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  • 1.
    Barbabella, Francesco
    et al.
    National Institute of Health and Science on Ageing (INRCA), Italy.
    Chiatti, Carlos
    National Institute of Health and Science on Ageing (INRCA), Italy.
    Lamura, Giovanni
    National Institute of Health and Science on Ageing (INRCA), Italy.
    Increasing inclusion and participation of the young-old and the old-old2013In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 17, no Supplement, June/July, p. S132-S132Article in journal (Refereed)
    Abstract [en]

    Introduction: While healthy ageing represents a pre-condition for older people to enjoy a longer and disability-free life span, quality of life in older age is dependent also upon society’s ability to grant individuals social protection, as well as to promote their active participation in the community until the very end of life. These issues constitute a challenge for current and future research on ageing.

    Method: A 2-year consultation process with over 70 international experts was conducted within the FUTURAGE work-stream focussedon social and economic resources in ageing research. This process allowed a comprehensive discussion on most relevant social participation and protection issues involving scientists, users’ organisations, policy makers and other stakeholders, which led to a set of specific research priorities.

    Results: The main challenges identified for future ageing research concerning social participation are: ageism; migration; life-long learning; digital divide; spirituality; volunteering; mobility and accessibility; discrimination in the labour market; consumption and access to products and services; and work-life balance. As for social protection, the following core issues have been spotted: sustainability; support to informal carers (also through ICT-based services); efficiency; access to care; cost-effectiveness and quality of interventions; initiatives to improve intergenerational solidarity.

    Conclusion: Societal challenges related to social participation and sustainability of social protection systems clearly urge new actions in research, practices and policy on ageing. In particular, the identification of over-arching issues, barriers and enablers contributes to strengthen scientific research in the field, as well as to support policy makers in improving social life and quality of life of older people.

  • 2.
    Barbabella, Francesco
    et al.
    National Institute of Health and Science on Ageing (INRCA), Italy.
    Di Rosa, Mirko
    National Institute of Health and Science on Ageing (INRCA), Italy.
    Chiatti, Carlos
    National Institute of Health and Science on Ageing (INRCA), Italy.
    Melchiorre, Maria Gabriella
    National Institute of Health and Science on Ageing (INRCA), Italy.
    Lamura, Giovanni
    National Institute of Health and Science on Ageing (INRCA), Italy.
    Opportunities and challenges of migrant work in the Italian long-term care system2013In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 17, no Supplement, Juny/july, p. S133-S133Article in journal (Refereed)
    Abstract [en]

    Introduction: Italy is one of the most aged countries in the world, with a longstanding tradition of family care of the dependent elderly. Inrecent times, however, Italy has been witnessing in-depth social and cultural changes, which have been negatively impacting on informal care provision. In addition, the public long-term care (LTC) system highly relies on cash-for-care schemes for supporting older people, whereas “formal” care services are characterised by weak coverage and intensity. This situation has led to a remarkable increase in theprivate employment of migrant care workers (MCWs), whose number increased by four times in the last two decades.

    Method: An overview of MCWs phenomenon in Italy is provided through the analysis of empirical data retrieved by available official sources at national level, as well as by results from own surveys conducted in recent years on large samples of MCWs.

    Results: The following opportunities and challenges concerning MCWs’ employment in the LTC sector were identified: improve MCW’s capacity to deliver quality care; reduce therisk of elder abuse and neglect and of meeting MCWs’ own care needs; increase their social integration in destination countries and reduce “care drain” in sending countries; and how to improve stakeholders’ involvement for a better exchange of good practices and more effective policy measures.

    Conclusion: In these years, privately employed MCWs have contributed to change the traditional Italian “family care model” into a new “migrant-in-the-family care model”. However, the issue concerning the sustainability of this model within the Italian LTC system in the future is still open.

  • 3.
    Barbabella, Francesco
    et al.
    National Institute of Health and Science on Ageing (INRCA), Italy.
    Schmidt, Andrea
    European Centre for Social Welfare Policy and Research, Austria.
    Chiatti, Carlos
    National Institute of Health and Science on Ageing (INRCA), Italy.
    Lamura, Giovanni
    National Institute of Health and Science on Ageing (INRCA), Italy.
    Impact of ICT-based interventions on family caregivers: A cross-analysis of 54 good practices in Europe2013In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 17, no Supplement, June/July, p. S447-S447Article in journal (Refereed)
    Abstract [en]

    Introduction: Information and communication technologies (ICTs) have gained an increasing relevance for delivering innovative care and support services for dependent older people and their family caregivers. Although ICT-based interventions can vary remarkably in terms of functions, target users, operational aspects and technologies used, little knowledge is available concerning their implementationand impact in Europe, a gap that the CARICT project (http://is.jrc.es/pages/EAP/eInclusion/carers.html) has tried to fill.

    Method: 54 ICT-based interventions addressing needs of older peopleor their family caregivers have been identified in 12 European countries through internet search, literature review and expert interviews. Reports have been delivered for each case studied, and cross-analysed to better understand their potential impact at micro, meso and macro level.

    Results: Little evidence was found for positive outcomes at micro-level, including improvements in users’ health relatedquality of life and social inclusion. At meso-level, implementation of 1st/2nd generation telecare contributes to reduce hospitalization and institutionalization rates of older users, as well asto cost savings for local care providers. At macro-level, only one intervention shows concrete effects on a larger scale through a targeted program evaluation, while most ICT-based interventions do not useany tool to assess their impact, and can thus demonstrate only technology acceptance or users’ satisfaction.

    Conclusion: The lack of relevant evidence at all levels, as well as difficulties in comparing and generalising results, strongly urge practitioners to improve impact assessment methodologies and researchers to develop a better general framework of ICT potentials at a conceptual, theoretical and methodological level in this area.

  • 4.
    Fagerström, Cecilia
    et al.
    Blekinge University of Technology.
    Borglin, Gunilla
    Blekinge University of Technology.
    Mobility, functional ability and quality-of-life among people of 60 years or older2009In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 13, no suppl 1, p. S442-S442, article id PB7 327Article in journal (Refereed)
    Abstract [en]

    It is well known that reduced ability to perform activities of daily living (ADL) and declining mobility are both related to advanced age. This relation is also valid for low quality-of-life. It is not, however, the advanced age per se that causes the low quality-of-life. Rather, it seems that it is the declining mobility that unable people to manage their daily lives satisfactory - a circumstance that is often overlooked, since the most frequently used measuring method, the ADL-scale, is mainly focusing on people's functional ability and not their mobility. Hence, the assumption and aim for this study has been to investigate to which extent mobility factors, in comparison to the control factors age, gender and ability to perform ADL, may explain low (physical) quality-of-life (SF-12, PCS-12). The study includes people (n=1402) aged 60-96, who participated in a baseline survey in one (Blekinge) of four included centres of the longitudinal and multi-centre cohort study, The Swedish National study on Ageing and Care (SNAC), in 2001, a study with a 61% response rate. Collected data indicated that mobility factors such as reduced ability either to walk a distance of 200 metres or less without stopping, or walking in stairs, or rising from a chair or opening a bottle played a crucial part when developing conditions of low (physical) quality-of-life (PCS-12), while control factors such as gender, age and ability to perform ADL, did not. The results suggest that multiple factors of reduced mobility, rather than impairment in ability to perform ADL, appear to increase the risk for low (physical) quality-of-life, and that targeting these phenomena in health care interventions, are essential.

  • 5.
    Lammes, Eva
    et al.
    Karolinska University Hospital.
    Rydwik, Elisabeth
    Karolinska Institutet.
    Akner, Gunnar
    Örebro University Hospital.
    Effects of nutritional intervention and physical training on energy intake, resting metabolic rate and body composition in frail elderly: a randomised controlled pilot study2012In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 16, no 2, p. 162-167Article in journal (Refereed)
    Abstract [en]

    Objectives: To analyse the effect of nutritional intervention and physical training on energy intake, resting metabolic rate (RmR) and body composition in the frail elderly.

    Design: Open, randomised, controlled pilot treatment study.

    Setting: Community-based research centre. Participants: ninety-six community-dwelling frail elderly people aged 75 and older, 40% men.

    Intervention: Four treatment arms: i) individual nutritional advice and group sessions on nutrition for the elderly, ii) physical training 2 x 45 minutes per week for 3 months, iii) combined nutritional and physical intervention and iv) control group. 

    Measurements: The outcomes were energy intake (4-day food diary); resting metabolic rate (indirect calorimetry) and body composition (anthropometry) performed at baseline, after 3 months’ intervention (completed by 79 individuals), and as a follow-up at 9 months (completed by 64 individuals).

    Results: The training group showed a significantly increased RmR at 3 months. Otherwise, there were no observed differences within or between the four groups.There was no correlation over time between energy intake, RmR and fat free mass. The participants with a low energy intake who managed to increase their energy intake during the study (‘responders’) had a statistically significantly lower Bmi (21 vs. 24) and a lower fat percentage (23 vs. 30) at baseline than the ‘non-responders.’The ‘non-responders’ showed a small but statistically significant decrease in body fat percentage at F1, and inbody weight, Bmi and FFm at 9 months (F3).

    Conclusion: individual nutrition counselling and physical exercise had no effect on energy intake, RmR or fat free mass in community-dwelling frail elderly people aged 75 and older. interventions in frail elderly people should be targeted according to the needs of the individual patients. The issues of randomisation, targeting and responders in are problematised and discussed.

  • 6.
    Lamura, Giovanni
    et al.
    National Institute of Health and Science on Ageing (INRCA), Italy.
    Chiatti, Carlos
    National Institute of Health and Science on Ageing (INRCA), Italy.
    Barbabella, Francesco
    National Institute of Health and Science on Ageing (INRCA), Italy.
    Di Rosa, Mirko
    National Institute of Health and Science on Ageing (INRCA), Italy.
    Current LTC challenges in Italy2013In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 17, no Supplement 1, June/july, p. S227-S227Article in journal (Refereed)
    Abstract [en]

    Introduction: The rapid ageing of the Italian population is reflected by a growing demand for LTC services. As families are facing increasing difficulties in providing everyday elder care, the pressure on formal services is growing. At the same time, the current financial crisis is making the public response less and less able to provide the needed resources. As a consequence, the current approach of indirect public support to the private employment of migrant care workers (MCWs) through cash-for-care schemes is likely to continue.

    Method: The presentation is based on a detailed analysis of empirical findings and policy documents, outlining the crucial features characterising the Italian LTC system and describing also some of the main differences existing between different regional care approaches.

    Results: After adecade of increasing availability of publicly funded LTC services for older people, in some sectors, such as integrated home care, the audience of recipients has started receiving a lower number of hours of care. The mainly monetary focus of the Italian care regime has a clear incentivizing effect to employ foreign migrant care workers, often on an undeclared basis, to provide everyday elder care in Italian homes. Another crucial characteristic is the strong heterogeneity of Italian regions, according to which today different clusters of regions can beidentified, with strong inequalities in LTC provision.

    Conclusion : Thelack of a coherent national LTC policy has been recently accompaniedby an increasing focus on cash-for-care payments, which in the future will require a stronger attention to care quality issues.

  • 7.
    Naseer, M.
    et al.
    Malmö University.
    Fagerström, Cecilia
    Blekinge Institute of Technology ; Blekinge Center of Competence.
    Prevalence and association of undernutrition with quality of life among Swedish people aged 60 years and above: results of the SNAC-B study2015In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 19, no 10, p. 970-979Article in journal (Refereed)
    Abstract [en]

    Objectives: This study aimed to assess the prevalence of undernutrition among elderly and to investigate the association of risk of undernutrition with health-related quality of life and life satisfaction controlling for age, gender, marital status, economic status, housing arrangement, education level, functional ability, and diseases.

    Design: A cross-sectional study design was used for this study. The baseline data (2001-€“2003) of "€œThe Swedish National Study of Aging and Care-Blekinge (SNAC-B)"€ was used.

    Setting: This population-based study focused on both home-living and special-housing residents.

    Participants: The participants (n=1402) were randomly selected and included both males and females 60-€“96 years of age residing in a municipality of south-east Sweden.

    Measurements: The risk of undernutrition was estimated by the occurrence of at least one anthropometric measure (body mass index, mid-arm circumference, and calf circumference) below cut-off, in addition to the presence of at least one subjective measure (declined food intake, weight loss, and eating difficulty). The dependent variables, health-related quality of life and life satisfaction, were measured by the validated short form health survey (SF-12) and Liang’s life satisfactions index A (LSIA), respectively.

    Results: According to the criterion, 8.5% of the participants were at risk of undernutrition, and subjects at nutritional risk were significantly older, female, unmarried/widowed/divorced, residing in special housing, and functionally impaired. The risk of undernutrition was significantly associated with poor health-related quality of life, both in the physical (OR 2.31, 95% CI 1.18-€“4.52) and mental (OR 2.34, 95% CI 1.22-€“4.47) dimensions. However, no significant association was observed between nutritional status and life satisfaction (OR 1.30, 95% CI 0.70-€“2.40).

    Conclusion: The risk of undernutrition significantly increases the risk of poor physical and mental health-related quality of life but has negligible impact on life satisfaction. This study also highlights the importance of functional ability both for the prevention of undernutrition and promotion of quality of life. However, more studies are needed to validate the tool used here for undernutrition risk assessment before it can be used in clinical or population settings.

  • 8.
    Selan, Suzana
    et al.
    Lund University ; Blekinge Institute of Technology.
    Hellström, Amanda
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Fagerström, Cecilia
    Blekinge Institute of Technology ; Blekinge Centre of Competence.
    Impact of nutritional status and sleep quality on hospital utilisation in the oldest old with heart failure2016In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 20, no 2, p. 170-177Article in journal (Refereed)
    Abstract [en]

    Objectives: To describe three-year trends in nutritional status and sleep quality and their impact on hospital utilisation in the oldest old (80 +) with heart failure (HF). Design: Single-centred longitudinal observational study. Setting: South-eastern Sweden. Participants: 90 elderly (80+) with objectively verified HF. Measurements: Baseline data from the Mini Nutritional Assessment (MNA) and on sleep quality were collected through structured interviews following the HF diagnosis (n= 90) and at a three-year follow-up (n= 41). Data on hospital utilisation during the three years following the HF diagnosis were also collected. Results: Nineteen percent of the participants were found to have impaired nutritional status, a condition that increased hospital utilisation by four bed days per year. A majority (85%) had impaired sleep quality, but no impact on hospital utilisation was found. Nutritional status and sleep quality were stable over the three-year period. Conclusion: In the oldest old with HF, impaired nutritional status and impaired sleep quality are already common at HF diagnosis. Impaired nutritional status increases hospital utilisation significantly. Therefore, it is of supreme importance to systematically evaluate nutritional status and sleep quality in the oldest old when they are diagnosed with HF, as well as to take action if impairments are present.

  • 9.
    Stina, Engelheart
    et al.
    Örebro University.
    Akner, Gunnar
    Örebro University.
    Dietary intake of energy, nutrients and water in elderly people living at home or in nursing home2015In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 19, no 3, p. 265-272Article in journal (Refereed)
    Abstract [en]

    Objectives: There is a lack of detailed information on dietary intake in elderly people at an individual level, which is crucial for improvement of nutritional support. The aim of this study was to investigate the dietary intake in elderly people in two types of living situations. 

    Design: Observational study, analysing prospective data.

    Setting: The dietary intake was studied in elderly people living at home or in nursing home, in different cities of Sweden.

    Participants: A total of 264 elderly people (mean age 84) participated in the observational study.

    Measurements: Dietary intake was measured using weighed food records and food diaries, comparing females and males. The observed dietary intake was related to Recommended intake and Lower intake level.

    Results: All dietary intake and patient characteristic variables showed large individual differences (ranges). We found no significant differences (p>0.05) between those living at home and nursing home residents regarding the average intake of energy, protein and water when expressed as total intake per kg of body weight. A very low daily intake of energy (<20 kcal/kg body weight/day) was observed in 16% of the participants. For vitamin D and iron, 19% and 15%, respectively, had intakes below the Lower intake level. There was no correlation between intake of energy, protein or water and resident characteristics such as age, autonomy, morbidity, nutritional state or cognition.

    Conclusions: The large individual differences (ranges) in energy, nutrients and water show that the use of mean values when analysing dietary intake data from elderly people is misleading. From a clinical perspective it is more important to consider the individual intake of energy, nutrients and water. Ageism is intrinsic in the realm of ‘averageology’.

  • 10.
    Wimo, Anders
    et al.
    Karolinska Institute ; Uppsala University ; County Council of Gävleborg ; HC Bergsjö.
    Elmstål, S.
    Lund University.
    Fratiglioni, L.
    Karolinska Institute ; Stockholm Gerontology Research Center.
    Sjölund, B.-M.
    Karolinska Institute.
    Sköldunger, A.
    Karolinska Institute.
    Fagerström, Cecilia
    Blekinge Institute of Technology.
    Berglund, Johan
    Blekinge Institute of Technology.
    Lagergren, M.
    Stockholm Gerontology Research Center.
    Formal and informal care of community-living older people: a population-based study from the Swedish National study on Aging and Care2017In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 21, no 1, p. 17-24Article in journal (Refereed)
    Abstract [en]

    Objectives: Study formal and informal care of community-living older people in the Swedish National study of Aging and Care (SNAC).

    Design: Cross-sectional, population based cohort.

    Setting: Three areas in Sweden: Municipality of Nordanstig, Stockholm and Skåne County.

    Participants: 3,338 persons ≥72 years.

    Measurements: Patterns and amounts of informal and formal care by cognition and area of residence.

    Results: 73% received no care; 14% formal care; and 17% informal care (7% received both). In the whole study population, including those who used no care, individuals in small municipalities received 9.6 hours of informal care/month; in mid-size municipalities, 6.6; and in urban areas, 5.6. Users of informal care received 33.1 hours of informal care/month in small municipalities, 54.6 in mid-size municipalities and 36.1 in urban areas. Individuals with cognitive impairment received 14.1 hours of informal care/month, 2.7 times more than people with no/slight impairment. In the whole study population, individuals in small municipalities received an average of 3.2 hours of formal care/month; in mid-size municipalities 1.4; and in urban areas, 2.6. Corresponding figures for formal care users were 29.4 hours in small municipalities, 13.6 in mid-size municipalities and 16.7 in urban areas. Formal care users received 7.1 hours, and informal care users, 5.9 hours for each hour/month received by people in the study population as a whole.

    Conclusions: More informal than formal care was provided. Informal care is more frequent in small municipalities than urban areas and for those with than without cognitive impairment. The relationship between data on the whole population and the data on users or care indicates that population-based data are needed to avoid overestimates of care.

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