Perspectives on the role and synergies of architecture, social and built environment in enabling active healthy ageing.

Research has demonstrated active and healthy aging can be enhanced by enabling societal infrastructure, urban planning, architecture of healthcare facilities and personal accommodations throughout the life span. Yet, there is a paucity of research on how to bring together the various disciplines involved in a multi-domain synergistic collaboration to create new living environments for aging throughout the life span. This paper aims to explore the key domains of skills and knowledge that need to be considered in order to generate a conceptual prototype of an enabling educational process and environment where healthcare professionals, architects, planners and entrepreneurs may establish a shared theoretical and experiential knowledge base, vocabulary and implementation strategies, for the creation of next generation of living communities of active healthy adults, as well as for persons with disabilities and chronic disease conditions. We focus on synergistic, paradigmatic, simple, and practical issues that can be easily up-scaled through market mechanisms. This practical and physically concrete approach may also become linked with more elaborate and neuroscientific and technologically sophisticated interventions, to generate significant health benefits with relatively low costs. In summary, we examine the domains of knowledge that need to be included in establishing a learning model that focuses on the still very understudied impact of the benefits toward active and healthy aging, where architects, urban planners, clinicians, healthcare facility managers are educated toward a synergistic approach at the operational level

Co-creating integrated health-hospitality hybrids for across the lifespan

Salutogenesis ensures that physical environments promote wellbeing across people’s lifespan. Although this has influenced medical architecture, it has not yet penetrated into the domain of urban development. Despite the gradual decrease of medicalization of healthcare facilities, a conceptual gap remains between hospitality and healthcare facilities. This paper explores the possibilities of synergistic domains between healthcare and hospitality facilities. Using the architectural typology interpretation of a dementia village as a case study this paper explores how to create hybrids between healthcare and hospitality facilities that contribute to the silver economy while providing the ageing population with better built environments

Architectural hybrids for living across the lifespan: lessons from dementia

The built environment is essential for well-being at old age. The theory of salutogenesis, focusing on health, rather than the disease itself, provides evidence that space contributes to health and well-being. This has influenced healthcare architecture through facilities designed to support well-being. So, increasingly healthcare facilities aim to look like hotels to improve user experience. This retains conceptual and usage gaps between hospitality and healthcare but supports cross-fertilization of best practice. This paper explores possibilities of synergies between healthcare facilities and hospitality industry. Appropriate services and well-being across the lifespan is the ultimate objective, and the physical environment is critical in that provision. Examining the architectural typology of the dementia village as case study, it explores healthcare–hospitality hybrids. Learning from both domains can contribute to silver economy while providing the aging population with enhanced environment. Aging population and stakeholders in this ecosystem can benefit from these synergies

The role of health determinants in the influenza vaccination uptake among older adults (65+): a scope review

Background: Although the burden of influenza infection is the highest in older adults, vaccination coverage remains low, despite this age group being more vulnerable than others. Aims: Given the current pandemic of SARS-CoV-2, it was the aim of this scope review to update knowledge on factors affecting seasonal influenza vaccine uptake among older adults to strengthen prevention approaches in the context of an overall burden of infectious diseases. Methods: We searched bibliographic databases from 2012 to 2019. All studies reviewed one or more social determinant of health listed by WHO, or factors affecting the decision-making process whether to accept influenza vaccine or not. Results: Overall, 44 studies were included, 41 determinants were extracted and summarized into six categories. Older age and constitutional factors including multiple chronic diseases as well as preventive lifestyle and frequent routine healthcare utilization positively affected vaccination uptake (VU). Living and working conditions are also researched determinants of influenza vaccine uptake. A small number of studies explored the role of social inclusion and system-based interventions. Discussion and conclusions: This scope review provides a comprehensive overview on factors affecting seasonal influenza vaccination uptake among older citizens. The review also clearly shows gaps for evidence on system-based level or political strategies to improve vaccination uptake

From the bench to practice - Field integration of community-based services for older citizens with different levels of functional limitation across European Regions

The meeting of the European Innovation Partnership on Active and Healthy Ageing (EIPonAHA) action group A3 together with members of the Reference site collaborative network (RSCN) in December 2019 in Rome focused on integration of evidence-based approaches on health and care delivery for older citizens at different levels of needs with expertise coming from stakeholder across Europe. It was the final aim of the group to co-create culturally sensitive pathways and facilitate co-ownership for further implementation of the pathways in different care systems across Europe. The study design is a mixed method approach. Based on data analysis from a cohort of community-dwelling over-65 citizens in the framework of a longitudinal observational study in Rome, which included health, social and functional capacity data, three personas profiles were developed: the pre-frail, the frail and the very frail personas. Based on these data, experts were asked to co-create care pathways due to evidence and eminence during a workshop and included into a final report. All working groups agreed on a common understanding that integration of care means person-centered integration of health and social care, longitudinally provided across primary and secondary health care including citizens' individual social, economic and human resources. Elements for consideration during care for pre-frail people are loneliness and social isolation, which, lead to limitation of physical autonomy in the light of reduced access to social support. Frail people need adaption of environmental structures and, again, social resource allocation to maintain at home. Very frail are generally vulnerable patients with complex needs. Most of them remain at home because of a strong individual social support and integrated health care delivery. The approach described in this publication may represent a first approach to scaling-up care delivery in a person-centered approach

Rethinking palliative care in a public health context: addressing the needs of persons with non-communicable chronic diseases

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

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 VIGOUR

Diffusion and dissemination of evidence-based dietary srategies for the prevention of cancer

OBJECTIVE: The purpose was to determine what strategies have been evaluated to disseminate cancer control interventions that promote the uptake of adult healthy diet? METHODS: A systematic review was conducted. Studies were identified by searching MEDLINE, PREMEDLINE, Cancer LIT, EMBASE/Excerpta Medica, PsycINFO, CINAHL, the Cochrane Database of Systematic Reviews, and reference lists and by contacting technical experts. English-language primary studies were selected if they evaluated the dissemination of healthy diet interventions in individuals, healthcare providers, or institutions. Studies of children or adolescents only were excluded. RESULTS: One hundred one articles were retrieved for full text screening. Nine reports of seven distinct studies were included; four were randomized trials, one was a cohort design and three were descriptive studies. Six studies were rated as methodologically weak, and one was rated as moderate. Studies were not meta-analyzed because of heterogeneity, low methodological quality, and incomplete data reporting. No beneficial dissemination strategies were found except one that looks promising, the use of peer educators in the worksite, which led to a short-term increase in fruit and vegetable intake. CONCLUSIONS AND IMPLICATIONS: Overall, the quality of the evidence is not strong and is primarily descriptive rather than evaluative. No clear conclusions can be drawn from these data. Controlled studies are needed to evaluate dissemination strategies, and to compare dissemination and diffusion strategies with different messages and different target audiences