European Geriatric Medicine - Supplement 1 - Volume 6

Symposia / European Geriatric Medicine 6S1 (2015) S157

–

S176

S173

to their higher burden of co-morbidities. CGA measures these

functional limitations which are of importance for several reasons.

First, CGA uncovers functional limitations which would go

undetected, if not screened for. The detected functional problems

are important for prevention during the TAVI procedure (e.g.,

delirium prevention in patients with cognitive impairment).

Second, CGA might help identifying TAVI patients who likely benefit

from additional geriatric interventions before or after the procedure

(e.g., geriatric rehabilitation). Third, functional limitations (e.g.,

cognitive impairment, mobility impairment, or disability) are

determinants of prognosis after TAVI. Many established risk

scores, such as EuroSCORE or Society of Thoracic Surgeons (STS)

score, insufficiently assess the risk of elderly co-morbid patients

undergoing surgical cardiovascular procedures. CGA therefore helps

improving risk stratification. Fourth, CGA domains may be used for

a more detailed assessment of TAVI outcomes beyond mortality

and adverse events. For all these reasons, use of CGA in the context

of TAVI is of great importance.

Post-operative Delirium in Octogenarians after Surgical and

Interventional Cardiac procedures

(Leslie SP. Eide, Bergen,

Norway): A high incidence of postoperative delirium (PD) has been

identified in elderly cardiac patients, a patient group where the

prevalence of aortic stenosis is high. TAVI is an option to patients

with AS not suitable for surgical aortic valve replacement (SAVR).

Until recently, it was unclear if the incidence of PD after less

invasive treatments such as TAVI was the same as after SAVR.

In a recent article, Eide et al., 2015, identified a lower incidence

of PD in octogenarian patients receiving TAVI when compared to

octogenarians treated with SAVR. Differences in the time of onset

and course of PD between treatment groups were also described.

Negative outcomes of PD in terms of functional decline have been

reported after cardiac surgery. Eide et al, was also able to determine

the negative consequences that PD has on ADL and IADL function

at 1 month follow-up, especially in TAVI patients. In conclusion,

PD is still an unwanted outcome, also after more gentle techniques

such as TAVI.

Update from the CGA-TAVI study of EUGMS

(Andrea Ungar,

Florence, Italy): In 2012, the European Union Geriatric Medicine

Society (EUGMS) undertook a Web based survey on TAVI

for geriatricians across Europe. The survey revealed that the

involvement of geriatricians in the care of patients undergoing

TAVI is, in general, low. Only 17% of respondents who referred

patients for TAVI in the previous two years were members

of a multidisciplinary cardiac team. The EUGMS recommends

that geriatricians should be involved at an early stage of

management and should have a substantial impact on decision-

making, rehabilitation and long-term care of elderly patients

with AS requiring valve-replacement therapy. Therefore, the

EUGMS carried out a prospective, observational study designed

to evaluate the effectiveness of TAVI from the perspective of

the geriatrician: Transcatheter Aortic Valve Implantation Registry

with Comprehensive Geriatric Assessment (CGA-TAVI). The study

is ongoing in different European centers. The incorporation

of CGA-based measures into clinical decision-making related

to patients with AS may be essential for providing the best

possible care to this vulnerable group of patients. Implementation

of CGA into clinical routine before treatment is essential

for decision-making in frail older patients affected by severe

symptomatic AS.

These presentations are of high quality and we expect the audience

to get a thorough understanding of the challenges in geriatric

cardiology, with a special focus on TAVI. We have no financial

support from commercial parties.

SIG Symposium

S-19

Geriatric Emergency Medicine

–

the future of modern

healthcare

. . .

S. Conroy

University of Leicester, Leicester, United Kingdom

Rationale:

For older people, attendance in the emergency room

is a “sentinel event” that can mark the start of significant

functional impairment and loss of independence. From a clinical

perspective, the initial assessment in the emergency department

is critical to ensuring subsequent good quality decision making

and care. In the context of a growing collaboration between

the European Society of Emergency Medicine and the European

Union Society of Geriatric Medicine, we propose a symposium that

will report on common emergency presentations in older people

and the latest research and educational proposal for Geriatric

Emergency Medicine.

Chairs:

Abdel Belou (FRA) Anna Bj ¨org J ´onsd ´ottir (ICE)

Talk 1: Management of polytrauma in older patients in the

Emergency Department, speaker, Abdel Belou, FRA

Talk 2: Presentation and outcomes of out of hospital cardiac arrest

in older patients, Abdel Belou, FRA

Talk 3: Academic Geriatric Emergency Medicine – a roadmap for

research and a draft European GEM curriculum, Fredrik Sjostrand

(SWE)/Simon Conroy (UK))

Learning Objectives:

From this symposium participants will be

able to:

•

Develop an understanding of the Emergency Medicine approach

to polytrauma in older people

•

To review the outcomes from cardiac arrest in older people

•

To input into the future academic agenda for GEM in Europe

•

To develop and network with experts in the field

SIG Symposium: Infectious diseases and

vaccines

S-20

Vaccine for seniors: present and future

G. Gavazzi

, S. Maggi

, J. Flamaing

, J. Gaillat

University of Grenoble Alpes, Grenoble, France;

National Research

Council, Aging Branch, Brescia, Italy;

Department of Geriatric

Medicine University Hospitals Leuven and KU Leuven, Leuven,

Belgium;

Division of Infectious Diseases, Pringy, France

Prof Joahn Flamaing (Belgium) Prof Stefania Maggi (Italy), Dr

Jacques Gaillat (France), and Prof G. Gavazzi (France) on behalf

of vaccine group of EUGMS.

Introduction:

As individuals age, and disability increases,

prevalence and incidence of most of infectious diseases increase;

several infection are preventable by vaccination. However, if

vaccinations for children are well accepted and firmly organised

in many countries, vaccination for elderly shows lower interests.

Indeed it seems that immune senescence leads to decreased

efficacy that may decrease the interest in vaccination in the

oldest population. Yet, there is a requirement to better know

which infection may be efficiently prevented by vaccine in elderly

population.

We then propose on behalf of vaccine study group of EUGMS a

symposium regarding controversies of known and already used

vaccines (health care workers/) but also news and future available

vaccines.