Aging Population Research Articles

Right-Siting Care and Decongesting Specialist Outpatient Clinics - A Singapore Case Study

Abstract Issue Globally, Specialist Outpatient Clinics (SOCs) face a growing burden due to rising chronic diseases. This strain on resources leads to long appointment wait times (LAWTs), delaying diagnoses and treatments. This is particularly of concern in countries with rapidly ageing populations such as Singapore. Description The Right-Site Care Program is a healthcare transformation initiative implemented by individual healthcare clusters within Singapore to improve access to timely SOC care by directing patients to the most appropriate care level (right-siting). This transitions stable chronic disease patients to primary care providers (PCPs) for ongoing management. A standardised approach utilises evidence-based guidelines for patient selection, followed by identification and transfer of suitable patients to PCPs. This multi-center program offers a real-world example of healthcare system optimisation for chronic disease management. Results A multi-source data analysis, including program reports and peer-reviewed studies from participating healthcare clusters, was conducted to evaluate program impact. The analysis focused on LAWTs, patient outcomes and implementation challenges. Right-siting yielded mixed results across various conditions. Right-sited patients had better survival rates, likely due to closer monitoring and management of chronic conditions with higher total outpatient attendance frequencies. (1) Improvements were particularly significant for diabetes mellitus patients who successfully transitioned to PCPs. (2) However, challenges such as patient scepticism about PCP competence and a preference for specialist care have been identified. (3) Lessons learned Right-siting care can improve patient outcomes for certain chronic diseases. The program’s impact varied across different chronic diseases, highlighting the need for tailored strategies. Educational interventions addressing patient concerns can facilitate smoother patient transitions and program success. Key messages • Right-siting care shows promise, with improved patient outcomes for conditions like diabetes mellitus. • Patient education is crucial to overcome patient scepticism and preference for specialists.

Association between frailty and fear of falling among the elderly in Latvia

Abstract Background Frailty and fear of falling in the ageing population represent notable public health challenges. Fear of falling among the elderly population is a significant concern, as it can lead to decreased mobility, loss of independence, and increased risk of injury. Frailty intensifies this fear, as frail individuals often have reduced strength, balance, and coordination, making them more susceptible to falls. Methods Data from the population-based survey SHARE with respondents aged 50+ in Latvia of Wave 9 (collected 2022) was analysed. Frailty was assessed using the SHARE-Frailty Instrument. Fatigue, appetite, walking difficulties, and physical activity were self-reported and grip strength was measured using a hand grip dynamometer. Fear of falling was evaluated using visual material. Financed by the project RSU internal and RSU with LSPA external consolidation No.5.2.1.1.i.0/2/24/I/CFLA/005, Postdoctoral Grant Associated factors of frailty and fall-related mortality in the older population in Latvia No.RSU-PG-2024/1-0005. Results The sample comprised 1439 older adults from Latvia (60.4 % female) with a mean age of 67.9 (95% CI 67.5 - 68.4). Based on SHARE-FI, frailty and pre-frailty prevalence were 7.2% and 44.5% respectively. In the study, 11.3% of females and 6.5% of males interviewed reported experiencing fear of falling. Frailty was correlated with fear of falling in 43.7% of frail individuals and 11.5% of pre-frail individuals. After adjusting for age and gender, those with pre-frailty and frailty had greater odds of fear of falling. Conclusions Understanding the interaction between the fear of falling and frailty in older adults can guide the development of public health policies and initiatives that aim to mitigate the fear of falling and, consequently, reduce the prevalence of frailty. Promoting healthy ageing behaviours, such as regular exercise, balanced nutrition, and social engagement, can help prevent frailty and its associated risks. Key messages • Fear of falling results in limitation of activities, intensification of physical decline, and increased susceptibility to frailty. • Encouraging healthy ageing underscores the significance of early recognition of frailty symptoms and accessing suitable support.

Prioritizing health, well-being, active ageing needs in Lithuania: insights from stakeholders

Abstract Background The rate of aging in Lithuania is faster than the EU average. The number of long-term health problems in older (65+yrs) people increases, posing changes in societal needs. The aim of our study was to identify the most important needs of older people in Lithuania. Methods Generic qualitative inquiry employed purposeful sampling of stakeholders in Lithuania: policymakers, administration, academia, civil society, health care, social service, public health, organizations of elderly. 43 experts, engaged in online focus groups, generated a list of needs for health, wellbeing, active ageing in elderly; they deliberated to prioritize top 5; scientific team condensed a list of 10 for voting to determine final 5 national needs. Research was done within project “Roadmap to improve the health and well-being of the ageing population in the Baltic Sea Region (AgeFLAG)”, 2020. Results Top needs identified were: shaping healthy lifestyle habits and motivation for change (72%) / age friendly environment and virtual assistive technologies (72%); person centred care (domiciliary care, residential care and nursing, social activities and etc. depending on the needs and wishes of the older person) (58%); increasing and maintaining physical capacity (56%); intersectoral collaboration and integration of social and health services (53%); establishment of positive public attitudes towards elderly people (50%). All stakeholders indicated that “Establishment of positive public attitudes towards elderly people” is the corner stone of all priorities for action to healthy ageing in Lithuania. Conclusions The main issue hindering active and healthy ageing in Lithuania - negative image of ageing in the society. Recommendations on the public health actions included promoting intergenerational conversation, reducing stigmas around ageing, strengthening social inclusion, generating age-friendly environments, and creating a safe space for self-realization and development. Key messages • The main issue hindering active and healthy ageing in Lithuania – negative image of ageing in the society. • The change in the population requires the transformation of health care and social care systems building age friendly environments in Lithuania.

Risk factors for cardiometabolic multimorbidity: an analysis of 4 million participants from May Measurement Month 2017-2019

Abstract Background Cardiometabolic multimorbidity (CMM), defined as the presence of two or more cardiometabolic conditions, presents a significant global challenge due to aging populations and a growing prevalence of cardiometabolic diseases. However, evidence regarding the risk factors for CMM is scarce, particularly in low- and middle-income countries. May Measurement Month (MMM) is the largest annual global campaign collecting data on blood pressure (BP) and cardiometabolic diseases. Purpose To determine the proportion of hypertension in people with CMM and risk factors associated with CMM, from the three MMM campaigns in 2017-2019. Methods A total of 3 397 746 participants (≥18 years) were included, arising from 103 countries. CMM was defined as having two or more of three cardiometabolic diseases: myocardial infarction, stroke, and diabetes. Hypertension was defined as a systolic BP≥140mmHg and/or diastolic BP≥90mmHg, using the average of the second and third of three readings and/or taking antihypertensive medication. A multivariable logistic mixed effects regression model was used to examine associations between CMM and potential risk factors, including age, sex, BMI category, smoking status, and alcohol consumption in the model, with random effects for country. Results Amongst all participants, 316 940 (9.3%), 62 731 (1.8%), and 28 491 (0.8%) had one, two or three cardiometabolic conditions, respectively, and 91 222 (2.7%) had CMM. The proportion with hypertension increased with an increasing number of cardiometabolic conditions: 29.6% in those with none, and 63.0%, 68.6% and 71.2% in those with one, two, or three conditions, respectively. In a fully adjusted model, females had 16% (OR = 1.16, 95% CI: 1.12-1.20, p-value <0.001) higher odds of having CMM than males (Figure). Increasing age was associated with higher odds of having CMM, the highest risk being found in participants ≥70 years. Participants who were underweight, overweight, or obese, were more likely to have CMM than those with a healthy weight. Of the risk factors studied, current smoking was associated with the highest odds for CMM, (OR = 12.8, 95% CI: 12.62-13.04, p-value<0.001) compared with not smoking. Participants consuming alcohol at least once per week had 74% lower odds (OR = 0.26, 95% CI: 0.25-0.27, p-value <0.001) of having CMM compared with those who never or rarely consumed alcohol (Figure 1). Conclusions The risk of CMM increases with female sex, older age, abnormal weight, and smoking. Additionally, CMM is associated with a higher likelihood of having hypertension. Efforts targeting high-risk populations with modifiable CMM related-risk factors are crucial for prevention of CMM.Figure 1.Risk factors for CMM

Landscape Design Strategies for Healthy Aging-in-Place in Communities: Case Studies from Suzhou, China

As the global population ages, the World Health Organization promotes “Healthy Aging” to enhance the quality of life for the elderly. In China, with its substantial aging population, the “9073” elderly care mode, which prioritizes community-based care, was implemented in 2011. However, the specific needs of elderly residents in different climatic and cultural contexts are often overlooked. This study addresses this gap by examining how community green space design can support healthy aging, using Suzhou as a case study due to its significant elderly population. This research examines the relationship between community environments, elderly needs, and behaviors. Our findings reveal that elderly residents have complex needs, seeking safety, comfort, health, social interaction, and spiritual richness simultaneously. A mismatch was observed between their stated preferences for features like seating and shade and their actual usage patterns, suggesting that existing green spaces may not fully meet their needs. This study underscores the importance of incorporating both expressed preferences and proactive design strategies to enhance the healthy benefit of community green spaces. These insights support the “Healthy China 2030” strategy and promote the well-being of elders, contributing to sustainable urban regeneration.

Approaches to Dementia Control in a Community in Japan

Abstract Background In order to consider future dementia countermeasures in the community, we conducted a survey to understand the characteristics of the elderly living in the community. Methods A self-administered questionnaire survey was conducted in collaboration with Hanno-city, Saitama Prefecture, targeting all persons aged 65 years or older (excluding institutionalized residents) living in Hanno-city (aging rate: 32.0%). The questionnaire items included basic attributes, lifestyle, daily living conditions, and willingness to participate in activities. The survey was sent to 7,133 people, and 3,623 valid responses were received (valid response rate: 50.8%). Results Respondents were 1,135 males (51.2%) and 1,080 females (48.8%); 1,979 (54.6%) were aged 65-74 and 1,644 (45.4%) were aged 75 and over. The proportion of single-person households was 12.1%. 56.1% of the respondents had been living in the community for 30 years or more, and the overall membership rate of the residents’ association was high at 91.0%. A total of 691 (19.1%) of the respondents had seen someone suspected of having dementia. 1,178 (32.5%) answered ‘yes,’ 1,452 (40.1%) answered ‘no,’ and 881 (24.3%) answered ‘don’t know. There were 472 (8.1%) dementia supporters. Conclusions The membership rate of local residents’ associations was high at 91.0%, indicating that the community maintains relatively close relationships with its residents. Based on the National Dementia plan, further consideration will be given to long-term goals such as human resource development for each region and policies to support these goals. Main messages: In a mountainous district with an aging population similar to that of Japan as a whole, only about one-third of the respondents knew of a contact point for dementia-related issues. Based on the National Dementia Plan, the government will consider dementia policies, including long-term goals and policies to support these goals in the community. Key messages • In a mountainous district with an aging population similar to that of Japan as a whole, only about one-third of the respondents knew of a contact point for dementia-related issues. • Based on the National Dementia Plan, the government will consider dementia policies, including long-term goals and policies to support these goals in the community.

Epidemiological profile and mortality of infective endocarditis over the past decade: a systematic review and meta-analysis of 133 studies comprising 132,355 cases

Abstract Background Understanding the epidemiology of infective endocarditis (IE) is crucial in the context of an aging population, increased comorbidities, and the heightened occurrence of healthcare-associated cases. Comprehensive data on causative agents, affected valves, and associated mortality are essential for current clinical practice. Methods This systematic review was conducted according to the PRISMA guidelines. A random effects model meta-analysis was conducted. Eligible studies reporting outcomes on IE were identified through a search of the PubMed/Medline database from 2010 to 2021. Results One hundred-thirty-three studies with 132,584 patients from six continents were included in the analysis. The most common causative agents of IE were Staphylococci species in 36% of cases, followed by Streptococci species in 26% of cases and Enterococci species in 10% of cases. Of the studies providing further speciation, the predominant species was Staphylococcus aureus with an incidence of 29%, followed by Viridans Streptococcus with an incidence of 12%. We found an in-hospital/30-day mortality of 17% (CI: 16%-19%) from 109 studies worldwide. In the subgroup analysis, the highest mortality rates were observed in Latin America 33% (CI: 28%-38%) and Africa 25% (CI: 21%-30%), while the lowest mortality rates were reported in Oceania 13% (CI: 8%-19%), followed by North America 14% (CI: 11%-18%), Asia 15% (CI: 12%-18%), and Europe 17% (CI: 16%-19%). The aortic valve was affected in 46% of cases, followed by the mitral valve in 43%. Tricuspid valve IE and multivalvular IE were identified in 7% and 14% of the cases, respectively. Conclusion Our study highlights the shift in epidemiological profile of IE over the last decade with S. aureus identified as the most common causative microorganism of IE in almost one third of cases. IE remains a highly morbid and fatal condition with high mortality rates even in tertiary and high-expertise centers worldwide. While left-sided IE is by far more common, right-sided IE and multivalvular IE are not rare entities and should be considered early in the differential of patients presenting with suspected IE to decrease the risk of future complications.Global burden of infective endocarditis.

Long Covid autonomic syndrome and his impact on workability: results of observational prospective study and 1-year FU in patients admitted to hospital with COVID19

Abstract Long-COVID19 has been recently associated with long-sick leave and unemployment. We will present recent data obtained by a prospective observational study conducted during the 2nd wave of the pandemic in Italy to assess the time course of Long-COVID19 autonomic syndrome in working age population and its impact on patient’s work ability. The patients were consecutively enrolled at the time of their hospital discharge and were followed-up for 1 year. Clinical data and work ability have been collected at 1, 6, and 12 months after hospital discharge in our out-patient clinic. Data on Long-COVID19 autonomic syndrome occurrence in working-age and the effects on work ability will be presented and discussed. Long-COVID19 autonomic syndrome occurred in one in three working-age people and was still evident 6 and 12 months after the acute infection resolution. This was associated with a significant reduction in the work ability. Timely recognition of long-COVID19 autonomic syndrome and its potential impact on work ability represents important steps in the prevention of long-term disabilities among active working adults.

A graded association between mobility limitation and prognosis in patients with heart failure

Abstract Background In the era of an aging population worldwide, geriatric conditions have become a high-priority clinical concern in treating heart failure (HF). Although mobility limitation is one of the most common geriatric conditions, no study has quantified the dose-response relationship between the level of mobility limitation and the risk of adverse clinical outcomes in patients with HF. Purpose This study aimed to characterize the association between the level of mobility limitation and prognosis in patients with HF. Methods This study was conducted as a patient-level pooled analysis of data from two prospective multicenter cohort studies. The analysis included consecutive patients hospitalized for HF without any exclusion criteria, with a total of 2103 participants. We categorized the patients into four groups based on their level of mobility limitation: Category I, independent outdoor walking; Category II, independent indoor walking; Category III, indoor walking with assistance; and Category IV, abasia. The primary endpoint was a 2-year composite outcome of re-hospitalization for HF or all-cause mortality after hospital discharge. Results During the 2820.7 person-year follow-up period, 998 patients experienced the composite outcome. The cumulative incidences of the composite outcome for Categories I to IV were 24.9, 47.0, 59.3, and 84.8 per 100 person-years, respectively (Figure). After adjusting for potential confounders, a 1-point increase in the mobility limitation category was associated with a 19% higher risk of the composite outcome (hazard ratio: 1.19; 95% CIs: 1.10–1.29; p<0.001). Conclusions A strong and graded association exists between the level of mobility limitation and prognosis in patients with HF. Even among patients with mobility limitations, the risk of adverse clinical outcomes varies in a dose-response manner depending on the magnitude of mobility limitation. Our findings contribute to a more individualized approach for managing older patients with HF.Figure

Telemonitoring activities of daily living in home healthcare services to support aging in place

Abstract Context Assessing older adults’ abilities to carry out their activities of daily living (ADLs) is a key determinant in the provision of homecare services for aging in place. Amidst a growing aging population and lack of human resources, continuous remote monitoring technology appears promising to support health and social care professionals (HSCPs) in identifying service needs. However, implementation studies conducted in real-life settings are lacking. This study is part of an on-going action design research project aimed at developing an ambient telemonitoring system monitoring ADLs to support clinical decision making. It focused on the initial step of implementation and aimed to understand 1) which HSCPs would want to use the system, 2) for which care recipient they requested it, and 3) for which reasons. Methods A multiple embedded case study utilizing mixed methods was conducted across 3 healthcare establishments in Quebec, Canada. Descriptive statistics from surveys and medical records was conducted to describe the profile of HSCPs and their care recipients. An inductive qualitative analysis was carried out through interviews with 23 HSCPs, in charge of 31 care recipients, to deepen our understanding of the reasons why they requested the system. Results HSCPs were primarily women (89%) occupational therapists (43%). Home care recipients were also primarily women (74%), with documented refusal of homecare services (65%), diagnosed with cognitive decline (94%), and living in a single-family home or apartment (68%). Overall, interviews revealed HSCPs challenges in getting the necessary information to assess their care recipients needs, despite the presence of in-home services and other strategies in place (e.g. informal carer support). Moreover, the telemonitoring system was perceived as promising for risk management. Conclusions There is an interest for the use of ADL telemonitoring technology in the delivery of home healthcare services for aging in place. Key messages • To facilitate its integration in practice, we explored the need for, and value of, ADLs telemonitoring technology by health and social care professionals (HSCPs) in real-life contexts. • By studying the integration of innovative technologies in home healthcare practices, such as ADLs telemonitoring, we aim to support HSCPs practice in fulfilling older adults desire to age in place.

Impact of retirement on physical activity in older adults: a longitudinal analysis from SHARE

Abstract Background With ageing populations experiencing longer post-retirement years, understanding the influence of major life transitions on health behaviours such as physical activity (PA) is crucial. This study assesses how retirement affects PA levels by analysing longitudinal data from the Survey of Health, Ageing and Retirement in Europe (SHARE). Methods This analysis utilised longitudinal data from 2004 to 2020, categorising PA according to WHO guidelines adapted to individual-level data from successive waves of SHARE. The study examined the relative risks (RR) of being physically active, using generalised estimating equation models to compare periods before and after retirement. Results The cohort consisted of 8,998 individuals aged 50 and older who were employed at baseline and retired during the study period. Initially, 83.6% of participants were categorised as physically active. A noticeable decline in PA was observed post-retirement, with RR decreasing from 1.08 (95%CI 1.07-1.10) more than 10 years before retirement to 0.90 (95%CI 0.88-0.93) more than 10 years after retirement, compared to the year of retirement. Previously inactive individuals often increased their PA levels, peaking 3 to 4 years post-retirement (RR increased from 0.79, 95%CI 0.70-0.88, to 1.49, 95%CI 1.36-1.63), suggesting a temporary boost in moderate-intensity PA during the so-called “honeymoon phase”. Conclusions Retirement can serve as a window of opportunity for enhancing leisure-time PA, particularly among those previously inactive. Sustained increases in PA are less common, highlighting the need for targeted interventions to support continued engagement in PA among retirees. The variations in PA trends suggest that interventions should be tailored to individual characteristics such as age at retirement, previous job type, and educational background to maximise public health impact. This study underscores the challenges of ensuring long-term health benefits through PA. Key messages • Retirement significantly alters physical activity patterns, highlighting an opportunity for targeted health interventions. • Longitudinal data reveals critical periods post-retirement that could benefit from public health strategies to maintain or increase physical activity among older adults.

Epidemiology of Dementia in the Campania Region (Italy): A 2015-2020 population-based study

Abstract As the global population ages, dementia poses a significant health challenge, ranking seventh among leading causes of death worldwide. Considering the high societal and financial burden of dementia, our study aims to provide estimates of prevalence and incidence for any dementia and Alzheimer’s dementia (AD) in the Campania Region (South Italy). It is Population-based study, using routinely collected healthcare data of individuals living in the Campania Region (South Italy) from 2015 to 2020. We included individuals aged ≥65 years who had at least one administrative record for dementia and/or AD. Prevalence rates adjusted for age and sex used 2020 European population as reference. To estimate incidence, we tested three possible algorithms, which differed for the duration of the time interval between study baseline (Jan 1, 2015) and index date (first record for dementia and/or AD in administrative databases). We employed a clinical database for the validation of our algorithms towards neuropsychological test results. Among individuals, 80,392 had dementia, of which 35,748 had AD. The age- and sex-standardized prevalence rates per 1,000 individuals for any dementia and AD were 77.64 (95%CI=77.57; 77.68) and 34.05 (95%CI=34.01; 34.09), respectively. There were 82.10 incident cases of any dementia per 100,000 per year (0.79 sensitivity and 0.62 specificity), and 59.89 incident cases of AD per 100,000 per year (0.80 sensitivity and 0.59 specificity). The capture-recapture method showed low number of undetected cases (1.7% for any dementia and 3.0% for AD). Our algorithms showed acceptable performance with AUC ranging from 0.59 to 0.72, and double likelihood ratio of correctly identifying individuals above and below MMSE standard cut-offs (24 and 26). Our algorithm, integrating administrative and clinical data, holds potential for assessing dementia’s epidemiological burden, identifying risk factors, planning healthcare access, and developing prevention strategies. Key messages • Providing comprehensive estimates of dementia burden aids public health planning and resource allocation. • Integrated administrative and clinical data provide robust tools for epidemiological analysis and preventive strategies.

The spatial dimension of ageing and growth in European regions

AbstractThis study aims to tackle the potential effects of population ageing on regional growth dynamics in the EU. We collected information at a NUTS2 level for EU countries from the years 2000 to 2020 to understand the extent to which the ageing of EU society might impact the EU convergence process. Our results emphasize that the ageing of EU society does not seem to harm the possibility of regional economic growth if we think that immigrants can fill openings in local labour markets (left by retired persons), as well as new jobs stemming from new services needed by retired persons (mostly in health and daily care). Our outcomes also stress the relevance of considering the spatial dimension of the analysis to detect the place-based dimension of this dynamic and, hence, the need for tailored policies.

Refined selection of individuals for preventive cardiovascular disease treatment with a transformer-based risk model

Abstract Background Although statistical models have been commonly used to identify patients at risk of cardiovascular disease (CVD) for preventive therapy, these models tend to over-recommend therapy [1]. Moreover, in populations with pre-existing diseases, the current approach is to indiscriminately treat all individuals, as modelling in this context is currently inadequate. Aims To develop and validate a novel deep learning model, the Transformer-based Risk assessment survival model (TRisk) model, for prediction of 10-year risk of CVD in both the general population and individuals with diabetes. Methods An open cohort of 3 million adults aged 25 to 84 years free of CVD and statin use was identified using linked primary and secondary electronic health records from 291 and 98 general practices in England, which were used for TRisk model development and external validation, respectively. Comparison against two commonly recommended statistical models (QRISK3 [2] and SCORE2 [3]) and a deep learning derivation of QRISK3 was conducted. Additional analyses compared discriminatory performance in other age groups, by sex, and across categories of socioeconomic status. Similar analyses were conducted in a subgroup of 59 thousand patients with diabetes. Results TRisk demonstrated superior discrimination (C index in the general population: 0.910; 95% confidence interval [CI]: 0.906 to 0.913). TRisk’s performance was found to be less sensitive to population age range than the benchmark models and outperformed other models also in all stratified analyses. All models were overall well-calibrated. In decision curve analyses, TRisk demonstrated greater net benefit than benchmark models across the range of relevant thresholds. In impact analyses, at the widely recommended 10% risk threshold and the higher 15% threshold for the general population, TRisk reduced both the total number of patients classified at high risk (by 27% and 39% respectively) and the number of false negatives as compared with currently recommended strategies. TRisk similarly outperformed other models in patients with diabetes. Compared with the widely recommended treat-all policy approach for patients with diabetes, TRisk at a 10% risk threshold would lead to deselection of 24% of individuals with a small fraction of false negatives (0.2% of cohort). Conclusion TRisk enabled a more targeted selection of individuals at risk of CVD compared to benchmark statistical and deep learning models, in both the general population and patients with diabetes. Incorporation of TRisk into routine clinical care would allow a reduction in the number of treatment-eligible patients in general population and subgroup with diabetes by approximately one-third and one-quarter respectively while preventing at least as many events as with currently adopted approaches.Models' discrimination on both cohortsImpact analyses for both cohorts

Promoting active ageing: The positive impact of older people’s participation in Urban Gardens

Abstract Background The socio-health and economic consequences of the progressive population ageing constitute a global challenge for public health, which is committed to the promotion of active and healthy ageing as a strategy to mitigate these consequences. The European project U-GARDEN has evaluated from a comprehensive and innovative approach the impact of urban gardens on the promotion of active ageing through the participation of older people in urban agriculture. Methods A qualitative methodology was designed and implemented in order to analyse the information provided by people over 65 years of age, who actively participated in urban gardens, from a personal and subjective perspective through semi-structured in-depth interviews. The benefits obtained from participation in urban gardens were analysed, considering the different dimensions that make up the paradigm of active ageing: physical, psychological, economic, health, behavioural and personal impact. A total of 20 interviews were used to reach the saturation point. Results Qualitative analysis showed multiple benefits of active and healthy aging. Participants reported increased physical activity and psychosocial improvements such as higher personal satisfaction, reduced stress, and enhanced self-esteem, strengthening community connections and fostering a sense of belonging. Economically, they reported savings on food costs and increased food security. Overall, respondents noted improvements in general health and quality of life, highlighting urban gardening as valuable for well-being and social-economic integration. Conclusions The findings reported in the framework of the U-GARDEN project support the importance of implementing innovative strategies that encourage participation in urban gardens as a tool to improve the overall wellbeing and health of older people, effectively addressing some of the main challenges of ageing such as loneliness unwanted frailty and disability. Key messages • The U-GARDEN project is an example of good practice in the use of urban gardens as a platform for promoting active and healthy ageing. • The promotion of green spaces through the establishment of urban gardens should be considered by health and political authorities for their ability to promote the general well-being of society.

Close clinical monitoring of patients after TAVI implantation using artificial intelligence with a virtual voice assistant

Abstract Introduction The number of procedures and patients candidates for transcatheter aortic valve implantation (TAVI) has increased considerably due to population ageing and the rise in scientific evidence supporting this technique in patients with increasingly lower surgical risk. Early discharge would allow for a more efficient use of available resources, in addition to improving patients’ functionality and quality of life. Objective The use of a virtual voice assistant based on artificial intelligence, could be an effective and safe alternative to closely monitor patients after TAVI implantation in order to facilitate early identification of complications and a more efficient use of the resources available in Cardiology services. Material and methods Observational, prospective, single-center and consecutive study of the implementation of a technology based on artificial intelligence and natural language processing to monitor all patients undergoing transfemoral TAVI implantation, according to usual clinical practice, in the hemodynamics unit of our hospital in the year 2023. The virtual voice assistant, "Lola", carries out a telephonic follow-up during week 1, week 2, month 1, month 3 and 12. In these calls, it asks a series of questions mainly related to vascular access and with the patient's cardiovascular situation. After finishing the call, all the information collected is uploaded to a web platform where we monitor the collected data and thus take the appropriate measures. Results After 12 months, 274 patients have been included to whom 1,039 calls have been made with a total of 385 hours of autonomous conversation. In 44% of the calls, no alerts were detected and, therefore, did not required further review. From the remaining calls, a total of 926 alerts were collected, the predominant ones being: dizziness (24.9%), contact with the emergency services (11.3%) and alteration of general status (10.4%). The number of alerts decreases as the follow-up progresses, reflecting the need for closer monitoring in the initial stages after implantation. These alerts generated at least one intervention in 57% of the calls, the predominant ones being: medical contact (43.0%), nursing contact (26.3%) and medication adjustment (4.0%). These calls resulted in a total of 15 in-person examinations (5.4% of patients), detecting in 2 of them a 3rd degree atrioventricular block, in 3 a femoral pseudoaneurysm and in 1 a critical stenosis of the common femoral artery. According to a patient survey, 88.9% of patients were satisfied or very satisfied (Customer Satisfaction score 4.68/5). Conclusions The application of artificial intelligence permits strict control of the patient after TAVI implantation, thus facilitating early detection of complications. Patient satisfaction regarding this follow-up system was very high.

Social prescribing for healthy ageing: insights from older people referral and uptake in Portugal

Abstract The population ageing presents multifaceted challenges for health systems, with implications for healthcare delivery and health and well-being outcomes. Innovative integrated-care approaches are needed to promote healthy aging and the quality of life of older people. Social Prescribing (SP) has emerged as a promising strategy to address the complex health and social needs of populations, including those older, offering non-medical interventions that encompass social, cultural, and community-based activities. SP has been implemented in Portugal since 2018 and currently target different subgroups, including elderly. This study aims to examine referral and uptake of older people to SP in Portugal. This cross-sectional study analysed sociodemographic, health condition, referral and uptake-related data from older patients (≥65 years) engaged in SP, collected through a survey and registries at primary healthcare units in Lisbon between 2018-2023. Of the 1060 patients referred to SP, 43.9% (n = 465) were aged 65 years or older. Within this age group, 38.1% were 71-80 years old and 36.1% were 81-90 years old; 67.5% were female. Around 48% were referred to SP for social isolation, 40% for social and financial support, and 32.5% for functional dependency. Two thirds had two or more chronic conditions, with cardiovascular disease (59,1%), mental health disorders (29,2%), and obesity (27,1%) being the most frequent. The SP consultations uptake rate was 59.1%, and patients were referred to a range of activities provided by third-sector organisations, as psychosocial support, home care, senior university classes, arts activities, and support in medicine management. The elderly population accounts for a large proportion of SP referrals. Further efforts are needed to identify the factors that influence patients’ acceptability and adherence and to promote the sustainability of SP and the well-being of the population. Key messages • Older people referred to SP initiative in Portugal have complex health-social needs, which reinforces the relevance of adopting a holistic centred-care approach to respond to the aging challenges. • Through SP older people have been integrated in community-based activities that promote their health and wellbeing, thus it is needed to develop tailored strategies to improve patient uptake.

The 5-Item Modified Frailty Index (mFI-5) for risk stratification of patients with infective endocarditis undergoing cardiac surgery

Abstract Background population aging has led to an increased burden of frailty as an emerging global health issue, and variables for its quantification in patients with infective endocarditis (IE) are lacking in current surgical risks scores. The 5-item modified frailty index (mFI-5) score has shown to be effective in the prediction of surgical outcomes in other medical scenarios. Purpose this study aimed to assess the role of the mFI-5 in the prediction of surgical outcomes in patients with left-sided IE undergoing cardiac surgery. Methods a total of 112 cases of confirmed left-sided IE undergoing surgery, were consecutively collected and followed during one year after diagnosis in two tertiary hospitals between 2016 and 2021. The mFI-5 score included 5 baseline patient-specific comorbidities: diabetes, congestive heart failure, non-independent functional status (Barthel index <80), hypertension and chronic obstructive pulmonary disease (range 0-5), and patients were categorised as mFI-low (<2, n=65), and mFI-high (>=2, n=47). Results mean age was 66 [SD 15] years, 67% were men and community-acquired infections were 75%. As shown in Table 1, mFI-high patients were older and, aside from the specific comorbidities included in the score, with more chronic kidney disease. The most isolated pathogen was S. viridans (n=32), predominantly in mFI-low, in contrast to enterococcal and polymicrobial IEs, which were more frequent in mFI-high. Larger vegetations were reported in mFI-high [16 (10) vs 13 (9) mm, p 0.03], with no differences regarding infection site or periannular complications. Acute kidney injury, decompensated heart failure and higher natriuretic peptides were more common in mFI-high. Regarding mortality, in-hospital deaths were more frequent in mFI-high group. When analyzing mFI-score as a discrete variable, in-hospital mortality was associated with higher median scores values [2 (2) vs 1(1) points, p 0.02], being 2 points the optimal cutoff point for prediction [AUC 0.64 (95% CI 0.54-0.73), Fig.1A]. Among survivors who completed follow-up (n=82), rehospitalization and all-cause mortality rates in mFI-high exceeded those from mFI-low. Predictors of in-hospital and 1-year mortality were assessed by logistic regression (Fig. 1B), confirming the independent prognostic association of mFI-5-score in patients with IE undergoing surgery. Conclusions patients with IE undergoing cardiac surgery with higher mFI-5 scores were older, more predisposed to enterococcal and polymicrobial infections, and had a greater comorbidity burden with a more complicated clinical course. The mFI-score was independently associated with in-hospital mortality as well as rehospitalizations and 1-year mortality, positioning itself as an additional tool for risk stratification in this cluster of patients.Table 1Figure 1

Prevalence and prognostic value of thrombocytopenia in aortic valve replacement surgery: bioprosthesis versus mechanical prosthesis

Abstract Background Thrombocytopenia is a frequent complication of valve surgery, and is associated with different postoperative outcomes. Concern has recently arisen about thrombocytopenia following aortic valve replacement (AVR), as some authors have reported increased postoperative thrombocytopenia with certain biological aortic valves. In adittion, it is unclear whether thrombocytopenia predicts mortality in this type of surgery. Purpose The aim of this study was to determine the prevalence and prognostic value of thrombocytopenia in biological and mechanical aortic valve replacement. Methods The study was an observational analysis of patients undergoing AVR with or without associated coronary artery bypass grafting (CABG) at a single center between October 2014 and October 2023. Cardiac Surgery database was computerized and prospectively completed. Preoperative and first 4 days postoperative platelet counts were analyzed. Thrombocytopenia was defined as platelet count < 100 × 10³/mm³. To obtain comparable populations, a propensity score matching analysis was performed. Results A total of 1,197 patients underwent AVR with (n = 494) or without CABG (n = 703). Patients received either a mechanical prosthesis (n = 320), or a biological prosthesis (n = 877). The mean population age was 68 years (SD 6), with the majority being male (68%). Univariate analysis of the baseline characteristics of both groups of patients showed that they were not comparable. A risk-adjusted subanalysis was performed according to a propensity score (n=278). The nadir of bioprostheses was on the third postoperative day with an average of 93.8 × 10³/mm³, while in mechanical prostheses was also on the same day but with an average of 114.7 × 10³/mm³ (p: 0.001). (Figure 1) Bioprosthesis implantation was significantly associated with a higher prevalence of thrombocytopenia (72.7% vs. 45.3%, p<0.001). The presence of postoperative thrombocytopenia has been associated with higher in-hospital mortality (6.7% vs. 0.9%, p=0.019); but not with other postoperative complications. (Figure 2) Conclusions Patients undergoing AVR with bioprostheses had a significantly higher prevalence of thrombocytopenia, and also lower platelet counts than mechanical prothesis within the first 4 postoperative days. Thrombocytopenia was associated with higher in-hospital mortality in a risk score-adjusted population.Platelet counts after AVROutcomes according to platelet count

Multimorbidity patterns in adults admitted to hospital with heart failure: an analysis of 175 million hospitalisation episodes

Abstract Background The prevalence of heart failure (HF) is increasing as a result of population ageing, improved survival following myocardial infarction and the widespread uptake of evidence-based HF treatments. Greater understanding of multimorbidity patterns in patients with HF may enable the development of treatment strategies that target multiple, related long-term conditions (LTCs), producing synergistic benefits. Purpose To characterise multimorbidity patterns in patients with HF and compare these to a matched population without HF. Methods A retrospective matched cohort study was conducted using the United States National Readmission Database (NRD), 2010–2020. International Classification of Disease (ICD) codes were used to identify HF and 92 other common LTCs. The most frequent combinations of LTCs were identified for individuals with HF and a control cohort of individuals of the same age and sex, with a non-HF-related hospital admission in the same year (matched in a 1:5 ratio). Multivariable regression analysis (adjusted for age, sex, socioeconomic status, tobacco use, year of hospitalisation, and hospital characteristics) was used to evaluate the association between multimorbidity burden, length of stay (LOS; negative binomial regression) and 30-day readmission (logistic regression). Results From a total of 175,388,410 hospitalisation episodes, 3,913,924 individuals with an HF-related hospitalisation were identified and matched to 19,552,954 controls (Figure 1a). The median (interquartile range, IQR) age of a patient admitted with HF was 74 (63–85) years; 1,856,268 (47.5%) were female. The most common comorbidities in those with HF were hypertension (87.2 vs. 72.8% in matched controls), chronic kidney disease (CKD; 55.3 vs. 34.6%), coronary artery disease (CAD; 53.7 vs. 31.0%), dyslipidaemia (46.9 vs. 39.7%), diabetes (46.6 vs. 33.9%), atrial fibrillation (AF; 43.0 vs. 23.0%) and anaemia (33.2 vs. 30.1%; p all < 0.001). Patients with HF had a greater number of LTCs compared with matched controls (median [IQR] 7 [5–9] vs. 6 [4–8]; p < 0.001). From 2010–2020, the number of LTCs in those with an HF admission increased (from 6 [4–8] in 2020, to 8 [6–10] in 2020; Figure 1b). The most common multimorbidity patterns in those with HF are presented in Figure 2. In the HF cohort, a greater multimorbidity burden was associated with a longer LOS (+6% for each additional LTC; 95% confidence interval [CI] 5–7%; p<0.001) and greater risk of 30-day readmission (adjusted odds ratio [aOR] for 6 vs. 0 LTCs: 1.15, 95% CI 1.08–1.22; aOR for ≥12 vs. 0 LTCs: 1.54, 95% CI 1.45–1.64). Conclusions Patients admitted to hospital with HF have a significant burden of multimorbidity, which has increased over time and is associated with increased length of stay and unplanned hospital re-admission. The high prevalence of multiple LTCs warrants the development of novel treatment strategies that target common multimorbidity patterns observed in HF.