Integrated care for the management of ageing-related non-communicable diseases: current gaps and future directions

Abstract

Due to the increase in the older population in Europe and associated rise in the absolute number of persons with Non-Communicable Diseases (NCDs), it is becoming increasingly important to find ways to promote healthy ageing, which is defined as the process of developing and maintaining the functional ability that enables well-being in older age. Older persons with NCDs can have complex care needs due to the increased risk of frailty, multimorbidity, and polypharmacy. However, current health systems in Europe often provide fragmented care for older people with NCDs; many receive disjointed care from numerous specialists or via different levels of care. In the current article, we discuss barriers and challenges in implementing integrated care models in European settings for older NCD patients. Specifically, we discuss the need for greater use of case managers in the care and treatment persons with complex care needs as well as the lack of training and education in healthcare professionals on topics related to multimorbidity, frailty, and polypharmacy. We discuss the limitations that arise from the current focus on disease-specific guidelines and care models that do not take comorbid conditions into account, and the lack of good quality evidence that evaluates the effectiveness of integrated care interventions, especially in European health settings. We highlight the importance of evaluating and monitoring mental health in conjunction with somatic symptoms in NCD patients and discuss the integral role of information and communication technology in healthcare to streamline integrated care processes and help to achieve better outcomes for patients.

COVID-19 Pandemic and Burden of Non-Communicable Diseases: An Ecological Study on Data of 185 Countries

“…Life expectancy and HALE in high-income countries are higher than in other countries, and this improved longevity is associated with a higher prevalence of noncommunicable disease. 1 These findings may explain the increased rates of COVID-19 cases and deaths in highincome countries, where a considerable portion of the community consists of older adults with baseline noncommunicable diseases, including cardiovascular diseases. Many COVID-19-related deaths in high-income countries are older individuals and residents of long-term care facilities, 22À24 where a considerable number of people may have concurrent non-communicable diseases.…”

Digital Health Tools for Managing Noncommunicable Diseases During and After the COVID-19 Pandemic: Perspectives of Patients and Caregivers

“…In terms of this viewpoint's methodology, we first identified several themes from previous NCD Partnership advisory board meetings that reflected major barriers to NCD management for patients, including integrated care [21], health technology [20], and COVID-19-related changes to the management of risk factors and diseases in patients with NCDs [5]. Afterward, we prepared a draft of talking points based on these themes.…”

“…Even before the COVID-19 pandemic, many have emphasized that digital health tools are important for the prevention and management of NCDs [20], as digital health tools play an essential role in integrated care [9,21], especially in managing multimorbidity [8][9][10]22], delivering precision medicine [23], and increasing medication adherence [24]. However, older patients are less likely to choose telemedicine visits over office visits than younger patients, and other factors, such as access to technology, also play a role in patients' preferences for service delivery modes [25].…”

Scaling-up an integrated care for patients with non-communicable diseases: An analysis of healthcare barriers and facilitators in Slovenia and Belgium

“…Such an approach possibly facilitates the accessibility of health services, but could also be a major barrier to coordinated care and can lead to patient getting lost in the complex health system. This has also been acknowledged by other recently published research (7). On the other hand, the capitation system in Slovenia is established at the primary level, so that patients cannot move freely between different GPs.…”

“…However, some universal barriers have been identified in European countries: fragmented care by different specialists from different levels of care, lack of guidelines and education/ training for treating patients with multiple NCDs, focus on a single NCD, focus on exclusively somatic health, and neglect of mental health. Implementation and increased use of care coordinators for more complex patients and improvement of information and communication technology were identified as facilitators (6,7).…”