Leader: Alessandra Buja (UNIPD); Other collaborator(s): Giulia Grotto, Sohail Akhtar, Mark Herbert Ebell, Stefania Lopatriello (UNIPD)
To solve the challenges of an ageing population, it is necessary to work with a community-based approach to address the full range of factors influencing a person's overall health and well-being, including interventions that extend care beyond the care setting and reach the entire target population with health promotion and prevention activities and not just a small group of potential beneficiaries.
The activities of this task will be focused on the production of tools tailored to promote health and well-being in older adults, adapting and building a favorable environment, communities, and social context, and defining preventive actions with a population approach, also with the use of new Information and Communication Technologies.
Brief description of the activities and of the intermediate results
A systematic literature review was conducted to assess the effectiveness of using information and communication technologies (ICT) in increasing vaccination rates for vaccines recommended for older adults (influenza, pneumococcal, COVID-19 and shingles). Overall, more than half of the included studies found some level of effectiveness of ICT strategies in increasing vaccination rates, while a quarter of the included studies were partially effective (for specific vaccines or population subgroups) and another quarter reported no significant effect. The results showed that prevention programmes using ICT tools can be effective in promoting vaccination among older adults.
Main policy, industrial and scientific implications
Acceptance and rejection of vaccines are highly context-dependent and are influenced by ‘local vaccine cultures’, as well as social, cultural, historical and political factors. Despite the use of ICT communication methods, which are particularly new when considering non-phone-based studies, most interventions appeared to be effective in older adults, similar to what was observed in another study that looked at different ages. This could be partly due to their acceptance of commonly used technologies and the fact that patients with greater difficulties in using ICT can provide a close relative as a contact through the healthcare system. Overall, ICT tools may be an additional strategy to be used in health promotion campaigns to improve vaccine uptake in older adults by providing information directly to people at a relatively low cost.
Brief description of the activities and of the intermediate results
A systematic review was conducted to examine the impact of religion and spirituality on the longevity of older adults and most of the studies showed a reduction in mortality risk, particularly among those engaged in religious activities with an active social component. Results showed that the link between religiosity and longevity could be mediated by social support from the religious community, better health behaviour and mental health. However, most studies found a reduction in all-cause mortality even after adjusting for these mediating factors, indicating that other mechanisms might be involved.
Main policy, industrial and scientific implications
Most studies conducted among older adults have supported the protective role of religiosity or spirituality on longevity, particularly for religious activities with an active social component. The link between religiosity and longevity could be mediated by the beneficial effects of social support and improved health behaviour that often characterise religious persons. However, since most studies have found a reduction in all-cause mortality even after adjusting for these confounding variables, other mechanisms not yet understood may be involved. These results highlighted the importance of allowing older people to attend their religious community and maintain their spirituality.
Brief description of the activities and of the intermediate results
A scoping review was conducted to evaluate the effectiveness of mHealth interventions (healthcare interventions delivered via smartphone or tablet) in improving sleep quality among older persons suffering from primary insomnia. All five included studies reported improvements in subjective sleep quality after the application of mHealth interventions. Two studies also conducted objective assessments of sleep outcomes using actigraphy and reported improvements in some of the variables
Main policy, industrial and scientific implications
mHealth interventions have shown promise for improving sleep health in the elderly by reaching a wide audience, being easily accessible and cost-effective, offering flexibility to patients and requiring less time from specialists. Furthermore, the incorporation of special tools such as animations, multimedia content, dynamic feedback, interactivity and social networking can improve compliance and increase the perceived value of the intervention. Over the past decades, mobile technology has been widely used worldwide and mHealth has developed in parallel with it. This method offers the advantages of greater availability of medical services everywhere, quick access and greater simplicity. The use of mHealth and telemedicine has become increasingly important for healthcare professionals, especially in view of the COVID-19 pandemic, with greater importance for older, more vulnerable adults with limited mobility.
Brief description of the activities and of the intermediate results
A systematic review was performed to evaluate digital health interventions’ effect on physical activity levels among community-dwelling older adults. Twelve studies were included. Four main conceptually distinctive types of intervention were identified: motivational reminders (messages and reminders aimed at promoting and sustaining participants’ active behaviors, sent exclusively through automated tools, either individually or to the entire intervention group); dynamic exercise programs (tailored physical activity schedules made by a automated software using physical activity data gathered through a digital device, such as pedometers or accelerometers), self-monitoring of physical activity goals (digital versions of a personal diary to record and monitor over time, with or without automatic data collection via digital device and peer support, the amount of physical activity performed and/or goals achieved), physical activity digital coaching (automated tools that provide instruction and guidance on performing physical exercises without the need for a human instructor available during training sessions). For the “motivational reminders” category, a positive effect was reported by three low-quality studies. For the “dynamic exercise programs” category results were mixed, with a positive effect reported by one high-quality study with a high sample size versus two contrasting low-quality studies. For “digital physical activity coaching,” no positive effect was reported by one high-quality and one low-quality study. For the “self-monitoring of physical activity goals” category no positive effect was reported by three low quality studies versus one contrasting medium quality study. The results showed that additional support provided in daily life by motivational reminders, alongside exercise prescription, can be effective in promoting physical activity. Also, well-designed interventions leveraging wearable devices for automated goal setting and tracking could significantly enhance physical activity levels in older adults.
Main policy, industrial and scientific implications
Motivational reminders and dynamic exercise programs appeared to be more effective in increasing physical activity in older adults than other interventions and should be more embedded in structured public health programs. As digital devices become increasingly accessible to older adults, policymakers should consider evaluating this diverse array of digital health interventions to identify and implement the most evidence-based, effective health promotion interventions tailored to this demographic.
Brief description of the activities and of the intermediate results
A systematic literature review was conducted to evaluate the association between digital technology use and social capital among older adults. Social capital is defined as the potential tangible and intangible resources that can be obtained via social connections typically found in relationships within kinship, professional, organizational, and neighborhood contexts. Studies have found a positive association between social capital and wellbeing, health, and sociability. As digital technology becomes a prominent source of information, communication, and participation in industrialized countries, it is critical to investigate how it affects social resources from an age-comparative perspective; research has found a positive association between digital technology use and social capital, though limited attention has been paid to older adults. Twenty studies met the inclusion criteria and were included in the systematic review. Among them, 12 studies evaluated the association between digital technology use and social capital, and 8 studies evaluated the association between digital technology use and various health outcomes analyzing the mediating role of social capital. All the included studies had a cross-sectional design and were conducted on seniors aged 60 years or over. All the included studies found a positive association between digital technology use and social capital among older adults suggesting that digital technology could offer opportunities to maintain or increase social capital, which typically tends to reduce with age. Since social capital positively impacts on health and well-being, the importance of enabling older adults to use digital technologies must be considered when designing and implementing health behavior intervention programs. Considering that all the included studies had a cross-sectional design, a bidirectional association might also be at play, implying that older adults with high levels of social capital might be more likely to use digital technologies. In this context, since a person's social connections form the essential foundation of their social capital, individuals with robust and interconnected social circles (such as family, friends, and volunteer companions) are more inclined to receive support in learning to navigate digital technologies, along with both emotional and practical help from their network members.
Main policy, industrial and scientific implications
To fully harness the advantages of online social interactions for building social capital, individuals must have enough digital literacy to effectively utilize the Internet for fostering and sustaining social connections. Supporting older individuals, particularly the most disadvantaged ones, in their use of digital technology to satisfy social demands might mitigate this disparity. The results highlight some implications for the development of digital technology training for older adults. Specifically, when providing computer and Internet education for seniors, it is essential to acknowledge the important influence that social support systems have on the learning experiences of older individuals as they engage with digital technology. Children, relatives, and companions can serve as valuable sources of guidance and inspiration when navigating the digital landscape. Furthermore, training in digital technology for seniors should prioritize specific groups, including older individuals, racial and ethnic minorities, those with limited education and financial resources, individuals who are unmarried and live alone, as well as those experiencing low social integration and support, to effectively bridge the digital gap. Seniors possessing these traits may gain the greatest advantages from the resources available through Internet technology.
Brief description of the activities and of the intermediate results
1.A website (www.in-forma.it) dedicated to older adults and their relatives and caregivers is being developed, bringing together the most important scientific evidence in the field of health promotion and disease prevention for older adults.
The website gathers recommendations in different thematic areas in the field of health promotion and wellness for older adults (nutrition, physical activity, sleep and rest, mental well-being, spirituality, cultural activities, social activities, pets), disease prevention (screening, vaccinations, pharmacological prevention), prevention of frailty in specific areas (cognitive impairment, incontinence, fall prevention, edentulia, insomnia, constipation, fractures, pressure injuries), and tools and aids to facilitate autonomy and active living.
For some areas of health promotion in which scientific literature was lacking (e.g., the effects of the urban environment on the quality of life, caring for pets, cultivating spirituality and religion, having a high social capital and performing artistic activities), specific literature reviews were conducted to support some of the indications on the website.
The studies conducted contributed to a solid knowledge base. These were then translated into accessible and practical messages designed to motivate and support the adoption of healthy behaviors. The approach focused not only on disease prevention, but also on the active promotion of well-being, embracing the concept of ‘salutogenesis’.
2.An umbrella review entitled “Effects of the Urban Environment and Urban Design on the Well-being of Older Adults: an Umbrella Review” was conducted to provide a comprehensive synthesis of how the urban environment influences the well-being of older adults. In recent years, the impact of the urban environment on the well-being of older individuals has gained significant attention, particularly considering the increasing number of older adults living in urban areas. The umbrella review aims to identify, through an analysis of existing second-level studies, the key elements of urban environment, urban design, and planning that either facilitate or hinder the well-being of the aging population and to highlight which specific aspects of older adults’ well-being are influenced by the urban environment.
The results highlighted several urban elements that can impact different aspects of the physical, psychological, and social well-being of older adults. Accessibility to natural areas, the quality of walking paths, public transportation options, neighborhood safety, and the availability of social and recreational amenities are essential for improving health, alleviating mental distress, and fostering social engagement among older adults. Accessibility and equity issues are prominent in urban planning, as the inadequate distribution of services and green spaces, along with unsafe pedestrian areas and limited public transportation, particularly affect vulnerable older adults.
Main policy, industrial and scientific implications
1.The World Health Organization has, in the past, conducted a census of international websites dedicated to health promotion in older adults. This survey revealed a significant gap in the provision of online information for this population group in our country. With the creation of this website, we want to fill this gap and make it possible to provide the Italian older population with information and advice based on scientific evidence that can motivate the adoption of healthy behaviors and help improve the quality of life in old age, while reducing the burden of disease. Such an approach can have a positive impact both on an individual level and on the National Health Service.
2.To address the challenges of an aging population, public health strategies should integrate the experiences and needs of older adults into urban design and policies to create an equitable and inclusive urban environment. The umbrella review informs policymakers with an evidence-based urban health framework that could be used in interventions co-designed with community stakeholders to ensure responsiveness to the diverse needs of aging individuals. Given the rapid demographic aging of the global population, the integration of older adults’ perspectives into the planning, design, and management of urban spaces became essential. Urban planners and policymakers are urged to systematically incorporate the lived experiences and needs of older adults into urban design and policy frameworks, thereby promoting environments that are equitable, inclusive, and responsive to the challenges of population aging.
Brief description of the activities and of the intermediate results
1.An application has been developed that collects key information on prevention for older adults. The app consists of five main sections: drug prevention, vaccination prevention, cancer screening, screening for chronic diseases, and mental health. All information contained herein is supported by scientific evidence gathered from systematic reviews, meta-analyses and recommendations from scientific societies.
2.An umbrella review entitled “Quantitative and qualitative analysis of the effects of human-animal interactions on health and well-being of older adults: an umbrella review” was conducted to assess how interactions between animals and older adults impact health and well-being. Research shows that older adults can experience physical, emotional, and social benefits from owning or interacting with pets. However, different variables, such as the type of animal, the context, and the duration of human-animal contact, can influence the effects of animal companionship on health. The aim of this umbrella review was to assess the effects on the health and well-being of older adults resulting from different types of exposure and interactions that may exist between animals and older adults, particularly in the context of animal-assisted support programs for seniors living in care facilities and pet ownership for community-dwelling older adults. The main findings regard the beneficial effects of dog-assisted interventions on social interaction and loneliness of older adults living in facilities and, regarding dog owners, the higher levels of walking activity in which they engage. Qualitative research reported that older adults attributed to pets an important role and a variety of beneficial impacts (i.e., emotional support, sensory engagement, reciprocal interactions); some negative aspects related to pet ownership were also described as worries about pets’ health, and pets’ related expenses.
Main policy, industrial and scientific implications
1.The development of health promotion tools will make it possible to provide the older population with information and advice based on scientific evidence that can motivate the adoption of healthy behaviors and help improve the quality of life in old age, while reducing the burden of disease. The creation of this tool allows health information to be brought directly to users, making older people more informed, responsible and actively involved in managing their own health.
2.Understanding the potential positive and negative aspects of interaction between older adults and animals can serve as a conceptual framework for developing guidelines, tools, and interventions involving companion animals, preferably in collaboration with stakeholders such as managers and staff of care homes and home care programs, older adults, and family carers.
Brief description of the activities and of the intermediate results
Completion of a systematic literature review aimed at evaluating the effectiveness of digital technology interventions in improving nutritional status and promoting healthy eating habits among older adults and examining users' perceptions of these digital nutrition programs. In the context of an ageing population, nutrition plays a fundamental role and eating habits can change in old age due to physical disorders, social isolation, and decreased appetite, leading to a decline in nutritional status. Digital technologies, which have become widespread in recent years even among older adults, can be used to develop nutritional interventions tailored to the older population; although, the effectiveness of these interventions is still little studied. The literature search was conducted on PubMed, PsycINFO, CINAHL, and Scopus databases. Retrieved studies were evaluated for compliance with eligibility criteria, which involved selecting studies of nutritional interventions delivered through digital technologies and aimed at community-dwelling older adults. A descriptive analysis was performed to report on the characteristics of the included studies and their outcomes. Thirteen studies met the eligibility criteria and were included in the systematic review. Among the analyzed outcomes, digital nutrition interventions appeared effective in increasing dietary fiber intake, while no effect emerged on quality of life, appetite, or calorie intake. Mixed results were found regarding improvements in nutritional status, self-perceived health, adherence to the Mediterranean diet or other dietary guidelines, and protein intake. Dropout rates were generally high and tended to increase towards the end of the interventions. Qualitative analyses revealed some negative aspects such as the perceived complexity of using the apps, low acceptability, restrictions, and the heavy burden brought into daily life by the interventions, and frustration derived from technical issues. Conversely, participants appreciated increased knowledge, greater awareness of nutrition, and motivational and inspirational content.
Main policy, industrial and scientific implications
Digital nutrition interventions have demonstrated effectiveness in enhancing dietary fiber intake among the elderly population. However, no significant impact was observed concerning quality of life, appetite, or caloric intake. The findings regarding other assessed outcomes were mixed. Notably, there was no definitive evidence to support the efficacy of digital interventions in improving nutritional status, self-perceived health, adherence to the Mediterranean diet or dietary guidelines, and protein consumption.
OUTPUTS
• Buja A, Grotto G, Taha M, Cocchio S, Baldo V. Use of Information and Communication Technology Strategies to Increase Vaccination Coverage in Older Adults: A Systematic Review. Vaccines. 2023; 11(7):1274. https://doi.org/10.3390/vaccines11071274.
• Buja A, Grotto G, Vo D. Association of religiosity and spirituality with survival among older adults: a systematic review. Journal of Public Health. 2024; 1-12. 10.1007/s10389-024-02303-1.
• Grotto G, Martinello M, Buja A. Use of mHealth Technologies to Increase Sleep Quality among Older Adults: A Scoping Review. Clocks & Sleep. 2024; 6(3):517-532. https://doi.org/10.3390/clockssleep6030034
• Di Pumpo M, Miatton A, Riccardi MT, et al. Digital Health Interventions to Promote Physical Activity in Community-Dwelling Older Adults: A Systematic Review and Semiquantitative Analysis. Int J Public Health. 2025;69:1607720. Published 2025 Jan 3. doi:10.3389/ijph.2024.1607720
• Grotto G, Buja A. Association between Digital Technology Use and Social Capital among Older Adults: A Systematic Review. Digital Health. 2025. doi:10.1177/20552076251336973
• Creation of an information website on health promotion and disease prevention in older people (www.in-forma.it): under development.
• Creation of an app that collects the main recommendations in the field of prevention for older adults.
• Mensi L, Grotto G, Buja A. Effects of the urban environment and urban design on the well-being of older adults: an umbrella review. J Public Health (Berl.) (2026). https://doi.org/10.1007/s10389-026-02699-y
• Grotto G, Buja A. Quantitative and qualitative analysis of the effects of human-animal interactions on health and well-being of older adults: an umbrella review. BMC Geriatr. 2026;26(1):126. Published 2026 Jan 22. doi:10.1186/s12877-025-06487-3
• Poster accepted for presentation at the 58th National Congress of the Italian Society of Hygiene and Preventive Medicine, 22–25 October 2025. Poster title: “Utilizzo delle tecnologie digitali negli interventi di promozione della salute e prevenzione delle malattie rivolti alla popolazione anziana”.
• Poster accepted for presentation at the 58th National Congress of the Italian Society of Hygiene and Preventive Medicine, 22–25 October 2025. Poster title: “Creazione di un sito web per la promozione della salute e la prevenzione delle malattie nella popolazione anziana”.
• Poster accepted for presentation at the 13th National Meeting of the Italian Society for Health Promotion, 17–18 October 2025. Poster title: “Utilizzo delle tecnologie digitali negli interventi di promozione della salute e prevenzione delle malattie rivolti alla popolazione anziana”.
• Poster accepted for presentation at the 13th National Meeting of the Italian Society for Health Promotion, 17–18 October 2025. Poster title: “Creazione di un sito web per la promozione della salute e la prevenzione delle malattie nella popolazione anziana”.