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Background: Geriatric Medicine (GM), concerned with well-being and health of older adults, can play a crucial role in the alignment of healthcare systems to the needs of the aged populations. However, countries have varying GM development backgrounds. The goal of PROGRAMMING- COST 21,122 Action is to propose the content of education and training activities in GM for healthcare professionals across various clinical settings, adapted to local context, needs, and assets. Defining relevant stakeholders and addressing them on both an international as well as a country-specific level is crucial for this purpose. In this paper we are describing the methods used in the PROGRAMMING Action 21,122 to map the different categories of stakeholders to be engaged in the Action. Methods: Through conceptualizing a model for stakeholders by literature research, and online discussion group meetings, a synthesis for the potential stakeholders was defined as a template, and pilot applications were requested from participant countries. Results: There were 24 members from 14 countries (6 males/18 females) of multidisciplinary professions involved in this study. A model for the list of stakeholders to be addressed was developed and, after seven online discussion meetings, a consensus framework was provided. Invited countries completed the templates to pilot such operationalization. Conclusion: Our framework of stakeholders will support the research coordination and capacity-building objectives of PROGRAMMING, including the participation into the assessment of educational needs of healthcare professionals. Identified stakeholders will also be mobilized for purposes of dissemination and maximization of the Action's impact. By defining and mapping multidisciplinary stakeholders involved in older people's care specific to countries, particularly where GM is still emerging, GM tailored educational activities will be facilitated and optimally targeted. [ABSTRACT FROM AUTHOR]

Key summary points: Aim: The aim of the study was to check the frequency of reporting of appetite status in hospitalized older adults and to analyze the terms documented by physicians when reporting reduced appetite. Findings: In our setting appetite was not assessed using standardized questionnaires. Appetite was mentioned in 13.3% of medical notes. Message: The lack of routinely performed appetite assessment procedures results in low rates of mention of appetite status in electronic medical records. Purpose: Reduced appetite is a common issue among older adults. However, its formal assessment is rarely undertaken in clinical practice. The aim of the study was to check the frequency of reporting of appetite status in hospitalized older adults and to analyze the terms documented by physicians when reporting reduced appetite. Methods: A retrospective analysis of electronic medical records of hospitalized patients aged 65 and older was conducted. To determine patients' appetite status structured appetite assessment or any references related to appetite were considered. Results: We included 1291 individual patients' medical records, of which 13.3% contained any reference to appetite. We showed that in our setting, appetite was not assessed according to standardized questionnaires. In addition, appetite status was documented with inconsistent terminology. Conclusions: Appetite status was rarely noted in electronic medical records. The lack of a structured assessment of reduced appetite in older patients was found. [ABSTRACT FROM AUTHOR]

Purpose: To present the two-day Delirium Awareness Day-related event held at the University Hospital, Kraków, Poland. Methods: Activities included a lecture, a multimedia presentation, meetings with healthcare workers at their respective wards, and distribution of information posters about delirium. Local news outlets were also engaged. Results: We reached out to approximately 300 persons in the hospital itself and several thousand via TV and radio broadcasts. We prompted interdisciplinary discussions about delirium, especially concerning preventive measures. The most common questions were how to alleviate symptoms as soon as possible, with the expectation of straightforward solutions for the non-geriatrician staff. Patient distress and burden on caregivers were important topics brought-up in the discussions. Conclusion: We demonstrated that our educational initiative was feasible and well-accepted among medical staff. Local media helped in building public understanding of delirium. Education about the syndrome should be one of the key societal tasks of geriatricians. [ABSTRACT FROM AUTHOR]

Background: The prevalence of frailty and its components may be affected by age, diseases and geriatric deficits. However, the current operational definition of frailty assigns equal weight to the five components of frailty. Aims: To perform a population-based assessment of physical frailty, its prevalence, and distribution of its components across different age, disease and deficit spectrum. Methods: From 2018 to 2019, we conducted a face-to-face cross-sectional assessment of a representative sample of older Poles. We obtained data on frailty components, chronic disease burden, and prevalence of particular diseases and geriatric deficits. We calculated weighted population estimates, representative of 8.5 million older Poles, of prevalence of frailty and its components across the disease burden, associated with the particular diseases and the geriatric deficits present. Results: Of 10,635 screened persons ≥ 60 years, 5987 entered the face-to-face assessment. Data of 5410 have been used for the present analysis. Seventy-two percent of the population are burdened with at least one frailty component. The estimated weighted population prevalence (95% CI) of frailty was 15.9% (14.6–17.1%), and of pre-frailty 55.8% (53.3–58.2%). Slow gait speed predominated across disease burden, specific diseases, geriatric deficits and the age spectrum. Overall, the prevalence of slow gait speed was 56.3% (52.7–60.0%), followed by weakness 26.9% (25.4–28.4%), exhaustion 19.2% (17.6–20.8%), low physical activity 16.5% (14.8–18.3%), and weight loss 9.4% (8.4–10.3%). Conclusions: Slow gait speed predominates among the components of frailty in older Poles. This may affect the component-tailored preventive and therapeutic actions to tackle frailty. [ABSTRACT FROM AUTHOR]

Background: Ankle-brachial index (ABI) is a screening tool for peripheral arterial disease (PAD). However, persons with normal ABI may still exhibit abnormalities in the physical examination of arterial system (PHEA). Objective: In older persons from the PolSenior study, we aimed to assess the risk of total mortality associated with abnormalities in PHEA in the context of dichotomised ABI. Methods: We used data from the PolSenior survey and matched them with mortality information from the Polish Census Bureau. We obtained sociodemographic, medical history, and lifestyle data. The PHEA by a geriatrician included carotid, femoral, popliteal, posterior tibial and the dorsalis pedis arterial pulses, and auscultation of aorta, carotid, femoral, and renal arteries. Ankle-brachial index was tibial to brachial SBP ratio. We plotted the stratified Kaplan–Meier curves and used Cox's regression to assess the unadjusted and adjusted influence of PHEA result on time to death. Results: The mean (standard deviation, SD) age of 852 persons (46.7% women) was 74.7 (10.6) years. In the ABI < 0.9 group, the PHEA was not associated with mortality. However, in the ABI ≥ 0.9 group, both in unadjusted and adjusted (RHR; 95% CI: 1.08; 1.02–1.16, p = 0.01) Cox regression, PHEA greater by 1 score was associated with mortality. Presence of 4 or more PHEA abnormalities was raising the risk in the ABI ≥ 0.9 group to the level associated with ABI < 0.9. Conclusions: In the older persons with normal ABI, the greater number of abnormalities during physical examination of arteries may be indicative of higher risk of death. [ABSTRACT FROM AUTHOR]

To assess the relationship between ankle-brachial index (ABI) and up to 10-year mortality in older individuals below and above the age of 80 years. In a multicenter survey of health status in the community dwelling subjects aged 55–59 and 65 + years in Poland, we assessed baseline medical history including risk-factors. We measured ABI, and serum creatinine, cholesterol, NT-proBNP, and interleukin-6 (IL-6) concentrations. We assessed mortality based on public registry. Between 2009 and 2019, 27.3% of 561 participants < 80 years, and 79.4% of 291 participants ≥ 80 years, died (p < 0.001); 67.8, 41.5, and 40.3% in the ABI groups < 0.9, 0.9–1.4, and > 1.4, respectively (p < 0.01). In the unadjusted Cox models, ABI was associated with mortality in the entire group, and < 80 years. In the entire group, analysis adjusted for age and sex showed mortality risk increased by 11% per year, and 50% with male sex. Mortality decreased by 37% per 1 unit ABI increase. In the group of people ≥ 80 years, only age was significantly associated with mortality (p < 0.001). In stepwise regression ABI < 0.9, male sex, active smoking, and NT-proBNP level were associated with risk of death < 80 years. In the ≥ 80 years old, mortality risk was associated with older age, and higher levels of IL-6, but not ABI. The ABI < 0.9 is associated with higher mortality in older people, but not among the oldest-old. In the oldest age group, age is the strongest predictor of death. In this age group, inflammageing is of importance. [ABSTRACT FROM AUTHOR]

In this review, we discuss the pathophysiologic and management aspects of acute sarcopenia in relation to SARS-CoV-2 infection. COVID-19 is as a multi-organ infectious disease characterized by a severe inflammatory and highly catabolic status, influencing the deep changes in the body build, especially the amount, structure, and function of skeletal muscles which would amount to acutely developed sarcopenia. Acute sarcopenia may largely impact patients' in-hospital prognosis as well as the vulnerability to the post-COVID-19 functional and physical deterioration. The individual outcome of the COVID-19 and the degree of muscle mass and functional loss may be influenced by multiple factors, including the patient's general pre-infection medical and functional condition, especially in older adults. This paper gathers the information about how the SARS-CoV-2 hyper-inflammatory involvement exacerbates the immunosenescence process, enhances the endothelial damage, and due to mitochondrial dysfunction and autophagy, induces myofibrillar breakdown and muscle degradation. The aftermath of these acute and complex immunological SARS-CoV-2-related phenomena, augmented by anosmia, ageusia and altered microbiota may lead to decreased food intake and exacerbated catabolism. Moreover, the imposed physical inactivity, lock-down, quarantine or acute hospitalization with bedrest would intensify the acute sarcopenia process. All these deleterious mechanisms must be swiftly put to a check by a multidisciplinary approach including nutritional support, early physical as well cardio-pulmonary rehabilitation, and psychological support and cognitive training. The proposed holistic and early management of COVID-19 patients appears essential to minimize the disastrous functional outcomes of this disease and allow avoiding the long COVID-19 syndrome. [ABSTRACT FROM AUTHOR]

Background: Sarcopenia is a potentially reversible condition, which requires proper screening and diagnosis. Aims: To validate a Polish version of sarcopenia screening questionnaire (SARC-F), and assess its clinical performance. Methods: Cross-sectional validation study in community-dwelling subjects ≥ 65 years of age. Diagnosis of sarcopenia was based on the 2018 2nd European Working Group on Sarcopenia in Older People (EWGSOP2) consensus. Hand grip and 4-m gait speed were measured, and the Polish version of SARC-F was administered. Results: The mean (SD) age of 73 participants (21.9% men) was 77.8 (7.3) years. Seventeen participants (23.3%) fulfilled the EWGSOP2 criteria of sarcopenia, and 9 (12.3%) criteria for severe sarcopenia. Fourteen (19.2%) participants fulfilled the SARC-F criteria for clinical suspicion of sarcopenia. The Cronbach's alpha coefficient for internal was 0.84. With EWGSOP2 sarcopenia as a gold standard, the sensitivity of SARC-F was 35.3% (95% CI 14.2–61.7, p = 0.33), specificity was 85.7% (95% CI 73.8–93.6, p < 0.0001). The corresponding positive and negative predictive values were 42.9% (p = 0.79) and 81.4% (p < 0.0001), respectively. The probability of false-positive result was 14.3% (95% CI 6.4–26.2, p < 0.0001) and the probability of false-negative result was 64.7% (95% CI 38.3–85.8, p = 0.33). Overall the predictive power of SARC-F was low (c-statistic 0.64). Discussion: SARC-F is currently recommended for sarcopenia case finding in general population of older adults. However, its sensitivity is low, despite high specificity. Conclusions: At present SARC-F is better suited to rule out sarcopenia then to case-finding. Further refinement of screening for sarcopenia with the use of SARC-F seems needed. [ABSTRACT FROM AUTHOR]

Key summary points: Aim: Standardizing the use of ultrasound in the assessment of muscle and sarcopenia. Findings: Approach of muscle assessment has been updated according to the most recent literature and anatomical landmarks for 39 different muscles are provided. Message: Using these recommendations, ultrasonographical muscle assessment can be standardized worldwide. Purpose: In 2018, the SARCUS working group published a first article on the standardization of the use of ultrasound to assess muscle. Recommendations were made for patient positioning, system settings and components to be measured. Also, shortcomings in knowledge were mentioned. An important issue that still required standardization was the definition of anatomical landmarks for many muscles. Methods: A systematic search was performed in Medline, SCOPUS and Web of Sciences looking for all articles describing the use of ultrasound in the assessment of muscle not described in the first recommendations, published from 01/01/2018 until 31/01/2020. All relevant terms used for older people, ultrasound and muscles were used. Results: For 39 muscles, different approaches for ultrasound assessment were found that likely impact the values measured. Standardized anatomical landmarks and measuring points were proposed for all muscles/muscle groups. Besides the five already known muscle parameters (muscle thickness, cross-section area, pennation angle, fascicle length and echo-intensity), four new parameters are discussed (muscle volume, stiffness, contraction potential and microcirculation). The former SARCUS article recommendations are updated with this new information that includes new muscle groups. Conclusions: The emerging field of ultrasound assessment of muscle mass only highlights the need for a standardization of measurement technique. In this article, guidelines are updated and broadened to provide standardization instructions for a large number of muscles. [ABSTRACT FROM AUTHOR]

Key summary points: Aim: To assess the impact on the older population of policies to decrease the overall impact of the COVID-19 pandemic in Europe. Findings: Ageism has occurred during the COVID-19 pandemic. Message: Analysis of the effects of the COVID-19 pandemic on the older population will help us to develop fairer and more inclusive policies in the future. Purpose: The United Nations (UN) has published a Policy Brief on the impact of the Coronavirus Disease 2019 (COVID-19) that identifies policies and responses to protect older adults. Our objective was to summarize actions, health policies and clinical guidelines adopted by six European countries (Belgium, France, Italy, Poland, Spain and United Kingdom) during the pandemic, and to assess the impact of national policies on reducing adverse effects of the COVID-19 pandemic in older populations. Methods: Reports by geriatricians on the measures and actions undertaken by governmental institutions in each country between March and July 2020, as well as the role of primary care during the pandemic, covered three areas: (a) general health strategies related to the pandemic; (b) impact of COVID-19 on health inequity; and (c) initiatives and challenges for the COVID-19 pandemic and beyond. Results: In the six countries, COVID-19 mortality in nursing homes ranged from 26 to 66%. Although all countries endorsed the World Health Organization general recommendations, the reports identified the lack of harmonized European guidelines and policies for nursing homes, with competencies transferred to national (or regional) governments. All countries restricted visits in nursing homes, but no specific action plans were provided. The role of primary care was limited by the centralization of the crisis in hospital settings. Conclusions: The older population has been greatly affected by COVID-19 and by the policies initiated to control its spread. The right to health and dignity are transgenerational; chronological age should not be the sole criterion in policy decisions. [ABSTRACT FROM AUTHOR]

Key summary points: Aim: To report on the 2019 EuGMS Congress in Krakow. Findings: Evidence-based medicine in geriatrics is a previously neglected, now rapidly expanding field. Heterogeneity of our older population brings many questions and challenges for research. Message: Personalized approaches based on evidence-based practices, standardisation of definitions and meaningful outcomes, in collaboration with older people themselves, and with other specialties, are the new frontiers and challenges for research. The 2019 EuGMS Congress "Evidence-Based Medicine in Geriatrics" was held in Krakow, Poland, and attended by over 1600 participants from 64 different countries. A summary and reflection on the congress was presented in the Closing Ceremony by European Academy for Medicine of Aging graduates, and summarised in this article. Keynote lectures, 'state of the art' sessions and symposia presented the evidence relating to different age-related conditions, their prevention, management and treatments. Hot topic areas included frailty and multimorbidity, and evidence-based attempts to address these conditions at different life stages. The field of geriatrics represents unique challenges for evidence-based medicine practice. There is much research going on. Clear leadership is needed to facilitate consensus agreements on standard definitions, methods and relevant outcomes, in collaboration with older people themselves, to maximise the opportunities and benefits of doing this research, and benefiting our patients and society at large. [ABSTRACT FROM AUTHOR]

Key summary points: Aim: To report the most important messages of the 2018 EuGMS Congress in Berlin. Findings: From social issues to nutrition, from cardiovascular aspects to new definition of sarcopenia, the congress has informed more than 1800 participants on the hottest issues of geriatric medicine of today. Message: The EuGMS congress brings together both bench-to-bedside knowledge and clinical practice, which is of paramount importance in the further development of geriatric medicine in Europe. Purpose: To report the most important messages of the 2018 EuGMS Congress in Berlin. Methods: Review based on an on-site attendance in the sessions by the European Academy for Medicine of Aging graduates. Results: The 14th Congress of the European Geriatric Medicine Society which took place in Berlin, Germany, from 10 to 12 October 2018, addressed the issue of challenges and opportunities associated with a fast changing modern world. Covering among other topics social issues, new technologies and the much-awaited new European definition of sarcopenia, the meeting streamed with important information. Conclusions: Attended by more than 1800 participants from Europe and from across the world, it was one of the most successful geriatric events in 2018. In the following text, in preparation to the next, 15th Congress in Kraków, Poland, we briefly describe the highlights of the Berlin Congress. [ABSTRACT FROM AUTHOR]

Background: Prevalence of peripheral arterial disease increases with age and is related to increased morbidity and mortality. The clinical diagnosis includes the measurement of ankle–brachial index (ABI). Aims: To check the prevalence of abnormal ABI, and the value of physical examination of arterial system in detection of ABI < 0.9. Methods: We performed subgroup analysis of patients included in the PolSenior survey. We measured ABI, performed physical examination of arterial system, assessed laboratory and questionnaire factors related to atherosclerosis. Participants were divided according to ABI strata of < 0.9, 0.9–1.4 and > 1.4. Clinical score of abnormalities on physical examination was proposed. Using logistic regression, we obtained areas under the curve (AUC). Results: The mean age of 844 participants (53.3% men) was 74.7 (10.6) years. ABI < 0.9 was found in 20.3% participants and it was linked to history of myocardial infarction, hypertension and renal failure. In the entire group, 72.4% of subjects declared, that they were able to walk a distance of 200 m without interruption. Higher clinical score was associated with lower ABI. Full physical examination (AUC = 0.67) followed by examination of lower extremities (AUC = 0.65) showed strongest diagnostic value for PAD based on ABI. Neither ABI nor clinical examination was a good predictor of the inability to walk 200 meters without difficulties. Discussion/conclusions: Full clinical examination, only moderately, adds to detection of PAD. The ability to walk 200 m is not a good measure of PAD in older subjects. [ABSTRACT FROM AUTHOR]

Background: Since its introduction by Hodkinson in 1972, Abbreviated Mental Test Score (AMTS) and its English and other language versions have been widely used in research and clinical practice alike. However, whether the various versions of AMTS yield equivalent information has never been tested. Methods: We performed cross-sectional assessment of inpatients aged 65+ years with seven AMTS versions and the Mini-Mental State Examination (MMSE) after correction for age and education (MMSEc). We used the MMSEc cut-off score of < 24 as comparator and fitted linear regression models from which we obtained the receiver operating characteristics, and further compared the c-statistics obtained for each version of AMTS. We used Spearman's correlation to check the relation between different AMTS versions. Results: The mean (SD) age of 72 (52.8% women) patients was 76.2 (7.6) years. The average time spent on education was 11.3 (3.5) years. The AMTS score across versions varied between 7.4 (2.0) and 8.2 (1.7). The MMSE averaged 24.1 (4.6) and the MMSEc averaged 25.2 (4.1). We found that the c-statistic across AMTS versions with dichotomised MMSEc as comparator ranged from 0.83 to 0.85 and did not significantly differ from the c-statistic of 0.87 for original AMTS (all p > 0.16). We found AMTS versions to be significantly correlated (all r between 0.83 and 0.99, all p < 0.0001). Conclusions: We found AMTS to be a reliable and useful tool in the screening for possible cognitive impairment. This seems to be true irrespective of whether we use the original test or any of its studied modifications. [ABSTRACT FROM AUTHOR]

Purpose: Measurement of muscle mass is paramount in the screening and diagnosis of sarcopenia. Besides muscle quantity however, also quality assessment is important. Ultrasonography (US) has the advantage over dual-energy X-ray absorptiometry (DEXA) and bio-impedance analysis (BIA) to give both quantitative and qualitative information on muscle. However, before its use in clinical practice, several methodological aspects still need to be addressed. Both standardization in measurement techniques and the availability of reference values are currently lacking. This review aims to provide an evidence-based standardization of assessing appendicular muscle with the use of US.Methods: A systematic review was performed for ultrasonography to assess muscle in older people. Pubmed, SCOPUS and Web of Sciences were searched. All articles regarding the use of US in assessing appendicular muscle were used. Description of US-specific parameters and localization of the measurement were retrieved.Results: Through this process, five items of muscle assessment were identified in the evaluated articles: thickness, cross-sectional area, echogenicity, fascicle length and pennation angle. Different techniques for measurement and location of measurement used were noted, as also the different muscles in which this was evaluated. Then, a translation for a clinical setting in a standardized way was proposed.Conclusions: The results of this review provide thus an evidence base for an ultrasound protocol in the assessment of skeletal muscle. This standardization of measurements is the first step in creating conditions to further test the applicability of US for use on a large scale as a routine assessment and follow-up tool for appendicular muscle. [ABSTRACT FROM AUTHOR]

A correction to this paper has been published: https://doi.org/10.1007/s41999-021-00476-6 [ABSTRACT FROM AUTHOR]