Can Integrated Care Help in Meeting the Challenges Posed on Our Health Care Systems by COVID-19? Some Preliminary Lessons Learned from the European VIGOUR Project

The COVID-19 pandemic puts health and care systems under pressure globally. This current paper highlights challenges arising in the care for older and vulnerable populations in this context and reflects upon possible perspectives for different systems making use of nested integrated care approaches adapted during the work of the EU-funded project VIGOU

Nutritional and physical improvements in older adults through the DOREMI remote coaching approach: a real-world study

Background: Malnutrition (excess or defect) and sedentariness act as an accelerator in the older people frailty process. A systemic solution has been developed to engage older people in a healthier lifestyle using serious games and food monitoring. The study aimed to evaluate protocol influence on variables related to unhealthy behaviors improving dietary habits through a remote nutritional coaching approach and stimulating the population to increase physical activity through Exergames. Methods: Thirty-two subjects (25 Treatments and 7 Controls, aging 65–80 years), of which 15 (11 Treatments and 4 Controls) living in the UK (ACCORD and ExtraCare Villages placed in Shenley Wood (Milton Keynes), St. Crispin (Northampton), and Showell Court (Wolverhampton)) and 17 (14 Treatments and 3 Controls) in Italy (Genoa, Liguria), were recruited and characterized in terms of nutritional status, physical, somatometric, hemodynamic and biochemical measurements, and body composition. Participants were stimulated to adopt the Mediterranean dietary pattern, by a food diary diet-app, and perform regular physical activity, by the Exergame app, for three months. At the end of the trial, users underwent the same test battery. Data were tested for normality of distribution by the Shapiro-Wilk test. Comparisons between groups were performed at baseline by unpaired Student's t-test for continuous variables, chi-square test, or Fisher's exact test for categorical variables. Analysis of Variance (ANOVA) for repeated measures was used to analyze the significance of changes over time between groups. Results: At the end of the trial, significant reductions of systolic (15 mmHg, P = 0.001), diastolic (5 mmHg, P = 0.025), mean (10 mmHg, P = 0.001) blood pressure, and rate-pressure product (RPP) (1,105 mmHg*bpm, P = 0.017) values were observed in DOREMI users. A trend of improvement of physical performance by the short physical performance battery (SPPB) was observed for balance and walk subtests. A significant decrease (0.91 kg, P = 0.043) in Body Mass Index (BMI) was observed in overweight subjects (BMI >25 kg/m2) after DOREMI intervention in the entire population. The Mini Nutritional Assessment (MNA) score (1, P = 0.004) significantly increased after intervention, while waist measure (3 cm, P <0.001) significantly decreased in the DOREMI users. A reduction in glycated hemoglobin (Hb) was registered (0.20%, P = 0.018) in the DOREMI UK users. Conclusions: Improvement of healthy behavior by technological tools, providing feedback between user and remote coach and increasing user's motivation, appears potentially effective. This information and communication technologies (ICT) approach offers an innovative solution to stimulate healthy eating and lifestyle behaviors, supporting clinicians in patient management

Tackling frailty and functional decline: Background of the action group A3 of the European innovation partnership for active and healthy ageing

Ageing populations represent a challenge to the sustainability of current healthcare systems. The need to balance these demographic changes with gains in healthy life years and quality of life (QoL) constitutes an additional challenge. Aware of this, the European Commission (EC) launched the European Innovation Partnership on Active and Healthy Ageing (EIPonAHA) in 2012. The EIPonAHA is an interdisciplinary and cross-sector initiative involving more than 3000 partners with two specific objectives: to increase the healthy life expectancy of Europeans by two years by 2020, while increasing their QoL. The initiatives of the EIPonAHA have been organized according to six thematic action groups (AGs), with the A3 group targeting areas relating to the prevention of functional decline and frailty. In addition to the good practices of partners, there are several on-going collaborative works. The involvement of the EC includes support through an elaborated research programme in which the Consumers, Health, Agriculture and Food Executive Agency (CHAFEA) and the Directorate-General for Communications Networks, Content and Technology (DG CONNECT) are the main funding bodies. Screening approaches and preventive interventions constitute most of the initiatives within the A3 AG. Partners are distributed across five sub-groups according to good practices: i) cognitive decline, ii) food and nutrition, iii) physical activity, iv) caregivers, and v) frailty and functional decline. Regular updates of the progression of both good practices and collaborative works are presented in A3 AG meetings. The 2017 meeting in Valencia, Spain, showcased in this paper, provides an up-to-date overview of the current status of A3 activities.Frailty management Optimisation through EIPAHA Commitments and Utilisation of Stakeholders input (FOCUS) project; Consumers, Health, Agriculture and Food Executive Agency (CHAFEA) [664367