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Key summary points: Aim: To explore content preferences, potential barriers and facilitators as perceived by European older adults who have experienced falls with regards to using a fall-prevention patient portal, and to explore regional differences between European participants. Findings: About two-thirds of the participants (n = 121) reported interest in a fall-prevention patient portal providing information on risk factors for falls, relevant medical conditions, Fall-Risk Increasing Drugs (FRIDs), and advice on how to manage fall-related conditions. Fees for use and privacy concerns appeared to be the most important barriers, while a user-friendly portal with easily-accessible information and a physician recommendation seemed to be the most important facilitators. A recommendation for portal use by a family member appeared to be a more important facilitator for participants from Southern and Eastern Europe compared to the other regions. Message: There is considerable interest in a fall-prevention patient portal providing personalized treatment advice, used in addition to a consultation with a physician. The barriers and facilitators to using a portal as identified by participants should be taken into account when developing future fall-prevention patient portals in order to optimize clinical effectiveness. Purpose: Falls are a major and growing health care problem in older adults. A patient portal has the potential to provide older adults with fall-prevention advice to reduce fall-risk. However, to date, the needs and preferences regarding a patient portal in older people who have experienced falls have not been explored. This study assesses content preferences, potential barriers and facilitators with regard to using a patient portal, as perceived by older people who have experienced falls, and explores regional differences between European participants. Methods: We conducted a survey of older adults attending an outpatient clinic due to a fall or fall-related injury, to explore their content preferences, perceived barriers, and facilitators with respect to a fall-prevention patient portal. Older adults (N = 121, 69.4% female, mean age: 77.9) were recruited from seven European countries. Results: Almost two-thirds of respondents indicated they would use a fall-prevention patient portal. The portal would preferably include information on Fall-Risk-Increasing Drugs (FRIDs), and ways to manage other related/relevant medical conditions. Facilitators included a user-friendly portal, with easily accessible information and physician recommendations to use the portal. The most-commonly-selected barriers were privacy issues and usage fees. A family member's recommendation to use the portal was seemingly more important for Southern and Eastern European participants compared to the other regions. Conclusion: The majority of older people with lived falls experience expressed an interest in a fall-prevention patient portal providing personalized treatment advice to prevent further falls. The results will be used to inform the development of a fall-prevention patient portal. The fall-prevention patient portal is intended to be used in addition to a consultation with a physician. Future research is needed to explore how to prevent falls in older patients who are not interested in a fall-prevention patient portal. [ABSTRACT FROM AUTHOR]

Nutritional factors can influence the risk of Alzheimer's disease and its rate of clinical progression, suggesting that the association between diet, nutrient status and cognitive function deserves more attention. The European Union Geriatric Medicine Society (EUGMS) working group “Healthy Brain Ageing and Cognition” supports the development of practical recommendations for nutritional strategy, focused predominantly on the preventive aspects of diet and nutrition on cognitive decline. Adopting a healthy lifestyle and avoiding nutritional deficiencies in young or midlife adults is essential and there is compelling evidence to justify recommending a Mediterranean diet as a way of achieving these goals. There is currently insufficient evidence to endorse the use of specific nutrients to promote healthy brain ageing. In addition, currently there is no generally applicable evidence to recommend the use of single-agent micronutrient supplementation at any stage of dementia or for prevention. Omega-3 fatty acids or specific medical foods may be considered for selected patients with early dementia. When signs of malnutrition are detected, correction of specific deficiencies is necessary to improve nutritional status. Individuals at risk of malnutrition should be advised to improve nutritional intake from dietary food sources and should avoid taking high doses of specific nutrients as supplements. Nutritional awareness, advice and intervention are important in the general management and follow-up of people with cognitive problems. [ABSTRACT FROM AUTHOR]

Introduction Frailty is characterized by increased vulnerability to stressors that poses the older subject at risk of adverse health-related outcomes, including hospitalization, disability and mortality. Early identification of community-dwelling frail older subjects is important in order to implement preventive strategies against negative health-related outcomes, in particular disability. Validated brief screening tools are needed to detect frail community-dwelling elders. Materials and methods The aim of the present study, promoted by the European Union Geriatric Medicine Society (EUGMS) working group on “Frailty in older persons”, is to determine the agreement between the Gérontopôle Frailty Screening Tool (GFST) (administered by the general practitioner) and the Fried’ criteria for frailty phenotype as reference measure (administered by a blinded assessor). The study is performed in older primary care patients in nine European countries after translation of the GFST into eight languages. Results The sample ( n = 109 older patients,) included 37.6%, 56.9%, and 5.5% robust, pre-frail or frail, and disabled individuals, respectively. The GFST showed a sensitivity of 71.0%, a specificity of 70.2%, a positive predictive value of 75.9% and a negative predictive value of 64.7% at the identification of non-disabled frail elders. The positive and negative likelihood ratios were 2.38 and 0.41, respectively. In logistic regression models only slow gait speed (odds ratio [OR]: 19.65, 95% confidence interval [95% CI]: 4.69–82.35) and mobility issues (OR: 18.04, 95% CI: 3.11–104.78) were significantly associated with the condition of frailty in the absence of disability. Conclusions Our findings demonstrate an overall moderate agreement between the GFST and the frailty phenotype. [ABSTRACT FROM AUTHOR]

Purpose The MPI_AGE project is a multicenter project co-funded by the Executive Agency for Health and Consumers in the frame of Active and Healthy Ageing 2nd-Health Programme 2008–2013. Aim of the project is to implement Multidimensional Prognostic Indices (MPI) that predict survival, based on the Comprehensive Geriatric Assessment, in order to improve the cost-effectiveness of health interventions in frail older individuals with multimorbidity and polypharmacy. Materials and methods The project is divided in seven Work Packages (WP). WP1, WP2 and WP3 include the activities of coordination, evaluation and dissemination, respectively. WP4 is a retrospective analysis of clinical, functional and administrative data carried out in order to develop and validate MPI in community-dwelling older subjects. In WP5, the best cost-effective profile of different therapeutic interventions in older individuals with different MPI-based mortality risk profile will be identified. WP6 is a multicenter prospective study with a follow-up of 12 months carried out in 11 geriatric clinical centres with the aim of evaluating the usefulness of the MPI in the clinical decision making in patients with different mortality risk. In WP7, a systematic process of recommendations will be carried out through the wide involvement of partners, external experts and stakeholders in meetings and web diffusion. Conclusions Mortality risk may influence the effectiveness of specific treatments and interventions in frail older subjects with multimorbidity and polypharmacy. Clinicians and health policy makers need to consider the prognostic information obtained through the MPI to identify those setting-specific profiles of older subjects who may better benefit from interventions. [ABSTRACT FROM AUTHOR]

Abstract: Quality of geriatric care depends on institutional resources e.g. hospitals, medical departments engaged in acute medicine, rehabilitation and long term care but especially in quality and quantity of well educated and trained specialists, i.e. “geriatricians”. This survey initiated by the Academic Board of the European Union Geriatric Medicine Society (EUGMS) aimed to give an European overview by mapping the current situation in number and geographical distribution of geriatricians in relation to national demographic data. The discussion focuses on special national aspects including information about the national training tenure circumstances as well as political and historical influences on the geriatric care situation. The need for an European consensus concerning training curriculum is clearly stated, but also the need for fostering geriatric medicine with look on the demographic background, which is very similar in European countries. Last but not least: The survey can function as a benchmark, which every country may use in it''s own medical and political environment. [Copyright &y& Elsevier]

The transition from independence to disability in older adults is characterized by detectable changes in body composition and physical function. Epidemiologic studies have shown that weight loss, reduced caloric intake and the reduced intake of specific nutrients are associated with such changes. The mechanisms underlying these associations remain unclear, and different hypotheses have been suggested, including the reduction of the antioxidant effects of some nutrients. Changes in muscle mass and quality might play a central role in the pathway linking malnutrition, its biological and molecular consequences, and function. A different approach aims at assessing diets by dietary patterns, which capture intercorrdations of nutrients within a diet, rather than by selective foods or nutrients: epidemiologic evidence suggests that some types of diet, such as the Mediterranean diet, might prevent negative functional outcomes in older adults. However, despite a theoretical and empirical basis, intervention studies using nutritional supplementation have shown inconclusive results in preventing functional impairment and disability. The present work is the result of a review and consensus effort of a European task force on nutrition in the elderly, promoted by the International Association of Gerontology and Geriatrics (IAGG) European Region. After the critical review of different aspects related to the role of nutrition in the transition from independence to disability, we propose future lines for research, including the determination of levels of inadequacy and target doses of supplements, the study of interactions (between nutrients within a diet and with other lifestyle aspects), and the association with functional outcomes. [ABSTRACT FROM AUTHOR]

BACKGROUND AND AIMS: Data on the use of antipsychotics among older people in need of regular home care services are rare. The aim of this study was to ascertain the differences in the use and type of antipsychotic medications between European home-care sites. METHODS: A cross-sectional study was designed by means of RAI (Resident Assessment Instrument for Home Care) assessments. A random sample of 3251 assessments was gathered during the period September 2001-January 2002 from home care patients aged 65 and over in nine European countries (Czech Republic, Denmark, Finland, Germany, Iceland, Italy, Netherlands, Norway and United Kingdom). RESULTS: Two hundred of the home care patients (6.2%) received antipsychotic medication. The prevalence of the use of one or more antipsychotics varied widely between study sites, ranging from 3.0% in Denmark to 12.4% in Finland. Factors independently associated with the use of antipsychotics were: delusions (OR 3.09, 95% CI 1.66-5.76), any diagnosis of dementia (OR 2.57, 95% CI 1.70-3.87), youngest age group (65-74 yrs) (OR 2.37, 95% CI 1.53-3.66) and hallucinations (OR 2.28, 95% CI 1.17-4.45). Concomitant use of anxiolytics (OR 2.32, 95% CI 1.58- 3.41), hypnotics (OR 2.08, 95% CI 1.44-3.03) and antidepressants (OR 2.06, 95% CI 1.41-3.00) together with signs of depression (OR 1.78, 95% CI 1.24- 2.56), moderate to severe cognitive impairment (OR 1.30, 95% CI 1.12-1.51) and residing in Finland (OR 2.52, 95% CI 1.21-5.24) or Italy (OR 2.15, 95% CI 1.10-4.19) were associated with the use of antipsychotics. The most commonly used antipsychotic agent was risperidone (n=42, 21%). CONCLUSIONS: The frequency of antipsychotic drug use in older home-care patients varied considerably among the European countries studied. Antipsychotic drug treatment in older home-care recipients seems to be less common than in residents in long-term institutional care, and more common than among the independently-living elderly. [ABSTRACT FROM AUTHOR]

Objective: To describe associations between unintended weight loss (UWL) and characteristics of nutritional status. Design: A comparative cross-sectional assessment study at 11 sites in Europe. The target population was a stratified random sample of 4,455 recipients of home care (405 in each random sample from 11 urban areas) aged 65 years and older. Measurements: the Resident Assessment Instrument for Home Care, version 2.0. Epidemiological and medical characteristics of clients and service utilisation were recorded in a standardized, comparative manner. UWL was defined as information of 5% or more weight loss in the last 30 days (or 10% or more in the last 180 days). Results: The final sample consisted of 4,010 persons; 74% were female. The mean ages were 80,9 ± 7.5 years (males) and 82.8 ± 7.3 years (females). No associations were found between single diagnoses and UWL, except for cancer. Cancer patients were excluded from further analyses. Persons with a Cognitive Performance Scale value (CPS) > 3 (impaired) had increased risk of UWL (OR = 2,0) compared with those scoring ≤ 3 (less impaired). Only in the oldest group did we find a significant association between UWL and reduction in ADL and IADL functions, comparing those who scored 3 or less with those who scored more than 3 (disabled). A binary logistic regression model explained 26% of UWL: less than one meal/day, reduced appetite, malnutrition, reduced social activity, experiencing a flare-up of a recurrent or chronic problem, and hospitalisation were important indicators. Conclusion: We recommend a regular comprehensive assessment in home care to identify clients with potential risk factors for weight loss and malnutrition, in particular those discharged from hospital, and those with physical dependency or cognitive problems. This study may provide incentives to create tailored preventive strategies. [ABSTRACT FROM AUTHOR]

BACKGROUND AND AIMS: The increase in the proportion of elderly people and a consequent increase in the demand for care have caused healthcare systems to become overloaded. This paper describes the use of Home Care Quality Indicators (HCQIs), derived from the Minimum Data Set for Home Care, for monitoring quality of care. Research questions were, 'Do HCQI scores vary between home care organizations in different countries?' and 'Are one or more country-specific sites consistently scoring better on most or all HCQIs'? METHODS: a cross-sectional observational study of 65+ randomly selected clients of home care organizations in urban areas in 11 European countries who had been receiving home care for at least two weeks. Data were collected with the MDS-HC. The scoring of 16 prevalent quality indicators for home care, adjusted for population differences, was calculated with baseline data. RESULTS: Population size at baseline was 4,007 clients. Among home care clients in Europe, 'rehabilitation potential in Activities of Daily Living and no therapies' (average 75.9%) and 'inadequate pain control' were the most common quality problems. The prevalence between populations studied in various countries varied substantially. No country-specific site consistently scored worst or best. CONCLUSIONS: HCQIs derived from the MDS-HC detect variance in quality scores between home care in the 11 partner countries. The highest prevalence of unwanted outcomes were most often found in the Czech Republic, Italy and Germany. Although further research is necessary, we believe that HCQIs may be of great value for quality improvement in home care. [ABSTRACT FROM AUTHOR]

The question of whether aging is a disease is old and controverted. Three possible positions are outlined: (i) aging is a natural event, not a disease; (ii) aging is a disease, to be combated by medical knowledge and skills; and (iii) aging, while natural, can be treated as if it is a disease and efforts made to lessen its undesirable impact. The last position seems, de facto, the one that is being pursued by contemporary medicine; however, in such a pursuit, important issues will be raised of intergenerational justice in paying for advances in medicine, and the need to balance the medical goals of care for aged people against other important social needs. [ABSTRACT FROM AUTHOR]