Over the past 20 years, the region of Friuli-Venezia Giulia in Italy, has utilized WHO frameworks on healthy ageing to develop a regional policy response to an ageing population, involving all levels of governance. In 2018, the region started the PRISMA-7 project on detecting frailty in older people early and improving the response of health and social services. The project seeks to enhance quality of life in this age group, promote independence and prevent or delay hospitalization and functional dependency.
Challenges of population ageing
Population ageing is rapidly accelerating worldwide. Frailty develops as a consequence of physiological decline, rendering older people more vulnerable to minor stress events. It represents one of the most concerning issues related to the growing number of older people in the WHO European Region.
In Italy, 47% of those aged 75 and over have difficulties in performing daily activities. Friuli Venezia Giulia has one of the oldest populations in the European Union, 26% being in this age group.
To respond to the challenges of population ageing, profound changes in the formulation of health policies and provision of services are recommended. WHO proposes a societal approach, which includes the goal of creating an age-friendly world. This requires health systems to move away from the use of disease-based curative models towards the provision of integrated care centred on the needs of older people.
What is PRISMA-7?
PRISMA-7 is a 7-question screening instrument developed within the Program of Research on Integration of Services for the Maintenance of Autonomy (PRISMA) of the University Research Centre of Quebec, Canada, the Canadian University Institute of Geriatrics and the Canadian Health Services Research Foundation with the aim of identifying seniors, requiring a full assessment to determine eligibility for integrated care services.
In adopting the PRISMA-7 project in 2018, the Friuli Venezia Giulia region relied on the multisectoral collaboration of the health and social services to implement the initiative, which is supported by the Regional Ministry of Health, Social Policies and Disability. PRISMA-7 increases policy coherence at the local level by promoting the empowerment and social inclusion of older people and an integrated, people-centred approach towards ageing and frailty.
The Friuli Venezia Giulia PRISMA-7 project to promote a healthier, more equitable society
This project has two phases, namely,:
- through short telephone interviews and using the 7-question screening tool, to identify people aged 75 and over who are at risk of frailty; and
- to discuss their conditions with them and ensure that they are provided with integrated support by involving their families, general practitioners and health and social services.
In 2018, more than 23 000 older people were interviewed, 38% of whom were identified as potentially frail. The local health services contacted them and their families to develop intersectoral interventions focused on prevention and early management.
A 75-year-old man, caring for his wife suffering from dementia, reports, “Taking part in the PRISMA-7 project helped me understand my wife’s clinical condition better, gave me reference points, and allowed me to access various services. Accepting and managing a severe disability alone was very hard. Thanks to the project, my life has improved, and I no longer feel alone”.
In 2018, Friuli Venezia Giulia implemented PRISMA-7 through the local health services in four districts. In 2019, the project is being scaled up and extended to all districts of the region, the aim being to map the level of frailty in the entire regional population.
Communication campaigns about PRISMA-7 conducted across the region are also increasing awareness about frailty in older people. The results of the project are informing and steering policies on better preventing and managing the condition and improving healthy life expectancy.
The PRISMA-7 project was showcased at the High-level conference on health equity: healthy, prosperous lives for all in the WHO European Region, Ljubljana, Slovenia, 11–13 June 2019, as a concrete measure towards providing the conditions required to assure healthier, more equitable and prosperous societies.