European Geriatric Medicine最新文献

Purpose: To explore a set of psychosocial and behavioural correlates of self perceptions of aging among geriatric healthcare professionals.

Methods: A cross-sectional online survey was distributed through the EuGMS and the COST Action CA21122 "PROGRAMMING" network. Self perceptions of aging, resilience, health-related lifestyle behaviours, sociodemographic, health, and subjective age data were collected. Correlations and multiple linear regressions were performed.

Results: 176 professionals from multiple countries participated. Professionals aged 60 + showed more positive attitudes in the physical change domain compared with younger peers, while psychosocial loss and psychological growth did not differ by age. Participants who felt younger than their chronological age had higher physical change, psychological growth, and resilience scores, indicating that feeling younger was associated with more positive attitudes toward physical and psychological aspects of aging, as well as greater psychological resilience. Resilience correlated positively with physical change and psychological growth, and negatively with psychosocial loss. Participants with academic postgraduate degrees showed more positive attitudes in the psychological growth subdomain. In adjusted regression analyses, higher psychological resilience was significantly associated with lower psychosocial loss perceptions (p < 0.001) and greater psychological growth (p = 0.003). Subjective age was associated with physical change perceptions (p < 0.001). Physical activity showed significant associations with both psychosocial loss (p = 0.036) and physical change perceptions (p < 0.001).

Conclusion: Geriatric specialists' self perceptions of aging were associated with resilience, subjective age, physical activity, and professional factors, rather than demographic or lifestyle variables. These might be relevant targets for supporting more adaptive ageing perceptions among healthcare professionals, although causal direction cannot be inferred.

Purpose: Falls affect one-third of older adults each year, often resulting in low balance confidence, which is associated with reduced mobility and quality of life. This study examined the association between MFES scores and incident injurious falls and evaluated whether MFES scores mediate the relationship between previous and subsequent falls in older adults.

Methods: Data for participants (n = 952, age ≥ 65 yr) from the Geelong Osteoporosis Study were linked with the Victorian Emergency Minimum Dataset (VEMD). The outcome was the time to first emergency presentation for an injurious fall. Balance confidence was measured using the Modified Falls Efficacy Scale (MFES). Competing risk regression evaluated the MFES score as a predictor of incident injurious falls. Receiver operating characteristic (ROC) analysis determined the optimal MFES cut point for predicting incident injurious falls based on the maximum Youden's index, while mediation analysis assessed MFES score's role between prior and subsequent falls.

Results: The median follow-up time was 11.5 years (IQR: 5.9-19.0), with a total of 11,368 person-years. Over the follow-up period, 219 participants (23.0%) experienced at least one incident injurious fall, with an incidence rate of 19.3 per 1000 person-years (95% CI: 16.9-22.0). Low MFES score was a significant predictor of incident injurious falls (aSHR = 1.019, 95% CI: 1.005-1.033). Although an MFES cutoff of 55 was identified, the AUC (0.508) indicated no meaningful discriminative ability. Low MFES score explains 14.9% of the relationship between prior self-reported and subsequent injurious falls.

Conclusion: A low MFES score is associated with incident injurious falls and partially mediates the relationship between previous and subsequent falls. Although an optimal MFES cut point of 55 was identified, its very low specificity and lack of meaningful discriminative ability limit its reliability for prediction. These findings support recommendations, consistent with the World Falls Guidelines, to incorporate assessments of balance confidence-captured through validated measures such as the MFES-into multifactorial fall risk management.

Introduction: Self-management skills can help patients with Parkinson's disease to adopt healthy behaviors and live well, thereby improving outcomes and reducing costs.

Methods: Patients with parkinsonism and caregivers in this single-center study self-completed questionnaires including the Patient Activation Measure (PAM®) which quantifies self-management capability. Predictors of activation were determined using linear regression.

Results: 64% (279/438) of patients and 59% (189/323) of caregivers were categorized as the lowest two activation levels. Increasing patient age, frailty, non-motor and depressive symptoms, four or more comorbidities, and worse quality of life were associated with lower patient activation. Increased hours spent caring and use of emotion-focused and problem-focused coping strategies were associated with increased caregiver activation. There was moderate evidence that male caregivers had lower activation.

Conclusion: Low activation levels were common among this more representative population of parkinsonism patients and caregivers. Proactive management of non-motor symptoms may improve activation and outcomes.

Purpose: A Multicenter prospective observational study to investigate the association between sarcopenia and diaphragmatic motility in patients admitted for acute respiratory failure (ARF) requiring high-flow nasal cannula (HFNC) or non-invasive ventilation (NIV), and to evaluate whether diaphragmatic ultrasound parameters predict short-term outcomes.

Methods: A total of 127 patients hospitalized in the Sub-intensive care units of Fondazione Policlinico Universitario Campus Bio-Medico (Rome), Monaldi Hospital (Naples), and University Hospital of Ferrara with ARF due to various respiratory diseases and requiring respiratory support between January 2023 and January 2025. Sarcopenia was defined using EWGSOP2 criteria (reduced handgrip strength and calf circumference). Diaphragmatic excursion (DE) and thickening fraction (TF) were assessed by ultrasonography during spontaneous breathing prior to respiratory support. Logistic regression and Cox models were used to examine associations with sarcopenia, 3-month mortality and hospital outcomes.

Results: Sarcopenia was diagnosed in 52.7% of patients. Compared with non-sarcopenic individuals, sarcopenic patients showed lower diaphragmatic excursion (2.04 cm, SD 0.8 vs. 2.58 cm, SD 0.9, p = 0.001) and thickening fraction (20.5%, SD 10 vs. 24.0%, SD 9.9, p = 0.03). Reduced DE remained independently associated with sarcopenia (adjusted OR = 0.28; 95% CI 0.11-0.59; p = 0.002). No significant associations were found between diaphragmatic parameters and 3-month mortality or hospital outcomes.

Conclusion: Older adults with sarcopenia hospitalized for ARF exhibit reduced diaphragmatic motility, independently of comorbidities and disease severity. Ultrasonographic assessment of diaphragm excursion may represent a simple bedside tool to identify patients with underlying muscle weakness, supporting a more individualized management approach during acute respiratory failure, although further studies are required to validate its prognostic and clinical utility.

Purpose: To map and characterise major transnational initiatives in geriatrics education and training, and explore complementarities as a basis for a more integrated and equitable global framework.

Methods: A mapping exercise and expert consultation were undertaken by the European Geriatric Medicine Society (EuGMS) Special Interest Group on Education and Training between January and October 2025, including a meeting of international experts during the Twenty-First EuGMS Congress in Reykjavík. Eligible initiatives operated across national borders with an explicit mandate in education and training related to geriatrics and were not confined to a specific topic or subspecialty. Each initiative was profiled by scope, target audience, and contributions, and classified within a three-tier framework: (1) foundational capacity-building, (2) professional and interprofessional development, and (3) leadership and specialist advancement.

Results: Seventeen initiatives were identified. Tier 1 included the International Federation on Ageing (IFA), International Institute on Ageing, United Nations-Malta (INIA), PAHO's ACAPEM (Basic), ASEAN's Centre for Active Ageing and Innovation (ASEAN-ACAI), IAGG's e-Training in Gerontology and Geriatrics (e-TRIGGER) programmes, WHO's Integrated Care for Older People (WHO ICOPE approach), and AfriAGE. Tier 2 included the IAGG, EuGMS, EICA, PROGRAMMING CA2112, Victorian Geriatric Medicine Training Programme (VGMTP), and ACAPEM (Intermediate); and Tier 3 was represented by leadership academies (EAMA, ALMA, MEAMA/MENAAA, and AAMA), and UEMS-GMS.

Conclusion: Collectively, these programmes form a considerably disjointed but potentially complementary global ecosystem for geriatrics education. Greater mutual awareness and alignment, anchored in equity and interprofessional inclusion, could enhance efficiency and sustainability in developing the global geriatrics workforce.

Purpose: To determine the effectiveness of integrating a web-based tool into hospital pharmacist medication optimization activities on high-risk medication use and explore implementation.

Methods: An implementation study with retrospective control group. The intervention consisted of multi-step pharmacist-led medication review using The Drug Burden Index (DBI) Calculator© implemented on four wards. Patients aged ≥ 70 years admitted on one or more medications with anticholinergic or sedative properties were eligible to participate. Primary outcome was change in DBI score and secondary outcomes included safety (adverse drug withdrawal events), feasibility (pharmacist time) and fidelity (whether intervention elements were conducted). Implementation was explored through mixed methods: post-intervention interviews with participants/caregivers, pharmacists and prescribers, and subgroup analyses.

Results: Data were analyzed from 148 retrospective control and 40 intervention participants. Participants were median 79 (interquartile range = 12) years old and 61% were female. A meaningful reduction in DBI score (≥ 0.5) occurred in 23% (9/40) of intervention versus 6% (9/158) of control group (p = 0.003). No adverse drug withdrawal events occurred in the intervention group. Pharmacists took an average of 68 min to complete all intervention elements. Interviews (n = 13) confirmed that the DBI Calculator© supported deprescribing although several barriers remained, including a need for incorporation of tools into the electronic medical record and protected time for pharmacists on the wards for clinical activities.

Conclusion: Integrating The DBI Calculator© into pharmacist-led medication reviews supported deprescribing efforts and was effective at reducing the DBI score in older hospital inpatients. Further research is required to explore widespread implementation and sustainability.

Trial registration: Clinicaltrials.gov NCT03698487, registered 2018-10-09.

Introduction: Dementia is a chronic disease characterized by progressive and mostly irreversible cognitive and functional decline. Advanced dementia is linked to high mortality and morbidity, with over 85% of patients experiencing feeding-related problems. Care should focus on comfort and quality of life, with medical societies recommending against tube feeding, supporting instead careful hand feeding. However, awareness among healthcare professionals regarding tube indications and complications remains limited.

Purpose: To identify the frequency of hospitalizations related to feeding problems, analyze healthcare professionals' attitudes, and compare the outcomes of patients with and without tube feeding.

Methods: This retrospective, observational cohort study analyzed patients aged ≥ 65 years with advanced dementia admitted to Internal Medicine Department of Coimbra's Healthcare Integrated Delivery System between January 1 and March 31, 2023. Sociodemographic, clinical, feeding-related data, along with complications, mortality, and readmissions, were collected and analyzed via STATA.

Results: Of the 1,735 admissions, 178 patients met the inclusion criteria (mean age 86; 64.5% female). Respiratory illnesses were the primary diagnosis (56.7%), and in-hospital mortality rate was 23%. Feeding-related hospitalizations occurred in 17.4% of the patients, mainly due to aspiration. At discharge, 102 patients had no feeding tube (Group A), and 76 did (Group B). Group B had significantly higher complication rates at one year than did Group A, without a survival benefit.

Conclusion: Our findings demonstrate that feeding-related complications also occur in patients receiving enteral tube feeding, without increasing survival or reducing complications and underscore the need for professional training and individualized evidence-based care in advanced dementia.

Purpose: To evaluate a novel educational intervention for mental health clinicians and peer workers on Advance Care Planning (ACP). The aims of the intervention were to improve staff knowledge, attitudes, and confidence in facilitating ACP with older people with mental illness and increase staff engagement in ACP.

Methods: A pre-post-intervention study was conducted across two public mental health services in Australia. Multidisciplinary clinicians and peer workers (n = 110) participated in a one-hour, evidence-informed educational session combining theory, video demonstrations, and discussion of case vignettes. Uniquely, this study utilized purpose-developed audio-visual resources designed for local legal frameworks and engagement of peer workers as both educators and participants. Paired pre- and post-intervention questionnaires assessed staff knowledge, attitudes, and confidence. A pre-post-audit of mental health consumer (patient) electronic medical records (eMR) quantified changes in ACP documentation rates. Thematic analysis of free-text feedback was conducted.

Results: The intervention significantly improved staff attitudes (p < 0.001, r = 0.48), knowledge (p < 0.001, r = 0.51), and confidence (p < 0.001, r = 0.87). However, eMR audits (pre: n = 1104; post: n = 1118) with a 2-3-month follow-up period revealed no significant change in ACP documentation rates (7.6% vs. 8.0%). Participants' feedback highlighted a desire for further practical training incorporating experiential learning (e.g., role-play) and systemic support.

Conclusions: While a brief, standalone educational intervention significantly improved staff readiness for ACP, this did not translate into documented changes in clinical practice (eMR documentation). Bridging this knowledge-to-practice gap requires multifaceted strategies beyond standalone education, such as organizational governance, audit-feedback cycles, skills practice, and champions to embed ACP into routine practice.

Background: Sarcopenia, defined by a decline in muscle strength, muscle mass and physical performance, is associated with poorer health-related quality of life (HRQoL) in older adults. However, longitudinal studies investigating this relationship using sarcopenia-specific HRQoL instruments remain scarce.

Objective: To investigate the association between changes in sarcopenia components and changes in HRQoL over four years using the SarQoL questionnaire, a tool specifically designed for individuals with sarcopenia.

Methods: This study included 333 community-dwelling older adults from the SarcoPhAge cohort, followed annually for four years. HRQoL was evaluated using the SarQoL questionnaire. Sarcopenia components were measured using a handgrip dynamometer to assess muscle strength, dual-energy X-ray absorptiometry (DEXA) to assess muscle mass and the Short Physical Performance Battery (SPPB) test to assess physical performance. Associations between changes in sarcopenia components and changes in global and domain-specific SarQoL scores were assessed using linear mixed models, with random effects to account for within-subject variation.

Results: 333 community-dwelling older adults were included in this study (age: 72.6 years (68.7-77.5), 58.9% women). Over four years, despite an overall age-related decline in sarcopenia components and HRQoL, the increases in physical performance (β = 1.04; p < .0001), grip strength (β = 0.195; p = .0001), and muscle mass (β = 2.47; p < .0001) were independently associated with higher global SarQoL scores. Analyses of the seven SarQoL domains yielded consistent findings.

Conclusion: The results support the use of the SarQoL questionnaire as a specific and sensitive instrument for monitoring HRQoL in older adults as it appears responsive to changes in muscle mass, strength, and physical performance.