Effects of Health Risk Assessment and Counselling on Fruit and Vegetable Intake in Older People: A Pragmatic Randomised Controlled Trial

Sustainable Health-Related Quality of Life in Older Adults as Supported by the vINCI Technology

The vINCI technology represents an innovative instrument developed specifically but not exclusively for older adults by technology researchers together with a medical team specialized in geriatrics and gerontology. It was designed to be independently and effortlessly used by older adults in the comfort and safety of their own environment. It is a modular and flexible platform that can integrate a large array of various sensors and can easily adapt to specific healthcare needs. The pilot study tested sensors and standardized instruments capable of evaluating several care-related parameters and of generating personalized feedback for the user dedicated to optimizing physical activity level, social interaction, and health-related quality of life. Moreover, the system was able to detect and signal events and health-related aspects that would require medical assistance. This paper presents how the innovative vINCI technology improves quality of life in older adults. This is evidenced by the results obtained following the clinical validation of the vINCI technology by older adults admitted to the Ana Aslan National Institute of Gerontology and Geriatrics (NIGG) in Bucharest.

Health care for older adults in Europe: how has it evolved and what are the challenges?

Geriatric medicine has evolved to an accepted specialty in 23 European countries. Despite much heterogeneity of postgraduate geriatric curricula, European societies have succeeded in defining a common core curriculum with a list of minimum training requirements for obtaining the specialty title of geriatric medicine. Geriatricians play a leading role in finding solutions for the challenges of health care of multimorbid older patients. One of these challenges is the demographic shift with the number of adults aged 80 years and older in Europe expected to double by 2050. Although geriatric units will play a role in the care of frail older patients, new care models are needed to integrate the comprehensive geriatric assessment approach for the care of the vast majority of older patients admitted to non-geriatric hospital units. Over the last few years, co-management approaches have been developed to address this gap. Innovative models are also in progress for ambulatory care, prevention and health promotion programs, and long-term care. Efforts to implement geriatric learning objectives in undergraduate training, and the generation of practice guidelines for geriatric syndromes may help to improve the quality of care for older patients.

A Method to Estimate the Efficacy vs. Effectiveness in Meta-Analysis of Clinical Trials with Different Adherence Scenarios: A Monte Carlo Simulation Study in Nutrition

Randomized clinical trials (RCTs) evaluating the effectiveness of interventions to promote fruit and vegetable (FV) consumption usually report intention-to-treat (ITT) analysis as the main outcome. These analyses compare the randomly assigned groups and accept that some individuals may not follow the recommendations received in their group. The ITT analysis is useful to quantify the global effect of promoting the consumption of FV in a population (effectiveness) but, if non-adherence is significant in the RCT, they cannot estimate the specific effect in the individuals that increased their FV consumption (efficacy). To calculate the efficacy of FV consumption, a per protocol analysis (PP) would have to be carried out, in which groups of individuals are compared according to their actual adherence to FV consumption, regardless of the group to which they were assigned; unfortunately, many RCTs do not report the PP analysis. The objective of this article is to apply a new method to estimate the efficacy of Meta-analysis (MA) PP which include RCTs of effectiveness by ITT, without estimates of adherence. The method is based on generating Monte Carlo simulations of percentages of adherence in each allocation group from prior distributions informed by expert knowledge. We illustrate the method reanalyzing a Cochrane Systematic Review (SR) of RCTs on increased FV consumption reported with ITT, simulating 1000 times the estimation of a PP meta-analyses, and obtaining means and ranges of the potential PP effects. In some cases, the range of estimated PP effects was clearly more favourable than the effect calculated with the original ITT assumption, and therefore this corrected analysis must be considered when estimating the true effect of the consumption of a certain food.