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Infectious diseases pose a significant burden on the general population, particularly older adults who are more susceptible to severe complications. Immunization plays a crucial role in preventing infections and securing a healthier aging, but actual vaccination rates among older adults and frail individuals (OAFs) remains far from recommended targets. This study aims to collect and share good practices implemented in several Italian local health districts during the SARS-CoV-2 pandemic to ease routine immunization for OAFs. A 28-items questionnaire has been developed to collect information on organization aspect of immunization services and local good practices implemented before and during the SARS-CoV-2 pandemic. Twelve Public Health managers representative of 9 Italian Regions were further interviewed between January and March 2021. Despite literature suggests several effective interventions to increase vaccine demand, improve vaccine access, and enhance healthcare providers' performance, our survey highlighted substantial heterogeneity in their implementation at local level. Seven good local practices have been identified and described: mass vaccination centers; vaccination mobile units; drive-through vaccination; co-administration; tailored pathways; cooperation among providers involved in vaccination; digitization. Our survey pointed out valuable strategies for enhancing routine immunization for OAFs. Providers should combine effective interventions adequate to their specific context and share good practices.

Objective: The care processes directed towards institutionalized older people needs to be tailored on goals and priorities that are relevant for this specific population. The aim of the present study was (a) to describe the distribution of selected health determinants in a sample of institutionalized older adults, and (b) to investigate the impact on survival of such measures. Design: Multicentre longitudinal cohort-study. Setting: 57 nursing homes (NH) in 7 EU countries (Czech Republic, England, Finland, France, Germany, Italy, The Netherlands) and 1 non-EU country (Israel). Participants: 3036 NH residents participating in the Services and Health for Elderly in Long TERm care (SHELTER) study. Measurements: We described the distribution of 8 health determinants (smoking habit, alcohol use, body mass index [BMI], physical activity, social participation, family visits, vaccination, and preventive visits) and their impact on 1-year mortality. Results: During the one-year follow up, 611 (20%) participants died. Overweight (HR 0.79; 95% C.I. 0.64-0.97) and obesity (HR 0.64; 95% C.I. 0.48-0.87) resulted associated with lower mortality then normal weight. Similarly, physical activity (HR 0.67; 95% C.I. 0.54-0.83), social activities (HR 0.63; 95% C.I. 0.51-0.78), influenza vaccination (HR 0.66; 95% C.I. 0.55-0.80) and pneumococcal vaccination (HR 0.76 95% C.I. 0.63-0.93) were associated with lower mortality. Conversely, underweight (HR 1.28; 95% C.I. 1.03-1.60) and frequent family visits (HR 1.75; 95% C.I. 1.27-2.42) were associated with higher mortality. Conclusions: Health determinants in older NH residents depart from those usually accounted for in younger and fitter populations. Ad hoc studies are warranted in order to describe other relevant aspects of health in frail older adults, with special attention on those institutionalized, with the ultimate goal of improving the quality of care and life.

Objective The care processes directed towards institutionalized older people needs to be tailored on goals and priorities that are relevant for this specific population. The aim of the present study was (a) to describe the distribution of selected health determinants in a sample of institutionalized older adults, and (b) to investigate the impact on survival of such measures. Design Multicentre longitudinal cohort-study. Setting 57 nursing homes (NH) in 7 EU countries (Czech Republic, England, Finland, France, Germany, Italy, The Netherlands) and 1 non-EU country (Israel). Participants 3036 NH residents participating in the Services and Health for Elderly in Long TERm care (SHELTER) study. Measurements We described the distribution of 8 health determinants (smoking habit, alcohol use, body mass index [BMI], physical activity, social participation, family visits, vaccination, and preventive visits) and their impact on 1-year mortality. Results During the one-year follow up, 611 (20%) participants died. Overweight (HR 0.79; 95% C.I. 0.64–0.97) and obesity (HR 0.64; 95% C.I. 0.48–0.87) resulted associated with lower mortality then normal weight. Similarly, physical activity (HR 0.67; 95% C.I. 0.54–0.83), social activities (HR 0.63; 95% C.I. 0.51–0.78), influenza vaccination (HR 0.66; 95% C.I. 0.55–0.80) and pneumococcal vaccination (HR 0.76 95% C.I. 0.63–0.93) were associated with lower mortality. Conversely, underweight (HR 1.28; 95% C.I. 1.03–1.60) and frequent family visits (HR 1.75; 95% C.I. 1.27–2.42) were associated with higher mortality. Conclusions Health determinants in older NH residents depart from those usually accounted for in younger and fitter populations. Ad hoc studies are warranted in order to describe other relevant aspects of health in frail older adults, with special attention on those institutionalized, with the ultimate goal of improving the quality of care and life.

BACKGROUND: The number of Europeans aged over 65 will double between 2010 and 2060, reaching 30% of the European population. Nutrition is emerging as a key element of healthy life since both obesity and malnutrition are established risk factors for morbidity and disability. The aim of this umbrella review (UR) is to summarize the findings of all current systematic reviews (SRs) and meta-analyzes (MAs) on the effectiveness of nutritional intervention designed to promote healthy aging in older individuals. METHODS: Eligible articles published in English or Italian between January 2000 and May 2016 were identified in six databases. Only studies that analyzed nutritional interventions in the population of 65 years and over, or papers specifically targeting older adults were deemed eligible. RESULTS: Twenty-eight papers, out of which twenty-five SRs and three MAs, met the inclusion criteria and were included in this umbrella SR. Supplementation with vitamin D and other kind of products was highly effective in preventing falls and fractures. Furthermore, several interventions, ranging from the prescription of supplements to environmental and organizational programs, resulted in an improvement in energy and protein intake, as well as positive weight outcomes. Positive findings were also found for the elderly at risk of malnutrition and for older patients with dementia. CONCLUSIONS: The findings of this UR indicate that the use of a wide range of supplements and environmental and organizational intervention improve a number of anthropometric, nutritional and functional indices in the elderly

Health Promotion for Older People (HP4OP) is a relevant issue in Italy, one of the countries where people live the longest. Strategies, programmes and projects are set and planned at the national level, mainly by the Ministry of Health within the National Health Service, but strong competencies, funds and resources derive also from the Government, the Ministry of Labour and Social Policies and the Ministry of Internal Affairs. Moreover, European funds contribute to programmes and projects in this field. After strategic implementation at the regional level, programmes and projects are carried out at the local level under the National Health Service, mainly by the Local Health Authorities in conjunction with municipalities and other relevant stakeholders such as NGOs, the voluntary sector, families and educational and religious entities, etc. Even though Italy has been engaged in HP4OP to improve active life expectancy since 1992, a lack of planning and resources for HP4OP, policy diversification at the regional level and a prevailing interest in care-assistance rather than health promotion and prevention have prevented consistent implementation of HP4OP throughout the country.

In a country like Portugal where life expectancy is very high, Health Promotion for Older People (HP4OP) is a relevant issue and specific strategies are considered within priority health programmes defined at the national level by the Directorate-General of Health on behalf of the Ministry of Health. The National Health Plan 2016–2020 includes directives to facilitate health promotion and access to health and social services, as well as to reduce the burden of chronic diseases. HP4OP funds and resources derive mainly from the Ministry of Health and also from the Ministry of Labour, Solidarity and Social Security. Moreover, institutions can access European and other funds to develop projects in this field and some municipalities also finance projects and initiatives. Health plans, strategies and programmes outlined at the national level are adopted by Regional Health Administrations and the Groups of Health Centres guide implementation at the local level through dedicated units that work within the primary health care context. The integration of both social and health actions in terms of HP4OP depends on collaboration between the Ministry of Health; the Ministry of Labour, Solidarity and Social Security; municipalities; institutions in the cooperative and social sector and other stakeholders such as families, educational institutions, religious communities and health professionals. As a whole, health promotion policies for the older people in Portugal tackle the social determinants of health too. Nevertheless, a systematic approach and an integrated strategy to tackle HP4OP might constitute an important condition for the full implementation of such policies. Additionally, fragmentation of initiatives at the regional and local levels, together with other barriers to addressing health promotion activities among health professionals, might lead to the non-homogeneous implementation of interventions of HP4OP throughout the country. It is expected that many of these const

Introduction: The aim of this study is to sum up the current knowledge on the effectiveness of the existing interventions for alleviating loneliness and social isolation among older persons. Methods: We used a systematic approach and performed a literature search of MEDLINE, ISI Web of science, SCOPUS, The Cochrane Library, and CINAHL databases. After identifying 13 eligible reviews addressing interventions of our interest, we proceeded with a narrative description of the study findings. Results: The initiatives largely encompassed one-to-one interventions, group activities or community engagement approaches. In particular, technology interventions were recently given much attention. Overall, the studies showed non-satisfying methodological quality and their results were often inconclusive. Conclusions: Although there is a growing body of evidence referring to implementation of interventions targeting social isolation and loneliness among the older populations, future well-designed interventions are necessary in order to draw firm conclusions.

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Background Increasing participation of elderly population in modern societies is a source of great challenges for health and social systems. Health promotion and disease prevention interventions may have a significant effect on health status of older people. The main objective of this paper is presentation of potential gaps in secondary evidence in the area of health promotion interventions addressed to audiences 65 years old or more (65+). Methods The results of the scoping review of secondary evidence on the effectiveness of health promotion and related interventions addressed to older adults (55+) and elderly persons (65+) published from 2000 to April 2015 were further explored. From these reviews, only these which analysed health promotion activities, combined with other general areas (primary prevention, screening, and/or social support) or alone, and designed for the subjects 65+ were selected. The analysis was focused on elicitation of publication trends and identification of targeted areas which were not or were addressed less frequently. Results Among 334 systematic reviews analysing the interventions related to health promotion, primary prevention, screening and social support, there were 66 which were classified to health promotion (as exclusive domain or in combination with other general area) and which were addressed specifically to persons of at least 65 years old. Potential areas which were covered the least frequently or not covered by reviews encompassed: addictions (n = 1), sleep quality (n = 1), psychosocial functioning (n = 1), social isolation (n = 0), social participation (n = 0) and elderly abuse (n = 0). Conclusions Although the secondary evidence on health promotion and related interventions addressed to population 65+ is growing, there are still blind spots not covered by adequate systematic review or/and meta-analyses. Identified deficient areas are potentially important for wellbeing of elderly persons in the context of social interaction

Background: Aging of the workforce is a growing problem. As workers age, their physical, physiological and psychosocial capabilities change. Keeping older workers healthy and productive is a key goal of European labor policy and health promotion is a key to achieve this result. Previous studies about workplace health promotion (WHP) programs are usually focused on the entire workforce or to a specific topic. Within the framework of the EU-CHAFEA ProHealth65+ project, this paper aims to systematically review the literature on WHP interventions specifically targeted to older workers (OWs). Methods: This systematic review was conducted by making a comprehensive search of MEDLINE, ISI Web of Science, SCOPUS, The Cochrane Library, CINAHL and PsychINFO databases. Search terms included ageing (and synonyms), worker (and synonyms), intervention (and synonyms), and health (and synonyms). The search was limited to papers in English or Italian published between January, 1st 2000 and May, 31st 2015. Relevant references in the selected articles were also analyzed. Results: Of the 299 articles initially identified as relating to the topic, 18 articles met the inclusion criteria. The type, methods and outcome of interventions in the WHP programs retrieved were heterogenous, as was the definition of the age at which a worker is considered to be 'older'. Most of the available studies had been conducted on small samples for a limited period of time. Conclusion: Our review shows that, although this issue is of great importance, studies addressing WHP actions for OWs are few and generally of poor quality. Current evidence fails to show that WHP programs improve the work ability, productivity or job retention of older workers. In addition, there is limited evidence that WHP programs are effective in improving lifestyles and concur to maintain the health and well-being of older workers. There is a need for future WHP programs to be well-designed so that the effectiveness and cost-benefit

Over the years, different operational definitions have been elaborated to identify frail older persons, but none of them has received unanimous consensus. This, in turn, has hampered the clinical implementation of frailty as well as the design of targeted interventions. To overcome the current limitations in the field, a novel operationalization of physical frailty (PF) is proposed which grounds its roots in the recognition of sarcopenia as its central biological substrate. This conceptualization is based on the fact that the clinical picture of PF overlaps substantially with that of sarcopenia. The two conditions may therefore be merged into a new clinical entity, the PF & sarcopenia (PF&S) syndrome, in which muscle loss represents both the biological substrate for the development of PF and a major pathway whereby the negative health outcomes of PF occur. All of the components defining the PF&S syndrome are measurable in an objective manner, which will facilitate its incorporation into standard practice. The recognition of a precise biological substratum for PF&S (i.e., skeletal muscle decline) also opens new venues for the development of preventive and therapeutic interventions.

Sarcopenia is the loss of skeletal muscle mass and function that occurs with aging. This condition is associated with increased risk for several adverse health outcomes, including frailty, disability, falls, loss of independent living, and mortality. As yet, no pharmacological treatment exists to halt the progression of sarcopenia; similarly, no pharmacological remedies are available to prevent its onset. The combination of nutritional interventions and physical exercise is currently considered to be the most effective strategy for the management of sarcopenia. In this chapter, the role of nutrition as a countermeasure for sarcopenia is discussed. The chapter is organized into three main sections: established dietary recommendations, novel nutritional candidates, and possible dietary strategies. We conclude with presenting issues related to inappropriate prescription of nutritional supplements, and the prospect of adopting cutting-edge technologies to design targeted dietary interventions.

Influenza and pneumococcal vaccines have been proved to be effective and safe in preventing and controlling infection among elderly, reducing morbidity and mortality. However, some evidences raised health concerns related to these vaccinations. OBJECTIVES: Aim of the present study is to identify prevalence and outcomes related to influenza and pneumococcal vaccinations in a large European population of frail old people living in nursing home(NH).

INTRODUZIONE: La realizzazione del benessere della popolazione si concretizza, per molte delle società, attraverso programmi che favoriscono l’accesso all’assistenza sanitaria. Diversi studi hanno dimostrato che i governi dei Paesi, pur considerando l'assistenza sanitaria come una responsabilità chiave, si avvalgono di diversi modelli organizzativi. La Sanità Pubblica e Privata, nell’ambito di questi modelli, possono integrarsi, sovrapporsi o differenziarsi completamente, generando estremi dall’efficienza organizzativa alla disorganizzazione se non sostanziale confusione. Il presente studio origina dalla crescente preoccupazione, in un periodo di crisi economica e di “spending review”, di fattiva sostenibilità dell’attuale modello universalistico e solidaristico della Sanità Pubblica Italiana e di come esso possa evolvere nel futuro. MATERIALI E METODI: La ricerca è stata effettuata, attraverso una revisione sistematica, consultando la letteratura scientifica, nazionale e internazionale, relativa a studi pubblicati sul branding di salute pubblica disponibili nei più importanti e principali database on-line, ad accesso gratuito. Sono stati analizzati, in modalità comparata, i principali meccanismi di governance presenti nei differenti sistemi sanitari dei Paesi Europei ed Extra Europei. RISULTATI: Dall’analisi svolta, consultando 32 siti istituzionali oltre medline e cochrane, derivando 239 articoli e relazioni di cui 24 rispondenti ai criteri di inclusione nello studio, si evidenzia che il più grande mercato sanitario assistenziale complementare è in Olanda (utilizzato dall’89% della popolazione), seguita da Israele (80%). L’Australia e l’Irlanda, che presentano un Sistema Sanitario Pubblico, hanno duplicato il mercato di offerta assistenziale, fornendo attraverso il settore privato quelle prestazioni che avrebbero dei tempi di attesa lunghi. Inoltre si rileva che alcuni Paesi, come Francia, Israele, Belgio, Canada e Stati Uniti, garantiscono le prestazion

Adherence to vaccination campaigns can be negatively influenced by Web presence of unreliable information. Aim of study is qualitative and quantitative evaluation of Italian WebPages contents about vaccinations to address prevention strategies in countries that, like Italy, wouldn't like vaccination to be mandatory any longer In August 2011 two researchers conducted a Systematic Review in Italian WebPages about vaccination risks. First 100 results of 9 common search engines have been combined; pro and against pages were compared (CHI2, p <0,05). 144 WebPages were analysed: 67% of them, often on top positions, was against vaccinations and 24% of them was written by Medical Doctors. All institutional pages (12%) were pro vaccinations but they resulted in less important positions. Against WebPages were different from pro ones in terms of use of emotional images, personal negative experiences, advertising purposes (books or alternative medicine products). Main criticism was: inefficacy, low safety profile and stakeholder's interests. This study would like to represent a useful tool for parents and Medical Doctors, especially because many of them are progressively more sceptical about vaccination practises. The great number of anti-vaccination movements on Italian Web should improve public health strategies in terms of "Evidence-Based prevention".

La valutazione della qualità è importante per garantire un reale e continuo miglioramento in Sanità. L’utente e la sua valutazione del servizio, influenzata, soprattutto negli ambienti critici, da fattori soggettivi e aspettative personali, è attore fondamentale di questo processo. Lo studio si propone di misurare dal punto di vista dell’utente, attraverso l’applicazione della “Customer Satisfaction” (metodologia largamente diffusa ed efficace per la valutazione della qualità), le prestazioni in un Pronto Soccorso (PS) di una Azienda Ospedaliera Umbra, così da ottenere informazioni per valutare le decisioni manageriali attuate e indirizzare correttamente le scelte future. L’indagine è stata condotta tra settembre e novembre 2010. Per la raccolta dei dati è stato utilizzato un questionario semi-strutturato, anonimo, che indagava la qualità percepita dal compilatore (secondo 4 giudizi: insufficiente(1), sufficiente(2), buono(3), ottimo(4)) nell’ambito di tre aree principali: organizzativa, tecnico-professionale e relazionale. È stato inoltre effettuato un confronto, attraverso il test del Chi 2, con i risultati ottenuti dalla somministrazione dello stesso questionario nella stessa struttura nel 2007. Nel periodo oggetto dello studio ci sono stati 9870 accessi al PS. Su un totale di 460 questionari somministrati, ne sono stati restituiti 216. Per quanto riguarda qualità percepita nel 2010, si nota come il giudizio (Media±DS) sulle domande concernenti l’informazione(2,9±0,8), l’Accoglienza(3,0±0.8), la conformità della sala d’aspetto(2,6±0,9) e il rispetto della privacy(2,8±0,8), sia da considerarsi complessivamente buona. Inoltre, rispetto al 2007, le differenze più significative hanno riguardato la qualità percepita nelle aree inerenti la completezza delle informazioni ricevute (P=0,001) e l’accoglienza al triage da parte dell’operatore (P=0,002), quelle che, nel 2007, manifestavano le maggiori criticità. Al contrario, le altre aree sono rimaste stabili. I risultati d

In Italia, come in molti altri Paesi, è in corso l’implementazione del Fascicolo Sanitario Personale (FaSP) come strumento di miglioramento. Il FaSP dovrà consentire una sicura condivisione in rete della documentazione clinica di ogni singolo cittadino e prevede, pertanto, un ruolo importante degli utenti che, oltre a dover esprimere il proprio consenso per il FaSP, dovranno, attivamente e costantemente, interagire con il fascicolo contribuendo in questo modo al successo dello stesso. La presente revisione sistematica della letteratura ha lo scopo di sintetizzare le attuali conoscenze sull’impatto e sulla soddisfazione che l’Electronic Health Record (EHR) ha conseguito presso gli altri Paesi in cui tale sistema è già stato implementato, al fine di derivare un’ipotesi di scenario per l’Italia all’adozione del FaSP. La ricerca è stata effettuata su alcune delle principali banche dati (MEDLINE, EMBASE, The Cochrane Library, CINAHL). Sono state selezionate le pubblicazioni nel periodo 2006-2011 ed è stata valutata la loro qualità ed attinenza agli obiettivi dello studio. Lo screening di testo ed abstract attraverso keywords (patient satisfaction, adoption electronic health records, web portal, ecc) ha identificato 1962 pubblicazioni potenzialmente rilevanti, di cui 41 valutate come testo integrale e solo 13 scelte secondo i criteri di inclusione (inglese, con Impact Factor, studi su pazienti cronici, ecc). Ogni tipologia di utente ha identificato dei fattori, di criticità e di beneficio, del sistema EHR correlabili alla propria abilità ad utilizzare uno strumento informatico ed alle proprie priorità individuali. Le principali criticità riscontrate sono state di tipo tecnico, di adattamento allo strumento, di perplessità sulla sicurezza e privacy del sistema. I principali benefici riscontrati, interpretati quali miglioramento della qualità delle prestazioni sanitarie erogate, sono stati: garanzia nella continuità delle cure, disponibilità immediata dei dati riguardanti l