is6.01: can we fight against sarcopenia?

1
Invited symposia / European Geriatric Medicine 5S1 (2014) S1S15 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 in European 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

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Page 1: IS6.01: Can we fight against sarcopenia?

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