two-year MEAMA course that started in 2003 by
a group of Middle-East and European Professors
had finished in July 2005.
The number of older
people is growing and they frequently have health-related
problems with a mixture of physical, mental, social
and behavioural aspects. In the past, these problems
were seen only in a few older people and the families
were able to take care of their parents or old relatives.
However, societies are changing as a result of the demographic
and cultural developments and they face the increasing
possibilities of modern medicine.
The Middle East
Academy for Medicine of Ageing Started in 2002. The
first course 2003/2005 to stimulate the development
of health care services for older people in the Middle-
East area. The course has been build up with 4 sessions,
each of 4 days, that will covered important topics of
the health-related problems in older people.
OF THE MIDDLE-EAST ACADEMY FOR MEDICINE OF AGEING
- To stimulate the development of services
to meet the health related problems in increasing number
of older people in the Middle-East Area. We formulated
the goals as:
- To improve knowledge and skills of professionals,
physicians, nurses and health care officers, in health
related problems in older people, starting with a special
interest in community care in the Middle-East area.
- To harmonise the attitudes and goals
of future opinion leaders in approaching the health
related problems of older people in the Middle East
- To establish a network among physicians,
nurses and health care officers, responsible for the
health care of older people and those responsible for
medical and nurse students instruction, as well as general
physicians caring for aged people.
- To stimulate scientific interest in
the health related problems in older people.
The course will increase knowledge and
skills in the management of health related problems
in older people in the Middle-East area. Participants
will be trained in searching literature, presenting
state of the art lectures, discussion with opinion leaders
and chairing and reporting groups discussions. Each
participant will be evaluated individually, to reach
a maximum improvement of experiences and skills. The
certificate of the course will be a valuable document
for the participants' career.
The two-year MEAMA course was started
in 2003 by a group of Middle-East and European Professors
and the plan is to have two sessions every year either
in Tripoli-Lebanon or elsewhere in the Middle-East.
The highly successful format of intensive attending
participation in working groups, giving short presentations
and leading discussions as well as state-of -of-the-art
lectures by expert in the field is still followed today.
The organisers of the Middle-East Academy for Medicine
of Ageing organise this course with support of the Abyad
Medical Center, the European Academy for Medicine of
Ageing, the European Union of Geriatric Medicine, the
Geriatric Medicine Section of the European Union of
Medical Specialists and the International Association
of Gerontology, and Arab Scientists Organisation. None
of these organisations has possibilities for financial
The first session took place between Oct
2-5 , 2003 . The participants came from six Middle-East
countries. The members of this small enthusiastic group
were all very much engaged in the problems they will
face in older people in the nearby future. During the
course the participants presented lectures about the
situation in their own countries. The teachers' state
of the art lectures focused on demographic aspects in
the Middle-East area. Differences were observed between
the countries. The MEAMA seems to be an excellent forum
for the exchange between countries and the discussion
for developments. Other subjects we discussed were heart
failure, diabetes mellitus, osteoporosis, dementia,
depression and behavioural disturbances. The evaluation
by the participants was excellent, with correct critical
and constructive remarks.
The second session took place in Tripoli
between 8-11, 2004. Development with the second session
was the support of Case Western University and the concurrent
first annual Middle-east Conference of Age & Aging
From 8 through 11 April, 2004, the second
session of the first MEAMA course was organized in Tripoli,
Lebanon. In contrast to the first session this session
was divided in two parts, the regular course for a limited
number of participants and a one day symposium, accessible
for physicians from Lebanon. Financial reasons were
the background of the course-symposium combination.
The costs for a course with highly qualified speakers
from several countries in the Middle-East and the European
Union can not be afforded by a small group of participants.
The symposium was the First Annual MEAMA
Symposium for continuing professional development for
geriatric medicine for physicians from Lebanon and the
participants of the MEAMA course. Several speakers from
the Middle-East, the European Union and India presented
lectures about pharmacotherapy in older patients, depression,
pulmonary diseases, peptic ulcer disease, falls and
walking problems and decisions regarding the end of
life. A well chosen and well presented mixture of relevant
clinical problems in older patients.
The main objectives of the course' session
were: care for older patients: who should be referred
to hospital and which facilities needs a hospital to
meet the problems of older patients? In addition common
problems in older patients were discussed.
The course opened with a state of the
art lecture by prof. S.M. Karandikar from India. He
presented data and discussed how in India the coordination
of health care services and social services offered
better and more comprehensive care for older people.
Dr P. Overstall, form the United Kingdom, presented
information about the interaction between the services
available in the community and the support that can
be expected from the hospital. The third speaker, prof.
S.A. Duursma, from the Netherlands, discussed the organization
of and services to be given by a hospital unit for geriatric
medicine. The participants discussed in small groups
questions regarding an old patient who had to be admitted
to a hospital department for geriatric medicine. The
questions were: What do you expect from the hospital
as patient's general practitioner? What do you expect
in the hospital as the patient herself? What do you
expect in the hospital as the daughter who regularly
cared her mother at home? What will be the approach
of the nurses in the hospital to the patient and what
is the position of the daughter? After these discussions
dr P. Overstall gave an informative lecture about the
issues in nursing homes and how to improve the long
The second day started with lectures by
the participants. Dr Sami Helou, from the United Arabia
Emirates, focused on the role of the community health
nurse, the community physician and the community physiotherapist.
Attention was also given to the role of the hospital
nurse, who is engaged with discharge planning for older
patients. Dr Oscar Shucri described the three health
care systems in Jordan, the governmental system, the
private system and the United Nations Programme for
Refuges. He also reported the start of the Jordan Society
for Gerontology and Geriatrics, to stimulate the development
of the services for health related problems in older
people. Fatima Habib reported about Bahrain, she described
the elderly care units of the government and private
organizations. One of the Bahrain hospitals has a department
for geriatric medicine as part of the department of
internal medicine. Bahrain has a specialized hospital
for psychogeriatric patients.
Prof. dr S.M. Karandikar followed these
presentations with a draw how to develop community based
services in developing countries. He stressed the focus
on community services to be client centred and family
centred. Special attention should be given to the access
of information and communication and the cooperation
amongst providers of health care services. Education
and how to introduce programmes about teaching elderly
care in an undergraduate medical school was covert by
prof. F. Amin from Bahrain. He presented the well developed
and nicely organized programme at the Bahrain university.
The participants continued the programme with groups
discussions about how older patients will experience
the services at home and how to set up and manage a
team for individual services at home. Enhancing independence
through the use of assistive technology was well presented
by dr M. Halimi from Lebanon.
The last day of the course opened with
an overview by Dr A. Abyad, from Lebanon, regarding
the needs for care by older patients, the important
role of the care giver at home and the support of the
family. Mrs Lorita, participant from Lebanon, presented
a nice paper on exercises in older persons. Dr Nazih
Kamal Eddine, participant from Lebanon discussed the
interesting problems of visual impairment. In a combined
presentation dr Mohammed Al Shaqi, participant from
Saudi Arabia and dr Emad Esbaiti, participant from Kuwait,
a good overview was given of quality indicators for
scientific journals and for research projects. Dr A.
Abyad continued this subject with a state of the art
lecture regarding how to write a research protocol.
Hormonal substitution in older women and men was the
nicely presented lecture of prof. dr C. Netelenbos from
the Netherlands. Ten years ago hormonal substitution
in women was well accepted, however, the increasing
number of publications with negative effects changed
the ideas about oestrogen and progestogen substitution
therapy. For men the pro's and contra's regarding testosterone
substitution are still under discussion.
The final part of the programme was the
evaluation by the participants. Like after the first
session the participants gave well documented critical
remarks. Suggestions were: to coach the participants
during the preparation of the students' state of the
art lectures; ending the day programme at 17.00 hour;
the symposium day at the first day of the programme
in stead of the third day in this session; more attention
for the typical problems in the Middle-East region and
more pharmacotherapy in the programme. Friendly was
the judgement about the session: it was well organized
in a good venue and well qualified speakers were attracted
for the course. The last remark especially regards all
speakers, they all accepted travelling economy class
and did not receive any financial allowance for there
presentations. In this way they all supported the goal
of the MEAMA, to stimulate the development of health
care services for older people in the Middle-East area.
The number of people attending the
conference day was 100 physicians and paramedical staff.
The number of participants in the workshop was 16 participants
representing six countries.
The evaluation by the participants was
excellent, with correct critical and constructive remarks.
The third session will take place in Sept 30th, -Oct
3, 2004 in Bahrain and the fourth session between 1st
of April to 4th of April 2005 in Tripoli.
From 1 through 3 September, 2004, the
third session of the first MEAMA course was organized
in Bahrain in the Kingdom of Bahrain. Seventeen participants
from six Middle-East countries participated in the session.
Originally a one day symposium on aspects of quality
of life was planned at the day before the third session.
For the participants of the course this symposium would
have been the first day of the session. Unfortunately,
because of an unavoidable change in the date of the
course, the symposium had to be cancelled. A disappointment
which was compensated by the presence of two highly
qualified speakers, who participated during the whole
session, with excellent presentations and fruitful discussions.
It was a pleasure for both participants and organizers
to have prof. dr Miel Ribbe from Amsterdam, the Netherlands,
and prof. dr Palmi Jonsson from Reykjavik, Iceland,
available for information and advise.
The main objective for the session was
quality of life. It was introduced by prof. Miel Ribbe.
Quality of life is an individual experience and it changes
over time during life. It has to be expressed by the
individual or to be observed by others and it is based
on resources, abilities and goals. It has social, psychological
and health related indicators and environmental and
cultural dimensions. Dr Abdul Razzak Abyad discussed
the typical problems related to quality of life in older
patients with dementia. He focused on how to improve
quality of life in these patients, how to handle personal
freedom and how to measure patients' mental incapability.
Special attention was given to non-verbal communication
with these patients. The groups' discussions focused
on quality of life in patients with chronic heart failure,
on haemodialysis, with depression or in the end stage
of life. The general conclusion was the differences
in the needs, and measures for each group of patients.
Dr Adel Al-offi presented the results
of a community geriatric team for mental disorders in
Bahrain. Consultations are offered at home, in nursing
homes and in hospitals. The model was cost effective
and postponed hospitalisation or admittance in a nursing
The level of adherence to the guidelines
for diabetes mellitus in older patients in Canada was
discussed by Al Malik Waleed from Saudia Arabia. The
use of aspirin and blood pressure control were good,
however, the measurements of HbA1c and the lipid profile
was measured in less than 15% of the patients. Physicians
know the guidelines, but do not use them in older patients.
How to select a guideline from the increasing
number of guidelines? Prof. Fawzi Amin recognizes six
domains for the quality of a guideline: 1. the scope
and purpose; 2. the stakeholder involvement; 3.te rigour
of development; 4. the clarity and presentation; 5.
the applicability; 6. the editorial independence. A
critical review of a guideline should be followed by
a discussion how to implement the guideline. For simple
problems the guidelines are usually simple, for complex
problems the guidelines are mostly broad and complicated.
The groups' discussions asked for guidelines for special
problems in patients, but also for caregivers, rehabilitation,
safety and environmental risks and lifestyle improvement.
For the nursing homes attention was asked for the end
of life problems and cognitive functioning. For hospital
discharge guidelines were requested. Guidelines for
outpatient clinics were felt to be difficult to develop,
for example regarding non-verbal communication.
In a second lecture prof. Miel Ribbe emphasized
the subjective, dynamic, normative and comprehensive
aspects of quality. And quality care includes the impact,
the process and the output. Quality indicators and the
minimum data set were discussed, followed by an introduction
of the interRai group and instruments. Several members
of the participants showed serious interest to participate
in a study of the interRai, to get information end insight
in the Arabic patients. It offers the possibility to
compare the outcomes of the Arabic world with other
countries and cultures.
As an area of the world, different from
the Arabic world, prof. Palmi Jonsson was invited to
explain the health care system in the Nordic countries
of Europe: Norway, Sweden, Finland, Denmark and Iceland.
Iceland has the highest life expectancy for people over
65 years of age in Europe. The limited population of
Iceland made it possible to set up a system to keep
older people at home as long as possible and to offer
nursing home care only when needed. The success and
the problems of the system were discussed. A problem
in the system is the insufficient coordination between
the institutions. Another problem is that general physicians
have not been accustomed to visit patients at home.
Because the incidence of chronic diseases in patients
roughly doubles per five years increase of age, a programme
for prevention has been developed in Iceland, with preventive
measures for the age group 15-40 years, the age group
40-50 years and the age group 50 to 70 years and older.
As in former sessions the participants
evaluated the session and made suggestions for subjects
of special interest for the last session of the course.
The six subjects with the highest score of interest
will be included in the programme of the next session:
education and training for general practitioners and
team members; how to start a society for gerontology
and services for older people; theories about the process
of ageing; nutrition, weight loss and adipositas; falls
and fall prevention; management models in health care
services for older people.
The course was accommodated by the Bahrain
Ministry of Health in the attractive Novotel, build
in accordance with the typical old Bahrain architecture.
A major sponsor for the course was the Merck Institute
of Aging & Health. The Ministry of Health of the
government of Bahrain offered excellent support and
Gulf Air offered generous and excellent travel facilities
for the European speakers. The acceptance of a board
position by prof. Miel Ribbe will strengthen further
development of the board and will support the preparations
for the second course, to be started in the autumn of
The fourth session took place in
Tripoli, Lebanon between July 7th to 10th , 2005. The
session was attended by ten participants and six of
the participants finished their four sessions of training.
The six graduating participants became part of the newly
created network. The executive board planned to continue
the course in the future. Dependant on the developments
of the services for the health related problems for
older people in the Middle East area the future programmes
will be adapted to the specific needs. The idea
is not only to teach and train people, but also to give
support in the process of the development in the countries
by adaptation of the programmes. A very beneficial side
effect we want to reach is the development of a useful
network for the participants of the course. For this
reason we make all participants a 'member of the MEAMA'
after the graduation and will offer them the opportunity
for feed back, positions as speakers and participation
in special activities of the following courses.