Sarcopenia: a physical marker of frailty

peer reviewedSarcopenia is defined by loss of muscular mass, strength and quality that occur in elderly. Multiple factors underlie this process: low physical activity, low steroids hormones, increase of cytokines, loss of motoneurons, decrease of protein synthesis...However, the role of these factors is not yet well understood and consensual clinical definition and assessment are still needed. It has become an important area of research because of its frequency and the influence in the disability of old people. It is a major component of frailty. So far, no pharmacological treatment has proven definitive evidence to treat or prevent sarcopenia. Nevertheless, it needs a multidimensional approach based on physical activity and prevention of malnutrition

Pitfalls in the measurement of muscle mass: a need for a reference standard

Background All proposed definitions of sarcopenia include the measurement of muscle mass, but the techniques and threshold values used vary. Indeed, the literature does not establish consensus on the best technique for measuring lean body mass. Thus, the objective measurement of sarcopenia is hampered by limitations intrinsic to assessment tools. The aim of this study was to review the methods to assess muscle mass and to reach consensus on the development of a reference standard. Methods Literature reviews were performed by members of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis working group on frailty and sarcopenia. Face‐to‐face meetings were organized for the whole group to make amendments and discuss further recommendations. Results A wide range of techniques can be used to assess muscle mass. Cost, availability, and ease of use can determine whether the techniques are better suited to clinical practice or are more useful for research. No one technique subserves all requirements but dual energy X‐ray absorptiometry could be considered as a reference standard (but not a gold standard) for measuring muscle lean body mass. Conclusions Based on the feasibility, accuracy, safety, and low cost, dual energy X‐ray absorptiometry can be considered as the reference standard for measuring muscle mass

Management of osteoporosis of the oldest old

Summary: This consensus article reviews the diagnosis and treatment of osteoporosis in geriatric populations. Specifically, it reviews the risk assessment and intervention thresholds, the impact of nutritional deficiencies, fall prevention strategies, pharmacological treatments and their safety considerations, the risks of sub-optimal treatment adherence and strategies for its improvement. Introduction: This consensus article reviews the therapeutic strategies and management options for the treatment of osteoporosis of the oldest old. This vulnerable segment (persons over 80years of age) stands to gain substantially from effective anti-osteoporosis treatment, but the under-prescription of these treatments is frequent. Methods: This report is the result of an ESCEO (European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis) expert working group, which explores some of the reasons for this and presents the arguments to counter these beliefs. The risk assessment of older individuals is briefly reviewed along with the differences between some intervention guidelines. The current evidence on the impact of nutritional deficiencies (i.e. calcium, protein and vitamin D) is presented, as are strategies to prevent falls. One possible reason for the under-prescription of pharmacological treatments for osteoporosis in the oldest old is the perception that anti-fracture efficacy requires long-term treatment. However, a review of the data shows convincing anti-fracture efficacy already by 12months. Results: The safety profiles of these pharmacological agents are generally satisfactory in this patient segment provided a few precautions are followed. Conclusion: These patients should be considered for particular consultation/follow-up procedures in the effort to convince on the benefits of treatment and to allay fears of adverse drug reactions, since poor adherence is a major problem for the success of a strategy for osteoporosis and limits cost-effectiveness

New horizons in geriatric medicine education and training: the need for pan-European education and training standards

The ageing population ought to be celebrated as evidence for the efficacy of modern medicine, but the challenge that this demographic shift presents for 21st century healthcare systems, with increasing numbers of people living with multi-morbidity and frailty, cannot be ignored. There is therefore a need to ensure that all healthcare professionals grasp the basic principles of care of older people. In this paper, we make a case for the development of pan-European education and training standards for the field of geriatric medicine. Firstly, the challenges which face the implementation and delivery of geriatric medicine in a systematic way across Europe are described – these include, but are not limited to; variance in geriatric medicine practice across Europe, insecurity of the specialty in some countries and significant heterogeneity in geriatric medicine training programs across Europe. The opportunities for geriatric medicine are then presented and we consider how engendering core geriatric medicine competencies amongst nongeriatricians has potential to bridge existing gaps in service provision across Europe. Finally, we consider how work can proceed to teach sufficient numbers of doctors and health professionals in the core knowledge, skills and attitudes required to do this. To safeguard the future of the specialty across Europe, we contend that there is a need to strive towards harmonisation of post-graduate geriatric medicine training across Europe, through the establishment of pan-European education and training standards in the specialty

European postgraduate curriculum in geriatric medicine developed using an international modified Delphi technique

the European Union of Medical Specialists (UEMS-GMS) recommendations for training in Geriatric Medicine were published in 1993. The practice of Geriatric Medicine has developed considerably since then and it has therefore become necessary to update these recommendations.under the auspices of the UEMS-GMS, the European Geriatric Medicine Society (EuGMS) and the European Academy of Medicine of Ageing (EAMA), a group of experts, representing all member states of the respective bodies developed a new framework for education and training of specialists in Geriatric Medicine using a modified Delphi technique. Thirty-two expert panel members from 30 different countries participated in the process comprising three Delphi rounds for consensus. The process was led by five facilitators.the final recommendations include four different domains: General Considerations on the structure and aim of the syllabus as well as quality indicators for training (6 sub-items), Knowledge in patient care (36 sub-items), Additional Skills and Attitude required for a Geriatrician (9 sub-items) and a domain on Assessment of postgraduate education: which items are important for the transnational comparison process (1 item).the current publication describes the development of the new recommendations endorsed by UEMS-GMS, EuGMS and EAMA as minimum training requirements to become a geriatrician at specialist level in EU member states

Do statins have a place for cardiovascular prevention in elderly people?

peer reviewedCardiovascular prevention should only be considered if the treatment reduces the incidence of coronary and cerebrovascular events and death. In elderly people, such treatment should also, and most importantly, help maintain a good quality of life, without increasing the risk of iatrogenic side-effects. These key-elements should be kept in mind when prescription of a statin is envisaged in the old (> 70 years) and especially the very old (> 80 years) individual. Randomised controlled trials in people above 70 years are rather rare. In the field of cardiovascular prevention, two studies provide information, on post-hoc analysis of the Heart Protection Study (HPS) with simvastatin and the PROSPER trial with pravastatin. The protection observed in the general population of HPS was also present in the subgroup of subjects aged above 70, both for coronary and cardiovascular events. The difference was less impressive in PROSPER, without any significant difference as far as the incidence of stroke was concerned. None of these two prospective trials provide specific data on individuals above 80. Interestingly, some experimental and epidemiological observations suggested that statins may prevent Alzheimer disease. However, the data from HPS and PROSPER are not convincing in this respect. Thus, results from new ongoing trials should be awaited, especially in patients with mild to moderate Alzheimer disease. Finally, it is noteworthy that low serum cholesterol level can be used as a marker of poor nutrition in very old people. Such condition is rather common, especially among institutionalised subjects, and is usually associated with a higher risk of morbidity and mortality