Receiving Care Through Digital Health Technologies: Drivers and Implications of Old-Age Digital Health Exclusion

AbstractThe transition from traditional to progressively digitised health systems is leading to new forms of care including, for instance, telehealth and mobile health (mHealth) solutions. On the one hand, such solutions hold the potential for allowing easier, quicker and remote access to health care. On the other hand, digital health technologies can set new challenges for older people, especially for those who are not familiar with such technologies, in terms of receiving the care they need through good access and level of use of services. Furthermore, these services do not necessarily reflect everyone's preferences and needs. This chapter aims to conceptualise and systematically discuss old-age digital health exclusion. First, we highlight key structural, environmental, individual and socio-technical drivers of the non-use and low-use of digital technologies, considering also the aspect of agency and personal preferences. Second, we point out the main individual and societal implications of old-age digital health exclusion. Third, we provide a conceptual framework for old-age digital health exclusion which includes older people, drivers and implications. Finally, we offer some reflections about digital health technologies in health care, highlighting related issues, risks and challenges for ageing societies

Active Ageing: The Need to Address Sub-National Diversity. An Evidence-Based Approach for Italy

Artículo 13319[Abstract] While active ageing has emerged as a main strategy to address the challenges of population ageing in Europe, recent research has stressed the need to increase knowledge on within-country differences to promote active ageing through appropriate policy responses. This article draws on the Active Ageing Index (AAI) to capture recent trends in active ageing in Italy with a focus on sub-national diversity. To this end, we compute AAI breakdowns by region separately for men and women for four different years: 2007, 2009, 2012 and 2018. Then, we use linear regression to describe the geographical and sex-specific patterns of change in the AAI over the considered period. The results demonstrate the diversity of regional outcomes and trends in the active ageing of Italian men and women, indicating that the widening geographic gap deserves further consideration by national and regional authorities in designing and implementing active ageing policies. By showing the persistence of disparities in the value of the indicator to the disadvantage of women, results also suggest the need to further integrate both the gender dimension and the life-cycle perspective into active ageing strategies. This article provides an example of how the AAI can be used as a practical tool by policy makers to monitor active ageing trends and outcomes at the sub-national level, and to identify target areas that require further action

Mapping variability in allocation of Long-Term Care funds across payer agencies in OECD countries

Introduction: Long-term care (LTC) is organized in a fragmented manner. Payer agencies (PA) receive LTC funds from the agency collecting funds, and commission services. Yet, distributional equity (DE) across PAs, a precondition to geographical equity of access to LTC, has received limited attention. We conceptualize that LTC systems promote DE when they are designed to set eligibility criteria nationally (vs. locally); and to distribute funds among PAs based on needs-formula (vs. past-budgets or government decisions). Objectives: This cross-country study highlights to what extent different LTC systems are designed to promote DE across PAs, and the parameters used in allocation formulae. Methods: Qualitative data were collected through a questionnaire filled by experts from 17 OECD countries. Results: 11 out of 25 LTC systems analyzed, fully meet DE as we defined. 5 systems which give high autonomy to PAs have designs with low levels of DE; while nine systems partially promote DE. Allocation formulae vary in their complexity as some systems use simple demographic parameters while others apply socio-economic status, disability, and LTC cost variations. Discussion and conclusions: A minority of LTC systems fully meet DE, which is only one of the criteria in allocation of LTC resources. Some systems prefer local priority-setting and governance over DE. Countries that value DE should harmonize the eligibility criteria at the national level and allocate funds according to needs across regions

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

17.06.2020. 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.This study was co-funded by the Erasmus+ programme of the European Union, under the Project “Apps for carers”, Grant Agreement n. 2016-1-SE01-KA204-022067. This study was partially supported by Ricerca Corrente funding from the Italian Ministry of Health to IRCCS INRCA

Recruitment of adolescent young carers to a psychosocial support intervention study in six European countries: lessons learned from the ME-WE project

Young carers provide a substantial amount of care to family members and support to friends, yet their situation has not been actively addressed in research and policy in many European countries or indeed globally. Awareness of their situation by professionals and among children and young carers themselves remains low overall. Thus, young carers remain a largely hidden group within society. This study reports and analyses the recruitment process in a multi-centre intervention study offering psychosocial support to adolescent young carers (AYCs) aged 15–17 years. A cluster-randomised controlled trial was designed, with recruitment taking place in Italy, the Netherlands, Slovenia, Sweden, Switzerland and the United Kingdom exploiting various channels, including partnerships with schools, health and social services and carers organisations. In total, 478 AYCs were recruited and, after screening failures, withdrawals and initial dropouts, 217 were enrolled and started the intervention. Challenges encountered in reaching, recruiting and retaining AYCs included low levels of awareness among AYCs, a low willingness to participate in study activities, uncertainty about the prevalence of AYCs, a limited school capacity to support the recruitment; COVID-19 spreading in 2020–2021 and related restrictions. Based on this experience, recommendations are put forward for how to better engage AYCs in research

Research and Innovation for and with Adolescent Young Carers to Influence Policy and Practice—The European Union Funded “ME-WE” Project

Young carers are children and adolescents who provide care to other family members or friends, taking over responsibilities that are usually associated with adulthood. There is emerging but still scarce knowledge worldwide about the phenomenon of young carers and the impact of a caring role on their health, social and personal development spheres. This paper provides an overview of the main results from the ME-WE project, which is the first European research and innovation project dedicated to adolescent young carers (AYCs) (15–17 years). The project methods relied on three main activities: (1) a systematization of knowledge (by means of a survey to AYCs, country case studies, Delphi study, literature review); (2) the co-design, implementation and evaluation of a primary prevention intervention addressing AYCs’ mental health (by means of Blended Learning Networks and a clinical trial in six European countries); (3) the implementation of knowledge translation actions for dissemination, awareness, advocacy and lobbying (by means of national and international stakeholder networks, as well as traditional and new media). Project results substantially contributed to a better understanding of AYCs’ conditions, needs and preferences, defined tailored support intervention (resilient to COVID-19 related restrictions), and significant improvements in national and European policies for AYCs

The role of semiotic textology in assessing ict-based intervention for carers.

Information and communication technologies (ICTs) are a powerful driver of development in many fields, especially experimenting their potentialities in supporting people’s activities and, in a direct or indirect way, quality of life. In particular, research on technologically-innovative care and support services is currently addressing needs of dependent older people and their family carers. There is some evidence that demonstrates the positive impact of such technology-based interventions on these categories of users in many different ways.\ud However, research in this specific field has been affected by several limits. In fact, current practice in impact assessment of ICT-based interventions is lacking of good evidence that can explain in a systematic way the outcomes of single technologies, failing to lead to comparable results: there is few attention in describing the nature of ICTs, their features and the type of communication established. There is a gap concerning the role of communication research in the field, not yet considered. The paradox is to plan, implement and evaluate an ICT-based intervention without considering at any stage the initiative from a communication point of view, i.e. its real essence. In fact, when talking about ICT-based services, we are basically dealing with the broad fields of human communication and signification processes. Even if some applications of communication sciences can be found in the field of public health, no research was conducted on the impact of ICTs on home care contexts from a communication perspective.\ud In this sense, the Semiotic Textology discipline was never applied neither to the public health sector nor to ICTs: since it works with an interdisciplinary framework and with a complex notion of sign, as well as with a metalanguage for making different disciplines interoperate with the same concepts, it may constitute a good theoretical framework for analysing features and functions of social (communication) interactions enabled by ICTs in home care settings.\ud This dissertation aims to fill the previous mentioned gaps through the development of an interdisciplinary theoretical framework for assessing the impact of ICT-based interventions for carers, applying and adapting selected theoretical instruments from Semiotic Textology. The attempt is to consider such initiatives from a communicative point of view – totally missing from current research – and show the added value of a well-defined framework that puts communication at its centre. Indeed, the development of a theoretical and conceptual framework is the main output of the present research. Of course, such a goal required a multi-step methodology to be achieved.\ud A general literature review on Semiotic Textology is carried out in order to explain the main theoretical pillars. This is a necessary step, since literature is very fragmented (even in more languages) and there are no updated, comprehensive works summarising the discipline. As well, also a literature review on ICT-based interventions for carers is carried out as means for identifying a conceptual core framework from available evidence. The review aims to summarise results from recent papers (2000-2011) describing the impact of initiatives and to discuss them according to some crucial communication dimensions: technologies, actors, interactions and proximal goals. In addition, a general methods section aims to describe the CARICT project, its methodology and findings, because the final framework is developed on the basis of the data-set created within the project: CARICT mapped and analysed over 50 ICT-based interventions for carers in Europe, that constitutes the largest database available at this time. \ud The overall theoretical and conceptual framework is developed by integrating results and implications coming from the literature review with recent European studies that analysed in-depth these ICT-based solutions. Such operation is finalised by the development of semiotic-textological theoretical constructs and their application to the CARICT database, which allowed to consider further improvements of the framework. Finally, the overall framework is further developed and structured into five typologies of constitutive factors – addressing the main aspects of communication and signification processes in ICT-based interventions – through a detailed analytical framework that deconstructed each intervention in minimum interactions providing a formalisation of their features.\u

Strategie retoriche e mondi possibili nel linguaggio delle icone software

Al giorno d’oggi è innegabile l’importanza che i dispositivi elettronici hanno acquisito nella nostra vita quotidiana. Il rapporto uomo-macchina, in questi casi, si realizza in gran parte attraverso l’utilizzo di interfacce grafiche che ci permettono di manipolare e controllare i dati intangibili e le funzioni degli apparecchi. Nel corso del tempo il linguaggio grafico è stato raffinato per facilitare l’usabilità dei prodotti: a questo scopo, gli elementi visivi nelle interfacce digitali sono andati convergendo verso standard convenzionalmente accettati, in modo da permettere a chiunque un utilizzo intuitivo e proficuo degli strumenti elettronici.Il ruolo delle icone nella dimensione digitale merita un particolare approfondimento. La capacità delle icone di rinviare intuitivamente ad un determinato senso convenzionale dipende in gran parte dai meccanismi retorici che attivano. Anche se il processo di ideazione di questi elementi è spesso lasciato all’intuizione libera dei creativi, è possibile rintracciare delle vere e proprie strategie retoriche implicite che permettono all’icona di adempiere le proprie funzioni comunicative.Attraverso l’analisi di alcuni casi celebri, si vuole affrontare l’innovazione del linguaggio iconico nel mondo digitale attraverso i punti di vista della retorica e della semiotica, anche in relazione ai mondi possibili che un linguaggio di tale complessità sottintende

Kieran Walsh, Gemma M. Carney and Áine Ní Léime (eds.) (2015). Ageing through Austerity: Critical Perspectives from Ireland. Bristol, UK: Policy Press, 196 pp. ISBN 978 1 4473 1623 7 (hardback)

n/