Socioeconomic Predictors of the Employment of Migrant Care Workers by Italian Families Assisting Older Alzheimer's Disease Patients: Evidence from the Up-Tech Study

Background: The availability of family caregivers of older people is decreasing in Italy as the number of migrant care workers (MCWs) hired by families increases. There is little evidence on the influence of socioeconomic factors in the employment of MCWs. Method: We analyzed baseline data from 438 older people with moderate Alzheimer's disease (AD), and their family caregivers enrolled in the Up-Tech trial. We used bivariate analysis and multilevel regressions to investigate the association between independent variables - education, social class, and the availability of a care allowance - and three outcomes - employment of a MCW, hours of care provided by the primary family caregiver, and by the family network (primary and other family caregivers). Results: The availability of a care allowance and the educational level were independently associated with employing MCWs. A significant interaction between education and care allowance was found, suggesting that more educated families are more likely to spend the care allowance to hire a MCW. Discussion: Socioeconomic inequalities negatively influenced access both to private care and to care allowance, leading disadvantaged families to directly provide more assistance to AD patients. Care allowance entitlement needs to be reformed in Italy and in countries with similar long-term care and migration systems. � 2015 The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved

COMPLEX DOMAIN FLEXIBLE NON-LINEAR FUNCTION FOR BLIND SIGNAL SEPARATION

In this paper a new adaptive non-linear function for blind complex domain signal processing is presented. It is based on a couple of spline functions, one for the real and one for the imaginary part of the input, whose control points are adaptively changed using gradient-based techniques. B-splines are used, because they allow to impose only simple constraints on the control parameters in order to ensure a monotonously increasing characteristic. This new adaptive function is then applied to the outputs of a one-layer neural network in order to separate complex signals from mixtures by maximizing the entropy of the function outputs. We derive a simple form of the adaptation algorithm and present some experimental results that demonstrate the effectiveness of the proposed method

eHealth in integrated care programs for people with multimorbidity in Europe: insights from the ICARE4EU project.

Introduction: Care for people with multimorbidity requires an integrated approach in order to adequately meet their complex needs. In this respect eHealth could be of help. This paper aims to describe the implementation, as well as benefits and barriers of eHealth applications in integrated care programs targeting people with multimorbidity in European countries, including insights on older people 65+. Methods: Within the framework of the ICARE4EU project, in 2014, expert organizations in 24 European countries identified 101 integrated care programs based on selected inclusion criteria. Managers of these programs completed a related on-line questionnaire addressing various aspects including the use of eHealth. In this paper we analyze data from this questionnaire, in addition to qualitative information from six programs which were selected as ‘high potential’ for their innovative approach and studied in depth through site visits. Results: Out of 101 programs, 85 adopted eHealth applications, of which 42 focused explicitly on older people. In most cases Electronic Health Records (EHRs), registration databases with patients’ data and tools for communication between care providers were implemented. Percentages were slightly higher for programs addressing older people. eHealth improves care integration and management processes. Inadequate funding mechanisms, interoperability and technical support represent major barriers. Conclusion: Findings seems to suggest that eHealth could support integrated care for (older) people with multimorbidity. (aut. ref.

How to improve care for people with multimorbidity in Europe? Policy Brief 23. Health systems and policy analysis.

European health systems do not meet the needs of patients with multimorbidity because they are “disease oriented” and organized around single medical specialties which fragments care. Fragmented care is associated with contradictory medical advice, over-prescribing, over-hospitalization and poor patient satisfaction. Policy-makers can improve care for people with multimorbidity by better integration. Making care patient-centred is another way of approaching the fragmentation of care and of increasing patient satisfaction. It requires a clear strategic (and ideally shared) vision. Policy-makers can foster both integrated and patient-centred care by: Aligning policy, regulatory and financial environments so that they are supportive of integrated care and help make effective care for people with multimorbidity sustainable; Developing multidisciplinary guidelines; Developing new professional roles (e.g. care coordinator) or functions and assigning explicit responsibility for coordination and links between sectors; Implementing individualized care planning (supported by integrated electronic health records); Putting in place electronic decision support systems that enable patient-centred care and integrating them with information systems and eHealth applications; Adapting privacy and data protection legislation to allow sharing of patient information; Investing in training and tools that help care professionals adopt patient-centred approaches (including training in patient-centred communication and multiprofessional and intersectoral teamwork); Developing the knowledge and skills of patients and their informal carers and encouraging active participation in decision-making and self-management; Promoting collaboration between health care, social care, patient organizations and carers; Including patient-relevant outcomes as performance indicators, as well as clinical outcomes, so that providing integrated care becomes part of quality measurement; Putting in place payment mechanisms to incentivize patient-centred integrated care. The continuous evaluation of innovative practices is needed over the long term to identify effective elements and further strengthen patient-centred integrated care. (aut. ref.

Summarizing evidence on the personalisation of care in Europe

International audienc

Review and Selection of Online Resources for Carers of Frail Adults or Older People in Five European Countries: Mixed-Methods Study

BACKGROUND: Informal carers have a crucial role in the care of older people, but they are at risk of social isolation and psychological exhaustion. Web-based services like apps and websites are increasingly used to support informal carers in addressing some of their needs and tasks, such as health monitoring of their loved ones, information and communication, and stress management. Despite the growing number of available solutions, the lack of knowledge or skills of carers about the solutions often prevent their usage. OBJECTIVE: This study aimed to review and select apps and websites offering functionalities useful for informal carers of frail adults or older people in 5 European countries (Cyprus, Greece, Italy, Portugal, and Sweden). METHODS: A systematic online search was conducted from January 2017 to mid-March 2017 using selected keywords, followed by an assessment based on a set of commonly agreed criteria and standardized tools. Selected resources were rated and classified in terms of scope. Focus groups with informal carers were conducted to validate the list and the classification of resources. The activities were conducted in parallel in the participating countries using common protocols and guidelines, a standardization process, and scheduled group discussions. RESULTS: From a total of 406 eligible resources retrieved, 138 apps and 86 websites met the inclusion criteria. Half of the selected resources (109/224, 48.7%) were disease-specific, and the remaining resources included information and utilities on a variety of themes. Only 38 resources (38/224, 17.0%) were devoted specifically to carers, addressing the management of health disturbances and diseases of the care recipient and focusing primarily on neurodegenerative diseases. Focus groups with the carers showed that almost all participants had no previous knowledge of any resource specifically targeting carers, even if interest was expressed towards carer-focused resources. The main barriers for using the resources were low digital skills of the carers and reliability of health-related apps and websites. Results of the focus groups led to a new taxonomy of the resources, comprising 4 categories: carer's wellbeing, managing health and diseases of the care recipient, useful contacts, and technologies for eldercare. CONCLUSIONS: The review process allowed the identification of online resources of good quality. However, these resources are still scarce due to a lack of reliability and usability that prevent users from properly benefiting from most of the resources. The involvement of end users provided added value to the resource classification and highlighted the gap between the potential benefits from using information and communication technologies and the real use of online resources by carers