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This contribution provides insights from one of the four social innovations of the INNOVAGE project, focused on the development of the InformCare web platform for supporting informal caregivers of older people in Europe. The platform included information resources on different topics (major diseases in older age, public care services and benefits, coping and reconciliation strategies etc.) and interactive services for professional and peer support (dedicated social network, forum, chat and videochat). The design phase was based on a consultation process involving almost 200 stakeholders and on user tests. The pilot phase was carried out as a mixed-methods study in Germany, Italy and Sweden, which recruited totally 118 caregivers who could access the InformCare platform for 3 months. Positive findings led to its refinement and implementation in 27 European countries. Today, the platform is publicly accessible (www.eurocarers.org/informcare) in 32 versions and 23 languages, with over 2,500 web pages for informal caregivers.

Background: Informal caregiving is the main source of care for older people in Europe. An enormous amount of responsibility and care activity is on the shoulders of family caregivers, who might experience problems in their psychological well-being and in reconciling caregiving and their personal sphere. In order to alleviate such burden, there is increasing interest and growing research in Europe on Web-based support addressing family caregivers and their needs. However, the level of development and penetration of innovative Web-based services for caregivers is still quite low and the access to traditional face-to-face services can be problematic for logistic, availability, and quality reasons. Objective: As part of the European project INNOVAGE, a pilot study was conducted for developing and testing a Web-based psychosocial intervention aimed at empowering family caregivers of older people in Italy, Sweden, and Germany. The program offered information resources and interactive services to enable both professional and peer support. Methods: A mixed-methods, sequential explanatory design was adopted. Caregivers psychological well-being, perceived negative and positive aspects of caregiving, and social support received were assessed before and after the 3-month intervention. Poststudy, a subsample of users participated in focus groups to assist in the interpretation of the quantitative results. Results: A total of 94 out of 118 family caregivers (79.7%) from the three countries used the Web platform at least once. The information resources were used to different extents in each country, with Italian users having the lowest median number of visits (5, interquartile range [IQR] 2-8), whereas German users had the highest number (17, IQR 7-66) (P<.001). The interactive services most frequently accessed (more than 12 times) in all countries were the social network (29/73, 40%) and private messages (27/73, 37%). The pretest-posttest analysis revealed some changes, particularly the slight worsening of perceived positive values of caregiving (Carers of Older People in Europe [COPE] positive value subscale: P=.02) and social support received (COPE quality-of-support subscale: P=.02; Multidimensional Scale of Perceived Social Support subscale: P=.04), in all cases with small effect size (r range -.15 to -.18). Focus groups were conducted with 20 family caregivers and the content analysis of discussions identified five main themes: online social support, role awareness, caregiving activities, psychological well-being, and technical concerns. The analysis suggested the intervention was useful and appropriate, also stimulating a better self-efficacy and reappraisal of the caregivers role. Conclusions: The intervention seemed to contribute to the improvement of family caregivers awareness, efficacy, and empowerment, which in turn may lead to a better self-recognition of their own needs and improved efforts for developing and accessing coping resources. A major implication of the study was the finalization and implementation of the InformCare Web platform in 27 European countries, now publicly accessible (www.eurocarers.org/informcare).

InformCare is a European Web platform that supports informal caregivers of older people by providing access to online information and professional and peer support. The aim of this study was to assess the usage and usability of a psychosocial Web-based program carried out in three European countries (Italy, Sweden, and Germany). A mixed-methods sequential explanatory design was adopted, comprising baseline and postintervention assessments, as well as combined thematic content analysis of results and focus group findings. A convenience sample of 118 caregivers was enrolled, of whom 94 used the services offered by the program at least once. The subsamples in the three countries used the platform in different ways, with a predominance of passive strategies (eg, seeking information and reading other peoples comments) for Italian caregivers, and more active usage by Swedish and German caregivers. The usability assessment showed that the platform was perceived well by Italian and German caregivers, whereas technical problems affected the Swedish samples experiences. Focus group data highlighted user satisfaction with the online support and reliability of the environment. Recommendations for practitioners are to ensure digital training for caregivers who have lower confidence in use of the Internet, to involve different healthcare professionals in the provision of professional support, and to adequately manage online community building.

Older adults with functional limitations constitute a vulnerable group with usually lower levels of health status and quality of life (QoL). In both Italy and Greece, informal care and privately-hired care workers are common measures for providing them continuous care and support, more than public care services. This situation might increase the risk of worst QoL if older adults are not equipped with own social and economic resources for coping with daily life limitations, especially in a macro-context heavily influenced in recent years by the effects of the economic crisis. The study aimed at identifying the role of socio-economic status (SES) and social participation as predictors of QoL of older adults with functional limitations, after the Great Recession period. We used data on older adults (50+ years) from the Survey on health, ageing and retirement in Europe (Share) wave 6 (2015) for conducting a cross-sectional descriptive analysis and running a hierarchical linear regression model for both Italy and Greece, with blocs of predictors concerning demographic, socio-economic, health, access to care, and social participation domains. In both countries, higher levels of SES and social participation were strongly associated with higher QoL, although good health status remained the most influential predictor of better QoL. Our results suggested that multiple social inequalities are likely to occur among most socially disadvantaged older adults and may heavily affect their QoL and social inclusion.

Digital technologies have become an essential part of our everyday lives. While they were still a curious novelty in the 1960s and 1970s, they seem to permeate an ever- increasing part of today’s societies (Levin & Mamlok 2021). By now, they are no longer confined to offices, where people need to physically sit in front of computers to use them. Instead, they are ubiquitous, with handheld devices being portable, and wearable technologies frequently even unobtrusive (Delabrida Silva et al. 2018). Augmented Realities blur the lines between technology and reality, while Virtual Realities even place a technological layer over our realities (Arena et al. 2022). Our technologically embedded lives create a myriad of data, which is used for various kinds of communication and as a currency. It is shared on social media for social interaction and to cultivate a personal image (Hall 2018). Moreover, it is routinely shared with companies for marketing and product development, sometimes in exchange for services (Cao et al. 2022). Thus, the datafication of our lives pulls us into a complex network of interactions (...)

Workplace digitalization created a sea change in work practices and it altered the situation of older workers. Digitalization entails the increased use of digital technologies, such as computers and online services. Older workers often possess limited digital skills, which may put their labor market participation at risk. Previous studies began exploring how older workers fare when their workplaces are digitalizing. However, the research field is still emerging and remains fragmented. This article comprises a systematic literature review that takes inventory of what we currently know about older workers in digitalizing workplaces. It demonstrates that older workers experience the digitalization of their workplaces in various areas, reaching from health monitoring to work arrangements. Interestingly, challenges and opportunities emerge in each area affected. This Janus-faced situation underlines the complexity of consequences, and it raises questions about social inequalities in these consequences. The work environment plays a crucial role in shaping how older workers experience workplace digitalization. It shapes which options for adaptation they have, and to which degree they can act on these options. This circumstance makes workplaces an excellent starting point for interventions. Country-characteristics likewise exert an influence. While characteristics such as retirement regulations are purposefully modified for intervention, other characteristics, such as culture, are not. This circumstance limits governmental options for shaping the situation of older workers in digitalizing workplaces. Future research should further explore the situation of older workers in digitalizing workplaces, paying special attention to the theoretical framework and to developments in the wake of the COVID-19 pandemic.

Workplace digitalization created a sea change in work practices and it altered the situation of older workers. Digitalization entails the increased use of digital technologies, such as computers and online services. Older workers often possess limited digital skills, which may put their labor market participation at risk. Previous studies began exploring how older workers fare when their workplaces are digitalizing. However, the research field is still emerging and remains fragmented. This article comprises a systematic literature review that takes inventory of what we currently know about older workers in digitalizing workplaces. It demonstrates that older workers experience the digitalization of their workplaces in various areas, reaching from health monitoring to work arrangements. Interestingly, challenges and opportunities emerge in each area affected. This Janus-faced situation underlines the complexity of consequences, and it raises questions about social inequalities in these consequences. The work environment plays a crucial role in shaping how older workers experience workplace digitalization. It shapes which options for adaptation they have, and to which degree they can act on these options. This circumstance makes workplaces an excellent starting point for interventions. Country-characteristics likewise exert an influence. While characteristics such as retirement regulations are purposefully modified for intervention, other characteristics, such as culture, are not. This circumstance limits governmental options for shaping the situation of older workers in digitalizing workplaces. Future research should further explore the situation of older workers in digitalizing workplaces, paying special attention to the theoretical framework and to developments in the wake of the COVID-19 pandemic.

This presentation discusses how new technologies support family carers of older people with reference to the Eurocarers’ hub ‘InformCare’, the web-platform of support services for carers of older people co-funded by the European Union within the INNOVAGE project. After highlighting the status of technology-based services for carers in Europe, the main features of InformCare will be demonstrated. Tested in three European countries (Germany, Italy and Sweden), this tool provides a standardised, integrated, multilingual and culturally adapted set of on-line information and interactive services addressing carers’ needs and preferences which are available for the first time in 27 Member States. The implementation followed a pilot test with 117 carers, showing improvements in carers’ self-awareness and empowerment over a 3 month period. However, to ensure optimal benefit from InformCare, appropriate training and promotion campaigns are needed in order to overcome low digital literacy skills and lack of self-recognition characterising many carers.

This article illustrates the implications of two recent trends on family carers' health: the employment of home-based migrant care workers; and the provision of web-based supports. The main factors traditionally associated with carers' health are used to analyse the results of a six-country study via a multilevel linear regression. Attention will be dedicated to the role of migrant care workers, who are often hired by private households to provide eldercare. Finally, web-based services for carers will be investigated by considering InformCare, a recently implemented European platform tested on a sample of carers from three countries (Germany, Italy and Sweden).

This paper describes a serious game based on a knowledge transfer model using deep reinforcement learning, with an aim to improve the caretakers knowledge and abilities in post-stroke care. The iTrain game was designed to improve caregiver knowledge and abilities by providing non-traditional training to formal and informal caregivers who deal with stroke survivors. The methodologies utilized professional medical experiences and real-life evidence data gathered during the duration of the iTrain project to create the scenarios for the games deep reinforcement caregiver behavior improvement model, as well as the design of game mechanics, game images and game characters, and gameplay implementation. Furthermore, the results of the games direct impact on caregivers (n = 25) and stroke survivors (n = 21) in Lithuania using the Geriatric Depression Scale (GDS) and user experience questionnaire (UEQ) are presented. Both surveys had favorable outcomes, showing the effectiveness of the approach. The GDS scale (score 10) revealed a low number of 28% of individuals depressed, and the UEQ received a very favorable grade of +0.8.

This thesis aims at contributing to the understanding of digital inequalities among older people, by studying the involvement of older people in research on digital technologies. Some mechanisms driving old age digital inequalities are well known. For instance, people with lower social positions tend to have lower digital skills, to face technology accessibility and affordability issues, and, thus, to engage less with digital technologies compared to their counterparts. However, less attention has been paid to issues related to research and development of digital technologies, such as the involvement of older people in research evaluating new digital technologies. Previous studies indicate that participants and non-participants in research are different one another, with the former being younger, reporting higher educational levels, having better health status than the non-participants. This may bias research outcomes and lead to incorrect conclusions on the utility of digital technologies. The objective of this thesis is to investigate the link between the involvement of older people in digital technology evaluations and the research outcomes. Healthcare is used as exemplifying context in which digital technologies are used. In Study I, participation in digital health research is conceptualised, and a research tool for identifying and measuring selective participation is developed. In Study II and III, factors associated with participation in two digital health intervention studies are analysed. In Study IV, the impact of selective participation on the research outcomes of a digital health study is identified, measured, and corrected. Thesis findings show that participation of older people in digital health research is selective by age, gender, health status, job level, and digital skills, and can indicate a mechanism for digital inequalities. Selective participation biases research outcomes by overemphasising the intervention effects of the over-represented groups over those among the under-represented groups. It can cause an overestimation of the positive effects of digital health technologies due to the under-representation of those groups who do not benefit from the intervention. This promotes digital technologies which increase exclusion risks for some groups of older people and reinforce old age digital and social inequalities. Weighting procedures can be used for mitigating the impact of this mechanism on the research outcomes of intervention studies on digital technologies.

Many workers, including older ones, experienced changes at work during the COVID-19 pandemic, among which was a sudden increase in the use of digital technologies. This paper aims at understanding older workers' satisfaction with digital technology-related changes at work during the COVID-19 pandemic in the Nordics. Based on novel survey data collected in Sweden in 2020- 2021, we analyzed the experience with digital technology-related changes at work and modeled the (dis)satisfaction with such changes among older workers (aged 50+). Our findings show that groups of older, less educated, reporting concurrent workload changes and digital technologyrelated difficulties had an increased likelihood of being dissatisfied with digital technology-related changes at work during the COVID-19 pandemic. The results have implications for the theoretical understanding of late working life and for the redefinition of working life policies and age manage- ment strategies in times of work digitalization of work.

Introduction - Many (older) workers experienced changes in their working life as a result of the COVID-19 pandemic, some of them related to increased use of digital technologies. In this study, we aim at understanding older workers’ degree of affectedness as well as the experience of and satisfaction with technology-related changes at work during the COVID-19pandemic in Sweden.

Methods and Materials - Between June 2020 and December 2021, novel data on work during the COVID-19 pandemic was collected via a four-wave online survey (n=2901). Based on such data, which was collected in the Swedish regionÖstergötland, we modeled (a) the overall affectedness with technology-related changes at work in a sub-sample of workers aged 50 years and older, (b) the experience of specific types of technology-related changes at work in the same sub-sample, and (c) the satisfaction with technology-related changes at work in a sub-sample of 357 workers aged 50 years and older who reported to have experienced such changes.

Results - Our findings show how the experience with technology-related changes is structured along the lines of age, gender, education, occupation, and job status. Also, the satisfaction with technology-related changes proved to be unequally distributed among older workers with differences also between household and family types.

Conclusions - The results have implications for policies and practices to support equal and inclusive late working life in times of digitalisation of work.

Much research is conducted to evaluate digital-based solutions for health-care services, but little is known about how such evaluations acknowledge diversity in later life. This study helps fill this gap and analyses participation in the evaluation of a web-based mobile phone system for monitoring the post-operative progress of patients after day surgery. Participation is conceptualised as resulting from three processes: pre-screening, recruitment and self-selection. Based on field information and survey data, this study models (a) the (non-)participation in a sample of 498 individuals aged 60 and older that includes non-screened, non-recruited, decliners and participants in the evaluation, and (b) the individual decision to participate in a sample of 210 individuals aged 60 and older who were invited to take part in the evaluation. Increasing age enhances the likelihood of not being screened, not being recruited or declining the invitation. Those not recruited were most often ineligible because of technology-related barriers. Decliners and participants differed by age, gender, job, health status, digital skills, but not by social participation. Results suggest that highly specific groups of older people are more likely to be involved than others. Old-age diversity is not properly represented in digital health research, with implications for the inclusivity of new digital health technologies. This has implications for increased risks of old-age exclusion and exacerbation of social and digital inequalities in ageing societies.

Much research is conducted for evaluating digital-based solutions for healthcare among older people. However, some older people are less likely to be involved than others. We present an analysis of participation in the evaluation of a mobile-based system for monitoring post-operative progress after a day surgery in Sweden. We explore key factors associated with the unwillingness to participate and discuss the possible role of self-ageism in determining the decision not to participate. Based on field information and survey data, we compared participants and non-participants in a sample of 368 individuals aged 60 and older and modelled the individual decision to participate (or not) in the evaluation. Decliners and those who were willing to participate differ along the lines of (chronological) age, gender, job, health status, and digital skills. Age remains a significant factor explaining individual decision to participate even when controlling for other variables. Overall results indicate that very specific groups of older people are more likely to participate than others in digital health research. Age plays a major role in the decision to participate or not. Negative self-perception of being old with respect to digital health research could contribute to explaining the individual unwillingness to participate. 

Background: The use of digital technologies is increasing in health care. However, studies evaluating digital health technologies can be characterized by selective nonparticipation of older people, although older people represent one of the main user groups of health care. Objective: We examined whether and how participation in an exergame intervention study was associated with age, gender, and heart failure (HF) symptom severity. Methods: A subset of data from the HF-Wii study was used. The data came from patients with HF in institutional settings in Germany, Italy, the Netherlands, and Sweden. Selective nonparticipation was examined as resulting from two processes: (non)recruitment and self-selection. Baseline information on age, gender, and New York Heart Association Functional Classification of 1632 patients with HF were the predictor variables. These patients were screened for HF-Wii study participation. Reasons for nonparticipation were evaluated. Results: Of the 1632 screened patients, 71% did not participate. The nonrecmitment rate was 21%, and based on the eligible sample, the refusal rate was 61%. Higher age was associated with lower probability of participation; it increased both the probabilities of not being recruited and declining to participate. More severe symptoms increased the likelihood of nonrecruitment. Gender had no effect. The most common reasons for nonrecruitment and self-selection were related to physical limitations and lack of time, respectively. Conclusions: Results indicate that selective nonparticipation takes place in digital health research and that it is associated with age and symptom severity. Gender effects cannot be proven. Such systematic selection can lead to biased research results that inappropriately inform research, policy, and practice.

Background

Healthcare services are being increasingly digitalised in European countries. However, in studies evaluating digital health technology, some people are less likely to participate than others, e.g. those who are older, those with a lower level of education and those with poorer digital skills. Such non-participation in research – deriving from the processes of non-recruitment of targeted individuals and self-selection – can be a driver of old-age exclusion from new digital health technologies. We aim to introduce, discuss and test an instrument to measure non-participation in digital health studies, in particular, the process of self-selection.

Methods

Based on a review of the relevant literature, we designed an instrument – the NPART survey questionnaire – for the analysis of self-selection, covering five thematic areas: socioeconomic factors, self-rated health and subjective overall quality of life, social participation, time resources, and digital skills and use of technology. The instrument was piloted on 70 older study persons in Sweden, approached during the recruitment process for a trial study.

Results

Results indicated that participants, as compared to decliners, were on average slightly younger and more educated, and reported better memory, higher social participation, and higher familiarity with and greater use of digital technologies. Overall, the survey questionnaire was able to discriminate between participants and decliners on the key aspects investigated, along the lines of the relevant literature.

Conclusions

The NPART survey questionnaire can be applied to characterise non-participation in digital health research, in particular, the process of self-selection. It helps to identify underrepresented groups and their needs. Data generated from such an investigation, combined with hospital registry data on non-recruitment, allows for the implementation of improved sampling strategies, e.g. focused recruitment of underrepresented groups, and for the post hoc adjustment of results generated from biased samples, e.g. weighting procedures.

The involvement of older people in research on digital technologies is uneven. Some groups of older people, e.g. the older ones, are less likely to participate in research which evaluates new digital technologies, compared to their counterparts. This may bias research results and produce wrong research conclusions. In this work, we aim at understanding whether and how the uneven involvement of older people in research on digital technologies has an impact on the research results. Our example is an intervention study which evaluated a web-based system for monitoring the postoperative progress of individuals after day surgery, i.e. ‘Mobile Phone in Recovery after Ambulatory Surgery’ (MIRAS). We considered a sample of 717 individuals of age 50 years and older (mean age: 65) who underwent a day surgery at one of the MIRAS recruitment sites during the recruitment timeframe. This group included both MIRAS participants and those who were not recruited byMIRAS. Based on information on age, gender, recruitment status, and intervention results, we implemented a weighting procedure to adjust the intervention results for the over-representation and the under-representation of groups of older people in the MIRAS sample by age and gender. We found that weighted and unweighted intervention results differed one another. The unweighted intervention results were over-positive with regards to the efficacy of the intervention due to the under-representation of groups of older people who were older and men. Biased results generate inaccurate conclusions which, in turn, can inform inappropriate digitalisation strategies and policies.