Reshuffling community prevention and care: a new model for healthy ageing

Abstract Europe is facing a unprecedented change of the population structure due to demographic transition, that makes the European countries a laboratory for implementing policies aimed at healthy ageing. However, there is a paucity of evidence-based interventions, except for the ones focussed on changing individuals' life style, the main ones being nutrition, physical activities, smoking and drinking. Even in the case of life habits, there are no structured interventions, while health promotion activities are mainly entrusted to the GPs, who are responsible for communicating the needed changes of behaviours to the patients they meet. The increase of chronic diseases prevalence claims for rethinking this approach in order to set up structured prevention activities to mitigate the impact of diseases on functional decline. Based on the available data some elements to rethink community care and prevention can be identified. Bio-psycho-social frailty represents a synthetic indicator of the risk of negative events like the worsening of functional status, hospitalization, institutionalization and death, far more effective than single diseases or comorbidities or even than disabilities. The assessment of frailty should be pursued through a pro-active approach in order to fill the gap of the lack of awareness about frailty which is common. This approach should be reserved to the population with the highest risk of negative events, namely the over-75 one. At side of already well-known interventions on physical activities and malnutrition other risk factors for negative events such as social isolation or polypharmacotherapy should be considered. The increased frequency of heat waves should also be at the basis of yearly intervention able to reduce the risk of death and hospitalization, always associated to climate stressors. A schedule of prevention intervention should be formally structured in order to put the basis for a better aging in Europe as a model for other continents.