In the community, malnutrition is manifested by the loss of muscle mass, being associated with a decrease in muscle strength, an increased risk of frailty, functional impairment and impaired healing of chronic wounds, as well as a higher incidence of infections. It is estimated that malnutrition affects one in three elderly people at home and one in three patients in elderly care institutions. Malnutrition is reversible as long as the patient has access to timely nutritional screening that identifies their nutritional risk and as long as an individualized nutritional intervention is instituted. Disease associated malnutrition continues to be perceived as a secondary problem in primary health care, so the implementation of nutritional risk screening, as a routine parameter, is the first step in improving access to nutritional care in the community. In this article, the Malnutrition Universal Screening Tool is proposed for routine nutritional screening in primary care.

Introduction: Population aging is a global phenomenon, with implications in health services. The present study aims to analyse outcome predictors in elderly patients admitted to the internal medicine (IM) service. Methods: Observational, retrospective, longitudinal study Medical records of patients 65 or more years old admitted to the IM service of Hospital Garcia de Orta (HGO), Portugal, in the year 2019 were analysed. Results: In 2019 the HGO’s IM service admitted 2841 patients: 532 (18.7%) were less than 65 years old and 2309 (81.3%) were 65 years old or older. In the statistical analyses 2133 patients were included, with a mean age of 80.0 ± 7.8 years. Female gender represented 54.7% of the sample size. Mean number of comorbidities per patient was 6.1 ± 2.8, and 54.8% were considered frail. Frail patients were at higher risk of death in hospital (RR = 3.1) and after discharge (RR = 2), even after adjustment for confounders. Conclusion: The population admitted to IM services is mainly elderly with variable degrees of multimorbidity and frailty. frailty seems to be a major predictor of readmission and death in this population. Given the heterogenicity of this age group, multidimensional evaluations and individualized care plans are mandatory. It is urgent that Portuguese IM services adapt to the care of elderly patients, with a strong investment in interdisciplinary care focused on quality of life. Education in geriatric medicine should be a priority to IM teams.

Herpes zoster (HZ), or shingles, is caused by the reactivation of the latent varicella zoster virus. It is a high-incidence disease, associated with great morbidity, which might create or worsen a patient’s frailty condition, thus reinforcing the importance of vaccination. Among the risk factors for HZ infection and postherpetic neuralgia (PHN), its major complication, are age, immunosuppression and the presence ofchronic conditions. Vaccination is an efficacious strategy to prevent HZ and PHN. In Portugal, there are two available HZ vaccines: the live attenuated vaccine and the recombinant vaccine, which demonstrated a high efficacy against HZ and its complications, particularly in the populations with higher risk, immunosuppressed and with immunosenescence for whom live attenuated vaccine is contraindicated. Notwithstanding, the HZ vaccine is not included in the National Vaccination Program and there are not specific national recommendations for immunization. Hence, the Portuguese Society of Internal Medicine and the Portuguese Association of General and Family Medicine elaborated a consensus report establishing guidelines for HZ vaccination. Vaccination against HZ is recommended for all adults aged 50 years and over, as well as for adults aged between 18 and 49 years at high risk for HZ, namely patients with comorbidities or immunosuppression. Immunocompetent adults should be preferentially immunized with the recombinant vaccine, although they might receive the live attenuated vaccine in punctual situations; immunocompromised adults should only be immunized with the recombinant vaccine. The vaccination of individuals with a previous HZ episode is recommended, and individuals with prior immunization with the live attenuated vaccine should receive the recombinant vaccine. Promoting patient’s literacy when prescribing HZ vaccine is highly relevant, and the physician should have an active role in raising awareness about the importance of shingles vaccination.

Introduction: Although sarcopenia has been formally recognized in the World Health Organization International Classification of Diseases, it is still underdiagnosed and undertreated in clinical practice. This study aimed to assess the current knowledge and management of sarcopenia in a cohort of Portuguese physicians and the effectiveness of a training session on sarcopenia diagnosis and treatment. Methods: This longitudinal study included Portuguese physicians (n = 31) who completed a questionnaire on knowledge, practice, and barriers regarding sarcopenia screening, diagnosis, and treatment before, immediately after (n = 29), and three months after (n = 27) attending an interactive workshop on sarcopenia. Results: Before, immediately after, and three months after the workshop, respectively, 66.7%, 96.6%, and 81.5% of physicians knew the definition of sarcopenia. Before the workshop, 33.3% and 44.4% reported performing, respectively, screening and diagnosis in their practice; at three months of follow-up, this number increased to 70.4%. Reported use of SARC-F as a screening tool was increased (22.2% before vs 78.9% after three months). However, the reported use of diagnostic tools to assess muscle strength (i.e., handgrip strength [21.1%] and chair stand test [31.6%]) was low at follow-up. Nutritional intervention focusing on protein intake (87.0%) and resistance exercise (60.9%) were the main treatment strategies reported at three months. Respectively, 68.4% and 82.6% reported barriers to sarcopenia screening/diagnosis and treatment; lack of awareness or knowledge from other healthcare professionals (84.6%) and lack of reimbursement of the cost of oral nutritional supplements (89.5%) were the main barriers experienced. Conclusion: After the educational event, knowledge on the basic principles of clinical management of sarcopenia improved. Nevertheless, physicians recognize important constraints in sarcopenia diagnosis and treatment in daily clinical practice after three months. Although the workshop effectively raised awareness of sarcopenia, knowledge retention over time remains a challenge.

Aging is one of the greatest challenges of the 21st century. "Chronic kidney disease (CKD) is highly prevalent in geriatric patients, but its management requires particular consideration due to the high heterogeneity of this population.". Comprehensive geriatric assessment (CGA), encompassing the identification of frailty and other geriatric syndromes, can modify prognostic outcomes, including quality of life, hospitalization rates, and mortality, as evidenced in oncology. Consequently, several nephrology guidelines recommend frailty screening in older adults with CKD. Nephrology-tailored geriatric assessment (NGA) emerges as a potentially valuable instrument for facilitating shared decision-making in elderly patients with end-stage kidney disease (ESKD). However, its implementation remains inconsistent in Portuguese clinical practice. This article aims to critically evaluate the potential benefits of CGA and NGA in the context of nephrology clinical practice.

Celiac disease is a chronic and autoimmune disorder that can occur at any age. Currently, a quarter of new diagnoses occur after the age of 60. The subtle clinical presentation with micronutrient deficits and osteopenia or osteoporosis, associated with the medical underestimation of this hypothesis leads to its underdiagnosis in the elderly. Celiac disease in old age may have a higher risk of association with autoimmune, lymphoproliferative and cardiovascular diseases, with an impact on morbidity and mortality. Adherence to a gluten-free diet does not seem to be problematic and the quality of life does not appear to decrease. A multidisciplinary follow-up adapted to the patient is essential. In this review, the current evidence of celiac disease in the elderly is systematized, including epidemiology, pathophysiology, clinical manifestations, diagnosis and therapeutic approach, in order to raise awareness and reduce the diagnostic delay.

The project NEWAYS − Cancer Network for Welfare Aging aimed to raise national awareness for Geriatric Oncology issue in Portugal. To do so, it set to define strategic courses of action in four preponderant areas in the care of elderly with cancer, in order to foster its optimization and promote the development of Geriatric Oncology policies in Portugal: clinic, economics and health policy, epidemiologic and social investigation and other areas (health literacy, patient-oriented information technologies, ethics, patient advocacy and awareness). After a wide consensus amongst the group of experts who composed the network that leveraged this project, the proposed courses of action are now presented.

In the current pandemic times for SARS-CoV-2, several challenges are posed to the scientific community. With regard to the implementation of treatments for the elderly with cancer, despite the high complexity in its approach, a variable (SARS-CoV-2) now appears that represents a high impact on multidisciplinary decision-making processes when deciding which therapeutic strategies to use. In accordance with various international declarations, this article aims to sensitize the national medical community to the problems of the elderly with cancer regarding its approach in pandemic times of the COVID-19.

Introduction: Malnutrition is frequent in the elderly and is a healthcare problem. Our objective was to characterize the elderly population admitted to a convalescence unit and relate the nutritional status on admission with functional and health-related outcomes. Methods: All patients over 65 years old admitted to a convalescence unit during an 18-month period were analysed in regard to nutritional, functional and socio-familial status, risk of falling and risk of developing pressure ulcers. Results: Hundred eighty one patients, 57.5% females, aged 80.0±7.1 years old were included. Mini Nutritional Assessment classified 1/3 as undernourished and 66.3% as at risk for malnutrition. The great majority did not have a good socio-familial situation. Almost 2/3 had high risk of falling. Over 80% had no or mild risk for developing pressure ulcers. Over half were discharged home. Moderate correlations were found between nutritional status and both dependence for activities of daily living (ADL) and risk of developing pressure ulcers. Discussion: We found a high incidence of malnutrition, dependence for ADL, socio-familial problems and high risk of falling. We found a statistically significant relation between nutritional status and risk of developing pressure ulcers, constituting an important alert that nutritional evaluation and support may have a crucial role in people’s quality of life. Conclusion: Our findings are concerning and support the recommendations to routinely screen for malnutrition and provide nutritional support in all healthcare settings. To the best of our knowledge, this was the first survey of malnutrition and its implications carried out in a Portuguese convalescence unit.