European Geriatric Medicine - Supplement 1 - Volume 6

S172

Symposia / European Geriatric Medicine 6S1 (2015) S157

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S176

intervention, increasing the sense of security of older persons, and

reducing some of the negative consequences of falls.

Finally, ICT can support fall prevention measures. The PROFOUND

app for example can support health care professionals such as

general physicians, physiotherapists or community nurses in the

decision-making and counselling process regarding older persons

living at home and being at risk of falling. The app could be started

from different information such as the result of a sensor-based

assessment or as part of a clinical pathway after an injurious fall.

In summary, technology can help to improve identification of

persons at fall risk, to guide these persons to specific fall prevention

interventions according to individual deficits, to understand the

biomechanics of falls and to automatically detect falls and call for

help.

Lecture 4: Logic-Based Foundations Within Fall Prevention

Recommendations:

In this presentation we identify the overall

scope and structure of classifications and terminologies necessary

for a European information and registry infrastructure based on

existing registries for frailty, injuries, fractures, and interventions,

focusing on frailty and fall-related injuries. A common language,

indeed based on a formal logic language, a ‘lative logic’

presenting and entirely new approach to logic-based medicine

(complementing evidence-based medicine), including the overall

scope and structure of classifications and terminologies, is needed

to harmonize existing national and regional guidelines, and provide

an enrichment of them into an extended European Guideline

for Fall Prevention. Spatial and geometric data alone will not

suffice, and purely device and electronic approaches to active and

healthy ageing will turn out to be all too shallow. Nomenclature

and terminology based approaches are taking over and will

establish success stories. On the one hand, our approach has

the ambition to support the development of a personalized

prevention guideline, developed in cooperation with professionals

for professionals, with prevention action focusing on individuals

rather than populations. On the other hand, it is intended

to be a guide to design, commitment and implementation of

fall prevention programmes within regions and municipalities.

Our approach responds specifically to the needs and visions

described in “Growing the Silver Economy in Europe”. We

position ourselves e.g. with respect to ongoing and new silver

economy related policy initiatives within the European Commission

as represented by several Directorate-Generals. We strengthen

economic sustainability of outcome, which is an important support

for the industry. The Commission and its DGs has recognized the

need to overcome obstacles caused by fragmentation of data. Our

fall prevention approach contributes to bridge these gaps, seen

as absence of nomenclature and common language across DGs.

Providing that common language, our approach is expected to be

useful also for further work within the DGs and in particular for

communication and dialogue between the DGs. Our approach also

supports the assembly of the global approach with a European

wide partnership (Ecosystem for Innovation) and a regional/local

approach (Ecosystems of Implementation), including modelling of

pre-commercial procurement.

SIG Symposium: Pre- and postoperative care

S-18

Successful aging creates new challenges in geriatric

cardiology

–

TAVI as novel treatment in aortic stenosis

T.M. Norekv ˚al

, D.E. Forman

, A. Schoenenberger

, L.L.S.P. Eide

A. Ungar

, E. Skaar

Haukeland University Hospital, Bergen, Norway;

University of

Pittsburgh Medical Center, Pittsburgh, United States of America;

Switzerland;

University of Bergen, Bergen, Norway;

Azienda

Ospedaliero Universitaria Careggi, Florence, Italy;

Norway

Chairs:

Tone M Norekv ˚al, Bergen, Norway and Elisabeth Skaar,

Bergen, Norway

Cardiac treatment has great a potential in reducing mortality and

morbidity, yet the oldest patients have an increased risk when

undergoing invasive procedures. Future patient care will most likely

be more individualized in the oldest patients and considerations

of patient preferences, comorbidities and risk/benefit assessment

more emphasized than today. In this symposium we aim to

accentuate cardiac care for the elderly, with a special focus on

treatment of aortic stenosis.

Cardiac care for Older Adults

–

Time for a New Paradigm?

(Daniel E. Forman, Pittsburgh, USA): A key challenge for

today’s cardiology providers is to better match provision of

cardiovascular care to the circumstances and preferences of our

older patients. More adults are surviving into old age when

vulnerability to cardiovascular disease predictably accelerates.

Ironically, while cardiology providers often speak of “patient-

centered care”, implications of fundamental aging dynamics

remain poorly delineated. Aging has transformative bearing on

cardiovascular disease such that traditional standards of efficacy

become relatively less reliably aligned with outcomes that are

necessarily satisfying to older patients. Application of TAVI reflects

many of these complex issues. With TAVI, cardiology providers

have evolved the technical proficiency to treat life-threating

aortic stenosis even in debilitated patients. However, beyond

the fact that patients can survive the procedure, benefits often

remain ambiguous. The Partners trial showed, for example, that

only a subset of the patients receiving TAVI and successfully

enduring the procedure actually benefitted in terms of functional

and quality of life gains, i.e., resiliency cannot be assumed.

Whereas therapeutic efficacy has traditionally been oriented

to mortality and morbidity, for many older adults the range

of meaningful endpoints is often broader, e.g., quality of life,

function (physical function and cognition), independence, pain,

and personal cost are often their dominating patient concerns.

Unfortunately, trials that have served as the basis of “evidence”

for cardiovascular guidelines have excluded senior cardiovascular

patients with relevant age complexities, and which thereby

limit generalizability to the “real” older patients who providers

actually treat. Adding to the challenge, the impact of aging varies

considerably in each patient, and traditional risk-stratification

tools rarely stratify in respect to integral aging dynamics.

While frailty has, for example, recently been recognized as

an important consideration, metrics to evaluate frailty remain

relatively controversial. Overall, a key opportunity for cardiology

in 2015 is to address aging as a transformative dimension of

health that mandates reconsideration of precepts and methods of

cardiovascular care.

Comprehensive Geriatric Assessment prior to TAVI procedure

(Andreas W. Schoenenberger, Bern, Switzerland): Comprehensive

geriatric assessment (CGA) in the context of TAVI is of great

importance. TAVI is predominantly performed in older patients.

Older patients frequently have functional limitations in addition