The global phenomenon of demographic aging is considered one of the greatest social and economic challenges of the 21st century (World Health Organization, 2014). The demographic changes have an impact on family and social structures due to worsening health status, functional capacity and autonomy associated with aging. This reality demands a readjustment by the international and national health systems, in order to make them economically sustainable without losing the capacity to respond in a timely and adequately way to the needs of older adults (Cesari et al., 2016). In this context, action plans aiming to increase healthy aging were developed. The World Health Organization (2014) and the European Innovation Partnership for Active and Healthy Aging (European Commission, 2016) have proposed action plans considering measures of health promotion and disease prevention that maximize the functional capacity of the elderly and promote the independence and autonomy (Apóstolo, Bobrowicz-Campos, Holland & Cano, 2018).
The arising need
One of the most problematic expressions of global aging is a condition of frailty (Clegg, Young, Iliffe, Rikkert, & Rockwood, 2013). As an age-related state of decreased physiological reserves, frailty is characterized by a weakened response to stressors associated with an increased risk of adverse health outcomes such falls, fractures, disability, dependence, hospitalization, institutionalization and death (Clegg et al., 2013). This clinical condition leads to a continuous decline in functional domains and increases the risk of development of geriatric syndromes (Apóstolo et al., 2018). Preventing the evolution of frailty is an emerging priority (Cesari et al., 2016) due to its high prevalence and consequences. As a vulnerable population, frail older adults must be empowered and should receive the support of different health professionals integrated into transdisciplinary teams (European Commission, 2015) working on the improvement of independent living to promote health care quality (Clegg et al., 2013).
Therefore, nurses should act in line with preferences for care, social norms and international/national policies and priorities, to warrantee the most feasible decision-making process that can be directed regardless frail older adult’s functional capacity (Donnelly, O’Brien, Begley, & Brennan, 2016). Nursing leadership associated to geriatric transdisciplinary research projects can work towards improvement and management of health-related outcomes of frail older adults based on the identified priorities and needs, and available resources (Cesari et al., 2016). Evidence-based practice constantly generates new challenges and establishes new research questions that should reflect those real needs of older adults. Innovative procedures from evidence-based practice are required as frail older adults needs and priorities are changing, especially considering the context of increasing technological society.
Older adults recognize that technology can have benefits for their independence and well-being, decreasing the impact of declining capacities (Donnelly et al., 2016). The future generations would benefit if interventions interconnected with digital solutions take older adults and their caregivers to act and intervene more in their health and maximize their functional capacity. To prepare nurses for leadership roles in geriatric care is essential to contribute to the improvement of health-related outcomes (Holm & Severinsson, 2014).
The MIND&GAIT project as a proposed solution
The MIND&GAIT project emerged as a response to the societal challenges. By adopting a transdisciplinary approach, the research team followed a methodology framework with a cross-disciplinary and problem-oriented research. The project with a multicentric and a co-designed approach proposed an integrated, creative and dynamic strategy to prevent frailty in older adults from elderly end-users organizations. It was conducted by a transdisciplinary research team, led by nurses and developed seven working packages in an 18 months period. It involved the areas of nursing, occupational therapy, sports sciences, mechanical and computer engineering. The MIND&GAIT aimed to build and disseminate a strategy to promote independent living of frail older adults by improving cognition and gait ability. To ensure the best solutions for frailty through the congregation of different types of expertise and “Know-how”, each research area established specific objectives and adopted adequate scientific methods.
Outputs and impact of the project
From this strategy had resulted: i) a combined intervention composed by a cognitive stimulation program and a structured and adapted physical exercise program, both with digital components; ii) an auto-blocking kit mechanism for rolling walkers as an assistive product to prevent falls; iii) a web platform to be used as a repository to provide digital intervention’s materials and results; iv) involvement of students from different research areas in the development of each working package; iv) academic research collaborations and multi-stakeholder partnerships; and vi) citizen engagement through the inclusion of older adults and caregivers during the research process. MIND&GAIT provided practical orientations based on science translation that guide and support nurses and another health professionals towards independence of frail older adults.
Transdisciplinary nursing leadership challenges
During the leadership process, nurses were able to contact with different and specific scientific languages of several research areas involved, a fact that made the initial communication complex. This complexity was overtaken during the development of each working package once different concepts, processes, mechanisms, approaches and methodologies demanded a constant concept adaptation and standardization. Nurses have noticed that similar languages and research processes were identified among the research areas of nursing, occupational therapy and sports sciences. However, the connection between nursing, occupational therapy and sports sciences with mechanical and informatics engineering was more difficult. Through this leadership role, nurses shared, received and analyzed the best project results and lead to translate the new knowledge into clinical practice.
Nursing leadership sustainability
As a guarantee of sustainability and expansion of geriatric nursing care, the MIND&GAIT project encouraged not only researchers but also the future generation of nurses by giving to the students an opportunity to collaborate in the project development. It also fostered the sense of transdisciplinary partnerships of all future professionals from the different areas involved.
Nurses are an important part of the healthcare systems. In this way, by disseminating this experience, the developed materials and produced solutions, MIND&GAIT will not only influence everyday clinical practice as described above but also may influence health policies. This influence on health policies will be materialized if policymakers understand the impact of the outcomes of this project and if it continues supporting and founding transdisciplinary health projects.
Acknowledgements
The current abstract is being presented on behalf of a research group and it is part of the MIND&GAIT Project - Promoting independent living in frail older adults by improving cognition and gait ability and using assistive products.
Funding
MIND&GAIT is a project in 02/SAICT/2016 reference number 023822 and is funded by the program COMPETE 2020 under the Scientific and Technological Research Support System, with an incentive of European Regional Development Fund (ERDF).