Background Image
Table of Contents Table of Contents
Previous Page  12 / 210 Next Page
Show Menu
Previous Page 12 / 210 Next Page
Page Background


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



Dementia diagnostics

state of the art in Europe

J. Snaedal

Geriatric Department, Landspitali University Hospital, Reykjavik,


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.


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.


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


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].


[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.