The sustainability of a community nurses programme aimed at supporting active ageing in mountain areas.

BACKGROUND: Community Nurse Supporting Elderly iN a changing SOciety is a project funded by the European Union, which is aimed at developing an innovative care model based on community nurses to support active ageing in mountain areas. The planned sustainability of this innovative approach relies on social entrepreneurship, and this work highlights the necessary conditions for the existence of these entrepreneurial initiatives on the market, with community nurses' services purchased by the public health care system. METHODS: The authors propose a sustainability framework for this project based on three relevant dimensions (ie, health, organisation, and context), highlighting the necessary conditions for continued provision of health services beyond project conclusion. Then, considering the Piedmont Region and those aged 65 or older as target population, health outcomes are analysed, proposing a break-even analysis to calculate expected levels. RESULTS: According to our results, in order to care for 191 977 elderly people for 3 years, a successful pro-active approach is needed to prevent 1657 falls with hip fracture, reducing the prevalence of this adverse outcome by 36%. These are the expected health outcome levels for the existence of a social market, which can be achieved through the successful involvement of local public health organisations and stakeholders. CONCLUSIONS: Policy makers need clear information on the economic impact of extending this new intervention to the whole target population and on the required preconditions for its financial sustainability in terms of health outcomes. However, a participatory process involving all relevant local stakeholders and organisations is crucial to extend current achievements beyond project conclusion.

Digital Health Service for Identification of Frailty Risk Factors in Community-Dwelling Older Adults: The SUNFRAIL+ Study Protocol.

This article reports the study protocol of a nationwide multicentric study in seven Italian regions aimed at assessing the effectiveness of a digitally supported approach for the early screening of frailty risk factors in community-dwelling older adults. SUNFRAIL+ is a prospective observational cohort study aimed at carrying out a multidimensional assessment of community-dwelling older adults through an IT platform, which allows to connect the items of the SUNFRAIL frailty assessment tool with a cascading multidimensional in-depth assessment of the bio-psycho-social domains of frailty. Seven centers in seven Italian regions will administer the SUNFRAIL questionnaire to 100 older adults. According to the answers provided by older adults, they will be subjected to one or more validated in-depth scale tests in order to perform further diagnostic or dimensional evaluations. The study aims to contribute to the implementation and validation of a multiprofessional and multistakeholder service model for the screening of frailty in community-dwelling older adult population.

[What family nursing really means?] / Cosa significa infermiere di famiglia e di comunità?

. What family nursing really means? The Family and Community Nurse (IFeC) was introduced in 1998 by the World Health Organization, with the aim of extending the care of nurses to the family, which represent the center of people's lives and care, and to shift the focus of care and interventions (particularly those of prevention) from the individual, to the family, and also to the community to which they belong. Investment in prevention requires strategies and foresight on the part of decision-makers, and does not guarantee immediate returns. IFeCs, if empowered to care for the community, can make a major contribution to population health.

Preventing frailty in older people: An exploration of primary care professionals' experiences.

BACKGROUND: An increasing number of the ageing population worldwide is at risk of becoming frail and incapacitated. This has the potential to impact not only on the well-being of individuals but also on the sustainability of healthcare systems. OBJECTIVE: The aim of this study was to explore the views and experiences of frailty from the perspective of primary care professionals, including nurses, who work directly with older people within the community. METHODS: A qualitative approach with a descriptive phenomenological methodology was used, which focused on exploration of primary care professionals' current experiences of early detection and prevention of the onset of frailty. Four multi-professional focus groups were held with a total of thirty-three primary care professionals who worked with older people as part of their daily role. Participants included district nurses, general practitioners, home care workers, physiotherapists and social workers. RESULTS: Professional views encompassed typical patterns of ageing, loneliness, presence of comorbidity, disability and end of life, with social conditions prevalent in most frailty they encountered. Three main themes emerged: the psychosocial nature of frailty, late detection of frailty and barriers to the feasibility of prevention. Physical frailty was considered a constituent part of ageing, which recognised the presence of a skills gap related to the detection of the early signs of frailty. Present health and social care systems are not designed to prevent frailty, and the competencies required by health and social care professionals are not usually included as part of their training curricula. This may hinder opportunities to intervene to prevent associated decline in ability of older adults. CONCLUSIONS: To enhance the early assessment of frailty and the planning of preventive multi-factorial interventions in primary care and community settings, training and effective detection strategies should be incorporated into the role and daily care activities of primary care professionals. IMPLICATIONS FOR PRACTICE: Using a multidimensional assessment instrument can help primary care professionals to identify older people who are frail or may become frail. In order to be able to carry out this properly strong inter-professional collaboration is needed. In addition, interventions aimed at preventing frailty or adverse outcomes of frailty should be tailor-made and thus should meet the needs and wishes of an older person.

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.