scholarly journals The bio-psycho-social frailty: a key to the integrate territorial and hospital care in Europe

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
R Roller-Winsberger
Keyword(s):  
Public Health ◽  
Good Practice ◽  
Functional Decline ◽  
Population Level ◽  
Adverse Outcomes ◽  
Healthy Ageing ◽  
Active And Healthy Ageing ◽  
Age Related ◽  
Practice Models ◽  
Health And Social Care

Abstract Demographic changes have forced communities and people themselves to reshape ageing concepts and approaches and try to develop actions towards Active and Healthy Ageing (AHA). The prevalence of frailty at population-level is expected to increase in Europe, changing the focus of Public Health. The European Innovation Partnership on Active and Healthy Ageing (EIPonAHA), a private public partnerships (PPP) launched by the European Commission (EC) is aimed at developing new solutions to facilitate AHA. The partnership combined the view on frailty coming from public health as well as the clinical management, and managed to overcome barriers between these two worlds. Bio-Psycho-Social frailty represents a synthetic indicator providing an effective basis to overcome a silos approach that is often performed by health and social professionals working in the field. The A3-Action Group on ' Lifespan Health Promotion & Prevention of Age-Related Frailty and Diseases” proposes good practice models to achieve and support the healthy ageing of European citizens using a bottom-up approach targeting the prevention of frailty and subsequent functional decline. Multiple factors were highlighted by the group as useful for healthcare planning: malnutrition, polypharmacy, impairment of physical function and social isolation were targeted to mitigate frailty and its consequences. Integrated health and social care is a key factors to affect ageing positively either in the field of prevention of functional decline and in the field of care. Studies focused on the management of frailty highlighted that tailored interventions can improve physical performance and reduce adverse outcomes. A crucial role is played by training of health personnel and education at population level in order to achieve a new awareness about AHA trajectory.

scholarly journals Frailty as the Future Core Business of Public Health: Report of the Activities of the A3 Action Group of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA)

2018 ◽  
Vol 15 (12) ◽  
pp. 2843 ◽  
Author(s):  
Giuseppe Liotta ◽  
Silvia Ussai ◽  
Maddalena Illario ◽  
Rónán O’Caoimh ◽  
Antonio Cano ◽  
...  
Keyword(s):  
Public Health ◽  
Population Level ◽  
Adverse Outcomes ◽  
Healthy Ageing ◽  
Community Level ◽  
Public Health Perspective ◽  
Public Health Report ◽  
Action Group ◽  
Health Report ◽  
Health And Social Care

Background: The prevalence of frailty at population-level is expected to increase in Europe, changing the focus of Public Health. Here, we report on the activities of the A3 Action Group, focusing on managing frailty and supporting healthy ageing at community level. Methods: A three-phased search strategy was used to select papers published between January 2016 and May 2018. In the third phase, the first manuscript draft was sent to all A3-Action Group members who were invited to suggest additional contributions to be included in the narrative review process. Results: A total of 56 papers were included in this report. The A3 Action Group developed three multidimensional tools predicting short–medium term adverse outcomes. Multiple factors were highlighted by the group as useful for healthcare planning: malnutrition, polypharmacy, impairment of physical function and social isolation were targeted to mitigate frailty and its consequences. Studies focused on the management of frailty highlighted that tailored interventions can improve physical performance and reduce adverse outcomes. Conclusions: This review shows the importance of taking a multifaceted approach when addressing frailty at community level. From a Public Health perspective, it is vital to identify factors that contribute to successful health and social care interventions and to the health systems sustainability.

scholarly journals Perspectives on Frailty Screening, Management and Its Implementation Among Acute Care Providers in Singapore: A Qualitative Study

2020 ◽  
Author(s):  
Xiao Liu ◽  
Vivienne Mai Khanh Le ◽  
Amber Lim Yew Chen ◽  
Emily Jiali Koh ◽  
Tu Nguyen ◽  
...  
Keyword(s):  
Public Health ◽  
Qualitative Study ◽  
Acute Care ◽  
Group Discussion ◽  
Functional Decline ◽  
Adverse Outcomes ◽  
Health Concern ◽  
Care Providers ◽  
Care Givers ◽  
Age Related

Abstract Background Frailty has emerged to be a public health concern among aging populations. COVID-19 pandemic has reminded how the frailest individuals are particularly exposed to adverse outcomes. It is important to identify and manage frailty to delay functional decline and reduce unnecessary health utilizations. Our study explored understanding on frailty and practice of frailty screening among different acute care professionals in Singapore, (2) identify barriers and facilitators concerning frailty screening, management and its implementation.Methods A qualitative study using focus group discussion among nurses and individual interviews among physicians from four departments (Accident & Emergency, Anaethesia, General Surgery, Orthopedics) in three acute hospitals from the three public health clusters in Singapore. Participants were recruited through a combination of purposive, convenience and snowball approach with a directed approach by using NVIVO 12.0 to analyse the data. Result Frailty was mainly but inadequately understood as a physical and age-related concept. Screening for frailty in acute care was considered necessary to reduce adverse health outcomes. Specific issues related to screening, management and implementation identified were: cooperation from patient/caregivers, acceptance from healthcare workers/hospital managers, need for dedicated resources, guidelines for follow-up management and consensus on the scope of measurement for different specialties. Conclusion Our findings indicated the need for 1) education program for patients/care givers and stakeholders 2) hospital wide push to adopt and develop a uniform frailty screening tool and process and 3) applying relevant guidelines, developing whole of hospital approach and process for the management of frail patients.

The biology of ageing

2012 ◽  
pp. 1507-1512
Author(s):  
Alan H. Bittles
Keyword(s):  
Allostatic Load ◽  
Empirical Studies ◽  
Functional Decline ◽  
Twin Studies ◽  
Population Level ◽  
Major Influence ◽  
Control Group ◽  
Major Life ◽  
Age Related ◽  
Physiological Dysregulation

Although old age is readily recognizable, methods to define and measure the underlying biological processes are much less amenable to study. For this reason, life expectancy has been widely used as a surrogate measure of ageing, as well as to monitor economic progress at national and regional levels. It is generally acknowledged that lifespan is a constitutional feature of the human phenotype, and twin studies have indicated that 25–33 per cent of the variance in human longevity is genetic in origin. External factors including lifestyle can also exert a major influence, as illustrated by the current mean life expectancies of 79 and 86 years for males and females in Japan, whereas the comparable figures for Botswana are 35 and 33 years, respectively. The importance of genetic inheritance as a determinant of extended survival has been illustrated by population level studies in Okinawa, an island prefecture of southern Japan with a very high prevalence of long-lived individuals. On the island, the mortality rates of the male and female siblings of centenarians were approximately half those of birth cohort-matched, non-centenarian siblings. These findings parallel an earlier study of the family of Jeanne Calment, who died in France in 1997 aged 122 years. Of her 55 relatives, 24 per cent had lived to >80 years compared to just 2 per cent of a matched control group. However, it remains unclear whether the enhanced lifespan of individuals who exhibit above average longevity is due to a slowing of the overall ageing process or is primarily associated with resistance to major life-threatening pathologies. The concept of an ‘allostatic load’, potentially involving the neuroendocrine, sympathetic nervous, immune and cardiovascular systems, and metabolic pathways, has been advanced to describe the lifetime costs of adapting to physical and psychological stresses. According to this hypothesis, while the actions of biological mediators of stress can be initially beneficial to health, chronic stimulation results in regulatory imbalance and subsequent pathophysiological changes. Empirical studies have indicated increased physiological dysregulation and functional decline at >70 years of age, which would imply that predicted global increases in the numbers of older persons will be accompanied by disproportionately larger groups of individuals with major age-related pathologies.

scholarly journals Implications of skeletal muscle loss for public health nutrition messages: a brief report

2015 ◽  
Vol 74 (4) ◽  
pp. 426-429 ◽  
Author(s):  
Louis B. Levy ◽  
Ailsa A. Welch
Keyword(s):  
Public Health ◽  
Skeletal Muscle ◽  
Weight Loss ◽  
Older People ◽  
Morbidity And Mortality ◽  
Muscle Loss ◽  
Dietary Recommendations ◽  
Age Related ◽  
Health And Social Care ◽  
Skeletal Muscle Loss

Age-related skeletal muscle loss, sarcopenia, cachexia and wider malnutrition (under nutrition) are complex in aetiology with interaction of clinical, social and economic factors. Weight loss and loss of skeletal muscle mass in older people are associated with increased morbidity and mortality with implications for increasing health and social care costs. There is insufficient evidence to identify the ideal treatment options. However, preventing weight loss and loss of skeletal muscle in older age will be keys to reducing morbidity and mortality. This will require all those coming into contact with older people to identify and address weight loss early, including through diet, improving physical activity and increasing social interaction. Public health messages on diet should, in the main, continue to focus on older people achieving current UK dietary recommendations for their age as visually depicted in the eatwell plate together with associated messages regarding dietary supplements where appropriate.

scholarly journals Feasibility of population screening tests to establish a healthy ageing trajectory

2019 ◽  
Vol 7 ◽  
pp. 205031211882244 ◽  
Author(s):  
Susan J Gordon ◽  
Karen A Grimmer ◽  
Nicky Baker ◽  
Elaine Bell ◽  
John Coveney ◽  
...  
Keyword(s):  
Functional Decline ◽  
Community Dwelling ◽  
Healthy Ageing ◽  
Test Battery ◽  
Screening Tests ◽  
Rapid Review ◽  
Community Based ◽  
Age Related ◽  
Foot Sensation ◽  
Age Related Changes

Objectives: There are no agreed comprehensive tests for age-related changes to physical, emotional, mental and social functioning. Research into declining function focuses on those 75 years and older and little is known about age-related changes in younger people. The aims of this project were (1) to ascertain a comprehensive test battery that could underpin community-based health screening programmes for people aged 40–75 years and pilot both (2) community-based recruitment and (3) the utility, acceptability, response burden and logistics. Methods: A total of 11 databases were searched using a broad range of relevant terms. An identified comprehensive, recent, high-quality systematic review of screening instruments for detection of early functional decline for community-dwelling older people identified many relevant tools; however, not all body systems were addressed. Therefore, lower hierarchy papers identified in the rapid review were included and expert panel consultation was conducted before the final test battery was agreed. Broad networks were developed in one Australian city to aid pilot recruitment of community-dwellers 40–75 years. Recruitment and testing processes were validated using feasibility testing with 12 volunteers. Results: The test battery captured (1) online self-reports of demographics, health status, sleep quality, distress, diet, physical activity, oral health, frailty and continence; and (2) objective tests of anthropometry; mobility; lung function; dexterity; flexibility, strength and stability; hearing; balance; cognition and memory; foot sensation; and reaction time. Recruitment and testing processes were found to be feasible. Conclusion: This screening approach may provide new knowledge on healthy ageing in younger people.

scholarly journals 9.I. Workshop: Healthy ageing and public health: a bound fate

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
◽  
Keyword(s):  
Public Health ◽  
Older Adults ◽  
Community Care ◽  
Population Level ◽  
Healthy Ageing ◽  
Health Policies ◽  
Model Of Care ◽  
Term Care ◽  
Public Health Policies

Abstract The promotion of healthy ageing at all ages of life is a key point of public health strategy in almost all health systems throughout the world with a special focus on the systems of the advanced economies. The World Health Organization promotes a lifespan approach in order to put the basis of healthy ageing in the early life, supported by a growing set of data that show the relevance of life habits and socio-economic condition since the childhood for the older adults' health. However, we already witness the impact of large cohort of older adults who fuel the demand for health and social services, with worrying projection for the next 20-30 years in terms of economic stressors on the public finances coming from the request for Long Term Care as well as for Acute care services. Prevention at all age, namely at older age, is crucial to manage the demand for care. What interventions can lead this approach? What model of care could be put on the field in order to offer a mix of integrate health and social care able to meet the individual needs and to promote the best possible quality of life for each individual? what is the role of bio-psycho-social frailty as synthetic indicator of the needs of care at population level as well as of key information to stratify the risk of negative event at individual level? what professionals should be more involved in the new model of community care? what pathway in terms of training could we promote in the next years to support the shift from acute to long term care? what contribution should be asked to civil society to allow the spread of community care? Answers to these questions should fit with different geographical, political, social and economic settings as well as with different health systems. At the same time the development of a multidimensional assessment of the demand of care, both at individual and population level, is a crucial step to plan effective interventions. The main obstacles to this process seem to stem from the organization of community care still in silos with rare collaboration among different professionals. To overcome the obstacles a mindset change should be achieved mainly by training of personnel to set up a new model of care based on the systematic interaction among the prevention and care actors. Moreover, a pro-active component of prevention and care programs at community level, could strengthen many interventions that address a population which is not always aware of the risk associated to the progression of frailty. Finally, ICT devices could provide a valuable contribution to the reshuffling of community care, if they are embedded in a comprehensive model including a robust investment in human resources. The aim of the workshop is to report on the challenges that healthy ageing process has to face in different world areas and to discuss future developments likely to affect public health policies. Key messages Multidimensional approach to public health policies aimed at increasing health promotion programs impact on older adults is the key to promote healthy ageing. Pro-active services could increase the involvement of older adults’ population into healthy ageing program.

scholarly journals Efficacy of Nutritional Interventions as Stand-Alone or Synergistic Treatments with Exercise for the Management of Sarcopenia

Nutrients ◽  
2019 ◽  
Vol 11 (9) ◽  
pp. 1991 ◽  
Author(s):  
Sarah Damanti ◽  
Domenico Azzolino ◽  
Carlotta Roncaglione ◽  
Beatrice Arosio ◽  
Paolo Rossi ◽  
...  
Keyword(s):  
Physical Exercise ◽  
Strength Function ◽  
Functional Decline ◽  
Public Health Problem ◽  
Adverse Outcomes ◽  
Major Public Health Problem ◽  
Related Condition ◽  
Nutritional Interventions ◽  
Exercise Interventions ◽  
Age Related

Sarcopenia is an age-related and accelerated process characterized by a progressive loss of muscle mass and strength/function. It is a multifactorial process associated with several adverse outcomes including falls, frailty, functional decline, hospitalization, and mortality. Hence, sarcopenia represents a major public health problem and has become the focus of intense research. Unfortunately, no pharmacological treatments are yet available to prevent or treat this age-related condition. At present, the only strategies for the management of sarcopenia are mainly based on nutritional and physical exercise interventions. The purpose of this review is, thus, to provide an overview on the role of proteins and other key nutrients, alone or in combination with physical exercise, on muscle parameters.

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