Global Sessions

Latest United Kingdom guidelines on osteoporosis Abhaya Gupta Department of Medicine and Elderly care, Hywel Dda University Health Board, Glangwili hospital, Carmarthen, United Kingdom Older, frail, and multimorbid patients have the highest fracture risk and therefore the most to gain from anti-osteoporosis treatments to reduce this risk. Currently, an unacceptable treatment gap exists between those eligible for and those who receive treatment. The UK National Osteoporosis Guideline Group (NOGG) recently released new guidelines for the prevention and treatment of osteoporosis that include several key updates. The guidelines recommend that patients with a fragility fracture receive prompt treatment to reduce the risk of further fractures. A FRAX risk assessment should be done in postmenopausal women and men >50 years of age with a clinical risk factor for fragility fracture. The guidelines emphasize the importance of detecting vertebral fractures and recommend routinely reviewing spine radiographs. The new concept of “very high fracture risk” is introduced, which indicates the need for anabolic treatment as a first-line option. Intravenous zoledronate is now recommended as a first-line anti-osteoporosis therapy in older patients following a hip fracture. Careful planning is needed when stopping Denosumab treatment due to the increased risk of vertebral fractures. Consider prescribing oral bisphosphonates for at least five years, and intravenous bisphosphonates for at least three years. Reassess fracture risk after any new fracture, and after pausing drug treatment. Consider fall risk and exercise programs in osteoporosis patients. Acknowledgments: None Conflict of interest: None Managing Difficult-to-Treat Rheumatoid Arthritis (D2TRA) in the Elderly AB Maharaj Department of Internal Medicine & Therapeutics, Faculty of Health Sciences, Walter Sisulu University, Mthatha & Nelson Mandela Academic Hospital, South Africa Difficult-to-treat rheumatoid arthritis (D2TRA) in older persons is a complex term in which older patients may present with difficulties in the management not only from rheumatoid arthritis but from comorbidities as well. These complexities require a multifaceted approach, especially in older patients who may have inadequate responses to various disease-modifying antirheumatic drugs for multiple reasons. Chronic pain in these patients may be a result of inflammation, structural damage, and pain sensitization syndromes. Cognisance has to be taken of toxicity and adverse effects of the drugs used to treat older patients due to alterations in homeostasis as well as other comorbidities. Polypharmacy and drug interactions need to be closely monitored. Given the ever-increasing aging population, late-onset rheumatoid arthritis or rheumatoid arthritis in the older population is becoming increasingly common. It has led to this population being given more attention. The challenges associated with treating older patients with rheumatoid arthritis are not limited to primary care physicians but may also be encountered by specialist physicians, geriatricians, and rheumatologists. Elderly onset rheumatoid arthritis is generally referred to patients >65 years. Due to the various comorbidities the use of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) may be limited in this group of patients. This increases the use of targeted synthetic disease-modifying antirheumatic drugs (tsDMARDs) and biological disease-modifying antirheumatic drugs (bDMARDs), which may pose problems in this population group. Treat to target paradigms should be employed in older patients and should be no different from those employed in the younger population. Shared decision-making should be engaged in, not only with the patient but with supporting family members to improve adherence and outcomes. Other causes for inflammatory arthritis in older patients not responsive to conventional therapies and labeled as “difficult to treat” should be looked for. Conflict of interest: Ajesh Maharaj received grants/research support from AbbVie, Eli Lilly, Janssen, and Servier Laboratories, as well as consulting fees/honoraria from AbbVie, Eli Lilly, Janssen, Novartis, Pfizer, AstraZeneca, Aspen, Roche Pharmaceuticals, and Zydus Healthcare. The Hidden Face of Parkinson’s Disease C Padmakumar Hunter Postgraduate Medical Institute, University of Newcastle, NSW, Australia While Motor symptoms of Parkinson’s Disease (PD) are well-described and widely researched, the same cannot be said about Non Motor Symptoms. Non Motor Symptoms (NMS) though originally described by Dr James Parkinson himself in 1817, they were not well associated with the disease per se and hence didn’t get the clinical and academic interest as Motor Symptoms did. NMS affects the QoL of an older person with PD and their carers quite significantly. This talk is about the different Non-Motor Symptoms, their assessment and diagnosis, and most importantly how they affect an Older Person with Parkinson’s Disease. Advancing Real-World Digital Mobility Outcomes in Aging through Wearable Motion Sensors Kamiar Aminian Ecole Polytechnique Fédérale de Lausanne (EPFL), Institute of Bioengineering, Lausanne, Switzerland Gait impairment, particularly slow gait speed, is a critical predictor of falls, disability, and mortality in older adults. Traditional gait assessments are typically conducted in laboratory settings, which do not reflect real-world behavior. This presentation will highlight the significance of real-world gait speed as a key measure of functional health and mobility in older adults. It will demonstrate how gait speed can be reliably estimated outside of clinical or laboratory environments using wearable motion sensors, emphasizing the importance of real-world digital mobility outcomes. The first part of the talk will present findings from a cohort study of community-dwelling older adults, showcasing how dual-task conditions impact gait speed. It will then focus on the use of wearable sensors for estimating physical behavior and assessing real-world gait speed. By combining gait speed data with walking bout duration, walking distance is proposed as a relevant endpoint in clinical trials involving older populations, such as those recovering from proximal femoral fractures. In the second part, the concept of the ’activity barcode’ will be introduced—a method that aggregates the type, intensity, and duration of daily activities to create a comprehensive signature of physical behavior. This approach offers valuable insights into how activity patterns evolve with aging and serves as a crucial tool for tracking functional decline and changes in mobility over time. The presentation will conclude by discussing the broader implications of these advancements, particularly how they can enhance the use of digital mobility outcomes in clinical settings for aging populations. Autoimmune Encephalitis in Elderly Padma S Gunaratne Nawaloka Hospital, Colombo, Sri Lanka Autoimmune Encephalitis (AE) is characterized by immune-mediated inflammation of the brain, caused by B cell-originated IgG autoantibodies, formed predominantly against cell surface antigens of neuronal and glial cells. The knowledge on AE has been rapidly expanding over the last several decades, particularly since the identification of anti-NMDA receptor encephalitis in 2007. There are more than 20 disorders with antibody-associated AE recognized and evaluation and treatment defined. AE is the third leading cause of encephalitis, the first two being viral and Acute Disseminated Encephalomyelitis (ADEM). Out of many antibodies recognized LGI1, CASPR2, GABA(B), AMPA, IgLON5 and Septin 7 more often afflict older adults. Age and gender are of relevance in the clinical evaluation of AE. While presenting clinical features do not differ, as for aetiologies, NMDA receptor encephalitis tends to affect more females less than 18 years of age whereas older males over 60 years of age are more afflicted by LGI1 antibody and CASPR2 encephalitis. Older persons with multiple comorbidities are more vulnerable to complications of the disease as well as the adverse effects of the treatment. Being over 65 years of age, presenting with fever, GCS less than 13, and the presence of seizures are associated with poorer outcomes. The benefits of early diagnosis of AE and the reversible nature of symptoms with early commencement of immunotherapy have been recognized. The criteria for possible and definitive AE to facilitate early diagnosis have been established. Subacute onset of memory deficits, altered mental status, psychiatric symptoms, and seizures are common presenting clinical features. The presence of CSF pleocytosis (Cells >5/mm3), slow waves or ictal discharges in EEG, and swelling or hyperintensity in the medial temporal lobe and hippocampus in T2 FLAIR images of MRI support the diagnosis of AE. Further evaluation of AE encephalitis could be carried out either by lumping them as AE and requesting a standard autoimmune panel of antibodies or by further splitting with a phenotype-specific autoimmune evaluation of CSF and serum. It is always essential to correlate with clinical features when interpreting antibody lab reports. Immune therapy should be initiated after reasonable exclusion of non-immune-mediated diagnosis while antibody test reports are pending. Antibody test results can further refine cancer workup, immunotherapy choices, and prognosis. Importance of frailty recognition and management Sanjay Suman Medway NHS Foundation Trust, Gillingham, Kent, United Kingdom Frailty is a clinical condition characterized by increased vulnerability to stressors, reduced physiological reserve, and increased risk of adverse outcomes such as falls, hospitalization, disability, and death. Early Identification allows for timely intervention, which can slow its progression, reduce risks, and improve patient outcomes. Recognizing frailty helps to tailor treatment plans and interventions and avoid aggressive treatments that may pose a greater risk than benefit. Early recognition helps stratify patients based on their risk, allowing for better planning of medical or surgical interventions. Once frailty is identified, steps can be taken to prevent worsening through physical activity, nutritional support, and management of underlying diseases. Preventive strategies can reduce the frequency of hospital admissions and improve long-term survival. Frailty management aims to maintain or improve the patient’s functional status through interventions such as strength and balance exercises. Appropriate management of frailty can prevent unnecessary hospitalizations, reduce the length of hospital stays, and minimize complications such as infections or pressure ulcers. Frailty often involves malnutrition, and proper dietary interventions (such as increased protein and caloric intake) are essential for preventing further decline. A multidisciplinary approach to frailty management—including physicians, nurses, physical therapists, and social workers—ensures that all aspects of a patient’s physical, mental, and social needs are addressed. Recognizing frailty also allows for better discussions around end-of-life care, ensuring that care aligns with the patient’s values and goals, particularly when aggressive interventions may no longer be appropriate. Key Interventions in Frailty Management include resistance and aerobic exercises to improve muscle strength, balance, and mobility. Nutritional Interventions through diet or supplements (e.g., vitamin D, protein) are essential for combating muscle loss. Polypharmacy reduction and adjusting doses of prescribed medications to minimize adverse drug effects. Engaging caregivers, family members, and social services to provide adequate care and prevent isolation. Conflict of Interest: No conflicts of interest relevant to this presentation Frailty in the Elderly: Evolution, Impact, and Pathways to Better Care Shahrul Bahyah Kamaruzzaman Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia Frailty in the elderly is a distinct clinical syndrome marked by vulnerability to stressors due to diminished physiological reserves. Initially viewed as a general part of aging, frailty has evolved into a well-defined concept with significant implications for care. The 2001 phenotypic model by Fried et al. defined frailty based on five criteria: weight loss, exhaustion, weakness, slow gait, and low activity, while Rockwood’s deficit accumulation model broadened the understanding to include physical, cognitive, and psychosocial deficits. These models have shaped our understanding of frailty, moving away from a simplistic view of aging decline to recognizing it as a condition that can be assessed, managed, and even delayed. Validated tools like the Fried Frailty Index, Clinical Frailty Scale, and Edmonton Frail Scale now aid in detecting and managing frailty in both clinical and community settings. In a rapidly aging population like Malaysia, the impact of frailty is profound, leading to increased risks of hospitalization, disability, and mortality. Frail older adults are more likely to suffer adverse outcomes from acute illnesses or surgical interventions, which makes frailty a critical predictor of poor prognosis. This highlights the need for a comprehensive and tailored approach to frailty management in hospitals, including early recognition, multidisciplinary care, and careful decision-making regarding treatment options. In the community, recognizing pre-frailty and frailty is crucial for implementing preventive strategies that promote independence and enable older people to age in place. Such strategies involve promoting physical activity, nutritional interventions, and addressing modifiable risk factors like social isolation and polypharmacy. Multidisciplinary interventions, such as comprehensive geriatric assessment, individualized care plans, exercise programs, and social support networks, have been shown to mitigate frailty progression. Addressing frailty proactively enhances the quality of life for older adults, reduces healthcare utilization, and fosters healthy aging across diverse settings. By shifting the focus to prevention and early management, healthcare systems can alleviate the burden on hospitals and empower older adults to maintain their functional independence for as long as possible. Acknowledgment and Conflicts of Interest: None Implementing World Falls Guidelines in Lower middle-income Countries Tan Maw Pin Department of Geriatric Medicine, Universiti Malaya, Malaysia The World Guidelines for Falls Prevention and Management for Older Adults were published and launched simultaneously in Age and Ageing and the European Geriatric Medicine Society Annual Meeting respectively on 30 September 2022. Low- to Middle-Income Countries were assigned their own working group which comprised three experts from Malaysia, two from Brazil, and one from Columbia. A scoping review was conducted to inform the recommendations. Though many recommendations were submitted initially, it was felt that they were not different from those provided by the other working groups, and instead, specific mention of potential differences associated with LMICs was then highlighted within the relevant recommendations. The implementation of the World Falls guidelines within LMICs now forms the next challenge. Specific regional efforts are currently being established in Asia, which bring together both high-income countries and LMICs within the region. However, with limited resources and capacity, despite plans to evaluate the level of implementation of the guidelines, they have yet to be carried out.

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