搜索结果：European geriatric medicine

The European Geriatric Medicine Society (EuGMS) is an umbrella organization including 39 national geriatric societies across Europe (www.eugms.org), which was established in 2000.1 From the beginning, a major focus of EuGMS has been the advancement of geriatric pharmacotherapy and the advocacy for a better evaluation of drugs in older patients. For older adults, just like for children, the things that matter most can be very different. Particularly with increasing experiences of multimorbidity, frailty, and functional decline, goals and expectations for pharmacotherapy might also change (Figure 1). The Paediatric Regulation came into force in the European Union (EU) on January 26, 2007. Its objective is to improve the health of children in Europe by facilitating the development and availability of medicines for children aged 0–17 years. Previously, most medicines used in children were approved on the basis of studies performed in adults. At that time, EuGMS wrote a letter to the European Commissioner of Industry to suggest that a similar initiative was also needed for older adults. After this letter, the Commissioner requested the European Medicines Agency (EMA) to assess the adequacy of current guidance on drug evaluation in older people and to contact EuGMS. EuGMS promoted also a dialogue with the American Geriatric Society (AGS) on this topic, which resulted in the organization of a joined symposium with their respective regulatory agencies EMA and the US Food and Drug Administration (FDA) at the 2008 AGS meeting, titled “Fighting age discrimination in clinical trials.”2 The exclusion of older adults from clinical trials was also addressed by an EU funded research project (Predict).3 The project developed a Charter for the rights of older people to participate in clinical trials, which was endorsed by several international organizations, including EuGMS and the AGS.3 The constant interaction of EuGMS with EMA was one of the factors contributing to the decision of the EMA to develop a geriatric medicines strategy in 2011.4 The strategy acknowledged that older adults are the main users of medicines and it clearly recognized that the oldest old patients and those with multiple chronic diseases were likely to be excluded from clinical trials. In this document, EMA declared two main goals: first, to ensure that every new medication likely to be used in this population would be properly evaluated to better appreciate the safety and the benefit-risk balance and second, to promote a better availability of information for both patients and prescribers. At the same time, EMA established a Geriatric Expert Group (GEG) to provide scientific advice for the implementation of its geriatric medicine strategy. During the following years, however, the GEG was seldom consulted. The major request was to identify points to consider on frailty and propose evaluation instruments for baseline characterization of clinical trial populations. These points to consider were intended to provide guidance only for the evaluation of the baseline frailty status of patients (typically, but not exclusively aged >65 years) enrolled in a clinical trial or other clinical investigation (e.g., registry) and to supplement the requirements of ICH E7 Questions and Answers.5 The short physical performance battery, with gait speed as an alternative, were identified as the most suitable tools.6 After 2019, following the withdrawal of the United Kingdom from the European Union, there was a complete interruption of the activity of the GEG. The COVID-19 pandemic was a strong reminder of the vulnerability of older adults and highlighted the need for appropriate testing of therapeutic interventions. An expert group convened by EuGMS carried out a systematic review demonstrating that older subjects, particularly those older than 75 years, were clearly underrepresented in clinical trials evaluating the efficacy and safety of COVID-19 vaccines.7 The presence of a large representation gap between the clinical trial participants and the real-world patient population was also confirmed by Lau et al., who evaluated clinical trials published between 2010 and 2019 concerning drugs used in seven important therapeutic areas for geriatric patients. The most important finding was the large underrepresentation of subjects older than 75 years, whereas adults 60–74 years old were adequately represented.8 “…to fully appreciate the efficacy and safety of drugs, it is necessary to promote the inclusion of participants who are reasonably representative of those who will be treated in clinical practice. In this respect, the heterogeneity of older subjects represents a major challenge which is important to recognize in the evaluation process of medicines.” Therefore, it is necessary not only to take into account age, but also to consider sex and gender, as well as the prevalence of geriatric characteristics, such as frailty, multimorbidity, and functional limitations. Because the older population in Europe is primarily composed of individuals of European descent, that is, White individuals, neither race nor ethnicity as variables are discussed in this commentary. One of the most common elements overlooked in clinical trials is the differences between men and women across age groups. The overall underrepresentation of women in clinical trials is particularly concerning in the older population, where women significantly outnumber men. Sex and gender differences have an important role in affecting patient's health, risk for chronic illnesses, functional decline, and vulnerability to adverse effects of drugs.9 Although sex is always registered in clinical trials but rarely considered as an effect modifier, frailty, functional impairment, and multimorbidity are often not considered nor measured. Frailty has a stronger association with risk of adverse events than age.10 Moreover, frailty is associated with a higher risk of adverse drug reactions11 and is important to be considered during treatment decisions, for example, concerning the treatment of malignancies, arterial hypertension, or atrial fibrillation.12-14 Functional status is a key indicator of health status in older patients, because functional impairment and even more overt disability are associated with worse clinical outcomes.15, 16 Finally, multimorbidity, that is, the presence of multiple chronic diseases, is common in older subjects and causes a higher probability of polypharmacy and adverse clinical outcomes. Because the exclusion criteria set in clinical trials often concern chronic diseases or drugs used to treat them, multimorbid older subjects are underrepresented in clinical research.17 The lack of structured measurement of these domains leads to their retrospective evaluation, considering the available information. In the case of frailty, this can induce the use of heterogeneous versions of the frailty index. However, this measure often is mainly based on chronic diseases or established disabilities, lacking measures of early functional impairment. This approach limits the possibility to detect the early stages of the frailty process, which are better identified by performance deficits. Therefore, it is important to assure that frailty, multimorbidity, and functional impairment measures are assessed in clinical studies already at the baseline evaluation as well as during follow-up. Of course, and when feasible, other domains commonly evaluated with comprehensive geriatric assessment such as cognition, mood, socioeconomic situation, sensory impairment, and falls history can be extremely informative to further characterize the clinical trial population. Another important point concerns the choice of outcomes. Traditional outcomes, such as mortality or healthcare service use is still important for older subjects, but those who are frail or have limited life expectancy might value more other aspects, such as preservation of cognitive and physical function and quality of life. Outcomes that matter most to older people should be carefully selected and implemented18 not only as secondary outcomes but possibly also as primary outcomes for some indications, provided that a thorough development and validation have been performed. This certainly includes patient reported outcomes (PROMS) or experiences (PREMS). Many of the abovementioned aspects have been discussed in more detail in a recent publication by the EuGMS pharmacology special interest group together with representatives of other scientific organizations and EMA.19 Besides the points raised above, this article also summarizes several other measures that EuGMS considers important and achievable to improve a better appraisal of drugs for older people. This includes the promotion of studies that advance geriatric approaches for patients and health systems alike such as trials with longer duration, trials that evaluate time to benefit, pragmatic clinical trials, and deprescribing/de-escalation studies. In view of the limited generalizability of randomized clinical trials in the older population, post-marketing studies might have an important role in generating useful evidence, provided that they are carefully designed, collecting all the relevant data that allow a proper adjustment for relevant geriatric variables and confounders that might influence the response to drug treatments and adverse events.20 In this respect it is important to take into account the indications provided by the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH), an organization that brings together regulators and drug developers from Europe, Japan, and the United States with the aim of achieving international harmonization for the development and approval of safe, effective, and high-quality medicines. In the update of the guideline devoted to the evaluation of drugs in geriatric patients,5 originally released in 1994,21 the ICH stated that “Every effort should be made to include geriatric patients using concomitant therapies and with co-morbidities in the premarketing clinical development program. In some cases, enrollment of these patients can be challenging and it could be appropriate to collect data post-marketing. However, the adequacy of, and the need for, data in these patients should be considered during drug development and discussed in the marketing application submission. Where enrollment of geriatric patients has been insufficient despite the efforts of the applicant, a specific plan to collect data post-marketing should be discussed during development and presented in the marketing application.” Therefore, post-marketing studies should be carefully justified and planned, being complementary rather than substitutive to a proper premarketing evaluation. Furthermore, the opportunity of acquiring relevant scientific information concerning the effects of drugs in older people using real-world data that are produced in clinical practice is being increasingly appreciated. However, studies with real-world data should be carefully selected, because many studies have important methodological biases.22 The main EuGMS recommendations are summarized in Table 1. EuGMS will continue to advocate a better evaluation of drugs in older subjects in order to maximize the clinical benefits while minimizing harms, providing the necessary information to tailor the treatment to specific subgroups of the older population. To achieve this goal, EuGMS not only aims to continue the collaboration with other scientific societies, including AGS, but also to reactivate the discussion with regulatory agencies and stakeholders to promote a new revision of the international regulatory guideline concerning clinical trials in older subjects.5, 21 All authors contributed to the writing of this commentary. The authors have no conflicts of interest. None.

We recently returned from the European Geriatric Medicine Society (EuGMS) annual congress and are excited to share with you this vibrant opportunity for healthcare professionals working with older adults. This event is a valuable experience for trainees, clinicians, and researchers alike. Founded in 2001, EuGMS recently celebrated its 20th year and has made remarkable progress during this time. Its membership now includes 39 national Geriatrics societies and two national societies with observer status (Table S1). The Society has a comprehensive website (https://www.eugms.org/home.html), and a very well-attended annual congress. The society is led by internationally recognized geriatricians from diverse countries, including Professors Mirko Petrovic (President) from Belgium, Nathalie van der Velde (Academic Director) from the Netherlands, and Graziano Onder (Research Director) from Italy. This year's local organizing chair was Professor Francisco Jose Tarazona Santabalbina from Spain. The EuGMS also has its own journal, European Geriatric Medicine (https://link.springer.com/journal/41999), with Professor Alfonso Cruz-Jentoft from Spain as the Editor-in-Chief. Among other highly relevant articles, this journal recently featured the third, revised version of the STOPP/START criteria [1], authored by Professor Denis O'Mahony from Ireland and many prestigious geriatricians. These criteria have become highly regarded in the field and nicely complement the American Geriatrics Society Beers Criteria [2]. Each EuGMS annual congress is hosted in a European city, with recent locations including Krakow, Poland; Athens, Greece; London, England; and Helsinki, Finland. This year, from September 18 to 20, 2024, Valencia, Spain, hosted the most widely attended congress in the EuGMS history, drawing over 2300 participants from 76 countries (15% outside Europe). The theme for this year's congress, “From Healthy Ageing to Complex Needs in Older Adults” provided a rich platform for exploring the latest advancements in geriatric care. The diversity of backgrounds allowed attendees to learn about healthy aging from different perspectives and hear about novel care approaches. While the official language was English, the atmosphere buzzed with multiple languages throughout the halls, reflecting a tapestry of cultural perspectives. The EuGMS program was designed to engage all attendees, featuring poster sessions, symposiums, and keynote presentations. The symposia promoted international collaborations and gender equity. Specifically, symposium submissions needed to include three presentations submitted by authors and co-chairs from more than one country. A gender balance was expected among the panel members and chairs. For trainees, conferences like EuGMS offer invaluable experiences to connect with researchers, scientists, and clinicians. Engaging with leading experts and peers allowed for rich networking opportunities, essential for career development. The exposure to diverse perspectives on aging and geriatric care fosters a broader understanding of the field and encourages innovative thinking. The congress also featured several special interest groups convened for in-depth discussions, including a robust session on geriatric pharmacology. These special interest groups are also a valuable platform for trainees to connect with established investigators, allowing them to gain insights into ongoing projects and explore potential collaborations. EuGMS could consider establishing a trainee-focused group at future annual congress to support future young professionals in the field. Beyond the scientific and educational sessions, attendees could immerse themselves in Valencia's rich local culture. It is a city renowned for its high quality of life, science, and culture, including the stunning City of Arts and Sciences (Figure 1A). Designed by architect Santiago Calatrava, it is an impressive sculptural space with a complex of buildings, including the Museum of Science and a performance centre for the arts. The old city, with its 2000-year history, is home to landmarks such as the Catedral De Valencia, the Silk Exchange, and the San Nicolás Church (Figure 1B). We were inspired by Valencia's commitment to physical activity, evident by its network of walking and cycling paths along the former Turia riverbed. We experienced these paths on a sunny day, where locals walked, biked, or played sports in the many fields and courts. The Turia riverbed was transformed into a large green space after a historic flood in 1957. We were saddened to learn about the intense rainfalls and flash floods occurring shortly after our return in October 2024 which heavily affected the city and the region with more than 220 victims (Figure 1C). Social interactions were also a highlight of the event. Networking with colleagues from around the world enriched the experience with face-to-face interactions, including a lively group reception and much-anticipated group dinner. This is an occasion best reserved early due to its popularity. There is also ample opportunity for informal congress over a cup of coffee or for groups to meet in a quiet room. The closing session was just amazing—featuring a local group performing a centuries old folk dance, fully clothed in dress from the period, and a drummer and piccolo player providing the music. (Figure 2). We observed a notable absence of our colleagues from Canada and the United States. As representatives from these countries, we strongly encourage participation in future EuGMS congresses to gain insights into global approaches to geriatric medicine and the diversity of care. The timing is ideal given that the Canadian and American Geriatric Society congress' are in May and the EuGMS is typically in September, making it feasible to attend both. We strongly encourage participation in future EuGMS congresses to gain insights into global approaches to geriatric medicine and the diversity of care. Looking ahead, the 2025 EuGMS congress will take place in Reykjavik, Iceland—an excellent opportunity for North Americans due to its proximity. The theme will be “New landscapes in geriatric medicine.” We recommend planning early to prepare your submissions and secure your spot at a very worthwhile event. (See Figure S1). Study concept: Paula A. Rochon, Darly Dash, Joseph G. Ouslander. Drafting of the manuscript: Paula A. Rochon. Critical revision of the manuscript for important intellectual content: All authors. Paula A. Rochon holds the RTOERO Chair in Geriatric Medicine at the University of Toronto. Darly Dash is supported by a doctoral scholarship through the Canadian Institutes of Health Research (Funding reference number #FBD-181577). Dr. Paula A. Rochon is a Deputy Editor and Dr. Joseph G. Ouslander is the Executive Editor for the Journal of the American Geriatrics Society. The other authors declare no conflicts of interest. Table S1. Figure S1. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

PURPOSE: Despite the rapidly expanding knowledge in the field of Geriatric Emergency Medicine in Europe, widespread implementation of change is still lacking. Many opportunities in everyday clinical care are missed to improve care for this susceptible and growing patient group. The aim was to develop expert clinical recommendations on Geriatric Emergency Medicine to be disseminated across Europe. METHODS: A group of multi-disciplinary experts in the field of Geriatric Emergency Medicine in Europe was assembled. Using a modified Delphi procedure, a prioritized list of topics related to Geriatric Emergency Medicine was created. Next, a multi-disciplinary group of nurses, geriatricians and emergency physicians performed a review of recent guidelines and literature to create recommendations. These recommendations were voted upon by a group of experts and placed on visually attractive posters. The expert group identified the following eight subject areas to develop expert recommendations on: Comprehensive Geriatric Assessment in the Emergency Department (ED), age/frailty adjusted risk stratification, delirium and cognitive impairment, medication reviews in the ED for older adults, family involvement, ED environment, silver trauma, end of life care in the acute setting. RESULTS: Eight posters with expert clinical recommendations on the most important topics in Geriatric Emergency Medicine are now available through https://posters.geriemeurope.eu/ . CONCLUSION: Expert clinical recommendations for Geriatric Emergency Medicine may help to improve care for older patients in the Emergency Department and are ready for dissemination across Europe.

BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.

INTRODUCTION: 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. The aim of this project was to develop a consensus among geriatricians on a curriculum with the minimal requirements that a medical student should achieve by the end of medical school. METHODS: a modified Delphi process was used. First, educational experts and geriatricians proposed a set of learning objectives based on a literature review. Second, 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. RESULTS: the number of disagreements following Delphi Rounds 1 and 2 were 81 and 53, respectively. Complete agreement was reached following the third round. The final curriculum consisted of detailed objectives grouped under 10 overarching learning outcomes. DISCUSSION: a consensus on the minimum requirements of geriatric learning objectives for medical students has been agreed by European geriatricians. 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.

BACKGROUND: With an increasing number of people dying in old age, collaboration between palliative care and geriatric medicine is increasingly being advocated in order to promote better health and health care for the increasing number of older people. The aim of this study is to identify barriers and facilitators and good practice examples of collaboration and integration between palliative care and geriatric medicine from a European perspective. METHODS: Four semi-structured group interviews were undertaken with 32 participants from 18 countries worldwide. Participants were both clinicians (geriatricians, GPs, palliative care specialists) and academic researchers. The interviews were transcribed and independent analyses performed by two researchers who then reached consensus. RESULTS: Limited knowledge and understanding of what the other discipline offers, a lack of common practice and a lack of communication between disciplines and settings were considered as barriers for collaboration between palliative care and geriatric medicine. Multidisciplinary team working, integration, strong leadership and recognition of both disciplines as specialties were considered as facilitators of collaborative working. Whilst there are instances of close clinical working between disciplines, examples of strategic collaboration in education and policy were more limited. CONCLUSIONS: Improving knowledge about its principles and acquainting basic palliative care skills appears mandatory for geriatricians and other health care professionals. In addition, establishing more academic chairs is seen as a priority in order to develop more education and development at the intersection of palliative care and geriatric medicine.

Older people represent a growing proportion of attendees in Emergency Departments across Europe. Traditionally Emergency Departments have not focused on care for older people, especially those with frailty. Similarly, geriatric services have not traditionally focused upon the care of older people in Emergency Departments. This work seeks to bring together the two disciplines of Geriatric and Emergency Medicine through a defined and validated curriculum on Geriatric Emergency Medicine. Domains and items for inclusion in the curriculum were derived through a combination of literature reviewing and a nominal group workshop. The domains and items underwent validation using a Delphi technique involving the European Societies of Geriatric and Emergency Medicine. In the development stage, 100 individual learning outcomes were identified, reflecting 16 domains; following the stage 2 validation process, 98 items remained. All items were approved by the relevant EU societies. In the final validation step, the curriculum was formally approved by the UEMS sections for Geriatric Medicine and Emergency Medicine (responsible for curriculae in the respective disciplines).

Older people represent a growing proportion of attendees in Emergency Departments
\nacross Europe. Traditionally Emergency Departments have not focused on care for older
\npeople especially those with frailty. Similarly, geriatric services have not traditionally
\nfocused upon the care of older people in Emergency Departments. This work seeks to
\nbring together the two disciplines of Geriatric and Emergency Medicine through a defined
\nand validated curriculum on Geriatric Emergency Medicine.
\nDomains and items for inclusion in the curriculum were derived through a combination of
\nliterature reviewing and a nominal group workshop. The domains and items underwent
\nvalidation using a Delphi technique involving the European Societies of Geriatric and
\nEmergency Medicine.
\nIn the development stage, 100 individual learning outcomes were identified, reflecting
\n16 domains; following the stage 2 validation process, 98 items remained. All items were
\napproved by the relevant EU societies.
\nIn the final validation step, the curriculum was formally approved by the UEMS sections
\nfor Geriatric Medicine and Emergency Medicine (responsible for curriculae in the
\nrespective disciplines).

Falls among older adults represent a significant public health challenge due to their consequences, including serious injuries, increased morbidity and mortality, decreased quality of life, and heightened healthcare costs. The World Falls Guidelines (WFG), published in 2022, offer a robust framework for evidence-based interventions; however, the uptake of these guidelines into clinical practice across Europe remains inconsistent. Key barriers to implementation include insufficient resources, a lack of trained healthcare professionals, and limited integration into existing healthcare systems. This position paper by the EuGMS Special Interest Group (SIG) on Falls and Fractures addresses the implementation of the WFG among community-dwelling older adults and falls prevention across Europe by providing an overview of the current status of WFG adoption in Europe and discusses the challenges and opportunities for implementation. We provide an overview of the current resources to support the clinical practice of falls prevention, implementation guides, and educational programs. Additionally, we discuss what is necessary for the future development of these resources and for advancing research. The EuGMS SIG on Falls and Fractures advocates for a commitment of healthcare providers as well as insurers, policymakers, and other stakeholders to collaborative European initiatives-such as developing a standardised falls prevention strategy, promoting evidence-based implementation plans, establishing a European-wide research agenda, and creating under- and postgraduate curricula-which are essential for advancing falls prevention efforts across Europe.

This position document has been developed by the Dysphagia Working Group, a committee of members from the European Society for Swallowing Disorders and the European Union Geriatric Medicine Society, and invited experts. It consists of 12 sections that cover all aspects of clinical management of oropharyngeal dysphagia (OD) related to geriatric medicine and discusses prevalence, quality of life, and legal and ethical issues, as well as health economics and social burden. OD constitutes impaired or uncomfortable transit of food or liquids from the oral cavity to the esophagus, and it is included in the World Health Organization's classification of diseases. It can cause severe complications such as malnutrition, dehydration, respiratory infections, aspiration pneumonia, and increased readmissions, institutionalization, and morbimortality. OD is a prevalent and serious problem among all phenotypes of older patients as oropharyngeal swallow response is impaired in older people and can cause aspiration. Despite its prevalence and severity, OD is still underdiagnosed and untreated in many medical centers. There are several validated clinical and instrumental methods (videofluoroscopy and fiberoptic endoscopic evaluation of swallowing) to diagnose OD, and treatment is mainly based on compensatory measures, although new treatments to stimulate the oropharyngeal swallow response are under research. OD matches the definition of a geriatric syndrome as it is highly prevalent among older people, is caused by multiple factors, is associated with several comorbidities and poor prognosis, and needs a multidimensional approach to be treated. OD should be given more importance and attention and thus be included in all standard screening protocols, treated, and regularly monitored to prevent its main complications. More research is needed to develop and standardize new treatments and management protocols for older patients with OD, which is a challenging mission for our societies.

We present an executive summary of a guideline for management of type 2 diabetes mellitus in primary care written by the European Geriatric Medicine Society, the European Diabetes Working Party for Older People with contributions from primary care practitioners and participation of a patient's advocate. This consensus document relies where possible on evidence-based recommendations and expert opinions in the fields where evidences are lacking. The full text includes 4 parts: a general strategy based on comprehensive assessment to enhance quality and individualised care plan, treatments decision guidance, management of complications, and care in case of special conditions. Screening for frailty and cognitive impairment is recommended as well as a comprehensive assessment all health conditions are concerned, including end of life situations. The full text is available online at the following address: essential_steps_inprimary_care_in_older_people_with_diabetes_-_EuGMS-EDWPOP___3_.pdf.

PURPOSE: This position paper aims to address the challenges of managing type 2 diabetes mellitus (T2DM) in frail older adults, a diverse and growing demographic with significant variability in health status. The primary research questions are: How can frailty assessment be effectively integrated into diabetes care? What strategies can optimize glycaemic control and outcomes for frail older adults? How can innovative tools and technologies, including artificial intelligence (AI), improve the management of this population? METHODS: The paper uses the 5 I's framework (Identification, Innovation, Individualization, Integration, Intelligence) to integrate frailty into diabetes care, proposing strategies such as frailty tools, novel therapies, digital technologies, and AI systems. It also examines metabolic heterogeneity, highlighting anorexic-malnourished and sarcopenic-obese phenotypes. RESULTS: The proposed framework highlights the importance of tailoring glycaemic targets to frailty levels, prioritizing quality of life, and minimizing treatment burden. Strategies such as leveraging AI tools are emphasized for their potential to enhance personalized care. The distinct management needs of the two metabolic phenotypes are outlined, with specific recommendations for each group. CONCLUSION: This paper calls for a holistic, patient-centered approach to diabetes care for frail older adults, ensuring equity in access to innovations and prioritizing quality of life. It highlights the need for research to fill evidence gaps, refine therapies, and improve healthcare integration for better outcomes in this vulnerable group.

PURPOSE: The COVID-19 pandemic has been a dramatic trigger that has challenged the intrinsic capacity of older adults and of society. Due to the consequences for the older population worldwide, the Special Interest Group on Comprehensive Geriatric Assessment (CGA) of the European Geriatric Medicine Society (EuGMS) took the initiative of collecting evidence on the usefulness of the CGA-based multidimensional approach to older people during the COVID-19 pandemic. METHODS: A narrative review of the most relevant articles published between January 2020 and November 2022 that focused on the multidimensional assessment of older adults during the COVID-19 pandemic. RESULTS: Current evidence supports the critical role of the multidimensional approach to identify older adults hospitalized with COVID-19 at higher risk of longer hospitalization, functional decline, and short-term mortality. This approach appears to also be pivotal for the adequate stratification and management of the post-COVID condition as well as for the adoption of preventive measures (e.g., vaccinations, healthy lifestyle) among non-infected individuals. CONCLUSION: Collecting information on multiple health domains (e.g., functional, cognitive, nutritional, social status, mobility, comorbidities, and polypharmacy) provides a better understanding of the intrinsic capacities and resilience of older adults affected by SARS-CoV-2 infection. The EuGMS SIG on CGA endorses the adoption of the multidimensional approach to guide the clinical management of older adults during the COVID-19 pandemic.

PURPOSE: Geriatric Emergency Medicine (GEM) focuses on delivering optimal care to (sub)acutely ill older people. This involves a multidisciplinary approach throughout the whole healthcare chain. However, the underpinning evidence base is weak and it is unclear which research questions have the highest priority. The aim of this study was to provide an inventory and prioritisation of research questions among GEM professionals throughout Europe. METHODS: A two-stage modified Delphi approach was used. In stage 1, an online survey was administered to various professionals working in GEM both in the Emergency Department (ED) and other healthcare settings throughout Europe to make an inventory of potential research questions. In the processing phase, research questions were screened, categorised, and validated by an expert panel. Subsequently, in stage 2, remaining research questions were ranked based on relevance using a second online survey administered to the same target population, to identify the top 10 prioritised research questions. RESULTS: In response to the first survey, 145 respondents submitted 233 potential research questions. A total of 61 research questions were included in the second stage, which was completed by 176 respondents. The question with the highest priority was: Is implementation of elements of CGA (comprehensive geriatric assessment), such as screening for frailty and geriatric interventions, effective in improving outcomes for older patients in the ED? CONCLUSION: This study presents a top 10 of high-priority research questions for a European Research Agenda for Geriatric Emergency Medicine. The list of research questions may serve as guidance for researchers, policymakers and funding bodies in prioritising future research projects.

<b>Background</b>: <br/>Frailty is a multicomponent, age-associated syndrome, with mobility at its core. As many RCTs in frail older adults target mobility, accurate quantification of mobility is essential to establish the efficacy of interventions. This review aims to describe and assess the tools currently used to capture mobility in RCTs.<br/><br/><b>Methods</b>: <br/>Four electronic databases were systematically searched (MEDLINE, EMBASE, AMED, PsychInfo) up to January 5th, 2024. Studies were included if they were an RCT, captured mobility as an outcome measure, population was aged ≥ 65 years, identified as frail or prefrail using a validated frailty instrument. A risk of bias analysis was conducted using the RoB2 tool.<br/><br/><b>Results</b>: <br/>After identifying 4056 papers, removing duplicates and performing screening, 65 studies were included. The most common intervention and frailty tool were exercise (55/65) and the phenotypic model of frailty (39/65), respectively. Performance based tools were most common (60/65) specifically Short Physical Performance Battery, gait speed, and Timed Up and Go (33, 27 and, 21 studies, respectively). Three studies used technology in a laboratory environment.<br/><br/><b>Discussion</b>: <br/>Mobility is usually evaluated as a single faceted concept in RCTs, only considering the physical domain, often at a single time point. This fails to reflect the multifaceted nature of mobility that encompasses cognitive, psychosocial, physical, environmental, and financial domains. In future, technology might address some of these deficits but further work is required before this is deployed routinely in trials to accurately evaluate the efficacy of novel interventions.

This is an expert opinion paper on oral health policy recommendations for older adults in Europe, with particular focus on frail and care-dependent persons, that the European College of Gerodontology (ECG) and the European Geriatric Medicine Society (EUGMS) Task and Finish Group on Gerodontology has developed. Oral health in older adults is often poor. Common oral diseases such as caries, periodontal disease, denture-related conditions, hyposalivation, and oral pre- and cancerous conditions may lead to tooth loss, pain, local and systemic infection, impaired oral function, and poor quality of life. Although the majority of oral diseases can be prevented or treated, oral problems in older adults remain prevalent and largely underdiagnosed, because frail persons often do not receive routine dental care, due to a number of barriers and misconceptions. These hindrances include person-related issues, lack of professional support, and lack of effective oral health policies. Three major areas for action are identified: education for healthcare providers, health policy action plans, and citizen empowerment and involvement. A list of defined competencies in geriatric oral health for non-dental healthcare providers is suggested, as well as an oral health promotion and disease prevention protocol for residents in institutional settings. Oral health assessment should be incorporated into general health assessments, oral health care should be integrated into public healthcare coverage, and access to dental care should be ensured.

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.

Attended by over 1700 people worldwide, the European Geriatric Medicine Society (EuGMS) Congress took place in Helsinki, Finland on September 20–22, 2023. Over 1000 abstracts were presented, and 115 oral presentations were delivered across 54 sessions on topics including the prevention of falls, frailty, and cognitive impairment, management of musculoskeletal and gastrointestinal disorders, drug therapy, addiction, loneliness, as well as many others. Herein, we present some conference highlights.