Active Aging Policies Targeting Health and Care During the of COVID-19 Pandemic: A Systematic Review and Thematic Analysis of Italian National and Regional Policies.

A primary objective of active aging policies is to promote health and optimize care for individuals. In aging societies, the maintenance of good physical and mental health and the management of risk factors are of utmost importance. Few research studies have analyzed active aging policies related to health and care from a multi-level governance perspective. The aim of this study was to determine what national and regional policies in these domains existed in Italy. We conducted an inductive thematic analysis of health- and care-related policies on active aging, selected through a systematic review in 2019-2021. The analysis uncovered three themes at both the national and regional levels (health promotion and disease prevention, health monitoring, and informal caregivers) and two additional themes at the regional level (access to health and social care services, and mental health and well-being). According to the findings, COVID-19 partially influenced the evolution of active aging policies.

Helping Behavior of Older Adults during the Early COVID-19 Lockdown in Belgium.

This study aimed to understand whether older adults not only received but also provided help during the first COVID-19 lockdown in Belgium, which factors motivated them to help, and whether older adults differed from younger age groups in terms of helping behavior and motives. Bivariate analyses were performed using data generated from an online cross-sectional survey in Belgium (N = 1892).The results showed that older adults who received help also provided it. This "interdependence" - mutual or reciprocal dependence - occurred regardless of age. In terms of motives for providing help, both older adults and their younger peers were primarily motivated by present-oriented and emotion-related motivation: older people were motivated to provide help by altruistic values and humanism, and enhancement motives linked to self-development.Policy implications of these results entail: during crisis situations, make use of the bond between older adults and their neighbors, such as caring communities.

Changes in Volunteering of Older Adults in the Time of the COVID-19 Pandemic: The Role of Motivations.

This paper elucidates the relationship between possible changes in volunteering experienced by older people during the COVID-19 pandemic, and their motivation to volunteer, as well as the direct or indirect experience of COVID-19 symptoms. Given the well-known positive benefits of volunteering in older age both for individuals (in terms of improved health and wellbeing) and society at large, there is a paucity of studies on older volunteers in the time of COVID-19. In this context, older people's volunteering was highly challenged due to age-based physical and social restrictions put in place by national governments, which have been considered as ageist by a large part of the gerontological scientific community. This study was carried out on a sample of 240 Italian older volunteers. The results suggest that during the COVID-19 pandemic, especially older volunteers driven by social goals (e.g., opportunities to have relationships with others) were able to continue volunteer activities without needing to change them. The study also clarified that having directly or indirectly experienced COVID-19 symptoms did not influence changes in voluntary activities of older people. These results have important policy implications, given the indication that through volunteering, older individuals may try to counter the undesired calls by the governments for self-isolation and physical distancing. It is important that in emergency situations involving older people, policy makers should not treat them as only recipients of health and social care, but also as useful providers of help in the community.

Active Ageing in Italy: An Evidence-Based Model to Provide Recommendations for Policy Making and Policy Implementation.

In ageing societies, active ageing (AA) has been recognized as a useful conceptual tool due to its holistic approach to social issues and recognised benefits from it at multiple levels (micro, meso and macro) for addressing demographic challenges. However, one of the main problems identified in relation to AA, is to turn into practice, at the policy making level, the many positive aspects that it promises at the conceptual level, as is demonstrated by the available evidence based on experiences carried out in some European countries. As an advancement in this field, through an original research experience carried out in Italy between 2019 and 2021, this study for the first time provides a model for producing recommendations for policy making and policy implementation in the field of AA, by managing the main problematic aspects related to the operationalization, at the policy making level, of the AA concept, with the potential for replication in other countries. The main challenges were identified, as well as the way to deal with them through a model, for a proper operationalization of the AA concept, based, among other aspects, on a solid international framework concerning this matter, on a mainstreaming ageing approach (at the public policy level) and on a wide stakeholder participation through co-decisional tools. A multi-level (national-regional-local) perspective was adopted to consider cultural and geographical diversity, among other challenges.

Active Ageing in Italy: A Systematic Review of National and Regional Policies.

Active ageing is defined as the process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age. The design of active ageing policies intersects with different overarching societal challenges, especially ageing populations, social rights and sustainability. However, there are no previous attempts to review active ageing policies in the light of these challenges and the international policy objectives and targets that are guiding the international community. The aim of this study is to systematically identify, review and analyse all national and regional policies on active ageing adopted in Italy, by applying a conceptual framework derived from main international policy initiatives in the three areas. The research was conducted in two stages. First, a case study analysis was carried out per each relevant national institution and regional government. Standardised interviews were combined with policy document search, selection and analysis. Second, we performed a policy analysis in the light of a conceptual framework adopted. This latter was composed by nine policy domains, selected and integrated from principles and objectives of three overarching international frameworks on ageing-i.e., the Regional Implementation Strategy (RIS) commitments of the Madrid International Plan of Action on Ageing (MIPAA), social rights-i.e., the European Pillar of Social Rights and sustainability-i.e., the Sustainable Development Goals (SDGs) of the Agenda 2030 for Sustainable Development. Results pointed out that out of the identified nine policy fields, the major intervention areas by Italian policy makers concerned labour market participation, life-long learning, social and economic inequalities, health and well-being. Less attention had been given to issues such as gender and equal opportunities and sustainable cities. This systematic policy review is a milestone for understanding how active ageing policies contribute to address major societal challenges and what domains need further policy development.

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

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.

Physical Activity during the Retirement Transition of Men and Women: A Qualitative Longitudinal Study.

The retirement transition is a major life change affecting people's lifestyles and behaviors, including those in relation to physical activity (PA), which is a key component of active ageing. Previous research analyzing the effect of retirement on PA levels has shown mixed results, and few studies investigated this issue in a gender perspective, thus, highlighting a need of knowledge in this respect. Aims of this study focused on the experience of PA during the retirement transition were to understand typologies of PA and possible changes in these typologies, to identify behavioural types relative to PA practice and levels, and to distinguish the main drivers and barriers for practicing PA associated with the different behavioural types. A further goal of the study was to investigate the abovementioned aims considering differences between women and men. Analyses were carried out within a three-year qualitative longitudinal study (2014-2016), which explored the individual experience of PA during the transition from work to retirement of 24 women and 16 men in Italy, with interviews carried out one year before and one and two years after retirement. Results show that preferred PA for both women and men was walking, along the transition to retirement. Over time, several participants replaced physically demanding activities with lighter ones. Six behavioural types were identified, describing individuals who incremented, started, or maintained the same level of PA, people who decreased PA levels or stopped it, and individuals who had a fluctuant behavior towards PA, or who had never practiced it. In general, poor health represented the main barrier to PA. For men, the main driver to PA was its effects on body shape, while for women, socialization/networking. In order to stimulate a more effective promotion of PA during the retirement transition, policy implications were discussed in light of the results obtained.

Impact of working situation on mental and physical health for informal caregivers of older people with Alzheimer's disease in Italy. Results from the UP-TECH longitudinal study.

OBJECTIVES: This longitudinal study explores whether the working situation (no change in working hours despite care, reduction of working hours due to care or not working) moderates mental and physical health of informal caregivers of older people with Alzheimer's disease (AD) in Italy. METHODS: Data from a sample of 146 caregivers of older people with moderate AD involved in the UP-TECH trial across three waves were analysed. Multivariate analyses were used to study the association between independent variables (caregivers' work situation) and dependent variables (caregivers' psycho-physical health). In a second model, elements relating to the caregiver, the cared-for individual and the caregiving situation were added as controls. RESULTS: Being forced to reduce working hours due to care tasks or not being employed independently from care was negatively associated with informal caregiver's physical health, compared with working carers not experiencing reduction of working hours. In the extended model, this result was confirmed. In comparison with working carers not forced to reduce working hours, non-working carers experienced higher levels of caregiver burden and depression, however these results were not confirmed in the adjusted model. Other factors also emerged as important including weekly hours of care, the cared-for older individual's ADL/IADL scores and informal support network. CONCLUSIONS: Given the positive effect of labour force participation on health of informal caregivers of older people with AD, policy makers should promote their employment avoiding their forced reduction of working hours, while also putting measures in place to decrease the intensity of informal care provision.

New Multilevel Partnerships and Policy Perspectives on Active Ageing in Italy: A National Plan of Action.

Active ageing (AA) policies aim to improve quality of life of older people by enabling better social participation and inclusion. Despite many international initiatives to promote AA undertaken in recent years, Italy did not systematically address this policy challenge until very recently. This paper presents the first national Plan-of-Action (PoA) (2019-2022) adopted by this country for supporting policy design and recommendation in this field. The PoA aims to create a multilevel, co-managed coordination of AA policies, by involving a network of national and regional policy makers, experts, researchers and stakeholders in civil society. The ad-hoc consultation process established for this purpose helps the recognition of different interests and expectations on AA, fostering new solutions by involvement, consultation and joint discussion of policy options. The PoA is designed to cover the traditional policy cycle, including the stages of agenda setting, policy formulation, decision-making, implementation and monitoring. At the end of the period covered by the PoA, an Italian AA Strategy will be launched to achieve systematic impact in this field, thus ensuring a long-term, sustainable impact on national and regional policy makers, civil society and research community.

The Participation of Senior Citizens in Policy-Making: Patterning Initiatives in Europe.

Worldwide, active aging policy calls for greater participation of senior citizens in the social, economic, and political realms. Despite emerging evidence of initiatives engaging senior citizens in social activities, little is known about the use of participatory approaches in the design and/or implementation of policies that matter to older citizens. This article identifies initiatives facilitating the civic participation of older people in policy-making in European Union member and associate states, drawing on a review of the literature, consultation of national policy experts, and exemplary case studies. Four main patterns of senior civic participation are identified: adopting consultative or co-decisional participatory approaches in policy design or policy implementation. The four are represented to varying degrees at different geographical levels (national, regional, local), with different actor configurations (appointed, elected/nominated, corporate representation), and with varying degree of institutionalization (temporary/permanent). Case studies illustrate approaches taken to enhance the quality and effectiveness of public services for senior citizens. Future research should strengthen this line of enquiry to cast further light on conditions facilitating the civic participation of senior citizens.

Social Innovation in Long-Term Care: Lessons from the Italian Case.

The debate on policies addressing the challenges posed by population ageing pays increasing attention to sustainable and innovative ways to tackle the multidimensional impact this phenomenon has on society and individuals. Moving from the findings of two European research projects, a qualitative study based on a rapid review of the literature, expert interviews, focus groups and case studies analysis has been carried out in Italy. This study illustrates which social innovations have been recently implemented in this country's long-term care (LTC) sector, and the areas in which further steps are urgently needed in the future. This takes place by first highlighting the existing links between social innovation and LTC, and then by identifying the key factors that can facilitate or hinder the implementation of these initiatives. Finally, the study suggests how to promote social innovation, by strengthening the "integration" and "coordination" of available services and resources, through a-for this country still relatively-new approach towards ageing, based on pillars such as prevention and education campaigns on how to promote well-being in older age.

Active Aging: Social Entrepreneuring in Local Communities of Five European Countries.

Building on the active aging framework, the aim of this study, carried out between 2016 and 2018, is to analyze concrete experiences of older individuals acting as key players of social change in six local communities of five European countries (Bulgaria, Denmark, England, France, Spain). The 19 seniors involved in the study, according to social contexts, individual past experiences, knowledge, and motivations, acted as senior social entrepreneurs, trying to build a pathway towards social solutions for unmet social problems they detected in local communities. Data were collected via templates and questionnaires and analyzed using the thematic analysis. The results highlighted that the 16 local initiatives created by seniors concerned social problems such as food waste, social isolation, multicultural integration, etc. The social solutions implemented by seniors seemed to have the potential to produce social value and, to different degrees, encouraging results and impact. Since this "social experiment" provided evidence that senior social entrepreneuring could be a driver to solve societal problems, policy makers should sustain the spread of both social entrepreneurial mindset and practices at the European level, for catalyzing the active potential of older people for the benefit of European local communities.

Employees' Longer Working Lives in Europe: Drivers and Barriers in Companies.

This paper identifies, within companies' sectors of activity, predictors of Human Resource (HR) policies to extend working life (EWL) in light of increasing policy efforts at the European level to extend working life. Three types of EWL practices are investigated: the prevention of early retirement (i.e. encouraging employees to continue working until the legal retirement age); delay of retirement (i.e. encouraging employees to continue working beyond the legal retirement age); and, recruitment of employees who are already retired (i.e. unretirement). A sample of 4624 European organizations that was stratified by size and sector is analyzed in six countries. The main drivers for companies' EWL practices are the implementation of measures for older workers to improve their performance, their working conditions, and to reduce costs. In industry, the qualities and skills of older workers could be more valued than in other sectors, while the adoption of EWL practices might be less affected by external economic and labor market factors in the public sector. Dutch and Italian employers may be less prone than others to extend working lives. These results underline the importance of raising employers' awareness and increase their actions to extend employees' working lives by adopting age management initiatives, especially in SMEs, and in the services and public sectors.

Health and Volunteering in Europe: A Longitudinal Study.

This article examines the relationship between health and volunteering in advanced age in a cross-national comparison. We used longitudinal data from five waves of the Survey of Health, Ageing and Retirement in Europe covering 13 European countries from 2004 to 2015 and employed dynamic random-effects probit models to study the consequences of declining health on voluntary work. Our results confirm that worsening health conditions (i.e., mobility limitations and depression) reduce the likelihood of volunteering, whereas chronic diseases do not. Most interestingly, we found important differences across countries: Worsening health reduces voluntary work participation, especially in contexts characterized by high rates of volunteering. Our findings have implications for policy makers and voluntary organizations that aim to encourage participation: Individual characteristics and contextual aspects must be taken into account, and people with health problems might need specific support through policies, recruitment, and retention even in contexts of overall high levels of volunteering.

Valuing and Integrating Informal Care as a Core Component of Long-Term Care for Older People: A Comparison of Recent Developments in Italy and Spain.

The international long-term care (LTC) debate has recently been focusing on how to strengthen home care provision. In this regard, a major role has been played by informal care and how to best integrate it in a holistic care approach. Italy and Spain, usually labeled as "familialist" or "family-based" care models, have been promoting national reforms or actions to support the integration of "informal" actors into the overall LTC system. Through a comparative review of recent trends observed in the two care regimes, this article aims at contributing to improve our cross-national understanding of how LTC is changing across Europe, identifying the basic approaches adopted in Italy and Spain and highlighting both their strengths and drawbacks.

Participation in formal learning activities of older Europeans in poor and good health.

Little attention has been given to the involvement in formal learning activities (FLA) in the older population when considering different health statuses. The aim of this study is to explore the extent to which possible predictors (derived from previous research as well as a conceptual model) of FLA differ for older people in poor and good health. Data are used from SHARE 2010/2011 for the 50+ populations in 16 European countries. Poor health is defined as self-report of having two or more chronic diseases assessed by a medical doctor, i.e. multimorbidity. Possible predictors of learning activities represent individual characteristics: functional limitations, demography (age, gender, marital status and household size), human capital (achieved level of education), employment, income and participation in other social activities. To assess the predictors of FLA, logistic regression models are used and average marginal estimates are compared across groups. In addition to multimorbidity, labour market activity is used as a grouping variable. The average participation of individuals in the group with multimorbidity was nearly 50 % lower than that in the group in good health (6.5 vs. 13.3 %). Regardless of multimorbidity, human capital proved to be significant predictors of FLA, especially in those active on the labour market. However, the associations were weaker in the multimorbidity group. Also, significant associations were observed of other types of social activities, in particular cultural and leisure activity and volunteering, with FLA. This study suggests that similar factors are predictors of FLA in older people with and without multimorbidity.

Predictors of social leisure activities in older Europeans with and without multimorbidity.

Older people spend much time participating in leisure activities, such as taking part in organized activities and going out, but the extent of participation may differ according to both individual and environmental resources available. Chronic health problems become more prevalent at higher ages and likely necessitate tapping different resources to maintain social participation. This paper compares predictors of participation in social leisure activities between older people with and those without multimorbidity. The European Project on Osteoarthritis (EPOSA) was conducted in Germany, UK, Italy, The Netherlands, Spain and Sweden (N = 2942, mean age 74.2 (5.2)). Multivariate regression was used to predict social leisure participation and degree of participation in people with and without multimorbidity. Fewer older people with multimorbidity participated in social leisure activities (90.6 %), compared to those without multimorbidity (93.9 %). The frequency of participation was also lower compared to people without multimorbidity. Higher socioeconomic status, widowhood, a larger network of friends, volunteering, transportation possibilities and having fewer depressive symptoms were important for (the degree of) social leisure participation. Statistically significant differences between the multimorbidity groups were observed for volunteering and driving a car, which were more important predictors of participation in those with multimorbidity. In contrast, self-reported income appeared more important for those without multimorbidity, compared to those who had multimorbidity. Policies focusing on social (network of friends), physical (physical performance) and psychological factors (depressive symptoms) and on transportation possibilities are recommended to enable all older people to participate in social leisure activities.

Predictors of religious participation of older Europeans in good and poor health.

Religious attendance is an important element of activity for older Europeans, especially in more traditional countries. The aim of the analysis is to explore whether it could be an element contributing to active ageing as well as to assess differences between the religious activity of older individuals with and without multimorbidity defined as an occurrence of two or more illnesses. The analysis is conducted based on the SHARE database (2010-2011) covering 57,391 individuals 50+ from 16 European countries. Logistic regressions are calculated to assess predictors of religious activity. Results point that religious activity often occurs in multimorbidity what could be driven by the need for comfort and compensation from religion. It is also significantly correlated with other types of social activities: volunteering or learning, even among the population with multimorbidity. There is a positive relation between religious activity and age, although its effect is weaker in the case of multimorbidity, as well as being female. Mobility limitations are found to decrease religious participation in both morbidity groups and might be related to discontinuation of religious practices in older age. The economic situation of older individuals is an insignificant factor for religious attendance. Religious attendance can be an element of active ageing, but also a compensation and adaptation to disadvantages occurring in older age and multimorbidity. At the same time, religious activities are often provided at the community level and targeted to population in poorer health.

Do predictors of volunteering in older age differ by health status?

It has been widely recognised that poor health is one of the main barriers to participation in volunteer activities in older age. Therefore, it is crucial to examine the participation of older people in volunteering, especially those in poor health. Based on the resource theory of volunteering, the aim of this study is to better understand the correlates of volunteering among older people with different health statuses, namely those without health problems (neither multimorbidity nor disability), those with mild health problems (multimorbidity or disability), and those with severe health problems (multimorbidity and disability). Data were drawn from the fourth wave (2011-2012, release 1.1.1) of the Survey of Health, Ageing and Retirement in Europe, which includes European people aged 50 years or older. The results showed that variables linked to volunteering were generally similar regardless of health status, but some differences were nevertheless identified. For older people with mild or severe health problems, for instance, depressive symptoms were negatively associated with their involvement in volunteer activities. We found a positive association of being widowed (rather than married) with volunteering in older people with particularly poor health, whereas high income was associated with volunteering in the case of mild health problems only. These results demonstrate that variables associated with volunteer participation partially differ between older people depending on their health status. These differences should be considered by policy makers in their attempts to promote volunteering in older people, as a means of preventing their social exclusion.