European Geriatric Medicine 6 (2015) 9397

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EUGMS & EAMA columns

European Academy for Medicine of Ageing (EAMA). Abstracts from the

9th EAMA Network Meeting 20 years jubilee celebration
C.C. Sieber
Institute for Biomedicine of Aging, Friedrich-Alexander-University, Erlangen-Nurnberg, Germany

Since 1995, the European Academy for Medicine of Ageing has been organising an Advanced Postgraduate Course in Geriatrics. The
EAMAs goals are: to improve knowledge and skills in geriatric medicine for junior faculty members and promising candidates for future
teachers in geriatrics; to raise future opinion leaders in the discipline, and to establish a network among medical doctors responsible for the
care of older persons. (http://www.eama.eu).

Why geriatric knowledge AND

infrastructure should be implemented
into the out-patient sector: Findings
and innovative interventions from the
Hamburg Longitudinal Urban Cohort
Ageing Study (LUCAS)

We invite the EAMA-Community to participate in further analyses

and interpretation of the extensive LUCAS-database.

J. Anders *, U. Dapp
Albertinen-Haus, Centre of Geriatrics and Gerontology, Hamburg,
Germany
*Corresponding author.
E-mail address: jenny.anders@albertinen.de (J. Anders)
Aim & methods The LUCAS study design (individual trajectories
[Fig. 1] since 2000 with embedded RCTs) revealed unexpected
ndings leading to appropriate preventative interventions
(BMBF01ET1002A).
Results Geriatric syndromes start with pre-clinical loss of health
resources followed by accumulation of risk-factors resulting in
frailty as a leading cause of disability and premature death. This
process covered at least 1000 days in initially robust communitydwelling older persons. Therefore, simple but highly predictive selfscreening tools were developed and implemented in general
practices. Then, identied pre-frail persons underwent an extended
geriatric-gerontological assessment (instruments to avoid ceiling
effects, technical supported gait analyses). We identied underlying
causes (i.e. impact disease, post traumatic distress syndrome) of the
frailty cascade and derived therapeutic strategies.
Conclusion LUCAS showed a population-based approach was
effective in selecting different target groups for interventions
preventing frailty and functional decline in pre-clinical stages. We
conclude that the outpatient sector in many European countries is
inadequately prepared to provide comprehensive medical care to
older persons. We recommend implementing not only geriatric
knowledge but also appropriate infrastructure like outpatient
assessment units planned since 2013 by the German Government.

Organisers: Denkinger M. (Ulm, Germany), Onder G. (Rome, Italy).

http://dx.doi.org/10.1016/j.eurger.2014.06.009
1878-7649/

Fig. 1.
2014.

The development of the LUCAS-Cohort between 2000 and

Disclosure of interest The authors have not supplied their

declaration of conict of interest.
http://dx.doi.org/10.1016/j.eurger.2014.06.007

Role of protein supplements in

prevention and treatment of frailty
and sarcopenia
M. Bjorkman
University of Helsinki, Porvoo, Finland
E-mail address: mikko.bjorkman@helsinki.
Background Frailty and sarcopenia are closely related and
common causes of disability in older people. Physical exercise
and dietary protein have been emphasized in prevention and
treatment of these conditions. There is increasing interest for the
use of protein supplements, but evidence from well-designed
randomized controlled trials is scarce.

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EUGMS & EAMA columns / European Geriatric Medicine 6 (2015) 9397

Objectives This talk will discuss and focus on the effects of

protein supplementation on physical performance across different
settings and older patient populations.
Methods Review of the current literature. A series of three
randomized controlled trials performed by the authors group.
Results Based on the current evidence the effects of protein
supplementation on physical performance in robust and nonsarcopenic older people are minor. Some evidence suggests
increase in muscle mass of sarcopenic patients and single studies
have shown improvement in physical performance of pre-frail and
frail older people. The authors group has screened the 75+
population living in Porvoo, Finland (n = 3275) and successfully
randomized home-dwelling sarcopenic patients (Table 1, n = 217)
to an on-going 12-month randomized controlled protein supplementation trial. The interventions will be completed during spring
2014 and at least preliminary intervention results will be available.
Discussion Protein supplements should be considered in a
context of a multidimensional approach.
Table 1 Some baseline characteristics of home-dwelling sarcopenic patients enrolled in a 12-month randomized controlled
protein supplementation trial.

Number
Age, years
Living alone, %
Sedentary, %
Number of regular medications
Body mass index, kg/m2
Mini-mental state examination
Short physical performance battery
Habitual walking speed, m/s
Maximal grip strength, kg

Women

Men

147
83.8  4.7
72
57
5.8  2.7
26.0  3.9
26.1  2.7
8.0  2.8
0.87  0.31
16.5  4.1

70
83.7  4.3
27
53
5.6  3.0
26.5  4.1
25.5  3.3
7.6  2.8
0.85  0.32
25.8  5.6

relationship between use of PPIs and 1- year mortality or combined

end-point mortality and rehospitalization and incident dependency
by using time-dependent Cox proportional hazard regression models
and after propensity score matching. The association between use of
PPIs, IGF-1 and bone mineral density was estimated by multivariate
regression model adjusted for multiple confounders in 938 subjects
(413 men and 525 women) aged  65 years, from the InCHIANTI
Study, with complete information on tibial pQCT, IGF-1, IGF-binding
protein-1 (IGFBP-1) and medications.
Results In the hospitalized population the use of PPIs was
independently associated with mortality (hazard ratio, 1.51 [95%
CI, 1.032.77]) but not with the combined end point (1.49 [0.98
2.17]). An increased risk of mortality was observed among patients
exposed to high-dose PPIs vs none (hazard ratio, 2.59 [95% CI, 1.22
7.16]). Use of PPIs was signicantly associated with functional
decline either before (OR = 1.75; 95% CI = 1.172.60) and after
propensity score matching (OR = 2.44; 95% CI = 1.364.41). In the
InCHIANTI population, PPI users showed age- and sex-adjusted
lower vBMDt than nonusers (180.5  54.8 vs. 207.9  59.4,
P = 0.001). The inverse association between PPI use and vBMDt
remained almost unchanged after adjustment for multiple confounders. There was no statistically signicant difference in vBMDc
between PPI users and nonusers. PPI users had lower IGF-1 levels
(81,9 [61,1-113,8]) than non-users (110 [77,8148,6]), P = 0.02. After
further adjustment for BMI, liver function, number of medications,
caloric intake and IGFBP-1, the relationship between use of PPI and IGF1 remained statistically signicant (b  SE = 18,09  9,38, P = 0,05).
Conclusions In older persons discharged from acute care
hospitals, the chronic use of PPIs is associated with increased 1year mortality and functional decline. The lower trabecular bone
mineral density and IGF-1 levels found in PPI users are potential
mechanisms explaining this association.
Disclosure of interest The authors have not supplied their
declaration of conict of interest.

Disclosure of interest The authors have not supplied their

declaration of conict of interest.

http://dx.doi.org/10.1016/j.eurger.2014.06.009

http://dx.doi.org/10.1016/j.eurger.2014.06.008

Nutritional status and mortality in the

elderly: The obesity paradox

Use of proton pump inhibitors in older

subjects: Risk of adverse clinical
outcomes and potential mechanisms
M. Maggio 1,*, A. Corsonello 2
University of Parma, Italy
2
Italian National Research Center on Aging (INRCA), Cosenza, Italy
*Corresponding author.
E-mail address: marcellomaggio2001@yahoo.it (M. Maggio)

Background In the last 2 decades, it was observed a widely

increased use of proton pump inhibitors (PPIs) especially in older
populations. Despite the fact that PPIs are superior to histamine
receptor antagonists in treating gastroesophageal reux disease
(GERD) and peptic ulcers, the chronic use of PPIs has been associated
with adverse clinical outcomes including higher risk of fractures and
Clostridium difcile infections. In vitro studies have shown that PPIs
negatively modulate the bioactivity of insulin-like growth factor-1
(IGF-1), anabolic hormone and nutritional marker. However,
whether or not PPIs use has negative inuence on survival and
independence of activities of daily living (ADL) and the mechanisms
underlying these hypothesized associations are still poorly known.
Aims of the study The aims of the study were to test the
relationship between the use of PPIs and adverse clinical outcomes
(mortality and rehospitalization, loss of ADL) and the association
between use of PPIs and cortical and trabecular bone mineral
density, IGF-1 bioactivity in older patients of 2 different populations.
Methods In 491 patients (mean age 80.1  5.9 years), categorized
as PPI users and non users, discharged from 11 acute care medical
wards and 3 long-term care/rehabilitation units, we tested the

M. Drame 1,*, P.O. Lang 2, the SAFES Study Group

1
University Hospital, Reims, France
2
Nescens Centre of Preventitive Medicine, Clinic of Genolier,
Switzerland
*Corresponding author.
E-mail address: mdrame@chu-reims.fr (M. Drame)
Introduction The obesity paradox is poorly understood in
vulnerable elderly hospitalised populations. Thus, we aimed to
analyse the impact of body mass index (BMI) on early (6 week),
one- and two-year mortality.
Design Prospective multicentre cohort study with a two-year
follow-up of elderly patients.
Settings Nine university hospitals in France.
Participants Patients aged 75+, hospitalised in medical wards
through the emergency department.
Measurement Inpatients characteristics were obtained through
a comprehensive geriatric assessment, conducted in the rst week
of hospitalisation. All-cause mortality at 6 week, one and two years
were studied using multivariable Cox modelling.
Results The cohort included 1306 patients, aged 85  6years,
with a majority of women (65%). By multivariable analyses, when
adjusted for age, walking disorders, dementia syndrome, dependency,
and comorbidities, one and two-year all-cause mortality were
inversely associated with a levels of BMI. Association between early
(6-week) mortality and BMI values did not reach signicance.
Conclusion While our ndings seem to conrm the reality of the
obesity paradox in vulnerable older hospitalized population,
the exact understanding of underlying mechanisms and even the