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Maxime Billot,1,2 Riccardo Calvani,3,4 Annele Urtamo,5 Juan Luis Sánchez-Sánchez,6 Cecilia Ciccolari-Micaldi,1 Milan Chang,7,8 Regina Roller-Wirnsberger,9 Gerhard Wirnsberger,10 Alan Sinclair,11 Nieves Vaquero-Pinto,12 Satu Jyväkorpi,5 Hanna Öhman,5 Timo Strandberg,13,14 Jos MGA Schols,15 Annemie MWJ Schols,16 Nick Smeets,17 Eva Topinkova,18 Helena Michalkova,19 Anna Rita Bonfigli,20 Fabrizia Lattanzio,20 Leocadio Rodríguez-Mañas,21 Hélio Coelho-Júnior,4 Marianna Broccatelli,4 Maria Elena D’Elia,4 Damiano Biscotti,4 Emanuele Marzetti,3,4 Ellen Freiberger22 1Clinical Gerontology, University Hospital of Limoges, Limoges, France; 2PRISMATICS (Predictive Research in Spine/Neurostimulation Management and Thoracic Innovation in Cardiac Surgery), Poitiers University Hospital, Poitiers, France; 3Università Cattolica del Sacro Cuore, Rome, Italy; 4Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy; 5University of Helsinki, Department of General Practice and Primary Health Care, Helsinki University Central Hospital, Unit of Primary Health Care, Helsinki, Finland; 6Foundation for Biomedical Research Getafe University Hospital, Madrid, Spain; 7Faculty of Health Promotion, Sports and Leisure Studies, School of Education, University of Iceland, Reykjavik, Iceland; 8The Icelandic Gerontological Research Center, Landspitali University Hospital and University of Iceland, Reykjavik, Iceland; 9Medical University of Graz, Department of Internal Medicine, Graz, Austria; 10Medical University of Graz, Division of Nephrology, Department of Internal Medicine, Graz, Austria; 11Foundation for Diabetes Research in Older People, Diabetes Frail Ltd., Luton, UK; 12University Hospital of Ramon Cajal IRYCIS, Madrid, Spain; 13University of Helsinki, Clinicum, Helsinki, Finland; Helsinki University Hospital, Medicine and Rehabilitation, Helsinki, Finland; 14University of Oulu, Center for Life Course Health Research, Oulu, Finland; 15Department of Health Services Research, Maastricht University Medical Center, Maastricht, The Netherlands; 16Department of Respiratory Medicine, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Center, Maastricht, The Netherlands; 17Department of Health & Fitness, Maastricht University Medical Center, Maastricht, The Netherlands; 18 First Faculty of Medicine, Charles University, Prague, Czech Republic; 19Faculty of Social and Health Sciences, South Bohemian University, Ceske Budejovice, Czech Republic; 20Scientific Direction, IRCCS INRCA, Ancona, Italy; 21Geriatrics Service, University Hospital of Getafe, Madrid, Spain; 22Institute for Biomedicine of Aging, FAU Erlangen-Nürnberg, Nürnberg, GermanyCorrespondence: Maxime Billot CHU De Poitiers, PRISMATICS (Predictive Research in Spine/Neurostimulation Management and Thoracic Innovation in Cardiac Surgery)Poitiers University Hospital, 2 Rue De La Miléterie, Poitiers 86021, FranceTel +33 549 443 224Email maxime.billot2@gmail.comAbstract: One of the most widely conserved hallmarks of aging is a decline in functional capabilities. Mobility loss is particularly burdensome due to its association with negative health outcomes, loss of independence and disability, and the heavy impact on quality of life. Recently, a new condition, physical frailty and sarcopenia, has been proposed to define a critical stage in the disabling cascade. Physical frailty and sarcopenia are characterized by weakness, slowness, and reduced muscle mass, yet with preserved ability to move independently. One of the strategies that have shown some benefits in combatting mobility loss and its consequences for older adults is physical activity. Here, we describe the opportunities and challenges for the development of physical activity interventions in people with physical frailty and sarcopenia. The aim of this article is to review age-related physio(patho)logical changes that impact mobility in old age and to provide recommendations and procedures in accordance with the available literature.Keywords: physical exercise, muscle mass, strength, walking, balance, better aging

BACKGROUND: This study assesses prevalence and patients characteristics related to polypharmacy in a sample of nursing home residents. METHODS: We conducted a cross-sectional analysis on 4,023 nursing home residents participating to the Services and Health for Elderly in Long TERm care (SHELTER) project, a study collecting information on residents admitted to 57 nursing home in 8 countries. Data were collected using the interRAI instrument for long-term care facilities. Polypharmacy status was categorized in 3 groups: non-polypharmacy (0-4 drugs), polypharmacy (5-9 drugs) and excessive polypharmacy (>= 10 drugs). RESULTS: Polypharmacy was observed in 2,000 (49.7%) residents and excessive polypharmacy in 979 (24.3%) residents. As compared with non-polypharmacy, excessive polypharmacy was directly associated not only with presence of chronic diseases but also with depression (odds ratio [OR] 1.81; 95% confidence interval [CI] 1.38-2.37), pain (OR 2.31; 95% CI 1.80-2.97), dyspnoea (OR 2.29; 95% CI 1.61-3.27), and gastrointestinal symptoms (OR 1.73; 95% CI 1.35-2.21). An inverse association with excessive polypharmacy was shown for age (OR for 10 years increment 0.85; 95% CI 0.74-0.96), activities of daily living disability (OR for assistance required vs independent 0.90; 95% CI 0.64-1.26; OR for dependent vs independent 0.59; 95% CI 0.40-0.86), and cognitive impairment (OR for mild or moderate vs intact 0.64; 95% CI 0.47-0.88; OR for severe vs intact 0.39; 95% CI 0.26-0.57). CONCLUSIONS: Polypharmacy and excessive polypharmacy are common among nursing home residents in Europe. Determinants of polypharmacy status include not only comorbidity but also specific symptoms, age, functional, and cognitive status. [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]

Aim: The aim of this study was to obtain evidenced-based knowledge about older persons in home care; we conducted a population-based study at 11 sites in Europe (2001/2002). This article focuses on urinary incontinence and need for help in home care. Methods: A sample of 4010 respondents 65 years or older were assessed by the Resident Assessment Instrument for Home Care. Urinary incontinence was defined as leakage once a week or more including use of catheters. Results: A total of 1478 individuals had urinary incontinence, 45% men and 47% women. The use of pads ran from 29% to 52% between the sites. The associates of urinary incontinence were: moderate or severe cognitive impairment, dependency in toileting and other activities of daily living compared with less impaired; urinary infections, obesity and faecal incontinence. Caregivers to persons with urinary incontinence reported burden or stress more often then carers to nonurinary incontinence individuals (OR = 2.2, 95% CI 1.8-2.7). Conclusions: To enable older people with incontinence to stay at home with a better quality of life, they need caring assistance during toileting on a regular basis. [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]

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]

Objective. To examine the health and needs of extremely obese women aged over 65 years receiving home care in Europe. Study design. A cross-sectional assessment study based on the Aged in Home Care (AdHOC) project recruited 2974 women aged 65 or over who were receiving home care at 11 sites in European countries. Extreme obesity was defined as 'Obesity of such a degree as to interfere with normal activities, including respiration'. Main outcome measures: Resident Assessment Instrument for Home Care (RAI-HC version 2.0); Activity of Daily Living Scale; Instrumental Activity of Daily Living Scale; the Minimum Data Set Cognitive Performance Scale; and a health profile. Results: One hundred and twenty women (4.0%) were extremely obese. They were younger than their thinner counterparts, with a median age of 78.3 versus 83.3 years, and they more often had multiple health complaints and needed more help with mobility outside the home. The extremely obese had received home care longer than the non-extremely obese (median 28.7 versus 36.6 months). Extremely obese women also needed more help with personal care than the other group and, due to lower age, they were less cognitively impaired. Conclusions: Extreme obesity is a problem that increasingly affects home care of elderly women. INSET: 4. [ABSTRACT FROM AUTHOR]

BACKGROUND: using data from a cross-national data base we report the prevalence of urinary incontinence in nursing home residents, describe the main factors associated with bladder incontinence, and compare the usage of incontinence-related tests and care practices across countries. RESULTS: urinary incontinence is highly prevalent (43-65%) in the seven countries studied. Dependency in ambulating, cognitive impairment and urinary tract infections are significantly associated with urinary incontinence in nursing home populations in most countries. Large cross-country differences are observed in the percentage of elderly undergoing incontinence-related testing and in the percentage of residents using appliances and programmes to treat or prevent incontinence. CONCLUSION: this study of different cultural approaches and strategies to evaluate and treat urinary incontinence may stimulate a public debate on the quality of care in nursing homes and promote the sharing of care practices designed to reduce urinary incontinence. [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]

AIM: to illustrate demographic differences and recent trends in the provision and structure of long-term care systems in the 10 countries participating in the Resident Assessment Instrument studies (Denmark, France, Iceland, Italy, Japan, The Netherlands, Sweden, Switzerland, the UK and the USA). METHOD: data were assembled from government documents, statistical yearbooks and articles from journals; supplemental data on long-term care and nursing homes were solicited from colleagues. RESULTS: All 10 countries are developed nations with high life-expectancies. Sweden has the oldest and Iceland the youngest population in this study, with Japan showing the highest ageing rates over the next three decades. Between 2 and 5% of elderly people reside in nursing homes. Interestingly, Iceland, as the 'youngest country' in this study, has the highest rate of institutionalization (living in residential or nursing homes), while the 'oldest country' (Sweden) has a low rate of institutionalization. In all countries the support ratio (number of elderly people per 100 younger adults) is high and increasing rapidly. CONCLUSIONS: no relation appears to exist between the ageing status of a country and the number of nursing home beds. Institutionalization rates among the nations studied differ even more, due at least in part to differences in the organization and financing of long-term care services, in the amount of responsibility assumed in the care for disabled elderly people by each sector and the availability of long-term care beds. Facing a rapid ageing of their population, many countries are in the process of health and social care reforms. [ABSTRACT FROM AUTHOR]