Background: Modern health systems are increasingly faced with the challenge to provide effective, affordable and accessible health care for people with chronic conditions. As evidence on the specific unmet needs and their impact on health outcomes is limited, practical research is needed to tailor chronic care to individual needs of patients with diabetes. Qualitative approaches to describe professional and informal caregiving will support understanding the complexity of chronic care. Results are intended to provide practical recommendations to be used for systematic implementation of sustainable chronic care models. Method: A mixed method study was conducted. A standardised survey (n = 92) of experts in chronic care using mail responses to open-ended questions was conducted to analyse existing chronic care programs focusing on effective, problematic and missing components. An expert workshop (n = 22) of professionals and scientists of a European funded research project MANAGE CARE was used to define a limited number of unmet needs and priorities of elderly patients with type 2 diabetes mellitus and comorbidities. This list was validated and ranked using a multilingual online survey (n = 650). Participants of the online survey included patients, health care professionals and other stakeholders from 56 countries. Results: The survey indicated that current care models need to be improved in terms of financial support, case management and the consideration of social care. The expert workshop identified 150 patient needs which were summarised in 13 needs dimensions. The online survey of these pre-defined dimensions revealed that financial issues, education of both patients and professionals, availability of services as well as health promotion are the most important unmet needs for both patients and professionals. Conclusion: The study uncovered competing demands which are not limited to medical conditions. The findings emphasise that future care models need to focus stronger on individual patient needs and promote their active involvement in co-design and implementation. Future research is needed to develop new chronic care models providing evidence-based and practical implications for the regional care setting.

Background: Modern health systems are increasingly faced with the challenge to provide effective, affordable and accessible health care for people with chronic conditions. As evidence on the specific unmet needs and their impact on health outcomes is limited, practical research is needed to tailor chronic care to individual needs of patients with diabetes. Qualitative approaches to describe professional and informal caregiving will support understanding the complexity of chronic care. Results are intended to provide practical recommendations to be used for systematic implementation of sustainable chronic care models. Method: A mixed method study was conducted. A standardised survey (n = 92) of experts in chronic care using mail responses to open-ended questions was conducted to analyse existing chronic care programs focusing on effective, problematic and missing components. An expert workshop (n = 22) of professionals and scientists of a European funded research project MANAGE CARE was used to define a limited number of unmet needs and priorities of elderly patients with type 2 diabetes mellitus and comorbidities. This list was validated and ranked using a multilingual online survey (n = 650). Participants of the online survey included patients, health care professionals and other stakeholders from 56 countries. Results: The survey indicated that current care models need to be improved in terms of financial support, case management and the consideration of social care. The expert workshop identified 150 patient needs which were summarised in 13 needs dimensions. The online survey of these pre-defined dimensions revealed that financial issues, education of both patients and professionals, availability of services as well as health promotion are the most important unmet needs for both patients and professionals. Conclusion: The study uncovered competing demands which are not limited to medical conditions. The findings emphasise that future care models need to focus stronger on individual patient needs and promote their active involvement in co-design and implementation. Future research is needed to develop new chronic care models providing evidence-based and practical implications for the regional care setting.

Ein gesundes Alter(n) ist sowohl auf individueller Ebene als auch auf gesellschaftlicher Ebene von großer Relevanz. So wächst die Bedeutung von Prävention und Gesundheitsförderung bis ins hohe Alter – einerseits, um die Autonomie, Selbstbestimmtheit, soziale Teilhabe und Lebensqualität des älteren Menschen aufrecht zu erhalten und andererseits, um den durch den demografischen Wandel bedingten gesundheitspolitischen Herausforderungen begegnen zu können. Dabei weist der gesundheitliche Status im Alter neben hoher Vulnerabilität eine Vielzahl an Ressourcen und somit Ansatzpunkte für präventive und gesundheitsförderliche Interventionen auf. Technische Innovationen bieten hier ein wachsendes Potenzial, um Maßnahmen dieser Art zu stützen. Zur Erschließung des neuartigen Themenfeldes werden die Ergebnisse dreier Einzeluntersuchungen berichtet, in welchen sowohl qualitative als auch quantitative Methoden angewandt werden. Mit Hilfe der Durchführung von Expertinneninterviews werden Bedarf und Potenzial innovativer Technik in Prävention und Gesundheitsförderung für Ältere und erste Anforderungen an eine solche Technik erfasst. Eine innovative Möglichkeit zur Umsetzung präventiver und gesundheitsförderlicher Interventionen bieten digitale Bewegungsspiele. So werden darauffolgend im Rahmen einer quasi-experimentellen Kohortenstudie gesundheitsbezogene Veränderungen durch das Spielen sog. Serious Games im Setting (teil-)stationäres Pflegewohnen evaluiert. Die Ergebnisse zeigen erste gesundheitsförderliche Tendenzen. Innerhalb einer Fokusgruppe werden abschließend drei digitale Bewegungsspielsysteme unter Beachtung zielgruppenspezifischer Bedarfe bewertet und notwendige Ressourcen für den erfolgreichen Einsatz im Anwendungskontext erarbeitet. Um die neugewonnenen Erkenntnisse in nachhaltiger Form nutzbar zu machen, werden diese in einem Anforderungskatalog für die erfolgreiche Implementierung eines digitalen Bewegungsspiels im Kontext der Pflege zusammengefasst. / Being healthy in old age and aging healthily is of great relevance at both the individual and societal level. Thus, the importance of prevention and health promotion even in an old age is growing - on the one hand, to maintain the autonomy, self-determination, social participation and quality of life of the elderly and, on the other hand, to be able to meet the health policy challenges caused by demographic change. Health in old age is not only highly vulnerable but also offers a multitude of resources and starting points for preventive and health-promoting interventions. Technical innovations offer a growing potential to support measures of this kind. In order to open up this new field of research, the results of three individual studies are reported, in which both qualitative and quantitative methods are applied. By conducting expert interviews, the need and potential of innovative technology in prevention and health promotion for the elderly as well as first requirements for such a technology are identified. Digital exercise games offer an innovative possibility for the implementation of preventive and health-promoting interventions. Subsequently, health-related changes caused by playing digital exercise games, so-called serious games, in the setting of nursing care are evaluated within the framework of a quasi-experimental cohort study. The results show first health-promoting tendencies through playing serious games. Last, three digital exercise game systems will be evaluated in a focus group on the basis of the needs of the target group. Additionally, the necessary resources for successful use of such systems in a real application context are developed in a participatory way. In order to make the newly gained knowledge usable in a way that is sustainable and relevant for practical use, it is then summarized in a catalogue of requirements for the successful implementation of a digital exercise game in the nursing environment.