Caroline Wachtler

Research problem and specific questionsWorldwide, welfare societies strive to overcome fragmentation of services through increased integration. Despite this, evidence and support is lacking to guide local actors in social services and primary care on how to co-create integration with and for end users, such as older people. The aim is to, together with local actors and older people, develop and evaluate a research-based toolbox to integrate services for older people in need of both social services and primary care.What support do local actors need to co-create, test and monitor improvements of integrated services?What content, structure and design are needed in a toolbox to support local actors in co-creating, testing, and monitoring integrated services?What is the feasibility, perceived value, and impact of the toolbox?Data and methodThis participatory action research project comprises of three work packages (WP). In WP 1, we will use a participatory, longitudinal multiple case study design including four cases to explore actors’ need of support. In WP 2, we will use a Delphi-study design and participatory methods to develop the toolbox. In WP 3, we will use an observational case study design to evaluate feasibility, value, and impact. Data will be generated through structured and semi-structured observations, focus group and individual interviews, and surveys. Data will be analyzed with qualitative and quantitative methods.Societal relevance and utilisationA welfare society reform is launched in Sweden to integrate services and meet the needs of an aging population. However, the task of developing, implementing, and evaluating integrated services is a complex challenge that requires collaborative approaches, involving multiple stakeholders and end users. Yet, this task has been delegated primarily to local actors with limited decision-making mandates and possibilities to involve end users. The toolbox will support local actors with practical tools to co-create integrated services with and for older people.Plan for project realisationThe project will be conducted in collaboration between five Research and Development Units in Stockholm with partnering stakeholders in social services, primary care, and pensioner organizations. Costs for stakeholders’ involvement are included in the budget.

This study aims to prevent the development of dementia in individuals with mild cognitive impairment (MCI) through innovative solutions for early detection, precision diagnostics, and individualized evidence-based prevention and treatment.The epidemiological part will focus on two aspects: the impact of depression and sleep disturbances on cognitive impairment and dementia development and use register data and AI to develop a risk prediction model to identify people at risk for MCI, Alzheimer disease, and other dementia early in primary health care. Both risk factors and protective factors will be examined, thus the model will suggest individuals who should be further evaluated for MCI, Alzheimer´s, and other forms of dementia and provide support for preventive advice and interventions.The clinical part aims to determine the clinical and health economic value of a precision diagnostic algorithm based on a combination of digital cognitive tests and blood-based biomarkers in the assessment of subjective cognitive complaints (SCC) in primary care. The study will actively screen for SCC among individuals at increased risk of dementia, with risk factors including age, hypertension, and/or type II diabetes mellitus. Digital cognitive tests and blood-based biomarkers will be utilized to diagnose SCC, mild cognitive impairment (MCI), and dementia due to Alzheimer´s disease, as well as to examine how these biomarkers predict disease conversion after two years.