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Moïsi L, Mino JC, Guidet B, Vallet H. Frailty assessment in critically ill older adults: a narrative review. Ann Intensive Care 2024; 14:93. [PMID: 38888743 PMCID: PMC11189387 DOI: 10.1186/s13613-024-01315-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/17/2024] [Indexed: 06/20/2024] Open
Abstract
Frailty, a condition that was first defined 20 years ago, is now assessed via multiple different tools. The Frailty Phenotype was initially used to identify a population of "pre-frail" and "frail" older adults, so as to prevent falls, loss of mobility, and hospitalizations. A different definition of frailty, via the Clinical Frailty Scale, is now actively used in critical care situations to evaluate over 65 year-old patients, whether it be for Intensive Care Unit (ICU) admissions, limitation of life-sustaining treatments or prognostication. Confusion remains when mentioning "frailty" in older adults, as to which tools are used, and what the impact or the bias of using these tools might be. In addition, it is essential to clarify which tools are appropriate in medical emergencies. In this review, we clarify various concepts and differences between frailty, functional autonomy and comorbidities; then focus on the current use of frailty scales in critically ill older adults. Finally, we discuss the benefits and risks of using standardized scales to describe patients, and suggest ways to maintain a complex, three-dimensional, patient evaluation, despite time constraints. Frailty in the ICU is common, involving around 40% of patients over 75. The most commonly used scale is the Clinical Frailty Scale (CFS), a rapid substitute for Comprehensive Geriatric Assessment (CGA). Significant associations exist between the CFS-scale and both short and long-term mortality, as well as long-term outcomes, such as loss of functional ability and being discharged home. The CFS became a mainstream tool newly used for triage during the Covid-19 pandemic, in response to the pressure on healthcare systems. It was found to be significantly associated with in-hospital mortality. The improper use of scales may lead to hastened decision-making, especially when there are strains on healthcare resources or time-constraints. Being aware of theses biases is essential to facilitate older adults' access to equitable decision-making regarding critical care. The aim is to help counteract assessments which may be abridged by time and organisational constraints.
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Affiliation(s)
- L Moïsi
- Department of Geriatrics, Hopital Saint-Antoine, Assistance Publique Hôpitaux de Paris (AP-HP), Sorbonne Université, 75012, Paris, France.
- UVSQ, INSERM, Centre de Recherche en Epidémiologie Et Santé Des Populations, UMR 1018, Université Paris-Saclay, Université Paris-Sud, Villejuif, France.
- Département d'éthique, Faculté de Médecine, Sorbonne Université, Paris, France.
- Service de Gériatrie Aigue, Hopital St Antoine, 184 rue du Fbg St Antoine, 75012, Paris, France.
| | - J-C Mino
- UVSQ, INSERM, Centre de Recherche en Epidémiologie Et Santé Des Populations, UMR 1018, Université Paris-Saclay, Université Paris-Sud, Villejuif, France
- Département d'éthique, Faculté de Médecine, Sorbonne Université, Paris, France
| | - B Guidet
- Service de Réanimation Médicale, Hopital Saint-Antoine, Assistance Publique Hôpitaux de Paris (AP-HP), 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France
- INSERM, UMRS 1136, Institute Pierre Louis d'Épidémiologie Et de Santé Publique, 75013, Paris, France
| | - H Vallet
- Department of Geriatrics, Hopital Saint-Antoine, Assistance Publique Hôpitaux de Paris (AP-HP), Sorbonne Université, 75012, Paris, France
- UMRS 1135, Centre d'immunologie Et de Maladies Infectieuses (CIMI), Institut National de La Santé Et de La Recherche Médicale (INSERM), Paris, France
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Hammel IS, Chapman EN. Frailty training among healthcare professionals. J Nutr Health Aging 2024; 28:100258. [PMID: 38703761 DOI: 10.1016/j.jnha.2024.100258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 04/27/2024] [Indexed: 05/06/2024]
Abstract
As the population ages worldwide, frailty becomes more prevalent, leading to a higher risk of poor outcomes. Therefore, there is an increased need to educate healthcare providers in the areas of frailty screening, assessment, and treatment. In our review of the current state of frailty education worldwide we showed that, with the exception of a few European countries, education of clinicians on frailty screening, assessment, and treatment is inadequate. Interprofessional team competencies, quality measures and clinical guidelines that require screening, assessment and management of frailty are needed to propel frailty education forward. It is evident that there is much-needed collaboration between high-, mid-, and low-income countries to reach consensus and create worldwide recommendations for frailty education.
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Affiliation(s)
- Iriana S Hammel
- Geriatric Research Education and Clinical Center, Miami VA Healthcare System, 1201 NW 16th Street, Miami, FL 33125, USA; University of Miami Miller School of Medicine, 1600 NW 10th Ave, Miami, FL 33136, USA.
| | - Elizabeth N Chapman
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial VA Medical Center, 2500 Overlook Ter, Madison, WI 53705, USA; University of Wisconsin School of Medicine and Public Health, 750 Highland Ave Ste 4230, Madison, WI 53705, USA
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Monfardini S, Perrone F, Balducci L. Pitfalls in Oncogeriatrics. Cancers (Basel) 2023; 15:cancers15112910. [PMID: 37296871 DOI: 10.3390/cancers15112910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/28/2023] [Accepted: 05/05/2023] [Indexed: 06/12/2023] Open
Abstract
An oncogeriatric interdisciplinary activity exists only in a minority of high-income countries, and it is almost absent in those with lower incomes. Considering topics, sessions, and tracks in the main meetings and conferences of the major Oncological Societies in Europe and worldwide, the USA excluded, little attention has thus far been paid to the problem of cancer in the elderly. Again, with the exception of the USA, the major cooperative groups, for example, the EORTC in Europe, have only dedicated marginal attention to the research of cancer in the elderly. Despite major shortcomings, professionals interested in geriatric oncology have taken a number of important initiatives to highlight the benefits of this particular activity, including the organization of an international society (Société Internationale de Oncogeriatrie, or SIOG). In spite of these efforts, the authors believe that the management of cancer in the older population is still encountering several important and generalized pitfalls. The main obstacle is the grossly inadequate number of geriatricians and clinical oncologists necessary to an integrated care of the ever-expanding aging population, but other hurdles have been reported. Additionally, the prejudice of ageism can lead to missing potential resources for the development of a generalized oncogeriatric approach.
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Affiliation(s)
- Silvio Monfardini
- History of European Oncology Program, European School of Oncology, 20121 Milan, Italy
| | - Francesco Perrone
- Director Clinical Trial Unit, National Cancer Institute, IRCCS Fondazione G. Pascale, 80131 Naples, Italy
| | - Lodovico Balducci
- Oncology and Medicine, University of South Florida College of Medicine and Division of Geriatric Oncology, Senior Adult Oncology Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33620, USA
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Almarwani M. Does Ageism Exist Among Multidisciplinary Rehabilitation Students? Predictors of Attitudes Toward Older Adults. J Multidiscip Healthc 2023; 16:181-189. [PMID: 36714237 PMCID: PMC9875585 DOI: 10.2147/jmdh.s398994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 01/12/2023] [Indexed: 01/21/2023] Open
Abstract
Background With the growing population of older adults, the demand for health rehabilitation services has rapidly increased. Like many countries around the world, the older population in Saudi Arabia is increasing. Tackling ageism has powerful provenance for uncovering and changing the dynamics of contemporary aging in Saudi Arabia. This study examined the attitudes toward older adults and the potential predictors influencing these attitudes among multidisciplinary health rehabilitation students. Methods A total of 293 health rehabilitation students completed an online survey with a mean age of 21.1± 1.3 years. The survey included data about demographic and geriatric-related characteristics, attitudes toward older adults (UCLA-GA), knowledge of aging (FAQ) and aging anxiety (AAS). Results Most participants were female (70.3%), with 53% of the students specializing in physical therapy. The average score of attitudes toward older adults was 3.43 (0.40). The predictors of attitudes toward older adults were knowledge of aging (β = 0.34, p < 0.0001), living with older adults (β = 0.12, p = 0.02) and the importance of contact (very important, β = 0.31, p = 0.04). Conclusion These results provide further evidence to support that ageist attitudes among students can be overcome by enhancing knowledge of aging and promoting positive contact with older adults. With the demographic shift in Saudi Arabia, we propose that there is a great need for establishing a competency-based geriatric education and strategies to enhance positive contact with older adults.
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Affiliation(s)
- Maha Almarwani
- Rehabilitation Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia,Correspondence: Maha Almarwani, Rehabilitation Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, 11433, Kingdom of Saudi Arabia, Email
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Stuck AE, Masud T. Health care for older adults in Europe: how has it evolved and what are the challenges? Age Ageing 2022; 51:6931745. [PMID: 36529998 PMCID: PMC9760902 DOI: 10.1093/ageing/afac287] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Indexed: 12/23/2022] Open
Abstract
Geriatric medicine has evolved to an accepted specialty in 23 European countries. Despite much heterogeneity of postgraduate geriatric curricula, European societies have succeeded in defining a common core curriculum with a list of minimum training requirements for obtaining the specialty title of geriatric medicine. Geriatricians play a leading role in finding solutions for the challenges of health care of multimorbid older patients. One of these challenges is the demographic shift with the number of adults aged 80 years and older in Europe expected to double by 2050. Although geriatric units will play a role in the care of frail older patients, new care models are needed to integrate the comprehensive geriatric assessment approach for the care of the vast majority of older patients admitted to non-geriatric hospital units. Over the last few years, co-management approaches have been developed to address this gap. Innovative models are also in progress for ambulatory care, prevention and health promotion programs, and long-term care. Efforts to implement geriatric learning objectives in undergraduate training, and the generation of practice guidelines for geriatric syndromes may help to improve the quality of care for older patients.
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Affiliation(s)
- Andreas E Stuck
- Address correspondence to: Andreas E. Stuck, Geriatrics University Department, Inselspital, Freiburgstr. 46, CH 3010 Bern, Switzerland. Tel: +41 31 632 78 30; Fax: +41 31 632 69 42. E-mail:
| | - Tahir Masud
- Healthcare of Older People, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK,Medical Research Council and Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Nottingham, UK,National Institute for Health and Care Research Nottingham Biomedical Research Centre for Musculoskeletal Disease theme, Nottingham, UK
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von Streng Paats T, Masud T, Huwendiek S, Blundell A, Vassallo M, Stuck AE. Geriatric medicine learning objectives and entrustable professional activities in undergraduate medical curricula: a scoping review. Age Ageing 2022; 51:6583201. [PMID: 35536879 PMCID: PMC9089827 DOI: 10.1093/ageing/afac100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Indexed: 11/29/2022] Open
Abstract
Background entrustable professional activities (EPAs) have become an important component of competency-based medical education. The aim of this study is to evaluate how geriatric medicine learning objectives are addressed by undergraduate medical curricula including EPAs. Methods we performed a scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines to identify undergraduate medical curricula that include EPAs. A content analysis was conducted to examine how these curricula address the care of older individuals. In addition, we mapped the curricula to 19 geriatric medicine learning objectives identified from the European curriculum of undergraduate medical education. Results we found nine curricula, each containing between 4 and 16 core EPAs. In the sections describing the EPAs, three of the nine curricula specify that all core EPAs apply to all age groups including older patients, whereas the remaining six curricula either only refer to older patients in selected EPAs or not at all. Mapping revealed that some geriatric medicine learning objectives are covered by most curricula (e.g. medication use, multidisciplinary team work), whereas others are lacking in the majority (e.g. normal ageing, geriatric assessment, cognitive assessment, nutrition assessment, decision-making capacity assessment, long-term care). Three curricula cover most geriatric learning objectives by using a matrix aligning EPAs with geriatric competencies. Conclusions geriatric learning objectives continue to be missing from undergraduate medical curricula, also from those adopting the novel approach of EPAs. However, this review also identified some curricula that might serve as models for how geriatric learning objectives can be successfully covered within future EPA frameworks.
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Affiliation(s)
- Tasslem von Streng Paats
- Department of Geriatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tahir Masud
- Healthcare of Older People, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Medical Research Council and Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Nottingham, UK
- National Institute for Health Research Nottingham Biomedical Research Centre: Musculoskeletal Disease theme, Nottingham, UK
| | - Sören Huwendiek
- Department for Assessment and Evaluation, Institute for Medical Education, University of Bern, Bern, Switzerland
| | - Adrian Blundell
- Healthcare of Older People, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Michael Vassallo
- University Hospitals Dorset, Bournemouth, UK
- Clinical Research Unit (BUCRU) Faculty of Health and Social Sciences, Bournemouth, Dorset, UK
| | - Andreas E Stuck
- Department of Geriatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Romero-Ortuno R, Stuck AE, Masud T. The giants of education in geriatric medicine and gerontology. Age Ageing 2022; 51:6532277. [PMID: 35187575 DOI: 10.1093/ageing/afac004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Indexed: 11/14/2022] Open
Abstract
In 2014, the European undergraduate curriculum in Geriatric Medicine was published to cover the minimum requirements that a medical student should achieve by the end of medical school. In 2019, the European postgraduate curriculum in Geriatric Medicine outlined the minimum recommended training requirements to become a geriatrician at specialist level in the EU. The postgraduate dimension of Geriatric Medicine education is a highly relevant topic for all, since most physicians-independently of their specialty-are inevitably involved in the care of older patients, but for most physicians, geriatrics is not part of their postgraduate generalist or specialty training. A key area for postgraduate education remains the provision of Geriatric Medicine competencies to all specialties outside geriatrics. There is also need for wider educational initiatives to improve the gerontological education of patients and the public. Bernard Isaacs famously coined the expression 'geriatric giants' or the four clinical I's: Intellectual impairment, Incontinence, Immobility, and Instability. However, non-clinical giants exist. In education, we face challenges of Investment, Inspiration, Integration, and Interprofessionality; and in research, we need to attract Interest and Income, and generate Innovation and Impact. Without strengthening the links between all giants, we will not be able to achieve the ambition of age-attuned societies. A key goal for gerontological education is to enhance everyone's understanding of the wide diversity underlying the 'older people' demographic label, which will ultimately promote services and societies that are more responsive and inclusive to the needs of all older adults, irrespective of their health status.
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Affiliation(s)
- Roman Romero-Ortuno
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin D08 NHY1, Ireland
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin D08 NHY1, Ireland
| | - Andreas E Stuck
- Geriatrics Department, Inselspital and University of Bern, Bern 3010, Switzerland
| | - Tahir Masud
- Department of Health Care for Older People (HCOP), Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
- Department of Geriatric Medicine, Odense University Hospital, Odense 5000, Denmark
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Affiliation(s)
- A Abyad
- Abyad Medical Center, Tripoli, Lebanon. .,Middle-East Academy for Medicine of Aging, Tripoli, Lebanon. .,Middle East and North Africa Association on Aging and Alzheimer's, Tripoli, Lebanon. .,Middle-East Journal of Family Medicine, Tripoli, Lebanon. .,Middle-East Journal of Age and Aging, Tripoli, Lebanon.
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Flores-Sandoval C, Sibbald S, Ryan BL, Orange JB. Interprofessional team-based geriatric education and training: A review of interventions in Canada. GERONTOLOGY & GERIATRICS EDUCATION 2021; 42:178-195. [PMID: 32787710 DOI: 10.1080/02701960.2020.1805320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Given world-wide rises in the number of older adults, interprofessional education and training in geriatrics must be promoted across the learning spectrum, both for students and for health care professionals. This review examined interprofessional team-based education and training interventions in Canada focusing on the team component. A total of 10 studies (1997-2017) were eligible for analyzes. Studies offered health care providers opportunities to enhance their knowledge of geriatric competencies, as well as their ability to work in interprofessional geriatric teams. Although several interventions did not include team-based learning content explicitly, team-building opportunities, as well as assignments related to working on teams yielded positive impacts on learners. Results showed improved geriatric competencies as well as team functioning. Geriatric health care teams add significant value to the Canadian health care system. Consequently, opportunities to improve health care providers' geriatric knowledge and their ability to work in teams should be encouraged.
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Affiliation(s)
- Cecilia Flores-Sandoval
- Health and Rehabilitation Sciences Program, Faculty of Health Sciences, Western University, London, Canada
| | - Shannon Sibbald
- Department of Family Medicine, Faculty of Health Sciences, School of Health Studies, Schulich School of Medicine and Dentistry, Western University, London, Canada
- The Schulich Interfaculty Program in Public Health, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Bridget L Ryan
- Centre for Studies in Family Medicine, Department of Family Medicine; Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Joseph B Orange
- Health and Rehabilitation Sciences Program, Faculty of Health Sciences, Western University, London, Canada
- School of Communication Sciences and Disorders, Western University, London, Canada
- Canadian Centre for Activity and Aging, Western University, London, Canada
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Reilly JM, Stevens G, Halle A, Resnik C, Teoh J, Williams B, Joosten-Hagye D, Segal-Gidan F. Interprofessional, older adult, team-based home visits: A 6-year prospective analysis. GERONTOLOGY & GERIATRICS EDUCATION 2021; 42:196-206. [PMID: 32362239 DOI: 10.1080/02701960.2020.1758081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This 6-year prospective study describes the impact on student attitudes of an innovative, interprofessional geriatrics curriculum (IPGC) focused on team-based care with older adults in a home-based community setting. Dental, medical, occupational therapy, pharmacy, physical therapy, and physician assistant students were placed into teams each led by faculty members from all of the professions. The curriculum consisted of five, four-hour sessions over one academic year. Teams met with a community-dwelling older adult three times. Students completed the Geriatric Assessment Scale (GAS) before and after the IPGC experience. At the conclusion, improvements in attitudes toward older adults in the GAS and its four domains - social value, medical care, compassion, and societal resources-were observed across a wide spectrum of students. Students with the lowest initial attitudes improved the most, as did the scores of the youngest students. Older students improved more than younger students in the social value domain (i.e., the perceived social value of older adults). Among disciplines, occupational therapy and social work students improved the most in the social value domain. This study demonstrates improvement in attitudes toward older adults from student involvement in IPGC that combines didactic and experiential learning through community partnerships in a home-based setting.
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Affiliation(s)
- Jo Marie Reilly
- Keck School of Medicine of USC, Los Angeles, California, USA
| | - Gregory Stevens
- Keck School of Medicine of USC, Los Angeles, California, USA
| | - Ashley Halle
- USC Chan Division of Occupational Science and Occupational Therapy, Los Angeles, California, USA
| | - Cheryl Resnik
- USC Division of Biokinesiology and Physical Therapy, Los Angeles, California, USA
| | - Jeremy Teoh
- Herman Ostrow School of Dentistry of USC, Los Angeles, California, USA
| | - Brad Williams
- USC School of Pharmacy, Los Angeles, California, USA
| | - Dawn Joosten-Hagye
- USC Suzanne Dworak-Peck School of Social Work, Los Angeles, California, USA
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Kotsani M, Avgerinou C, Haidich AB, Smyrnakis E, Soulis G, Papageorgiou DI, Andreou M, Zeimbekis D, Kokkali S, Gavana M. Feasibility and impact of a short training course on frailty destined for primary health care professionals. Eur Geriatr Med 2021; 12:333-346. [PMID: 33646537 DOI: 10.1007/s41999-021-00467-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/04/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND There is an unmet need for training primary health care professionals on frailty, especially in countries where geriatrics is still emerging. PURPOSE We aimed to evaluate the feasibility and efficacy of a training course for primary health care professionals on the detection, assessment, and management of frailty. METHODS A single-day training course, developed and facilitated by three physicians trained in geriatrics abroad, was organized by the Aristotle University of Thessaloniki Primary Hearth Care Research Network. Primary health care professionals' attitudes, knowledge, and everyday practices regarding frailty were assessed by self-administered anonymous questionnaires (using Likert-type scales) at three time-points (before, upon completion of the training course, and 3 months afterward). RESULTS Out of 31 participants (17 physicians, 12 nurses, 2 health visitors; 87.1% women; mean age 46.4 years), 31(100%) filled in the first, 30(97%) the second, and 25(81%) the third questionnaire. Improvements were reported in familiarization with the frailty syndrome (p = 0.041) and in self-perception of knowledge and skills to detect (p < 0.001) and manage (p < 0.001) frailty, that were also sustained 3 months afterward (p = 0.001 and p = 0.003 respectively). Improvement was also observed in the attitude that frailty is an inevitable consequence of aging (p = 0.007) and in the frequency of application of screening (but not management) strategies, 3 months following the workshop compared to baseline (p = 0.014). Participants reported less disagreement with the statement that systematic screening for frailty was unfeasible in their daily practice at 3 months compared to baseline (p = 0.006), mainly due to time restrictions. CONCLUSION A short skill-oriented training course can significantly and sustainably improve primary health care professionals' attitudes and practices regarding frailty.
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Affiliation(s)
- Marina Kotsani
- Université de Lorraine, CHRU-Nancy, Pôle «Maladies du Vieillissement, Gérontologie et Soins Palliatifs», 54000, Nancy, France.
| | - Christina Avgerinou
- Department of Primary Care and Population Health, University College London, London, UK
| | - Anna-Bettina Haidich
- Department of Hygiene, Social-Preventive Medicine and Medical Statistics, Medical School, Aristotle University of Thessaloniki, University Campus, 54124, Thessaloniki, Greece
| | - Emmanouil Smyrnakis
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Soulis
- Outpatient Geriatric Assessment Unit, Henry Dunant Hospital Center, Athens, Greece
| | - Dimitra Iosifina Papageorgiou
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Stamatia Kokkali
- Department of Hygiene, Social-Preventive Medicine and Medical Statistics, Medical School, Aristotle University of Thessaloniki, University Campus, 54124, Thessaloniki, Greece
| | - Magda Gavana
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Start low, go slow, but look far: the case of geriatric medicine in Balkan countries. Eur Geriatr Med 2020; 11:869-878. [PMID: 32588380 DOI: 10.1007/s41999-020-00350-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/13/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE To present an insight of the situation of geriatric medicine in Balkan countries, as it was presented in the context of the 2nd pre-congress seminar of the 16th European Geriatric Medicine Society (EuGMS) Congress Athens 2021. METHODS Representatives from 8 Balkan countries (Albania, Croatia, Greece, Republic of North Macedonia, Romania, Serbia, Slovenia, Turkey) answered 3 questions to reflect the state of geriatric medicine in their country: education on geriatrics; systems/methods for assessment of functional status and frailty; pre-operative risk assessment. An open discussion followed. RESULTS Undergraduate education in geriatric medicine seems underestimated in medical faculties of Balkan countries, whereas a high heterogeneity is observed at a post-graduate level. Only a few Balkan countries have geriatric medicine as a recognized medical specialty or subspecialty. Functional status and frailty are only sporadically assessed, and pre-operative risk assessment is very rarely performed with a geriatric focus. Scarcity of expertise and structures relevant to geriatric medicine seems to be common. Developing a training curriculum and geriatrics-related structures are two interconnected aspects. Cooperation among physicians and multidisciplinary teams are essential for the practice of geriatric medicine. A functional geriatric network is eventually necessary and ambulatory geriatric expertise is probably a feasible and clinically relevant starting point. Providing pragmatic solutions to the pressing challenges in variable clinical settings, supplementing and working in harmony with existing components of each health system, is probably the most convincing strategy to gain political support in developing geriatric medicine. CONCLUSION Balkan countries share common experiences and challenges in developing geriatrics. Whilst the principles of geriatric medicine are perhaps universal, proposed solutions should be adapted to each country's specific circumstances. Cooperation of the Balkan countries could promote in each the development of geriatric medicine. EuGMS is willing to foster relevant actions.
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Roller-Wirnsberger R, Masud T, Vassallo M, Zöbl M, Reiter R, Van Den Noortgate N, Petermans J, Petrov I, Topinkova E, Andersen-Ranberg K, Saks K, Nuotio M, Bonin-Guillaume S, Lüttje D, Mestheneos E, Szekacs B, Jonsdottir AB, O’Neill D, Cherubini A, Macijauskiene J, Leners JC, Fiorini A, van Iersel M, Ranhoff AH, Kostka T, Duque S, Prada GI, Davidovic M, Krajcik S, Kolsek M, del Nozal JM, Ekdahl AW, Münzer T, Savas S, Knight P, Gordon A, Singler K. European postgraduate curriculum in geriatric medicine developed using an international modified Delphi technique. Age Ageing 2019; 48:291-299. [PMID: 30423032 PMCID: PMC6424375 DOI: 10.1093/ageing/afy173] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/14/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND the European Union of Medical Specialists (UEMS-GMS) recommendations for training in Geriatric Medicine were published in 1993. The practice of Geriatric Medicine has developed considerably since then and it has therefore become necessary to update these recommendations. METHODS under the auspices of the UEMS-GMS, the European Geriatric Medicine Society (EuGMS) and the European Academy of Medicine of Ageing (EAMA), a group of experts, representing all member states of the respective bodies developed a new framework for education and training of specialists in Geriatric Medicine using a modified Delphi technique. Thirty-two expert panel members from 30 different countries participated in the process comprising three Delphi rounds for consensus. The process was led by five facilitators. RESULTS the final recommendations include four different domains: 'General Considerations' on the structure and aim of the syllabus as well as quality indicators for training (6 sub-items), 'Knowledge in patient care' (36 sub-items), 'Additional Skills and Attitude required for a Geriatrician' (9 sub-items) and a domain on 'Assessment of postgraduate education: which items are important for the transnational comparison process' (1 item). CONCLUSION the current publication describes the development of the new recommendations endorsed by UEMS-GMS, EuGMS and EAMA as minimum training requirements to become a geriatrician at specialist level in EU member states.
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Affiliation(s)
| | - Tahir Masud
- Department of Healthcare for Older People, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, UK
| | - Michael Vassallo
- Royal Bournemouth and Christchurch NHS Hospitals Foundation Trust, Castle Lane East, Bournemouth, UK
| | - Martina Zöbl
- Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz, Austria
| | - Raphael Reiter
- Department of Geriatric Medicine, Paracelsus Medical University Strubergasse 22, Salzburg, Austria
| | - Nele Van Den Noortgate
- Department of Geriatric Medicine, Ghent University Hospital Corneel Heymanslaan 10, Gent, Belgium
| | - Jean Petermans
- Geriatric Department, CHU Rue de Gaillarmont 600, Liège, Belgium
| | - Ignat Petrov
- Clinical Centre of Endocrinology and Gerontology, Medical University of SofiaBoulevard “Akademik Ivan Evstratiev Geshov” 15, Sofia Center, Sofia, Bulgaria
| | - Eva Topinkova
- Department of Gerontology and Geriatrics, 1st Faculty of Medicine, Charles University and General Faculty HospitalOvocný trh 3-5, Staré Město, Czechia
| | - Karen Andersen-Ranberg
- Department of Geriatric Medicine, Odense University Hospital and Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 4, Odense, Denmark
| | - Kai Saks
- Department of Internal Medicine, University of Tartu, Ülikooli 18, Tartu, Estonia
| | - Maria Nuotio
- Department of Geriatric Medicine, Seinäjoki Central Hospital, Hanneksenrinne 7, Seinäjoki, Finland
- Department of Geriatrics, University of Turku, Turku, Finland
| | - Sylvie Bonin-Guillaume
- Department of Geriatric Medicine, Hopital de la Timone, 264 Rue Saint Pierre, 13005 Marseille 05, Provence-Alpes-Côte d'Azur, France
| | - Dieter Lüttje
- Medizinische Klinik IV, Geriatrie und Palliativmedizin, Klinikum Osnabrück, Germany
| | - Elizabeth Mestheneos
- Hellenic Association of Gerontology and Geriatrics, Past President Age Platform Europe, Greece
| | - Bela Szekacs
- Hungarian Association of Gerontology and Geriatrics (HAGG)
| | - Anna Björg Jonsdottir
- Department of Geriatric Medicine, The National University Hospital of Iceland Landakoti, 101, Reykjavík Iceland
| | - Desmond O’Neill
- Department of Clinical Gerontology, College Green, Dublin 2, Ireland
| | - Antonio Cherubini
- Geriatria, Accettazione geriatrica e Centro di ricerca per l’invecchiamento, IRCCS INRCA, Ancona, Italia
| | - Jurate Macijauskiene
- Department of Geriatrics, The Faculty of Nursing, Medical Academy Lithuanian, University of Health Sciences, A. Mickevičiaus g. 9, Kaunas, Lithuania
| | - Jean-Claude Leners
- House Omega & LTCF Alzheimer, University of Luxembourg, 2, avenue de l'Université, Esch-sur-Alzette, Luxembourg
| | - Anthony Fiorini
- The Geriatric Medicine Society of Malta, Karin Grech Hospital, Telghat Gwardamangia, Pieta' Malta PTA, Malta
| | - Marianne van Iersel
- Department of Geriatric Medicine, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Nijmegen, Netherlands
| | | | - Tomasz Kostka
- Department of Geriatrics, Medical University of Lodz, plac Hallera 1, Łódź, Poland
| | - Sofia Duque
- Internal Medicine Specialist with Geriatrics Competence, Orthogeriatric Unit Coordinator, Internal Medicine Department, Hospital São Francisco Xavier, Centro Hospitalar de Lisboa, Ocidental, Invited Lecturer of Geriatrics, Faculdade de Medicina, Universidade de Lisboa, Estr. Forte do Alto Duque, Lisboa, Portugal
| | - Gabriel Ioan Prada
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Ana Aslan National Institute of Gerontology and Geriatrics, Romania
| | - Mladen Davidovic
- Serbian Association of Geriatricians and Gerontologist, Udruženje gerijatara i gerontologa Srbije, Preševska 31, Beograd, Serbia
| | - Stefan Krajcik
- Geriatric Department, Slovak Medical University, 831 01 Bratislava, Slovakia
| | - Marko Kolsek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana Korytkova ulica 2, Ljubljana, Slovenia
| | | | - Anne W Ekdahl
- Department of Clinical Sciences Helsingborg, Helsingborg Hospital, Lund University, Svartbrödragränden 3-5, Helsingborg, Sweden
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical geriatrics, Solnavägen 1, Solna, Sweden
| | - Thomas Münzer
- Department of Geriatrics, Geriatrische Klinik St. Gallen and University of Zürich, Zürich, Switzerland
| | - Sumru Savas
- Section of Geriatrics, Department of Internal Medicine, School of Medicine, Ege University Erzene Mahallesi, Bornova/İzmir, Turkey
| | - Paul Knight
- Department Geriatric Medicine, Royal Infirmary, Glasgow, UK
| | - Adam Gordon
- CLAHRC-East Midlands ‘Caring for Older People and Stroke Survivors’ (COPSS), Nottingham Biomedical Research Centre (BRC)
| | - Katrin Singler
- Institute of Biomedicine of Ageing, Friedrich Alexander University Erlangen, Schloßplatz 4, Erlangen, Germany
- Department of Geriatrics, Klinikum Nürnberg, Paracelsus Private Medical University, Prof.-Ernst-Nathan-Straße 1, Nürnberg, Germany
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Eglseer D, Visser M, Volkert D, Lohrmann C. Nutrition education on malnutrition in older adults in European medical schools: need for improvement? Eur Geriatr Med 2019; 10:313-318. [DOI: 10.1007/s41999-018-0154-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 12/10/2018] [Indexed: 11/30/2022]
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15
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Windhaber T, Koula ML, Ntzani E, Velivasi A, Rizos E, Doumas MT, Pappas EE, Onder G, Vetrano DL, Roudriguez Laso A, Roudriguez Manjas L, Illario M, Roller-Wirnsberger RE. Educational strategies to train health care professionals across the education continuum on the process of frailty prevention and frailty management: a systematic review. Aging Clin Exp Res 2018; 30:1409-1415. [PMID: 29476480 PMCID: PMC6267124 DOI: 10.1007/s40520-018-0918-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 02/14/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND In addition to the normal process of ageing, frailty, defined as a geriatric syndrome, is becoming more prevalent. Around 10% of people over 65 years and 25-50% of those aged over 85 years are frail. Frail elderly are more vulnerable to external stressors and have an increased risk of adverse health outcomes. To tackle these challenges, European Union (EU) member states need to develop a health work force capable of the right skills mix. A goal-centred education and training of professionals is crucial for effective and efficient health care delivery for Europe's greying population. AIMS The aim of this study was to systematically collect, review and critically appraise studies carried out to investigate the efficacy and effectiveness of comprehensive educational programmes for health professionals related to frailty prevention and/or frailty management. METHODS A systematic review was carried out searching the databases PubMed, CINAHL, Cochrane CENTRAL, Medline, Up to date and Embase. Additionally, a manual search of the reference lists and searches via Google Scholar and greylit.org was done. RESULTS No relevant publications addressing the evidence and sustainability of educational/training programmes for frailty prevention and/or frailty management were identified. DISCUSSION The result of an empty review is surprising because several educational programmes in different countries are currently run. CONCLUSIONS A significant knowledge gap exists in the scientific literature regarding education and training of health care workers regarding prevention and management of frailty. Further research is needed to identify effective educational strategies for health professionals to prevent and manage frailty.
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Affiliation(s)
- Thomas Windhaber
- Department of Internal Medicine, Medical University of Graz, Graz, Austria.
| | | | - Evangelia Ntzani
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
- Center for Evidence Synthesis in Health, Department of Health Services, Policy and Practice, School of Public Health, Brown University, Rhode Island, USA
| | | | - Evangelos Rizos
- Department of Internal Medicine, University Hospital of Ioannina, Ioannina, Greece
- School of Medicine, University of Cyprus, Nicosia, Cyprus
| | | | | | - Graziano Onder
- Department of Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Davide Liborio Vetrano
- Department of Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden
| | | | | | - Maddalena Illario
- Campania Region Health Directorate, Division on Health Innovation, Federico II University and Hospital, Naples, Italy
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Geriatric Helper: An mHealth Application to Support Comprehensive Geriatric Assessment. SENSORS 2018; 18:s18041285. [PMID: 29690569 PMCID: PMC5948578 DOI: 10.3390/s18041285] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/08/2018] [Accepted: 04/19/2018] [Indexed: 01/02/2023]
Abstract
The Comprehensive Geriatric Assessment (CGA) is a multidisciplinary diagnosis approach that considers several dimensions of fragility in older adults to develop an individualized plan to improve their overall health. Despite the evidence of its positive impact, CGA is still applied by a reduced number of professionals in geriatric care in many countries, mostly using a paper-based approach. In this context, we collaborate with clinicians to bring CGA to the attention of more healthcare professionals and to enable its easier application in clinical settings by proposing a mobile application, Geriatric Helper, to act as a pocket guide that is easy to update remotely with up-to-date information, and that acts as a tool for conducting CGA. This approach reduces the time spent on retrieving the scales documentation, the overhead of calculating the results, and works as a source of information for non-specialists. Geriatric Helper is a tool for the health professionals developed considering an iterative, User-Centred Design approach, with extensive contributions from a broad set of users including domain experts, resulting in a highly usable and accepted system. Geriatric Helper is currently being tested in Portuguese healthcare units allowing for any clinician to apply the otherwise experts-limited geriatric assessment.
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