Approach

The Vision of A3 EIP-AHA Working Group on Nutrition

The Working Group on Nutrition, a subgroup of the A3 Action Group in the European Innovation Partnership on Active and Healthy Ageing (EIP-AHA) has developed a common, integrated vision on the nutritional approach to frailty, taking into account also the impact of social integration and psychosocial behavior of the elderly.

The focus is to carry out personalized interventions that take advantage of validated screening, assessment and monitoring tools, recognizing a coherent set of work packages aimed at a common goal.

The core vision is worked out in the 2 Pyramids Model (Screening, Assessment & Monitoring Pyramid - Action Pyramid) leading to:

inclusion of all the commitments in the Working Group on Nutrition (and the knowledge gathered);
innovative & implementable programs for prevention and adequate care;
substantial added value for EIP-AHA & the people in the EU,

and benchmarking with the WHO approach on health care, through:

early detection (screening, assessment, monitoring) of risk factors;
appropriate triaging and intervention (action pyramid);
follow-up (monitoring).

Stepstones

1. Action Pyramid

The strategy of the A3-Nutrition Working Group is focused on a culinary/clinical approach to food.

By introducing the Action Pyramid (similar to the idea of Maslow’s hierarchy of needs), we aim to enlarge the view on nutrition.

The Action Pyramid is based on a collaborative model between the culinary approach and the clinical approach, that is:

person-centered
evidence-based and epc-informed (evidence, practice, creative)
functionally interoperable with relevant topics, such as food safety and nutritional contents, regional needs.

Fig. 1: Action Pyramid; our approach represented as a modified food pyramid.

2. Culi-clinical approach

The culinary/clinical approach is similar to the partitioning of health care by the WHO: primary, secondary, tertiary.

Culinary approach (primary food care)
Culi-clinical approach (collaboration primary food care/secondary nutritional care)
Clinical approach (secondary nutritional care).

Fig. 2: Action Pyramid; our approach represented as a modified food pyramid with 3 levels.

3. Two Pyramids Model (Screening, Assessment & Monitoring Pyramid - Action Pyramid)

By assembling all the validated screening, assessment and monitoring tools on malnutrition in a pyramid interrelated to the action pyramid, the A3-Nutrition WG launches her common, integrated vision on the nutritional approach to frailty; the SAM-AP Model.

Fig. 3: SAM Pyramid (Screening, Assessment & Monitoring) with 3 levels.

The Screening & Assessment Pyramid shows the ranking of variables or tools needed to screen, assess, or monitor malnutrition and that eventually may result in consultation of a health care professional. This model applies to the various health care settings (community level, hospitals and nursing homes). The SAM-AP Model is dynamic, in which levels of care and levels of food care may change over time. Moreover the screening and assessment may result in food & nutritional care from all levels of the Action Pyramid. For example Secondary Care may be related to Primary Food Care and so on.

Fig. 4: The 2 Pyramids Model of the A3-Nutrition WG showing a common, integrated vision on the food & nutritional approach to frailty.

4. Digital Food Platform

The digital version of the 2 Pyramids Model can be brought into practice allowing close collaboration between all actors involved at the lowest operational cost by scaling it up to European digital level.

The idea of a SAM-AP Digital Food Platform fits into the idea of the three pillar model in operational food care, built on the concept that food and nutritional information can be important in the medical record, in the nursing record and the dietetic record as well as in the food & nutrition record.

In this vision, authorized professionals have also access to the food & nutrition records in the platform (not the other way around), and/ or can automatically pick up the food & nutritional information needed.

In the SAM-AP Digital Food Platform:

the concept of transmurality is crucial. Wherever a patient may be, his food & nutrition record will always be available, because it is managed centrally and not bound to an organization or doctor.
the person-centered concept is crucial. The individual person decides who can see, use, add, and share his personal data, and which food/health apps have access to it. He/she is the owner of his record and no food/health information is provided to any other app or service without permission by the owner. Furthermore, the individual person has a crucial role in the decision making in the SAM-AP Model.
the community-based approach is crucial. This means that further development of the platform can be a joint effort with other partners, because we believe that in this way together we can build something very unique that eventually can lead to a healthier and happier life, resulting in less medical expenses.

The outline broad approach translates into personalized interventions to be scaled up, and has the potential to contribute/reach the EC goal to increase the average healthy lifespan in the EU by two years by 2020 in a more accessible way.

The SAM-AP Model was published in “Advances in Public Health”, Volume 2016, Article ID 5678782, 9 pages.