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Purpose: The digital age requires people of all ages to communicate and organise their lives through digital technologies. The project EQualCare investigates how the growing population of older people living alone is managing this transition, how it shapes their (non-)digital social networks and what changes on a local level need to be brought about. This paper aims to give insight into the process of participatory action research (PAR) with older people in the community across four countries and reflects on experiences made by academic and co-researchers. Design/methodology/approach: Following the emancipatory underpinnings of PAR, which aims to reduce inequalities through collaboration and co-design, EQualCare involved nine teams of co-researchers across Finland, Germany, Latvia and Sweden making older people the centre of policy development. Co-researchers were involved in formulating research aims, collecting data, reflecting on data, formulating and disseminating recommendations for local policy stakeholders. Findings: Co-researchers' motivation to invest considerable time and effort was driven by a desire to create a more equal future for older people living alone. Moreover, they were keen to involve marginalised older people and became frustrated when this proved difficult. Power dynamics played a role throughout the process but became productive as roles and responsibilities were renegotiated. Doing PAR with older people can be emotionally challenging for co-researchers when negative feelings around ageing are encountered. Originality/value: The paper advances understanding on the process of PAR in ageing research by reflecting on the social, cultural and political contexts of doing PAR with diverse sets of older people. [ABSTRACT FROM AUTHOR]

A person's health status is one of the strongest determinants of well-being. The negative impact of poor health on subjective well-being may be moderated by providing care to individuals in need. In this paper, we investigate the relationships between receiving informal care and the amount of care received and subjective well-being among people aged 65 or older in selected European countries. Our analysis of data from the 6th wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) showed that receiving regular informal care was associated with higher subjective well-being among older people in Northern European countries, and with lower subjective well-being among older males in Southern European countries. Moreover, we found that the perception of the amount of help received affected the subjective well-being of older people, as those who reported that the support they received was either insufficient or met their needs had lower subjective well-being than those who were not in need of care. Our results also showed that receiving formal care was negatively related with subjective well-being among older adults in Northern Europe and Central and Eastern Europe. In the context of population ageing and the growing need for care, social policies that support both sides of the caregiving relationship could enhance subjective quality of life. [ABSTRACT FROM AUTHOR]

Objectives Research among older adults reveals that the loss of core network members is a risk factor for loneliness. Still, it is not clear whether all such losses induce similar levels of loneliness, particularly as network members are distributed at varied geographic distances. Neither is it clear whether tie addition—the other ubiquitous aspect of network turnover in later life—offsets the loneliness that arises from different network loss scenarios. Methods This paper scrutinized core network losses across multiple relationship–distance scenarios. We used the fourth and sixth waves of data from the Survey of Health, Ageing, and Retirement in Europe and estimated fixed-effect models. Results The loss of a child from a core network increases feelings of loneliness across variant distances, especially when not complemented by additional connections. Losing relatives or nonkin core connections in proximity (within 1 km and 5 km radius, respectively) is also associated with increased loneliness, yet such effects are also largely mitigated by the addition of new core network members. Discussion The relationship between core network member losses and loneliness can significantly differ based on the nature of the lost connection and its geographic distance. Active rebalancing of one's core network following losses and proactive network expansion can serve as pivotal strategies to prevent loneliness for the aging population. [ABSTRACT FROM AUTHOR]

Introduction: Although person-centredness is a key principle of integrated care, successfully embedding and improving person-centred care for older people remains a challenge. In the context of a cross- European project on integrated care for older people living at home, the objective of this paper is to provide insight at an overarching level, into activities aimed at improving person-centredness within the participating integrated care sites. The paper describes experiences with these activities from the service providers' and service users' perspectives. Methods: A multiple embedded case study design was conducted that included thirteen integrated care sites for older people living at home. Results: Service providers were positive about the activities that aimed to promote person-centred care and thought that most activities (e.g. comprehensive needs assessment) positively influenced personcentredness. Experiences of service users were mixed. For some activities (e.g. enablement services), discrepancies were identified between the views of service providers and those of service users. Discussion and conclusion: Evaluating activities aimed at promoting person-centredness from both the service providers' and service users' perspectives showed that not all efforts were successful or had the intended consequences for older people. Involvement of older people in designing improvement activities could ensure that care and support reflect their needs and preferences, and build positive experiences of care and support. [ABSTRACT FROM AUTHOR]

To promote long-term care policies for older adults, accurate mapping of the often invisible and insufficiently recognized role of their informal caregivers is needed. This paper measures the prevalence of informal caregivers in the European population, illustrates current difficulties in gathering unequivocal information on this topic and deals with the scientific and policy implications of the problem. Using the European Health Interview Survey (EHIS), the European Quality of Life Survey (EQLS) and the Study on Health and Ageing in Europe (SHARE), the current difficulties in gathering unequivocal information on this topic are illustrated. In most countries, the share of informal caregivers varies, sometimes markedly, among the three surveys. As for the sex of caregivers, while confirming the well-known higher prevalence of caregivers among women than among men, large variations emerge across the three surveys in most countries in respect of the two sexes. The takeaway message of the paper is that it is urgent to promote international concerted action in gathering comprehensive informal caregiving information and/or exploring in greater depth the different intercultural understandings of informal care itself. [ABSTRACT FROM AUTHOR]

This paper combines SHARE Corona Survey and SHARE Wave 7 data for 25 European countries and Israel (N = 40,919) with institutional and epidemic-related country characteristics to investigate healthcare access for Europeans aged 50+ during the outbreak of COVID-19. We use a micro–macro approach to examine whether and to what extent barriers to accessing healthcare measured by reported unmet healthcare needs vary within and between countries. We consider various aspects of barriers and distinguish among: (1) respondents who forewent medical treatment because they were afraid of becoming infected with the Coronavirus; (2) respondents who had pre-scheduled medical appointments postponed by health providers due to the outbreak; and (3) respondents who tried to arrange a medical appointment but were denied one. Limited access to healthcare during the initial outbreak was more common for the occupationally active, women, the more educated and those living in urban areas. A bad economic situation, poor overall health and higher healthcare utilisation were robust predictors of unmet healthcare. People aged 50+ in countries of 'Old' Europe, countries with higher universal health coverage and stricter containment and closure policies were more likely to have medical services postponed. Policymakers should address the healthcare needs of older people with chronic health conditions and a poor socio-economic status who were made more vulnerable by this pandemic. In the aftermath of the health crisis, public health systems might experience a great revival in healthcare demand, a challenge that should be mitigated by careful planning and provision of healthcare services. [ABSTRACT FROM AUTHOR]

This study examines the relationship between the provision of informal care and three specific feelings important in later life – loneliness, meaningfulness of life, and overload. The paper contributes to the research of this frequently studied topic through examining effects of the intensity and multiplicity of care as well as the availability of formal care at the national level to consider the complexity and context-dependence of the effect of caregiving. Data from the Survey of Health, Ageing and Retirement in Europe for 14 countries is analysed using multilevel regression with important domains of subjective quality of life in older ages as dependent variables. The general effect of providing care is enhancing and this effect is even more pronounced for multiple caregiving. However, this beneficial effect is not significant for very intensive care. Further, higher availability of formal care increases the quality of life, but reduces the beneficial effect of caregiving on loneliness. Overall, the theory of role accumulation is more suitable to explain the provision of care at older ages than the theory of role strain, but the crucial factor for understanding the effect of caregiving is context-sensitivity. [ABSTRACT FROM AUTHOR]

Background in 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) published a sarcopenia definition that aimed to foster advances in identifying and caring for people with sarcopenia. In early 2018, the Working Group met again (EWGSOP2) to update the original definition in order to reflect scientific and clinical evidence that has built over the last decade. This paper presents our updated findings. Objectives to increase consistency of research design, clinical diagnoses and ultimately, care for people with sarcopenia. Recommendations sarcopenia is a muscle disease (muscle failure) rooted in adverse muscle changes that accrue across a lifetime; sarcopenia is common among adults of older age but can also occur earlier in life. In this updated consensus paper on sarcopenia, EWGSOP2: (1) focuses on low muscle strength as a key characteristic of sarcopenia, uses detection of low muscle quantity and quality to confirm the sarcopenia diagnosis, and identifies poor physical performance as indicative of severe sarcopenia; (2) updates the clinical algorithm that can be used for sarcopenia case-finding, diagnosis and confirmation, and severity determination and (3) provides clear cut-off points for measurements of variables that identify and characterise sarcopenia. Conclusions EWGSOP2's updated recommendations aim to increase awareness of sarcopenia and its risk. With these new recommendations, EWGSOP2 calls for healthcare professionals who treat patients at risk for sarcopenia to take actions that will promote early detection and treatment. We also encourage more research in the field of sarcopenia in order to prevent or delay adverse health outcomes that incur a heavy burden for patients and healthcare systems. [ABSTRACT FROM AUTHOR]

An editorial is presented on European Union's fundamental achievements interrupted and people avoided seeking medical treatment in fear of an infection. Topics include pandemic and the epidemic control decisions being implemented having major efects on the economic and social well-being of the older population ; and people avoided seeking medical treatment in fear of an infection.

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This paper investigates the potential trade‐offs between extension of coverage and adequate generosity in cash‐for‐care (CfC) programmes in six European countries (Austria, Germany, France, Great Britain, Italy, and Spain), which are characterised by different configurations of CfC programmes. Building on an empirical analysis of the eligibility rules, of the regulation applied to classify beneficiaries according to their level of dependency, and the ways CfC benefits are distributed among them, it becomes clear that these programmes differ substantially in terms of coverage and generosity. Such differences reflect the variety of ways by which universalism, selectivity, and adequacy are built up together throughout Europe. [ABSTRACT FROM AUTHOR]

This paper contributes to the ongoing refinement of citizenship as a feminist concept through the development of understandings of the relationship between economic and intimate citizenship in contemporary Europe. It draws on two cross-national research projects that each focus on a group of people who might be thought to be affected by particular processes of individualization: the economic “activation” of large numbers of women in increasingly deregulated labour markets, and the progressive detraditionalization of intimate life. The paper examines patterns of intimate life and citizenship that accompany employment in the elder care sector, and patterns of economic life and citizenship that accompany the experience of living outside the conventional family. It argues that there are significant and hitherto unrecognized tensions between “flexible” jobs and the ability of individuals to exercise agency as intimate citizens. It suggests that it is difficult to flourish as an intimate citizen without enjoying a degree of economic autonomy, and that economic autonomy is elusive for women working in the most deregulated sectors of the labour market. It also points to the important role that social policies play in mediating the relationship between intimate and economic citizenship. [ABSTRACT FROM PUBLISHER]

The role of children's caregiving has received substantial attention in studies on care in old age. Previous research shows that children's care provision is strongly intertwined with both their individual and siblings' situation regarding employment and geographic parent-child distance. This study uses data from six waves of the Survey of Health, Ageing and Retirement in Europe (SHARE), taking a within-family approach, to examine how caregiving is (re-)distributed between siblings over time. The provision of continuous parent care is observed more frequent and volatile in European countries with a family-based care system. The results from family fixed-effects regression models demonstrate that children working less than siblings persist in caregiving more. Living closest to parents facilitates children to keep up care efforts, while changing to living closest enhances the start of parent care. This study suggests that geographic distance is vital in the long-term organization of parent care between siblings. [ABSTRACT FROM AUTHOR]

This paper investigates how restriction policies have impacted elderly self-assessed health (SAH) in Europe during the pandemic, and how the Covid-19 infection interacts with policy stringency to modulate the SAH deterioration. Using the Survey of Health, Aging and Retirement in Europe (SHARE) between October 2019 and August 2021, including 9,034 adults aged 50 years and above, alongside with a stringency index from the Oxford's Coronavirus Government Response Tracker (OxCGRT), we design both an adjusted probit model and a recursive bivariate probit model to test for endogeneity of Covid-19 infection. Estimations results show a bell curve between stringency and SAH degradation: a deleterious effect of restrictions at low levels of stringency up to a tipping point after which more stringent policies become protective. Covid-19 infection moderates this association. Depending on individuals' initial health, the effect of restrictions is uneven: highly stringent policies become damaging for individuals most likely to enter a vulnerabilization path, for whom the bell curve is thus inverted. Overall, this study shows clear patterns of association between policy stringency and perceived health among older Europeans, and highlights the potential trade-off between targeting as many people as possible, those in poor health or those on the edge of vulnerability. • The association between policy stringency and SAH degradation is a bell curve. • Strict restrictions only affect the SAH of people likely to become vulnerable. • Covid-19 infection moderates the deterioration of SAH caused by policy stringency. • The recursive bivariate probit model controls for endogeneity in infection. [ABSTRACT FROM AUTHOR]

Background: Transfers of money and help with daily activities by family and friends are important sources of support for older people and contribute to their well being. On the other hand, older adults are not only recipients of support but also important providers of support and financial transfers as giving and receiving are often reciprocal. For this, it is important to understand the determinants of receiving and giving money and help as well as the relationship between these two. Methods: The aim of this paper is to explore the relationship between giving and receiving of the same or of different types of transfers as well as to get more insights in the motivation behind giving and receiving of money gifts or informal care. We use data from the Survey of Health Aging and Retirement in Europe and employ a multinomial logit model to analyse 16 different categories resulting from combining information on the incidence of giving and receiving of both informal care and financial gifts. Results: We show that despite the differences that exist in the incidence of giving and receiving of both informal care and financial gifts there are clearly a few patterns that are consistent between the European countries in our analysis. Both 'altruistic-like' and 'exchange-like' motives are more likely to increase by age, gender and physical proximity of network members, while 'reciprocal-like' giving and receiving is more likely among females and those with a network at close distance. Conclusions: Our results show that the incidence of informal care and gifts to and from older people is related to particular characteristics and transfers patterns. Further research should be dedicated to exploring the situations leading to the 'altruistic-like' and 'exchange-like' combinations of transfers. [ABSTRACT FROM AUTHOR]

Elderly people with functional limitations are predominantly cared for by family members. Women – spouses and daughters – provide most of this care work. In principle, gender inequality in intergenerational care may have three causes: first, daughters and sons have different resources to provide care; second, daughters and sons respond differently to the same resources; third, welfare state programmes and cultural norms affect daughters and sons differently. In this paper, we address the empirical question whether these three assumed causes are in fact responsible for gender differences in intergenerational care. The empirical analyses, based on the Survey of Health, Ageing and Retirement in Europe (SHARE), reveal that parents in need are in fact more likely to receive care from daughters than from sons. Daughters are more responsive to the needs of their parents than sons and respond differently to the same resources. Gender inequality is highest in countries with a high level of intergenerational care, high public spending on old-age cash-benefits, a low provision of professional care services, high family obligation norms and a high level of gendered division of labour. Welfare state programmes reduce or increase gender inequality in intergenerational care by reducing or increasing the engagement of daughters in intergenerational care. In general, care-giving by sons is hardly influenced by social care policies. [ABSTRACT FROM PUBLISHER]

Background: Despite many studies evaluating the effectiveness of integrated care, evidence remains inconsistent. There is increasing commentary pointing out the mismatch between the ability to capture the somewhat 'illusive' impact of integrated care initiatives and programmes, and the most appropriate way to do this. Focusing on methodology, this paper describes and critically reviews the experiences of SUSTAIN, a Horizon 2020 funded project (2015-2019) with the purpose of advancing knowledge and understanding of cross-European integrated care evaluation. SUSTAIN sought to improve integrated care initiatives for older people in seven countries, and to maximise the potential for knowledge transfer and application across Europe. The methods approach drew from implementation research, employing the participative Evidence Integration Triangle (EIT) and incorporating a mixed method, multiple embedded case study design. A core set of qualitative and quantitative indicators, alongside context and process data, were created and tested within four key project domains (person-centredness, prevention-orientation, safety and efficiency). The paper critically discusses the overall approach, highlighting the value of the EIT and case study design, and signalling the challenges of data collection with frail older people and stakeholder involvement at the sites, as well as difficulties developing the core set of indicators.Conclusions: Lessons learned and recommendations for advancing integrated care evaluation are put forward that focus on the status of integrated care as a complex intervention and a process. The use of implementation research methods and case study design are recommended as an additional evaluation approach for researchers to consider, alongside suggested ways of improving methods of data collection with frail populations and cost analysis. [ABSTRACT FROM AUTHOR]

The age profile of a country influences the organization of healthcare arrangements for older people. In southern European countries, the low performance of the welfare state and traditional family-oriented culture have led to an informal and gendered model of care, with women often responsible for the (unpaid) caregiving work. However, the increasing female participation in the labour market challenges these welfare regimes, prompting a shift in family responsibilities outside the family. Moreover, in response to the growing need for long-term care workers, some European countries have relied on individuals with a "migratory background" rather than restructuring their public elderly care services. This article examines the demographic, cultural, economic, and social changes of southern welfare regimes. The introduction of policies that, directly or indirectly, eliminate gender stereotypes in informal caregiving work and the diffusion of equal family-care culture are measures that can no longer be postponed in addressing the future of such welfare regimes. [ABSTRACT FROM AUTHOR]

The progressive population ageing observed in Western countries determines a growing need for long-term care for older people. At the same time, migrants and refugees often have integration difficulties in regards to the hosting country society and labour market, with one reason being the lack of EU recognition of the educational degrees obtained in their native country. Creating educational opportunities in elderly care for migrants may facilitate their social inclusion, increase their employability, and constitute a response to the growing labor demand. The HERO project moved in this direction by planning, designing, and carrying out an original training curriculum targeted to migrants and refugees from African and Middle Eastern countries, piloted in four Mediterranean countries (Cyprus, Greece, Italy, and Portugal). The impact of the training on migrants and refugees' quality of life was assessed through the WHOQOL-BREF questionnaire, while social inclusion was assessed through semistructured interviews and participant observation carried out during the internship in elderly care facilities. Eighty-two migrants (70.7 percent women) were involved in the study. The results showed that despite the fact that the training did not have an impact on the trainees' quality of life, it was associated with social inclusion. Four ideal types of migrant learners were drawn: "ex-professional trainees," "fall-back trainees," "care-oriented trainees," and "nonprofessional care workers," based on which as many possible educational pathways were drawn to optimise the trainees' learning process. The study results shaped the formulation of suggestions on migrants' education in elderly care. [ABSTRACT FROM AUTHOR]

Purpose: The comment addresses the idea of substituting professional elder care with informal care provided by early retirees to save economic costs. Design/methodology/approach: The comment arose from reading "How to handle gerontocracy", scientific research and critical, analytical thinking. Findings: While having early pensioners deliver elderly care has positive implications, substituting professional with informal care must be challenged. First, the "unused reservoir" of early pensioners might be overestimated, as they often already have care responsibilities. Second, the substitution of professional services is already happening due to staff shortages. Third, untrained caregivers might struggle to provide the needed care quality, resulting in worse health outcomes (and higher follow-up costs). Finally, there are concerns of social sustainability: because of role expectations, mainly women may take on care tasks, reinforcing social inequality. Also, the third sector might lose hours of volunteer work. Originality/value: The comment appeals to a critically rethinking of the idea of substituting professional services with informal care provision and argues for differentiated and well-tailored policy measures, taking into account the complex nature of (informal) caregiving. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic began impacting Europe in early 2020, posing significant challenges for individuals requiring care. This group is particularly susceptible to severe COVID-19 infections and depends on regular health care services. In this article, we examine the situation of European care recipients aged 50 years and older 18 months after the pandemic outbreak and compare it to the initial phase of the pandemic. In the descriptive section, we illustrate the development of (unmet) care needs and access to health care throughout the pandemic. Additionally, we explore regional variations in health care receipt across Europe. In the analytical section, we shed light on the mid- and long-term health consequences of COVID-19-related restrictions on accessing health care services by making comparisons between care recipients and individuals without care needs. We conducted an analysis using data from the representative Corona Surveys of the Survey of Health, Ageing and Retirement in Europe (SHARE). Our study examines changes in approximately 3,400 care-dependent older Europeans (aged 50+) interviewed in 2020 and 2021, comparing them with more than 45,000 respondents not receiving care. The dataset provides a cross-national perspective on care recipients across 27 European countries and Israel. Our findings reveal that in 2021, compared to the previous year, difficulties in obtaining personal care from someone outside the household were significantly reduced in Western and Southern European countries. Access to health care services improved over the course of the pandemic, particularly with respect to medical treatments and appointments that had been canceled by health care institutions. However, even 18 months after the COVID-19 outbreak, a considerable number of treatments had been postponed either by respondents themselves or by health care institutions. These delayed medical treatments had adverse effects on the physical and mental health of both care receivers and individuals who did not rely on care. [ABSTRACT FROM AUTHOR]

This is an expert opinion paper on oral health policy recommendations for older adults in Europe, with particular focus on frail and care‐dependent persons, that the European College of Gerodontology (ECG) and the European Geriatric Medicine Society (EUGMS) Task and Finish Group on Gerodontology has developed. Oral health in older adults is often poor. Common oral diseases such as caries, periodontal disease, denture‐related conditions, hyposalivation, and oral pre‐ and cancerous conditions may lead to tooth loss, pain, local and systemic infection, impaired oral function, and poor quality of life. Although the majority of oral diseases can be prevented or treated, oral problems in older adults remain prevalent and largely underdiagnosed, because frail persons often do not receive routine dental care, due to a number of barriers and misconceptions. These hindrances include person‐related issues, lack of professional support, and lack of effective oral health policies. Three major areas for action are identified: education for healthcare providers, health policy action plans, and citizen empowerment and involvement. A list of defined competencies in geriatric oral health for non‐dental healthcare providers is suggested, as well as an oral health promotion and disease prevention protocol for residents in institutional settings. Oral health assessment should be incorporated into general health assessments, oral health care should be integrated into public healthcare coverage, and access to dental care should be ensured. [ABSTRACT FROM AUTHOR]

The use of formal and informal care for the elderly depends on many factors: income, urban-rural environment, educational attainment, family composition (singles/multi-member family), age and severity of health complications. For this analysis, a pro-rich poverty model is used based on data from the latest (8th) edition of SHARE (Survey of Health, Aging and Retirement in Europe) to examine the impact of socioeconomic inequalities among older people in the use of home care in European Union. The main results indicate that the pro-poor distribution of long-term care prevails in most of the studied countries. At the same time, health variables contribute to pro-poor inequality in the use of long-term care, mainly in informal care. When it comes to formal care, most countries have pro-poor contributions. Formal care inequalities disappeared when adjusted for need factors, while informal care inequalities remained in most countries. [ABSTRACT FROM AUTHOR]

Geriatric medicine has evolved to an accepted specialty in 23 European countries. Despite much heterogeneity of postgraduate geriatric curricula, European societies have succeeded in defining a common core curriculum with a list of minimum training requirements for obtaining the specialty title of geriatric medicine. Geriatricians play a leading role in finding solutions for the challenges of health care of multimorbid older patients. One of these challenges is the demographic shift with the number of adults aged 80 years and older in Europe expected to double by 2050. Although geriatric units will play a role in the care of frail older patients, new care models are needed to integrate the comprehensive geriatric assessment approach for the care of the vast majority of older patients admitted to non-geriatric hospital units. Over the last few years, co-management approaches have been developed to address this gap. Innovative models are also in progress for ambulatory care, prevention and health promotion programs, and long-term care. Efforts to implement geriatric learning objectives in undergraduate training, and the generation of practice guidelines for geriatric syndromes may help to improve the quality of care for older patients. [ABSTRACT FROM AUTHOR]

Using data from the COVID-19 questionnaire of the Survey of Health, Ageing and Retirement in Europe (SHARE), we investigate the time patterns of precautionary health behaviours of individuals aged 50 years and above during the summer of 2020, an easing phase of the COVID-19 pandemic in Europe. We also examine how these health behaviours differ by the presence of chronic conditions such as hypertension, high cholesterol level, heart disease, diabetes or chronic bronchitis, which can be considered as risk factors for COVID-19. Our results suggest that while on average, people became less precautious during the analysed time period, this is less so for those who are at higher risk. We also document large regional differences in precautionary health behaviours and show that higher-risk individuals are on average more cautious in all regions. We conclude that people adjusted their health behaviours in line with the generally understood risk of the COVID-19 disease. At the same time, our results also point out divergences in the level of willingness to take different precautionary steps. [ABSTRACT FROM AUTHOR]

Background: Sustainable tailored integrated care for older people in Europe (SUSTAIN) is a Horizon 2020 nine country collaborative project that aims to improve existing integrated care initiatives for older people living at home with multiple health and social care needs, ensuring they are patient-centred, prevention-oriented, efficient, and safe. This paper to be presented will describe our approach to evaluation and present some early findings of its application in practice. In the world of integrated care, health and social care solutions involve complex problems in complex community and healthcare environments, faced by complex patients, settings, and cultures. These challenges demand evaluation approaches that can accommodate this complexity but ensure robust and timely outcomes, creating evidence that is based on the experience of those who know, live, and work with the problem that the evidence needs to solve (Green 2001). The Evidence Integration Triangle model: With its origins in implementation science, the Evidence Integration Triangle (EIT) (Glasgow 2013) moves away from often unreliable and slow efficacy approaches towards creating a dynamic and transferable flow of high quality evidence to practice, ensuring a rapid and informed response to change and improvement. The EIT is a participative approach, including practitioners, policymakers, and citizens, and fosters robust and high-impact knowledge implementation by practitioners and community partnerships. Such knowledge is created through 'rapid learning cycles' and can support sustainability of initiatives. The EIT depicts in a simple framework the complex multilevel factors affecting the integration of scientifıc knowledge into practical applications. There are three main components to the model, namely the evidence-based intervention; participatory implementation processes; and practical measures of progress and outcome. Bringing evidence and relevant stakeholders together is central. These three components enable stakeholders to use scientific evidence to maximise positive health impact and encourage development and sharing of new knowledge to inform future interactions. The high participation and user involvement levels within this evaluation model enable the research to be relevant and applicable from the onset, and ensure that indicators and measures generated to gather evidence remain sensitive and applicable to the research and practice environment. Qualitative and quantitative evidence is accumulated and used throughout so that the change process remains responsive to improvement. Context is pivotal to the EIT. The conditions surrounding health problems and intervention opportunities in a particular place with a particular population, is a key starting point. Context also changes over time, and continually informs the other key components. The EIT model promotes a reorientation of the current clinical effectiveness research paradigm toward greater recognition of innovation and practice-based approaches to evidence (Green 2008). Within this model, a multi-method evaluation encompasses both an outcomes-based and a process evaluation in order to comprehensively identify whether and how improvements in integrated care initiatives came about. Translating the model to SUSTAIN: • the intervention will focus on existing integrated care sites and the over 65s living at home, and consist of a tailored set of improvements constructed with stakeholders, aimed at the micro, meso, and macro levels within the health and social care system; • the practical measures will consist of 1) a core set of qualitative and quantitative indicators measured at intervals; 2) multi-method process evaluation focusing on implementation processes and perceptual outcomes; • the participatory implementation process will consist of key stakeholders attached to the existing integrated care initiatives (e.g. decision-makers, policy makers, senior citizens, health insurers, health and social care providers, commissioners and representatives from the technology industry). They will use the on-going data collection and analysis and their own experiences to give regular feedback informing on progress, identifying problems and creating solutions and modifications to further the intervention improvements to service delivery. Conclusions: This approach is highly suited to SUSTAIN. Given the integrated care complexities and associated difficulties identifying meaningful outcomes, this methodology will help us to find out what works for whom, how, in what context and with what outcomes. In terms of the wider research agenda, the EIT model can also identify and guide strategic decision-making about research areas to pursue as initiatives are rolled out, so that evidence can inform health promotion and healthcare-quality research. [ABSTRACT FROM AUTHOR]

Throughout Europe the most damaging consequences of the coronavirus have fallen disproportionately on older people who live in care homes. This study involves the analysis of secondary data sources relating to deaths, and related harms, in European care homes from seven countries between March and December 2020. The findings are reviewed using the framework of the European Convention on Human Rights to identify examples of human rights violations - namely the right to life, liberty and security, respect for private and family life, and prohibition of torture, and general prohibition of discrimination. A significant contributing factor to the scale and nature of deaths and harms is the abject disregard of older people's human rights. Based on the findings, the authors, a group of social work academics, call for an urgent re-examination of the role of social work in relationship to care homes and the importance of re-engaging with human rights issues for care home residents. [ABSTRACT FROM AUTHOR]

Like other fields of social policy, the organization of long‐term care (LTC) varies temporally and geographically. The present article aims to advance the comparison of LTC systems worldwide by proposing a conceptual framework to analyse variation, putting a special focus on analysing the role of public and private actor types. In a precluding literature review of existing LTC typologies, we find that there are various promising classification approaches, but with an overwhelming concentration on European countries and often constructed in‐transparently and superficially. Building on the concept of the care/welfare mix, we develop a multi‐dimensional, actor‐centred typology of LTC systems. In doing so, we employ the methodological procedure of theoretically constructing a typological attribute space. We argue that three dimensions, that is service provision, financing and regulation, are crucial for differentiating types. Furthermore, we chose an actor‐centred approach, asking who bears the main responsibility in each dimension. Five relevant types of corporate actors are distinguished: state, societal actors, private for‐profit actors, private individual actors, and global actors. Finally, we present and discuss the resulting attribute space and further illustrated the typology's use by exemplarily classifying three countries. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to obtain a consensus on oral health policy, access to dental care, oral hygiene measures and training levels.Background: Poor oral health is widespread in care-dependent older people, but no consensus for a minimum standard of oral health care exists yet.Methods: The e-Delphi approach was applied to a selected panel of interdisciplinary experts. Data analysis was based on three measurements: (a) ≥70% of experts' opinion fall into category "agree or strongly agree," (b) median score on the 5-point Likert scale ≥4, (c) interquartile range ≤1.Results: A total of 31 experts from 17 European countries participated in this survey. Agreement was achieved for a compulsory dental examination when an elder is admitted to a long-term care (LTC) facility. Older people should brush their teeth twice/day and regularly clean interproximal spaces and oral mucosa. Dentures should be rinsed after meals and cleaned twice/day. The use of denture cleansing tablets was considered necessary. Dentures should be removed before sleeping and stored dry. A 5000 ppm fluoride toothpaste should be applied daily in elder with high caries risk. A short report on the oral health status of the elder should be included in the geriatric assessment. All experts concluded that the knowledge and the training in oral health care for caregivers and family members of care-dependent older people were imperative.Conclusions: Using the e-Delphi method, multidisciplinary healthcare professionals from different countries agreed on certain cardinal recommendations for a standard oral health care for care-dependent older people. [ABSTRACT FROM AUTHOR]

Objectives We examine whether socioeconomic inequalities in home-care use among disabled older adults are related to the contextual characteristics of long-term care (LTC) systems. Specifically, we investigate how wealth and income gradients in the use of informal, formal, and mixed home-care vary according to the degree to which LTC systems offer alternatives to families as the main providers of care ("de-familization"). Method We use survey data from SHARE on disabled older adults from 136 administrative regions in 12 European countries and link them to a regional indicator of de-familization in LTC, measured by the number of available LTC beds in care homes. We use multinomial multilevel models, with and without country fixed-effects, to study home-care use as a function of individual-level and regional-level LTC characteristics. We interact financial wealth and income with the number of LTC beds to assess whether socioeconomic gradients in home-care use differ across regions according to the degree of de-familization in LTC. Results We find robust evidence that socioeconomic status inequalities in the use of mixed-care are lower in more de-familized LTC systems. Poorer people are more likely than the wealthier to combine informal and formal home-care use in regions with more LTC beds. SES inequalities in the exclusive use of informal or formal care do not differ by the level of de-familization. Discussion The results suggest that de-familization in LTC favors the combination of formal and informal home-care among the more socioeconomically disadvantaged, potentially mitigating health inequalities in later life. [ABSTRACT FROM AUTHOR]

Background Multi-morbidity and polypharmacy increase the risk of non-trivial adverse drug reactions (ADRs) in older people during hospitalization. Despite this, there are no established interventions for hospital-acquired ADR prevention. Methods We undertook a pragmatic, multi-national, parallel arm prospective randomized open-label, blinded endpoint (PROBE) controlled trial enrolling patients at six European medical centres. We randomized 1,537 older medical and surgical patients with multi-morbidity and polypharmacy on admission in a 1:1 ratio to SENATOR software-guided medication optimization plus standard care (intervention, n  = 772, mean number of daily medications = 9.34) or standard care alone (control, n  = 765, mean number of daily medications = 9.23) using block randomization stratified by site and admission type. Attending clinicians in the intervention arm received SENATOR-generated advice at a single time point with recommendations they could choose to adopt or not. The primary endpoint was occurrence of probable or certain ADRs within 14 days of randomization. Secondary endpoints were primary endpoint derivatives; tertiary endpoints included all-cause mortality, re-hospitalization, composite healthcare utilization and health-related quality of life. Results For the primary endpoint, there was no difference between the intervention and control groups (24.5 vs. 24.8%; OR 0.98; 95% CI 0.77–1.24; P  = 0.88). Similarly, with secondary and tertiary endpoints, there were no significant differences. Among attending clinicians in the intervention group, implementation of SENATOR software-generated medication advice points was poor (~15%). Conclusions In this trial, uptake of software-generated medication advice to minimize ADRs was poor and did not reduce ADR incidence during index hospitalization. [ABSTRACT FROM AUTHOR]

Aim Potentially inappropriate medication (PIM) use is prevalent in older adults and is associated with adverse events, hospitalisation and mortality. We assessed the patterns and associations of PIM use in older adults with mild-to-moderate Alzheimer's Disease (AD), who may represent a particularly vulnerable group. Design Analysis of data from NILVad, an 18-month Randomised Control Trial of Nilvadapine in mild-to-moderate AD. The v2 STOPP criteria were applied in duplicate to identify PIM use. Associations between PIM use and adverse events/unscheduled healthcare visits in addition to the associations between PIM use and AD progression were evaluated. Setting and Participants 448 older adults with mild-to-moderate AD from 23 centres in nine European countries. Results Of 448 participants (mean age: 72.56 ± 8.19 years), over half (55.8%) were prescribed a PIM with 30.1% being prescribed 2+ PIMs. The most frequent PIMs were (i) long-term benzodiazepines (11.6% N  = 52/448), (ii) selective serotonin reuptake inhibitors without appropriate indication (11.1% N  = 50/448), and (iii) Proton-Pump Inhibitors (PPIs) without appropriate indication (10.7% N  = 48/448). Increasing number of PIMs was associated with a greater risk of adverse events (IRR 1.17, 1.13–1.19, P  < 0.001), serious adverse events (IRR 1.27; 1.17–1.37, P  < 0.001), unscheduled hospitalisations (IRR 1.16, 1.03–1.30, P  = 0.016) and GP visits (IRR 1.22, 1.15–1.28, P  < 0.001). PIM use was not associated with dementia progression. Conclusions and Implications PIM use is highly prevalent in mild-to-moderate AD and is associated with adverse events and unscheduled healthcare utilisation. Further attention to de-prescribing in this vulnerable group is warranted. [ABSTRACT FROM AUTHOR]

The article focuses on report by World Health Organization revealing death occurred in people older than 60 years due to COVID-19 in the European Region. Topics discussed include protection of each nation's older adults and to promote intergenerational equity and solidarity, and priori age cut-offs to decide who should get access to healthcare, as such ideas discriminate against older people.

Spouses (and partners) are the most important source of care in old age. Informal care for frail spouses is provided by both sexes and across all socio-economic backgrounds and welfare policy contexts. There are, however, interesting differences as to whether spouses care alone, receive informal support from other family members or formal support from professional helpers, or outsource the care of their spouse completely. The present article contributes to the literature by differentiating between solo spousal care-giving and shared or outsourced care-giving arrangements, as well as between formal and informal care support. Moreover, we show how care-giving arrangements vary with gender, socio-economic status and welfare policy. Adding to previous research, we compare 17 countries and their expenditures on two elder-care schemes: Cash-for-Care and Care-in-Kind. The empirical analyses draw on the most recent wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) data from 2015. Our results show that men have a higher propensity to share care-giving than women, albeit only with informal supporters. As expected, welfare policy plays a role insofar as higher expenditure on Cash-for-Care schemes encourage informally outsourced care-giving arrangements, whereas Care-in-Kind reduce the likelihood for informally shared or outsourced care-giving arrangements. Moreover, the influence of these welfare policy measures differs between individuals of different socio-economic status but not between men and women. [ABSTRACT FROM AUTHOR]

Background: While the need for palliative care in long-term care facilities is growing, it is unknown whether palliative care in this setting is sufficiently developed. Aim: To describe and compare in six European countries palliative care provision in long-term care facilities and to assess associations between patient, facility and advance care planning factors and receipt and timing of palliative care. Design: Cross-sectional after-death survey regarding care provided to long-term care residents in Belgium, England, Finland, Italy, the Netherlands and Poland. Generalized estimating equations were used for analyses. Setting/participants: Nurses or care assistants who are most involved in care for the resident. Results: We included 1298 residents in 300 facilities, of whom a majority received palliative care in most countries (England: 72.6%–Belgium: 77.9%), except in Poland (14.0%) and Italy (32.1%). Palliative care typically started within 2 weeks before death and was often provided by the treating physician (England: 75%–the Netherlands: 98.8%). A palliative care specialist was frequently involved in Belgium and Poland (57.1% and 86.7%). Residents with cancer, dementia or a contact person in their record more often received palliative care, and it started earlier for residents with whom the nurse had spoken about treatments or the preferred course of care at the end of life. Conclusion: The late initiation of palliative care (especially when advance care planning is lacking) and palliative care for residents without cancer, dementia or closely involved relatives deserve attention in all countries. Diversity in palliative care organization might be related to different levels of its development. [ABSTRACT FROM AUTHOR]

Aim: In the present study, we aimed to update the data of frailty status in the European community‐dwelling population of older adults, based on the latest data released (wave 6) of the Survey of Health, Aging and Retirement in Europe database, and to study the impact of each criterion on frailty assessment. Methods: Frailty status was assessed applying a version of the Fried phenotype operationalized for the Survey of Health, Aging and Retirement in Europe. We included all participants who answered all the questions used in a frailty assessment and who disclosed their sex and, furthermore, who were aged ≥50 years. Our final sample was 60 816 individuals. Of these, the mean age was 67.45 ± 9.71 years; 38 497 (56.4%) were women. Results: The overall prevalence of pre‐frailty was 42.9% (ranging from 34.0% in Austria to 52.8% in Estonia), and frailty was 7.7% (ranging from 3.0% in Switzerland to 15.6% in Portugal). Pre‐frailty and frailty prevalence increased along with age, and were more frequent among women. Regarding the five criteria considered on frailty assessment, exhaustion seems to be the criterion that contributes most to frailty status, followed by low activity, weakness, loss of appetite and slowness. Conclusions: With this work, we showed that >50% of the European population aged >50 years are pre‐frail/frail, which must be considered when designing interventions to reduce/postpone/mitigate the progression of this condition, thus reducing the burden associated with it. Geriatr Gerontol Int 2019; 19: 723–729. [ABSTRACT FROM AUTHOR]

The introduction of cash‐for‐care (CfC) schemes in different European countries over the last years has responded to a plurality of strategies aimed at attending the rising demand and increasing costs of the long‐term care needs of an ageing population. The specific system of care provision in each country shaped the response given to those challenges, as well as the room for manoeuvre for policymakers when trying to transform the domain of care into a sphere where markets may play a larger role, partly relieving families, and also the state, from these responsibilities. Policy debates and scholarly analyses largely overlooked the contribution of these schemes to the creation and shaping of employment. This article provides a comparative analysis of how CfC‐based policies entail—alongside the regulation of informal care—a(n implicit or explicit) connection with care employment and may contribute to structuring employment relations in this sector. It looks jointly at the specific features of CfC and at the institutional context—welfare regime—in which they are embedded in order to assess the extent to which these schemes contributed (generally unintendedly) to a transformation of the care employment size and features in seven European countries. [ABSTRACT FROM AUTHOR]

The article aims to understand how governments across Europe have modified the regulation of the delivery of cash‐for‐care schemes (CfCs) to dependent older people since the beginning of the century. In our terminology, the regulation of the CfCs delivery defines the norms, rules, and practices that public actors adopt to manage how beneficiaries can use the benefits. To discuss the regulation of CfCs delivery, we employ an original framework that take three analytical dimensions into account: the degrees of freedom in benefits' utilization ("CfCs utilization" dimension), the provision of information/orientation/advices/counselling to older people and families ("professional support" dimension), and the relationship between the delivery of CfCs and the delivery of the other publicly funded long‐term care inputs ("care system" dimension). The analysis adopts a comparative perspective, looking at six countries—Italy, Austria, the Netherlands, France, Germany, and England. Among various findings, the main one consists in showing that there has been a shared and increased interest in consolidating the regulation of CfCs delivery. This trend has been mostly directed towards the new policy aim of strengthening the professional support, a goal underestimated in the past, when this dimension was not a major topic of both debate and practice concerning CfCs across Europe. [ABSTRACT FROM AUTHOR]

Resource allocation has been a main policy issue in cash‐for‐care schemes (CfCs) for older people in Europe since their inception. It regards how publicly funded care benefits and services are distributed among older people. The raising pressures of an ageing population and the tensions on the financial sustainability of welfare regimes in place have further exacerbated the relevance of this topic over the recent years. Nevertheless, comparative research so far has overlooked changes in resource allocation in CfCs over time. This article contributes to fill this gap, exploring changes in resource allocation of CfCs for older people in a sample of European countries—Austria, England, France, Germany, Italy, and The Netherlands—since the early '90s (or since the introduction of the scheme). It examines three analytical dimensions: (a) The mix of public services and benefits provided to older people (CfCs, community services in kind, residential care); (b) the level of CfCs coverage; and (c) its generosity. A combined view of these dimensions leads to the discussion of two dilemmas: How to allocate the resources devoted to CfCs in the light of the trade‐off between its coverage and intensity? And, within the whole long‐term care system, how to allocate resources between CfCs and services in kind? [ABSTRACT FROM AUTHOR]

The diversification of caregiving arrangements in European societies has drawn attention to the factors that condition the use of care by older people. Social and family relations appear as a key factor, mainly to be related to the availability and accessibility to potential informal caregivers. Recent studies evidenced that geographical proximity and a larger social network increase the probability of receiving informal support in old age. However, the ways in which interpersonal relationships are associated with the use of formal care, as well as the cross‐country variability of this association, have been barely explored. Using a sample of 37,708 individuals aged 65 and over from Wave 6 of the Survey of Health, Ageing and Retirement in Europe (SHARE), this study examines to what extent the characteristics of older people's social networks predict the use of three types of home care; formal, informal, or combined, exploring the cross‐European convergences and divergences. Binomial logistic regressions are conducted to compare four macro‐regions in continental Europe (northern countries: Denmark and Sweden; western countries: Austria, Belgium, France, Germany, Switzerland, and Luxembourg; southern countries: Italy, Spain, Greece, and Portugal; and eastern countries: Poland, Czech Republic, Slovenia, Estonia, and Croatia). The structure, availability, and accessibility to the members of the social network are the major predictors of the receipt of informal care everywhere. Regional divergences are observed regarding to formal care, alone or combined with informal caregivers. [ABSTRACT FROM AUTHOR]

Background: Dementia is underrecognized in older adult emergency department (ED) patients, which threatens operational efficiency, diagnostic accuracy, and patient satisfaction. The Society for Academic Emergency Medicine geriatric ED guidelines advocate dementia screening using validated instruments. Objectives: The objective was to perform a systematic review and meta‐analysis of the diagnostic accuracy of sufficiently brief screening instruments for dementia in geriatric ED patients. A secondary objective was to define an evidence‐based pretest probability of dementia based on published research and then estimate disease thresholds at which dementia screening is most appropriate. This systematic review was registered with PROSPERO (CRD42017074855). Methods: PubMed, EMBASE, CINAHL, CENTRAL, DARE, and SCOPUS were searched. Studies in which ED patients ages 65 years or older for dementia were included if sufficient details to reconstruct 2 × 2 tables were reported. QUADAS‐2 was used to assess study quality with meta‐analysis reported if more than one study evaluated the same instrument against the same reference standard. Outcomes were sensitivity, specificity, and positive and negative likelihood ratios (LR+ and LR–). To identify test and treatment thresholds, we employed the Pauker‐Kassirer method. Results: A total of 1,616 publications were identified, of which 16 underwent full text‐review; nine studies were included with a weighted average dementia prevalence of 31% (range, 12%–43%). Eight studies used the Mini Mental Status Examination (MMSE) as the reference standard and the other study used the MMSE in conjunction with a geriatrician's neurocognitive evaluation. Blinding to the index test and/or reference standard was inadequate in four studies. Eight instruments were evaluated in 2,423 patients across four countries in Europe and North America. The Abbreviated Mental Test (AMT‐4) most accurately ruled in dementia (LR+ = 7.69 [95% confidence interval {CI} = 3.45–17.10]) while the Brief Alzheimer's Screen most accurately ruled out dementia (LR– = 0.10 [95% CI = 0.02–0.28]). Using estimates of diagnostic accuracy for AMT‐4 from this meta‐analysis as one trigger for more comprehensive geriatric vulnerability assessments, ED dementia screening benefits patients when the prescreening probability of dementia is between 14 and 36%. Conclusions: ED‐based diagnostic research for dementia screening is limited to a few studies using an inadequate criterion standard with variable masking of interpreter's access to the index test and the criterion standard. Standardizing the geriatric ED cognitive assessment methods, measures, and nomenclature is necessary to reduce uncertainties about diagnostic accuracy, reliability, and relevance in this acute care setting. The AMT‐4 is currently the most accurate ED screening instrument to increase the probability of dementia and the Brief Alzheimer's Screen is the most accurate to decrease the probability of dementia. Dementia screening as one marker of vulnerability to initiate comprehensive geriatric assessment is warranted based on test–treatment threshold calculations. [ABSTRACT FROM AUTHOR]

Comparative studies of health inequalities have largely neglected age and ageing aspects, while ageing research has often paid little attention to questions of social inequalities. This article investigates cross-country differences in gradients in self-rated health and limiting long-standing illness (LLSI) in middle-aged and in older people (aged 50–64 and 65–80 years) linked to social class, and degrees to which the social health gradients are associated with minimum pension levels and expenditure on elderly care. For these purposes, data from the European Social Survey (2002–2010) are analysed using multilevel regression techniques. We find significant cross-level interaction effects between class and welfare policies: higher expenditure on elderly care and particularly more generous minimum pensions are associated with smaller health inequalities in the older age group (65–80 years). It is concluded that welfare policies moderate the association between social class and health, highlighting the importance of welfare state efforts for older persons, who are strongly reliant on the welfare state and welfare state arrangements such as pensions and care policies. [ABSTRACT FROM AUTHOR]

The university programs designed for older people (UPOP) is an important educational resource and it is essential to study them to identify their characteristics, the key aspects of their effects, and the possible additional benefits of participation in formal educational activities for its students. This systematic review aimed to examine the current state of empirical research focusing on UPOP in the European context. We performed a systematic search of scientific literature between 1980 and May 2017 in various databases (ProQuest Psychology Journal, ERIC, Sociological Abstracts and Social Science Citation Index) from which 1663 works were extracted. After applying the inclusion and exclusion criteria, the selected articles were reduced to 23. Analyzing the articles and their main themes, we identified a specific profile of UPOP students, their reasons for attending, the perceived benefits of attending UPOP and several factors could be optimized in research of these areas of formal education, especially the methodological aspects. Empirical research focusing on UPOP in Europe is currently at an early stage and needs further development. [ABSTRACT FROM AUTHOR]

Objectives Little is reported about the family’s role in preparation for future care (PFC) before the onset of care needs. The primary aim was to examine the relationships between PFC and different types of family support exchanged with generations both above and below. Method Path analysis was conducted on 516 Chinese baby boomers aged 45–65 to examine the associations between PFC (care expectation, awareness, information gathering, and decision making) and 4 types of family support (instrumental support, financial assistance, information and appraisal, and emotional support) when the covariates were controlled for. Results The current planning status and planning paths are consistent with those of the U.S. and European populations. Providing instrumental support to a parent was positively associated with awareness of care needs. Providing emotional support to a child was negatively associated with information gathering. In general, receiving support from a child facilitated PFC. Although those receiving emotional support from an adult child had less awareness of care needs, they displayed more information gathering. Discussion The role of family support in PFC is more subtle than simply increasing and decreasing resource volumes. Future research is needed to better understand this complexity. [ABSTRACT FROM AUTHOR]

Objectives: The general aim of the article is to incorporate the stratification perspective into the study of (long-term) care systems. In particular, 3 issues are investigated: the extents to which (a) personal and family resources influence the likelihood of using formal care in later life; (b) the unequal access to formal care is mediated by differences in the availability of informal support; (c) the relationship between individuals' resources and the use of formal care in old age varies across care regimes and is related to the institutional design of long-term care policies. Method: Data from Waves 1 and 2 of the Survey of Health, Ageing and Retirement in Europe for 4 countries: Denmark, Germany, France, and Italy, and population aged at least 65 (N = 9,824) were used. Population-averaged logit models were used. Results: Logit models revealed that in terms of access to formal care: an individual's educational level plays a limited role; family networks function similarly across the countries studied; in general, financial wealth does not have a significant effect; there is a positive relation between income and the use of formal care in Germany and Italy, and no significant relation in France and Denmark; home ownership has a negative effect in Germany and Denmark. On accounting for informal care, inequality associated with individuals' economic resources remains substantially unaltered. Discussion: The study shows that care systems based on services provision grant higher access to formal care and create lower inequalities. Moreover, countries where cash-for-care programs and family responsibilities are more important register inequalities in the use of formal care. Access to informal care does not mediate the distribution of formal care. [ABSTRACT FROM AUTHOR]

The article discusses the significant changes in the long-term care policy and systems in many European countries. It refers to ageing of society which is considered as one of the crucial factors that led to the increasing demand for informal care. It mentions the development of Informal Care Model that reveals the intention to provide care is based on general attitudes, quality of the relationship, normative beliefs and perceived barriers.

Background: Informal caregivers are essential figures for maintaining frail elderly at home. Providing informal care can affect the informal caregivers' physical and psychological health and labour market participation capabilities. They need support to prevent caregiver burden. A variety of existing support measures can help the caregiver care for the elderly at home, but with some limitations. The objective of this review was to explore the experiences of informal caregivers caring for elderly in the community with the use of supportive policy measures in Belgium and compare these to the experiences in other European countries.Methods: An empirical qualitative case study research was conducted in five European countries (Belgium, The Netherlands, Luxembourg, France and Germany). Semi-structured interviews were conducted with informal caregivers and their dependent elderly. Interview data from the different cases were analysed. In particular data from Belgium was compared to data from the cases abroad.Results: Formal services (e.g. home care) were reported to have the largest impact on allowing the caregiver to care for the dependent elderly at home. One of the key issues in Belgium is the lack of timely access to reliable information about formal and informal services in order to proactively support the informal caregiver. Compared to the other countries, informal caregivers in Belgium expressed more difficulties in accessing support measures and navigating through the health system. In the other countries information seemed to be given more timely when home care was provided via care packages.Conclusion: To support the informal caregiver, who is the key person to support the frail elderly, fragmentation of information regarding supportive policy measures is an important issue of concern. [ABSTRACT FROM AUTHOR]

The aim of this study is to examine the influence of the recent economic crisis on the quality of long-term care for older people in Belgium and the Netherlands. A mixed-method approach was applied, primarily focused on conducting semi-structured qualitative interviews with health professionals working in a management role in organizations providing long-term care for older people. The results show that Dutch organizations seem to be prepared for the influences of the economic crisis on the quality of its care provision primarily in terms of a sound system readiness. At the same time, Belgian organizations seem to be prepared for the influences of the economic crisis on the quality of its care provision primarily in terms of a favorable sociopolitical context. Comparing two countries allows for reciprocal lesson-drawing. The conclusion drawn in this study is that a sustainable long-term care system requires above all stability and structure. [ABSTRACT FROM PUBLISHER]

Purpose: screening tool of older people's prescriptions (STOPP) and screening tool to alert to right treatment (START) criteria were first published in 2008. Due to an expanding therapeutics evidence base, updating of the criteria was required.Methods: we reviewed the 2008 STOPP/START criteria to add new evidence-based criteria and remove any obsolete criteria. A thorough literature review was performed to reassess the evidence base of the 2008 criteria and the proposed new criteria. Nineteen experts from 13 European countries reviewed a new draft of STOPP & START criteria including proposed new criteria. These experts were also asked to propose additional criteria they considered important to include in the revised STOPP & START criteria and to highlight any criteria from the 2008 list they considered less important or lacking an evidence base. The revised list of criteria was then validated using the Delphi consensus methodology.Results: the expert panel agreed a final list of 114 criteria after two Delphi validation rounds, i.e. 80 STOPP criteria and 34 START criteria. This represents an overall 31% increase in STOPP/START criteria compared with version 1. Several new STOPP categories were created in version 2, namely antiplatelet/anticoagulant drugs, drugs affecting, or affected by, renal function and drugs that increase anticholinergic burden; new START categories include urogenital system drugs, analgesics and vaccines.Conclusion: STOPP/START version 2 criteria have been expanded and updated for the purpose of minimizing inappropriate prescribing in older people. These criteria are based on an up-to-date literature review and consensus validation among a European panel of experts. [ABSTRACT FROM PUBLISHER]

The authors discuss a study that examined the consequences of applying the new versus the original European Working Group on Sarcopenia (EWGSOP) guidelines in 144 geriatric inpatients aged 70 years and older. Highlights include definitions for sarcopenia released by three expert groups between 2010 and 2014, overlap of who is identified as sarcopenic by the definitions and differences in prevalence, and sufficiency of low muscle mass alone for the diagnosis of sarcopenia.