed using the Fried Frailty Phenotype (FFP), Clinical Frailty Scale (CFS), Frailty Index of Accumulative Deficits (FI-CD), and Short Physical Performance Battery (SPPB). Cox proportional hazard regression and Poisson regression were used to evaluating the association of the adverse outcomes with frailty as assessed using the four instruments. The discrimination accuracy of these tools in predicting the 1-year all-cause mortality was also compared. Results Prevalence of frailty ranged from 51% (using FFP) to 64.2% (using CFS). The four frail instruments were associated with 1-year mortality. After an average follow-up time of 2.18 years (IQR: 1.56–2.62 years), frailty as defined by four instruments (except for FI-CD), was associated with death [FFP: Hazard ratio (HR) = 3.11, 95% confidence interval (CI) 1.30–7.44; CFS: HR = 3.68, 95% CI 1.03–13.16; SPPB: HR = 3.74, 95% CI 1.39–10.06). Frailty was also associated with acute exacerbation (using FFP) and hospitalization (using FFP, CFS, and FI-CD). Frail showed a moderate predictive ability [area under the curve ranging (AUC) 0.70–0.80] and a high negative predictive value (0.98–0.99) for 1-year mortality. Conclusions With the four different frailty assessment tools, frailty was associated with poor prognosis in older patients with stable COPD. The FFP, CFS, FI-CD, and SPPB instruments showed similar performance in predicting 1-year mortality.

Ageing societies and the first and second waves of the COVID-19 pandemic – Statements of the European Geriatric Medicine Society and measures of the Hungarian Government concerning older people

Purpose Ageing of the societies is a demographic phenomenon in the developed world. SARS-CoV-2 is a novel human coronavirus responsible for a pandemic of coronavirus disease 2019 (COVID-19). World Health Organization (WHO) data demonstrated that the first two waves of the pandemic had the most severe impact on older people and that is why new guidelines and protocols were necessary in geriatric medicine to protect senior citizens. Materials and methods In our publication, we summarise the three statements of EuGMS concerning the first and second waves of COVID-19 pandemic in Europe. Besides following the European recommendations, a proper local response was necessary in each country. Results The Hungarian Government has successfully completed the necessary measures during the first two waves, which are summarised in our publication. Those measures took into consideration not only the international guidelines, but the capacities of the healthcare system, as well as the sociodemographic and economic characteristics of the country. Conclusions Successful local defence against COVID-19 required adequate and optimised interpretation of the international guidelines to save the life of thousands of older adults in Hungary.

A scoping review of the changing landscape of geriatric medicine in undergraduate medical education: curricula, topics and teaching methods

Purpose The world’s population is ageing. Therefore, every doctor should receive geriatric medicine training during their undergraduate education. This review aims to summarise recent developments in geriatric medicine that will potentially inform developments and updating of undergraduate medical curricula for geriatric content. Methods We systematically searched the electronic databases Ovid Medline, Ovid Embase and Pubmed, from 1st January 2009 to 18th May 2021. We included studies related to (1) undergraduate medical students and (2) geriatric medicine or ageing or older adults and (3) curriculum or curriculum topics or learning objectives or competencies or teaching methods or students’ attitudes and (4) published in a scientific journal. No language restrictions were applied. Results We identified 2503 records and assessed the full texts of 393 records for eligibility with 367 records included in the thematic analysis. Six major themes emerged: curriculum, topics, teaching methods, teaching settings, medical students’ skills and medical students’ attitudes. New curricula focussed on minimum Geriatrics Competencies, Geriatric Psychiatry and Comprehensive Geriatric Assessment; vertical integration of Geriatric Medicine into the curriculum has been advocated. Emerging or evolving topics included delirium, pharmacotherapeutics, healthy ageing and health promotion, and Telemedicine. Teaching methods emphasised interprofessional education, senior mentor programmes and intergenerational contact, student journaling and reflective writing, simulation, clinical placements and e-learning. Nursing homes featured among new teaching settings. Communication skills, empathy and professionalism were highlighted as essential skills for interacting with older adults. Conclusion We recommend that future undergraduate medical curricula in Geriatric Medicine should take into account recent developments described in this paper. In addition to including newly emerged topics and advances in existing topics, different teaching settings and methods should also be considered. Employing vertical integration throughout the undergraduate course can usefully supplement learning achieved in a dedicated Geriatric Medicine undergraduate course. Interprofessional education can improve understanding of the roles of other professionals and improve team-working skills. A focus on improving communication skills and empathy should particularly enable better interaction with older patients. Embedding expected levels of Geriatric competencies should ensure that medical students have acquired the skills necessary to effectively treat older patients.

Joseph T. Freeman Award: Creating Synergy in Interdisciplinary Aging Research and Practice

Over 30 years of interdisciplinary practice stimulated many research questions. Early intervention research in sensory impairment, specifically vision and/or hearing impairment was heavily supported by interdisciplinary colleagues from Geriatric Medicine, Nursing, Occupational Therapy, Optometry and Audiology. Challenges and opportunities from this research created a growing interest in developing and designing technologies for older adults. Creating the need for partnerships with engineering. My expertise in aging and access to willing research participants made me an ideal research partner. Effectively expanding my focus beyond sensory impairment interventions to designing and testing robots with older adults. Currently we are testing low cost mobile robots in acute care and the community and are developing and testing a soft robot to assist persons out of a chair as well as turn and lift persons up in bed. The synergy of interdisciplinary practice and research is helping us innovate to improve the lives of older adults.

Nursing Home COVID-19 Action Network: Responding With Stress First Aid and Caring for Residents With Dementia

The GWEP at the University of Rochester (New York) has an established network of nursing homes participating in Project ECHO. This ECHO hub includes geriatric medicine, psychiatry, pharmacy, aging services network and the Alzheimer’s Association focusing on best practices in geriatric mental health and dementia care. With the COVID-19 pandemic, this infrastructure quickly pivoted to expansion of 80 facilities and the addition of expertise in medical direction, trauma informed care, and infectious disease. A stress first aid training module was developed in partnership with Ithaca College and the National Center for PTSD to support front line nursing home workers. Dementia care experts contributed to practical problem-solving in addressing social isolation and mental health. Work now is focusing on vaccination and how to best support trauma-informed needs of residents with dementia.

Approaching Multimorbidity From a Translational Geroscience Perspective

Multimorbidity describes the accumulated burden of chronic disease. Multimorbidity erodes physiologic reserve, increasing the risk of frailty, disability and death. Most older adults have at least one chronic health condition by age 65. Once established, many age-related conditions progress and accumulate with age. Geroscience holds that there are key biologic pathways that explain the increase with age in multimorbidity, frailty and disability Translation of geroscience principles to human studies requires careful assessment of biomarkers of these pathways and multisystem outcomes. In this symposium, translational researchers in geriatric medicine and gerontology will present current work to elucidate biologic underpinnings of aging and potential intervention targets. We will address whether blood biomarkers of aging processes are prognostic using combinatorial techniques and explore the potential for proteomics to identify novel pathways for health aging. New insights into the role of inflammation will be discussed with an emphasis on its relationship to multimorbidity. Brain aging will be considered with respect to the interactions between external stressors and resilience evaluating the role of ketone bodies which have immunomodulatory effects particularly on innate immune cells. Finally, the role of multimorbidity as an intervention target and potential intermediate outcomes including biomarkers will be presented with discussion of next steps needed to realize the potential for translational geroscience clinical trials to improve health span.

Aging Across the Lifespan: Rethinking the David Barker Hypothesis

For many years, the scope of geriatric medicine has been the care of older persons affected by multiple disease with the aim of improving their functional status and optimize quality of life. As our knowledge of the mechanisms of aging grows rapidly, it is becoming clear that accomplishing this scope requires taking a life-course perspective. Research have failed to establish a clear-cut distinction between normal aging and pathology leading to the hypothesis that aging is at the root of chronic diseases, and difference in health can be ascribed to different aging rates. Research in model organisms, suggest that aging can be modified with consequent changes on healthspan and longevity. Interventions that modulate aging may ultimately prevent most-age-associated diseases and their consequences. From this perspective, geriatric medicine is the leading and most promising branch of biomedical science. Challenges remain: first, demonstrating that certain interventions slow down the aging rate requires the valid measure of aging, and while many tools were developed, “epigenetic clocks” being the most promising, the underline mechanism that drive their changes with aging and validity in clinical applications are unclear. We do not know whether variability in the rate of biological aging assessed in old age are already detectable in younger individuals and person-specific rates remain constant during life. In 1986, David Barker stated the hypothesis that the period of gestation, characterized by a strong epigenetic imprinting, affects health and wellbeing across life, perhaps by setting the aging rate. Perhaps pediatric and geriatric medicine are more connected than previously believed.

Geriatrics Perspectives From Japan

In 2025, Japan’s baby boomers will cross the threshold of 75 years of age; a phenomenon that has been referred to as “the 2025 crisis”, resulting in a significant burden on the healthcare system. To address this issue, the Japanese government is establishing the Integrated Community Care System, to provide comprehensive medical and long-term care services in each community. In cooperation with government and affiliated organizations, the Japan Geriatrics Society (JGS) has been working to develop the Integrated Community Care System. As a result of this effort, geriatric medicine is being integrated into the health care system through incentives for practitioners. For instance, medical facilities can be reimbursed if they perform comprehensive geriatric assessments (CGA) and CGA-based management/care. Additionally, home care medicine and polypharmacy are emerging issues of interest to the government. In this symposium, I will discuss how JGS has been trying to achieve “Aging in Place” in Japan.