Giovanni Lamura

Social Support, Socio-Economic Status, Health and Abuse among Older People in Seven European Countries

Background Social support has a strong impact on individuals, not least on older individuals with health problems. A lack of support network and poor family or social relations may be crucial in later life, and represent risk factors for elder abuse. This study focused on the associations between social support, demographics/socio-economics, health variables and elder mistreatment. Methods The cross-sectional data was collected by means of interviews or interviews/self-response during January-July 2009, among a sample of 4,467 not demented individuals aged 60–84 years living in seven European countries (Germany, Greece, Italy, Lithuania, Portugal, Spain, and Sweden). Results Multivariate analyses showed that women and persons living in large households and with a spouse/partner or other persons were more likely to experience high levels of social support. Moreover, frequent use of health care services and low scores on depression or discomfort due to physical complaints were indicators of high social support. Low levels of social support were related to older age and abuse, particularly psychological abuse. Conclusions High levels of social support may represent a protective factor in reducing both the vulnerability of older people and risk of elder mistreatment. On the basis of these results, policy makers, clinicians and researchers could act by developing intervention programmes that facilitate friendships and social activities in old age.

The impact of migrant work in the elder care sector: recent trends and empirical evidence in Italy

Italy is characterized by a very high and increasing demand for elder care but, paradoxically, also by a surprisingly low level of public service provision in this sector. Due to current demographic, economic and socio-cultural trends, the potential availability of informal family care has been decreasing while, on the other hand, still strong familistic attitudes have so far limited the emergence of formal—both home and residential—care services. The ‘cash-for-care’ orientation of the Italian welfare system, with direct payments prevailing over in-kind services, has thus gradually developed into a care regime where monetary transfers to dependent (older) people are often used to privately employ migrant care workers. This phenomenon is analyzed in the context of two different studies (EUROFAMCARE and DIPO), in order to understand how migrant care work has been affecting both family care and professional care work in Italy. The main findings suggest that the widespread employment of migrant care workers—propelled by public care allowances—has certainly relieved many families from most burdensome care tasks, but at the same time partly ‘crowded out’ formal care services. Care quality issues remain. however, largely under-investigated, as do care drain effects in sending countries.

Disabled older people's use of health and social care services and their unmet care needs in six European countries

BACKGROUND The national health and social care systems in Europe remain poorly integrated with regard to the care needs of older persons. The present study examined the range of health and social care services used by older people and their unmet care needs, across six European countries. METHODS Family carers of older people were recruited in six countries via a standard protocol. Those providing care for disabled older people (n = 2629) provided data on the older persons service use over a 6-month period, and their current unmet care needs. An inventory of 21 services common to all six countries was developed. Analyses considered the relationship between older peoples service use and unmet care needs across countries. RESULTS Older people in Greece, Italy and Poland used mostly health-oriented services, used fewer services overall and also demonstrated a higher level of unmet care needs when compared with the other countries. Older people in the United Kingdom, Germany and Sweden used a more balanced profile of socio-medical services. A negative relationship was found between the number of different services used and the number of different areas of unmet care needs across countries. CONCLUSIONS Unmet care needs in older people are particularly high in European countries where social service use is low, and where there is a lack of balance in the use of health and social care services. An expansion of social care services in these countries might be the most effective strategy for reducing unmet needs in disabled older people.

The Engagement of Older People in Civil Society Organizations

This article reviews recent international literature on the opportunities and restrictions experienced by older people to act as volunteers in civil society organizations. Our aim was to develop a conceptual framework applicable to the European ageing society. This aim was pursued through a computerized database search focused on studies analyzing the individual, organizational, and/or societal levels. Findings show that senior volunteers are characterized by “younger” age, good health, and a high level of both educational and socioeconomical status. Volunteers are involved mainly in religious organizations as well as in social and personal care, while main barriers are represented especially by ageist practices. The review shows that the debate on this topic has been barely developed in Europe, both from an individual and societal point of view. Therefore, European countries might take advantage from experiences made in other contexts, but the identification of how this can occur requires further and more specific cross-national research.

Socioeconomic determinants of influenza vaccination among older adults in Italy

Abstract Objectives Seasonal influenza represents a major threat to public health but vaccination campaigns are strongly recommended to reduce the risks of serious complications and mortality among community-dwelling elderly persons. We investigated on potential social predictors of influenza vaccination among older adults in Italy. Methods Data analysis was based on the national survey “Health and use of health care,” which was carried out in 2004/2005 and reached a sample of 25,183 elderly persons. After initial univariate and bivariate statistics, we used multivariate logistic regression to evaluate potential independent predictors of influenza immunization. Results 62.6% of the recruited subjects declared to be vaccinated against influenza. At bivariate analysis, significative differences in immunization rates arose by each socioeconomic variable investigated. Logistic regressions confirmed that individuals in lower social classes have higher chances of being vaccinated. Moreover, older age and chronic disease were associated with higher likelihood of immunization. Conversely, reporting good health predicted a lower uptake. Conclusion In our analysis we found several independent predictors of influenza vaccination. Surprisingly, individuals belonging to lower social classes have higher chances of being vaccinated. These results suggest that vaccination policies have a positive effect in preventing socioeconomic inequalities in access to this service in Italy.

Components of the difficulties, satisfactions and management strategies of carers of older people: A principal component analysis of CADI-CASI-CAMI

Objectives: To perform a psychometric evaluation of the Carers Assessment of Difficulties Index, Carers Assessment of Satisfactions Index and the Carers Assessment of Managing Index (CADI-CASI-CAMI). Method: Data was collected in three European countries from informal carers of older people (n = 295) via a common protocol. Carers completed: (a) a questionnaire containing items on demographics and caregiving characteristics and (b) the CADI-CASI-CAMI indices. Principal component analysis of the CADI-CASI-CAMI indices was followed by internal consistency analysis of emergent components. Scales derived by summing items loading on the components were analysed for their association with the demographic and caregiving characteristic variables. Results: CADI produced six internally consistent and interpretable components, CASI five and CAMI seven. Subscales derived from the components were significantly associated with the demographic and caregiving characteristic variables, providing initial support for construct validity. Conclusion: The CADI-CASI-CAMI indices are recommended as an assessment tool for in-depth work with family carers of older people and as a research tool for large-scale studies of family care.

Education for Older People in Italy

This article provides information on trends in formal and informal adult education in Italy, with a particular focus on the older learners (over 65). Main providers, programs, objectives/motivations, and financial and legal framework are described. In general, over-65-year-old people were found to be underrepresented in participation. They were also concentrated in activities of informal education (through, for example, Third Age Universities) instead of formal courses that are oriented mainly towards the development of skills/competencies for the labor market. In order to improve the situation of older people in the future, the question of financing is one of the main challenges to be addressed by policymakers.

Happy Aged People Are All Alike, While Every Unhappy Aged Person Is Unhappy in Its Own Way

Aging of the worlds population represents one of the most remarkable success stories of medicine and of humankind, but it is also a source of various challenges. The aim of the collaborative cross-cultural European study of adult well being (ESAW) is to frame the concept of aging successfully within a causal model that embraces physical health and functional status, cognitive efficacy, material security, social support resources, and life activity. Within the framework of this project, we show here that the degree of heterogeneity among people who view aging in a positive light is significantly lower than the degree of heterogeneity of those who hold a negative perception of aging. We base this conclusion on our analysis of a survey involving 12,478 people aged 50 to 90 from six West European countries. We treat the survey database as a bipartite network in which individual respondents are linked to the actual answers they provide. Taking this perspective allows us to construct a projected network of respondents in which each link indicates a statistically validated similarity of answers profile between the connected respondents, and to identify clusters of individuals independently of demographics. We show that mental and physical well-being are key factors determining a positive perception of aging. We further observe that psychological aspects, like self-esteem and resilience, and the nationality of respondents are relevant aspects to discriminate among participants who indicate positive perception of aging.

Tensions Related to Care Migration: The South-North Divide of Long-Term Care

This part of the book focuses on tensions arising from the combination of changes in migration patterns and in long-term care (LTC) policies for the elderly.1 The interrelation of migration and LTC for the elderly has become an increasingly important issue in recent years as societies are ageing and labour market and family structures are re-structuring, both in countries with extensive and formalized public support for care for the elderly as well as in those with less public and more informal involvement with these people.

Erfahrungen von pflegenden angehörigen älterer menschen in Europa bei der inanspruchnahme von unterstützungsleistungen: Ausgewählte ergebnisse des projektes EUROFAMCARE

ZusammenfassungIn diesem Beitrag werden ausgewählte Ergebnisse der EUROFAMCARE-Studie zur Nutzung und Erreichbarkeit unterstützender Angebote für pflegende Angehörige präsentiert. Die Untersuchung wurde in sechs europäischen Ländern (Deutschland, Griechenland, Italien, Polen, Schweden und Großbritannien), die unterschiedliche Typen von Wohlfahrtsstaaten repräsentieren, durchgeführt. Mit Hilfe eines gemeinsam entwickelten Erhebungsinstrumentes und gemeinsamer Rekrutierungsstrategien wurden in allen sechs Ländern jeweils rund 1000 pflegende Angehörige älterer Menschen persönlich interviewt. Die dargestellten Ergebnisse zeigen die unterschiedliche Nutzung von Diensten/Angeboten und die Verfügbarkeit von finanziellen Unterstützungsmöglichkeiten in den verschiedenen Ländern. Weiter werden die Erfahrungen der pflegenden Angehörigen, insbesondere hinsichtlich der Kosten von Unterstützungsleistungen und die größten Hilfen bzw. Hindernisse bei der Inanspruchnahme, dargestellt. Schließlich werden die Gründe für eine Nichtinanspruchnahme bestimmter Unterstützungsleistungen, als auch für eine Aufgabe von Unterstützungsleistungen, die eigentlich noch benötigt werden, aufgezeigt. Insbesondere in den nordeuropäischen Ländern zeigt sich einerseits zwar eine höhere Verfügbarkeit von Diensten/Angeboten, die aber andererseits aufgrund ihrer geringe Flexibilität bei deren Anpassung an die Bedürfnisse der Pflegenden und ihrer betreuten Angehörigen z.T. nicht genutzt werden.SummaryThis article presents selected findings of the EUROFAMCARE research project, reporting up-to-date information on the use and accessibility of support services for family carers of older people in six European countries representing different typologies of welfare systems (Germany, Greece, Italy, Poland, Sweden and the UK). Data were collected by means of face-to-face interviews to national samples of about 1000 family carers per country (i.e. 6000 in total), based on a common recruitment and data collection protocol. The reported findings reveal the crossnational usage of different support services – subdivided for comparative reasons in the categories of socio-emotional support, information, respite care, training and assessment services – as well as of available care allowances. The analysis includes the perceived experience of carers in using them, in terms of costs sustained, factors affecting service accessibility – i.e. main obstacles and greatest helps in accessing them – as well as reasons for not using (needed) services or for stopping using (still needed) services. Cross-national differences are relevant, showing a greater availability in Northern European countries, where however higher refusal rates by potential users of available services are recorded, possibly in connection to their lack of flexibility and low customisation.