is6.01: can we fight against sarcopenia?
TRANSCRIPT
Invited symposia / European Geriatric Medicine 5S1 (2014) S1–S15 S7
to assess preferences regarding life-sustaining treatments, site of
death, presence of advance care planning, and quality of patient-
clinician communication about end-of-life care.
Results: 78% of the patients completed 1-yr follow-up (64% men;
mean (SD) age: 67 (13) yrs). Most patients asserted that in their
current health status, they would prefer CPR. Patients’ treatment
preferences were influenced by burden of treatment, outcome of
treatment, and likelihood of outcome. CPR preferences changed in
38.3% of the patients during follow up. Most patients preferred to
die at home, but within one year, 61.2% of the patients changed their
preference. Advance directives were discussed with the physician
specialist by 5.9% of patients with COPD, 3.9% of patients with
CHF and 30.3% of the patients with CRF. Patients rated quality of
patient-physician end-of-life care communication as poor.
Conclusions: Despite the fact that patients are able to indicate
their preferences regarding life-sustaining treatments and end-of-
life care, these preferences are rarely discussed with their physician
specialist. This study shows a need for advance care planning among
patients with COPD, CHF, or CRF, including patient-physician end-
of-life care communication.
SIG geriatric education across Europe
IS5.05
Development of a European undergraduate curriculum across
Europe
T. Masud
Nottingham University Hospitals NHS Trust, United Kingdom
The rise in the number of older, frail adults necessitates that future
doctors are adequately trained in the skills of geriatric medicine.
Few countries have dedicated curricula in geriatric medicine at the
undergraduate level. This presentation describes the development
of a consensus using a Delphi technique among geriatricians on a
curriculum with the minimal requirements that a medical student
should achieve by the end of medical school. Firstly, educational
experts and geriatricians proposed a set of learning objectives based
on a literature review. Secondly, three Delphi rounds involving
a panel with 49 experts representing 29 countries affiliated to
the European Union of Medical Specialists (UEMS) was used
to gain consensus for a final curriculum. The final curriculum
consisted of detailed objectives grouped under 10 overarching
learning outcomes. All outcomes are specifically related to the
special knowledge, skills and attitudes needed for medical care
of older people. Major efforts will be needed to implement these
requirements, given the large variation in the quality of geriatric
teaching in medical schools. This curriculum is a first step to help
improve teaching of geriatrics in medical schools, and will also
serve as a basis for advancing postgraduate training in geriatrics
across Europe.
IS5.06
Undergraduate training in European medical schools:
achievements and challenges
A. Stuck
Geriatrics University of Bern, Switzerland
There is evidence of highly variable quality in geriatric
undergraduate training in universities across Europe. A recently
developed curriculum with minimum requirements for teaching
geriatrics in undergraduate medical training (Masud T et al, Age and
Ageing 2014) might help as a starting point for quality improving.
This presentation will analyse achievements and challenges in
the covering the 10 overarching learning outcomes as defined
in the curriculum (ageing principles, common medical conditions,
performance of geriatric assessment, medication use, multiple co-
morbidities and social factors, ethical/legal issues, role of other
health professions, healthcare in different settings, and regional
health and social care aspects). We will present and discuss new
didactic approaches that might help in the development of teaching
modules to address some of the key learning outcomes. With the
advancement of internet-based teaching approaches, there is a high
but underused potential for collaboration across countries.
Keynote Lecture
IS6.01
Can we fight against sarcopenia?
J.E. Morley
Saint Louis University, ST. Louis, USA
Sarcopenia is a major component of frailty. Sarcopenia is now
defined as decreased gait speed or grip strength together with
loss of muscle mass. A new screen for sarcopenia – The SARC F –
has been developed and validated. This can be rapidly utilized
by general practitioners. Resistance and aerobic exercise are the
cornerstone of the treatment of sarcopenia. Vitamin D and essential
amino acids represent secondary treatments. There is some data
to support the use of testosterone. The use of SARMs and
antimyostatin molecules remain experimental.
Round Table. Crossing borders: challenges inEuropean geriatric rehabilitation
IS6.03
Community hospital care, the answer to effective and efficient
geriatric rehabilitation?
A.L. Gordon
Nottingham University Hospitals NHS Trust, Nottingham, United
Kingdom
Community Hospitals in the UK are heterogeneous but are
commonly small and often have minimal medical staffing with
no or little diagnostic facilities. They are an important part of
the spectrum of intermediate care and provide a venue where
older adults can receive step-up admission from primary care
teams or step down admission following admission to an acute
hospital. Where they are used in this way, they are a venue for
Comprehensive Geriatric Assessment (CGA).
Community hospital-based intermediate care has been subjected
to robust evaluation and has been shown to improve patient
outcomes. When used in this way, they are clinically and cost-
effective and probably result in increased independence when
compared with routine discharge practice from acute hospitals.
Community Hospital-based rehabilitation, although cost-effective,
costs more than other forms of ‘bed-based’ intermediate care,
particularly that provided in residential homes. Although not
compared head-to-head in randomised controlled trials, residential
home-based intermediate care has less convincing evidence
supporting its efficacy. This presents a challenge for commissioners
trying to make the most of scarce financial resources whilst also
ensuring that they have services which are adequate to meet the
full range of ‘step up’ and ‘step down’ rehabilitation needs for older
adults with frailty.
In reality, services for older adults with frailty in acute hospital,
community hospital, residential and hospital-at-home settings
are a continuum and are likely to work most effectively when
commissioned jointly rather than as alternatives to each other.
The importance of clear conceptualisation and implementation
of CGA when commissioning such services as a spectrum of