- Email: [email protected]
Geriatric medicine in Costa Rica
96
EUGMS & EAMA columns / European Geriatric Medicine 6 (2015) 93–97
Aim of the RCT was to determine the feasibility, effectiveness, and sustainability of a three-month intensive, progressive motor training in people with dementia. Participants with confirmed mild to moderate dementia underwent a progressive resistance and functional training (intervention (IG), n = 62) compared to a low-intensity motor activity (control (CG), n = 60). Primary and secondary outcome measures for maximal strength and function were measured before the start of the training (T1), directly after training ceased (T2), after three months (T3), and after nine months (T4). Training significantly improved both primary outcomes (percentage change from baseline: functional performance five-chair-rise, IG: –25.9 15.1 vs. CG: +11.3 60.4 s, P < 0.001; maximal strength leg press, IG: +51.1 41.5 vs. CG: –1.0 28.9 kg, P < 0.001). Even after nine months, functional performance was significantly better in the intervention group (five-chair-rise: IG: – 8.54 22.57 vs. CG: +10.70 45.89 s, P = 0.014), confirmed by other functional tests. Strength was still elevated compared to baseline, but between-group differences disappeared (leg press: IG: +22.75 40.66 vs. CG: +15.60 39.26 kg, P = 0.369). The intensive motor training substantially improved motor performance in frail older people with dementia, functional improvement was sustained for nine months after cessation of training. The training program might represent a model for rehabilitation or outpatient training (Fig. 1).
Fig. 1. Primary endpoints, subgroup of patients (n = 91) that were tested at T4. left: Intervention effect on maximal strength (1Repetition Maximum, sum of maximal strength in both legs measured separately in kg); right: Intervention effect on function (5-chair rise: time needed to rise from chair and sit down 5 times consecutively measured in seconds). Measurements took place before the intervention (T1), directly after the 12-week intervention (T2), at short-term follow-up after 3 months (T3), and long-term follow-up after 9 months training cessation (T4). P-values are given for group time interaction effect as calculated by 2-way analysis of variance for repeated measures. Disclosure of interest The authors have not supplied their declaration of conflict of interest. http://dx.doi.org/10.1016/j.eurger.2014.06.014
Geriatric medicine in Tunisia: Still young? R. Gouiaa Tunisian Association of Gerontology, Sfax, Tunisia E-mail address: [email protected] Tunisian population is ageing rapidly. Since the 1990s, Tunisia started to provide special care for the elderly, and to develop policy to face this phenomenon of ageing. Training in geriatrics started in the faculty of medicine of Sfax in 1995 by a specialized graduate degree in geriatrics and later in the faculties of medicine of Tunis
and Sousse, then Monastir as a certificate of complementary studies in Geriatrics, as well as a specialized Master of Psychogeriatrics. Training programmes in gerontology are regularly organized by the Tunisian Association of Gerontology (ATUGER) in collaboration with the International Institute on Ageing (INIA–UN) and attended by Tunisian medical doctors. Some Tunisian medical doctors had their trainings and diplomas of geriatrics from European countries as France and Switzerland. Some others attended the EAMA advanced postgraduate courses in geriatrics, or the in situ training programmes organized by INIA. Many Tunisian papers and abstracts in geriatrics are published in international journals. Some units of geriatrics were created in departments of internal medicine, and homecare is started by the establishment of mobile teams. We still have to develop the specialty of geriatrics, the homecare and to create a journal of geriatrics/gerontology. Disclosure of interest The authors have not supplied their declaration of conflict of interest. http://dx.doi.org/10.1016/j.eurger.2014.06.015
Geriatric medicine in Costa Rica F. Morales-Martinez Hospital Nacional de Geriatria y Gerontologia, San Jose, Costa Rica E-mail address: [email protected] Dr Fernando Morales-Martinez spent over 30 years initiating, fostering, and guiding the education of geriatric medicine in Costa Rica as well as Latin America for medical students, residents, fellows, practicing general physicians and the general public. Currently, all medical students (since 1988) and all family residents rotate through a well-established geriatric medicine section. This section has an established medical staff and a geriatric fellowship-training program of 5 years duration that Dr. Morales initiated in 1992. This fellowship training is incorporated into an extended 4-year family medicine program (1987). Training sites are at the National Hospital of Geriatrics and Gerontology in the capitol, San Jose, as well as outlying community clinics and facilities. Dr Morales is both the general director and the academic director of the Department of Medicine at this hospital. EAMA inspires the model of excellence on his academic career (Table 1). Progressive Care Network For Comprehensive Care Of Older Persons In Costa Rica Introduction The increase in the population aged 65 years and over in Costa Rica is a reality that must be considered by the entire society and particularly by the government and its institutions. What is the Care Network? Is defined as: ‘‘Is a social structure composed of individuals, families, organized community groups, non-governmental and state institutions, articulated by actions, interests and programs, to ensure the proper care and satisfaction of needs for older people in the country, thereby promoting quality of life in aging’’. Beneficiary Profile/As The Network of Care program aims to support the sector of adult population that is in poverty, extreme poverty and social risk. Some Achievements This program runs since 2011, reporting significant achievements for the benefit of the older population. In December 2013, stands out: – the program has attended 8249 older persons at home; – the program was implemented by 50 community networks of care for older people. The flexibility offered by the program, is valued as an important feature, considering that the actors and the communities have very different running condition, as are the needs of the older population.
EUGMS & EAMA columns / European Geriatric Medicine 6 (2015) 93–97
Table 1
Teaching courses in the last 30 years.
Disclosure of interest The authors have not supplied their declaration of conflict of interest. http://dx.doi.org/10.1016/j.eurger.2014.06.016
Complementariness of experimental approaches to address research questions in older people ˜ as 1,2,* M. El Assar 1, C. Alonso 2, L. Rodrı´guez Man 1 Foundation for Biomedical Research, Spain 2 Service of Geriatrics, Getafe University Hospital, Spain *Corresponding author. E-mail address: [email protected] ˜ as) (L. Rodrı´guez Man
97
Vascular disease has been involved in the pathophysiology of frailty. However, the role of endothelial dysfunction, an obligatory step preceding vascular disease, is unknown. We addressed this issue in two phases: – searching if aging per se is accompanied by endothelial dysfunction in microvessels from human beings of different ages (range 18-89) free of cardiovascular risk factors or cardiovascular disease; – searching if endothelial dysfunction (assessed by high ADMA levels) is associated to frailty in older people enrolled in a cohort study (Toledo Study of Healthy Aging). Results Endothelial dysfunction is present in older people due to an increased oxidative stress and the presence of inflammation ˜ as et al., Aging Cell 2009) and in the vascular wall (Rodrı´guez Man ADMA levels are higher in frail people, in people without cardiovascular disease and after adjustment by Ankle-Brachial Index as a biomarker of subclinical disease (Alonso-Bouzo´n et al., Age 2013). Conclusion Different experimental approaches (from the bench to the population-based studies) exhibit a nice complementariness to ask research questions in older people. These findings have raised new hypotheses that are now being tested in EU funded projects (FRAILOMIC, FRAILCLINIC) led by our group to test biomarkers useful for the diagnosis and prognosis of frailty. Disclosure of interest The authors have not supplied their declaration of conflict of interest. http://dx.doi.org/10.1016/j.eurger.2014.06.017
EUGMS & EAMA columns / European Geriatric Medicine 6 (2015) 93–97
Aim of the RCT was to determine the feasibility, effectiveness, and sustainability of a three-month intensive, progressive motor training in people with dementia. Participants with confirmed mild to moderate dementia underwent a progressive resistance and functional training (intervention (IG), n = 62) compared to a low-intensity motor activity (control (CG), n = 60). Primary and secondary outcome measures for maximal strength and function were measured before the start of the training (T1), directly after training ceased (T2), after three months (T3), and after nine months (T4). Training significantly improved both primary outcomes (percentage change from baseline: functional performance five-chair-rise, IG: –25.9 15.1 vs. CG: +11.3 60.4 s, P < 0.001; maximal strength leg press, IG: +51.1 41.5 vs. CG: –1.0 28.9 kg, P < 0.001). Even after nine months, functional performance was significantly better in the intervention group (five-chair-rise: IG: – 8.54 22.57 vs. CG: +10.70 45.89 s, P = 0.014), confirmed by other functional tests. Strength was still elevated compared to baseline, but between-group differences disappeared (leg press: IG: +22.75 40.66 vs. CG: +15.60 39.26 kg, P = 0.369). The intensive motor training substantially improved motor performance in frail older people with dementia, functional improvement was sustained for nine months after cessation of training. The training program might represent a model for rehabilitation or outpatient training (Fig. 1).
Fig. 1. Primary endpoints, subgroup of patients (n = 91) that were tested at T4. left: Intervention effect on maximal strength (1Repetition Maximum, sum of maximal strength in both legs measured separately in kg); right: Intervention effect on function (5-chair rise: time needed to rise from chair and sit down 5 times consecutively measured in seconds). Measurements took place before the intervention (T1), directly after the 12-week intervention (T2), at short-term follow-up after 3 months (T3), and long-term follow-up after 9 months training cessation (T4). P-values are given for group time interaction effect as calculated by 2-way analysis of variance for repeated measures. Disclosure of interest The authors have not supplied their declaration of conflict of interest. http://dx.doi.org/10.1016/j.eurger.2014.06.014
Geriatric medicine in Tunisia: Still young? R. Gouiaa Tunisian Association of Gerontology, Sfax, Tunisia E-mail address: [email protected] Tunisian population is ageing rapidly. Since the 1990s, Tunisia started to provide special care for the elderly, and to develop policy to face this phenomenon of ageing. Training in geriatrics started in the faculty of medicine of Sfax in 1995 by a specialized graduate degree in geriatrics and later in the faculties of medicine of Tunis
and Sousse, then Monastir as a certificate of complementary studies in Geriatrics, as well as a specialized Master of Psychogeriatrics. Training programmes in gerontology are regularly organized by the Tunisian Association of Gerontology (ATUGER) in collaboration with the International Institute on Ageing (INIA–UN) and attended by Tunisian medical doctors. Some Tunisian medical doctors had their trainings and diplomas of geriatrics from European countries as France and Switzerland. Some others attended the EAMA advanced postgraduate courses in geriatrics, or the in situ training programmes organized by INIA. Many Tunisian papers and abstracts in geriatrics are published in international journals. Some units of geriatrics were created in departments of internal medicine, and homecare is started by the establishment of mobile teams. We still have to develop the specialty of geriatrics, the homecare and to create a journal of geriatrics/gerontology. Disclosure of interest The authors have not supplied their declaration of conflict of interest. http://dx.doi.org/10.1016/j.eurger.2014.06.015
Geriatric medicine in Costa Rica F. Morales-Martinez Hospital Nacional de Geriatria y Gerontologia, San Jose, Costa Rica E-mail address: [email protected] Dr Fernando Morales-Martinez spent over 30 years initiating, fostering, and guiding the education of geriatric medicine in Costa Rica as well as Latin America for medical students, residents, fellows, practicing general physicians and the general public. Currently, all medical students (since 1988) and all family residents rotate through a well-established geriatric medicine section. This section has an established medical staff and a geriatric fellowship-training program of 5 years duration that Dr. Morales initiated in 1992. This fellowship training is incorporated into an extended 4-year family medicine program (1987). Training sites are at the National Hospital of Geriatrics and Gerontology in the capitol, San Jose, as well as outlying community clinics and facilities. Dr Morales is both the general director and the academic director of the Department of Medicine at this hospital. EAMA inspires the model of excellence on his academic career (Table 1). Progressive Care Network For Comprehensive Care Of Older Persons In Costa Rica Introduction The increase in the population aged 65 years and over in Costa Rica is a reality that must be considered by the entire society and particularly by the government and its institutions. What is the Care Network? Is defined as: ‘‘Is a social structure composed of individuals, families, organized community groups, non-governmental and state institutions, articulated by actions, interests and programs, to ensure the proper care and satisfaction of needs for older people in the country, thereby promoting quality of life in aging’’. Beneficiary Profile/As The Network of Care program aims to support the sector of adult population that is in poverty, extreme poverty and social risk. Some Achievements This program runs since 2011, reporting significant achievements for the benefit of the older population. In December 2013, stands out: – the program has attended 8249 older persons at home; – the program was implemented by 50 community networks of care for older people. The flexibility offered by the program, is valued as an important feature, considering that the actors and the communities have very different running condition, as are the needs of the older population.
EUGMS & EAMA columns / European Geriatric Medicine 6 (2015) 93–97
Table 1
Teaching courses in the last 30 years.
Disclosure of interest The authors have not supplied their declaration of conflict of interest. http://dx.doi.org/10.1016/j.eurger.2014.06.016
Complementariness of experimental approaches to address research questions in older people ˜ as 1,2,* M. El Assar 1, C. Alonso 2, L. Rodrı´guez Man 1 Foundation for Biomedical Research, Spain 2 Service of Geriatrics, Getafe University Hospital, Spain *Corresponding author. E-mail address: [email protected] ˜ as) (L. Rodrı´guez Man
97
Vascular disease has been involved in the pathophysiology of frailty. However, the role of endothelial dysfunction, an obligatory step preceding vascular disease, is unknown. We addressed this issue in two phases: – searching if aging per se is accompanied by endothelial dysfunction in microvessels from human beings of different ages (range 18-89) free of cardiovascular risk factors or cardiovascular disease; – searching if endothelial dysfunction (assessed by high ADMA levels) is associated to frailty in older people enrolled in a cohort study (Toledo Study of Healthy Aging). Results Endothelial dysfunction is present in older people due to an increased oxidative stress and the presence of inflammation ˜ as et al., Aging Cell 2009) and in the vascular wall (Rodrı´guez Man ADMA levels are higher in frail people, in people without cardiovascular disease and after adjustment by Ankle-Brachial Index as a biomarker of subclinical disease (Alonso-Bouzo´n et al., Age 2013). Conclusion Different experimental approaches (from the bench to the population-based studies) exhibit a nice complementariness to ask research questions in older people. These findings have raised new hypotheses that are now being tested in EU funded projects (FRAILOMIC, FRAILCLINIC) led by our group to test biomarkers useful for the diagnosis and prognosis of frailty. Disclosure of interest The authors have not supplied their declaration of conflict of interest. http://dx.doi.org/10.1016/j.eurger.2014.06.017