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In light of the increasing life expectancy of Europe’s population and the rising significance of active and healthy ageing relating thereto, an integrated approach of nutritional care within primary health care is gaining importance. The aim of the review was to summarize evidence on the effectiveness of nutritional interventions in primary health care. The scoping review is based upon a comprehensive literature search of relevant literature published between January 2010 and August 2021 in PubMed, CINAHL, Cochrane Database of Systematic Reviews, Embase and Medline databases. Overall, 15 studies were included for evidence synthesis and interventions were basically clustered according to their type, into 1) eHealth and tele-medical interventions; 2) targeted single interventions; and 3) comprehensive, multi-faceted interventions. The review presents diverging evidence regarding the efficacy and effectiveness of interventions for nutritional care in primary health care, however, demonstrates encouraging outcomes. eHealth and tele-medical interventions partly show a careful positive tendency. Likewise, manifold single interventions on patient level present significant improvements in patient health outcomes. Multifaceted and comprehensive interventions found in the literature also partly demonstrate significant changes in intervention groups. Primary health care represents a critical setting for the care of older citizens and patients with complex health needs. This scoping review provides an overview of current nutrition care practices in primary health care and results reinforce the need to strengthen implementation of multi-faceted interventions carried out by the inter-disciplinary primary care team for advanced nutritional care.

Non-pharmacological interventions for people with dementia, like tablet-based cognitive trainings, are increasingly popular to counteract the disease progression. Usability research on such trainings in the field of dementia is essential to raise acceptance and increase training intensity, as regular practice may contribute to their effectiveness. The aim was to explore the experiences of people with Alzheimer's disease (PwAD), relatives, and dementia trainers regarding the usability of a tablet-based dementia training.This qualitative study is part of an ongoing randomized controlled trial (project multimodAAL) which investigates the effects of an individually performed tablet-based dementia training program (i.e., physical and cognitive exercises) in PwAD living at home. Individual interviews were conducted with people with mild AD (n=5), relatives (n=5) and dementia trainers (n=5) who had been performing the training for at least 6 months. A qualitative content analysis was conducted.Participants were predominantly women (73.3 %), with an average age of 73.4±11.4 years for PwAD, 66.2±10.7 years for relatives, and 43.1±10.4 years for trainers. Participants confirmed a good feasibility of the video-provided physical exercises (e.g., coordination, strength), but some PwAD reported feeling unchallenged. Relatives and trainers wished for exercises to be more motivating (e.g., direct motivational address by the gymnast in the video, colorful sportswear). Regarding cognitive exercises, participants appreciated the varied and alternating types of exercises (e.g., puzzle, quiz) within the training sessions. Trainers and relatives recognized that PwAD particularly enjoyed exercises related to topics of their past/biography (e.g., hobbies, previous occupation) and to religious/seasonal traditions (e.g., Easter). Relatives and trainers highlighted that most PwAD needed support during the physical and cognitive exercises in terms of (technical) guidance, motivation/feedback/praise, as well as hints/tips/thought-provoking impulses to perform their training successfully and to avoid frustration and cancellation of the training. Some suggested to extend the program regarding written and verbal support (e.g., hint button, voice assistant). Furthermore, participants emphasized a good sensitivity of the tablet-PCs' touch screen.Results show that the presented tablet-based dementia training is received well by participants, but there is still potential for (technical) enhancements regarding support through the exercises and motivational strategies.

People with mild cognitive impairment (MCI) are faced with a higher risk of developing dementia, but with a "window of opportunity" for prevention and treatment. Computerized cognitive interventions (CCIs) might constitute a beneficial non-pharmacological treatment approach. This systematic review evaluated evidence of CCIs performed individually with a computer, tablet-PC, game consoles, virtual reality (VR), or augmented reality (AR) on cognition in community-dwelling people with MCI.A systematic review and meta-analyses of randomized controlled trials (RCTs) was performed. The systematic literature search was conducted in MEDLINE, CINAHL, Embase, Cochrane CENTRAL, IEEE Xplore Digital Library, ISI Web of Knowledge, Scopus and PsycINFO, and included an additional search for gray literature. The search was completed by backward citation tracking. The methodological quality of the included RCTs was independently assessed by two reviewers. Comparable studies were pooled using the random-effects model.A total of 18 randomized controlled trials (RCTs) were identified. 12 RTCs were used for conducting meta-analyses which showed significant effects of CCIs for people with MCI in memory (SMD 1.12, CI 95 % [0.08, 2.16]), working memory (SMD 0.85, CI 95 % [0.32, 1.38]), attention/concentration/processing speed (SMD 0.61, CI 95 % [0.21, 1.02]), executive functioning (SMD 0.96, CI 95 % [0.26, 1.66]), and language (SMD 1.63, CI 95 % [0.20, 3.06]), but no significant improvement in global cognition. Pooling follow-up evaluations was not possible, but one of two studies showed continuing significant differences for the intervention group after 6 months post intervention in memory and working memory. CCIs were conducted predominantly with computers, followed by tablet-PCs, VR, AR, and mixed reality.This review demonstrated beneficial effects of CCIs on domain-specific cognition in people with MCI. Therefore, CCIs might be a valuable treatment option to maintain cognition and prevent progression to dementia. However, further research is necessary, especially on CCIs applied with emerging technologies like VR or AR. Furthermore, various outcome measurements used in the studies were challenging for the pooling of study results, which highlights the need for a predefined set of important cognitive outcomes and tools for future RCTs.

Introduction: Rates of falls increase with ageing and age-related biological and functional changes. Most falls in later life occur as a result of a complex interaction between multiple intrinsic and environmental risk factors. Falls and falls-related injuries are major public health problems that often require healthcare intervention and rehabilitation (1) and recurrent falls are a frequent trigger for older people and their families seeking long term institutional care. Therefore, the prevention and management of falls has substantial relevance for integrated care systems. This study sought to obtain international insight into the implementation of pathways or programs addressing balance, mobility and/or falls prevention in primary care or community services.Methods: A survey template was created to include the key elements detected during a literature review conducted by MUG. The template included questions on screening, assessment, intervention components, target group, professionals involved and tools used for assessment and/or monitoring experience and outcomes. Members of IFIC’s international Special Interest Groups(SIGs) on Ageing and Frailty, Intermediate Care were invited to complete an online EU Survey tool available from 01.06-01.08.2021. Responses were analysed by two researchers and results considered by the co-authors in an online focus group. Results: 16 people from 11 countries completed the online survey. 9/16 reported fully implemented falls programs or care pathways in their region or country: UK (3), Ireland (1), Spain (1), Indonesia (1), Peru (1), Australia (1) and Northwest USA (1). Seven examples are focused on older citizens but one is for older people with frailty & neurodegenerative diseases (New South Wales, Australia) and one is a pathway for patients in Indonesia, independent of disease and/or age limits. Professional disciplines involved differed across countries but allied health professionals and nurses were commonly involved. Family physicians were involved in only the examples from the USA and Indonesia. Specialist physicians in geriatric medicine were involved in five of the examples. Five programs involved pharmacists to advise on medication and two programs involved trained volunteers. Public/patient information and education was the most common intervention and was the sole intervention in the Spanish example reported. Three of the nine programs did not routinely evaluate patient experience or functional outcomes. Only three pathways enabled patient level data to flow through the electronic care record. Conclusion: The international survey offers initial insight into implemented pathways and programs for the prevention and management of falls in primary care and community settings in different countries. It paves the way for a more targeted survey and Delphi consensus process on the design and benchmarking of integrated services to address the challenge of falls in ageing societies.Implications: The evidence-based examples in the survey highlight processes and interventions that are readily transferable and where adoption will facilitate standardization and improved quality of care. The next phase aims to agree key components and performance indicators to allow future benchmarking and system-based evidence generation on prevention and management of falls in the community.References(1) World Health Organization. WHO global report on falls prevention in older age. World Health Organization; 2008.

Irritable bowel syndrome (IBS) is a common multifactorial condition that affects the large intestine and is characterized by chronic and relapsing abdominal pain and altered bowel habit. IBS is due to a combination of genetic, environmental and dietary factors. It's usually a lifelong problem very frustrating to live with and can have a big impact on quality of life, as single-agent therapy rarely relieves bothersome symptoms for all patients. The objective of this study was to analyze the approaches and solutions that address the social and health unmet needs of patients with IBS. A qualitative approach was adopted in the current study to identify and specify key digital solution and high impact user scenarios applied to IBS patients, through an adaptation of the "Blueprint on Digital Transformation in Health and Care in an Ageing Society" persona methodology. A Survey was administered to a group of patients in anonymous form. The theoretical elaboration IBS personas was developed through an interdisciplinary Focus Group, which also mapped the pathway for the patient's management. Three main needs were identified to be met to improve IBS patient's lifestyle: access to psychological support, mHealth solutions supporting diet and adapted physical activity, and homebased digital health support. mHealth intervention has been identified for diet adherence, physical exercise and psychological well-being. The process has been mapped and adapted to integrate the new solutions into the care pathway. Further research is needed to evaluate how mHealth services enable IBS patients to manage their conditions and improve their quality of life. KEY WORDS: Digital Health, Irritable bowel syndrome, mHealth, Nutrition, Physical activity, Psychological support.La sindrome dell’intestino irritabile (IBS) è una condizione multifattoriale comune che colpisce l’intestino crasso ed è caratterizzata da dolore addominale cronico e recidivante e alterazione delle abitudini intestinali. L’IBS è dovuta a una combinazione di fattori genetici, ambientali e dietetici. Di solito è un problema che permane per tutta la vita, molto frustrante per conviverci e può avere un grande impatto negativo sulla qualità della vita, poiché la terapia con un solo farmaco raramente allevia i sintomi fastidiosi per tutti i pazienti. L’obiettivo di questo studio era di analizzare gli approcci e le soluzioni che affrontano i bisogni sociali e sanitari insoddisfatti dei pazienti con IBS. Nel presente studio è stato adottato un approccio qualitativo per identificare e specificare la soluzione digitale chiave e gli scenari utente ad alto impatto applicati ai pazienti con IBS, attraverso un adattamento al singolo della metodologia “Blueprint on Digital Transformation in Health and Care in an Aging Society”. Un sondaggio è stato somministrato a un gruppo di pazienti in forma anonima. L’elaborazione teorica IBS personale è stata sviluppata attraverso un Focus Group interdisciplinare, che ha anche tracciato il percorso per la gestione del paziente. Sono state identificate tre esigenze principali da soddisfare per migliorare lo stile di vita dei pazienti affetti da IBS: accesso al supporto psicologico, soluzioni di mHealth a supporto della dieta e dell’attività fisica adattata e supporto sanitario digitale domiciliare. L’intervento mHealth è stato identificato per l’aderenza alla dieta, l’esercizio fisico e il benessere psicologico. Il processo è stato mappato e adattato per integrare le nuove soluzioni nel percorso assistenziale. Sono necessarie ulteriori ricerche per valutare in che modo i servizi di mHealth consentano ai pazienti con IBS di gestire le loro condizioni e migliorare la loro qualità di vita.

Background age-adapted definition of chronic kidney disease (CKD) does not take individual risk factors into account. We aimed at investigating whether functional impairments influence CKD stage at which mortality increases among older people. Methods our series consisted of 2,372 outpatients aged 75 years or more enrolled in a multicentre international prospective cohort study. The study outcome was 24-month mortality. Kidney function was assessed by estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (ACR). Geriatric assessments included handgrip strength, short physical performance battery (SPPB), cognitive impairment, dependency in basic activities of daily living (BADL) and risk of malnutrition. Analysis was carried out by Cox regression, before and after stratification by individual functional impairments. Survival trees including kidney function and functional impairments were also investigated, and their predictivity assessed by C-index. Results overall, mortality was found to increase starting from eGFR = 30–44.9 ml/min/1.73 m2 (hazard ratio [HR] = 3.28, 95% confidence interval [CI] = 1.81–5.95) to ACR = 30–300 mg/g (HR = 1.96, 95%CI = 1.23–3.10). However, in survival trees, an increased risk of mortality was observed among patients with impaired handgrip and eGFR = 45–59.9 ml/min/1.73 m2, as well as patients with ACR Conclusions physical performance helps to identify a proportion of patients at an increased risk of mortality despite a mild–moderate impairment in kidney function and improves predictive accuracy of individual measures of kidney function.

Background Although the burden of influenza infection is the highest in older adults, vaccination coverage remains low, despite this age group being more vulnerable than others. Aims Given the current pandemic of SARS-CoV-2, it was the aim of this scope review to update knowledge on factors affecting seasonal influenza vaccine uptake among older adults to strengthen prevention approaches in the context of an overall burden of infectious diseases. Methods We searched bibliographic databases from 2012 to 2019. All studies reviewed one or more social determinant of health listed by WHO, or factors affecting the decision-making process whether to accept influenza vaccine or not. Results Overall, 44 studies were included, 41 determinants were extracted and summarized into six categories. Older age and constitutional factors including multiple chronic diseases as well as preventive lifestyle and frequent routine healthcare utilization positively affected vaccination uptake (VU). Living and working conditions are also researched determinants of influenza vaccine uptake. A small number of studies explored the role of social inclusion and system-based interventions. Discussion and conclusions This scope review provides a comprehensive overview on factors affecting seasonal influenza vaccination uptake among older citizens. The review also clearly shows gaps for evidence on system-based level or political strategies to improve vaccination uptake.

Background Comprehensive geriatric assessment (CGA) has been in use for the last three decades. However, some doubts remain regarding its clinical use. Therefore, we aimed to capture the breadth of outcomes reported and assess the strength of evidence of the use of comprehensive geriatric assessment (CGA) for health outcomes in older persons. Methods Umbrella review of systematic reviews of the use of CGA in older adults searching in Pubmed, Embase, Scopus, Cochrane library and CINHAL until 05 November 2021. All possible health outcomes were eligible. Two independent reviewers extracted key data. The grading of evidence was carried out using the GRADE for intervention studies, whilst data regarding systematic reviews were reported as narrative findings. Results Among 1,683 papers, 31 systematic reviews (19 with meta-analysis) were considered, including 279,744 subjects. Overall, 13/53 outcomes were statistically significant (P Conclusions CGA seems to be beneficial in the hospital medical setting for multiple health outcomes, with a high certainty of evidence. The evidence of benefits is less strong for the use of CGA in other settings.

Key summary points Aim To assess which method (or combination of methods) are relevant and feasible to diagnose dehydration in nursing home residents. Findings International experts agreed on the relevance and feasibility of 9 anamnestic items, 8 physical symptoms and 3 blood tests to diagnose dehydration. This resulted in a diagnostic strategy consisting of a suspicion phase (including anamnestic items and physical symptoms) and a confirmation phase (including blood tests). Message This is the first study reaching international consensus about a strategy to diagnose dehydration in the nursing home. Electronic supplementary material The online version of this article (10.1007/s41999-020-00304-3) contains supplementary material, which is available to authorized users., Purpose Even though dehydration is a big problem among nursing home residents, a universally agreed method to diagnose dehydration among nursing home residents is missing. Therefore, this study aimed to establish consensus on a method to diagnose dehydration in this population. Methods Using an international Delphi study, 53 experts (physicians and advanced nurse practitioners) were asked to judge various methods to diagnose dehydration on relevance and feasibility in the nursing home. Based on the methods that gained consensus in the first and second round (≥ 75% consensus), a step-by-step diagnostic strategy was developed which was presented to, and judged by, the experts in round three. Results After the first and second round, consensus was reached on nine anamnestic items, eight physical symptoms and three blood tests. In the third round, 24 experts agreed with the developed step-by-step diagnostic strategy as a standard to diagnose dehydration in nursing home residents. Conclusion This is the first study reaching international consensus on a strategy to diagnose dehydration in the nursing home. This strategy comprehends a presumption phase, where anamnestic items and physical symptoms are examined, followed by a confirmation phase with blood tests to confirm the diagnosis of dehydration. Using this strategy, it is important to take the individual characteristics (e.g. co-morbidity) of the resident and its care environment (e.g. ambient temperature) into account. Electronic supplementary material The online version of this article (10.1007/s41999-020-00304-3) contains supplementary material, which is available to authorized users.

Background: Since the beginning of the COVID-19 pandemic, the treatment of patients with allergic and atopy-associated diseases has faced major challenges. Recommendations for “social distancing” and the fear of patients becoming infected during a visit to a medical facility have led to a drastic decrease in personal doctor-patient contacts. This affects both acute care and treatment of the chronically ill. The immune response after SARS-CoV-2 infection is so far only insufficiently understood and could be altered in a favorable or unfavorable way by therapy with monoclonal antibodies. There is currently no evidence for an increased risk of a severe COVID-19 course in allergic patients. Many patients are under ongoing therapy with biologicals that inhibit type 2 immune responses via various mechanisms. There is uncertainty about possible immunological interactions and potential risks of these biologicals in the case of an infection with SARS-CoV-2. Materials and methods: A selective literature search was carried out in PubMed, Livivo, and the internet to cover the past 10 years (May 2010 – April 2020). Additionally, the current German-language publications were analyzed. Based on these data, the present position paper provides recommendations for the biological treatment of patients with allergic and atopy-associated diseases during the COVID-19 pandemic. Results: In order to maintain in-office consultation services, a safe treatment environment must be created that is adapted to the pandemic situation. To date, there is a lack of reliable study data on the care for patients with complex respiratory, atopic, and allergic diseases in times of an imminent infection risk from SARS-CoV-2. Type-2-dominant immune reactions, as they are frequently seen in allergic patients, could influence various phases of COVID-19, e.g., by slowing down the immune reactions. Theoretically, this could have an unfavorable effect in the early phase of a SARS-Cov-2 infection, but also a positive effect during a cytokine storm in the later phase of severe courses. However, since there is currently no evidence for this, all data from patients treated with a biological directed against type 2 immune reactions who develop COVID-19 should be collected in registries, and their disease courses documented in order to be able to provide experience-based instructions in the future. Conclusion: The use of biologicals for the treatment of bronchial asthma, atopic dermatitis, chronic rhinosinusitis with nasal polyps, and spontaneous urticaria should be continued as usual in patients without suspected infection or proven SARS-CoV-2 infection. If available, it is recommended to prefer a formulation for self-application and to offer telemedical monitoring. Treatment should aim at the best possible control of difficult-to-control allergic and atopic diseases using adequate rescue and add-on therapy and should avoid the need for systemic glucocorticosteroids. If SARS-CoV-2 infection is proven or reasonably suspected, the therapy should be determined by weighing the benefits and risks individually for the patient in question, and the patient should be involved in the decision-making. It should be kept in mind that the potential effects of biologicals on the immune response in COVID-19 are currently not known. Telemedical offers are particularly desirable for the acute consultation needs of suitable patients.

No abstract available.

Background Polypharmacy is becoming increasingly common and all doctors must be prepared to manage it competently. Aims The aim of this project is to evaluate the feasibility and use of a novel gamification-based teaching intervention on polypharmacy among doctors undergoing advanced geriatric training. Among others, one of the learning goals for the students was to be able to describe the adherence to medication. Methods Electronic questionnaire sent to students of the third session “evidence-based medicine in geriatrics” of advanced postgraduate course in geriatrics of the European Academy for Medicine of Ageing. Results Most students reported issues with forgetting doses and remembering sufficiently to establish a medication routine due to busy schedules as well as social influences around medication taking. Reflecting on the challenges of the game, most students reported that their own prescribing practice was likely to change. Discussion and conclusion The current model of learning appears to be a feasible approach for postgraduate medical education or in other areas of healthcare such as nursing or physiotherapy. Learning through action and reflection promotes deeper thinking and can lead to behavioral change, in this case thus enhancing the attitudes and understanding regarding pharmacological issues associated with ageing. Recommendations for future research in medical education about medication adherence are outlined.

Background : Irritable bowel syndrome (IBS) is a common multifactorial condition that affects the large intestine and is characterized by chronic and relapsing abdominal pain and altered bowel habit. IBS is due to a combination of genetic, environmental and dietary factors. It's usually a lifelong problem very frustrating to live with and can have a big impact on quality of life, as single-agent therapy ra: Objective to analyze the approaches and solutions that address the social and health unmet needs of patients with IBS. Design: A quantitative-qualitative approach was adopted in the current study to identify and specify key digital solution and high impact user scenarios applied to IBS patients, through an adaptation of the “Blueprint on Digital Transformation in Health and Care in an Ageing Society” persona methodology. Settings: Digital health solutions bring the potential of supporting health interventions through mobile apps, wearable devices, telemedicine. Patients: A Survey was administered to a group of patients in an anonymous form, and no need for Medical Ethical Committee approval was identified. Interventions. The theoretical elaboration IBS personas was developed through an interdisciplinary Focus Group, which also mapped the pathway for the patient's management. Main Outcome : Three main needs were identified to be met to improve IBS patient’s lifestyle: access to psychological support, mHealth solutions supporting diet and adapted physical activity, and home-based digital health support. mHealth intervention has been identified for diet adherence, physical exercise and psychological well-being. The process has been mapped and adapted to integrate the new solutions into the care pathway. Limitation: Further research is needed to evaluate how mHealth services enable IBS patients to manage their conditions and improve their quality of life. Conclusion The person-centered approach was implemented through a multidisciplinary Focus group that enabled the identification of the need for a mHealth intervention

Non-pharmacological interventions, like tablet-based cognitive trainings, already present an important alternative treatment of dementia. For tablet-based cognitive trainings to be effective, regular practice seems to be required, highlighting the need for such trainings to be applicable not only in well-prepared laboratory settings, but also for continuous use at home. In order to raise the acceptance as well as the user-friendliness of such trainings to consequently increase training intensity, usability research is essential. Therefore, the aim of this study was to explore the experiences of people with Alzheimer’s disease (PwAD), relatives, and dementia trainers regarding the usability of a tablet-based dementia training practiced in the home setting.A qualitative study was performed within the ongoing randomized controlled trial of the project multimodAAL. In total 15 individual interviews (each 5 per target group) were conducted with people with mild AD, their relatives and dementia trainers, who were already assigned to the intervention group for at least 6 months, practicing a dementia training program, including physical and cognitive exercises on a tablet-PC at home. The interviews lasted 91.9 minutes on average. A qualitative content analysis was performed to analyze the data.Participants were predominantly female (73.3 %). PwAD and relatives stated that they had no previous experience with this type of computer-based cognitive training and had experienced the training as positive and enriching. Some relatives saw the joint performance as a meaningful activity with their loved ones. Participants confirmed that the different types of physical exercises (e.g., coordination, strength), presented in a video format were well feasible for PwAD. In this regard, some PwAD reported feeling a bit unchallenged. Relatives and dementia trainers recommended for the exercise videos to be more motivating and fun (e.g., direct motivational address by the gymnast in the video like in a tv show, colorful sportswear). Regarding cognitive exercises, participants appreciated the variety (e.g., quiz, puzzle, calculating) as well as the sequence of the different exercises within a training session. Dementia trainers and relatives perceived that exercises related to topics about past/biography (e.g., previous occupation, hobbies) and to religious/seasonal traditions (e.g., Christmas) were particularly appreciated among PwAD. In view of beneficial factors to complete a training session with its physical and cognitive exercises successfully, relatives and dementia trainers underlined that PwAD needed support in terms of (technical) guidance, motivation/feedback/praise, as well as hints/tips/thought-provoking impulses. Dementia trainers and relatives suggested that this could be achieved by a supporting person (e.g., dementia trainer) or an expansion of the program by written and verbal support (e.g., hint button, voice assistant). Furthermore, participants emphasized the need of a tablet pen for comfortable handling, as well as a high sensitivity of the tablet-PC's touch screen.The results show that the already applied tablet-based dementia training is well received and accepted by participants. However, there is still potential for enhancement regarding motivational and feedback strategies as well as user-friendliness by the addition of a comprehensive application for guiding through the physical and cognitive exercises to enable more independent practice sessions.

Key summary points Aim This scoping review aims to summarise recent developments in Geriatric Medicine that will potentially inform the updating of undergraduate medical curricula for geriatric content. Findings Based on the thematic analysis of 367 records out of 2503 identified records, we summarised findings across six major themes: curriculum; topics; teaching methods; teaching settings; medical students’ skills and medical students’ attitudes. Message This review could inform future shaping of undergraduate medical curricula for geriatric content, through model curricula, expansion of geriatric topics and use of various teaching methods and settings. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00595-0., 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. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00595-0.

Key summary points Aim The aims of this study were to describe communication experiences while wearing a mask during the COVID-19 pandemic in 2020, to identify possible mask-related barriers to COVID-19-adapted communications and to investigate whether the ABC mnemonic (A: Attend Mindfully; B: Behave Calmly; C: Communicate Clearly) might address these. Findings The majority of the respondents indicated issues related to lack of time during clinical encounters, uncertainty about how to adapt communication, lack of personal protective equipment, lack of communication skills and lack of information about how to adapt their own communication skills. In addition, the participants indicated acknowledging emotions and providing information using clear, specific, unambiguous, and consistent lay language while wearing a mask were among the main communication challenges created during the COVID-19 pandemic. Finally, the study showed significantly improved self-perceived competency regarding key communication after watching the short video presentation. Message Effective communication in medical encounters must utilize on both verbal and nonverbal skills., Purpose The aims of this study were to describe communication experiences while wearing a mask during COVID-19 pandemic in 2020, to identify possible mask-related barriers to COVID-19-adapted communications and to investigate whether the ABC mnemonic (A: attend mindfully; B: behave calmly; C: communicate clearly) might address these. Methods This study was a cross-sectional, voluntary, web-based survey between January and February 2021. A 22-item survey was developed using the Surveymonkey platform and question styles were varied to include single choice and Likert scales. The respondents were also asked to view a short video presentation, which outlined the ABC mnemonic. CHERRIES (Checklist for Reporting Results of Internet E-Surveys) was used to ensure completeness of reporting. Diverging stacked bar charts were created to illustrate Likert scale responses. Results We received 226 responses. The respondents were mostly women (60.2%) and the majority worked in a teaching hospital (64.6%). The majority of the respondents indicated issues related to lack of time during clinical encounters, uncertainty about how to adapt communication, lack of personal protective equipment, lack of communication skills and lack of information about how to adapt their own communication skills. In addition, the participants indicated acknowledging emotions and providing information using clear, specific, unambiguous, and consistent lay language while wearing a mask were among the main communication challenges created during the COVID-19 pandemic. Finally, the study showed significantly improved self-perceived competency regarding key communication after watching the short video presentation. Conclusion Effective communication in medical encounters requires both verbal and nonverbal skills.

Background : Frailty is associated with a prodromal stage called pre-frailty, a potentially reversible and highly prevalent intermediate state before frailty becomes established. Despite being widely-used in the literature and increasingly in clinical practice, it is poorly understood. Objective : To establish consensus on the construct and approaches to diagnose and manage pre-frailty. Methods : We conducted a modified (electronic, two-round) Delphi consensus study. The questionnaire included statements concerning the concept, aspects and causes, types, mechanism, assessment, consequences, prevention and management of pre-frailty. Qualitative and quantitative analysis methods were employed. An agreement level of 70% was applied. Results : Twenty-three experts with different backgrounds from 12 countries participated. In total 70 statements were circulated in Round 1. Of these, 52.8% were accepted. Following comments, 51 statements were re-circulated in Round 2 and 92.1% were accepted. It was agreed that physical and non-physical factors including psychological and social capacity are involved in the development of pre-frailty, potentially adversely affecting health and health-related quality of life. Experts considered pre-frailty to be an age-associated multi-factorial, multi-dimensional, and non-linear process that does not inevitably lead to frailty. It can be reversed or attenuated by targeted interventions. Brief, feasible, and validated tools and multidimensional assessment are recommended to identify pre-frailty. Conclusions : Consensus suggests that pre-frailty lies along the frailty continuum. It is a multidimensional risk-state associated with one or more of physical impairment, cognitive decline, nutritional deficiencies and socioeconomic disadvantages, predisposing to the development of frailty. More research is needed to agree an operational definition and optimal management strategies.

The meeting of the European Innovation Partnership on Active and Healthy Ageing (EIPonAHA) action group A3 together with members of the Reference site collaborative network (RSCN) in December 2019 in Rome focused on integration of evidence-based approaches on health and care delivery for older citizens at different levels of needs with expertise coming from stakeholder across Europe. It was the final aim of the group to co-create culturally sensitive pathways and facilitate co-ownership for further implementation of the pathways in different care systems across Europe. The study design is a mixed method approach. Based on data analysis from a cohort of community-dwelling over-65 citizens in the framework of a longitudinal observational study in Rome, which included health, social and functional capacity data, three personas profiles were developed: the pre-frail, the frail and the very frail personas. Based on these data, experts were asked to co-create care pathways due to evidence and eminence during a workshop and included into a final report. All working groups agreed on a common understanding that integration of care means person-centered integration of health and social care, longitudinally provided across primary and secondary health care including citizens' individual social, economic and human resources. Elements for consideration during care for pre-frail people are loneliness and social isolation, which, lead to limitation of physical autonomy in the light of reduced access to social support. Frail people need adaption of environmental structures and, again, social resource allocation to maintain at home. Very frail are generally vulnerable patients with complex needs. Most of them remain at home because of a strong individual social support and integrated health care delivery. The approach described in this publication may represent a first approach to scaling-up care delivery in a person-centered approach.

Background Frailty is associated with a prodromal stage called pre-frailty, a potentially reversible and highly prevalent condition before frailty becomes established. Despite this, there is no widely accepted definition of pre-frailty to support its early identification and management. This study applied an international consensus approach to define and better understand pre-frailty. Methods A modified electronic two-round Delphi Consensus study was conducted. In all, 23 experts from 12 countries with different backgrounds participated. The questionnaire was developed following a systematic literature review. An online consensus meeting was conducted with eight Delphi participants and two external experts. Qualitative and quantitative methods were employed for data analysis. An agreement level of 70% was applied for accepting statements. Results A total of 71 statements were circulated in Round 1. Of these, 52.8% were accepted. Fifty-one statements were re-circulated in Round 2, of which 92.1% were accepted. The online consensus meeting produced a consensus statement describing the concept, multi-factorial nature, and mechanism of pre-frailty as well as assessment, prevention and management approaches. All experts agreed that physical and non-physical factors such as psychological and social capacity are involved in the development of pre-frailty, potentially adversely affecting health and health-related quality of life outcomes. Practitioners should regard pre-frailty as a multi-factorial, multi-dimensional, and non-linear process that does not inevitably lead to frailty. It might be reversed or attenuated by targeted interventions. Brief, feasible and validated tools are recommended for opportunistic screening or case-finding followed by confirmation with multi-dimensional assessment. Conclusion It is difficult to establish consensus on one compact definition of pre-frailty, which is a multi-dimensional concept not only associated with physical impairment, but also with cognitive, nutritional, socioeconomic and other aspects of frailty. However, it may be too early to agree on an operational definition of pre-frailty since none yet exists for frailty.

The proportion of elderly, frail, and multimorbid people has increased dramatically in recent decades resulting from demographic changes and will further increase, which will impact acute medical care. Prospective, randomized studies on geriatric intensive care are still lacking. There are also no international or national recommendations regarding the management of critically ill elderly patients. Based on an expert opinion, this consensus paper provides 16 statements that should be considered when dealing with geriatric critical care patients.

It is well recognized that poor muscle function and poor physical performance are strong predictors of clinically relevant adverse events in older people. Given the large number of approaches to measure muscle function and physical performance, clinicians often struggle to choose a tool that is appropriate and validated for the population of older people they deal with. In this paper, an overview of different methods available and applicable in clinical settings is proposed. This paper is based on literature reviews performed by members of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) working group on frailty and sarcopenia. Face-to-face meetings were organized afterwards where the whole group could amend and discuss the recommendations further. Several characteristics should be considered when choosing a tool: (1) purpose of the assessment (intervention, screening, diagnosis); (2) patient characteristics (population, settings, functional ability, etc.); (3) psychometric properties of the tool (test–retest reliability, inter-rater reliability, responsiveness, floor and ceiling effects, etc.); (4) applicability of the tool in clinical settings (overall cost, time required for the examination, level of training, equipment, patient acceptance, etc.); (5) prognostic reliability for relevant clinical outcomes. Based on these criteria and the available evidence, the expert group advises the use of grip strength to measure muscle strength and the use of 4-m gait speed or the Short Physical Performance Battery test to measure physical performance in daily practice. The tools proposed are relevant for the assessment of muscle weakness and physical performance. Subjects with low values should receive additional diagnostic workups to achieve a full diagnosis of the underlying condition responsible (sarcopenia, frailty or other).

In daily clinical practice, the smooth, timely and comprehensive transfer of information between care settings is important and reflects a cornerstone of high-quality patient care. The integration of nutritional information in the medical information transfer is currently not included in an evidence-based approach. It was, therefore, the aim of this study to develop a nutritional documentation tool (NDoc) on the basis of evidence and test it for its usability in daily clinical practice. Based on the results of a literature review, the authors collected core content using a modified Delphi survey from experts across Europe and included the information collected in a structured, NDoc. The subsequently developed tool included thirty items and was tested for its usability on a daily basis among primary care physicians and clinical physicians. The new NDoc can be introduced for use in any computer-based hospital information system regionally and adapted for worldwide use.

Background Monitoring trajectories of intrinsic capacity (IC) in older adults has been suggested by the World Health Organization as a means to inform prevention to avoid or delay negative health outcomes. Due to a lack of longitudinal studies, it is currently unclear how IC changes over time and whether repeatedly measured IC predicts negative health outcomes. Methods Based on 4 751 repeated observations of IC (range = 0–100) during 21 years of follow-up among 754 older adults 70 and older, we assessed longitudinal trajectories of IC, and whether time-varying IC predicted the risk of chronic activities of daily living disability, long-term nursing home stay, and mortality using joint models. Results Average IC declined progressively from 77 to 11 points during follow-up, with substantial heterogeneity between older adults. Adjusted for sociodemographics and chronic diseases, a 1-point lower IC value was associated with a 7% increase in the risk of activities of daily living disability, a 6% increase in the risk of a nursing home stay, and a 5% increase in mortality. Accuracy for 5- and 10-year predictions based on up to 3 repeated measurements of IC ranged between moderate and good (area under the receiver operating characteristic curve = 0.76–0.82). Conclusions Our study indicates that IC declines progressively and that it predicts negative health outcomes among older adults. Therefore, regular monitoring of IC could work as an early warning system informing preventive efforts.

This article describes how innovations are exploited in Campania (Italy) to improve health outcomes, quality of life, and sustainability of social and healthcare services. Campania's strategy for digitalization of health and care and for healthy aging is based on a person-centered, life-course, “One Health” approach, where demographic change is considered capable of stimulating a growth dynamic linked to the opportunities of combining the “Silver Economy” with local assets and the specific health needs of the population. The end-users (citizens, patients, and professionals) contribute to the co-creation of products and services, being involved in the identification of unmet needs and test-bed activity. The Campania Reference Site of the European Innovation Partnership on Active and Healthy Aging is a flexible regional ecosystem to address the challenge of an aging population with a life-course approach. The good practices, developed in the context of research and innovation projects and innovative procurements by local stakeholders and collaborations with international networks, have been allowing the transfer of innovative solutions, knowledge, and skills to the stakeholders of such a multi-sectoral ecosystem for health.

In view of ongoing demographic developments resulting in a longer life expectancy of the European population, the creation of &ldquo, age-friendly&rdquo, environments represents an initiative picked up by the European Union and its Member States to enable active and healthy ageing. The present study aims at the co-creation of a cross-border framework model to deploy a healthy ageing region linking Austria and Slovenia, building on previous work dealing with the development of an integrated regional ecosystem for active and healthy ageing. A qualitative, community-based action research method based on focus group discussions allowed the development of an exemplary framework model for active and healthy ageing building on cross-border collaboration in the region of Promura. Within the project group, twelve cross-border regional key assets were identified. In the course of further open discussions, an exemplary model for the deployment of a cross-border healthy ageing region was developed, comprising underlying fundamental environmental aspects, regional structures in the field of health and care as well as crosscutting features spreading across all levels. This article presents a promising, strategic co-creation approach on how to span a model on active and healthy ageing across two cross-border regions with similar characteristics and assets.

The challenge of an ageing population requires a paradigmatic shift in the way we provide social and healthcare services, demanding the need to prioritize the functionality and independence of older adults. The risk and subsequent fear of falling is one of the most high-risk states for older adults, as it generates a destabilizing effect on their health that is often hard to recover. It is essential to thoroughly address their risk factors and mitigators. This discussion needs to be made in light of a person-centered perspective that goes beyond fragilities to capitalize on the strengths of the older adults. The chapter provides examples of how to connect assessment, interventions, and monitoring to a coherent framework approach that mitigates the risks and the impact of falls on an ageing society. The authors explore how technological innovation, urban planning, and regional policies that are culturally relevant can be incorporated in creating a circular economy while meeting the needs of an aging population and preventing falls and cognitive decline.

Background The analysis of mobile health (mHealth) data has generated innovative insights into improving allergic rhinitis control, but additive information is needed. A cross-sectional real-world observational study was undertaken in 17 European countries during and outside the estimated pollen season. The aim was to collect novel information including the phenotypic characteristics of the users. Methods The Allergy Diary–MASK-air–mobile phone app, freely available via Google Play and App, was used to collect the data of daily visual analogue scales (VASs) for overall allergic symptoms and medication use. Fluticasone Furoate (FF), Mometasone Furoate (MF), Azelastine Fluticasone Proprionate combination (MPAzeFlu) and eight oral H1-antihistamines were studied. Phenotypic characteristics were recorded at entry. The ARIA severity score was derived from entry data. This was an a priori planned analysis. Results 9037 users filled in 70,286 days of VAS in 2016, 2017 and 2018. The ARIA severity score was lower outside than during the pollen season. Severity was similar for all treatment groups during the pollen season, and lower in the MPAzeFlu group outside the pollen season. Days with MPAzeFlu had lower VAS levels and a higher frequency of monotherapy than the other treatments during the season. Outside the season, days with MPAzeFlu also had a higher frequency of monotherapy. The number of reported days was significantly higher with MPAzeFlu during and outside the season than with MF, FF or oral H1-antihistamines. Conclusions This study shows that the overall efficacy of treatments is similar during and outside the pollen season and indicates that medications are similarly effective during the year.

There are large between- and within-country variations in COVID-19 death rates. Some very low death rate settings such as Eastern Asia, Central Europe, the Balkans and Africa have a common feature of eating large quantities of fermented foods whose intake is associated with the activation of the Nrf2 (Nuclear factor (erythroid-derived 2)-like 2) anti-oxidant transcription factor. There are many Nrf2-interacting nutrients (berberine, curcumin, epigallocatechin gallate, genistein, quercetin, resveratrol, sulforaphane) that all act similarly to reduce insulin resistance, endothelial damage, lung injury and cytokine storm. They also act on the same mechanisms (mTOR: Mammalian target of rapamycin, PPARγ:Peroxisome proliferator-activated receptor, NFκB: Nuclear factor kappa B, ERK: Extracellular signal-regulated kinases and eIF2α:Elongation initiation factor 2α). They may as a result be important in mitigating the severity of COVID-19, acting through the endoplasmic reticulum stress or ACE-Angiotensin-II-AT1R axis (AT1R) pathway. Many Nrf2-interacting nutrients are also interacting with TRPA1 and/or TRPV1. Interestingly, geographical areas with very low COVID-19 mortality are those with the lowest prevalence of obesity (Sub-Saharan Africa and Asia). It is tempting to propose that Nrf2-interacting foods and nutrients can re-balance insulin resistance and have a significant effect on COVID-19 severity. It is therefore possible that the intake of these foods may restore an optimal natural balance for the Nrf2 pathway and may be of interest in the mitigation of COVID-19 severity.

ObjectiveTo determine whether a multicomponent intervention based on physical activity with technological support and nutritional counselling prevents mobility disability in older adults with physical frailty and sarcopenia.DesignEvaluator blinded, randomised controlled trial.Setting16 clinical sites across 11 European countries, January 2016 to 31 October 2019.Participants1519 community dwelling men and women aged 70 years or older with physical frailty and sarcopenia, operationalised as the co-occurrence of low functional status, defined as a short physical performance battery (SPPB) score of 3 to 9, low appendicular lean mass, and ability to independently walk 400 m. 760 participants were randomised to a multicomponent intervention and 759 received education on healthy ageing (controls).InterventionsThe multicomponent intervention comprised moderate intensity physical activity twice weekly at a centre and up to four times weekly at home. Actimetry data were used to tailor the intervention. Participants also received personalised nutritional counselling. Control participants received education on healthy ageing once a month. Interventions and follow-up lasted for up to 36 months.Main outcome measuresThe primary outcome was mobility disability (inability to independently walk 400 m in ResultsMean age of the 1519 participants (1088 women) was 78.9 (standard deviation 5.8) years. The average follow-up was 26.4 (SD 9.5) months. Among participants with SPPB scores of 3-7, mobility disability occurred in 283/605 (46.8%) assigned to the multicomponent intervention and 316/600 (52.7%) controls (hazard ratio 0.78, 95% confidence interval 0.67 to 0.92; P=0.005). Persistent mobility disability occurred in 127/605 (21.0%) participants assigned to the multicomponent intervention and 150/600 (25.0%) controls (0.79, 0.62 to 1.01; P=0.06). The between group difference in SPPB score was 0.8 points (95% confidence interval 0.5 to 1.1 points; PConclusionsA multicomponent intervention was associated with a reduction in the incidence of mobility disability in older adults with physical frailty and sarcopenia and SPPB scores of 3-7. Physical frailty and sarcopenia may be targeted to preserve mobility in vulnerable older people.Trial registrationClinicalTrials.gov NCT02582138.