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18/10/2018

The program +AGIL Barcelona or how to empower older people with fragility

fragilidad_884

18/10/2018

This research work, published in the European Journal of Internal Medicine, aims to build a framework for the implementation of complex interventions in independent but fragile older adults.

Professionals from the http://en.vhir.org/portal1/grup-equip.asp?s=recerca&contentid=196440 research group on Aging, Fragility and Transitions at Vall d'Hebron Research Institute in Barcelona and the Pere Virgili Health Park, together with the Terrtorial Management of Barcelona at the Catalan Institute of Health, have developed a decalogue of recommendations to implement multidisciplinary care to the fragile older population, within the framework of the + AGIL Barcelona program. The objective of the work, published in the https://www.ejinme.com/article/S0953-6205(18)30294-2/fulltext" Journal of Internal Medicine, is to build a framework for the implementation of complex interventions based on evidence for independent but fragile older adults. Fragility means the presence of at least one of these symptoms: slow walk, weakness, memory problems, involuntary weight loss or lack of social support. Fragility increases the risk of illnesses, rapid progression of dementia and disability, fractures by falls, institutionalization and, finally, death. In order for health professionals from both primary and geriatric care and for other actors from the community to optimize the management of disability, a decalogue of recommendations has been created based on three principles: scientific evidence, sustainability and older people's participation. Decalogue Design and implementation of programs that incorporate physical activity and nutritional interventions.Focus on the patients, taking into account their preferences and values.Empowerment of the person and caregivers.Flexible and easily adaptable interventions in any context.Implementation near the person's environment, preferably in primary care.Elaboration of comprehensive care models that involve all agents, including those of the community.Use of opportunistic screening programs or strategies for the identification of older people in situations of vulnerability.Adaptation through user's participation and co-design strategies.Dissemination and awareness among the population and decision-makers.Design of an investment plan and evaluation of the appropriate results. From this decalogue, they designed the Integrated Primary Care and Geriatrics Program with a Longitudinal Vision (+ AGIL) based on the strategic alliance between the Catalan Institute of Health and the Pere Virgili Health Park and has been initiated at the Primary Health Center CAP Bordeta Magòria. The + AGIL Program has included people over 80 with at least one risk factor of fragility, without any limitation to carry out daily activities and that can go to the CAP. The intervention and adequacy of the pharmacological treatment. The publication describes the basal characteristics of the sample and the intervention scheme. In the first 22 months of operation, 185 elderly people had an average age of 81.6 and were mostly women (72%). Physical activity was recommended to 95.5% and 89.7% received health education programs. In 66% of the cases, modifications were proposed in the pharmacological guidelines and 22% of participants were referred to a memory clinic. The document prepared by the experts summarizes the most relevant international recommendations on the implementation of comprehensive, multidisciplinary care in the management of fragile patients without manifest disabilities and living in the community. Special emphasis is placed on the need to contextualize and personalize the interventions, always seeking to empower the patient.

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