The International Journal of Integrated Care

Introduction According to the World Health Organization (WHO), the global population is aging at a significantly accelerated pace compared to historical trends. The demographic cohort aged 60 years and above is projected to escalate from 1 billion in 2020 to 1.4 billion. By 2050, this geriatric population segment will have doubled, reaching 2.1 billion individuals worldwide [1].

Introduction Priority populations are defined as specific groups within society who experience social disadvantage, poorer overall health, and inequities—such as avoidable and unfair differences in health status [1].

Introduction According to the latest data released by the World Health Organization, noncommunicable diseases caused the deaths of at least 43 million people in 2021, equivalent to 75% of non-pandemic-related deaths globally [1]. The rising prevalence of chronic conditions and multimorbidity highlights that populations requiring complex healthcare are expanding, straining health systems globally.

Context and Aim Chronic conditions often affect work capacity yet work participation as a treatment goal is frequently overlooked. This paper presents a Work-oriented Care Model (WoCM) that integrates work into clinical treatment and emphasizes collaboration with clinical occupational physicians (COPs) and nurses [1, 2]. The model aims to bridge gaps between healthcare and occupational health by aligning patient goals with (clinical) decision-making and promoting early, coordinated action.

Introduction The world population is expected to age significantly, as is the European population. The United Nations Department of Economic and Social Affairs predict that in 2050, 34% of the European population may be over 60 years old [1]. Ageing is related to frailty, disability, and multimorbidity [2] with a higher risk of adverse outcomes such as falls. This often results in complex care needs [3, 4].

Introduction Tuberculosis (TB) and diabetes mellitus (DM) represent growing dual epidemics with significant public health implications, particularly in South Asian countries [1] where both conditions are highly prevalent with three countries accounted for 35.8% for global total for tuberculosis include India (26%), Pakistan (6.3%), and Bangladesh (3.5%) [2] and diabetes prevalence in this region increase to 22.30% in 2020-2024 [3].

Introduction Use of primary care services increases with age. In Denmark, 12% of women and 8% of men aged 65 or older receive such assistance [1]. Older adults account for approximately 250,000 hospitalised individuals annually, totalling about 600,000 admissions [2]. The transition from hospital to home for older adults, those aged 65 years and older, is a dynamic process where changes are experienced [3, 4].

Introduction Contemporary mental health services (MHS) require integrated services and professional and organisational collaboration to meet recovery goals of service users with complex mental health needs [1, 2, 3]. Modern care policy emphasises person-centeredness [4, 5], and integrated care models attending to both acute crisis and long-term needs. Continuous and coordinated care and support are considered cornerstones in such high-quality support [6].

Introduction Frailty, defined as an accumulation of ‘deficits’ such as hearing loss or cognitive decline [1], is strongly associated with increased use of health and social care services [2, 3]. This includes high rates of unscheduled urgent frailty care, which is increasing pressure on emergency departments (ED), inpatient beds, and producing poorer outcomes for older frail patients [4, 5, 6]. A significant proportion of ED visits are considered either inappropriate or avoidable [7, 8].

When the International Foundation for Integrated Care (IFIC) first published the Nine Pillars of Integrated Care in 2020, the world was in the early months of the COVID-19 pandemic. The framework, conceived as a Call to Action to accelerate the global shift to integrated care, articulated nine conditions that any health and care system needs in place for integration to sustain and scale [1].