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Introduction: Rates of falls increase with ageing and age-related biological and functional changes. Most falls in later life occur as a result of a complex interaction between multiple intrinsic and environmental risk factors. Falls and falls-related injuries are major public health problems that often require healthcare intervention and rehabilitation (1) and recurrent falls are a frequent trigger for older people and their families seeking long term institutional care. Therefore, the prevention and management of falls has substantial relevance for integrated care systems. This study sought to obtain international insight into the implementation of pathways or programs addressing balance, mobility and/or falls prevention in primary care or community services.Methods: A survey template was created to include the key elements detected during a literature review conducted by MUG. The template included questions on screening, assessment, intervention components, target group, professionals involved and tools used for assessment and/or monitoring experience and outcomes. Members of IFIC’s international Special Interest Groups(SIGs) on Ageing and Frailty, Intermediate Care were invited to complete an online EU Survey tool available from 01.06-01.08.2021. Responses were analysed by two researchers and results considered by the co-authors in an online focus group. Results: 16 people from 11 countries completed the online survey. 9/16 reported fully implemented falls programs or care pathways in their region or country: UK (3), Ireland (1), Spain (1), Indonesia (1), Peru (1), Australia (1) and Northwest USA (1). Seven examples are focused on older citizens but one is for older people with frailty & neurodegenerative diseases (New South Wales, Australia) and one is a pathway for patients in Indonesia, independent of disease and/or age limits. Professional disciplines involved differed across countries but allied health professionals and nurses were commonly involved. Family physicians were involved in only the examples from the USA and Indonesia. Specialist physicians in geriatric medicine were involved in five of the examples. Five programs involved pharmacists to advise on medication and two programs involved trained volunteers. Public/patient information and education was the most common intervention and was the sole intervention in the Spanish example reported. Three of the nine programs did not routinely evaluate patient experience or functional outcomes. Only three pathways enabled patient level data to flow through the electronic care record. Conclusion: The international survey offers initial insight into implemented pathways and programs for the prevention and management of falls in primary care and community settings in different countries. It paves the way for a more targeted survey and Delphi consensus process on the design and benchmarking of integrated services to address the challenge of falls in ageing societies.Implications: The evidence-based examples in the survey highlight processes and interventions that are readily transferable and where adoption will facilitate standardization and improved quality of care. The next phase aims to agree key components and performance indicators to allow future benchmarking and system-based evidence generation on prevention and management of falls in the community.References(1) World Health Organization. WHO global report on falls prevention in older age. World Health Organization; 2008.

Irritable bowel syndrome (IBS) is a common multifactorial condition that affects the large intestine and is characterized by chronic and relapsing abdominal pain and altered bowel habit. IBS is due to a combination of genetic, environmental and dietary factors. It's usually a lifelong problem very frustrating to live with and can have a big impact on quality of life, as single-agent therapy rarely relieves bothersome symptoms for all patients. The objective of this study was to analyze the approaches and solutions that address the social and health unmet needs of patients with IBS. A qualitative approach was adopted in the current study to identify and specify key digital solution and high impact user scenarios applied to IBS patients, through an adaptation of the "Blueprint on Digital Transformation in Health and Care in an Ageing Society" persona methodology. A Survey was administered to a group of patients in anonymous form. The theoretical elaboration IBS personas was developed through an interdisciplinary Focus Group, which also mapped the pathway for the patient's management. Three main needs were identified to be met to improve IBS patient's lifestyle: access to psychological support, mHealth solutions supporting diet and adapted physical activity, and homebased digital health support. mHealth intervention has been identified for diet adherence, physical exercise and psychological well-being. The process has been mapped and adapted to integrate the new solutions into the care pathway. Further research is needed to evaluate how mHealth services enable IBS patients to manage their conditions and improve their quality of life. KEY WORDS: Digital Health, Irritable bowel syndrome, mHealth, Nutrition, Physical activity, Psychological support.La sindrome dell’intestino irritabile (IBS) è una condizione multifattoriale comune che colpisce l’intestino crasso ed è caratterizzata da dolore addominale cronico e recidivante e alterazione delle abitudini intestinali. L’IBS è dovuta a una combinazione di fattori genetici, ambientali e dietetici. Di solito è un problema che permane per tutta la vita, molto frustrante per conviverci e può avere un grande impatto negativo sulla qualità della vita, poiché la terapia con un solo farmaco raramente allevia i sintomi fastidiosi per tutti i pazienti. L’obiettivo di questo studio era di analizzare gli approcci e le soluzioni che affrontano i bisogni sociali e sanitari insoddisfatti dei pazienti con IBS. Nel presente studio è stato adottato un approccio qualitativo per identificare e specificare la soluzione digitale chiave e gli scenari utente ad alto impatto applicati ai pazienti con IBS, attraverso un adattamento al singolo della metodologia “Blueprint on Digital Transformation in Health and Care in an Aging Society”. Un sondaggio è stato somministrato a un gruppo di pazienti in forma anonima. L’elaborazione teorica IBS personale è stata sviluppata attraverso un Focus Group interdisciplinare, che ha anche tracciato il percorso per la gestione del paziente. Sono state identificate tre esigenze principali da soddisfare per migliorare lo stile di vita dei pazienti affetti da IBS: accesso al supporto psicologico, soluzioni di mHealth a supporto della dieta e dell’attività fisica adattata e supporto sanitario digitale domiciliare. L’intervento mHealth è stato identificato per l’aderenza alla dieta, l’esercizio fisico e il benessere psicologico. Il processo è stato mappato e adattato per integrare le nuove soluzioni nel percorso assistenziale. Sono necessarie ulteriori ricerche per valutare in che modo i servizi di mHealth consentano ai pazienti con IBS di gestire le loro condizioni e migliorare la loro qualità di vita.

Background : Irritable bowel syndrome (IBS) is a common multifactorial condition that affects the large intestine and is characterized by chronic and relapsing abdominal pain and altered bowel habit. IBS is due to a combination of genetic, environmental and dietary factors. It's usually a lifelong problem very frustrating to live with and can have a big impact on quality of life, as single-agent therapy ra: Objective to analyze the approaches and solutions that address the social and health unmet needs of patients with IBS. Design: A quantitative-qualitative approach was adopted in the current study to identify and specify key digital solution and high impact user scenarios applied to IBS patients, through an adaptation of the “Blueprint on Digital Transformation in Health and Care in an Ageing Society” persona methodology. Settings: Digital health solutions bring the potential of supporting health interventions through mobile apps, wearable devices, telemedicine. Patients: A Survey was administered to a group of patients in an anonymous form, and no need for Medical Ethical Committee approval was identified. Interventions. The theoretical elaboration IBS personas was developed through an interdisciplinary Focus Group, which also mapped the pathway for the patient's management. Main Outcome : Three main needs were identified to be met to improve IBS patient’s lifestyle: access to psychological support, mHealth solutions supporting diet and adapted physical activity, and home-based digital health support. mHealth intervention has been identified for diet adherence, physical exercise and psychological well-being. The process has been mapped and adapted to integrate the new solutions into the care pathway. Limitation: Further research is needed to evaluate how mHealth services enable IBS patients to manage their conditions and improve their quality of life. Conclusion The person-centered approach was implemented through a multidisciplinary Focus group that enabled the identification of the need for a mHealth intervention

The article describes some of the achievements of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA), after eight years in operation. These results were achieved thanks to the collaborative work of the action groups (AGs) and reference sites (RSs). RS regional ecosystems include key organisations committed to investing in innovation to foster active and healthy ageing. The AGs are groups of professionals committed to sharing their knowledge and skills in active and healthy ageing. This article reports on the approach used by the EIP on AHA to bring together experts and regions in identifying and addressing these challenges. Synergies between AGs offered substantial support to RSs, allowing regional health and care priorities and challenges to be identified and pursued through AG commitments. Building upon the experiences of the EIP on AHA, the Reference Sites Collaborative Network has set up a number of thematic action groups that bring together multidisciplinary experts from across Europe to address the main health and social care challenges at regional, national and European level.

Demographic change represents the most significant challenge of the 21st century. The aging population around the world will foster a consequent change in labor markets, wealth distribution, request of goods and services, as well as social and healthcare needs. The number of survivors to once deadly conditions, as well as the age associated increase in degenerative chronic conditions will represent a severe stress to our systems, that will not be sustainable any longer. At the same time, longevity might become an opportunity for the re-organization of services, leading to a new era of opportunities for economic and social prosperity. These challenges require a strong interdisciplinary approach in the identification of unmet needs, and new social, health and technological solutions, that are demand-driven and user-oriented. ICT is going to be the key to many of these revolutionary services. The European Community has proposed a new grant instrument to foster the collaboration between public administration and ICT industry for purchasing Research and Development services in order to develop a novel Information and Communication Technology solution, called Pre Commercial Procurement. ProEmpower is such a project aimed to enable patients to early diagnosis, daily management, and clinical data collection for people with type 2 diabetes. The project goes through a call for tenders issued by a consortium of four public procurers, that jointly defined a set of requirements and use cases, in collaboration with end-users, for the development of innovative solutions This manuscript describes the process that has led to the selection of two solutions that will be tested by end users in the four regions.

This article describes how innovations are exploited in Campania (Italy) to improve health outcomes, quality of life, and sustainability of social and healthcare services. Campania's strategy for digitalization of health and care and for healthy aging is based on a person-centered, life-course, “One Health” approach, where demographic change is considered capable of stimulating a growth dynamic linked to the opportunities of combining the “Silver Economy” with local assets and the specific health needs of the population. The end-users (citizens, patients, and professionals) contribute to the co-creation of products and services, being involved in the identification of unmet needs and test-bed activity. The Campania Reference Site of the European Innovation Partnership on Active and Healthy Aging is a flexible regional ecosystem to address the challenge of an aging population with a life-course approach. The good practices, developed in the context of research and innovation projects and innovative procurements by local stakeholders and collaborations with international networks, have been allowing the transfer of innovative solutions, knowledge, and skills to the stakeholders of such a multi-sectoral ecosystem for health.

Non-communicable chronic diseases (NCCDs) are the main cause of morbidity and mortality globally. Demographic aging has resulted in older populations with more complex healthcare needs. This necessitates a multilevel rethinking of healthcare policies, health education and community support systems with digitalization of technologies playing a central role. The European Innovation Partnership on Active and Healthy Aging (A3) working group focuses on well-being for older adults, with an emphasis on quality of life and healthy aging. A subgroup of A3, including multidisciplinary stakeholders in health care across Europe, focuses on the palliative care (PC) model as a paradigm to be modified to meet the needs of older persons with NCCDs. This development paper delineates the key parameters we identified as critical in creating a public health model of PC directed to the needs of persons with NCCDs. This paradigm shift should affect horizontal components of public health models. Furthermore, our model includes vertical components often neglected, such as nutrition, resilience, well-being and leisure activities. The main enablers identified are information and communication technologies, education and training programs, communities of compassion, twinning activities, promoting research and increasing awareness amongst policymakers. We also identified key ‘bottlenecks’: inequity of access, insufficient research, inadequate development of advance care planning and a lack of co-creation of relevant technologies and shared decision-making. Rethinking PC within a public health context must focus on developing policies, training and technologies to enhance person-centered quality life for those with NCCD, while ensuring that they and those important to them experience death with dignity.

BACKGROUND & AIMS: Mediterranean Diet (MD) is an eating pattern associated with multiple healthy benefits, including the conservation of skeletal muscle. Frailty is a major geriatric syndrome characterized by low muscle strength. The Hand Grip Strength (HGS) is the most frequently used indicator of muscle functional capacity for clinical purposes. The association between the adherence to the MD and HGS in elderly has not yet fully investigated. The goal of this study was to examine the association between the adherence to the MD and HGS in a not hospitalized elderly who participated in the project PERsonalised ict Supported Services for Independent Living and Active Ageing (PERSSILAA). METHODS: Eighty-four elderly women were consecutively enrolled (aged 60-85 years) in this cross-sectional observational study. Anthropometric measures were evaluated. A validated 14-item questionnaire PREDIMED (PREvención con DIeta MEDiterránea) was used for the assessment of adherence to the MD. Dietary data were collected by a 7-day food records. Muscle strength was measured by HGS using a grip strength dynamometer (KERN & SOHN GmbH). RESULTS: The majority of participants were overweight (46.4%). An average adherence to the MD was found in 52.4% of participants, while the minority of them showed a low adherence (21.4%). HGS > cut-point of 20 kg were found in 43 subjects (51.2%). According to the adherence to MD, 39% participants with HGS values higher than cut-point presented a high adherence score compared with 14% of those with lower values of HGS (p = 0.018). The participants with HGS > cut-point presented significantly higher PREDIMED score than those with HGS < cut-point (p < 0.001). Based on ROC curves, the most sensitive and specific cut-point for the PREDIMED score to predict HGS categories was ≥8. No evident correlations were observed between HGS and age, while HGS was negatively correlated with hip circumference (r = -0.233, p = 0.033) and BMI (r = -0.219, p = 0.045), and positively correlated with PREDIMED score (r = 0.598, p < 0.001). At binomial logistic regression analysis almost all 14-items of PREDIMED questionnaire were significantly associated with HGS adjusted for BMI. At multinomial logistic regression analysis to assess the association of the three classes of adherence to the MD with the HGS, after adjusting for BMI the lowest adherence to MD was associated with the lowest Odds Ratio of HGS (p < 0.001). CONCLUSIONS: This study evidenced a positive association between the adherence to the MD and muscle strength in a sample of active elderly women, stratified according to the HGS > cut-point of 20 kg. Our study highlights the usefulness of the developing health services to detect and prevent age-associated decline in physical performance in elderly subjects by addressing nutritional and physical intervention.