Bilkish Cassim

Promoting access to innovation for frail old persons. IAGG (International Association of Gerontology and Geriatrics), WHO (World Health Organization) and SFGG (Société Française de Gériatrie et de Gérontologie) Workshop--Athens January 20-21, 2012.

AbstractFrailty tends to be considered as a major risk for adverse outcomes in older persons, but some important aspects remain matter of debate.ObjectivesThe purpose of this paper is to present expert’s positions on the main aspects of the frailty syndrome in the older persons.ParticipantsWorkshop organized by International Association of Gerontology and Geriatrics (IAGG), World Health Organization (WHO) and Société Française de Gériatrie et de Gérontologie (SFGG).ResultsFrailty is widely recognized as an important risk factor for adverse health outcomes in older persons. This can be of particular value in evaluating non-disabled older persons with chronic diseases but today no operational definition has been established. Nutritional status, mobility, activity, strength, endurance, cognition, and mood have been proposed as markers of frailty. Another approach calculates a multidimensional score ranging from “very fit” to “severely frail,” but it is difficult to apply into the medical practice. Frailty appears to be secondary to multiple conditions using multiple pathways leading to a vulnerability to a stressor. Biological (inflammation, loss of hormones), clinical (sarcopenia, osteoporosis etc.), as well as social factors (isolation, financial situation) are involved in the vulnerability process. In clinical practice, detection of frailty is of major interest in oncology because of the high prevalence of cancer in older persons and the bad tolerance of the drug therapies. Presence of frailty should also be taken into account in the definition of the cardiovascular risks in the older population. The experts of the workshop have listed the points reached an agreement and those must to be a priority for improving understanding and use of frailty syndrome in practice.ConclusionFrailty in older adults is a syndrome corresponding to a vulnerability to a stressor. Diagnostic tools have been developed but none can integrate at the same time the large spectrum of factors and the simplicity asked by the clinical practice. An agreement with an international common definition is necessary to develop screening and to reduce the morbidity in older persons.

NOFSA Guideline for the Diagnosis and Management of Osteoporosis

This document is an update of the clinical guideline published by the National Osteoporosis Foundation of South Africa (NOFSA) in 2000, which aims to improve the overall efficacy of the diagnosis and management of patients with, or at risk for, osteoporosis. The guideline is not limited to any particular patient group and targets all health care workers. This is a detailed summary, which is cross-referenced to the full guideline and is available on the NOFSA (www.osteoporosis.org.za) and JEMDSA (www. jemdsa.co.za) websites.

The safety of osteoporosis medication

Osteoporosis is a common, costly and serious disease, which is still too often regarded as an inevitable part of the normal ageing process and therefore sub-optimally treated, especially in the elderly--in fact, only two out of every 10 patients who sustain a hip fracture receive any form of assessment or prophylactic therapy for osteoporosis. One out of five patients die within 1 year after a hip fracture, and < 50% are capable of leading an independent life. Yet very effective anti-fracture therapy, capable of reducing fracture risk by 35 - 60%, is available. A number of publications have recently questioned the safety of drugs routinely used to treat patients with osteoporosis. This paper attempts to put the situation into perspective and expresses the National Osteoporosis Foundation of South Africas view on the safety of these drugs. Their efficacy in preventing skeletal fractures and their cost-effectiveness are not addressed in any detail. The paper emphasises the fact that all osteoporosis medications have side-effects, some of which are potentially life-threatening.

Features of home and neighbourhood and the liveability of older South Africans

While older people live in developing countries, little is known about the relative importance of features of their communities in influencing their liveability. We examine components of home and neighbourhood among older South Africans. Linear regression analyses revealed that features of home (basic amenities, household composition, financial status and safety) and neighbourhood (ability to shop for groceries, participate in organizations and feel safe from crime) are significantly associated with life satisfaction. Approaches to liveability that are person-centred and also set within contexts beyond home and neighbourhood are needed to address boundaries between home and neighbourhood; incorporate personal resources into liveability models and import broader environmental contexts such as health and social policy.

Depressive symptoms in community-dwelling persons aged ≥60 years in Inanda, Ntuzuma and KwaMashu in eThekwini, KwaZulu-Natal

The number of people over 60 years old is expected to double by 2025 worldwide, and to reach 2 billion by 2050.[1] The elderly population faces unique stressors that contribute to an increase in disease, affecting their biopsychosocial wellbeing. The South African (SA) older population is faced with inherent stressors that increase their predisposition to depression and other health issues.[2] The HIV/ AIDS pandemic and other communicable diseases, especially tuberculosis, have placed an enormous financial and emotional burden on the elderly population, who may be either infected or affected. Older people often support entire households and take over the rearing of orphaned children.[3] Furthermore, the monthly pension received is not a substantial amount in view of inflation costs, and many older-personheaded households are living below the poverty line. Psychological distress and specifically depression may prevent successful ageing. The available data on depression in SA reflect a varied prevalence among the different ethnic groups, age categories and areas in which the studies were conducted. Using the present state exam, which is a screening tool assessing an individual’s mental state at the time of the interview, the prevalence of depression in a population of mixed ethnicity >65 years old living in Cape Town in 1987 was 13%.[4] In 2008, 3 840 South Africans aged ≥50 years participated in the Study of Global Ageing and Adult Health, with 4% reporting depressive symptoms in the preceding 12 months.[2] The population in the Inanda, Ntuzuma and KwaMashu (INK) area is estimated to be 510 000, with 6% of the population aged ≥60 years. This is a densely populated peri-urban area with poor infrastructure and unemployment. There is a paucity of data available on depression in the SA older population in general and even less on peri-urban populations such as those in the INK area. The objectives of this study were to determine if depression or depressive symptoms were significant problems in this population and to identify possible risk factors.

Recommendations for the acute and long-term medical management of low-trauma hip fractures

Abstract Hip fractures are the most serious complication of osteoporosis and are associated with high morbidity and mortality. Generally, patients who sustain osteoporotic hip fractures are older adults who have a number of co-morbid diseases which predispose them to perioperative complications, disability and death. Furthermore, patients who survive a hip fracture are at higher risk of a subsequent fracture. The morbidity and mortality of hip fractures can be substantially reduced by a structured multidisciplinary approach to pre- and postoperative management. This review will focus on the epidemiology of hip fractures, predictors of mortality and the acute and long-term management of hip fractures.

14th NOFSA Congress 2010

It is indeed a pleasure to host the 14th NOFSA Congress with the SEMDSA at the Elangeni Hotel in Durban on the 12th and 13th April 2010. An exciting programme has been compiled with contributions from international and national experts on bone and mineral metabolism. The two international speakers are John Eisman and Rene Rizzoli.