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The Final Program is sponsored by:
is the exclusive Communication Sponsor of the Seminar
"Physical Activities, Nutrition and Quality of Aging",
held on April 1st-3rd, Ionic Center, Plaka.
th International Seminar
on Preventive Geriatrics
st International Seminar
on Geriatric Rehabilitation
Final Program
“Physical Activities,
Nutrition & Quality of Aging”
Athens Greece
April 1st - 3rd, 2011, Ionic Center
Organized by:
Hellenic Society of Physical
& Rehabilitation Medicine
Association Franco-He΄llenique
pour les Etudes sur l'Athe΄roscle΄rose
Held under the auspices of:
The University of Nancy,
Dept. of Internal Medicine
& Geriatrics, Nancy, France.
The Ministry
of Health
& Welfare
The Medical
of Athens
Welcome Message
Geriatric medicine has focused primarily on the management of acute and chronic diseases in frail older persons, whilst recently much more
emphasis is given on the promotion of health and the prevention of age - related diseases.
Nowadays, a growing body of knowledge about disease prevention in later life, including important research, provides a valid basis for
strengthening efforts in preventive geriatrics.
The goal of preventive geriatrics is to nurture a state of somatic, mental and psychological health that allows maximal active life expectancy
while maintaining high levels of function.
The prevention of falls and osteoporosis can improve the patient’s health and longevity. Addressing malnutrition can promote healing and
vitalize the patient to participate in a formal rehabilitation program. Physical activities have a major contribution in better aging by acting in a
holistic way in the aging process.
Rehabilitation of geriatric patients is imperative for the patients’ well - being and for society, so that we can thrive socially and economically.
This 2 day Seminar, titled “Physical Activities, Nutrition and Quality of Aging” is planned to bring together all those concerned with aging and
interested in improving the care of the growing numbers of older adults in our communities, e .g physicians, nurses, occupational therapists,
physical therapists, and all professionals addressing the geriatric population.
The sessions, led by experts who have experience locally and internationally, will provide an environment for the interdisciplinary team to build
on requisite competencies as they provide care in all settings, to disseminate knowledge and to gain knowledge to utilize in practice.
Participants will thus have the opportunity to exchange ideas and promote their work, as well as to enrich their knowledge with results from
ongoing important research presented.
On behalf of the two Societies involved as well as of the Organising and Scientific Committee, we welcome you to the 4th International
Seminar on Preventive Geriatrics and 1st International Seminar on Geriatric Rehabilitation.
We hope each delegate leaves the Seminar not only more knowledgeable or proficient in the issues pertaining to geriatric care, but also goes
back home transformed when he or she sees his or her next elderly patient.
Welcome to Athens!
Prof. Athanase Benetos, M.D, PhD
Professor of Internal Medicine and Geriatrics, Head of Geriatrics
University of Nancy, Nancy, France
President of the French Greek Atherosclerosis Association
Prof. Xanthi Michail, M.D, PhD, SFEBPRM
President of the Hellenic Society of
Physical and Rehabilitation Medicine
Honorary Presidents:
Pr. Xanthi MICHAIL, Greece
Pr. Athanase BENETOS, France
Organizing & Scientific Coordinators
Dr. Nikolaos ROUSSOS, Greece
Dr. George SPATHARAKIS, Greece
Dr. Georgios TZANOS, Greece
Invited Faculty
Dr. Cornelius BOLHEIMER
Assistant Professor of Medicine, University of Nuremberg, Germany
Pr. Graziano ONDER
Assistant Professor, Università Cattolica del Sacro Cuore (UCSC), Rome, Italy
Pr. Patrice QUENEAU (France)
Professor of Medicine and Therapeutics,
Secretary General of the French National Academy of Medicine, France
Pr. Agathe RAYNAUD-SIMON (France)
Professor of Medicine and Geriatrics, University of Paris, France
Pr. Yves ROLLAND (France)
Professor of Medicine and Geriatrics, University of Toulouse, France
Pr. Mauro ZAMBONI (Italy)
Professor of Geriatrics and Metabolic Disease, University of Verona, Italy
Scientific Program
Friday, April 1st, 2011
09.00 - 09.15
Athanase BENETOS (France), Xanthi MICHAIL (Greece)
Chair: Dr. George SPATHARAKIS (Greece) - Pr. Agathe RAYNAUD-SIMON (France)
Physical activity and cardio - vascular prevention
Pr. Graziano ONDER (Italy)
09.35 - 09.55
Physical Activity and the musculo - skeletal system and the prevention of falls
Pr. Yves ROLLAND (France)
09.55 - 10.15
Physical activities and cognitive functions
Pr. Magda TSOLAKI (Greece)
10.15 - 10.30
Questions - Discussion
10.30 - 11.00
Friday, April 1st, 2011
09.15 - 09.35
Chair: Dr. Aikaterini KOTRONI (Greece) - Dr. Cornelius BOLHEIMER (Germany)
11:00 - 11:20
Sarcopenic obesity
Pr. Mauro ZAMBONI (Italy)
11:20 - 11:40
Evaluation of sarcopenia
Pr. Yves ROLLAND (France)
11:40 - 12:00
How to evaluate malnutrition in the elderly?
Pr. Agathe RAYNAUD-SIMON (France)
12:00 - 12:20
Evaluation of frailty
Pr. Graziano ONDER (Italy)
12:20 - 12:35
Questions - Discussion
12:35 - 15:00
Chair: Dr. Nikolaos ROUSSOS (Greece) - Pr. Yves ROLLAND (France)
15.00 - 15.20
Pathophysiology of osteoporosis in the elderly
Dr. George TROVAS (Greece)
15.20 - 15.40
How to assess the (fracture) risk for primary osteoporosis
Dr. Cornelius BOLHEIMER (Germany)
15.40 - 16.00
Shifting the focus from osteoporosis to falls in the elderly
Dr. Yannis DIONYSSIOTIS (Greece)
16.00 - 16.20
Exercise in osteoporosis
Dr. Asterios PAPANIKOLAOU (Greece)
16.20 - 16.35
Questions - Discussion
16.35 - 17.00
Friday, April 1st, 2011
Chair: Dr. Georgios TZANOS (Greece) - Dr. Kyriaki STATHI (Greece)
Practical considerations in the assessment and treatment of pain in adults with physical disability
Dr. Eleftheria ANTONIADOU (Greece)
17:20 - 17.40
Fatigue in the elderly population
Dr. Evaggelos MANAOS (Greece)
17.40 - 18.00
Delivery of rehabilitation services to people aging with a disability
Dr. Lambrini LILI (Greece)
18.00 - 18.15
Questions - Discussion
18.15 - 18.45
KEYNOTE LECTURE: Principles of Geriatric Rehabilitation
Dr. Alexandros PAPADEAS (Greece)
Friday, April 1st, 2011
17.00 - 17:20
Saturday, April 2nd, 2011
Chair: Pr. Mauro ZAMBONI (Italy) - Dr. Konstantina KOTSIFI (Greece)
09.00 - 09.20
Denutrition in the elderly
Pr. Patrice QUENEAU (France)
09.20 - 09.40
Pressure ulcers and nutritional support (prevention and treatment)
Dr. George SPATHARAKIS (Greece)
09.40 - 10.15
Dysphagia: From diagnosis to treatment
Patricia GIANNIKA (Greece), Dr. Anatoli PATARIDOU (Greece)
10.15 - 10.30
Questions - Discussion
10.30 - 11.00
Chair: Pr. Patrice QUENEAU (France), Pr. Graziano ONDER (Italy)
11.00 - 11.15
Mediterranean diet and longevity
Dr. George SPATHARAKIS (Greece)
11.15 - 11.30
Is Physical exercise sufficient to prevent Sarcopenia
Dr. Cornelius BOLHEIMER (Germany)
11.30 - 11.45
Calorie restriction and longevity. Is it valid for humans?
Pr. Athanase BENETOS (France)
11.45 - 12.00
Do elderly need vitamin supplementation
Pr. Agathe RAYNAUD-SIMON (France)
12.00 - 12.15
Sexual life and longevity: Is it only mechanics?
Pr. Athanase BENETOS (France)
12.15 - 13.00
Questions - Discussion
13:00 - 15.00
Saturday, April 2nd, 2011
Chair: Dr. Evangelia MARAGKOUDAKI (Greece) - Dr. Spyros SPYROU (Greece)
Aging with cerebral palsy
Dr. Zoi P. DALIVIGKA (Greece)
15.20 - 15.40
Aging with spinal cord injury
Dr. Christina - Anastasia RAPIDI (Greece)
15.40 - 16.00
Aging in polio
Dr. Tonia TATSIDOU (Greece)
16.00 - 16.20
The Impact of age on traumatic brain injury
Dr. Aggeliki GALATA (Greece)
16.20 - 17.00
Pr. Xanthi MICHAIL (Greece), Pr. Athanase BENETOS (France)
Saturday, April 2nd, 2011
15.00 - 15.20
Κυριακή 3 Απριλίου 2011
09.10 - 09.30
Πρόεδρος: Δρ. Γεώργιος ΣΠΑΘΑΡΑΚΗΣ
Δεδομένα της Ψυχολογίας της Άσκησης για την Τρίτη Ηλικία: Λόγοι Συμμετοχής, Εμπόδια και Παράμετροι Ενίσχυσης
Δρ. Εμμανουήλ ΓΕΩΡΓΙΑΔΗΣ
09.40 - 10.10
Ευπάθεια και Διατροφικές Παράμετροι στους Ηλικιωμένους Έλληνες: Στοιχεία από την Έρευνα για την Υγεία, την Γήρανση
και τη Συνταξιοδότηση (SHARE)
Δρ. Ιωάννης ΚΟΜΝΗΝΟΣ
Εργαλεία Διατροφικής Εκτίμησης - Παρουσίαση
Εργαλεία Διατροφικής Εκτίμησης - Παιχνίδι Ρόλων
Διαχωρισμός σε 3 ομάδες εργασίας
Αναφορές Ομάδων στην Ολομέλεια
Μεθοδολογία Διατροφικής Παρέμβασης σε Ευπαθείς Υπερήλικες με Έλλειμμα Διατροφής
Διαχωρισμός σε 3 ομάδες εργασίας
Αναφορές Ομάδων στην Ολομέλεια
Μεθοδολογία Διατροφικής Παρέμβασης σε Ευπαθείς Υπερήλικες με Έλλειμμα Διατροφής
Παρουσίαση και Ανάλυση Περιστατικών Παρέμβασης σε Υπερήλικες με Ελλειμματική Διατροφή
Καθ. Αθανάσιος ΜΠΕΝΕΤΟΣ
Λήξη Εργασιών - Απονομή Διπλωμάτων
10.10 - 10.20
10.20 - 11.00
11.00 - 11.45
11.45 - 12.00
12.00 - 12.30
12.30 - 13.15
13.15 - 13.45
13.45 - 14.00
14.00 - 15.00
Κυριακή 3 Απριλίου 2011
09.30 - 09.40
Μέσα από την πολυετή εμπειρία μας, δουλεύοντας ως ομάδα με ασθενείς που πάσχουν από
δυσφαγία, νιώθουμε την ανάγκη να εστιάσουμε στη μικρή υποομάδα από αυτούς που φέρουν και
τραχειοστομία. Ο κύριος λόγος είναι ότι οι ασθενείς αυτοί έχουν ανάγκη από ιδιαίτερη προσέγγιση
και φροντίδα, συντονισμένη από διεπιστημονική ομάδα. Στόχοι αυτού του σεμιναρίου είναι:
• Η ολοκληρωμένη θεωρητική κατάρτιση αναφορικά με την αξιολόγηση και αντιμετώπιση του
ασθενούς με δυσφαγία και τραχειοστομία, καθώς και με τα διαφορετικά είδη των τραχειοσωλήνων.
• Εξοικείωση των συμμετεχόντων σε όλα τα στάδια αξιολόγησης και παρέμβασης και πρακτική
εξάσκηση σε προπλάσματα όλων των τεχνικών αλλαγής του τραχειοσωλήνα και αναρρόφησης.
Κυριακή 3 Απριλίου 2011
Καθ. Ξανθή ΜΙΧΑΗΛ
Ενδείξεις τραχειοστομίας - Τεχνική - Είδη τραχειοσωλήνων Επιπτώσεις της τραχειοστομίας στο μηχανισμό κατάποσης
10:00 - 10:30
Μηχανική υποστήριξη της αναπνοής στη Μ.Ε.Θ: Βασικές αρχές
Αν. Καθ. Παύλος ΜΥΡΙΑΝΘΕΥΣ
10:30 - 10:45
Αναπνευστική φυσιοθεραπεία
10:45 - 11:00
Ο ρόλος του νοσηλευτή στη Μ.Ε.Θ.
11:00 - 11:45
Κλινική αξιολόγηση κατάποσης
Πατρίτσια ΓΙΑΝΝΙΚΑ
11:45 - 12:00
12:00 - 12:30
12:30 - 13:00
Ακτινοσκοπικός έλεγχος κατάποσης
Πατρίτσια ΓΙΑΝΝΙΚΑ
Ενδοσκοπικός έλεγχος κατάποσης - Live demonstration
13:00 - 15:00
Αίθουσα Α Video FEES & MBS
Πατρίτσια ΓΙΑΝΝΙΚΑ
Αίθουσα Β Είδη τραχειοσωλήνων-Τεχνική αλλαγής και αναρρόφησης
Λήξη Εργασιών - Συμπεράσματα
Κυριακή 3 Απριλίου 2011
08:45 - 09:00
Professor of Internal Medicine and Geriatrics, and
Chairman of Geriatrics, University of Nancy, France
Honorary Presidents Curricula Vitae
Athanase Benetos was born in Athens, Greece in 1956. He is married
and the father of four children.
He is Professor of Internal Medicine and Geriatrics, and Chairman
of Geriatrics, at the University of Nancy, France. He is also a Senior
Researcher at INSERM (National Institute of Biomedical Research)
Unit 961, as well as Chief of the University Centre for Research and
Education on Ageing (Centre EFORVIE, University of Nancy) and
Head of the Clinical Investigation Center on Aging at the University
Hospital of Nancy, France.
Prof. Benetos is the Treasurer of the International Association of
Gerontology and Geriatrics (IAGG) for the period 2009-2013, member
of the Board of the European Academy for Medicine of Aging
(EAMA) since 2006, and member of the National Center of the French
Universities (CNU), Commission 53-01 Internal Medicine, Geriatrics
and Biology of Aging, since 2004.
Prof. Benetos received his PhD from the University of Paris VI and
was a Research Fellow at the Boston University from 1984 to 1987.
He was Senior Consultant in Hypertension at the Broussais Hospital,
Paris, from 1988 to 2002. He was also Chief of the Epidemiology
Department of the Centre Médical d’Investigations Préventives et
Cliniques, Paris, from 1995 to 2002. His research interests include
biomarkers of ageing, telomere dynamics, epidemiology, genetics and
treatment of the age-related changes in large arteries, as well as the
role of hypertension and other risk factors on cardiovascular morbidity
and mortality.
Prof. Benetos is member of several French national and international
medical societies and has positions in several international peerreviewed journals.
Prof. Benetos has authored more than 240 papers published in peerreviewed international scientific journals and has participated in
several scientific books on the topics of telomeres, hypertension,
cardiovascular risk and arterial aging.
Adress: 2 Serifou str,.151 27, Melissia, Athens, GREECE
Born in Piraeus.
Graduated from Medical school of Athens University (1972)
Specialist in Physical and Rehabilitation Medicine after exam,
following 5 years training in K.A.T Accident and Orthopaedic
Hospital, Athens (1974-1978)
PhD diploma from Medical school of Athens University, 1985
Nominated as Senior fellow of European Board of PRM
(Title since 1994)
Post specialization training in Great Britain a) Oswestry Spinal Cord
Injuries Center on 1978,b) Dundee Limb Fitting Centre on 1980 and
Suisse (University dept. of PRM in Geneve) on 1983.
President of the Hellenic Society of Physical and Rehabilitation
Medicine (elected since 1998)
Past President of UEMS,/European Board of Physical and
Rehabilitation Medicine), 2006-2008
• President of European Society of PRM, 2011-2015
• Vice President of European Academy of Rehabilitation Medicine,
Honorary member of many National Societies of PRM in Europe.
Languages: English, French, Italian
Honorary Presidents Curricula Vitae
Professor of Rehabilitation Medicine since 1987 in the
Dept. of Physiotherapy studies, School of Allied Health
Professions, ATEI-Athens
Visiting Professor in Master degree courses of the
University of Athens and of the Public School of Health.
06.28.1967 / Karlsruhe, Germany
1988 - 1995
Study of medicine, University of Heidelberg, Germany
1991 - 1995
Graduate student, Department of Biochemistry II, University of
Heidelberg, Germany
- Doctoral degree in Medicine
Postdoc in Experimental Diabetology, Joslin Diabetes Center
Harvard Medical School, Boston and Southwestern Medical
School, Dallas, U.S.A.
1997 - 2008
Intern / Resident / Attending Physician Department of Internal
Medicine I, University of Regensburg, Germany
- Qualification in Nutritional Medicine
- Board Certification in Internal Medicine
- Board Certification in Endocrinology
- Senior lecturer (Habilitation) in Experimental Internal Medicine
2008 - Present
Attending Physician, Department of Internal Medicine I,
University of Regensburg and Department of Internal Medicine
2 - Geriatrics, Klinikum Nuremberg, University of ErlangenNuremberg, Germany
[each at part-time]
- Scholar of the Forschungskolleg Geriatrie of the Robert Bosch
- Fellow of the European Academy for Medicine of Ageing
Invited Faculty Curricula Vitae
1995 - 1997
2004 - current: Assistant Professor,
Università Cattolica del Sacro Cuore (UCSC), Rome, Italy.
November 15, 1972
Rome, Italy
M.D., UCSC, Roma, Italy
1999 - 2002:
Ph.D. in Preventive Geriatric Medicine, UCSC, Roma, Italy.
2000 - 2001:
Research Fellow, J. Paul Sticht Center on Aging - Wake Forest University,
Winston Salem, NC, USA.
June-July 2001:
Courses in Principles of Epidemiology and Statistical Reasoning in Public
Health I and II - Bloomberg School of Public Health, Johns Hopkins
University, Baltimore, MD, USA.
2002 - 2004:
Geriatric Clinical Fellow, UCSC, Rome, Italy.
2004 - 2007:
Advanced Postgraduate Course of the European Academy for Medicine of
Aging, Institut Universitarie Kurt Bosch, Sion, Switzerland.
Aug-Sept 1993:
Guest Researcher, Pittsburgh Transplantation Institute, Pittsburgh.
Aug-Sept 1996:
Guest Researcher, Nuclear Medicine Dept., National Institute of Health,
Bethesda, MD.
2001 - 2002:
Research Associate, J. Paul Sticht Center on Aging - Wake Forest
University, Winston Salem, NC, USA.
2004 - present:
Assistant Professor, UCSC, Rome, Italy.
2004 - present:
Teacher of ‘Geriatrics’ - Course for Physical Therapists - University of
Cassino, Italy
2007 - present:
Teacher of ‘Geriatrics’ - Course for Physical Therapists - UCSC, Roma,
2008 - present
Teacher of ‘Epidemiology’ - Course for Occupational Therapists - Università
Claudiana, Bolzano, Italy
Invited Faculty Curricula Vitae
1992 - 1997:
Member of the French Medical Academy (since 2003), Patrice QUENEAU was
teacher of Therapeutics in the Medical School of Saint-Etienne.
He was the President of the National Association of Teachers in Therapeutics
(Association Pédagogique Nationale pour l’Enseignement de la Thérapeutique :
APNET [1985-2005]) and the President of the European Network of Therapeutics
Teachers (ENOTT).
Patrice QUENEAU is author of books for large public :
- Soulager la douleur (Ed. Odile Jacob, 1998),
- Le malade n’est pas un numéro ! Sauver la Médecine (Odile Jacob Ed., 2004),
- La douleur à bras-le-corps (G. Ostermann, P. Grandmottet, PIEM, Médicis,
- Etre médecin à Villiers-le-Bel, une éthique au quotidien - Hommage au
Docteur Lionel Bécour, (Ed. L’Harmattan, 2010).
P. QUENEAU has also published 2 books of poems: S’il te plaît, décroche-moi la
lune (2009) and La douceur du piano de ma mère (Ed. L’Harmattan, 2011).
Patrice QUENEAU is named in the National Order of Légion d’Honneur.
Invited Faculty Curricula Vitae
He was:
- the head of the Internal Medicine and Therapeutics Department in the
Universitary Hospital of Saint-Etienne (1979-2003),
- the Dean of the Medical School of Saint-Etienne (1979-1997),
- the President of the section of Therapeutics in the National Council of
Universities (1991-2001),
- the President of the National College of Medical Teachers of Pain.
Patrice QUENEAU was in charge of a Report for the Ministry of the French
Health Government about “Iatrogenic diseases and their prevention” (Report
given to Jacques Barrot and Bernard Kouchner, ministers) (1998).
Patrice QUENEAU wrote as first author many pedagogic books of Therapeutics
for students and medical doctors. Two of them: Le médecin, le malade et la
douleur (4th Ed., 2004) and Thérapeutics for General Practictioners (2009).
Professional address
Geriatrics department, Bichat Hospital APHP
46, rue Henri Huchard, 75877, Paris 18, France
Tel : 33(1) 40 25 87 48
e-mail : [email protected]
Invited Faculty Curricula Vitae
I. Diplomas
- Medical Doctor, specialization in Endocrinology and
Metabolism, in Nutrition and in Geriatrics.
- PH D. in Biology of Aging
- European Academy for Medecine of Aging.
II. Hospital and faculty
- Head of the Geriatrics Department in Bichat Hospital
APHP, Paris.
- Professor in Geriatrics, Faculty of Medecine Denis
Diderot, Paris
III. Laboratory Work
Member of the Laboratory of Biology in Nutrition
(EA 4466) Pr. L. Cynober, Faculty of Pharmacy Paris
Descartes, Paris.
Date of birth:
Centre de Gériatrie - Gérontopôle de Toulouse;
170 Avenue de Casselardit, CHU Purpan France
W: 00 33 561 77 74 65
[email protected]
[email protected]
1987 - 93
University of Paris VII, College of Medicine.
1994 - 98
«Diplôme d’Étude Spécialisée de Rhumatologie
(D.E.S. de Rhumatologie)», Rheumatology thesis.
«Capacité de Gériatrie», Post graduate diploma
in geriatrics
«Diplôme d’Étude Spécialisée Complémentaire de
Gériatrie (D.E.S.C. de Gériatrie)», Post graduate
advanced diploma in geriatrics
«Capacité de Biologie et de Médecine du Sport »,
Post graduate diploma in Sports Medicine.
«Diplôme d’Etudes Approfondies de Biologie du
Vieillissement (D.E.A.)», Diploma in Biological
«Doctorat de Sciences », PhD.
«Habilitation à Diriger des Recherches, HDR »
Hability to supervise research.
Invited Faculty Curricula Vitae
Date and
place of birth:
24 June, 1956 Verona (Italy)
Professional Education
M.D. (University of Padova)
Board Certified Specialist in Internal Medicine
(University of Verona)
Board Certified Specialist in Geriatric Medicine
(University of Padua)
Research Fellow, Department of Internal Medicine,
University of Verona, Italy
Assistant Division of Geriatric Medicine, Negrar
Hospital (Verona)
Assistant Professor, Department of Internal Medicine,
University of Verona.
Assistant Professor, Department of Geriatric Medicine,
University of Verona.
Associate Professor Geriatric Medicine, Department of
Internal Medicine, University of Verona
Chief of the Master in “Advanced Nursing in Geriatric
Patients” University of Verona
Chief of the Geriatric School of the University of
Italian Society of Obesity (SIO)
Italian Society Geriatric and Gerontology (SIGG)
Referee for:
Obesity Research
Aging Clin Exp Research
American Journal Clinical Nutrition
International Journal of Obesity
Nutrition, Metabolism and Cardiovascular Disease
Lancet oncology
Referee for the Italian Ministry of health
Invited Faculty Curricula Vitae
PMR Specialist FEBPMR
Graduated from the University of Ferrara in 1997 with 110/110 and lode
Specialized in the National Rehabilitation Center in Athens in PMR in 2007
Received the Europpean Board Certification in 2006.
Actually working in a Private Practice.
Interest in - Pain medicine
- Stroke Rehabilitation
- Spastcity managment
- Injection procedures
Rehabilitation Medicine, in a Rehabilitation Center for cerebral palsy
patients, Spastic Society of Athens, “Porta Anoixti”.
I am a Research Fellow in the 3rd Paediatric Clinic of the University of
Athens, responsible physiatrist of the Outpatient department for Spasticity
and Paediatric Movement Disorders management, since 2008.
I am also member of the team of the Outpatient Clinic for Spasticity
and Movement Disorders Management, in the Neurosurgery Clinic of the
University of Athens, Evaggelismos Hospital, since 2004.
In my private practice, I am responsible of the PMR Department and
Outpatients Clinic in Mediterraneo Hospital, Glyfada, Athens, Greece.
As a practitioner, I specialize in paediatric and neurological rehabilitation
(spasticity and movement disorders management, orthotics) but I am also
especially interested in neurogenic bladder and bowel and dysphagia due to
neurological problems, in children and adults.
Correspondence: 1, Panionias str, 165 61, Ano Glyfada, Greece
Mob. 0030 6974489209
e-mail: [email protected]
I was born in Athens, Greece and obtained my degree in Medicine from
Aristoteleion University of Thessaloniki, in 1995 and the title of PMR
Specialist in 2002.
I specialized in Paediatric Rehabilitation at the “Université de la
Méditerranée», Marseille, France.
I obtained a University Degree in Orthotics and Prosthetics, Université de la
Méditerranée, in 2002.
I specialized in Spinal Injury patients in National Spinal Injuries Center,
Stoke Mandeville Hospital, Aylesbury, United Kingdom, in 2003.
Since September 2003, I work as a Consultant in Paediatric & Adult
Dr. med. Yannis Dionyssiotis was born in Athens in 1970 and
studied Medicine at the University of Athens. He finished his
specialization in National Rehabilitation Center in Athens “EIAA” and
obtained the title of specialized in Physical Medicine and Rehabilitation.
He worked as research fellow in the Laboratory for Research of the
Musculoskeletal System at the University of Athens, where he completed
his thesis and as consultant Physiatrist in the Rehabilitation department
of KAT Hospital and head of Physical Medicine and Rehabilitation
Department in Rhodes General Hospital in Greece. Actually is the Director
of Physical and Social Rehabilitation Center Amyntæo, Florina, Greece. He
is elected member of the board of International Society of Musculoskeletal
& Neuronal Interactions (ISMNI) and has written medical books and papers
for osteoporosis in spinal cord injury, exercise, spinal orthoses, jumping
mechanography and falls. He is also editor of the online Rehabilitation
Speakers Curricula Vitae
Rehabilitation Medicine Specialist (PRM)
Fellow of the European Board of Physical &
Rehabilitation Medicine
- Ιn medical school of National and Kapodistrian University of
Athens (1992-1998).
- National Board of Physical and Rehabilitation Medicine
(PRM) certification in 2006.
- European Board of PRM certification in2006.
Employment history:
- PRM Physician in “FILOKTITIS”-Rehabilitation Centre in Athens (January
2007- October 2007)
- PRM Physician in “OLYMPION”-Rehabilitation Centre in Patras (October
2007- June 2010)
- Scientific Director of “AROGI”- Thessalikon Rehabilitation Centre in
Kardtitsa (since June 2010)
Speech Language Pathologist
Mrs. Giannika studied in the USA where she received her Masters in Speech
and Language Pathology in 1995. She worked for several years in the USA
in hospitals and rehab centers with a main interest in adult neurologic
language disorders and dysphagia. She has been working in Greece
for the past 10 years privately and in Hygeia Hospital as a consultant
Speech Language Pathologist in the Physical Medicine and Rehabilitation
Department. She has been conducting Modified Barium Swallow
examinations in conjunction with the Radiology department and Fiberoptic
Endoscopic Evaluation of Swallowing along with the ENT doctors. She has
delivered presentations in many national and international conferences on
the topic of dysphagia as well as taught classes and overseen students.
Fellow Member of European Board of Physical and
Rehabilitation Medicine (FEBPRM)
M. Patsalia 4 & Antonopoulou, 47100 Arta
2681023196, 6972299873, [email protected],
M.D. University of Ioannina 13/11/1997
Greek Certificate of PMR 22/11/2005.
European Board Certificate of PMR 27/11/2004
MSc Applied Dietetics and Nutrition, Harokopeio University (15/09/06).
MSc Healthcare Management, School of Social Science, Hellenic Open
University (remains dissertation).
Private Outpatient Clinic of PMR at Arta from June 2007 till now and
Private Rehabilitation Center.
I have attended many Congresses, Seminars, Workshop and I have
written many papers and presentations for congresses in Greece and
worldwide. I am member of many societies. I am interested in areas like
healthcare management - quality, quality of life, sports, child and cardiac
rehabilitation, clinical nutrition, spinal cord injuries.
● Physiatrist, Specialized in Physical and Rehabilitation
● Awarded the Fellowship of the European Board of Physical
and Rehabilitation Medicine
● Medical office address: Kifisias Avenue 373 & Ionias 15,
Nea Erythrea, 14671
● Rehabilitation Doctor in Physical and Rehabilitation Medicine Centre
“Filoktitis”, Koropi, Athens
● Acquisition of specialty in:
- Physical and Rehabilitation Medicine Clinic of ΚΑΤ Hospital, Athens
- Midlands Centre for Spinal Injuries, Oswestry, UK.
● Specialized in Medical Acupuncture
Speakers Curricula Vitae
ENT Surgeon, Ygeia Hospital
Contact: Hygeia Hospital: Office 304 Β - 3rd floor
Tel: +30 210 6867206 -+30 6932291793
Private practice: Saphous 105, Kallithea
Tel: +30 210 9575252, Fax: +30 210 9596556
E-mail: [email protected]
EDUCATION: Medical School of Aristotle University of Thessaloniki
Clinical & Research field of Interest
- Endoscopic Surgery with CO2 Laser
- Dysphagia -Endoscopic evaluation of deglutition
- Endoscopic Surgery of the paranasal sinuses.
- Research of dyspagia and deglutition disorder with endoscopic evaluation
and video
Speakers Curricula Vitae
Personal Information:
Age: 53 years old
Place of Birthday: Athens
Family Status: Married, four children
Professional Address
20, Katechaki Str., N. Psychiko, 115 25, Athens
Tel. Number: 210-6728411, Fax Number: 210-6728413
e-mail address: [email protected]
Education - Studies:
1976 - 1982 Medical School, Aristotelian University of Thessaloniki
1982 - 1984 Practice School of the Medical Corp. Hellenic Army, Athens,
Trainee on Surgery, Internal Medicine and Anesthesiology
1986 - 1990 Trainee on Physical & Rehabilitation Medicine Specialty, PRM
Dept, General Hospital KAT, Athens
SEPT - DEC 1995, School of Staff Officers on Instructional System
Development and for Trainers, Headship of Instruction, General Army Staff
Practice Experience:
1984 - 1986 General Army Staff (GAS) / Special Forces Unit (Commando),
Cyprus, Commander of the Health Squad, Trainer of orderlies
1990 - 1993 GAS / Deputy Commander, Medical Battalion of Chios,
President of the Army Health Committee and the Committee for Disabled of
1993 - 1995 GAS / Head Director of the Physical & Rehabilitation Medicine
(PRM) Dept., 414 Military Hospital, Athens
1995 - 2000 GAS / Head Director of the PRM Dept., 401 General Military
Hospital of Athens
2000 - 2003 GAS / A’ Member of the Army Health Committee of Athens
2003 - 2006 GAS / Head Director of the PRM Dept., 401 General Military
Hospital of Athens
1990 - till today Medical Director in “Epiphany”, Private Medical
Rehabilitation Unit, Athens
EMG and Nerve Conduction Studies
Botulinum Toxin injections under EMG guidance
Injection Techniques (intra-articular, intrathecal, epidural, transforaminal,
facets’ joints)
Static and Dynamic Foot Analysis
Extracorporeal Shockwave Therapy
10/08/1994, Golden Cross of the Battalion of Phoenix (from the President of
the Greek Republic)
19/08/1994, Meritorious Command Medal for significant service Management
09/07/1996, Military Merit Medal for the valuable services rendered to the
Country in the circle of my actions.
13/05/1998, Golden Cross of the Battalion of Merit (from the President of
the Greek Republic)
Hellenic Society of Physical & Rehabilitation Member (Secretary General)
European Society of Physical & Rehabilitation Medicine - ESPRM
International Society of Physical & Rehabilitation Medicine - ISPRM
International Spinal Cord Society - ISCOS
Hellenic Society of the Studies on Bone Metabolism - EEMMO
4. 2002: PhD: “Sacral evoked potentials and conduction velocity of
peripheral nerves in the study of peripheral neuropathy in diabetic patients
with urination dysfunction”.
5. 7/2003 - 7/2004: post graduation studies in the Neurological Department
of children’s Hospital “Penteli”.
6. 2008: European Board Trainer of Physical and Rehabilitation Medicine.
Geriatrician- Gerontologist
Clinical Director of the Public Primary Health Care Center
of Itea, Phokida, Greece
Lectures in Geriatrics in the Schools of Physiotherapy and
Nurses, T.E.I, Lamia
National Representative for Greece in the European Council
(European Academy of Teachers in General Practice/Family Medicine)
EAMA (European Academy for the Medicine of Aging)
Senior Fellow of European Board of PRM
Hospital Address: National Rehabilitation Center “EKA”, 8th bus stop
Hassias Avenue, 1,Spyrou Theologou, Ilion, Athens, Greece.
Scientific responsible of Neuropathic Bladder Unit, National Rehabilitation
Center “EKA”
Tel: +30210 2314112, mobile: +306942404275
E-mail: [email protected]
Brief CV
1. 1992: Diploma in Physical and Rehabilitation Medicine , Athens Greece.
2. 1993 - till now, Department of PRM, National Rehabilitation Center
“EKA”, Ilion, Athens, Greece.
3. 1997: European Board of Physical & Rehabilitation Medicine.
Address: Chania, Crete, Greece
E-mail: [email protected]
Head of Rehabilitation unit “Olympion Chanion”
10/2008-present: “Olympion Chanion” Rehabilitation center, Chania, Crete,
Attending Physician-PRM
2007-08/2008: “Filoktitis” Rehabilitation center, Athens, Greece
1992-1998: Medical School of Thessaloniki, MD
21/03/2006: National Board of Physical and Rehabilitation Medicine
13/01/2006 : European Board of Physical and Rehabilitation Medicine
Speakers Curricula Vitae
- Application of endoscopic surgery with CO2 Laser in managing
malignancies of larynx - pharynx.
- Transoral Robotic Surgery
- Panhellenic Society of Otolaryngology - Head & Neck Surgery
- National Society of Otolaryngology - Head & Neck Surgery of Northern
- Scientific Dysphagia group, under the auspices of the National Society of
- European Study Group for Dysphagia and Globus (EGDG)
- European Rhinologic Society
Professional Experience
Children’s Hospital Aglaia Kyriakou, 2nd Peadiatric Surgeon Department
- ENT dpertament, General Athens Hospital “Evaggelismos”
- Postgraduate education in ENT dept, University Hospital of Edinburg,
- ENT dept, “Hygeia” Hospital
- ENT - Dyspagia dept, “Filoktitis”Recovery & Rehabilitation Center
- Participation in the writing of the book “Into deep neck infections”
06/2002-12/2005: Physical and Rehabilitation Medicine
National Rehabilitation Center, A’ Clinic, Athens, Greece
Hellenic Society of Physical and Rehabilitation Medicine
Hellenic Society of Wound Healing and Chronic Ulcers
International Spinal Cord Society (ISCoS)
with 201 abstracts in English International or European Conferences, she
is the first author or co-author in 154 Papers in Greek Journals, and in
126 International Journals (with more than 2000 citations), she has been
reviewer for Conferences and Journals (57). She has organized 13 National
Conferences on AD and six International. She was one of the three advisory
members for 11 doctora theses. She has organised 4 day centres from
which two were funded by European Union. She was participant in many
European Projects. She is married with four children (three daughters 30, 28
and 26 years and one son of 23 years old) and she has three grandchildren.
She was born in Thessaloniki, Greece and she has spent most
of her time in Thessaloniki, Greece. She is now Professor of
Aristotle University of Thessaloniki, Neuropsychiatrist since
1983, and she has worked at Aristotle University of Thessaloniki
since 1982 and at the 3rd Department of Neurology of Aristotle University
of Thessaloniki since 1988. She has created the Greek Alzheimer Association
in 1995 and Greek Federation of Alzheimer Disease in 2007 and she is
chair of this Federation. She has been the main author or co-author of
24 Books, she has participated with 310 abstracts in Greek Conferences,
Ο Δρ. Εμμανουήλ Γεωργιάδης έχει πραγματοποιήσει
Προπτυχιακές σπουδές στην Φυσική Αγωγή και τις Αθλητικές
Επιστήμες (Καποδιστριακό Πανεπιστήμιο Αθηνών) καθώς
και στην Εφαρμοσμένη Ψυχολογία (City University of Seattle,
U.S.A.). Είναι κάτοχος Μεταπτυχιακού Τίτλου στην Αθλητική
Ψυχολογία και στην Ψυχολογία της Άσκησης (University
of Exeter, U.K.) και Διδάκτορας Αθλητικής Ψυχολογίας και Ψυχολογίας
της Άσκησης (Loughborough University, U.K.). Έχει πιστοποιηθεί ως
Σύμβουλος Αθλητικής Ψυχολογίας από την Εταιρία Αθλητικής Ψυχολογίας
(, είναι Μέλος της Αμερικανικής Ψυχολογικής
Εταιρίας ( καθώς και Εκπαιδευμένο Μέλος της γνωστικής
θεραπευτικής μεθόδου EMDR ( Έχει πολυετή εμπειρία
στη συμβουλευτική της άσκησης και του αθλητισμού, καθώς και σε θέματα
υγείας και ευεξίας, ανθρώπινης απόδοσης και ψυχικής διάθεσης.
• Φυσικοθεραπεύτρια, Επίκουρος Καθηγήτρια στο
Τμήμα Φυσικοθεραπείας του ΤΕΙ Αθήνας, με γνωστικό
αντικείμενο ‘Αναπνευστική Φυσικοθεραπεία- Αναπνευστική
• Κάτοχος MSc και Διδακτορικού διπλώματος του ΤΕΦΑΑ,
Πανεπιστήμιο Αθηνών
• Τίτλος διατριβής: «Η επίδραση της επανεκπαίδευσης της αναπνοής στον
έλεγχο του άσθματος»
Speakers Curricula Vitae
Married with 2 children
ACTUAL POSITION: Laboratory for Musculoskeletal Research
-University of Athens
MAIN INTEREST: Male osteoporosis - Risk factors and
Nutritional aspects of osteoporosis -Calcium and vitamin D.
Publications in national and international journals in the bone field and
also books and monocrafies on the subject of male osteoporosis
Reviewer and member of the editorial board in several journals
Active member of several International Societies ,Past president of the
Hellenic Society for the Study of Bone Metabolism and also member in the
Board of Hellenic Foundation of Osteoporosis.
• Εξειδίκευση στη ΜΕΘ του ΝΝΘΑ
• Reviewer στο Journal of Asthma
• Συμμετοχή σε ερευνητικά προγράμματα του Πανεπιστημίου Αθηνών
• Δημοσιεύσεις ερευνητικών εργασιών σε έγκριτα ξενόγλωσσα επιστημονικά
• Citations
• Συγγραφή βιβλίου Αναπνευστικής Φυσικοθεραπείας, που διανέμεται στο
ΤΕΙ-Α καθώς και κεφαλαίων σε επιστημονικά βιβλία
• Συμμετοχή σε συνέδρια της ημεδαπής και της αλλοδαπής
• μέλος της ERS
• επιστημονική σύμβουλος στο ΔΟΑΤΑΠ
Μητροδώρου 22, Ακαδημία Πλάτωνος
[email protected]
Mr Ioannis Komninos is a medical doctor in Family Medicine,
(qualified in 2005) and a PhD candidate in the area of public
health at the University of Crete, under the supervision of
Associate Professor A. Philalithis. His research is taking place
at the University of Crete and it is based on the SHARE
project, (50 + in Europe, Cross-European Survey of Health, Ageing and
Retirement in Europe, SHARE, which started
in 2002. The topic of his research focuses on frailty among the aging
population in Europe and the impact of medical, social, psychological and
economic factors from the perspective of family medicine and primary
health care.
In this context, part of his research is accomplished at the University
College of London (UCL, 2009), Department of Public Health, under the
supervision of Sir prof M.Marmot on the subject of frailty in the aging
population of the English Longitudinal Study of Aging (ELSA,
uk/elsa/index.php ).
He is a member of the National Educational Committee of the Hellenic
Association of General Practitioners (ELEGEIA) since 2003 and Assistant
Educational Coordinator of trainees in Family Medicine at the University
Hospital of Herakleion, Crete since 2006.
E-mail: [email protected], [email protected]
Πνευμονολόγος - Εντατικολόγος
Αναπληρωτής Καθηγητής Ε.Κ.Π.Α
Πανεπιστημιακή Μ.Ε.Θ, Γ.Ο.Ν.Κ «Άγιοι Ανάργυροι»
Ο Δρ Παύλος Μυριανθεύς γεννήθηκε στην Κύπρο το 1965 και σπούδασε
Ιατρική στο Πανεπιστήμιο Αθηνών. Το 1997 έλαβε τον τίτλο της
Speakers Curricula Vitae
Ο κ Κατσούλας Θεόδωρος είναι πτυχιούχος του Τμήματος
Νοσηλευτικής του Πανεπιστημίου Αθηνών από το 1996. Το
2000 έλαβε Μεταπτυχιακό δίπλωμα ειδίκευσης στην Κλινική
Νοσηλευτική από το Τμήμα Νοσηλευτικής του Πανεπιστημίου
Αθηνών και το 2006 υποστήριξε τη διδακτορική του διατριβή. Μετά
τη λήψη του πτυχίου του εργάστηκε σε ερευνητικό πρόγραμμα του
Πανεπιστημίου Αθηνών στην Πανεπιστημιακή Χειρουργική κλινική του
Τμήματος Νοσηλευτικής. Ακολούθως εργάστηκε σε ιδιωτικές κλινικές και
το 2005 διορίστηκε στο Πανεπιστημιακό Γενικό Νοσοκομείο «ΑΤΤΙΚΟΝ»
όπου τοποθετήθηκε στο γραφείο εκπαίδευσης. Από το Μάρτιο του
2010 υπηρετεί ως Καθηγητής Εφαρμογών στο Τμήμα Νοσηλευτικής του
ΑΤΕΙ Αθήνας. Επιπλέον, από το ακαδημαϊκό έτος 2009-10 έως σήμερα
διδάσκει το μάθημα «Επείγουσα Νοσηλευτική και Εντατική Νοσηλεία»
στους προπτυχιακούς φοιτητές του Τμήματος Νοσηλευτικής του ΕΚΠΑ με
σύμβαση εργασίας σύμφωνα με τις διατάξεις του Π.Δ. 407/80. Επίσης του
έχει ανατεθεί η αυτοδύναμη διδασκαλία του μεταπτυχιακού μαθήματος
«Εντατική Νοσηλευτική - Πολυοργανική Δυσλειτουργία». Διδάσκει επίσης
στο πρόγραμμα μεταπτυχιακών σπουδών της Ιατρικής Σχολής ΕΚΠΑ
«Εργαστηριακή και κλινική νοσηλευτική καρδιολογία» από το 2007. Την
1-12-2010 εκλέχθηκε στη βαθμίδα του Λέκτορα με γνωστικό αντικείμενο
«Νοσηλευτική Μονάδων Εντατικής Θεραπείας» στο Τμήμα Νοσηλευτικής
του ΕΚΠΑ.
ειδικότητας της Πνευμονολογίας και το 2001 τον τίτλο της εξειδίκευσης
στην Εντατικολογία. Το 2002-2003 μετεκπαίδευση στις Η.Π.Α (Σικάγο,
Northwestern University) στο χώρο της Πνευμονολογίας και Εντατικής
Θεραπείας. Υπηρέτησε στο ΕΣΥ από το 2001 μέχρι το 2005 οπότε
εντάχθηκε στο Πανεπιστήμιο Αθηνών ως Επίκουρος Καθηγητής.
Από το 2010 είναι αναπληρωτής Καθηγητής Εντατικολογίας στο
Τμήμα Νοσηλευτικής του Πανεπιστημίου Αθηνών και εργάζεται στην
Πανεπιστημιακή Μ.Ε.Θ του Γ.Ο.Ν.Κ «Άγιοι Ανάργυροι» στη Νέα Κηφισιά.
Έχει 225 Ανακοινώσεις σε Ελληνικά και Διεθνή Συνέδρια, 115 Δημοσιεύσεις
σε Ελληνικά Περιοδικά και Πρακτικά Συνεδρίων, 70 Δημοσιεύσεις σε
Διεθνή Περιοδικά και Πρακτικά Συνεδρίων και 80 Ομιλίες σε Συνέδρια και
Ημερίδες μετά από πρόσκληση.
Speakers Curricula Vitae
• Γενική Ιατρός, Επιμελήτρια Α’ Γενικής Ιατρικής στο Π.Ι. Σίνδου Κ.Υ.
Διαβατών Θεσσαλονίκης από 9/9/2001 μέχρι σήμερα.
• Πτυχίο Ιατρικής Σχολής, ΑΠΘ, Ιούνιος 1996
• Ειδικότητα Γενικής Ιατρικής ΓΝΝ Βεροίας
• Τίτλος ειδικότητας Γενικής Ιατρικής, 8/6/2001
• Yποψήφια διδάκτωρ Πανεπιστημίου Κρήτης, Θέμα Διδακτορικής
Διατριβής: «Αξιολόγηση της διαχείρισης ασθενών με συμπτώματα του
ανώτερου πεπτικού στην Π.Φ.Υ»
Αριθμός πρωτοκόλου:342/4-5-2006
• Φοιτήτρια διετούς μεταπτυχιακού προγράμματος ΕΣΔΥ στη Διοίκηση
Υπηρεσιών Υγείας
• Επικουρική Συντονίστρια ειδικευομένων Γενικής Ιατρικής ΓΝΘ
Παπαγεωργίου από το 2005 μέχρι σήμερα
• Εξειδίκευση με άδεια του ΚΕΣΥ επί εξαμήνου στη Μονάδα Πρόληψης
και Πρώιμης Διάγνωσης του Πεπτικού Καρκίνου ΓΝΘ ΘΕΑΓΕΝΕΙΟΥ
• Εξειδίκευση με άδεια του ΚΕΣΥ επί διμήνου «Οργάνωση και Διοίκηση
Υπηρεσιών Πρωτοβάθμιας Φροντίδας Υγείας (Αναμόρφωση στον οργανισμό
Π.Φ.Υ. και Νομολογία για την υγεία και ανθρωποκεντρικά συστήματα
υγειονομικής πληροφόρησης»
Εκπαιδευτικό κέντρο: Portuguese National School of Public Health, New
University of Lisbon
• Συμμετοχή σε 12 ελληνικά και ευρωπαϊκά ερευνητικά πρωτόκολλα
• Συμμετοχή με ανακοινώσεις σε πολλαπλά ελληνικά και διεθνή συνέδρια
• Μέλος της Ελληνικής Εταιρείας Γενικής Ιατρικής (ΕΛΕΓΕΙΑ)
• Εθνική εκπρόσωπος της ΕΛΕΓΕΙΑ στο πανευρωπαϊκό δίκτυο EURIPA
• Εκπρόσωπος της ΕΛΕΓΕΙΑ για την επιτροπή του ΚΕΣΥ για την
εξειδίκευση στην επειγοντολογία
Mέλος της WONCA (Παγκόσμια Εταιρεία Γενικής Ιατρικής)
• Μέλος της Μεσογειακής Ιατρικής Εταιρείας
• Μέλος της δεκαμελούς διοικούσας επιτροπής της Μεσογειακής Ιατρικής
• Μέλος της Επιτροπής Διασύνδεσης της ΕΛΕΓΕΙΑ με το SIG (Special
Interests Group) της WONCA για Νευροψυχιατρικές Διαταραχές
(Neuropsychiatric disorders) από τον Απρίλιο 2006
• Μέλος της Συντακτικής Επιτροπής της ΕΛΕΓΕΙΑ για το περιοδικό
«Πρωτοβάθμια Φροντίδα Υγείας» από 12/6/2006
Physical Activity and the musculo - skeletal system and
the prevention of falls
Physical activities and cognitive functions
Inserm, U1027, Toulouse, France, University of Toulouse III, Toulouse,
F-31073, CHU Toulouse, Department of Geriatric Medicine, F-31059
Toulouse, France
Sarcopenic Obesity
With aging body composition changes with increase in fat mass and
decrease in muscle mass. Further, older subjects, even if stable weight across
ages, show higher amount of fat and lower amount of muscle mass than
when they were younger. In developed Countries the majority of people gain
weight with aging. Thus the prevalence of obesity increased even in old
ages in the last decades; some of these obese old subjects are characterized
by high level of fat and low level of muscle mass: therefore they have been
recently defined Sarcopenic-obese. Sarcopenic-obesity was first defined as
Among the multiple factors that contribute to the development of
sarcopenia, physical inactivity has been widely reported to be an important
risk factor. In treatment for sarcopenia, physical activity and particularly
resistance training is actually the most relevant treatment for improving
muscle strength, mass and power but also to slow down if not prevent the
muscle mass and muscle strength decline throughout lifetimes. Sarcopenia
is an important risk factor for falls. This has led to the develop exercise
programs to reduce the risk of falling by maximizing muscle function in
older people. Strong evidences in several studies indicate that resistance
training such as weight lifting increases myofibrillar muscle protein
synthesis, muscle mass and strength even in the frail elderly. Strength
gains result from a combination of improved muscle mass and quality and
neuronal adaptation (innervations, activation pattern). However, the same
exercise intensity results in a lower myofibrillar synthesis response in older
subjects than in young ones. Clinical researches demonstrate that resistance
training result in an improvement of the neuromuscular system without
an increase in muscle mass. The American Heart Association council
recommended 1 set of 10 to 15 repetitions for older people. The resistance
training should be performed 2 to 3 times a week with 8 to 10 different
exercises each time. Aerobic training may also slow down the process
of sarcopenia. No pharmacological or behavioral intervention to reverse
sarcopenia has proven to be as efficacious as resistance training. However,
only 12% of the United-States elderly population performs strength training
at least twice a week.
Literature data. Long-term aerobic exercise improves cognition in both
human -Normal older persons and Dementia- and nonhuman animals and
induces plastic changes in the central nervous system (CNS), including
neurogenesis and angiogenesis. Additionally, fitness correlates with brain
volume in persons who are cognitively normal and those with Alzheimer’s
disease. Mechanisms of action: There is a study which supports that
CNS neuronal apoptosis is a consequence of exercise in the adult rat and
suggests that this process is a potential mediator of rapid exercise-induced
plasticity. There is also a reticular-activating hypofrontality (RAH) model of
acute exercise which suggests that exercise engages arousal mechanisms in
the reticular-activating system, which involves a number of neurotransmitter
systems. Exercise, also, disengages the higher-order functions of the
prefrontal cortex. Our studies: Our data support that structured Cognitive
Motion Therapy improved cognitive and ADL performances in MCI patients
after 6 months, while control patients with MCI remained stable. Patients
with AD remain stable for more than six months. However, the early and
immediate effects of exercise on the CNS have not been adequately explored
and more prospective studies are needed to prove the neuroprotective effects
of physical exercise. Such a program is the Long Lasting Memories which is
European project.
relative skeletal muscle index (muscle mass adjusted by squared height) less
than 2 SD below the sex-specific mean of a young reference group, and
percent body fat greater than the median value for each sex group (27% of
body fat in men and 38% of body fat in women, corresponding to a BMI
of approximately 27 kg/m2). Alternative definition of Sarcopenic-obesity has
been also suggested.
The prevalence of Sarcopenic-obesity increases with age in each sex, from
13.5% in men younger than 70 years to 17.5% in those older than 80 years
and from 5.3% in women younger than 70 years to 8.4% in those older than
80 years.
Cross-sectional as well as longitudinal studies show that subjects classified
as sarcopenic-obese show significantly higher prevalence of physical
impairment and disability, as well as higher prevalence of metabolic
Evaluation of sarcopenia
Inserm, U1027, Toulouse, France, University of Toulouse III, Toulouse,
F-31073, CHU Toulouse, Department of Geriatric Medicine, F-31059
Toulouse, France
How to evaluate malnutrition in the elderly?
The prevalence of malnutrition is about 4 - 10 % in independently
living elderly, 15 - 38 % in nursing homes and 30-70 % in the hospital.
Malnutrition leads to an increased risk of infections, gait disorders and
falls, fractures, pressure sores, postoperative complications, disability
and death. Thus, screening for malnutrition and a correct evaluation of
nutritional status is mandatory in the elderly.
Screening for malnutrition needs to look for clinical situations that are
associated to malnutrition, such as chronic or acute diseases, disability,
dementia, depression… and many others. Appetite and food intake must
be assessed. Regular weight measurement will allow to detect weight loss,
and calculation of BMI. The Mini Nutritional Assessment® (MNA) may be
used to screen for malnutrition, and a shorter version of the MNA® is now
Many definitions, tools and thresholds for the diagnosis of malnutrition are
being used all over the world. The French Health Authorities have proposed
the following criteria for the diagnosis of malnutrition in subjects aged 70
and over:
- Weight loss ≥ 5 % in 1 month or ≥ 10% in 6 months.
- BMI ≤ 21
- Albuminemia < 35 g/l
- MNA < 17
These criteria will allow to diagnose and then to treat malnutrition in
clinical settings. However, an evaluation of body composition (muscle
mass, fat mass) would give better insight of functional and metabolic
consequences of malnutrition. Bioelectrical impedance and absorptiometry
are not of routine use but will contribute to a better evaluation of
consequences of malnutrition and efficacy of renutrition in clinical research.
On-going and future clinical trials on sarcopenia may radically change
our preventive and therapeutic approaches of mobility disability in older
people. Irwin Rosenberg defined sarcopenia in 1989 to describe a recognized
age-related decline in muscle mass among the elderly. Since 1989, various
definitions of sarcopenia have evolved as our understanding of the aging
process and the changes that occur therein progress along with improved
body composition measurement techniques and the availability of large
representative data sets. However, despite increasing knowledge and
improved technology, a worldwide operational definition of sarcopenia
applicable across racial/ethnic groups and populations lacks consensus. This
results in inconsistencies in the literature and paucity of clinical trials of
interventions which primarily target sarcopenia.
Currently, the European Working Group on Sarcopenia in older people
(EWGSOP), the International Academy of Nutrition and Aging (IANA),
and the International Association of Gerontology and Geriatrics-European
Region [IAGG-ER] recommend using the presence of both low muscle
mass and low muscle function (strength or physical performance) for the
diagnosis of sarcopenia.
Pathophysiology of osteoporosis in the elderly
Shifting the focus from osteoporosis to falls in the elderly
How to assess the (fracture) risk for primary osteoporosis?
Osteoporosis is a crucial risk factor for low energy-fractures of the spine,
Given the close interaction between osteoporosis and falls, prevention of
fractures in a geriatric population should be based on factors related to bone
strength and risk factors for falls. Pharmacologic therapy should be added
Age-related bone loss is associated with progressive changes in bone
remodeling characterizedby decreased bone formation relative to bone
resorption. Both trabecular and periosteal bone formation decline with
age in both sexes, which contributes to bone fragility and increased risk
of fractures. Studies in rodents and humans revealed that, independent
of sex hormone deficiency,the age-related decline in bone formation is
characterized by decreased osteoblast numberand lifespan and reduced boneforming capacity of individual osteoblasts. An important clinical question
is to identify the mechanisms involved in the age-related defective bone
There have been considerable advances in our understanding of the
pathogenesis of bone loss and osteoporosis in women and in men.
Thus, a better understanding of estrogen and androgen signaling in bone
has set the stage for the development of selective estrogen and androgen
receptor modulators to prevent and treat osteoporosis. Identification of the
role of increased RANKL production in the setting of estrogen deficiency
has provided a basis for blocking this pathway as a new approach to
potently inhibiting bone resorption. The key role of Wnt signaling in bone
metabolism and possibly in age-related bone loss has led to the development
of specific activators of this pathway in treating osteoporosis.
The role of SIRTUIN -1 (SIRT-1) in skeletal aging may also lead to new
compounds regulating this pathway as a means to both stimulate bone
formation and inhibit bone resorption. As these examples illustrate, the
collective basic and translational effort to understand the pathogenesis
of osteoporosis has formed a firm foundation on which to build various
therapeutic strategies to prevent and cure this important public health
the hip, the shoulder, and the wrist. Therefore, the assessment of primary age-related - osteoporosis is seen equal to the assessment of the impeding
fracture risk.
The DXA-test for bone mineral density is not sufficient to properly assess
the (fracture) risk of osteoporosis. Also from an economical point of view, it
is unrealistic to offer a DXA-test to everybody.
This has led to a two step approach. In the first step, assessment for fracture
risk is solely based on gender, age and clinical risk factors. Only when the
calculated fracture risk in this pre-assessment exceeds a certain degree it
triggers a DXA-test as second step.
Most attention in this field has been given to the so-called FRAX-algorithm
which stands for “WHO fracture risk assessment tool”. FRAX can be
downloaded as freeware under and includes
the following clinical risk factors: (i.) BMI (the lower the higher the risk
of fracture), (ii.) history of previous low energy fractures, (iii.) history of
a parent hip fracture, (iv.) current smoking, (v.) alcohol consumption, (vi.)
use of oral glucocorticoids, (vii.) history of rheumatoid arthritis as well
as (viii.) a catalogue of other risk factors which might aggravate primary
The individual clinical information together with the individual results
of the DXA-test is then compared and adjusted with the population-based
data-set of the FRAX-tool. This computer-based approach then allows the
calculation of the individual 10-year risk of a major osteoporotic fracture
(see above) or exclusively of the 10-year risk of hip fracture.
A 10-year probability of a major osteoporotic fracture between 20 and 30%
and a specific 10-year risk of hip fracture of 3 % should lead to a treatment
by antiosteoporotic drugs (e.g. bisphosphonates). However, these threshold
levels are primarily driven by public health care considerations and not by
the individualized care of the patient.
for those at high risk of fracture and vitamin D / calcium supplementation
is essential in all prevention strategies. The strongest single risk factor
for fracture is falling and not osteoporosis, meaning that the focus of
rehabilitation in elderly subjects with osteoporosis and/or fractures should
be to prevent falls. Based on published evidence in elderly communitydwelling and hospitalized subjects falls can be prevented, regardless of the
type of intervention.
Exercise in Osteoporosis
Aging with central and periferal nervous system trauma, diseases and
degenerative muscle diseases nowdays is the rule and not the exception.
People who are living and aging with these underlying medical conditions
often experience pain secondary to their physical impairment that may
worsen over time, resulting in increased disability and decreased quality
of life. The frequency and severity of persistent pain, can be expected to
increase because of the reduced biologic, psycological, and social reserves
associated with aging. A broad array of biological and psycosocial factors
may contribute to the development and the impact of pain, including
general medical status, underlying pathophysiological meccanism, emotional
and psycosocial factors, intrinsic and personal characteristics, and
interactions with the broader physical and social environment. The rates
of persistent pain varies between different studies for the same condition
generally being higher than the ablebodied aged adults. Efforts are made
to standardized pain assesments in physically impaired populations under
the recommendations of the IMMPACT group. Treatment strategies in the
elderly population is always a challenge, because of polipharmacy and other
conditions that can interact with the traetment plan.
Fatigue in the elderly population
Evangelos MANAOS
Fatigue is defined as a subjective lack of physical and/ or mental energy
that is perceived by the individual or caregiver to interfere with usual or
desired activities. Despite the fact that this “lack of energy” is believed to
be a common complaint among elderly population, in multiple studies of
self-reported fatigue older adults report fatigue less often than their younger
counterparts. This strange finding can be explained if the activity level in
which the fatigue occurs is taken into consideration. Thus, a new term
called “fatigability” is used as a phenotype characterized by the relationship
between self-reported fatigue and the level of activity with which the
Preventive exercise: A lifelong dedication to physical activity and exercise
is recommended (60 min. daily for all children aged 8 and older, and 30
min. for adults).
Therapeutic exercise: Is an essential element of the rehabilitation program
for patients with osteoporosis and should be tailored to the patient’s level of
fitness and anticipated propensity to fracture. Exercise increase muscle and
bone strength, joint flexibility, and balance, and prevent falls
SPEED: Spinal Proprioception Extension Dynamic Exercise program for
women with osteoporosis - kyphosis).
Functional exercises.
Exercise principles: Specificity, Reversibility, Progression, Initial Values,
Diminishing Returns.
Osteoporosis is a disease that is progressive and if unchecked can cause
severe disability.
In patients with physical disabilities: inactivity, can be especially
harmful because of a propensity for further deterioration with aging and
concomitant healthy problems.
The PASIPD questionnaire: (Physical Activity Scale for Individuals with
Physical Disabilities) can be useful in assessing levels of activity in the
persons with disability, such as home maintenance function, moderate and
vigorous sport and recreational activities, occupation and transportation.
Patient’s education: Concerning proper posture, body mechanics, and
increasing strength and aerobic capacity is an essential component of both
short-term and long-term interventions.
Practical considerations in the assessment and treatment
of pain in adults with physical disability
fatigue is associated. Measurement of fatigability may be done by self-report
measures of fatigue combined with objectively measured activity. This allows
meaningful and objective comparisons between studies. There is a variety
of potential mechanisms of increased fatigability with aging including agerelated alterations in energy production or utilization, functional disabilities
that decrease efficiency and inflammatory processes. Many clinical studies
have reported on attempts to decrease fatigue in older adults through a
variety of pharmacologic and non-pharmacologic interventions even if they
did not focus on increased fatigability. Fatigue may be a symptom that can
serve as a physiologic warning signal and additionally in older adults with
multiple conditions increased fatigability may reflect greater underlying
disease burden. Consequently, a shifting of the focus of attention to
fatigability may benefit our interventions for improving both symptoms and
function of the tired elderly population.
Delivery of rehabilitation services to people aging with a
Lamprini LILI
Principles of Geriatric Rehabilitation
Alexandros PAPADEAS
The aging of our population is an undoubted fact. Due to this, it has
become imperative to maximize and maintain the function of all patients in
order to preserve quality of life and decrease healthcare costs. With timely
intervention, the rehabilitation team can help restore function close to preinsult, pre-morbid functional level and attempt to preserve the functional
level for the remainder of the patient’s life span. This restoration of function
should help reduce the total healthcare cost.
Geriatric Rehabilitation can be defined as medical treatment plus
prevention, restoration plus accommodation, and education. The
accommodation is to irreversible effects of normal and pathological aging
and requires an associated education of the patient and his or her family.
The rehabilitation team can teach new ways to accomplish the functional
tasks that can no longer be executed as previously because of the effects of
aging. The team can teach these techniques to the patient or educate the
family, depending on the patient’s ability to learn.
A second component of geriatric rehabilitation is the prevention of disability
and the restoration of function. Many impairments combine reversible and
irreversible components. Therapeutic exercise, for example, can be used to
prevent or reserve the effects of disuse caused by inactivity or injury. The
preventive concept should be broadened to include all geriatric patients by
remembering the “use it or lose it” concept.
Medical treatment of impairment is the third integral part of geriatric
rehabilitation. Treatment is needed to cure when possible, or at least
to stabilize the disease process when cure is not possible. Many of the
impairments of the elderly are chronic and incurable but manageable, thus
Individuals with disabilities access health care in a variety of ways
depending on health care system, causing disease or disease phase, finances
or even geography or cultural differences. Also, as one ages, the systems
of care needed may change. Systems of care for disabled elderly are vast,
ranging from inpatient facilities to outpatient programs and home programs.
Recent advances in technology allow us to reach patients in their homes
through telemedicine. Support services within the community are growing,
and case managers are becoming more necessary as it becomes more
difficult to navigate the health care system. Providers of rehabilitative
services must help patients find the most appropriate setting to receive care
and advocate for patients and caretakers.
Nowadays, there is a trend the focus of care to shift from inpatient to
outpatient care and to home services. Additionally, there has been a shift in
focus from achieving short-term functional performance goals in a therapy
gym or inpatient rehabilitation unit to setting and achieving long-term
functional goals at home (for instrumental activities of daily life), including
goals addressing quality of life.
Significant research questions remain, and health care policy requires
development. As the population ages and the disabled elderly population
becomes a focus of fiscal experts, there must be an emphasis on providing
the most cost-effective yet functionally productive health care. We must
work to promote the strengths of the elderly population by addressing
preventative strategies while maintaining as long as possible functional
preventing or delaying progression, complications and associated disability
is reasonable.
In this presentation we will discuss about the factors, either age or diseaserelated, that may affect the rehabilitation plan. We will also discuss
about the optimal level of intensity or medical service needed to achieve
significant functional goals in the most cost-effective manner. Finally, we
should frame our definition of outcome.
in higher serum concentrations at equal dosage, hence possibility of adverse
Therefore, drugs with narrow therapeutic margin are those whose dosage
must be carefully adjusted to achieve efficacy without side effects
Diagnosis and management of denutrition should always be the case in
elderly patients.
Pressure ulcers and nutritional support
(prevention and treatment)
Definition of Iatrogenesis: Any disease or adverse event caused by a medical
intervention within the health care system. The term does not prejudge in
any way an error, fault or negligence: some risks are unavoidable, others
not. In Geriatrics, the mere decision to hospitalize can lead to undue loss
of autonomy. The drug-induced iatrogenesis my be related to the adverse
effects without therapeutic misuse, or with therapeutic misuse. This “misuse”
is caused by by the physician and by extension, other caregivers (notably the
pharmacist or the nurse) or the patient himself, through inappropriate selfmedication or poor compliance with treatment.
Oral anticoagulants, NSAIDs, aminoglycosides, corticosteroids, opiates,
antihypertensives and antipsychotics are the most frequent used drugs in the
elderly and the drugs that give the most important iatrogenic problems.
The adverse effects of drugs in the elderly are: More frequent from 3 to 20
% and are involved in 5 to 10 % of hospitalizations
They adverse effects are preventable in part: inadequate dosage,
drug interactions, interactions with diseases –> concept of misuse or
inappropriate prescriptions.
Nutritional problems in the elderly can promote iatrogenesis by several
- Hypoalbuminemia will cause a decrease in acidic binding (aspirin,
warfarin, phenytoin) leading to a risk of overdosing.
- Increase in fat mass at the expense of muscle mass (1/3 greater at age 75
than at age 30) increase volume of lyphophilic molecules due to a greater
distribution in (fat, adipose) tissue (antidepressant, anaesthetic, CNS) and
decrease volume of hydrophilic molecules (paracetamol, digoxin), resulting
Epidemiological and experimental data have shown that Pressure
Ulcers(PUs) enhance insufficient nutritional state and vice versa.
PUs affect 0.5% of the total population. Their distribution is clustered into
2 groups: a)Younger individuals, mostly neurologically impaired(30%), b)
Geriatric Population(70%). Undernutrition affects 9-47.1% of the elderly
while malnutrition is present in 0.7-3.2% of the geriatric population.
In a prospective study (Thomas, 1996) with high-risk patients,
undernutrition was present in 29% of patients at hospital admission. At
4 weeks, 17% of the undernourished patients had developed a pressure
ulcer, compared to 9% of the non-undernourished patients. In a long-termcare setting (Pinchcofsky-Devin, 1986) 59% of residents were diagnosed as
undernourished on admission. Among these residents, 7.3% were classified
as severely undernourished. Pressure ulcers occurred in 65% of these
severely undernourished residents. No pressure ulcers developed in the mildto-moderately undernourished or well-nourished groups
In a study of survival among residents in long-term care with severe
cognitive impairment, 135 residents were followed for 24 months. The
relative risk of death in the presence of a PU was 1.49 at the onset versus
1.06 after two years.
PUs mediate this effect through a generalized inflammatory response
creating thus the necessity of a nutritional supplementation. This
supplementation should focus on an increased caloric charge, a high protein
content and, possibly, addition of specific nutrients.
The protocols for caloric supplementation quote for requirements of 25 kcal/
kg/day for sedentary adults and 40 kcal/kg/day for stressed adults with 1.6
Denutrition in the elderly
times coverage of the Basal Energy Expenditure. Current recommendations
for protein intake in PUs are 1.5-1.8 gm/kg/day. Comments are presented on
the supplemantation of electrolytes, arginine, glutamine, vitamin C and zinc.
Dysphagia: From diagnosis to treatment
The normal mechanism of swallowing and its stages will be described
as well as the changes of the biomechanics of swallowing as they evolve
because of age and disease. Different means of diagnostics will be described,
both clinical and instrumental, such as the Modified Barium Swallow (MBS)
and the Fiberoptic Endoscopic Evaluation of Swallowing (FEES). A variety
of treatment techniques will be explored, both in the form of exercises and
swallowing maneuvers as well as surgical and medical procedures.
Mediterranean diet and longevity
Although most people believe that the Mediterranean diet is just a unique
one, reality shows that this consists of a series of diets, related to different
cultures and people around the Mediterranean Sea that share common
nutritional characteristics. The first proofs of a beneficial effect of these
diets on the health outcomes came in the early sixties with the “Seven
Countries’ Study” conducted by the American nutritionnist Ancel Keys.
These beneficial effects seem to be related to different biological factors and
pathways, most noticeable of which are: the fall of different inflammation
markers, especially the IL-8, a reduced oxidative stress and increased
Is physical exercise sufficient to prevent sarcopenia?
Sarcopenia does not only denote a reduction of (age-related) muscle mass it
also encompassess a compromised muscle strength and a reduced functional
The anti-sarcopenic potential of resistance training (both strength and
power resistance) has been reviewed by several meta-analyses. Accordingly,
resistance training works in principle but mainly on the components of
muscle mass and muscle strength. Its effect on performance however is
Other types of exercise (such as aerobic endurance training) and - more
generally speaking - voluntary physical activity do neither contribute to
muscle strength nor to performance.
Nutritional interventions are supposed to support the anti-sarcopenic effects
of resistance training. These encompass the consumption of (i.) protein
above the usual RDA-recommendation, (ii.) adequate amounts of leucine,
(iii.) high-quality protein immediately after exercise, and (iv.) nutritional
supplements such as creatine and hydroxymethylbutyrate.
Whether with or without nutritional support - there is the general problem
that for the majority of all seniors exercise is unfamiliar and too tedious.
Hence, science and pharamceutical companies are looking up for the
“exercise pill” which could replace the unpleasant life-style modifications
and easily prevent sarcopenia. But here we are only at the beginning of the
Since then, multiple observational -mostly- studies has relied Mediterranean
diet to longevity, although the adherence of each people to it seems to
differ importantly. This influence is mostly due to a significant decrease
of mortality due to cardiovascular dissease but also to a decline of cancer
insulin sensitivity and all these some times although the presence of obesity
and / or a sedentary way of life.
On the nutritional level these findings are mostly correlated to higher
consumption of wholegrain cereals, foods rich in polyunsaturated fatty
acids, and a limited amount of alcohol.
The observed effects of longevity, however, should not only be attributed to
the diet itself but to other concomitants like low smoking habit (smoking
cessation at the advanced age), mid-day naps (siestas), active social and
family life and possibly religion.
Caloric restriction, sexual life and way of life for a future
Athanase BENETOS
Aging with cerebral palsy
Medicine’s success in treating children with cerebral palsy (CP) and
other developmental disabilities creates many new challenges when these
individuals reach adulthood.
Aging with spinal cord injury
Christina-Anastasia RAPIDI
Many factors can influence the biological aging and the decline in organ
system functioning, including genetics and lifestyle factors. A specific
impairment, such as spinal cord injury (SCI), may also influence the rate of
biological aging.
Individuals with long term SCI report new declines in function or increased
disability. Twenty years or more duration of injury, and age ranging from
mid-40s to early 50s, have been identified as common time frames for
functional changes related to aging and SCI.
The demographic expansion of the elderly population, including those over
80 years of age, will be constant over the next forty years. If this segment
of the population represented 3.8% of Europe’s total in 2006, it is expected
to reach 9.5% in 2050, an increase of approximately 130%. Can we fight off
or at least slow down the weakening of the elderly? Can we prolong life
without getting old and weak? Are there interventions that alter the course
of aging? Can we be a centenarian in a good shape?
These questions are at the heart of an intense debate amongst clinicians,
researchers and public authorities alike who face problems of aging on a
collective basis, as well as their medical, social and economic consequences.
Every day we are bombarded by “scientific and medical revolutions” that
boast the miraculous effects of a new diet, a molecule, a new genetic
manipulation or a new method for achieving the objective of youth and
longevity. The fantasy of immortality has always been part of human history
and of the collective imaginary.
Environmental factors and way of life play an important role in the
evolution of aging and the possibility to be centenarian. In this session we
will discuss among others different question concerning:
- Caloric restriction: Luigi Cornaro’s recipe for longevity that made him live
to be 102 back in the 15th century? Fruit-flies, rats, monkeys and humans:
variant effects of surveyed starvation? How not to obese, how not to be a
hungry bore?
- Sexual activity. Is it all about physical activity or there is more to it? The
decrease of libido and how the hormones are not involved? The benefits of
afternoon naps in combination (or not) to sex?
The aging process interacts with the motor disorder in the adult with CP,
increasing the incidence of secondary musculoskeletal or neurological
complications and resulting in deterioration or loss of mobility, chronic
pain, fatigue and decline in functioning and participation.
The natural history of mobility in CP is one of early decline, mostly
due to: muscle weakness and sarcopenia, the effects of spasticity on the
musculoskeletal system, lever-arm disease of the lower limbs, neuromuscular
scoliosis, osteoporosis, early onset of osteoarthritis and pain, spinal stenosis
and spondylisthesis, overuse syndromes. Adults with CP also experience
pain associated with contractures, spasticity, othopaedic deformity, fractures,
pressure from sitting on bony prominencies, fatigue or gastroindestinal
Despite the lack of systematic, large-scale follow-up studies, it is a common
acknowledgement that about one third of adults with CP experience
modest-to-significant decreases in walking or self-care tasks, partly due
to musculoskeletal issues. Nonetheless, there is a consensus that all these
problems may be lessened or even prevented by early recognition and
Specialized care addressing the needs of cerebral palsy adults should
involve an interdisciplinary team of specialists, providing interventions for
rehabilitation but also for disease- or not-related medical issues. What is
also very important is the efficient transition from paediatric to adult care,
as this is now thought to be more of a process of gradual adoption of new
roles, than just a service approach.
There are international differences in outcomes associated with aging
and spinal cord injury. These differences may reflect differences in sociopolitical, health care system and cultural factors. Women report more
often pain, fatigue, and skin problems and more transportation problems.
Men experience more health problems, more diabetes, and more adaptive
equipment changes.
High rates of impaired glucose metabolism are found in persons with SCI
and this fact might help to explain other findings common in SCI, such
as the high rates of fatigue and weight gain. The loss of bone mineral in
persons with SCI, especially women but also in men, is accelerated. This
finding is part of “premature aging”.
The risk factors for the development of cardiovascular disease appear to
occur more often and earlier in life for persons with SCI. The presence of
SCI increases the risk of cardiovascular disease by 16% overall. The risk
increases further for persons with tetraplegia versus paraplegia as well as
for complete versus incomplete lesion.
Aging and duration of SCI influence urological complication rates, and
bladder management method. The long-term planning from the time of
injury is important in order to minimize late complications.
New needs for specially health care services develop as individuals aging
with SCI in order to maintain their health and function and preserve their
independence level in activities of daily living.
Aging in polio
The impact of age on traumatic brain injury
Angeliki GALATA
The number of elderly persons has increased dramatically along with the
number of people with disabilities who are aging. The overall death rate
from traumatic brain injury decreased with advances in long-term medical
care, rehabilitation and social support. However, successful aging is more
than simply living longer. It involves maintaining physical, cognitive and
social functions.
Older individuals with traumatic brain injury (TBI) differ from younger
adults with TBI in several ways, including their incidence rates, etiology
of injury, nature of complications, lengths of hospitalization, functional
outcomes and mortality. Despite the greater likelihood of poorer functional
outcomes, older adults with TBI often achieve good functional outcomes
and can live in community settings after receiving appropriate rehabilitation
services, although at higher costs and longer hospitalizations than younger
Little is known regarding the long- term impact of TBI on individuals as
they age, but this is an important issue as the population ages. Specific
issues that should be addressed in research include long-term disposition,
causes of mortality many years post TBI, long-term medical complications
Aging in polio is a definition of Post-Polio syndrome (PPS). Although
the number of cases of acute poliomyelitis has decreased, late effects of
poliomyelitis continue to be a source of disability.
PPS is a collection of musculoskeletal and neuromuscular symptoms
occuring several decades after a patient has recovered from the initial
infection with the poliovirus. There are no diagnostic tests to confirm the
diagnosis of PPS. The definition is based on a confirmed history of paralytic
polio, neurologic and functional recovery followed by a period of stability,
the onset of unaccustomed fatigue, new weakness, muscle and joint pain,
functional loss , muscular atrophy and the exclusion of other medical
Fatigue, both general and muscular, and weakness are the most common
sequelae of polio with aging. Usual findings are musculoskeletal deformities
such as scoliosis, pain, muscular atrophy, increase in fractures due to
osteopenia. The ventilatory limitation and dysphagia are also important. The
cognitive and the psychologic function after polio are affected.
The most accepted theory of the mechanism of PPS is “neural fatigue”. The
normal aging process may also play a role.
An interdisciplinary evaluation is essential.
The use of pharmacologic agents is limited. Management includes careful
strengthening, conservative pain treatment, appropriate assistive devices,
energy conservation measures and pacing of daily activities with frequent
rest periods, referral to a pulmonologist if needed, speech therapy and
attention to psychological issues. It should also include the identification
and treatment of conditions like hyperlipidemia, cardiac risk factors,
in institutionalized and community-dwelling individuals and the long-term
impact on families and caregivers of aging individuals with TBI.
As with all aging individuals, those with TBI require routine primary
medical care. After a person sustains TBI, routine preventative care should
be provided in addition to the services required as a result of TBI.
Δεδομένα της ψυχολογίας της άσκησης για την τρίτη
ηλικία: Λόγοι συμμετοχής, εμπόδια και παράμετροι
Παρά τις πολυάριθμες έρευνες σχετικά με τα οφέλη της άσκησης, πολλοί
άνθρωποι παραμένουν σωματικά ανενεργοί. Στην περίπτωση των ατόμων
της τρίτης ηλικίας, η σωματική άσκηση μπορεί να αποτρέψει νόσους
και να ενισχύσει την σωματική, την γνωστική και την ψυχική υγεία,
βελτιώνοντας ουσιαστικά την ποιότητα διαβίωσης. Παρά τις προτροπές
των ειδικών, η ηλικιακή αυτή κατηγορία συμμετέχει όλο και λιγότερο
σε προγράμματα άσκησης, αδυνατώντας έτσι να καρπωθεί σημαντικά
οφέλη. Μέσα από τις νεώτερες έρευνες, ερευνώνται τα αίτια της ελλιπούς
συμμετοχής στα προγράμματα άσκησης και παρουσιάζονται προτάσεις για
την αποτελεσματική αντιστροφή αυτού του φαινομένου. Η κατανόηση της
ανθρώπινης συμπεριφοράς μέσα από τα δεδομένα της ψυχολογίας, μπορεί
να βοηθήσει σημαντικά την εφαρμογή της νέας γνώσης στην ιατρική,
ιδιαίτερα σε πληθυσμούς που εμφανίζουν μεγάλες ανάγκες φροντίδας.
Στο χώρο της γηριατρικής είχε περιγραφεί από καιρό το «σύνδρομο» που
αποτελείται από «πολλαπλές συνυπάρχουσες καταστάσεις όπως αδυναμία,
Ευπάθεια και διατροφικές παράμετροι στους
ηλικιωμένους έλληνες: Στοιχεία από την Έρευνα για
την Υγεία, την Γήρανση και την Συνταξιοδότηση στην
Ευρώπη (SHARE)
μειωμένη κινητικότητα και ελαττωμένη αντοχή σε σωματικούς ή ψυχικούς
στρεσσογόνους παράγοντες».
Ο όρος «ευπάθεια» (frailty) χρησιμοποιήθηκε για να περιγράψει αυτό το
σύνδρομο. Πρόκειται για έναν πολυδιάστατο όρο, ευρέως διαδεδομένο, που
χρησιμοποιείται για να περιγράψει ένα σύνδρομο απώλειας αποθεμάτων
(ενέργειας, φυσικής ικανότητας, γνωστικής ικανότητας, υγείας), το οποίο
καθιστά τον ηλικιωμένο όχι μόνο περισσότερο «ευάλωτο», σε νόσους ή
κλινικά ψυχικά και οργανικά σύνδρομα, αλλά καθορίζει και την έκβαση των
καταστάσεων υγείας, την ανταπόκριση στη θεραπεία καθώς και τον βαθμό
αποκατάστασης και επανόδου σε σταθερότερη κατάσταση υγείας.
Αυτή η απώλεια φυσικών αποθεμάτων θέτει τα βιολογικά συστήματα του
οργανισμού σε φθίνουσα πορεία, ενώ ως «κατώφλι» για την κατάσταση
ευπάθειας θεωρείται η φθορά περισσότερων από δύο συστήματα. Οι
ευπαθείς ηλικιωμένοι παρουσιάζουν αυξημένο κίνδυνο εγκατάστασης
λειτουργικής ανικανότητας, κοινωνικής απομόνωσης και ιδρυματοποίησης.
Συνοψίζοντας όλες εκείνες τις παραμέτρους που εμπλέκονται στην
εγκατάσταση της ευπάθειας, οι Fried και Walston το 1998 παρουσίασαν
ένα μοντέλο στο οποίο νοσολογικοί και μεταβολικοί παράγοντες
σχετιζόμενοι και με την ηλικία αλληλεπιδρούν σε μια δυναμική σχέση
λειτουργικής και ενεργειακής έκπτωσης καθορίζοντας τον βαθμό της
ευπάθειας σε έναν άνθρωπο που γερνά.
Το μοντέλο αυτό ακολούθησε ένας ευρέως διαδεδομένος φαινοτυπικός
προσδιορισμός της ευθραυστότητας από την Fried το 2001 που
περιλαμβάνει παραμέτρους όπως η αναίτια απώλεια βάρους,
το υποκειμενικό συναίσθημα εξάντλησης, τα επίπεδα φυσικής
δραστηριότητας, η ταχύτητα βάδισης (walking speed) και η φυσική
αδυναμία (low grip strength).
Η συμπερίληψη της απώλειας βάρους στα κριτήρια της ευπάθειας είναι
άρρητα συνδεδεμένη με την κοινά αποδεκτή αντίληψη της ευπάθειας
ως ένα σύνδρομο «φθίνουσας πορείας», ή και «φθαρτότητας», με την
σαρκοπενία να αποτελεί μία από τις κυρίαρχες εκφράσεις της . Ωστόσο,
σε ολοένα και περισσότερες μελέτες από την διεθνή βιβλιογραφία
περιγράφεται το θεωρητικό υπόβαθρο στο οποίο η ευπάθεια συνδέεται
και με την παχυσαρκία: Καθώς η παχυσαρκία εκτός των άλλων αποτελεί
προδιαθεσικό παράγοντα και για κατάσταση χαμηλής λειτουργικότητας
με την οποία είναι συνδεδεμένη η ευπάθεια, διαφαίνεται ότι στο μοντέλο
του ευπαθούς ηλικιωμένου, η διατροφή και η άσκηση αποτελούν μείζονες
Μελετώντας τα δεδομένα από το ελληνικό δείγμα της Έρευνας για την
Υγεία, την Γήρανση και την Συνταξιοδότηση στην Ευρώπη (SHARE
Survey), περιγράφεται το προφίλ του ευπαθούς ηλικιωμένου σε σχέση
με διατροφικές παραμέτρους (όπως είναι ο Δείκτης Μάζας Σώματος) και
δίνεται έμφαση στους παράγοντες εκείνους που μπορούν να περιγράψουν
αλλά και να επηρεάσουν αυτήν τη σχέση όπως είναι οι δραστηριότητες, η
άσκηση και η διατροφή.
ξεκινούν νωρίς στην ζωή των υπερηλίκων ατόμων, ο κάθε ιατρός, ειδικά ο
γενικός / οικογενειακός ιατρός της πρωτοβάθμιας φροντίδας υγείας, αλλά
και ο ιατρός της φυσικής ιατρικής / αποκατάστασης θα πρέπει να μπορούν
να παρεμβαίνουν με απλά, πρακτικά και φθηνά μέσα για την βελτίωση της
διατροφικής κατάστασης των υπερηλίκων που διαβιούν στην κοινότητα.
Συζητάται και ο ρόλος της άσκησης στην παρέμβαση αυτή.
Μεθοδολογία διατροφικής παρέμβασης σε ευπαθείς
υπερήλικες με έλλειμμα διατροφής
Ως «Ευπάθεια (Frailty)» ορίζεται η αδυναμία του ηλικιωμένου ατόμου
/ οργανισμού να ανταποκριθεί κατάλληλα σε κάθε φυσικό, βιολογικό ή
ψυχολογικό stress. Μετά την έκθεση ενός ευπαθούς ηλικιωμένου ατόμου
σε ένα ισχυρό stress, η αποκατάσταση απαιτεί πολύ χρόνο και δεν είναι
πλήρης, σε αντίθεση με τα εύρωστα άτομα. Μια άλλη έκφραση της
ευπάθειας είναι η εξάντληση των ψυχο-βιολογικών εφεδρειών, οπότε το
άτομο για να ανταποκριθεί στις συνθήκες της συνηθισμένης καθημερινής
του ζωής πρέπει να χρησιμοποιεί αναγκαστικά ένα υψηλό ποσοστό των
δυνατοτήτων του (80-90%).
Υπάρχουν πολλά κριτήρια για τον ορισμό του συνδρόμου της ευπάθειας.
Βιολογικοί, ψυχολογικοί και κοινωνικοί παράγοντες μπορούν να συντείνουν
στην εμφάνιση του συνδρόμου. Ωστόσο, ένας κοινός παρονομαστής όλων
αυτών των διεργασιών σε βιολογικό επίπεδο είναι η σαρκοπενία. Ως
σαρκοπενία ορίζεται η συνολική απώλεια μυϊκής μάζας από τα ηλικιωμένα
και αυτή με την σειρά της μετράται ποσοτικά από την δύναμη σφιξίματος
του χεριού και την ταχύτητα βάδισης.
Η κακή διατροφική κατάσταση (ποσοτικά ή / και ποιοτικά ανεπαρκής)
αποτελεί μία από τις βασικές αιτίες πρόκλησης και εμφάνισης σαρκοπενίας
και ευπάθειας. Είναι σημαντικό για τον κάθε ιατρό να γνωρίζει τις βασικές
αρχές διατροφικής παρέμβασης, ποσοτικής και ποιοτικής, στον πληθυσμό
αυτό. Καθώς η εκτίμηση, παρακολούθηση και παρέμβαση πρέπει να
LILI Lambrini MD, PhD
Physical and Social Rehabilitation Center, Amyntaio, Florina, GREECE
BENETOS Athanase, MD, PhD
Professor of Internal Medicine and Geriatrics, Head of Geriatrics University
of Nancy, FRANCE
President of the French Greek Atherosclerosis Association
Physiatrist, Specialized in Physical and Rehabilitation Medicine,
Rehabilitation Doctor in Physical and Rehabilitation Medicine Centre
“Filoktitis”, Koropi, Athens, GREECE
Department of Internal Medicine I, University Hospital of Regensburg,
PRM specialist, 2nd PRM Department, National Rehabilitation Center “EKA”,
Athens, GREECE
PRM Specialist, Fellow of the European Board of PRM
Physiatrist of the Cerebral Palsy Greece Society, Athens, Greece
Research Fellow, Cerebral Palsy and Paediatric Movement Disorders Clinic,
Paediatric Department, Attikon University, Athens, GREECE
President of the Hellenic Society of Physical and Rehabilitation Medicine,
Physical and Social Rehabilitation Center
Amyntaio, Florina, GREECE
ONDER Graziano, PD Dr. Med
Assistant Professor, Università Cattolica del Sacro Cuore (UCSC), Rome,
GALATA Aggeliki, MD
PRM Physician, Scientific Director of “AROGI” Thessalikon Rehabilitation
Centre in Karditsa, GREECE
PAPADEAS Alexandros, MD
Senior Fellow of the European Board of PRM
Secretary General of Hellenic Society of Physical & Rehabilitation Medicine
ex. Head Director, Physical & Rehabilitation Dept., 401 General Military
Hospital of Athens, GREECE
Speech Language Pathologist, Athens, GREECE
Physical and Rehabilitation Medicine, Thessaloniki, GREECE
KOTRONI Aikaterini, MD
Physiatrist, General Athens Hospital “KAT”, Member of the European Board
of PRM, Athens, GREECE
ENT Surgeon, “Ygeia” Hospital, Athens, GREECE
Professor of Medicine and Therapeutics, Secretary General of the French
National Academy of Medicine, FRANCE
KOTSIFI Konstantina, MD
Physiatrist, Athens, GREECE
RAPIDI Christina-Anastasia, MD, PhD
Scientific responsible of Neuropathic Bladder Unit
2nd PRM Department, National Rehabilitation Center “EKA”, Athens,
Professor of Medicine and Geriatrics, University of Paris, FRANCE
Professor of Medicine and Geriatrics, University of Toulouse, FRANCE
ROUSSOS Nikolaos, MD
PRM specialist, PRM Unit, Asklipeion Voula Hospital, Athens, GREECE
Geriatrician- Gerontologist, Clinical Director of the Public Primary Health
Care Center of Itea, Phokida, Greece
SPYROU Spyros, MD, MSc
Physiatrist, Head of PRM Unit, Olympic Village Polyclinic, Athens, Greece
STATHI Kyriaki, MD
Physiatrist, Piraeus, Greece
TZANOS Georgios, MD
Physiatrist, Head of PRM Unit, “Thriassio”General Hospital of Elefsina,
Professor of Geriatric Medicine, Chief, Section of Geriatrics Medicine
Department of Medicine, University of Verona, ITALY
Αθλητικός Ψυχολόγος, Διδάκτορας Αθλητικής Ψυχολογίας και Ψυχολογίας
της Άσκησης, Loughborough University, U.K
Φυσικοθεραπεύτρια, Επίκουρος Καθηγήτρια στο Τμήμα Φυσικοθεραπείας
του ΤΕΙ Αθήνας
Νοσηλευτής ΠΕ, MSc, PhD
Καθηγητής Εφαρμογών Νοσηλευτικής Β ΣΕΥΠ, ΑΤΕΙ Αθήνας
Γενικός Ιατρός, Υπ. Διδ. Δημόσιας Υγείας, Ηράκλειο, Κρήτη
Physiatrist, Head of Rehabilitation unit “Olympion Chanion”, Crete, Greece
Πνευμονολόγος - Εντατικολόγος, Αναπληρωτής Καθηγητής Ε.Κ.Π.Α
Πανεπιστημιακή Μ.Ε.Θ, Γ.Ο.Ν.Κ «Άγιοι Ανάργυροι», Αθήνα
Endocrinologist, Laboratory for the Research of Musculoskeletal Diseases,
University Of Athens, GREECE
Γενική Ιατρός, Επιμελήτρια Α’ Γενικής Ιατρικής, Π.Ι. Σίνδου Κ.Υ. Διαβατών
Neuropsychiatrist, Professor of Aristotle University of Thessaloniki, GREECE
The Organising Committee of the
4th International Seminar on Preventive Geriatrics & 1st International Seminar on Geriatric
Rehabilitation would like to thank the following
for their fruitful cooperation
and valuable contribution to the organisation of the congress:
Τhe European Network of Teachers of Therapeutics (ENOTT)
Association de Recherche et d’Information Scientifique en Cardiologie (ARISC)
The Ministry of Health and Welfare
The Medical Association of Athens
General Information
Date & Venue
April 1st - 3rd 2011
Ionic Center, Athens, Greece
All official prices are in Euro (€)
Registration Type
Specialists, Residents
Nurses, Health Professionals
Registration Fees will cover participation to the scientific program, conference material, certificate of attendance, coffee breaks, welcome reception
Accreditation points CME Units
The 4th International Seminar on Preventive Geriatrics & 1st International Seminar on Geriatric Rehabilitation is accredited by the
European Accreditation Council for Continuing Medical Education (EACCME) to provide 16 European credits to medical specialists. The EACCME
is an institution of the European Union of Medical Specialists (UEMS).
Congress Language
The seminar’s official language is English.
P.O. Box 126, 1st km Paiania - Markopoulou Ave., 190 02 Paiania
Tel: 210 32 74 570, Fax: 210 33 11 021, [email protected],
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