Tahir Masud

Background: Interprofessional training is essential for high-quality care of older adults. Despite widespread recognition of its importance, evidence on perceived geriatric competence remains limited to studies on single countries or professions. Methods: Secondary analysis of a COST Action multinational multilingual web-based survey (PROmoting GeRiAtric Medicine in countries where it is still eMergING, PROGRAMMING) conducted across the 27 European Union Member States (EU-27) and non-EU-27 countries between 9 October 2023 and 5 June 2024. Four thousand seven hundred eighty-eight professionals from 10 core health and social care groups were included. We explored perceived Knowledge, Relevance and Interest across seven domains required for comprehensive geriatric assessment: frailty, falls and mobility, delirium, depression, mild cognitive impairment and dementia screening, nutritional assessment and malnutrition, polypharmacy and deprescribing. Student’s t test; one-way analysis of variance, hierarchical clustering and latent class analysis were used to identify interprofessional differences and shared patterns across professions. Results: Mean age was 42.4 years (SD 11.9); 3432 (71.7%) were women; 2893 (60.4%) worked in EU-27 countries. Interprofessional differences were observed across all topics. Physiotherapists led in falls and mobility (mean 4.21, SD 0.75), pharmacists in polypharmacy and deprescribing (mean 3.51, SD 1.07), and psychologists/psychotherapists in depression (mean 3.96, SD 0.82). A medical doctors–nurses–pharmacists cluster emerged for Knowledge and Interest; 34.4% pharmacists fell in the low relevance class. Social workers and speech and language therapists showed a low Knowledge–high Interest mismatch. EU-27 professionals reported higher scores than non-EU-27 professionals across most topics (P < .001). Conclusions: Perceived knowledge, relevance and interest showed substantial variation across professions and regions, while revealing shared professional profiles. This may inform team-based interprofessional education.

Background: Europe’s population is ageing. Therefore, all medical students should receive basic geriatric medicine education. It is essential to gain insights into their perceived educational needs and attitudes towards geriatric medicine. Aims: To explore: medical students’ perceived knowledge, relevance, and interest across key geriatric topics and skills; their aspirations to become a geriatrician and interest in geriatric medicine. Methods: We analysed data from the multinational multilingual open online cross-sectional survey on educational needs by COST Action PROmoting GeRiAtric Medicine in countries where it is still eMergING (PROGRAMMING) 21,122. Medical students were asked to rate their perceived knowledge, the relevance to their profession and their interest in further training in each of 33 geriatric topics or skills, from “very low” (scored as 1) to “very high” (scored as 5). They were also asked about their exposure to and attitudes towards geriatric medicine. Results: A total of 448 medical students-274 (61.2%) women, 238 (53.1%) studying in EU-27 countries- completed the survey. Students’ mean (standard deviation, SD) perceived knowledge was highest in bone health (3.53, 0.86), depression (3.17, 0.93), and falls and mobility (3.16, 0.94), while lowest in gerodontology (2.14, 1.06), geriatric rehabilitation (2.45, 0.95), and orthogeriatrics (2.54, 0.99). Overall, 312 (69.7%) students reported exposure to geriatric medicine through specific courses and 257 (57.4%) through rotations in acute hospital wards. Only 30 (7%) students wanted to become geriatricians, while 147 (32.8%) students expressed high or very high enjoyment in engaging with older people. Conclusion: Medical students reported limited knowledge in several key geriatric medicine topics and skills and relatively low interest in careers in geriatric medicine. In many cases learning experiences were limited to traditional lecture-based teaching and ward-based rotations. Active learning approaches such as case-based and problem-based learning were preferred.

Background: The growth of ageing populations is increasing the requirement for professionals trained to care for older adults. Aims: To explore factors associated with interest in further training in geriatrics across health and social care professionals. Methods: The COST Action 21122 PROGRAMMING conducted an online open survey to assess interest in geriatric medicine training among health and social care professionals across Europe and beyond. Data on demographics, educational background, clinical rotations, exposure to older patients, and attitudes were collected. Descriptive statistics, chi-square tests, and binary logistic regression were used to identify factors associated with interest. Results: 5474 professionals participated [mean age 42.6 Median 42.0 Std Dev 11.9 Range 18–88 years; women 3967 (72.5%)]. Medical doctors [2162 (39.5%)] nurses [850 (15.5%)] and dentists [509 (9.3%)] were the largest responders. The proportion of older patients in practice showed a dose-response increase in interest [0–25% older patients, OR 1.24 (95% CI 0.98–1.57) and 75–100% category, OR 2.73 (95% CI 2.22–2.35)]. Factors with negative associations included not having had previous courses/lectures (OR 0.73, 95% CI 0.65–0.81) and no voluntary work (OR 0.79, 95% CI 0.70–0.90). Enjoyment of engaging with older adults was independently associated with interest (OR 2.37, 95% CI 2.18–2.57). Discussion: Interest in geriatric training is associated with demographic, experiential, and attitudinal factors. Conclusion: These findings give insights for targeted educational strategies, enhanced experiential learning opportunities, and systemic efforts to elevate the prestige of geriatrics to strengthen workforce capacity in ageing societies.

Fragility fractures constitute a major global health burden and often result from falls. However, clinical care for fragility fractures is currently organized separately from fall prevention services leading to gaps in integrated care delivery. This joint position paper from the European Geriatric Medicine Society, the Fragility Fracture Network, the World Falls Prevention Society, the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases, the International Osteoporosis Foundation, the European Union of Medical Specialists-Geriatric Medicine Section, and the International Association of Gerontology and Geriatrics–European Region highlights the critical need for integrated falls and fracture prevention, with a focus on evidence-based clinical practice, knowledge dissemination, education, policy strategies, and research. We outline existing guidelines on fall and fracture prevention, with particular emphasis on how fracture risk assessment can be incorporated into fall prevention services and on integrating fall assessment into fracture prevention services. We advocate that future implementation guidelines place greater emphasis on fully integrated models of care. Moreover, training and education programs should be designed to encourage interdisciplinary collaboration among healthcare professionals. Integrated fall and fracture prevention services should be recognized as a public health priority and incorporated into national strategies for healthy aging, supported by adequate, dedicated, and sustainable resources including evidence-based exercise provision. Finally, future research should focus on evaluating the (cost) effectiveness of integrated care models and examining their practical implementation in real-world settings.

Purpose: Fall-risk-increasing drugs (FRIDs) are a significant and modifiable risk factor for falls in older adults. However, prospective data using robust fall ascertainment on specific FRID classes are scarce in community-dwelling populations. We aimed to investigate the association between individual FRID classes and both single and recurrent falls in older community-dwelling adults. Methods: We analysed data from a Danish prospective cohort of 241 community-dwelling adults aged ≥ 75 years. Medication records were collected at baseline, and drugs were classified using the STOPPFall consensus FRIDs list. Falls were recorded prospectively for 1 year using monthly fall-calendars, verified using telephone follow-ups. Associations between FRIDs and one-time (1 fall) and recurrent falls (≥ 2 falls) were explored using Cox proportional hazards model, adjusting for clinical and sociodemographic factors. Results: The median (IQR) age was 82 (80, 86) years, 66.4% were women, and 43.6% had a positive fall history. Prevalences of polypharmacy and use of any FRID were 70.5% and 73.9%, respectively. During follow-up, 88 participants (36.5%) fell at least once while 41 participants (17.0%) fell twice or more. The total number of FRIDs was not associated with falls. Baseline use of benzodiazepine-related drugs, strong anticholinergics, and antiepileptics were significantly associated with recurrent falls in the fully adjusted analyses with hazard ratios (95% confidence intervals) of 3.34 (1.28–8.75), 2.48 (1.04–5.89), and 4.78 (1.24–18.35), respectively. Conclusion: Several specific FRID classes were significantly associated with recurrent falls in this cohort of well-functioning community-dwelling adults, highlighting the importance of targeted medication review and careful prescribing strategies.

Background: Healthcare professionals (HCPs) with variable undergraduate geriatric education increasingly manage older adults with geriatric syndromes in ambulatory and home care settings. We aimed to identify specific unmet geriatric educational needs of the different professional groups involved in older people’s outpatient care. Methods: A cross-sectional structured questionnaire assessing self-perceived knowledge, interest and relevance to practice regarding 33 geriatric domains was disseminated online to interdisciplinary HCPs working in ambulatory and home care settings in the World Health Organization European Region, in the context of the PROGRAMMING COST Action 21122. A global topic score, derived from the formula (relevance + interest—knowledge) served as a surrogate of unmet educational needs, and was standardised using z-scores to enable comparisons across topics and professionals. Results: In the overall sample of 2380 responders from 41 countries, perceived relevance and interest consistently exceeded self-reported knowledge across all topics. Global topic scores ranking in the top Z-score quintile, indicative of perceived unmet educational needs for most HCP groups, included comprehensive geriatric assessment, resilience and diversity, chronic pain, management of behavioral and psychiatric symptoms in dementia, depression, frailty and cognitive impairment screening. Profession-specific priorities included communication, advance healthcare directives and assessment of capacity to consent for nurses and speech-language therapists, polypharmacy and deprescribing for medical doctors and pharmacists, sarcopenia, dysphagia and nutritional assessment for dieticians and mental health problems for psychologists and social workers. Conclusions: Substantial and profession-specific gaps in geriatric education exist in ambulatory and home healthcare settings, which warrant targeted interdisciplinary geriatric courses.

Background: Falls are a major cause of morbidity and mortality in older adults. The World Falls Guidelines (WFG) propose a risk stratification algorithm using fall history, three key questions (3KQ), mobility tests and clinical criteria, but it has yet to be systematically evaluated. Objective: To assess whether the WFG algorithm, in original or modified form, effectively stratifies community-dwelling older adults into low, intermediate or high risk of future falls; whether it has been prospectively validated; and whether it has been adequately operationalised. Methods: We conducted a systematic review (PROSPERO CRD420251151506) by searching MEDLINE, Embase and Google Scholar. Two reviewers independently screened studies and extracted data on cohort characteristics, algorithm adaptations, baseline risk distribution and prospective falls outcomes over ≥6 months. Given the heterogeneity of the studies included, quantitative meta-analysis was not conducted. Results: Eight cohort studies (n = 25 027; mean age range 61–82 years) met the inclusion criteria. No study implemented the WFG algorithm as published; two used minor modifications and six had major adaptations due to dataset limitations. Common modifications included rephrasing the 3KQ, replacing ‘subjective unsteadiness’ question with objective measures, applying mobility test universally, adjusting mobility tests thresholds and omitting fall severity definition components. Across studies, 7.9%–82.6% of participants were classified as low risk, 0.4%–18.3% as intermediate risk and 10.5%–88.7% as high risk. High-risk classification showed modest sensitivity (26.5%–52.3%) and moderate-to-high specificity (34.2%–88.9%) for future falls (1–2 years), with an overall accuracy of 61.2%–74.2%. High-risk groups consistently had a two- to three-fold higher incidence of falls than low-risk groups, while intermediate-risk groups only showed a slightly elevated risk. Use of 3KQ alongside fall history and universal mobility testing improved discrimination and increased the proportion in the intermediate-risk category. Conclusion: The operationalised versions of the WFG algorithm identify older adults at high falls risk with high specificity but limited sensitivity. Proposed pragmatic modifications improve stratification accuracy for intermediate risk group but require prospective validation.

The role of geriatricians has evolved across Europe in response to increasing ageing populations. However, there is much variation with some countries providing a range of geriatric medicine (GM) services, while others have few or no services. This survey assessed the type and frequency of different GM services provided across Europe. A cross-sectional survey of the board members of the European Union of Medical Specialists-Geriatric Medicine Section was performed, requesting information on the existence and frequency of 25 types of possible GM-related services (ranging from inpatient, rehabilitation, liaison, outpatient and community services). The questionnaire classified service availability from institutions into four levels: No-0(not available), Yes-1(Minority of institutions < 25%), Yes-2(Some; 25-75%) or Yes-3(Majority; > 75%). A descriptive comparative analysis was performed. We got responses from 39 countries, divided into 4 geographical regions: Nordic (n = 5), Central/West Europe (n = 9), East Europe (n = 17) and South Europe (n = 8). We found great variation in services between countries, with the Nordic (80%) and Central/West (86.2%) countries providing most of the surveyed geriatric medicine services, while East Europe lacked most geriatric medicine services (24.9% only) and South Europe having a mixed picture. A notable 33% of the countries reported having no acute geriatric wards, 17.9% in a minority, 17.9% in some and 30.7% in most of the institutions in their countries. This is the first large survey of provision of GM services across Europe and shows wide discrepancy across European countries. The data will be helpful for discussions with policy makers in developing GM services in their countries.

Acute hospitalization is a critical stressor that often leads to functional decline in older patients, highlighting the need for simple markers to identify at-risk individuals. Ultrasound is a feasible bedside tool for muscle mass assessment and has been proposed as a marker of physical function, but its prognostic value remains unclear. This study aimed to explore the association between ultrasound-derived muscle thickness (US-MT) and physical performance over time—gait speed (GS) and 30-s sit-to-stand (30s STS)—and selected clinical outcomes. In this prospective cohort study conducted in a geriatric department, adults aged ≥ 65 years with admission-related walking limitations were assessed at admission, discharge, 1 month, and 3 months. US-MT of the vastus lateralis was assessed at admission using ultrasonography. Longitudinal associations between US-MT and GS and 30s STS were examined using mixed-effects models. Associations with length of hospital stay (LOS), 3-month falls incidence, and 3-month mortality were examined using regression models. Among 243 participants, GS and 30s STS increased from admission to follow-up. Greater admission US-MT was modestly associated with faster GS in women (0.037 m/s; 95% CI 0.022–0.051) and with better 30s STS performance across sexes (IRR 1.24; 95% CI 1.00–1.53) across all time points. US-MT was not associated with trajectories of physical performance or with LOS, falls, or mortality. These findings suggest that admission US-MT may provide complementary bedside information on physical performance level, rather than serving as a standalone marker of recovery or clinical prognosis. ClinicalTrials.gov: NCT05798169