Aging Population Research Articles

Focal granule cell bilamination of the dentate gyrus-its prevalence across the human age spectrum and review of the literature.

The prevalence of focal granule cell bilamination (FGCB) in the hippocampal dentate gyrus varies from 0% to 44%, depending on age and study population. FGCB is commonly thought to be a specific feature of temporal lobe epilepsy (TLE) but its prevalence in cases without TLE is unclear. Using formalin-fixed, paraffin-embedded hippocampal sections, this retrospective postmortem study evaluated the prevalence of FGCB and other granule cell pathologies in infants (1-12 months of age, n = 16), children (4-10 years, n = 6), and adults (28-91 years, n = 15) with no known history of epilepsy or seizures. We found FGCB in 6% of infants, 17% of children, and 27% of adults. We then compared our findings with those in published reports of sudden unexpected deaths in infancy (SUDI), childhood (SUDC), and epilepsy (SUDEP), and in surgical specimens from patients with TLE. The reported prevalence of FGCB in those studies was 6%-19% in infants, 0%-17% in children, and 0%-2% in adults in non-seizure-related cases and 9% in children and 3%-25% in adults with TLE. Our findings highlight the presence of FGCB in individuals with no known epilepsy/seizure-related histories in proportions similar to those reported in individuals with clinical epilepsy.

Sex differences in secondary prevention and outcomes post-myocardial infarction in Scotland

Abstract Background Sex differences in outcomes after myocardial infarction (MI) are of increasing interest. Differential receipt of evidence-based treatments may contribute to such disparities. Purpose In this study, we investigate sex differences in the burden of risk factors, in-hospital and long-term treatment and outcomes in contemporary practice in Scotland, by analysing a nationwide sample of consecutive MI admissions. Methods All MI admissions centrally recorded between 2010-2016 by Public Health Scotland were included and followed up until the end of 2021. Poisson regressions analysed in-hospital outcomes (percutaneous coronary intervention (PCI), mortality and post-discharge secondary prevention medication). Models were adjusted for age, co-morbidities and ST-elevation on the electrocardiogram. Royston-Parmar models analysed long-term outcomes (all-cause and cardiovascular mortality, major adverse cardiovascular events (MACE)) and were sequentially adjusted for confounders (age, comorbidities, secondary prevention medications). A 2:1 age and sex-matched general population were included as controls. Results Of a total 47,063 MI patients, 15,776 (33.5%) were women. They were matched with 81,641 controls free of major cardiovascular disease. Median (interquartile range) age was 64 (56-72) years for men and 69 (60-75) years for women. Obesity, hypertension and renal disease were the risk factors more prevalent amongst women, while men had higher rates of previous MI, peripheral vascular disease and atrial fibrillation. Compared to men, women were less likely to undergo PCI (risk ratio (95% confidence interval) – 0.87 (0.86-0.89)) or receive secondary prevention (0.94 (0.93-0.95)), but had similar in-hospital mortality (1.06 (0.99-1.13)), after multi-variable adjustment. Over a median follow-up of 8.4 (6.8-10.2) years, women had higher raw rates of adverse outcomes. However, after full confounder adjustment, this translated into lower risk for women of all cause-mortality 0.92 (0.89-0.95), cardiovascular mortality 0.82 (0.78-0.87) and MACE 0.92 (0.88-0.95) (Figure 1). The female survival advantage was attenuated post-MI in comparison to controls free of significant cardiovascular disease (Figure 2). Conclusions Women and men have different MI risk factor profiles. Women had overall worse crude outcome rates after MI, driven by age and comorbidities. This may have been driven further by undertreatment after MI, including PCI and secondary prevention. Urgent identification of drivers for such disparities in care is warranted in order to improve outcomes and ensure health equity.

7.P. Skills building seminar: Using health impact assessment for assessing tobacco control policies

Abstract Tobacco use is the largest contributor to premature death and preventable disease in Europe. Despite decreasing tobacco use in recent years, the European Commission estimates that the number of smokers in Europe is 26% in the population, and 29% among 15-24 year olds. This persistent public health risk is amenable to policy, but targeted and effective strategies are needed. Health impact assessment (HIA) methods can aid decision-makers in exploring the consequences of policy actions on select outcomes, providing a platform for informed, evidence-based policy design. Routine data collection on risk factors including smoking and tobacco use behaviour is common and available in Europe. Analysing and valorising these data can provide a better picture of vulnerable and target groups for which tobacco use is a persistent problem, or where the attributable disease burden is particularly high. These data can form the basis for robust projections and the application of HIA methods. In addition, a number of policy strategies exist for tobacco control including changes in packaging, taxation, labelling, ingredients, creation of smoke-free environments, and restrictions on advertising. These policies have a common goal in improving tobacco control, but may lead to differential effects across age groups, populations, and different measures of tobacco use. It is thus necessary to use robust tools to understand these effects and better coordinate and plan policy. HIA methods, each with their own strengths and limitations, have been applied successfully to estimate the impact of different tobacco control measures. Novel methodologies that make use of available data, computational power, and provide a low-cost way to explore policy interventions can be an essential tool to policy planning and in particular to tackle the intractable areas of tobacco control. This skills building workshop will present two key approaches, each with their own strengths and weaknesses, that have been applied in HIA studies on tobacco control - i.e., a static approach based on the calculation of potential impact fraction, and a dynamic approach based on microsimulation models. Furthermore, the workshop will demonstrate, using two real-life examples, how policy measures can be translated into effect size estimates - which is one of the most crucial steps in any HIA. By providing a step-by-step presentation of how HIA has been applied in practice, attendees will gain unique insights in the different ways by which HIA can be used to gain insights into the relative impact of policy strategies for tobacco control. Key messages • Tobacco use remains the largest contributor to preventable disease burden in Europe; a key area for analysing policies using health impact assessment. • Attendees will gain unique insights in the different ways by which HIA can be used to gain insights into the relative impact of policy strategies for tobacco control.

The trajectory of frailty index among spousal caregivers: longitudinal evidence from China

Abstract Background Very few studies have investigated the association between providing unpaid caregiving to a spouse and the frailty of caregivers. This study aims to examine the impact of providing spousal care on frailty among the middle aged and older Chinese population. Methods Data were derived from the 2011, 2013, 2015, and 2018 waves of China Health and Retirement Longitudinal Study (CHARLS) including 4,008 participants aged 50 and above. Frailty was assessed using a composite mean score based on 41 indicators according to Rockwood frailty criteria, including self-reported health, medically diagnosed conditions, medical symptoms, functional activities assessment, Activities of Daily Living (ADLs), and Instrumental Activities of Daily Living (IADLs). A growth curve model was employed to investigate the differences in frailty among caregivers and non-caregivers. Results Compared to non-caregivers, spousal caregivers were more likely to have a higher frailty when adjusted for all covariates (Beta=0.010, SE = 0.003, p < 0.001). Furthermore, female caregivers exhibited a higher rate of change of frailty index over time (Beta=0.002, SE = 0.001, p < 0.05) compared to female non-caregivers, while no such effect was found in males. Conclusions The findings of this study reveal that providing unpaid care to a spouse is associated with an increase in the frailty index over time particularly among female caregivers. These insights underline the necessity for Chinese policymakers to develop and implement targeted interventions aimed at reducing burden on spousal caregiving, thereby preventing an increase in frailty among these caregivers. Such measures would also align with the broader objective of promoting healthy ageing. Key messages • Chinese policymakers need to develop and implement targeted interventions to reduce the burden on female spousal caregivers and prevent increased frailty. • Focusing on the frailty of female spousal caregivers is crucial for promoting healthy aging.

Association between high versus low cardiovascular risk in individuals with corresponding unexpected absent versus severe subclinical coronary atherosclerosis, a nationwide, multicenter study

Abstract Background It remains unclear as to why some individuals at low risk of cardiovascular disease (CVD) develop severe coronary atherosclerosis, while those at high CVD risk may remain free from coronary atherosclerosis. Purpose Using Coronary Computed Tomography Angiography (CCTA), we aimed to identify factors associated with absence and severe coronary atherosclerosis in subjects from the general population with very high and low-moderate CVD risk, respectively. Methods We assessed cross-sectionally a nationwide, multicenter population-based cohort, consisting of 30,154 individuals randomly recruited from the general population (age range 50-64 years, 51.4% women). Coronary calcified plaque burden was estimated by coronary artery calcium score (CACS) assessed by CCTA. Absent coronary atherosclerosis was defined as CACS 0 and severe coronary atherosclerosis was defined as CACS ≥301. We investigated only individuals with low-moderate (<5%) and very high CVD risk (≥10%) according to SCORE2 were included. Individuals with CACS 0 and prevalent CVD were excluded, as well as those with moderate CACS (1-300) or SCORE2 risk 5-9%. Out of 26 722 subjects with complete data on CACS and SCORE2, 13 075 were included. Logistic regression was performed adjusted for age and sex. Results The overall distribution of CACS in relation to SCORE2 CVD risk is illustrated in the Figure. Study characteristics are displayed in Table 1. Severe-extensive CACS in combination with low-moderate CVD risk was present in 2.3% (n=296). A further 2.3% (n=311) had very high CVD risk but CACS 0. Factors associated with CACS 0 despite a very-high estimated CVD risk included: lower age, being female, being born in Sweden, not having hypertension or hyperlipidemia, fewer pack-years of smoking, and lower waist circumference in men. On the contrary, severe-extensive CACS despite a low-moderate estimated CVD risk was associated with higher age, being male, being an ex-smoker, reporting more pack-years of smoking, having higher HbA1c, higher BMI, higher waist circumference, and prevalent hyperlipidemia and hypertension (Table 2). Conclusions We identified extreme cardiovascular risk phenotypes (subgroups) in the general population that either lacked coronary calcifications despite being at very high estimated CVD risk or had severe subclinical coronary atherosclerosis despite being at estimated low-moderate CVD risk. Further studies are warranted to elucidate putative enhancing or protective mechanisms explaining this unexpected phenomenon.

Increased risk for thoracic and abdominal aortic aneurysm in the relatives of abdominal aorta aneurysm patients

Abstract Introduction Genetic susceptibilities in aneurysm genes are risk factors for developing aneurysms of the aorta. This translates to a high aneurysm prevalence in relatives of aortic aneurysm patients. For relatives of abdominal aorta aneurysm (AAA) patients, guidelines recommend abdominal ultrasound screening for early detection and management, while for relatives of thoracic aorta aneurysm patients (TAA), transthoracic ultrasound of the ascending aorta and aortic root is recommended. Neither of these guidelines are designed to detect aneurysms in the whole aorta. The incidence of TAA in relatives of AAA index-patients is unknown and may determine whether abdominal ultrasound screening is sufficient for relatives of AAA patients or whether whole aorta screening should be recommended. Furthermore, focused screening of high risk relatives of aneurysm patients may improve the yield of aneurysm detection now that population frequencies are declining. Methods Whole aorta non-contrast CTs of relatives of AAA index-patients were collected retrospectively in a tertiary referral (2016 to 2021). Family history and DNA testing of AAA index-patients were used to classify relatives into high genetic risk (familial disease and/or pathogenic/likely pathogenic variant (P/LP) in an aneurysm gene) or unknown genetic risk (no familial disease or no P/LP detected). TAA were defined as ascending diameters ≥ 45mm or descending diameters ≥ 40mm. Thoracic aortic dilatations (TAD) were defined as ascending diameters of 40-45 mm or descending diameters of 35-40 mm. Abdominal diameters ≥30mm were classified as AAA and diameters between 25-29 mm as abdominal dilatations (AAD). References 1-3. Results CT scans (n=301 relatives, 47% male, age 58(50-65)) showed 34% aortic aneurysms and/or dilatations versus 14% in the general population (age adjusted, p<0.001). TAA was 28-times more frequent (2%, p<0001) and AAA 3 times more frequent (8%, p<0.001) than in the general population. Thoracic and abdominal dilatations occurred in 18% and 17% of relatives. Overall, males were 4 times more likely to have an aneurysm than females (p<0.05). Aneurysms and dilatations occurred at the same rate in relatives with or without a family history or a P/LP in an aneurysm gene. These results endorse total aorta screening for relatives of all AAA patients rather than restricting screening to the abdominal aorta. Conclusions Relatives of AAA patients had a high risk for thoracic and abdominal aneurysms as well as dilatations. This indicates that imaging of the whole aorta will improve early detection of aortic aneurysms in relatives both with and without a family history of aneurysms.

10.I. Scientific session: A National E-Infrastructure for Aging Research to Improve Public Health

Abstract Global life expectancy gains over the last half-century are remarkable. Yet the resulting demographic shift towards an older population poses substantial public health challenges, particularly in healthcare. To address these challenges, a profound and scientifically-based understanding of older adults’ health and care requirements is needed. Recognizing the need for a better understanding of the aging process and public health challenges, the National E-infrastructure for Aging Research (NEAR) was founded in 2018. NEAR seeks to promote and support aging research by facilitating longitudinal population-based data usage from 15 well-known Swedish cohort studies on aging and health. It is based on a collaboration between eight Swedish universities and includes 15 databases with individual assessments. NEAR comprises a broad range of biomedical, clinical, social, and psychological health data from more than 90,000 adults who are 50+ years old. These individuals have been followed between 12 and 52 years. The objective of this workshop is to give an overview of the NEAR infrastructure, present results from three ongoing NEAR projects, and their implications for public health: 1) Temporal trends in dementia incidence in Sweden; 2) Personality and biomarkers of neurodegeneration and Alzheimer’s disease in Swedish older adults, and 3) Characterizing risk profiles and transitions across living and care settings in Sweden. Infrastructures such as NEAR offer high-quality epidemiological data for achieving broad, interdisciplinary research goals that single databases often cannot provide. Moreover, the value added to these kinds of data includes enhanced sample sizes, variations, representativeness, and generalizability. In turn, this can address an aging society’s public and clinical health demands. Eventually, this could lead to sustainable intervention strategies for improving older persons’ health in the coming decades. Key messages • Discover new avenues in public health aging research: Gain insights into cutting-edge aging research opportunities in Sweden, exploring key NEAR projects. • Recognize the value of national infrastructures using high-quality epidemiological data in fostering collaborative and nationally representative public health research.

Pregnancy in women with congenital heart disease : new insights into neonatal risk predictioc

Abstract Background Advances in managing adult congenital heart disease (ACHD) have led to an increased number of women with CHD reaching childbearing age. This demographic shift underscores the need for improved understanding and prediction of complications during pregnancy in this specific ACHD population. Despite progress in maternal cardiac risk assessment, the prediction of neonatal outcomes for ACHD pregnancies remains underdeveloped. Therefore, the aims of this study are (1) to assess neonatal outcomes in a CHD women population, (2) to identify their predictive factors and (3) to propose a new risk score for predicting neonatal complications. Methods This registry study included all women born between 1975 and 1996 diagnosed with ACHD who underwent at least one cardiology consultation for ACHD in Cliniques Universitaires Saint-Luc. A multivariate analysis was performed to identify predictors of neonatal complications and these were incorporated into a new risk index. Its validity was assessed using bootstrap method. This score was then compared with scores adapted from the ZAHARA and CARPREG studies for offspring events prediction. Results Analysis of 491 pregnancies revealed 31.4% of neonatal complications. Four significant predictors of adverse neonatal outcomes were identified: cardiac treatment during pregnancy (OR 14.9, 95%CI [4.6-64.3]), hypertensive disorders of pregnancy (OR 10.4, 95%CI [3.4-39.5]), smoking during pregnancy (OR 10.3, 95% CI [3.0-44.9]), and pre-pregnancy BMI < 18.5 kg/m² (OR 6.2, 95% CI [2.6-16.5]). The risk model demonstrated an AUC of 0.70 (95% CI [0.65-0.75), which remained stable after bootstrap validation. This model significantly outperformed the scores adapted from ZAHARA and CARPREG data. Based on the regression coefficients, a risk score was subsequently developed comprising 5 risk categories. Conclusion One third of ACHD pregnancies are complicated by poor neonatal outcome. These complications are determined by 4 independent factors relating to the cardiac and non-cardiac status of the patients, which have been incorporated into a risk score. Our study is one of the first to propose a predictive risk score of neonatal outcomes in ACHD pregancies, and paves the way for other validation and confirmation studies.Offspring scores: performance comparisonNew risk score for neonatal outcome

Institutional Discrimination in Health Security Policies against Immigrants in South Korea

Abstract Background South Korea is poised to become Asia’s first mult-iethnic society with over 5% of its population, totaling more than 2.5 million, being immigrants. This demographic shift presents significant public health challenges linked to widespread, and even intensifying, institutional discrimination in healthcare services. Methods This study reviews discriminatory practices across ten essential health security programs, including National Health Insurance (NHI) system, disability assistance, occupational health services, maternal and child care services, national immunization program, health screening program, and assistance for catastrophic medical expenses. Government data and personal narratives were also reviewed to identify the discriminatory elements that can have significant consequences, including increased disease prevalence, higher incidence of occupational injuries, and broader socio-economic instability among migrants. Results Discriminatory elements were found in most programs, with the exception of emergency medical services. These programs commonly provide fewer benefits or impose stricter eligibility criteria for migrants compared to nationals. In particular, the Korean NHI system demands migrants to pay higher premiums and more rigorous maintenance requirements. Conclusions The findings emphasize the need for urgent reforms to equalize health insurance costs, simplify eligibility criteria for migrants, and broaden the scope of benefits to encompass all residency statuses. Implementing these changes will enhance public health infrastructure, improve occupational safety, and foster better integration of the diverse population, ultimately promoting social cohesion and a fairer health system for all. Key messages • A number of discriminatory elements against migrants have been identified in South Korea’s social security policies that can exacerbate health disparities. • Reforms are needed to expand benefits and relax eligibility criteria for migrants in key healthcare policies, including the National Health Insurance system.

Living alone and care levels’ distribution in first-time recipients of long-term care in Germany

Abstract Background As demographic shifts occur, along with longer life expectancies and advancements in medical care, there is a noticeable rise in the population requiring long-term care. In Germany, the Medical Service oversees the assessment for long-term care needs, which specifically evaluates the extent of limitations in maintaining independent living. These limitations are categorized into care levels ranging from 1 (indicating minor limitations) to 5 (denoting the most severe limitations). Methods Data from the long-term care assessment conducted nationwide in Germany are utilized for the analysis presented. The study focuses on individuals aged 60 and above with a first-time recognition of need of long-term care. Descriptive analysis is conducted on the distribution of care levels and living arrangements. Results The analysis encompassed 339,486 individuals, with an average age of 79.6 years (standard deviation: 8.4), of whom 59.0% were female. Approximately half of the sample were categorized under care level 2, while 32.4% fell into care level 1. Higher care levels (3-5) were less frequent (16.2%, 4.8%, 1.7% respectively). Individuals living alone were predominantly found in the lower care levels, whereas those not living alone were more commonly represented in care levels 3-5. Additionally, older individuals were more frequently assigned higher care levels. Conclusions Over 75% of initial applicants are classified within the lowest care levels (1 and 2) with a higher proportion of those living alone. One possible explanation is that within partnerships, the presence of a partner may serve as a form of support during the early phases of long-term care, with external assistance becoming necessary only as care needs escalate to higher levels. Further research should focus on examining the role of living alone in the need for long-term care. Key messages • Initial applicants of long-term care in Germany living alone are more often classified in lower care levels (indicating minor limitations) than in higher care levels (indicating severe limitation). • Partnerships may delay higher long-term care needs; research should explore living alone’s impact on long-term care.

Promoting healthy ageing at work through the development of coping strategies among senior workers

Abstract Background In France, the employment rate for individuals aged 50-64 has risen to almost 67% by 2023, with projections indicating that nearly one in three citizens will be over 60 by 2040. This demographic shift presents a significant labour challenge. To address this, the study explores how senior workers tackle workplace challenges and how their coping strategies influence healthy ageing at work. Methods This study explores critical factors in healthy ageing at work using a mixed QUAL/Quant methodology. 15 interviews provided insight into senior workers, while 28 participants from a French company completed an online questionnaire. Qualitative data were analysed using template analysis, and quantitative data were analysed using SPSS version 20. Results The interviews revealed that senior workers’ problem-solving methods were grouped into three approaches: technical solutions (ergonomic adjustments, supportive equipment), coping strategies (help-seeking, utilisation crafting and developmental crafting), and mindset changes (metacognition, positive reappraisal). Among the senior group, the survey results showed that developmental crafting was a significant positive predictor of work engagement (β = 1.52, p< .05). Utilisation crafting and relational crafting were significant positive predictors of general health (β=.53, p< .05, and β=.50, p= .05, respectively). Conclusions This study not only emphasizes the significance of technological solutions but also underscores the critical roles of help-seeking, utilisation crafting, developmental crafting, metacognition, and positive reappraisal in fostering healthy ageing at work. These insights emphasize the need for ongoing development of human resource management strategies to address the challenges associated with ageing at work. Key messages • Our study finds senior workers employ diverse strategies - technical solutions, coping strategies, mindset shifts - to promote healthy ageing at work. • The insights highlight the importance of human resource strategies for addressing challenges of the ageing workforce, emphasizing proactive approaches.

Quo vadis, the leading arrhythmia? Projecting the prevalence of atrial fibrillation up to 2070

Abstract Introduction The prevalence of atrial fibrillation (AF) is strongly associated with age, and with increasing life expectancy worldwide, the number of AF patients has been steadily rising. However, long-term projections of AF prevalence are scarse. Purpose To predict the prevalence and the number of patients with AF in Finland from 2021 until 2070. Methods In the Finnish Anticoagulation in Atrial Fibrillation (FinACAF) study we gathered data of all AF patients from all national health care registers (hospitalizations and outpatient specialist visits, primary health care contacts, and reimbursements for prescription medicines) from 2004 to 2018. The prevalence of AF on December 31st 2018 was calculated as the number of patients alive with AF divided by the number of Finnish population. We utilized age- and sex-specific prevalences on year 2018 to predict the prevalence by sex and 5-year age groups, using a 1-year time interval of AF in Finland between years 2021 and 2070. We obtained the projection for population structure in Finland between 2021 and 2070 from Statistics Finland. The prevalences in 2070 are provided for population ≥20 years as well as for populations ≥65 years, ≥75 years, and ≥85 years. Results In 2018, a total of 226 847 patients with the diagnosis of AF were documented in Finland. The number of adult patients with AF is predicted to increase strongly up to 2040 with a slower increase from 2040 to 2060, and again a faster increase is estimated from 2060 up to our final estimation of 2070. In total, the number of AF patients will increase with 60% until the year 2070. In 2021, prevalence of AF was 5.5% in adults and prevalence rate will increase to 8.6% in 2070. Proportion of men will be from 54.7 % to 56.0%, and the prevalence will be higher in men compared to women in all age groups with the exception in the age group ≥85 years. Among the population ≥65 years the prevalence in 2070 will be 19.7 %, and in the elderly, ≥75 years, the prevalence of AF will 25.6% and in the oldest, ≥85 years, 31.7%. In 2070 73.3 % of patients with AF are over 75 years, and 38.8% are over 85 years old. Conclusions Drawing upon extensive nationwide data covering all levels of care, our estimates indicate a continual rise in the number of AF patients in Finland until the year 2070. Notably, throughout the projected period, there is a discernible increase in the proportion of older and the oldest patients, highlighting the demographic shift in AF prevalence.Patients with AF 2021-2070 in Finland

Enhancing Labor Market Participation of Older Adults: Health and Workplace Adaptations

Abstract Background The labor market dynamics for older adults have significantly shifted due to extended life expectancy and evolving socioeconomic conditions. This study examines the prerequisites for older adults to remain longer in the labor market across various European countries, emphasizing the interplay between health status, workplace adaptations, and economic factors. Methods This cross-sectional study analyzed data from several European surveys focusing on older workers. The methodology included logistic regression to evaluate the impact of health status and workplace adaptations on continued employment among older adults. Data were further stratified by country to assess regional differences in employment patterns for this demographic. Results Preliminary results indicate that older adults with access to workplace adaptations-such as flexible working hours and ergonomic interventions-show a significantly higher likelihood of remaining in the labor market (OR = 2.3, 95% CI 1.8-2.9). Additionally, those reporting good to excellent health were 1.5 times more likely to continue working compared to their peers with poor health outcomes. The results also highlight substantial regional variability, with Scandinavian countries showing higher employment rates among older adults compared to Southern European regions. Conclusions The data strongly support the need for policy interventions that promote health maintenance among older workers and encourage employers to implement adaptive measures. Such strategies are likely to enhance the labor market participation of older adults, contributing to economic stability and reducing the potential strain on social security systems. Innovative public health policies aimed at supporting aging workers are crucial for sustaining workforce productivity in the face of demographic shifts. NordForsk supports the study Sustainable working-life for aging populations in the Nordic-Baltic region, Project No.: 139986. Key messages • Workplace adaptations and good health significantly extend working life among older adults. • Regional differences in employment for older workers highlight the need for tailored public health policies.

Future proof competencies for nurses working in primary care; a mixed methods study

Abstract Background Healthcare services, also those provided by nurses, are challenged by the increasing care demands of an ageing population and people with chronic conditions. To improve care efficiency and quality, now and in the future, nurses must have competencies regarding self-management support of patients, electronic communication, preventive care, and engaging relatives in care. This study aimed to assess primary care registered nurses’ (RNs) time allocation to these competencies and their perceived needs for further development of these competencies. Methods A mixed methods design was used, involving a nationwide survey (n = 303) and focus groups (12 participants), both with RNs working in community care services or general practitioners (GPs) practices. Survey data were analysed descriptively, and focus group transcripts underwent qualitative thematic analysis. Results The majority of RNs invest significant time in client self-management support (90%), preventive care (82%), and involving relatives in care (74%). RNs also recognized an increasing demand for these competencies in the future and the need to motivate patients and relatives to self-manage their health. Furthermore, RNs reported that competencies regarding electronic communication skills will become extra important in the future, yet currently only 37% dedicate substantial time to this. RNs face challenges in effectively utilizing electronic communication with patients and thus need opportunities to improve digital skills. Additionally, RNs desire enhanced collaboration with other healthcare professionals, such as GPs and medical specialists. Conclusions RNs’ limited time allocation and perceived inadequacy in electronic patient communication, underscore the importance of targeted training in this area, and prioritizing this by healthcare organizations. In addition, fostering collaboration between nursing staff and other healthcare professionals could support future proof nursing in primary care. Key messages • Nurses demonstrate resilience in addressing healthcare challenges, emphasizing client care, prevention and family engagement. • Training nurses in competencies for electronic communication with patients is essential to meet the anticipated increase in demand for this aspect in their practice.

Who are the superheroes? A cross-sectional study on the determinants of healthy ageing

Abstract People who reach old age while enjoying good physical and mental health are, in a sense, ‘superheroes’ (of health): in fact, they not only have a relatively low impact on health care spending but are also advantaged in playing an active role in society and achieving their aspirations (and perhaps helping others to do so). The aim of this study was to assess the prevalence and determinants of being ‘physical superheroes’ (i.e., lacking the 10 major chronic conditions plus obesity), ‘mental superheroes’ (i.e., lacking major mental symptoms) and ‘superheroes’ (i.e., both mental and physical superheroes). We used data from a telephone-based cross-sectional study (LOST in Lombardia) conducted in November 2020 (i.e., during the COVID-19 pandemic) on a representative sample of 4,400 adults aged ≥65 years from the Lombardy region, Northern Italy. All the participants provided data both during and before the COVID-19 pandemic. Mental and physical superheroes were 59.0% and 17.6%, respectively. Superheroes were 12.8% overall, 15.1% among men and 11.1% among women; 20.2% among individuals aged 65-69 years, 11.3% among 70-74, 10.0% among 75-79, and 8.3% among ≥80 years. Multivariable analysis showed that, besides female sex, higher age, and disadvantaged socio-economic status, ever tobacco smoking (adjusted odds ratio, aOR=0.71), alcohol drinking (aOR=0.77), and physical inactivity (p for trend<0.001) were inversely related to being superheroes. Participants with feelings of hopelessness showed an extremely low presence of “superheroes” (OR = 0.17). The COVID-19 pandemic reduced by 16.3% the proportion of superheroes. Given a steadily ageing population, public health policies should aim to ensure that people reach old age in the best possible state of health by preventing risky behaviours and paying special attention to inequalities derived from economic and social factors.

Patient and healthcare provider perspectives on a digital first general practice: mixed-method study

Abstract Background General practitioners (GPs) are facing an increased workload as a result of an aging population and a growing prevalence of chronic diseases. Utilizing eHealth may help to enhance healthcare accessibility and reduce costs. A digital platform was developed that integrates eHealth into the organizational aspects of general practices. This study aims to provide insight into the experiences of patients and healthcare professionals with this new, digital way of working. Methods A mixed-method study was conducted in three Dutch general practices working with the digital platform. The digital platform focuses on digital communication and remote healthcare delivery in primary care. Primary outcomes included acceptability, the implementation process, suggestions for improvement, and facilitators and barriers for future implementation. Patient perspectives were identified through online questionnaires and focus groups, and healthcare professionals’ experiences were explored through in-depth interviews. Results Five focus groups and ten in-depth interviews were held. The questionnaires were completed by 616 patients. Patient acceptability of the care concept was high (M = 3.9, SD = 1.0; on a scale from 1-5) and they were satisfied with received care (M = 30.1, SD = 3.4; on a scale from 8-32). Regarding the perceived quality of consults, patients were positive about the longer duration of physical consults (i.e., 20 instead of 10 minutes). Some participants indicated a less personal doctor-patient relationship, because care was provided by various GPs. Conclusions Overall, patients and healthcare professionals were positive about the digital platform. The study gives insights into how to improve the care concept, e.g., how to enhance the doctor-patient relationship. Key messages • Digital first general practices that integrate eHealth into the practice’s organizational aspects of are considered acceptable by patients and healthcare professionals. • Digital first general practices can help to improve healthcare accessibility for both patients and healthcare professionals.

2.X.2. Cancer Screening Across the Life Course and Surveillance Bias

Abstract The proposed workshop organized by the Chronic Disease EPH section will start with an overview of the impact of a life course perspective on cancer prevention and screening strategies, in the context of aging populations and fear of increasing health inequity. It will be followed by three presentations to address issues of cancer screening inequalities, low-value cancer screening, and cancer surveillance bias due to screening. Key messages • Due to population aging, the burden of cancer increases and calls for new cancer prevention and screening strategies. • Cancer screening strategies must be adapted among older adults and designed to prevent inequities.

Solutions for reducing the severe economic burden of musculoskeletal diseases

Abstract Issue In Slovenia the big group of over 150 musculoskeletal and connective tissue diseases (MSCTD) constitute a serious public health problem, a major burden on health systems and society as a whole. Patients with these diseases have a poorer quality of life and often retire early. Any early retirement that could have been prevented represents a loss of human capital, which is a major social and economic cost to society. The aim of this study was to analyze the economic burden of the six most common MSCTD in Slovenia for the period from 2020 to 2022, to contribute to a better understanding of this problem and suggest solutions. Methods At the Slovenian National Institute of Public Health, in collaboration with the Faculty of Economics at the University of Ljubljana, we calculated the burden of six most common MSCTD for the period 2020-2022. We used the National Transfer Accounts (NTA) methodology to calculate the indirect costs; direct costs were calculated based on the national routine health data. Results The calculated economic burden of the six most common diagnoses of MSCTD represents 5% of total health expenditure or 0.4% of Slovenian gross domestic product on average. Direct costs amounted to 2% of total health expenditure (hospitalizations 22.5%, costs for medicines 9.3%, first curative visits at the primary level and visits to the outpatient clinic at the secondary level 2.7%). Indirect costs amounted to 3% of total health expenditure. Conclusions Despite the reduced access to the health system due to COVID-19 the economic burden of MSCTD is high in Slovenia and would be significantly higher considering all diagnoses from this group of diseases. The research requires interdisciplinary cooperation between medicine and economics regarding demanding NTA methodology which is innovative in our country. Key messages • One of the main public health priorities in Slovenia should be to raise awareness of MSCTD. • In the light of the aging population prevention activities with focus on MSCTD should be intensified as soon as possible.

The future of screening and early detection in the Netherlands: a foresight study to support new screening policy strategies

Abstract The Dutch government provides several population screening programmes intended for early detection of diseases so that prompt treatment can be provided. These include population screenings for various forms of cancer and screenings for specific diseases in unborn and newborn children. The future provision of these screenings is influenced by various developments, including the ageing population, economic fluctuations and technological advancements. To understand these developments and their potential impacts on the future of screening and early detection, RIVM has conducted a foresight study based upon a systematic six-step approach. Important steps in this process are building a conceptual framework, identifying important developments via horizon scanning, selecting scenario logics and making scenarios in order to select important challenges and opportunities for the future. The final output of the foresight study consists of a broad horizon scan, two simple future scenarios and four societal perspectives on screening and early detection. In this foresight study, there was special attention for the role of different societal perspectives and the variation in desirable futures that these perspectives entail. These perspectives were presented to the Ministry and other important stakeholders in the future strategy planning, by playing a serious role game. The results of the foresight study and the experience of looking to the future through various perspectives forms the input for the Dutch Ministry of Health, Welfare and Sport in formulating a strategy for the future of screening and early detection and making informed decisions about potential actions. The presentation will focus on how the foresight process was done and how this has informed the Ministry of Health in order for them to follow the next steps in setting future goals and ambitions and planning for a future policy strategy.

Maximising the potential of National Cancer Mission Hub-like structures: A SWOT analysis approach

Abstract Cancer is a significant and urgent concern in public health, particularly in the context of an aging population like in Europe. It is estimated that new cancer cases will increase by 21% by 2040 in Europe. With the ambition of improving the lives of 3 million people by 2030, the European Commission launched 2 major initiatives: Europe’s Beating Cancer Plan (EBCP) and the Mission on Cancer (MoC). The EBCP is a policy-driven initiative aimed at supporting Member States in addressing the whole cancer continuum. It is supported by the MoC, a research driven initiative. Member States are implementing the EBCP and MoC in a way that fits their national contexts. This can take different forms, such as ‘cancer hub,’ ‘mirror group,’ or other similar structures. The role of these entities can vary, ranging from purely coordinating activities to involving more technical work. We performed a SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis with different national mission-hub-like (NCMH-like) structures to explore their strategic positioning. We collected results from 6 countries (Belgium, Italy, the Netherlands, Portugal, Poland, and Sweden) as part of the EU project ECHoS on setting NCMHs. Participants perceived that formal government endorsement, existing stakeholder mapping, and good stakeholder engagement as strengths for the structure. Whilst, they identified overlap with other ongoing initiatives and low stakeholder engagement as weaknesses that need to be addressed, the future of existing structures could be threatened by financial and human resources as well changing political landscape. National, regional alignment and the leverage of EU funding were recurrent opportunities to build on. Ultimately, NCMH-like structures can be leveraged to achieve national and European alignment on cancer initiatives, if they succeed in building a sustainable financial and governance structure. Key messages • National Cancer Mission Hub-like structures can build on existing initiatives to support the implementation of EU cancer initiatives if they achieve sustainable financial and governance structures. • SWOT framework is a good tool for a comprehensive overview of the strategic positioning of National Cancer Mission Hub-like structures in different European countries.