Background/Objectives: People aged 65 years and older who live alone and have limited functional abilities need support in many circumstances and for a variety of activities. This study was conducted to explore the available formal and informal help for seniors, using findings from the “Inclusive Ageing in Place” (IN-AGE) study. Methods: This descriptive study was carried out in 2019 in three Italian regions, i.e., Lombardy in the north, Marche in the centre, and Calabria in the south, and involved 120 older people who lived at home, either alone or with a personal/private care assistant (PCA). Using a mixed-methods approach revealed both qualitative (thematic/content analysis of narratives) and quantitative (quantifications of statements) results. Results: This study identified several needs of seniors in different circumstances concerning basic and instrumental activities of daily living (ADL and IADL), health, and mobility in/outside the home. The seniors reported that support was provided primarily by their families, followed by friends and neighbours. Public home services were considered insufficient. The participants also reported using mobility aids and instances of self-sufficiency. Conclusions: These results highlight the need to improve support services for frail seniors and to better integrate formal and informal caregiving to facilitate ageing in place and promote the well-being of older people. Adequate interventions should be implemented for both older people and their family caregivers, who play a central role in care.

Background Dementia is a growing global public health concern and India alone accounts for an estimated 4.1 million cases, a figure expected to rise substantially in coming decades. In such settings, dementia care is largely dependent on informal family caregivers, who often provide extensive, unpaid support with limited access to formal services. Caregiving is further complicated by low dementia awareness, cultural misconceptions, stigma, and inadequate healthcare infrastructure. This study aims to examine the multidimensional challenges faced by family caregivers of people living with dementia and to identify their unmet needs in urban areas of West Bengal, India. Methods Descriptive qualitative research design was adopted to explore caregivers’ lived experiences. Fourteen primary family caregivers were recruited using purposive and snowball sampling. Data were analysed using reflexive thematic analysis following Braun and Clarke’s six-phase framework. Ethical approval was obtained, and confidentiality was maintained throughout. Results Two overarching themes emerged: (1) multidimensional challenges in caregiving and (2) unmet needs of family caregivers. Key challenges included limited knowledge and awareness of dementia, distress associated with behavioural and psychological symptoms, cultural beliefs and misconceptions and stigma. Conclusion This study highlights the complex and interrelated challenges faced by family caregivers of people living with dementia in urban India. Findings underscore the urgent need for improved dementia awareness, accessible and integrated care services and culturally sensitive, person-centred approaches. Strengthening support systems for family caregivers, including education, healthcare access and psychological support is essential for enhancing caregiver well-being and ensuring sustainable dementia care in resource-limited settings.

BackgroundLoneliness is a subjective and distressing experience resulting from a discrepancy between desired and actual social relationships and represents an important public health concern among community-dwelling older adults. Although it can occur throughout the life course, older adults are particularly vulnerable because of age-related conditions such as multimorbidity, mobility limitations, sensory impairments, widowhood, and retirement. These factors highlight the need to understand loneliness as a multifactorial phenomenon requiring a multidimensional perspective considering biological, clinical, and psychosocial determinants and consequences.ObjectivesThis systematic literature review aims to investigate the extent to which the available literature on loneliness in older age adopts a multidisciplinary approach.Research design and methodsMultiple databases were searched and papers in biological, clinical and socio-psychological areas were selected according to predefined inclusion criteria and the PRISMA guidelines. Study characteristics (author, year of publication, methodology, and sample size) and contents (keywords, loneliness as primary or secondary outcome, multidisciplinary) were analysed.ResultsOne hundred thirty-one articles were selected: 22 biological; 51 clinical and 58 socio-psychological. Eighty-nine studies adopted quantitative methods, mostly concentrated in the biological area, while qualitative and mixed-method approaches are more common in the other two areas. In biological papers, loneliness is treated as an etiopathological factor or pathological condition, thus underestimating or denying its social significance. Clinical papers often associate loneliness with depression and socio-psychological ones do not investigate loneliness biological and clinical implications.Discussion and conclusionAlthough the COVID-19 was associated with a growing number of multidisciplinary studies, research on loneliness among older adults remains largely fragmented across disciplinary boundaries. Strengthening collaboration across biological, clinical, and psychosocial domains could contribute to a more comprehensive understanding of loneliness and support the development of more effective prevention and intervention strategies.

(1) Background: Older people ageing in place alone with functional limitations experience several difficulties in daily life, potentially hampering their social participation. This in turn could impact their perceived loneliness. This paper aims to investigate these issues based on findings from the IN-AGE (“Inclusive ageing in place”) study carried out in 2019 in Italy. (2) Methods: The focus of this paper is on the Marche region (Central Italy), where 40 qualitative/semi-structured interviews with seniors were administered in both urban and rural sites. A content analysis was carried out, in addition to some quantification of statements. (3) Results: Older people are mainly involved in receiving/making visits, lunches/dinners with family members and friends, religious functions, walking, and watching television (TV). Overall, the more active seniors are those living in rural sites, with lower physical impairments, and with lower perceived loneliness, even though in some cases, a reverse pattern emerged. The results also indicate some different nuances regarding urban and rural sites. (4) Conclusions: Despite the fact that this exploratory study did not have a representative sample of the target population, and that only general considerations can be drawn from results, these findings can offer some insights to policymakers who aim to develop adequate interventions supporting the social participation of older people with functional limitations ageing in place alone. This can also potentially reduce the perceived loneliness, while taking into consideration the urban–rural context.

The United Nations and European policy bodies encourage national governments to promote and implement active aging (AA), to address social and economic challenges linked to population aging. A crucial feature of AA as a construct is its multidimensionality. Indeed, a measuring tool of AA is the Active Ageing Index (AAI), a composite index which encompasses four domains (i.e., 1. Employment; 2. participation in society; 3. independent healthy and secure living; and 4. capacity and enabling environment for AA) for a total of 22 indicators within those domains. The aim of this study was to assess whether and to what extent AA was implemented in a multidimensional way within all the (20) Italian regional governments, over the period 2007-2018. An Italian ad-hoc version of the AAI was used. First, it was measured the percentage contribution of each AA domain to the overall growth of AA during the study’s time-frame. Then, ordinary least squares regression models were employed, to assess whether regional economic growth was correlated with the observed changes in the different AAI domains. Results show that changes in the AAI scores in Italy’s administrative regions are predominantly driven by changes in the employment domain. Thus, the implementation of multidimensionality was mostly neglected. Moreover, regional economic growth resulted to be positively associated with changes in the employment domain and negatively associated with changes in the participation in society domain. These results entail important implications for policy-making, as they highlight the need to promote AA multidimensionality more extensively.

Background and Objectives This study explores the association between informal caregiving for older adults and environmentally sustainable behaviors across the 27 European Union countries, aiming to identify how the gendered and domestic nature of environmentalism relates to senior care. Research Design and Methods Data from 41,742 respondents aged 16-74 were analyzed from the Survey of Gender Gaps in Unpaid Care, Individual and Social Activities, and conducted by a scientific consortium in 2022. Frequency of sustainable behaviors was measured across 10 indicators. Multilevel mixed-effects linear regressions examined associations between caregiving and sustainable behaviors, adjusting for demographic, socioeconomic, and attitudinal covariates. Results Informal caregivers engaged in eco-friendly actions significantly more frequently than noncaregivers across all 10 sustainable-behavior indicators (p < 0.001). The "caregiver effect" was strongest for sustainable-consumption choices like buying eco-friendly (beta = 0.16), fair-trade (beta = 0.15), and used products (beta = 0.17), and weaker for household practices such as recycling (beta = 0.05) and mindful resource consumption (beta = 0.06). Caregivers attained higher composite environmental behavior scores (33.93 +/- 8.23) than noncaregivers (31.88 +/- 8.00; p < 0.001). This association remained robust after adjusting for gender, age, education, employment, household size, attitudes, and other covariates. Caregiving had the strongest association with buying used items (beta = 0.20) and eco-friendly products (beta = 0.14). Country-level analyses revealed consistent caregiver versus noncaregiver differences, with the largest gaps in Southern and Eastern Europe. Discussion and Implications This is the first large-scale cross-national study that demonstrates a consistent association between older-adult caregiving and a wide range of environmentally sustainable behaviors. Results suggest the experience of caring for a vulnerable family member is closely related to a broader sense of social and environmental responsibility. Caregivers' heightened engagement in sustainable consumption positions them as potential early adopters and change makers. Findings highlight new avenues for environmental education and caregiver support initiatives that synergistically promote interpersonal and environmental care.

BackgroundIn Italy, population ageing is causing an unprecedented demand for long-term care (LTC) services, that led to the recent national reform of the LTC system (Law n. 33/2023). Since LTC services are provided by regional authorities, identifying drivers of and barriers to their use by older people and their family caregivers locally is very important to identify the mismatch between national regulation and local demand of these services.MethodsTo this purpose, in 2019-2020, 450 family caregiver (FC)-older care recipient (OCR) dyads from 13 healthcare districts of the Marche region (Central Italy) were surveyed. A Two-step Bayesian Multiclass procedure was used for the analysis. The main drivers of the use of healthcare services are FC’s age and gender (being a man), and OCR’s age and level of disability.ResultsThe main barrier to the use of private services is their cost, while for the public ones is their unavailability. The most common private service is represented by migrant care workers (MCWs), hired privately by the older people’s families.ConclusionFindings suggest that the recent national LTC reform in Italy does not seem to have fully captured the LTC needs of older people, and some policy suggestions are therefore provided in this regard.

BACKGROUND:When older people have limited physical ability, several difficulties could arise from a built environment that is not appropriate for their needs, especially when they live alone without cohabiting with their relatives. The study explores how frail older people with functional limitations are ageing in place alone and how they perceive and manage the built environment, i.e., housing (home and building) and neighbourhood, with regard to both urban and rural sites. METHODS:Data were collected for the main IN-AGE "Inclusive Ageing in Place" study, which was carried out in 2019 in Italy. For this paper, semi-structured interviews involving 40 participants aged 65 years and over in the Marche Region (Central Italy) were processed, and a mixed-methods analysis (quantitative/qualitative) was conducted. Simple quantitative/descriptive elaborations (univariate and bivariate analyses) were integrated with thematic content analysis. RESULTS:The findings suggested, among others, the following issues: high costs for managing the home, poor relationships with neighbours in some cases, scarcity of proximity services especially in rural sites, and the presence of architectural/mobility barriers, even though the latter are little perceived when inside the home. Moreover, the majority of seniors were emotionally attached to their living place, although feelings of loneliness and isolation emerged, also following depopulation in rural areas. CONCLUSIONS:Despite the small/not representative sample size, the results highlight how, a built environment that is perceived as inadequate, could hamper ageing in place and participating in communities for frail seniors. This could be managed with appropriate interventions to be implemented taking into account the diversity between rural and urban sites. CLINICAL TRIAL NUMBER:Not applicable.

Background: Access to and use of health services represent crucial issues/challenges for older people experiencing frailty with functional limitations and chronic diseases, especially when they age in place alone. Both access to and use of health services are also characterised by gender differences. The present study analysed these factors in three Italian regions (Lombardy, North; Marche, Centre; and Calabria, South), where in 2019, the “Inclusive Ageing in Place” (IN-AGE) project was carried out, involving 120 senior people aged 65 years and of both genders. Methods: In this mixed-methods study, both qualitative (predominant section) and some quantitative data (e.g., socio-demographic aspects and functional limitations) were collected through semi-structured interviews. In addition to basic quantitative analyses, content analysis and the quantification of statements were performed to process the qualitative data. The results for both men and women are presented. Possible barriers to accessing health services were also considered. Results: Women reported more cases of chronic diseases than men, especially arthritis/osteoporosis, and a greater use of drugs than men. Both genders used services provided by the general practitioner (GP) and medical specialist (MS), the latter being mostly private. More women than men used rehabilitation, especially in the private sector, and reported the issue of cost for private healthcare and the travel distance to reach medical units as barriers to access. The long waiting lists/times were complained about by both males and females. Conclusions: This study, despite its simple/descriptive qualitative approach with a limited sample, could provide, however, some insights for policymakers and healthcare professionals to plan prevention policies and deliver appropriate and timely health services to older people experiencing frailty and ageing in place alone, devoting attention to gender-related issues in the design and provision of such services.

OBJECTIVES:The process of population aging characterizing Italian society will lead to a greater demand for long-term care (LTC) services, while simultaneously reducing the availability of caregivers. Spoke 5 activities develop interdisciplinary solutions to meet the challenges and seize the opportunities that emerge from this transformation. METHODS:The article summarizes the outputs from Spoke 5 of the Age-It research program, highlighting their implications for practitioners and policymakers. The research activities contribute to: (a) mapping care needs and resources; (b) developing innovative digital tools to monitor caregivers' well-being and support them; (c) advancing integrative planning for age-friendly environments; (d) developing e-learning platforms addressing caregivers' needs; (e) identifying existing policy shortcomings. RESULTS:Spoke 5 developed an index of LTC risks that measures the balance between the demand and the potential supply of care at the municipal level; critical areas only partially overlap with traditional socioeconomic cleavages. The analysis of informal care distribution reveals that high socioeconomic status (SES) individuals outsource more demanding caregiving tasks, whereas low-SES families face high-intensity care demands. Innovative digital tools and e-learning platforms are presented. The analysis of policies supporting Italian informal caregivers indicates that they are characterized by a significant geographical and institutional fragmentation. DISCUSSION:The progression of macro sociodemographic trends has pushed Italy's existing "care equilibrium" to its limits; innovative solutions are needed. Adopting a multidimensional and multidisciplinary approach, focusing on the goal of supporting caregivers' well-being and training, and overcoming policy fragmentation are key to creating an LTC system that is socially and economically sustainable.

OBJECTIVES:As populations age, health, social, and long-term care policies must promote well-being, active participation, and inclusion in later life. This article examines how dissemination and participatory strategies can bridge research and practice, drawing on the Age-It Research Program-one of Europe's largest transdisciplinary initiatives on aging. METHODS:Age-It involves 1,000+ researchers across 10 "Spokes" and several cross-cutting Boards, engaging more than 100 stakeholder organizations. We describe the overarching dissemination and co-creation strategy developed by the Stakeholders and Dissemination Board, acknowledging the diverse participatory practices within Spokes. We term our approach incremental participatory, recognizing both early stakeholder involvement and the practical constraints of coordinating a program of this scale. RESULTS:Our experience highlights three key lessons. First, establishing a shared language, timeframe, and platform is essential for transdisciplinary collaboration and stakeholder engagement. Second, dissemination and knowledge mobilization must be embedded throughout the research process rather than treated as a final stage activity, combining digital tools (e.g., WikiAge-It, the Age-It Dashboard) with offline, community-based events to foster inclusive participation. Third, while co-creation enhances legitimacy and relevance, sustaining active engagement requires significant investments in resources, infrastructures, and facilitation processes. DISCUSSION:By integrating participatory research principles with implementation science frameworks, Age-It demonstrates how structured collaboration and knowledge mobilization can support evidence-based policies and practices. However, challenges remain, including uneven stakeholder engagement, time constraints, and the difficulty of translating complex scientific insights into actionable formats. We conclude that dissemination and participatory approaches in aging research must be seen as dynamic, iterative, and resource-intensive processes.

Background: In light of the main challenges recognized as being linked to the operationalization of the active aging concept at the policy level, the present study aimed to understand whether and to what extent Italian regional governments plan to deal with these challenges, i.e., implementing inter-sectoral and multilevel cooperation in a mainstreaming aging perspective; creating participatory processes by involving stakeholders in policymaking; and implementing the multidimensionality of active aging. Methods: Interviews with representatives of all Italian regions were conducted, and contributions by regional civil society stakeholders were collected. A framework analysis was conducted to identify and categorize policy objectives. Results: Policy plans to deal with the issues under study are in place in all Italian regions; however, differences across regions depend on two main factors: the presence of a relevant regulatory framework and its degree of implementation. Conclusion: policy recommendations for improving the current state concerned awareness-raising campaigns to strengthen the dialogue between regional governments and civil society stakeholders and the need for provisions issued at the national level to advance and harmonize regional policy tools in this area.

This chapter provides an updated overview of the emerging issues in long-term care (LTC) for older people. Based on recent developments in related policies at international level, the challenge of matching increasing LTC needs with the response from formal and informal care providers, as well as from society (volunteers, caring communities), is addressed by adopting a cross-national perspective and considering the lessons learnt from the recent COVID-19 pandemic. The main purpose of this chapter is to detect research gaps to formulate suggestions for key priorities and research questions for a forward-looking research agenda, keeping in mind the methodological issues identified in this area by international frameworks provided by UNECE, WHO, European Commission and other supranational initiatives in this field. This is achieved by first addressing the 'demand' side of LTC, and then the 'supply' side, including all interconnections between formal and informal care, in a societal context.

Background: During the COVID-19 pandemic, reduced access to care services and fear of infection prompted families to increase home care for their older relatives with long-term care needs. This had negative effects on both members of the caring dyad, impacting their quality of life (QoL) and mental well-being. This study investigated the factors that influenced the mental well-being and QoL of 239 dyads, before and after the first pandemic wave in Italy. Methods: Data were collected through a survey on the use of health and social care services and interventions by older care recipients living in the community and their family caregivers. Factors associated with deterioration of mental well-being and QoL in older care recipients (mean age 86.1 years old) and their family caregivers after the pandemic were studied. Results: The importance attached by family caregivers to the skills and training of healthcare professionals was a protective factor against the deterioration in the well-being of older care recipients. Similarly, the importance associated by family caregivers to the help received from healthcare professionals was a protective factor for QoL. Financial hardship of older care recipients was a risk factor for deterioration in caregivers’ mental well-being, while support from other family members was a protective factor for QoL. Conclusions: The presence of attentive healthcare professionals, a supportive family environment, and economic support can reduce the burden on both the caregiver and the older care recipient. These aspects need to be considered in any future emergency situation and when planning care services for community-dwelling older people.

During the COVID-19 outbreak, the care services interruption/delay resulted in increased amount of care for informal caregivers of older people with long-term care needs. This study aimed at understanding how the Pandemic affected physical health, mental well-being and quality of life of older people’ informal caregivers of different ages and to what extent starting caregiving affected such life realms among new caregivers. An online survey was carried out in Winter 2020–2021 targeted to informal caregivers living in 16 European countries. A sub-sample of 848 adult (aged 18–64) was compared to another of 542 older (over 65) informal caregivers. People who started caring during the Pandemic were also identified and the impact of the Pandemic on the three life realms of this group were analysed separately by gender and age. The differences between the two groups of adult and older caregivers were estimated using logistic regression, adjusted for potential confounders. Analyses were repeated after propensity score matching. During the second Pandemic wave hitting Europe in Winter 2020-21, regardless of age, being female entailed a worsening in physical health, mental well-being and quality of life, in line with previous research Also new caregivers were mostly females and their physical health and quality of life were worsened by caregiving. Gender-specific work-life balance policies and measures are needed to support female working caregivers. More attention should be paid to older female caregivers through scheduled physical and mental health screenings and home visits. Future studies on the topic in a gender and intergenerational perspective are encouraged.

The study aimed to explore and compare effects of lockdown, due to the COVID-19 pandemic in 2020, on frail older people living alone at home in Brescia and Ancona, two urban cities located respectively in Northern and Central Italy. This country was the Western epicenter of the first wave of the pandemic (February-May 2020), which affected the two cities differently as for infections, with a more severe impact on the former. A follow-up study of the IN-AGE research project (2019) was carried out in July-September 2020, by means of telephone interviews, involving 41 respondents. Semi-structured questions focused on the effects of the first wave of the pandemic on their mobility and functional limitations, available care arrangements, and access to health services. The lockdown and social distancing measures overall negatively impacted on frail older people living alone, to a different extent in Ancona and Brescia, with a better resilience of home care services in Brescia, and a greater support from the family in Ancona, where however major problems in accessing health services also emerged. Even though the study was exploratory only, with a small sample that cannot be considered as representative of the population, and despite differences between the two cities, findings overall suggested that enhancing home care services, and supporting older people in accessing health services, could allow ageing in place, especially in emergency times.

Background: COVID-19 pandemic can be used to test effectiveness and sustainability of public healthcare and LTC systems. Methods and Objectives: The study aims to find what population's demographic, socioeconomic characteristics and national resources impacted on incidence and mortality of COVID-19 during the main pandemic period, comparing three European countries: Italy, Spain, and Germany, stressing possible strengths and weaknesses that could be considered as hints of health and social intervention. Variables describing the main population demographics and socioeconomic characteristics and national resources were collected for the period 2001-2021 from the main international databases. Covid-19 incidence and death figures from 1st March 2020-31st March 2021 came from national health databases. Analysis focused on bivariate and weighted multivariable linear regression between incidence and mortality and socio-economic covariates. Results: In all three countries, care model and socio-demographic conditions' characteristics impacted the effectiveness of response to COVID-19 emergency. Formal and public care remains the main strategy to contrast the incidence and mortality of older people by COVID-19, because it mitigates the negative impact of socioeconomic characteristics, protecting frailer older people. Conclusion: Strategies oriented to privatisation of care result in less protection to mortality of older people, due to more significant impact of individual socioeconomic conditions on purchasing care schemes or services.

Background/Objectives: The main outcomes of the COVID-19 pandemic can be used to assess the capability and sustainability of public healthcare and Long-Term Care (LTC) systems. This study aims to identify the population’s demographic and socio-economic characteristics, as well as other national resources associated with the incidence and mortality of COVID-19, by comparing three European countries during the first pandemic period (Italy, Spain, and Germany). The results will identify possible strengths and weaknesses that could be considered as hints of the need for health and social intervention. Methods: Variables describing the countries’ core demographics, socio-economic characteristics, and national resources were collected from 2001–2021 from well-established international databases. COVID-19 incidence and death figures from 1 March 2020 to 31 March 2021 were extracted from national health databases. Analysis focused on bivariate and weighted multivariable linear regressions between incidence, mortality, and socio-economic covariates. Results: Findings show that both care models and socio-demographic characteristics influenced the capability of the first year’s response to the COVID-19 emergency. Formal public care appears to represent the most effective strategy against incidence and mortality regarding COVID-19, especially for older people, because it mitigates the adverse effects of socio-economic characteristics. Conclusions: Current strategies oriented towards privatizing care should, therefore, be considered critically, since they may result in weaker protection of vulnerable groups, such as frail older people, due to the unequal position of individuals with different socio-economic conditions in purchasing services from the care market.

Older people often report functional limitations and low digital skills, with the latter hampering the use of Information and Communication Technologies (ICTs) and having potentially negative consequences on their social isolation and loneliness. Against this background, we present some findings from the “Inclusive ageing in place” (IN-AGE) study, carried out in 2019 in Italy. This study explored seniors’ abilities and difficulties with the independent use of mobile phones, smartphones, and tablets/personal computers (PCs). Qualitative/semi-structured interviews involved 120 seniors aged 65 years and over, living alone in three Italian regions (Lombardy, Marche, and Calabria). Purposive sampling was conducted, and quantitative/qualitative analyses were performed. The main results showed that smartphones and PCs/tablets were used by older respondents living mainly in the north and in urban sites to talk with family members and less for other functionalities (e.g., internet). Those more educated and without serious functional limitations were more capable of utilising ICTs. Seniors using ICTs reported mainly low/moderate loneliness and less social isolation. Therefore, technological tools have the potential to mitigate both, even though some barriers (e.g., poor health, low education) can hinder this opportunity. These results can offer insights for policymakers to design adequate policies (e.g., e-training programs) for seniors, to facilitate their inclusion in digital society, thus enabling social sustainability in an ageing population.