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Keynote lectures / European Geriatric Medicine 6S1 (2015) S1



Cancer and aging: Facing realities and an uncertain future

J. Breivik

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

T. Rantanen

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

M. Myrstad

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

D. O’Neill

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 [1] 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 [2]. Research studies

on age-related diseases may also include endpoints that do not

reflect the desired endpoints of older people [3]. 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.


[1] Briggs R, O’Neill D. The informant history: a neglected aspect of clinical

education and practice, QJM, 2015.

[2] 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.

[3] 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

E. Molden

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-