THE LANCET: European Geriatric Medicine Society Congress 2023: healthy ageing in a changing world

Description

Attended by over 1700 people worldwide, the European Geriatric Medicine Society (EuGMS) Congress took place in Helsinki, Finland on September 20–22, 2023. Over 1000 abstracts were presented, and 115 oral presentations were delivered across 54 sessions on topics including the prevention of falls, frailty, and cognitive impairment, management of musculoskeletal and gastrointestinal disorders, drug therapy, addiction, loneliness, as well as many others. Herein, we present some conference highlights.

Cognitive impairment and its prevention

On day 1 of the conference, Dr Miia Kivipelto (Karolinska Institute, Stockholm, Sweden) presented an overview of the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) and ongoing projects. The FINGER study explores the efficacy of a multidomain lifestyle intervention, involving nutrition, exercise, cognitive training, social activities, and vascular risk monitoring domains, which is delivered over 2 years. From 5, 6, and 7-year follow-up data, participants who received the intervention showed cognitive benefits, a 20% lower risk of cardiovascular events, 30% lower risk for functional decline, 60% reduced risk of chronic diseases, and better health-related quality of life, as well as reduced health-care service costs when compared with controls. 11-year follow-up data have been collected, and the analyses suggest that longer-term multidomain lifestyle changes are feasible and effective. Ongoing work aims to understand the mechanisms underlying the observed effects in order to facilitate the development of precision prevention strategies and identify new drug targets. Preliminary results from the multinational proof-of-concept 6-month randomized controlled MIND-AD trial, demonstrated the feasibility of an adapted FINGER-based intervention, with or without medical food, in people with prodromal Alzheimer’s disease. In a move to investigate a more tailored approach that combines pharmacological and non-pharmacological strategies, the pioneering MET-FINGER trial aims to explore an upgraded FINGER lifestyle-based intervention, alone or in association with metformin in older adults at increased risk of dementia. Recruitment is currently underway.

Dr Jenni Kulmala (Finnish Institute for Health and Welfare, Helsinki, Finland) discussed practical implementation of the FINGER programme, presenting recent qualitative datashowing that health-care professionals face barriers related to resources and infrastructure, the lifestyle intervention itself, and patient’s personal characteristics. Dr Kulmala highlighted the importance of the FINGER collaboration network, which is a group of health and social care professionals from different sectors that aims to facilitate sharing of experiences and good practices to help support practical implementation of the FINGER strategy.

As part of the World-Wide FINGERS network, Dr Takashi Sakurai (National Center for Geriatrics and Gerontology, Obu, Japan) presented the results of the Japan-Multimodal Intervention Trial for Prevention of Dementia (J-MINT); an 18-month, multicentre, randomized controlled trial investigating the effectiveness of a multi-domain strategy on cognitive decline in older Japanese adults at high risk of dementia. A total of 531 older adults (aged 65–85 years) with mild cognitive impairment were enrolled and randomly assigned to receive the intervention or control. In the full analysis set, no significant difference in composite score (cognitive change) at 18-months follow-up between the two groups was observed; however, a prespecified subgroup analysis of patients in the adherent intervention group (those who participated in more than 70% of exercise) showed a significant interventional effect when compared with the non-adherent intervention group and the control group.

Tackling ageism and abuse in older adults

On day 2 of the conference, Emeritus professor Desmond O’Neill (Trinity College Dublin, Dublin, Ireland) highlighted the problem and implications of ageism towards older people in clinical care, and how society, particularly geriatricians and gerontologists, can challenge current negative attitudes towards ageing. Of particular importance is language; we should avoid the use of terms such as “elderly” that promote stereotypes, and instead use more neutral terms, such as “older people”. Conflict-orientated words such as “struggle” or “fight” to describe ageing experiences should also be avoided, and we should instead consider the “building momentum” metaphor, which fosters the understanding that ageing leads to new abilities and knowledge that can be shared by communities. Professor O’Neill advocates the Reframe Ageing movement, a social change endeavour that embodies this understanding, and aims to improve the public’s understanding of what ageing means.

Professor Ioana Dana Alexa (University of Medicine and Pharmacy “Gr. T. Popa” Iasi Clinical Hospital “Dr. C.I. Parhon” Iasi, Romania) discussed the detection and management of abuse of older persons. The prevalence of abuse varies between widely between countries worldwide, from 2.2% in Ireland and 10% in the USA to up to 61.1% in Croatia, and remains underdiagnosed in Romania. Abuse can take the form of physical, sexual, and financial or material abuse, as well as neglect, but the most common types are psychological, emotional, or verbal and mental abuse. Risk factors for maltreatment are female sex, advanced age, and the presence of multiple physical pathologies. Professor Alexa highlighted the signs and manifestations of abuse of older people, such as injuries that have not been cared for properly, malnourishment, or severe anxiety or fearfulness. Professor Alexa highlighted a clear need for more research in this area.

Updates to the ESPEN guideline for nutrition in dementia

In people with dementia, the risk of malnutrition and dehydration increases with disease progression. The European Society for Clinical Nutrition and Metabolism (ESPEN) has updated their nutrition in dementia guideline (previously published in 2015), with the aim of providing evidence-based recommendations for clinical nutrition and hydration in this vulnerable population. The new guidelines consider patients with all disease stages (excluding mild cognitive impairment) and all settings. Dr Elisabet Rothenberg (Högskolan Kristianstad, Kristianstad, Sweden) presented recommendations targeted at the organisational level, covering nutritional care concepts, staff, environment, and food and fluid provision. For example, the updated guidelines recommend that all health care professionals and staff should be educated on nutritional care issues, and informal caregivers should be offered training to ensure awareness and skills to promote adequate food and fluid intake of persons with dementia. In addition, organisations caring for people with dementia should offer attractive, individually tailored food and fluid with choice of food, snacks, and drinks to optimise intake.

In the same session, Dr Anne Marie Beck (Copenhagen University Hospital—Herlev and Gentofte, Hellerup, Denmark) presented updated ESPEN guideline recommendations regarding the role of nursing activities in supporting food and fluid intake in people with dementia, and whether persons with dementia should be encouraged to share mealtimes with others. Based on the available evidence, the new recommendations support the offer of assistance during eating in persons with impaired eating and drinking ability, based on individual preferences and capacity to support adequate food and fluid intake. The new recommendations also promote eating and drinking independence, both through the provision of appropriate utensils and the offering of rehabilitation programmes. Regardless of their nutritional and hydration status, persons with dementia should also be encouraged to share their eating and drinking occasion with others.

Technology to support healthy ageing

On day 3 of the conference, Dr Emma Stanmore (Faculty of Biology, Medicine and Health, Manchester, UK) discussed the Keep On Keep Up (KOKU) programme; a digital strength and balance programme that aims to prevent deconditioning, falls, and frailty in older adults. The programme is a National Institute for Health and Care Excellence-compliant, gamified, personalised, and validated application that has shown good safety, feasibility, and acceptability among older adults in the UK and USA. Results from a mixed-methods implementation study involving six care providers and 47 older adults in receipt of home care indicate improved outcomes such as reduced fear of falling, level of frailty, depression scores, and improved health, quality of life, levels of physical activity, pain, and fatigue. No adverse events were reported. In the same session, Dr Dorota Religa (Karolinska Institutet, Stockholm, Sweden) discussed the role of wearable technologies in helping people living with dementia, with a particular focus on the RADAR-AD project. The multicentre observational, cross-sectional, RADAR-AD cohort study is currently investigating whether remote monitoring technologies (including smartphone apps, accelerometery devices, and wearable cameras) are able to accurately measure function with improved sensitivity in a real-world environment across preclinical-to-moderate stages of Alzheimer's disease, and assessing the performance of selected remote monitoring devices against standard activities of daily life rating scale.

 

Article info

Publication history

Published: September 29, 2023

Identification

DOI: https://doi.org/10.1016/j.eclinm.2023.102263