Center for research and care of aging : a strategy for an integrate approach

The effects of longevity, real revolution of this century, are producing significant impact on social and public health programs, on family life, economy, job placements and training of health care employees. Center for Research and Care of Aging is an organical structure which tries to face up to preventive medicine with a close connection with Family Medicine, through a broad range of innovative and comprehensive programs in clinical care and education, closely related to biomedical research. The structure is an University Training Center for junior faculty of Medicine, Nursing, Biotechnology and for Postgraduate students in Geriatric Medicine. Continuing Medical Education (CME) program in Geriatric Medicine and in Geriatric Rehabilitation is yearly planned. The organical stucture extends for 30.000 sq.m. downtown in Milan, provides at the ground floor a variety of clinical services, radiology, an ambulatory care center with over 3000 patients weekly (80% are over 65 years old; at the first floor are simmetrically located a 12-bed inpatient Acute Care for the Elderly Unit and 4-bed and DH 18-bed inpatients Rehabilitation Unit and 15-bed DH.Long-term care services are provided three floors up, in a 160-bed teaching nursing home with high standard of medical care. Patients with requiring intensive care can be admitted to Coronary Care Unit and Stroke Unit in the same hospital. This structure also provides 4000 sq.m. of laboratories dedicated to diagnostic assays and to research on neurobiology, endocrinology and metabolism, cardiovascular diseases, immunological disesases and longevity linked to both a clinical department and a basic science department, to promote our goal of building a strong basic science program devoted to the study of clinically-relevant issues related to aging. Clinical geriatric researchers are working on search adequate tools for a good management of older patients with multiple chronic conditions, to better define diagnostic and therapeutic courses of a given individual. Electronic health records (EHR) are being developed to improve communication as health information follows patients from one care setting to another (Acute care and Rehabilitation Unit, Nursing home) reducing fragmentation of services for seniors transitioning from one level of care to another and from one health care system to another. EHR systems must accommodate information germane to a senior frail population, including, but not limited to, functional assessments, cognitive assessments, and information on advance directives to correctly choose location and practice setting of patients. The EHR should provide prompts on prevention relevant to seniors and on potential errors, e.g. drug-drug interactions or excessive dosing, specific for older adults.