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Keynote lectures / European Geriatric Medicine 6S1 (2015) S1
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KL-17
Dementia diagnostics
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state of the art in Europe
J. Snaedal
Geriatric Department, Landspitali University Hospital, Reykjavik,
Iceland
The view on diagnosis of the causes of cognitive impairment and
dementia has fundamentally changed in the last decade. Before, the
diagnosis of the most prevalent cause, Alzheimer’s Disease (AD) was
made only after other causes had been ruled out and furthermore,
the disease should have been progressed into dementia. After the
groundbreaking publications by B. Dubois and co-workers in 2007
and 2010, most clinicians regard biomarkers to form the basis
for positive diagnosis of the disease, irrespective of the disease
stage. In Europe, the biomarkers are generally considered to be
a clear indication of the disease but in North America, clinical
guidelines are more cautious even though they use the same types
of biomarkers.
In this presentation, the main types of biomarkers for AD will be
discussed, their importance as well as some pitfalls in interpretation
of results. Some glimpse into other possible biomarkers of AD will
be given as well as into biomarkers and clinical diagnosis of other
causes of cognitive impairment and dementia. Last but not least,
some ethical issues will be discussed regarding the importance of
early diagnosis as well as the challenges clinicians will face in the
coming years when they will have access to new and most probably
expensive pharmacological agents.
KL-19
Integrated geriatric care in acute hospitals
A.J. Cruz-Jentoft
Hospital Universitario, Ramon y Cajal, Madrid, Spain
Geriatric care has relentlessly grown in acute care hospitals in
most European countries. Geriatric departments usually deploy a
wide range of services, from acute care to outpatient geriatric
clinics to home care, to manage complex older patient needs.
Geriatric departments should have some common aspects in the
way they work, as is mostly true for some organ specialities. But
heterogeneity in acute geriatric care is wide both between and
within countries. In this presentation, usual services or levels of care
offered by geriatric departments will be described, and evidence
for their effectiveness will be showed. The question about a “core”
set of services that may be used to define a standard geriatric
department in Europe will be discussed.
Nowadays roughly half of the patients admitted to an acute care
hospital are older than 65, and the number of those over 80 is
increasing exponentially. Geriatric units cannot and should not take
care of every old individual, and in real practice most older patients
will not be cared for by geriatricians. Although evidence for geriatric
consultation is weak, there are many other ways that geriatric
departments can use to influence on the way older patients are
cared when admitted under other medical or surgical specialties.
These will be reviewed and discussed.
Finally, geriatric’s core is multidisciplinar. Special links should be
established with some key disciplines, that will have an impact on
results of geriatric care. A brief review of such links and how they
can be developed will be offered.
KL-20
Interface geriatrics in a nutshell
S. Conroy
University of Leicester, Leicester, United Kingdom
Health and social care systems are starting to experience the boom
in the oldest old. Much as this is a testament to societal advances
in general, it does present some challenges. Much of the focus in
recent times has been on hospital admissions and how to prevent
them.
However, preventing hospital admissions is not easy, and several
large scale projects targeting older people with varying levels of
risk of admission have failed to demonstrate either clinical or cost-
effectiveness [1–3].
An alternative is to look at the hospital’s response to the increasing
number of older people attending. Traditionally emergency
departments have not focussed on older people and the emergency
medicine curriculum has not hitherto covered geriatric medicine
in any great detail. These factors, combined with the immense
pressure of the 4-hour target, mean that the conversion rate
(proportion attending that are admitted) is higher in the oldest
old compared to any other group.
By introducing the principles of Comprehensive Geriatric
Assessment into the emergency care axis, it might be possible to
attenuate the ED conversion rate for older people. But this alone is
insufficient – closing the front door even with correct assessment,
is insufficient if attention is not paid to the back door.
Interface geriatrics seeks to re-establish the link between primary
secondary care, essentially re-introducing the ‘G’ of CGA into
emergency, acute and community care of older people.
Results from Leicester indicate that incorporating CGA in the
emergency department reduced admissions in those aged 85+ by
10%; in addition strengthening CGA in the community settings was
associated with a 25% reduction in readmissions [4].
Reference(s)
[1] Fletcher AE, Price GM, Ng ESW, Stirling SL, Bulpitt CJ, Breeze E, et
al. Population-based multidimensional assessment of older people in
UK general practice: a cluster-randomised factorial trial. The Lancet;
364(9446): 1667–77.
[2] Gravelle H, Dusheiko M, Sheaff R, Sargent P, Boaden R, Pickard S, et
al. Impact of case management (Evercare) on frail elderly patients:
controlled before and after analysis of quantitative outcome data.[see
comment]. BMJ 2007; 334(7583): 31.
[3] Ernst & Young. National Evaluation of the Department of Health’s
Integrated Care Pilots: RAND Europe, 2012.
[4] Conroy SP, Ansari K, Williams M, Laithwaite E, Teasdale B, Dawson J,
et al. A controlled evaluation of comprehensive geriatric assessment in
the emergency department: the ’Emergency Frailty Unit’. Age Ageing
2014; 43(1): 109–14.