WHAT IS “LONG LIVE THE ELDERLY!”?



Long Live the Elderly! started in Rome in 2004, as an experimental programme of the Community of Sant’Egidio and the Ministry of Health, in response to the huge rise inmortality in Summer 2003, when thousands of elderly people died in Europe due to exceptionally high temperatures.


The high mortality observed in 2003 was not due only to the frailty of the elderly population in the world, and particularly in Europe, but also to their social isolation.


The Programme is an innovative service to fight social isolation through the creation of networks that support a more traditional response (such as home care, institutionalisation, etc) reaching large sectors of the risk-exposed population.

Prevention is the priority: to combat the negative effects of critical events (heat waves, flu epidemics, falls, loss of one's partner, etc) on the health of over 80-year-olds.

The strategy of the Programme is active monitoring.

BENEFICIARIES
  • Direct beneficiaries: ALL over 80 year-old residents in the territory identified for the realisation of the programme.

  • Indirect beneficiaries: informal network actors (neighbours, porters, shopkeepers, medical doctors, etc).

METHOD OF ENROLMENT
  • Computer registration of the data of elderly people, according to the rules governing personal information.

  • The elderly are contacted regularly and entered in the telephone control programme, they receive visits at home or make use of direct interventions, upon their request.
BENEFICIARIES

The system of active monitoring enables to reach excellent results in terms of social and sanitary prevention and cost reduction.

The Programme:
  • Is a new European model of intervention that guarantees a greater coverage of needs at a sustainable cost, according to the Horizon 2020 guidelines.

  • Is a workshop of social and sanitary integration.

The Programme:

  • Employs a universalistic approach, targeting the entire over 80 year-old cohort in the reference territory.

  • Acts in terms of prevention and not emergency.

  • Creates synergies between public and private partners, according to the best models of horizontal subsidiarity.

  • Activates and strengthens support networks, acting on the surrounding environment and enhancing the quality of everyone’s life.

  • Favours a home-based approach to interventions, with home care visits to fragile elderly, which produce no extra cost for the general public.

  • Improves access to services.

  • Produces a fall in social and sanitary costs by developing resources (reduction of improper hospitalization and hospice admission).

  • Records a high appreciation among the elderly population (>al 98%);

  • Involves many of the elderly people followed by the programme as volunteers, making them protagonists of active aging.

OPERATORS

District social workers and volunteers (young and seniors):



  • Run the telephone centre

  • Guarantee proximity services

  • Organize and animate events

  • Visit the elderly at home

  • Help carry out bureaucratic procedures

Coordinators (generally social workers):
  • Programme and verify intervention plans

  • Insure constant relations with the local social and sanitary services

  • Prepare reports on the services offered

  • Promote dissemination actions

ACTIVITIES
  • Active monitoring

  • Telephone contacts

  • Home care visits

  • Direct personalised interventions

  • Activation and/or strengthening of formal and informal proximity networks

  • Managing heat emergencies

  • Managing cold emergencies

  • Promoting local events and animation
The Programme has been implemented with the contribution of:
  • ASL RMA

  • Associazione “Trenta ore per la vita”

  • AXA MPS

  • Cartasì S.P.A.

  • Fondazione BNC

  • Fondazione Cariplo

  • Fondazione Vodafone Italia

  • IBL Banca S.P.A.

  • Mediolanum Farmaceutici S.P.A.

  • Ministero dell’Interno

  • Ministero della Salute

  • Municipio Roma I Centro Storico

  • Progetto Europeo CROSS

  • (Citizen Reinforcing Open Smart Synergies)

  • Provincia di Roma

  • Regione Lazio

  • Roma Capitale

  • Rotary Club - Roma

Wednesday 26 October 2016

Identifying Specific Combinations of Multimorbidity that Contribute to Health Care Resource Utilization: An Analytic Approach


Abstract

BACKGROUND:
Multimorbidity affects the majority of elderly adults and is associated with higher health costs and utilization, but how specific patterns of morbidity influence resource use is less understood.
OBJECTIVE:
The objective was to identify specific combinations of chronic conditions, functional limitations, and geriatric syndromes associated with direct medical costs and inpatient utilization.
DESIGN:
Retrospective cohort study using the Health and Retirement Study (2008-2010) linked to Medicare claims. Analysis used machine-learning techniques: classification and regression trees and random forest.
SUBJECTS:
A population-based sample of 5771 Medicare-enrolled adults aged 65 and older in the United States.
MEASURES:
Main covariates: self-reported chronic conditions (measured as none, mild, or severe), geriatric syndromes, and functional limitations. Secondary covariates: demographic, social, economic, behavioral, and health status measures.
OUTCOMES:
Medicare expenditures in the top quartile and inpatient utilization.
RESULTS:
Median annual expenditures were $4354, and 41% were hospitalized within 2 years. The tree model shows some notable combinations: 64% of those with self-rated poor health plus activities of daily living and instrumental activities of daily living disabilities had expenditures in the top quartile. Inpatient utilization was highest (70%) in those aged 77-83 with mild to severe heart disease plus mild to severe diabetes. Functional limitations were more important than many chronic diseases in explaining resource use.
CONCLUSIONS:

The multimorbid population is heterogeneous and there is considerable variation in how specific combinations of morbidity influence resource use. Modeling the conjoint effects of chronic conditions, functional limitations, and geriatric syndromes can advance understanding of groups at greatest risk and inform targeted tailored interventions aimed at cost containment.