European Geriatric Medicine - Supplement 1 - Volume 6 - September 2015

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Symposia / European Geriatric Medicine 6S1 (2015) S157 –S176 S161
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S-06
Acute functional decline
A.H. Ranhoff
University of Bergen, Bergen, Norway
Chairs: Anette Hylen Ranhoff, Norway and Renzo Rozzini, Italy
Acute functional decline in older people is first of all an indicator of
acute disease. But it is also a prognostic factor for further functional
decline and mortaliy in the acute ill older person. It is a common
phenomenon as half of the older patients admitted to medical
departments are shown to have decline in function during the last
two weeks prior to hospitalisation.
In this symposium we will discuss risk assessment, risk factors
and rescilience to acute functional decline and also possibilities for
intervention to preserve function in older acutely ill persons.
Risk assessment of the older person at risk of functional decline
(Matteo Cesari, G ´erontopˆole, Centre Hospitalier Universitaire de
Toulouse, Toulouse, France): Disabling conditions at old age
represent a major burden for both the individual’s quality of
life as well as for the sustainability of public health systems.
Therefore, relevant efforts have been produced in the last decades
for supporting the detection of older individuals at risk of negative
outcomes (in particular, functional loss) across all the healthcare
settings. In this context, the so-called frailty syndrome has attracted
the interest of the scientific community as a potential condition
to which targeting preventive and therapeutic interventions.
Nevertheless, although there is an almost universal agreement
about the theoretical foundations of frailty, its operationalization
is still controversial. Multiple instruments have been proposed
in literature over the past years, but no consensus has yet been
reached about a possible “gold standard”. Interestingly, studies have
demonstrated that although the capacity of available instruments
at predicting negative health-related events is consistently present,
the agreement of these tools at identifying the same risk
profile is relatively modest. Such issue poses serious problems
in the standardization of the assessments and care, especially
if considering (1) the heterogeneity of the older population,
and (2) the different characteristics of the settings where the
assessment should be conducted.
In this presentation, issues related to the risk assessment of the
older person at risk of functional decline will be described and
discussed. Possible solutions (largely relying on the adoption of
objective models) will be proposed.
Acute functional decline before hospital admission. Limitation
and decline in functional status in an elderly population are
predictors of mortality (Renzo Rozzini, Poliambulanza Hospital,
Brescia, Italy): The change in function after an acute disease could
be viewed as the mirror of a broader condition of inability to react
to stressful events, and for this should be assessed as a relevant
prognostic indicator. The issue of functional change, as a marker of
clinical stability or instability (homeostasis) in the context of an ill
older adult, goes back to the concept of frailty, one that has proved
difficult to define operatively.
Some authors have suggested that the loss of homeostasis might
be a good indicator of frailty. Most clinicians, and for that matter
many of the public, can recognize frail elderly persons when they
see them. However, when asked to provide the characteristics that
make a particular person frail, they are often at a loss. Focusing the
attention on acutely ill hospitalized patients, it may be observed
that functional status at admission and the functional change after
an acute disease are mirrors of a broader condition of inability to
react to stressful events. The inability to remain functionally stable
after an acute illness (i.e., the loss of function) might be an evident
epiphenomenon of frailty. Interventions aimed to maintain, regain,
or improve functional performance; they can improve quality of
life of elderly persons and reduce health care utilization and risks
of admission to a nursing home.
In this presentation data from an acute care of the elderly unit will
be presented and discussed.
Acute functional decline and the Tipping Point Theory in Older
Adults (Marcel G.M. Olde Rikkert, Department of Geriatrics,
Radboudumc, Nijmegen, The Netherlands): As a leading physician
member of the SPARC center which embodies the Synergy
Programme for Analyzing Resilience for Critical Transitions, in
complex biological systems (see , I
will present the analysis of critical transitions in functional decline
of frail older adults over their tipping points of independent
functioning. Being part of SPARC I aim to catalyze novel insights
in the mechanisms that govern resilience and critical transitions
in geriatrics and complex geriatric syndromes such as syncopes,
delirium and acute functional loss. I will show examples of how
the knowledge successfully acquired in studying complex biological
models can now be applied to frail older persons. By the SPARC’s
collaboration we are able to add further knowledge on complex
systems theory from medical biology to clinical gerontology, and
thereby delivering added value to research, clinical practice and
teaching geriatrics.
Moreover, I will present the latest findings of our Coach2Move
project which proved that exercise training can improve frailty, and
is a cost-effective intervention in increasing resilience in adults
aged 75 years and over. The Coach2Move strategy was developed
together with older adults and professionals, and is based on:
(1) motivational interviewing techniques to answer the personal
question: why would you start to move? (2) Explore the barriers in
relation to physical and social activity, (3) Set priorities based on
physical examination and clinical reasoning. (4) Decide together on
meaningful goals. (5) Coach on self-management and self-efficacy
to increase long term results. (6) Accept help from family, friends
and/or professionals. (7) Stratify the intensity based on recovery.
The results show that a patient-centered focus on exercise, self-
management, and coaching is the key in restoring resilience and
again achieving adequate physical activity levels for older adults.
Investing in personalized and goal directed activating therapy
should have priority in frail older adults, and probably is far more
safe and effective than drug therapy.
S-07
Dementia, Biomarker, Genetics and Experimental treatment
N. Bogdanovic
University in Oslo, Oslo, Norway
Chairs: Nenad Bogdanovic, Professor, University of Oslo, Norway,
and Mustafa Cankurtaran, Professor, Hacettepe University, Turkey
Last two decades have brought improvements in understanding
of dementia pathogenesis, diagnostic assessment and symptomatic
therapy. After introduction of amyloid cascade hypothesis in 1992
by John Hardy (please see Key symposium on dementia on
18th September a.m.) the clinical and preclinical research were
focused on development of new biomarkers of dementia diseases
to improve the diagnostic procedure by “shifting to the left”