Summary
The aim of the “Vieillissement en Santé” (“Healthy aging”; VIeSA) project is to propose personalised health itineraries for older people living at home in the canton of Geneva, Switzerland. Phase one of the project consisted of a review of scientific and grey literature to identify effective interventions for the maintenance or reinforcement of intrinsic capacities, functional ability, and for support to caregivers. The findings from this review were integrated into a guide in the form of a booklet presenting the different health domains and the activities which could contribute positively towards them. Placing these findings into a local context, the guide also presents existing resources (associations and activities) in the form of maps and address lists. Focus groups were carried out with different stakeholders to evaluate and amend this guide before producing the printed prototype to be tested in the field. Phase two was the design and set-up of a feasibility study. It involved modelling an integrated multidimensional and coordinated intervention system for health and social professionals, determining the tools of evaluation, recruiting and training the inter-professional team (physiotherapists, occupational therapists, nurses, dietitians, social workers, doctors). Phase three, currently ongoing, is the implementation and testing of the feasibility of the intervention system. Over the course of about 4 months, professionals from the recruited team accompany senior participants using the guide as a means of information and local orientation. Both the seniors and the professionals assess the acceptability, relevance, and feasibility of the contents of the guide and the intervention system.
Planning and Implementation
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What was the challenge you were trying to address?
Today, aging in place is both an individual and a collective priority. The aging population, the high prevalence of chronic diseases, the increased risk of functional dependence and the heterogeneity of the older population are major challenges for the social and health care systems. The personalization of health care services must routinely integrate assistance and care, but also other health determinants, such as functional resources or intrinsic capacities, the environment, and social and health care policies. This can be done by actively involving older people, their relatives, professionals, associations and institutions as real actors in an "operational" perspective of prevention and health promotion. If current care in the home remains mostly curative and palliative, other services such as prevention and education are still anecdotal. The challenge is to move from an essentially curative approach to an increasingly preventive approach in a true continuum of integrated, anticipated and coordinated care. A second challenge addressed in the project is the lack of knowledge of the wide range of services available to older people living in the canton of Geneva. This diversity of services, whether cantonal, communal or even community-based, needs to be known, recognised and mobilised to facilitate the involvement and empowerment of everyone. Such an integrative approach constitutes an important evolution in operating models, which should make it possible to promote collective intelligence with and around the person by providing close support, optimised coordination of the various actors, and the implementation of concerted actions anchored in the local reality.
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Who were you trying to impact?
Older people in general, Older people with chronic health conditions or disability, Older people with vulnerabilities
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What sectors were you targeting?
Health
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Who else was involved?
Academia, Health Care
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How did older people participate?
Older people were part of the process at multiple or all stages
Lessons learned
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Please describe how collaboration worked in your initiative.
Inter-professional and inter-institutional collaboration are at the heart of the VIeSA project. The steering committee is composed of professionals representing four institutions in the canton of Geneva, notably the Institution of Home Care and Assistance (imad), the Geneva University Hospital (HUG), the Geneva School of Health Sciences (HES-SO), and the PLATEFORME du réseau seniors Genève. These different areas of expertise are also reflected in the research group and the inter-professional team. The overarching aim of the project is to mobilize all actors whose common goal is to put forward a local preventive health itinerary for all seniors and adapted to each individual.
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What was the impact of your initiative on older people, their families, and/or their communities?
Older people: It is expected that the process put in place will assist older people in gaining an understanding of what "healthy ageing" consists of, to become informed on the activities which may contribute towards it, to deepen their knowledge on what is available in the surrounding communities and the types of activities and aids they can seek. It is hoped that the process will empower older people to express their needs, goals, and aspirations, and that a greater engagement with local associations and activities will ensue. Overall, it is hoped that the VIeSA project will allow for better aging at home, regardless of the degree of vulnerability and frailty. Family/caregivers: accompany, guide and avoid exhaustion. With good orientation and coordinated actors, who are able to propose actions together, family caregivers benefit from concrete and adapted prevention, while having their role in the daily life of their loved one recognised. Community: support the cantonal and communal actors through accompaniment and assistance with coordination, integrating local associations and resources. Through repeated experiences of working together, it is hoped that proximity networks of professionals from different sectors will be created, with everyone benefitting from each other’s expertise. The project will also give insight to very different realities within the canton of Geneva, according to the place of residence of the person, as well as allow for flexibility and adaptability in terms of the implementation.
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What issues did you face, and how did you address them?
One of the challenges faced during the early stages of the project was finding a way to present information in a manner which would be comprehensible to all, and which would accommodate the needs of different stakeholders within a single document. To overcome this, care was taken in the language used, ensuring that the scientific concepts and evidence were presented in a manner accessible to all. Key messages and needs noted during the qualitative initial evaluation of the guide led to direct modifications of the document. For example, the guide was split into chapters to facilitate its accessibility, with certain elements maintained and elaborated, and others maintained, but presented differently. A second challenge was the vast network of associations and activities for older people available in the canton of Geneva. While this illustrates the canton’s willingness to promote health-related and social activities for this age group, it presented the challenge of listing these in a meaningful and accessible way, whilst also linking them back to the scientific concepts, notably the intrinsic capacities, functional ability, and caregiver support. To address this challenge, certain inclusion and exclusion criteria were defined through team consensus, as a means of restricting the parameters of the contents of the guide.
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What lessons did you learn from implementing this initiative?
Being at the start of the implementation phase of the project, many key lessons will emerge in the upcoming months. However, the early phases of the project confirmed the importance of including all stakeholders in order to give a chance for the process put in place to function in a manner that is useful to everyone concerned. This key element of inclusiveness of the VIeSA project has so far allowed for the production of tools that are more useful for those who will put them in practical use, which will consequently facilitate, and might make more efficient, the process of accompaniment put in place. Moreover, it created a sense of network, of collaboration, and of a common goal between groups of people who do not necessarily have the opportunity to interact or work together in the circumstances of real-life. Also, of primary importance was the training of the inter-professional team on a positive approach to ageing and one which places the person with his/her needs and wishes at the centre of the intervention system.
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Do you have any other reflections you would like to share?
The participatory approach is worthy of a further quick remark in that it has so far been mobilised with ease and success. The contribution of each of the actors was recognised and acknowledged per se, demonstrating the feasibility of an inter-professional approach that not only included “professionals”, but also citizens who are concerned. These are essential assets for the current project, but also for possible future developments.