Decreasing loneliness and social isolation among the older people: systematic search and narrative review

Introduction The aim of this study is to sum up the current knowledge on the effectiveness of the existing interventions for alleviating loneliness and social isolation among elderly persons. Methods We used a systematic approach and performed a literature search of MEDLINE, ISI Web of science, SCOPUS, The Cochrane Library, and CINAHL databases. After identifying 13 eligible reviews addressing interventions of our interest, we proceeded with a narrative description of the study findings. Results The initiatives largely encompassed one-to-one interventions, group activities or community engagement approaches. In particular, technology interventions were recently given much attention. Overall, the studies showed non-satisfying methodological quality and their results were often inconclusive. Conclusions Although there is a growing body of evidence referring to implementation of interventions targeting social isolation and loneliness among the elderly, future well-designed interventions are necessary in order to draw firm conclusions

Methodological issues in the observational studies conducted in older population: a narrative review

Introduction Well-conducted observational studies may represent valuable tools for getting insight to disease etiology, detecting the effect of age-related changes, and providing an important perspective on health risk factors and disabilities in an aging population. Nevertheless, this kind of research poses several challenges for researchers. The main aim of this narrative review was to address the potential methodological issues in performing the observational studies in the elderly, the factors that influence their participation, and the possible solutions for overcoming the barriers to research in this population. Methods Comprehensive search for the papers published in the period from January 1st 1980 until 31st July 2016 in English or Italian was conducted through MEDLINE, Scopus and Web of Science electronic databases. Findings from the included papers were finally summarized. Results In cohort studies, the following barriers were addressed: sample size calculation, ascertainment of the target population, frequency of data collection, exposure determination, multifactorial loss to follow-up (drop-outs), cognitive impairment, definition of confounders, and ethical aspects. Case-control studies were reported to be prone to the issues like ascertainment of cases and controls, willingness to participate, data accuracy, recall bias, issues related to patients’ multimorbidity, and cognitive impairment. Conclusions Important factors to consider in research in elderly people include: precise definition of the study population, well conducted recruitment process, engagement with family and home care staff, cognitive impairment assessment and the consequent relevant ethical and legal issues, relief of participant burden in order to minimize withdrawal, and engagement with the media

Enhancing routine immunization efforts for older adults and frail individuals: Good practices during the SARS-CoV-2 pandemic in Italy

Infectious diseases pose a significant burden on the general population, particularly older adults who are more susceptible to severe complications. Immunization plays a crucial role in preventing infections and securing a healthier aging, but actual vaccination rates among older adults and frail individuals (OAFs) remains far from recommended targets. This study aims to collect and share good practices implemented in several Italian local health districts during the SARS-CoV-2 pandemic to ease routine immunization for OAFs. A 28-items questionnaire has been developed to collect information on organization aspect of immunization services and local good practices implemented before and during the SARS-CoV-2 pandemic. Twelve Public Health managers representative of 9 Italian Regions were further interviewed between January and March 2021. Despite literature suggests several effective interventions to increase vaccine demand, improve vaccine access, and enhance healthcare providers' performance, our survey highlighted substantial heterogeneity in their implementation at local level. Seven good local practices have been identified and described: mass vaccination centers; vaccination mobile units; drive-through vaccination; co-administration; tailored pathways; cooperation among providers involved in vaccination; digitization. Our survey pointed out valuable strategies for enhancing routine immunization for OAFs. Providers should combine effective interventions adequate to their specific context and share good practices

Workplace health promotion for older workers: A systematic literature review

Background: Aging of the workforce is a growing problem. As workers age, their physical, physiological and psychosocial capabilities change. Keeping older workers healthy and productive is a key goal of European labor policy and health promotion is a key to achieve this result. Previous studies about workplace health promotion (WHP) programs are usually focused on the entire workforce or to a specific topic. Within the framework of the EU-CHAFEA ProHealth65+ project, this paper aims to systematically review the literature on WHP interventions specifically targeted to older workers (OWs). Methods: This systematic review was conducted by making a comprehensive search of MEDLINE, ISI Web of Science, SCOPUS, The Cochrane Library, CINAHL and PsychINFO databases. Search terms included ageing (and synonyms), worker (and synonyms), intervention (and synonyms), and health (and synonyms). The search was limited to papers in English or Italian published between January, 1st 2000 and May, 31st 2015. Relevant references in the selected articles were also analyzed. Results: Of the 299 articles initially identified as relating to the topic, 18 articles met the inclusion criteria. The type, methods and outcome of interventions in the WHP programs retrieved were heterogenous, as was the definition of the age at which a worker is considered to be 'older'. Most of the available studies had been conducted on small samples for a limited period of time. Conclusion: Our review shows that, although this issue is of great importance, studies addressing WHP actions for OWs are few and generally of poor quality. Current evidence fails to show that WHP programs improve the work ability, productivity or job retention of older workers. In addition, there is limited evidence that WHP programs are effective in improving lifestyles and concur to maintain the health and well-being of older workers. There is a need for future WHP programs to be well-designed so that the effectiveness and cost-benefit of workplace interventions can be properly investigated

The identification of gaps in secondary evidence on health promotion addressed to elderly persons

Background Increasing participation of elderly population in modern societies is a source of great challenges for health and social systems. Health promotion and disease prevention interventions may have a significant effect on health status of older people. The main objective of this paper is presentation of potential gaps in secondary evidence in the area of health promotion interventions addressed to audiences 65 years old or more (65+). Methods The results of the scoping review of secondary evidence on the effectiveness of health promotion and related interventions addressed to older adults (55+) and elderly persons (65+) published from 2000 to April 2015 were further explored. From these reviews, only these which analysed health promotion activities, combined with other general areas (primary prevention, screening, and/or social support) or alone, and designed for the subjects 65+ were selected. The analysis was focused on elicitation of publication trends and identification of targeted areas which were not or were addressed less frequently. Results Among 334 systematic reviews analysing the interventions related to health promotion, primary prevention, screening and social support, there were 66 which were classified to health promotion (as exclusive domain or in combination with other general area) and which were addressed specifically to persons of at least 65 years old. Potential areas which were covered the least frequently or not covered by reviews encompassed: addictions (n = 1), sleep quality (n = 1), psychosocial functioning (n = 1), social isolation (n = 0), social participation (n = 0) and elderly abuse (n = 0). Conclusions Although the secondary evidence on health promotion and related interventions addressed to population 65+ is growing, there are still blind spots not covered by adequate systematic review or/and meta-analyses. Identified deficient areas are potentially important for wellbeing of elderly persons in the context of social interactions. Key message: Although general issues included in health promotion strategies designed for elderly persons are adequately represented by secondary evidence, there are still important gaps in evidenc

Il Fascicolo Sanitario Personale: quale impatto sui cittadini italiani?

In Italia, come in molti altri Paesi, \ue8 in corso l\u2019implementazione del Fascicolo Sanitario Personale (FaSP) come strumento di miglioramento. Il FaSP dovr\ue0 consentire una sicura condivisione in rete della documentazione clinica di ogni singolo cittadino e prevede, pertanto, un ruolo importante degli utenti che, oltre a dover esprimere il proprio consenso per il FaSP, dovranno, attivamente e costantemente, interagire con il fascicolo contribuendo in questo modo al successo dello stesso. La presente revisione sistematica della letteratura ha lo scopo di sintetizzare le attuali conoscenze sull\u2019impatto e sulla soddisfazione che l\u2019Electronic Health Record (EHR) ha conseguito presso gli altri Paesi in cui tale sistema \ue8 gi\ue0 stato implementato, al fine di derivare un\u2019ipotesi di scenario per l\u2019Italia all\u2019adozione del FaSP. La ricerca \ue8 stata effettuata su alcune delle principali banche dati (MEDLINE, EMBASE, The Cochrane Library, CINAHL). Sono state selezionate le pubblicazioni nel periodo 2006-2011 ed \ue8 stata valutata la loro qualit\ue0 ed attinenza agli obiettivi dello studio. Lo screening di testo ed abstract attraverso keywords (patient satisfaction, adoption electronic health records, web portal, ecc) ha identificato 1962 pubblicazioni potenzialmente rilevanti, di cui 41 valutate come testo integrale e solo 13 scelte secondo i criteri di inclusione (inglese, con Impact Factor, studi su pazienti cronici, ecc). Ogni tipologia di utente ha identificato dei fattori, di criticit\ue0 e di beneficio, del sistema EHR correlabili alla propria abilit\ue0 ad utilizzare uno strumento informatico ed alle proprie priorit\ue0 individuali. Le principali criticit\ue0 riscontrate sono state di tipo tecnico, di adattamento allo strumento, di perplessit\ue0 sulla sicurezza e privacy del sistema. I principali benefici riscontrati, interpretati quali miglioramento della qualit\ue0 delle prestazioni sanitarie erogate, sono stati: garanzia nella continuit\ue0 delle cure, disponibilit\ue0 immediata dei dati riguardanti la propria salute. Inoltre \ue8 risultato che, sebbene in netta minoranza, gli utenti correggono i dati errati sul proprio fascicolo sanitario mentre l\u2019accesso al record \ue8 finalizzato principalmente alla consultazione dei risultati dei test diagnostici e delle relazioni cliniche. Il presente studio conferma che la soddisfazione del cittadino all\u2019estero nell\u2019utilizzo dell\u2019EHR risulta genericamente positiva e, pertanto, in Italia la risposta dei cittadini al FaSP potrebbe, se ben gestita, motivata con opportuno empowerment della popolazione, e strutturata a correggere gli errori gi\ue0 evidenziati, ottenere un buon grado di soddisfazione nella popolazione

Anticholinergic Drug Use and Negative Outcomes Among the Frail Elderly Population Living in a Nursing Home

AIM: Increasing evidence from experimental studies and clinical observations suggests that drugs with anticholinergic properties can cause physical and mental impairment. The aim of the present study was to evaluate the relationship between the use of drugs with anticholinergic activity and negative outcomes in older nursing home residents. METHODS: We used data from the database of the U.L.I.S.S.E project (Un Link Informatico sui Servizi Sanitari Esistenti per l'Anziani), a prospective multicenter observational study. Patients from 31 facilities in Italy were assessed at baseline and at 6 and 12 months by trained personnel, using the Minimum Data Set for Nursing Home (MDS-NH). The only exclusion criterion was age younger than 65 years. The Anticholinergic Risk Scale (ARS), a list of commonly prescribed drugs with potential anticholinergic effects, was used to calculate the anticholinergic load. RESULTS: A total population of 1490 patients was analyzed; almost half of the sample (48%) was using drugs with anticholinergic properties. The population of patients with ARS 1 or higher had a higher comorbidity index (P < .003) and greater cognitive impairment (CPS 5-6) (P < .007). They were more likely to suffer from heart failure, Parkinson disease, depression, anxiety, and schizophrenia. In multivariate analysis, a higher score in the ARS scale was associated with a greater likelihood of functional decline (described as the loss of ≥1 ADL point) (odds ratio [OR] 1.13; confidence interval [CI] 1.03-1.23), to a higher rate of falls (OR 1.26; CI 1.13-1.41), and to a higher incidence of delirium (OR 1.16; CI 1.02-1.32) during a 1-year follow-up. CONCLUSIONS: The use of medications with anticholinergic properties is common among older nursing home residents. Our results suggest that among older nursing home residents the use of anticholinergic drugs is associated with important negative outcomes, such as functional decline, falls, and delirium

Chronic diseases and geriatric syndromes: The different weight of comorbidity

Comorbidity is a relevant health determinant in older adults. Co-occurrence of several diseases and other age-associated conditions generates new clinical phenotypes (geriatric syndromes [GS] as falls, delirium etc.). We investigated the association of chronic diseases, alone or in combination, and GS in older adults receiving home care services in 11 European countries and one Canadian province

Anticholinergic drug use and negative outcomes among the frail elderly population living in a nursing home

AIM: Increasing evidence from experimental studies and clinical observations suggests that drugs with anticholinergic properties can cause physical and mental impairment. The aim of the present study was to evaluate the relationship between the use of drugs with anticholinergic activity and negative outcomes in older nursing home residents. METHODS: We used data from the database of the U.L.I.S.S.E project (Un Link Informatico sui Servizi Sanitari Esistenti per l'Anziani), a prospective multicenter observational study. Patients from 31 facilities in Italy were assessed at baseline and at 6 and 12 months by trained personnel, using the Minimum Data Set for Nursing Home (MDS-NH). The only exclusion criterion was age younger than 65 years. The Anticholinergic Risk Scale (ARS), a list of commonly prescribed drugs with potential anticholinergic effects, was used to calculate the anticholinergic load. RESULTS: A total population of 1490 patients was analyzed; almost half of the sample (48%) was using drugs with anticholinergic properties. The population of patients with ARS 1 or higher had a higher comorbidity index (P < .003) and greater cognitive impairment (CPS 5-6) (P < .007). They were more likely to suffer from heart failure, Parkinson disease, depression, anxiety, and schizophrenia. In multivariate analysis, a higher score in the ARS scale was associated with a greater likelihood of functional decline (described as the loss of 651 ADL point) (odds ratio [OR] 1.13; confidence interval [CI] 1.03-1.23), to a higher rate of falls (OR 1.26; CI 1.13-1.41), and to a higher incidence of delirium (OR 1.16; CI 1.02-1.32) during a 1-year follow-up. CONCLUSIONS: The use of medications with anticholinergic properties is common among older nursing home residents. Our results suggest that among older nursing home residents the use of anticholinergic drugs is associated with important negative outcomes, such as functional decline, falls, and delirium

MODELLI DI SISTEMI SANITARI PARALLELI A CONFRONTO

La Sanità Pubblica e Privata, nell’ambito dei modelli organizzativi nazionali, possono integrarsi, sovrapporsi o differenziarsi, generando estremi dall’efficienza organizzativa alla disorganizzazione. Il presente studio origina dalla crescente preoccupazione, in un periodo di crisi economica e di “spending review”, di fattiva sostenibilità dell’attuale modello universalistico e solidaristico della Sanità Pubblica Italiana e di come esso possa evolvere nel futuro