PurposeActive ageing (AA) concerns the optimisation of opportunities for health, social participation and security of people as they age. Limited research exists on understanding the multilevel governance of AA policies, including those targeting the labour market and retirement. The aim of this study is to identify and analyse national and regional AA policies focused on paid-work and the retirement transition in Italy.Design/methodology/approachA systematic policy review was conducted in 2019-2020 by means of 86 interviews and document search for 14 national governmental administrations and all 21 regional governments. A thematic analysis was carried out to review, select and compare themes from identified policies.FindingsThe results shown that prolonging working life and creating safety nets for socially-disadvantaged older workers remain predominant policy objectives at national level. At regional level, residual welfare programs are offered with limitations in scope, infrastructure and resources. Findings confirm the structural challenges for user needs, equity and inclusion in Italy.Research limitations/implicationsThe policy trends after the COVID-19 pandemic have not been investigated.Practical implicationsThe results suggest that national and regional governments need to carefully consider more harmonised, integrated, and long-term policies on labour market and retirement to meet the changing social demand.Social implicationsFindings highlights the structural challenges for user needs, equity and inclusion in Italy in relation to labour market and retirement policies.Originality/valueThis is the first study adopting a multilevel governance perspective on AA policies, which benefitted from a systematic policy review conducted in 14 national administrations (ministries, governmental departments) and all 21 regional institutions.

Research has highlighted that adolescent young carers (AYCs) are in a vulnerable position due to their caring responsibilities being combined with the challenges of adolescence. However, caring among adolescents does not have to be a solely negative experience and positive experiences of caring can co-exist. Identifying those factors that contribute to AYCs' positive or negative caring experiences is important if AYCs are to be offered appropriate support. This cross-sectional survey study examined factors associated with AYCs' positive and negative caring experiences. Pupils aged 15-17 years from schools in 11 Swedish municipalities completed a questionnaire addressing demographic characteristics, care activities and the reported influence of being an AYC on school results, received support, and perceived health, while caring experiences were measured by the Positive and Negative Outcomes of Caring (PANOC-YC20) instrument. Of 3015 participants, 702 (23%) were identified as AYCs. The PANOC-YC20 positive and negative caring experiences subscales were significantly associated with each other (r = 0.16), with the mean score on the positive subscale (M = 10.36) significantly higher than that of the negative subscale (M = 5.18). In a multinomial logistic regression model, AYCs providing higher levels of emotional care and sibling care had both stronger positive and negative caring experiences, with a relatively greater effect on negative experiences. AYCs who had better perceived health had stronger positive experiences, while poorer perceived health was associated with more negative experiences. Finally, AYCs who felt their school results were negatively affected by their caring role had an increased likelihood of experiencing caring negatively. It is important for relevant authorities and professionals to consider that AYCs can experience caring both positively and negatively when developing or providing support, as these experiences will likely be reflected in both their need of support, and in the forms of support that will be most effective for them.

Adolescent young carers (AYCs) face the challenges of adolescence while also having care responsibilities. Caring can negatively affect an adult carer's health, but there is less evidence on how caring affects AYCs, of whom there is little awareness among professionals. The aim of this survey study was to describe the AYCs' characteristics and investigate factors associated with their perceived health. School pupils aged 15-17 from 11 Swedish municipalities completed a questionnaire addressing caring activities, received support and perceived health. Of the 3,015 participants, 702 (23%) were AYCs. Female gender, having a parent with a health-related condition, mental illness in a family or non-family member, and addiction problems in a non-family member were associated with poorer perceived health, while receiving support with caring was associated with better perceived health. Identifying the factors associated with AYCs' perceived health can lead to appropriate support, but there also needs to be better representation of AYCs in policy.

Background/Objectives: This cross-national study focuses on adolescents who provide care and support to family members or significant others. Current evidence regarding their mental health and solutions to strengthen it is limited and mostly available in a few countries. The aim of this study is to evaluate the results of a primary prevention intervention for improving the mental health and well-being of adolescent young carers (AYCs) aged 15–17 years in six European countries. The intervention was based on a psychoeducational program and tools adapted from the Discoverer, Noticer, Advisor, and Values (DNA-V) model.

Methods: We designed a randomized controlled trial with 217 AYCs participating in the study, either in the intervention or control group. Quantitative and qualitative data were collected via questionnaires at baseline, post-intervention, and a 3-month follow up.

Results: The results were mixed, as positive improvements in primary (i.e., psychological well-being and skills) and secondary (school/training/work functioning) outcomes were shown by the experimental group but, in most cases, they were not statistically significant. The qualitative data supported positive claims about the intervention and its appropriateness for AYCs.

Conclusions: The study implementation during the peak of the COVID-19 pandemic forced the consortium to adapt the design and may have influenced the results. More long-term studies are needed to assess similar mental health programs with this hard-to-reach target group.

Adolescent young carers (AYCs) are a sub-group of young carers who carry out significant or substantial caring tasks and assume a level of responsibility which would usually be associated with an adult. They are a potentially vulnerable group of minors because of the risk factors associated with their caring role. AYCs face a critical transition phase from adolescence to adulthood often with a lack of tailored support from service providers. The recently completed European funded ‘ME-WE’ project, which forms the focus of this paper, aimed to change the ‘status quo’ by advancing the situation of AYCs in Europe, via responsive research and knowledge translation actions. This paper outlines the participatory, co-creation approach employed in the project to optimise AYC’s involvement. It describes the ethical framework adopted by the project consortium to ensure the wellbeing of AYCs within all project activities. Ethical issues that arose in the field study work in all six countries are presented, followed by a discussion of the level of success or otherwise of the consortium to address these issues. The paper concludes with lessons learned regarding ethically responsible research with and for AYCs that are likely transferable to other vulnerable research groups and pan-European projects.

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.

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.

BACKGROUND: Many studies investigated factors associated with overuse of Emergency Department (ED) by older people. However, there is little evidence of how a better access to long-term care services can affect ED visit rates. Therefore, we estimated the association between ED use and contextual (distance to closest ED), need (priority level at admission and care deprivation), predisposing (socio-economic conditions) and enabling factors (availability of health services) at the municipal level.

METHODS: We investigated ED visit rates by comparing the older population (aged 75 and more) to those aged less than 75 years among 233 municipalities and 13 health districts in the Marche Region, Central Italy. Administrative data were enriched by spatial dimensions. The outcomes were analysed using t-tests and ANOVA, while OLS and multilevel regressions have been used to identify independent correlates of ED visit rates.

RESULTS: Mean ED visit rate was 56.3% and 25.3% among older people and the rest of the population (< 75 years), respectively. The multivariate analysis for older people showed that the presence of an ED within the municipality and living alone were positively associated with ED use, whereas greater availability of nursing homes was negatively associated. For general population (< 75 years), distance to closest ED, economic deprivation and bigger hospitals were negatively associated with ED visits.

CONCLUSIONS: Our study shows that interventions to reduce frequent ED use by older people should include the availability of long-term care facilities in the area. As population ageing is progressing, our results suggest that investing in alternative care options for older people with long-term care needs might have the beneficial impact of reducing the overall ED rates and improving quality and appropriateness of care.

The 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.

Introduction: eHealth applications have the potential to provide new integrated care services to patients with multimorbidity (MM), also supporting multidisciplinary care. The aim of this paper is to explore how widely eHealth tools have been currently adopted in integrated care programs for (older) people with MM in European countries, including benefits and barriers concerning their adoption, according to some basic health system characteristics.

Materials and Methods: In 2014, in the framework of the ICARE4EU project, expert organizations in 24 European countries identified 101 integrated care programs. Managers of the selected programs completed an online questionnaire on several dimensions, including the use of eHealth. We analyzed data from this questionnaire, in addition to qualitative information from six innovative programs which were studied in depth through case study methodology, according to characteristics of national health systems: a national health model (financing system), overall strength of primary care (PC) (structure/service delivery process), and level of (de)centralization of health system (executive powers in a country).

Results: 85 programs (out of 101) adopted at least one eHealth tool, and 42 of these targeted explicitly older people. In most cases, Electronic Health Records (EHRs) were used and some benefits emerged like improved care management and integration, although inadequate funding mechanisms represented a major barrier. The analysis by health system characteristics showed a greater adoption of eHealth applications in decentralized countries, in countries with a National Health Service (NHS) model, and in countries with a strong/medium level of PC development.

Conclusions: Although in the light of some limitations, findings indicate a relation between implementation of care programs using eHealth tools and basic characteristics of health systems, with decentralization of a health system, NHS model, and strong/medium PC having a key role. However adaptations of European health systems seem necessary, in order to provide a more innovative and integrated care.