Bridging Aging and Disability Networks: "Strategies for Translating Knowledge into Practice"

Luis Salvador-Carulla MD, PhD

A number of questions

–What is the context?

–What is the challenge?

–What is the alternatives?

– What are the main components?

– What are the examples?

Advances in the XXI Century

Ageing as an opportunity – New models of ageing Active ageing, Promotion, Mental capital– New services and care systems– Supports and HTs for ageing

Disability as an advantage• New models of disability (ICF)• Social Inclusion, Person centred care• Empowerement and Recovery• Accesibility and Employment• Supports and HTs for disabilities

C&S in the era of complexity

• Health promotion

• Integrative / holistic care

• Life-span approach

• Person-centred care

• Recovery

• Universality

• Mental capital

Integrative care model: 10 priority areas

• Pre-disease pathways - Life-span• Positive psychology - Health promotion• Genetics - Behavioural

phenotypes• Personal links - Risks and outcomes• Healthy communities• Inequities - Context / environment• People’s health• Effective interventions - Routine practice• New methods - Analysis of

complexity• Infrastructure - Costs and health

policy

MENTAL CAPITAL THROUGH THE LIFE COURSE:Flourishing through life / Early detect. & tx. / Chronic conditions

What is the challenge?

– We need to know more about the link D&A

• Persons with disabilities who grow old

• Older persons who become disabled

– AGEING as a field has a lot to contribute to

the field of DISABILITY and viceversa

– AGEING AND DISABILITY share common

values, models, needs and priorities

• Common policy agenda (implicit –

hidden)

Can we understand disability without ageing?

Can we understand ageing without disability’

In the D&A fields, their agents and principals do not talk to each other

and, when they talk they do not communicate

“If the word ‘X’ is used I will leave this table...”

“Your model is not acceptable for us...”

D&A Gap: Unwanted consequences

• Functional Dependency EU Recommendation

and related Dependency laws were based

exclusively on Ageing and failed to provide

effective coverage for SMI, ID and other

Disabilities in Europe

• UN Convention for Persons with Disabilities is

seen

as ‘alien’ by the ageing sector

• Missing opportunities of knowlegde, innovation

and policy change

Ejemplos

Similar programs without any transfer…

Evidence based care (EBC)

Evidence Informed

Policy (1)

Knowkedge Guided

Policy(2)

• RCT• Expt. approach

• EBC• Local information• Epid & Routine

• IEP• Expert knowledge

• Practical / Implicit K.

• Complex decision support systems

Paradigm shift in health/social policy

1. Lavis et al, Health Research Policy and Systems 2009 (SUPPORT MODEL )2. Gibert et al, Health Research Policy and Systems 2010 (EbCA MODEL)

A number of questions

–What is the context?

–What is the challenge?

–What is the alternative?

– What are the main components?

– What are the examples?

Health vs Social care

Disabilities vs Ageing

Transla

tion

al re

searchM

ult

idis

ciplin

ari

ty

www.bridgingknowledge.net

Barcelona 5 – 7 March 2009

BARCELONA DECLARATION Bridging knowledge in Long Term Care and Support

• Political stand to make bridging and knowledge transfer key components of any program in the fields of disability and ageing.

• Need for action involving policy makers and stakeholders, including those from the health, education, social and justice sectors, social partners, as well as civil society organisations.

• Improve the knowledge base• Previous declarations and principles of

“Nothing about us without us” and the “World and society of all ages”.

www.ijic.org

Where next?

A&D: Knowledge transfer

- WHAT KNOWLEDGE?

- HOW SHOULD IT BE TRANSFERRED?

- WHO TRANSFERS IT?

BRIDGING & KNOWLEDGE TRANSFER

– B/KT is a construct with two main domains• Bridging cannot be made without KT

• KT cannot be made without bridging

– Tension between perspectives

• Broad perspective without content

• High content without generalisability

– B/KT has both general aspects and specific

aspects in D&A fields

What is B/KT?

– B/KT is a meta-discipline, a social net & space, a tool for innovation• Translational• Multidisciplinary• Complex• Dynamic

– The value of a B/KT scientific road map is very limited but also necessary

B/KT scientific road map

• Framework model and conceptual map• Knowledge base • Usability & implementation• Monitoring and evaluation• Methods of design and analysis• Procedures and best practice sets• Dissemination strategies• Training • Support and care policy & priority setting

What knowledge & disciplines?

• Practical vs semantical knowledge

• Economics, Ethics, Legal, Technological,

Business...

• Health Ontology Explicit formal specification

of :

– Representation of health related objects,

concepts and other entities which it is assumed

that exist in a given field of interest

– Properties characterising these entities

– Relationship between different entities

Mental Retardation to Intellectual Disab.: Disabilities

or Disorders?

Salvador-Carulla & Bertelli, 2008

Intellectual Developmental Disorder (IDD)

A GROUP OF DEVELOPMENTAL CONDITIONS

CHARACTERIZED BY A EXTENSIVE IMPAIRMENT

OF COGNITIVE FUNCTIONS, WHICH ARE

ASSOCIATED WITH LIMITATIONS OF LEARNING,

ADAPTIVE BEHAVIOR AND SKILLS.

SYNSET: IDD / ID / MR / LD

Polynomious-polysemic approach

IDD ID

Salvador-Carulla et al, World Psychiatry, 2011

Health / Statistics / Research/ Policy / Social Inclusion / Rights

What is a Hospital?

G U ID A N C E A N D A S S E S S M E N T

IN F O R M AT IO N

IN F O R M A TIO N FO R C A R E

COMMUNICATION

PERSONAL ACCOMPANIMENT

CASE COORDINATION

PHYSICAL MOBILITY

OTHER ACCESSIBILITY CARE

ACCESIBILITY TO CARE

NON-PROFESSIONAL STAFF

PROFESSIONAL STAFF

SELF-HELP AND VOLUNTARYCARE

HOME & MOBILE

NON MOBILE

ACUTE

HOME & MOBILE

NON MOBILE

NON ACUTE(Continuing care)

OUTPATIENT CARE

EPISODIC

CONTINUOS

ACUTE

WORK

WORK RELATED ACTIVITIES

NON-WORK STRUCTURED CARE

NON STRUCTURED CARE

NON ACUTE

DAY CARE

24 HOURS PHYSICIAN COVER

NON 24H PHYSICIAN COVER

ACUTE

24H PHYSICIAN COVER

NON 24H PHYSICIAN COVER

OTHER RESIDENTIAL

NON ACUTE(Programmed Availability)

RESIDENTIAL CARE

LONG TERM CARE

050100150200250300350400450500

Andalucía

Islas Baleares

Cantabria

Castilla-La Mancha

Cataluña

Madrid

Murcia

Navarra

TBACamas

R4-R7 adultos HOSPITAL – RESIDENTIAL CARE

Large variability in availability of ‘hospital non-acute care’ with lowest level in Andalucia and highest in Catalonia

0

50

100

150

200

250

300Andalucía

Islas Baleares

Cantabria

Castilla-La Mancha

Cataluña

Madrid

Murcia

Navarra

TBACamas

R8-R13 adultos

HOW TO TRANSFER KNOWLEDGE? -

- New organisation-relational

strategies

- New research strategies

Impact analysis

Knowledge Discovery from

Data

Expert-based Cooperative

Analysis

- New implementation strategies

- New dissemination strategies

WHO TRANSFERS THE KNOWLEDGE? -

- Health knowledge brokers

- Champions

- Interpreneurs

- Intra-Interpreneurs

Harvard School of Engineering and Applied

Science

– Cuisine and Science

• Ferran Adria

The new model of society

demands us to share our

knowledge with others. If

you are a millionaire you

should share your money,

if you are ‘creative’ share

your ideas. In the global

society those who refuse

to share there knowledge

are socially dead

Ferran Adria