OBJECTIVE: The World Health Organization (WHO) recently proposed an Integrated Care for Older People approach to guide health systems and services in better supporting functional ability of older people. A knowledge gap remains in the key elements of integrated care approaches used in health and social care delivery systems for older populations. The objective of this review was to identify and describe the key elements of integrated care models for elderly people reported in the literature.DESIGN: Review of reviews using a systematic search method.METHODS: A systematic search was performed in MEDLINE and the Cochrane database in June 2017. Reviews of interventions aimed at care integration at the clinical (micro), organisational/service (meso) or health system (macro) levels for people aged ≥60 years were included. Non-Cochrane reviews published before 2015 were excluded. Reviews were assessed for quality using the Assessment of Multiple Systematic Reviews (AMSTAR) 1 tool.RESULTS: Fifteen reviews (11 systematic reviews, of which six were Cochrane reviews) were included, representing 219 primary studies. Three reviews (20%) included only randomised controlled trials (RCT), while 10 reviews (65%) included both RCTs and non-RCTs. The region where the largest number of primary studies originated was North America (n=89, 47.6%), followed by Europe (n=60, 32.1%) and Oceania (n=31, 16.6%). Eleven (73%) reviews focused on clinical 'micro' and organisational 'meso' care integration strategies. The most commonly reported elements of integrated care models were multidisciplinary teams, comprehensive assessment and case management. Nurses, physiotherapists, general practitioners and social workers were the most commonly reported service providers. Methodological quality was variable (AMSTAR scores: 1-11). Seven (47%) reviews were scored as high quality (AMSTAR score ≥8).CONCLUSION: Evidence of elements of integrated care for older people focuses particularly on micro clinical care integration processes, while there is a relative lack of information regarding the meso organisational and macro system-level care integration strategies.
In most countries, the demand for integrated care for people with chronic diseases is increasing as the population ages. This demand requires a fundamental shift of health-care systems towards more integrated service delivery models. To achieve this shift in China, the World Health Organization, the World Bank and the Chinese government proposed a tiered health-care delivery system in accordance with a people-centred integrated care model. The approach was pioneered in Luohu district of Shenzhen city from 2015 to 2017 as a template for practice. In September 2017, China's health ministry introduced this approach to people-centred integrated care to the entire country. We describe the features of the Luohu model in relation to the core action areas and implementation strategies proposed and we summarize data from an evaluation of the first two years of the programme. We discuss the challenges faced during implementation and the lessons learnt from it for other health-care systems. We consider how to improve collaboration between institutions, how to change the population's behaviour about using community health services as the first point of contact and how to manage resources effectively to avoid budget deficits. Finally, we outline next steps of the Luohu model and its potential application to strengthen health care in other urban health-care systems.
There are currently about 6 million – mainly older – people with dementia in the European Union. With ageing, a number of sensory changes occur. Dementia syndrome exacerbates the effects of these sensory changes and alters perception of stimuli. People with dementia have an altered sensitivity for indoor environmental conditions, which can induce problematic behaviour with burdensome symptoms to both the person with dementia and the family carer. This paper, based on literature review, provides an overview of the indoor environmental parameters, as well as the integrated design and implementation of relevant building systems. The overview is presented in relation to the intrinsic ageing of senses, the responses of older people with dementia and the impact on other relevant stakeholders through the combined use of the International Classification of Functioning, Disability and Health, and the Model of Integrated Building Design. Results are presented as indicators of the basic value, functional value and economic value, as well as a synthesis of building-related solutions. Results can help designers and building services engineers to create optimal environmental conditions inside the living environments for people with dementia, and can be used to raise awareness among health care professionals about of the influence of the indoor environment on behaviour of the person with dementia.
The projectThe overarching goal of DIGNITY, DIGital traNsport In and for socieTY, is to foster a sustainable, integrated and user-friendly digital travel eco-system that improves accessibility and social inclusion, along with the travel experience and daily life of all citizens. The project delves into the digital transport eco-system to grasp the full range of factors that might lead to disparities in the uptake of digitalised mobility solutions by different user groups in Europe. Analysing the digital transition from both a user and provider’s perspective, DIGNITY looks at the challenges brought about by digitalisation, to then design, test and validate the DIGNITY approach, a novel concept that seeks to become the ‘ABCs for a digital inclusive travel system’. The approach combines proven inclusive design methodologies with the principles of foresight analysis to examine how a structured involvement of all actors – local institutions, market players, interest groups and end users – can help bridge the digital gap by co-creating more inclusive mobility solutions and by formulating user-centred policy frameworks.The objectivesThe idea is to support public and private mobility providers in conceiving mainstream digital products or services that are accessible to and usable by as many people as possible, regardless of their income, social situation or age; and to help policy makers formulate long-term strategies that promote innovation in transport while responding to global social, demographic and economic changes, including the challenges of poverty and migration.The missionBy focusing on and involving end-users throughout the process of designing policies, products, or services, it is possible to reduce social exclusion while boosting new business models and social innovation. The end result that DIGNITY is aiming for is an innovative decision support tool that can help local and regional decision-makers formulate digitally inclusive policies and strategies, and digital providers design more inclusive products and services.The approachThe DIGNITY approach combines analysis with concrete actions to make digital mobility services inclusive over the long term. The approach connects users’ needs and requirements with the provision of mobility services, and at the same time connects those services to the institutional framework. It is a multi-phase process that first seeks to understand and bridge the digital gap, and then to test, evaluate and fine-tune the approach, so that it can be applied in other contexts even after the project’s end.Partners: ISINNOVA (Italy), Mobiel 21 (Belgium), Universitat Politechnica deCatalunya Spain), IZT (Germany), University of Cambridge (UK), Factualconsulting (Spain), Barcelona Regional Agencia (Spain), City of Tilburg(Netherlands), Nextbike (Germany), City of Ancona (Italy), MyCicero (Italy),Conerobus (Italy), Vlaams Gewest (Belgium)
Family Dairy Tech Sustainable and affordable stable management systems for family dairy farms in India. An example of Dutch technology that is useful to an ?emerging economy?. Summary Problem The demand for dairy products in India is increasing. Small and medium-sized family farmers want to capitalize on this development and the Indian government wants to support them. Dutch companies offer knowledge and a wide range of products and services to improve dairy housing systems and better milk quality, in which India is interested. However, the Dutch technology is sophisticated and expensive. For a successful entry into this market, entrepreneurs have to develop affordable and robust (?frugal?) systems and products adapted to the Indian climate and market conditions. The external question is therefore: ?How can Dutch companies specialised on dairy housing systems adapt their products and offer these on the Indian market to contribute to sustainable and profitable local dairy farming??. Goal Since 2011, VHL University of Applied Sciences (VHL) is collaborating with a college and an agricultural information center Krishi Vigyan Kendra (KVK), Baramati, Pune district, Maharashtra State India. In this region many small-scale dairy farmers are active. Within this project, KVK wants to support farmers to scale up their farm form one or a few cows up to 15 to 100 cows, with a better milk quality. In this innovative project, VHL and Saxion Universities of Applied Sciences, in collaboration with KVK and several Dutch companies want to develop integrated solutions for the growing number of dairy farms in the State of Maharashtra, India. The research questions are: 1. "How can, by smart combinations of existing and new technologies, the cow-varieties and milk- and stable-management systems in Baramati, India, for family farmers be optimized in an affordable and sustainable way?" 2. "What are potential markets in India for Dutch companies in the field of stable management and which innovative business models can support entering this market?" Results The intended results are: 1. A design of an integral stable management system for small and medium-sized dairy farms in India, composed of modified Dutch technologies. 2. A cattle improvement programme for robust cows that are adapted to the conditions of Maharashtra. 3. An advice to Dutch entrepreneurs how to develop their market position in India for their technologies. 4. An advice to Indian family farmers how they can increase their margins in a sustainable way by employing innovative technologies.
Smart city technologies, including artificial intelligence and computer vision, promise to bring a higher quality of life and more efficiently managed cities. However, developers, designers, and professionals working in urban management have started to realize that implementing these technologies poses numerous ethical challenges. Policy papers now call for human and public values in tech development, ethics guidelines for trustworthy A.I., and cities for digital rights. In a democratic society, these technologies should be understandable for citizens (transparency) and open for scrutiny and critique (accountability). When implementing such public values in smart city technologies, professionals face numerous knowledge gaps. Public administrators find it difficult to translate abstract values like transparency into concrete specifications to design new services. In the private sector, developers and designers still lack a ‘design vocabulary’ and exemplary projects that can inspire them to respond to transparency and accountability demands. Finally, both the public and private sectors see a need to include the public in the development of smart city technologies but haven’t found the right methods. This proposal aims to help these professionals to develop an integrated, value-based and multi-stakeholder design approach for the ethical implementation of smart city technologies. It does so by setting up a research-through-design trajectory to develop a prototype for an ethical ‘scan car’, as a concrete and urgent example for the deployment of computer vision and algorithmic governance in public space. Three (practical) knowledge gaps will be addressed. With civil servants at municipalities, we will create methods enabling them to translate public values such as transparency into concrete specifications and evaluation criteria. With designers, we will explore methods and patterns to answer these value-based requirements. Finally, we will further develop methods to engage civil society in this processes.
