A Holistic Infrastructure to Support Elderlies' Independent Living

Background

In a common medical sense, the frail elderly have an advanced age, chronic pathologies, clinical instability, social isolation and a certain degree of disability. The condition of “pre-frailty” is present when only a few frailty factors are observed.

In Italy, there are one million of frail patients, and this number will double in next 20 years, with a consequent proportional increase in healthcare spending related to their management. Therefore, it is a fundamental goal for scientific research to define objective and standardized criteria of classification for these patients and for prediction of the temporal evolution of their frailty in order to implement appropriate forms of early diagnosis, monitoring of disease status and of intervention at the local and national level.

Within the framework of the EU initiative “Innovation Partnership on Active and Healthy aging” (EIP-AHA), the document “Prevention of functional decline and frailty”, action plan number 3 “Prevention and early diagnosis of frailty and functional decline, both physical and cognitive, in older people” issued at the 1st Conference of Partners on November 6th, 2012 in Brussels, clearly shifts the objective from “frailty” to “pre-frailty”, revealing the necessity not only to define diagnostic criteria but also prediction models with the “active elderly” population as their target. Moreover, the document reveals the need to add cognitive performance indicators, currently not always included in clinical status scales and in the frailty evaluation models, defining the “multidimensional and functional decline” due to physical and cognitive causes or their combination.

The need to implement indices and clinical practices for the collections of information related to cognitive functions comes from the dramatic increase in the probability of developing Alzheimer’s disease (AD), a neurodegenerative process which extends for several years without any manifestations of cognitive decline (pre-clinical phase). Then, for some years, there is a slight objective cognitive decline, called mild cognitive impairment (MCI). In a remarkable percentage of cases (approximately 50%) amnesic MCI subjects can be considered as prodromal AD that, after a few years, progresses into a serious cognitive impairment and loss of functional autonomy. To diagnose AD in the pre-clinical or prodromal phase, distinguishing it from benign cognitive deficits related to reversible psycho-physical condition, instrumental tests have been developed, such as the examination of beta and tau amyloid proteins in the cerebrospinal fluid, the volume of the hippocampus and of the cerebral cortex through magnetic resonance imaging (MRI), the assessment of cerebral metabolism and of the accumulation of beta amyloid through positron emission tomography (PET).