Leader: Cristina Gagliardi (INRCA); Other collaborator(s): UNIMOL
This task explores how Ambient Assisted Living (AAL) solutions reduce the care burden of informal caregivers of dependent older people. Caregivers became a crucial resource in the Long Term Care (LTC) system in many countries, due to their key contributions in providing monitoring and informal care. The term “caregiver burden” refers to the physical, emotional and psychological stress experienced by people providing care to older family members. Caregiving can be particularly challenging when dealing with frail older people with complex health needs (e.g. dementia, multimorbidity). Indeed, actually the caregiver perspective suffers a gap in the literature, with limited studies considering the caregiver-elder dyad in the context of assistive technology interventions. Often, studies prioritise the effects of technological devices on the health and well-being of older people, relegating caregiver’s concerns to a secondary role, thus loosing valuable insights into the dynamics influencing the usage choices of AAL systems.
Brief description of the activities and of the intermediate results
The goal of this task was to conduct a narrative review on the impact of Ambient Assisted Living solutions on the caregiver burden of non self-sufficient older people . For this purpose, a basic literature search was conducted to focus on topics and keywords, and search tools and criteria were identified. The results were analysed and elaborated in a text with highlights on the caregiver burden, named “ Co-design and impact of Ambient Assisted Living on the family caregiver: exploring new intelligent solutions for older people’s care. Collaboration to the report of wp1 and to the praparation of a book to be edited by Il Mulino. The results of the review will be presented at the Age-IT General Meeting in Venice (20-22 May); it is in preparation for submission to a peer-reviewed Journal. Results show the issue of privacy being a knot yet to be solved. The smart environment, given its pervasive nature, increases critical privacy issues and requires specific security standards. To prevent privacy issues from becoming a barrier to the use of technologies, it will be increasingly important to provide safeguards on one of the aspects of greatest interest to family members and the elderly, namely the protection of personal data collected. Another food for thought concerns the ethical aspects related to legitimate concerns about possible emotional and physical abandonment of the elderly. In practice, even if research findings generally show caregivers' appreciation of assistive technologies, some issues such as dehumanization of care and reduced personal contact as a consequence of technology use are potential barriers.
Main policy, industrial and scientific implications
Policy makers and AI and technology-related enterprises should be informed on the necessity to prevent privacy issues from becoming a barrier to the use of technologies: therefore it will be increasingly important to provide safeguards on one of the aspects of greatest interest to family members and the elderly, namely the protection of personal data collected. This can be done through comprehensive and effective communication aimed at device recipients, so that they place greater trust in the use of such solutions, thus enabling them to take full advantage of their potential. Another important aspect to be considered by policy makers and designers is that co-design becomes essential, transforming the process of designing assistive technology from an isolated act to a collaboration that takes into account the different perspectives of the actors involved. According to this method, the needs, interests and expectations of stakeholders should be transferred into requirements and then translated into measurable qualities, helping to improve the design of platforms and functionalities, as well as their usability by users. In conclusion, the integration of Ambient Assisted Living, artificial intelligence and robotics as a response to the growing needs of the elderly offers significant potential. However, to ensure the success of such solutions, it is essential to pursue a delicate balance between technological efficiency and consideration of ethical implications, thus ensuring a comprehensive and respectful approach in aging in place.
Brief description of the activities and of the intermediate results
The integration of AAL, artificial intelligence, and robotics holds significant potential for addressing the growing needs of the older population in need of care. However, achieving success requires a delicate balance between technological efficiency and ethical considerations, promoting a comprehensive and respectful approach to ageing in place. A new study in this task was proposed with the aim of approaching the prospects of aging in place in a long-term perspective through a future thinking approach (Inayatullah,2008). This approach will be based on an analysis of Italian population dynamics ina long-term perspective using demographic data. Subsequently, qualitative foresight tools will be applied to capture long-term perspectives, engaging a panel of experts from diverse fields related to elderly care in Italy, and crafting future scenarios for 2050. To accomplish this, social foresight techniques, as taught in the Master’s Degree Level II in Social Foresight (2023/2024) at the University of Trento, a UNESCO-affiliated program, have been employed. Task 1.3 completed the documentation phase of the study through:
- background research on forcasted changes such as expected transformations in demographics, social structures, technological trends and other areas concerning the care of older people by 2050;
- identification of key socio-economic, technological, and environmental factors that could impact the long-term well-being of older adults, particularly regarding care provision;
- a series of semi-structured interviews with experts: the "strategic interview" approach is a classic social foresight tool (Ratcliffe, 2002), and includes seven questions designed to offer insights into both future scenarios and current challenges, enriching the collected data.
Main policy, industrial and scientific implications
Task 1.3 developed results from the strategic interviews.Strategic interviews have highlighted additional insights, especially regarding the increasing isolation experienced by elderly people with health issues. Key themes suggest a pressing need to rethink Italy's welfare system, particularly to expand home-based care and support services for seniors with health challenges and limited independence. This would involve investing in personalized care and community-based services. The proposed approach emphasizes a holistic understanding of elderly individuals’ needs, addressing not only acute medical conditions but also their living situations, social support networks, and neighborhood contexts. This strategy could improve both physical and mental health outcomes and generate savings through more appropriate care. Experts also stress the importance of fostering a sense of community, benefiting both current and future elderly populations. They recommend creating local collaborative networks and social support systems at the neighborhood level to strengthen community bonds and provide meaningful local engagement.
Brief description of the activities and of the intermediate results
The sustainability of elderly care in Italy is a complex issue that could benefit from a systemic approach that takes into account the wide variety of phenomena at play and their interrelationships in an articulate way. Backcasting, which starts from a vision desired future and works backward to identify the actions needed to achieve it, can be a useful tool to address this challenge when precisely complex systems involve multiple sectors and social levels, when significant transformation is required to achieve goals, and when the context is influenced by external factors that are difficult to control.
Applying this method to the topic of aging in place, it was proposed to develop the exercise with respect to this theme: In 2050, every local community has a sustainable infrastructure in place that supports fully aging in place, with a high quality of life for the elderly. This backcasting exercise allows us to imagine and discuss, in an experience of intelligence collective, the path to a future sustainable in which the majority of the dependent elderly in Italy can be cared for at home while maintaining an active role in the community.
The backcasting exercise took place on September 13, 2024 at the conference “Sustainability of Elder Care Systems in an Aging Society" (Spoke 5 Meeting), held at University of Molise in Termoli (Isernia, Italy). Participants discussed the following theme: in 2050, every local community will have a sustainable infrastructure that fully supports aging in place, with a high quality of life for the elderly. The group characterized the scenario to 2050 and discussed the reverse steps to the indication of an agenda for 2025 as follows:
-2050 : Urban development of neighborhoods for the elderly that integrate green spaces, accessible public transportation and local services designed for the needs of the elderly with health problems;
-2035: Creation of multifunctional community hubs that provide health, social and recreational services. Incentives for the construction of housing adapted for the elderly and for accessibility-oriented renovations, promotion of co-housing.
-2025: Research and development of guidelines for the design of sustainable communities for the elderly and the development and dissemination of community hubs.
Main policy, industrial and scientific implications
From the backasting workshop some suggestions emerged regarding priority actions to be developed for fostering the sense of community of the older population and promoting intergenerationalism: -development of community projects that engage seniors in volunteer, mentoring and civic participation activities; -integration of seniors into co-housing and supportive community initiatives that foster resource sharing and intergenerational cooperation; -organizing regular community events that promote meeting and collaboration between seniors and other community members. Examples of Indicators of Progress could be: the percentage of older people participating in community activities: 50 percent by 2030; satisfaction of older people about their social integration: 80 percent positive feedback; number of active intergenerational programs: at least 1 program per Italian municipality. Results are going to be presented as the basis of a new project work inside Age-It.
Brief description of the activities and of the intermediate results
Task 1.3 continued with abalyzing and reporting the results of the Backcasting Workshop on Aging in Place held in Termoli. The backcasting session. The primary goal of the exercise was to promote a creative conversation and brainstorming upon the key milestones to achieve a desirable future where aging in place is fully supported socially, technologically, environmentally, and economically.
Main policy, industrial and scientific implications
On 5 December, a workshop was held at the headquarters of AC75, Startup Accelerator in Ancona, aimed at illustrating the point of view of family caregivers in the choice of technologies to support the autonomy of the elderly, on the basis of the work carried out within the Spoke 5, WP1 and contained in the volume published by Il Mulino, ‘Avanzare insieme nella società anziana, Considerazioni multidisciplinari sulla domanda di assistenza agli anziani in Italia’, edited by Cecilia Tomassini, Marco Albertini and Carlo Lallo. The work was presented by Cristina Gagliardi of the IRCCS INRCA.
Scientific Outputs
Books and book chapters
1) Gagliardi C. (2024), Co-progettazione e impatto delle soluzioni di Ambient Assisted Living sul caregiver familiare. in C. Tomassini, M. Albertini, e C. Lallo (eds.), Avanzare insieme nella società anziana, Bologna, Il Mulino.
Dissemination events and other (conference papers and proceedings, seminars, schools)
1) Gagliardi, C., Socci, M., Casanova, G., Cicconi, D. (2023), Burden del caregiver e tecnologie per l’independent living: il modello teorico. First workshop: Older carers in the digitalised society. July, 7th, University of Milano-Bicocca Room 6 AGORA, on-line also;
2) Gagliardi, C., Socci, M., Casanova, G., Cicconi, D., (2023), Caregiver burden and technologies for the independent living: reflections on the methods and future steps. Second workshop: Older carers in the digitalised society . October 9th , University of Milano-Bicocca Room 7 | Building U7 - CIVITAS on-line also;
3) Socci, M., Gagliardi, C., Cicconi, D., Casanova, G. (2024), Exploring the impact of Ambient Assisted Living for older people on caregiver burden: a systematic literature review. General Meeting Age-it , Venice, 20-22 May; https://ageit.eu/wp/wp-content/uploads/2024/06/Programma-Age-It-20-22-Maggio-2024-online.pdf
4) Gagliardi, C. (2024), Social backcasting as a tool for the well-being of older people by 2050. Age-It Spoke 5 Meeting, Sustainability of Elder Care Systems in an Aging Society, University of Molise, Termoli (IS, Italy), 11-13 September, 2024; https://age-it.github.io/spoke5.github.io/#venue
5) Gagliardi C. Report Aging in Place Termoli. (forthcoming)