Keynote lectures / European Geriatric Medicine 6S1 (2015) S1
Cancer and aging: Facing realities and an uncertain future
University of Oslo, Oslo, Norway
Cancer development is closely related to aging and arguably an
inevitable consequence of our multicellular composition. The better
we become at treating cancer and other diseases, the longer we
live and the more cancer cases there will be in the population.
Accordingly, the great cancer epidemic is not a problem modern
medicine is about to solve – it is a problem we are about to
create. Moreover, if we should find a solution to cancer – and
aging – presumably by replacing or reprogramming the cells of
the organism, this development will have dramatic implications
for society. It may in fact be the end to humanity, as we know it.
The prevailing dogma that the solution to cancer awaits around
the next corner, as some kind of ingenious therapy is highly
misleading, and it is time to communicate a more balanced and
realistic understanding of cancer and cancer research.
Physical activity as primary and secondary prevention
Department of Health sciences and Gerontology Research Centre,
University of Jyv¨askyl¨a, University of Jyv¨askyl¨a, Finland
In old age physical activity can mostly be studied in terms of
secondary or tertiary prevention as most people have comorbidity.
Alleviating the consequences of chronic conditions is essential in
postponing the transition from active old age (the third age) to
disabled old age (the fourth age) with reduced opportunities for
participation and good quality of life. A novel way to look at the
transition from the third to the fourth age is through changes in
life-space mobility. Life-space refers to the spatial area where a
person purposefully moves through. The smallest life-space may
comprise only one room. Going to other rooms, to the yard,
neighborhood or beyond extends the life-space. Mobility is optimal
when people are able to go where they wish, when they wish
and using the transportation they wish. Mobility is a prerequisite
for accessing community amenities. Life-space mobility is based
on the balance between a person’s internal capacity and the
external challenges encountered in daily life. Life-Space Mobility
in Old Age is a study among 848 75–90-year old people who
were followed up for two years for changes in their life-space
mobility. Of them, at the baseline, 174 wore an accelerometer for
seven days to objectively assess their physical activity level, and
360 kept a diary about their physical activity for seven days in
terms of activities and places visited. Higher life-space mobility
was associated with better quality of life, more physical activity, less
depressive symptoms, better sensory functions and lower extremity
performance, better sense of autonomy and better transportation
options. During the days when people did not go out of home, 70%
exhibited three minutes or less physical activity. Not going outdoors
daily was associated with poor lower extremity performance and
environmental mobility barriers especially in the entrance areas of
homes. The study suggests that solving mobility barriers around
the entrance areas and going out daily may be postpone life-space
restriction and transition to the fourth age.
Adverse events and negative consequences of physical exercise
in older people
Diakonhjemmet Hospital, Oslo, Norway
The benefits of physical exercise might be largest in the least active
individuals. At the same time, inactive old individuals are likely to
be the most vulnerable to adverse effects of exercise. There is a lack
of evidence regarding the safety of exercise in older people, but the
overall incidence of adverse events and negative consequences of
physical exercise seems to be low.
Individuals with underlying cardiovascular pathology have an
increased risk of sudden cardiac death during endurance exercise.
Furthermore, prolonged regular endurance exercise has been
associated with an increased risk of atrial fibrillation. Progressive
resistance strength training might be linked to musculoskeletal
injuries and many types of exercise might be associated with an
increased risk of falls and injuries, especially in frail individuals and
individuals with impaired mobility.
Some situations require evaluation by a physician prior to exercise.
The main goal of the evaluation is to achieve the valuable benefit of
the activity at minimal risk. The evaluation should be supportive,
enabling and solution oriented, in line with existing guidelines and
it should balance enthusiasm and caution. Co-morbid conditions
should be optimally treated and attention should be drawn to
the nutritional status. The dose and type of exercise should be
individually tailored and the abilities, needs and preferences of
each individual should be taken into account.
For the majority, potential harmful side-effects of exercise are by far
outweighed by the benefits of regular physical activity. With few
exceptions, all individuals, also those with impaired mobility or
chronic diseases, should be encouraged to practice regular physical
activity and exercise.
The patient’s choice and preferences
Trinity College Dublin, Dublin, Ireland
One of the most subtle and sophisticated areas of clinical practice
in geriatric medicine is that of eliciting and acting upon the
preferences of the patient, particularly those with impairments
of cognition and/or communication. Ageism (including that of
older people), gerontological illiteracy, and neglect of the ethical
and practical dimensions of the informant history  are among
the factors that hinder the emergence of the patient’s voice and
preference in care decisions within the complex matrix of more
vocal relatives/caregivers and healthcare professionals. Even within
the practice of geriatric medicine the format of care-planning
meetings may unwittingly impede the emergence of patient’s voice
and wishes if not appropriately structured . Research studies
on age-related diseases may also include endpoints that do not
reflect the desired endpoints of older people . This presentation
will cover recent research on how geriatricians and gerontologists
might best illuminate the viewpoint of older people, and diffuse
this knowledge base into the wider practice of healthcare.
 Briggs R, O’Neill D. The informant history: a neglected aspect of clinical
education and practice, QJM, 2015.
 Donnelly S, Carter Anand J, Gilligan R, Mehigan B, O’Neill D.
Multiprofessional Views on Older Patients’ Participation in Care
Planning Meetings in a Hospital Context, Practice: Social Work in
Action, 25, 2013.
 Hurria A et al. Designing therapeutic clinical trials for older and frail
adults with cancer: U13 conference recommendations. J Clin Oncol
2014; 32(24): 2587–94.
The role of pharmacogenetics in individualized drug treatment
of older people
Center for Psychopharmacology, Diakonhjemmet Hospital, and School
of Pharmacy, University of Oslo, Oslo, Norway
Aging and pharmacogenetics are two independent
factors that may predispose for unwanted drug effects. While age-