Leader: Mariangela Verrascina (ISTAT) and Massimo Armenise (ISTAT); Other collaborator(s): Eleonora Meli (ISTAT); Maria Mantuano (ISTAT); Federico Benassi (UNINA); Giuseppe Di Felice (UNIMOL); Emilio Cameli (UNIMOL); Carlo Lallo (UNIMOL).
The supply of social and health care services in Italy is characterized by a marked spatial heterogeneity. This heterogeneity often takes on the profile of inequality, especially when it is declined in terms of local contexts like the sub regional ones. Often, in fact, the most fragile territories from a demographic point of view (more aged and therefore with more potential demand for specific needs) are those that, paradoxically, are equipped with fewer services. The analysis of these spatial differences and the construction of territorial taxonomies capable of representing and mapping them become therefore a necessary tool for setting territorially targeted policies capable of countering the persistence of such inequalities.
Brief description of the activities and of the intermediate results
A new index has been designed to identify Italian local areas most in need of public interventions to assist communities facing health and social care challenges for dependent older people. Utilizing census data on municipal populations, the WP1 team has combined the proportion of people aged 80 and over (as an indicator of potential care needs) and care provision (derived from The Parent Support Ratio and the SNAIInner Areas Index) at the municipal level into a single synthetic index: the Municipal Potential Care Frailty Index (MPCFI). The MPCFI comprises 5 classes of care frailty, ranging from 0 (No Potential Care Frailty) to 5 (High Care Frailty). The more imbalanced the care needs are in comparison to the care supply, the higher the Care Frailty score. We have mapped the distribution of MPCFI across Italy and provided a regional breakdown of municipalities based on their MPCFI values. According to the MPCFI, 6.9% of municipalities exhibit a high care frailty, while 38.1% show no critical situation. The regions of Molise (24.3%) and Basilicata (21.4%) have the highest percentages of municipalities with high care frailty. Conversely, Trentino-South Tyrol and Veneto have the highest percentages of municipalities with no potential care frailty, at 72% and 58.8% respectively. A detailed methodology and results description will soon be available as a chapter in a book focusing on care policies. An abstract has been accepted for oral presentation at the General Meeting of Age-It, Venice, scheduled for May 20-22, 2024.
Main policy, industrial and scientific implications
All Italian regions contain municipalities that vary between high and no potential Care Frailty (except Valle d’Aosta: no municipalities in high vulnerability). Therefore, a local approach to care needs and related policies is needed: the Italian MPCFI distribution map could be a valid tool to design such place-based policies.
Brief description of the activities and of the intermediate results
Task 1.4. completed the application of the prototype of the Municipal Potential Frailty Index (MPFI for care of dependent older people) to the Italian national territory, presenting it for the first time at the May 2024 general meeting of the Age-It project in Venice. Task 1.4. then started to improve the index thanks to the work conducted by task 1.1., also taking advantage of the feedback received from both the scientific community and stakeholders. The improvement concerns both the inclusion of items on the health of the elderly over 80 and the availability of workers in the care sector (formal care). At the moment the task 1.4. is collecting data available at municipal level. In addition to improving the MPFI, the Task has also started work on the creation of a system for efficient location of care centres (and associated cost estimation) based on car travel times, based on the ISTAT methodology applied to the National Strategy for Inner Areas. At the moment, the task is experimenting different calculation and optimisation algorithms. The results of Task 1.4. on the prototype of the MPFI have been published as a chapter of the book "Avanzare Insieme nella società Anziana", published by "Il Mulino" in June 2024. Task 1.4. participated in the European Conference on Demography (EPC-EAPS) in Edinburgh in June 2024 with an in-depth study on the depopulation of municipalities in "Inner Areas" and the potential impact on care for the older people.
Main policy, industrial and scientific implications
Task 1.4. participated in a special issue of the business newspaper "il Sole 24 Ore" (Il Sole24Ore, Issue 76, Year 160, 17 March 2024), where it showed the results of the application of the MPFI prototype and compared them with the measurement of the population decline of Italian municipalities in "Inner Areas". The publication was a success among stakeholders and local administrators in the following months, with whom future collaborations for scientific and administrative applications are being planned.
Brief description of the activities and of the intermediate results
Task 1.4. continued to work on the improvement of the MPFI prototype and the algorithm for improving the location of care centres, presenting some results at the Spoke 5 meeting in Termoli (CB), in september 2024. Task 1.4. participated in the Summer School for Artificial Intelligence in Como (https://sites.google.com/unimib.it/advancesinai-2024/home) where it gave a lecture on the potential application of Artificial Intelligence to solve problems related to the spatial distribution of care provision for the dependent older people. The Summer School in Como was also an opportunity to establish scientific collaboration with the Research Centre for Advanced Science and Technology of the University of Tokyo (Japan), with respect to issues related to the spatial distribution of services for the elderly. In addition, a georeferencing of hospitals with emergency departments was carried out, accompanied by an analysis of the accessibility of these facilities for the elderly population in 14 municipalities in metropolitan areas. The results were presented at the above-mentioned conference held in Termoli on 12-13 September.
Main policy, industrial and scientific implications
In September 2024, a selection of the results of task 1.4. (together with task 1.1.) was presented to the Padua Chamber of Commerce, at its invitation, confirming the practical interest of stakeholders and local administrations in the instruments being developed by the Age-It project (https://www.unipd.it/sites/unipd.it/files/SIAMO%20TROPPI%20O%20TROPPO%20POCHI%20-%20LE%20SFIDE%20DELLA%20DEMOGRAFIA%20IN%20ITALIA%20E%20NEL%20VENETO.pdf).
Brief description of the activities and of the intermediate results
Task 1.4. continued to improve the MPCFI prototype and the algorithm for improving the location of care centres. Task 1.4. participated in the "Distances 3" workshop in Kyoto with a presentation: "How demography curves space beyond flat distances: towards the municipal potential frailty indices" (Japan, 15-16 November, https://iseas-kyoto.org/en/workshops/e6145), where it gave a presentation on the potential application of the MPCFI to the care of dependent elderly people, combining the concept of "temporal tresholds" (Pox, F.J., & Piesch, L. 2024) and ISTAT Inner Areas, proposing a new concept: the demographic "black holes" in relation to the care of dependent elderly people. The concept of the "demographic black hole" was further developed during the CNR-ISMED workshop "Aree Interne, spopolamento e rigenerazione territoriale", held at the University of Salerno on 26 November 2024, with the presentation: "Aree Interne e Assistenza nella Società Anziana: una proposta di indicatore delle criticità a livello comunale" (https://www.ismed.cnr.it/evento/aree-interne-spopolamento-e-rigenerazione-territoriale/).
Main policy, industrial and scientific implications
Task 1.4. continued its cooperation with associations and organisations involved in the care of dependent elderly persons. An article summarising the results of Task 1.4. and 1.1. on care for dependent older people was published in the divulgative review "il Mulino rivista di politica e di cultura", contributing to the public debate on ageing and care for dependent older people in Italy.
Scientific Outputs
Books and book chapters
1) Verrascina, M., Cameli, E., Di Felice, G., Benassi, F., e Lallo, C. (2024), La prospettiva geo demografica. La domanda potenziale di cura per piccole aree, in C. Tomassini, M. Albertini, e C. Lallo (eds.), Avanzare insieme nella società anziana, Bologna, Il Mulino.
Journal articles
1) Benassi, F., Tomassini, C., e Lallo, C. (2024), The Local Regression Approach as a Tool to Improve Place-Based Policies: The Case of Molise (Southern Italy). Spatial Demography, 12 (2). https://doi.org/10.1007/s40980-024-00123-1; https://doi.org/10.1007/s40980-024-00123-1
2) Lallo, C., Cameli, E., e Tomassini, C. (2024). Domanda e Offerta di Assistenza agli Anziani lungo la penisola. Il Mulino Rivista di politica e di cultura, 4/24. https://www.rivistailmulino.it/isbn/9788815423214
Dissemination events and other (conference papers and proceedings, seminars, schools)
1) Lallo, C., Benassi, F., e Cameli, E. (2024), L’Italia spopolata dei comuni interni: gli abitanti fuggono, restano gli over 80. Dossier published in Il Sole24Ore newspaper, participation and scientific advice in the editing of the dossier, Il Sole24Ore, n. 76, Year 160, March 17, 2024; https://24plus.ilsole24ore.com/art/italiani-fuga-zone-interne-che-si-spopolano-piu-anziani-meno-abitanti-AFpQMx4C
2) Lallo, C., Benassi, F., e Cameli, E. (2024), In Basilicata nasce la “clinica dei paesi”: un presidio per combattere l’abbandono, by Luigia Ierace. Sole24Ore Dorso Sud newspaper in-depth article. Participation and scientific advice in the drafting of the article. Il Sole24Ore online, Aprile 14, 2024; https://www.ilsole24ore.com/art/in-basilicata-nasce-clinica-paesi-presidio-combattere-l-abbandono-AFdPO3CD
3) Verrascina, M., Cameli, E., Di Felice, G., Benassi, F., e Lallo, C. (2024), Estimating the local differential of dependent older people care needs: The Municipal Potential Care Frailty Index (MPCFI) approach. Venice (Italy), May 20-22, 2024, General Age-It Meeting; https://ageit.eu/wp/wp-content/uploads/2024/06/Programma-Age-It-20-22-Maggio-2024-online.pdf
4) Lallo, C., Benassi, F., e Tomassini, C. (2024), Towards the identification of a Systemic Depopulation Areas Index: the case of Molise. European Population Conference of European Assocation for Population Studies (EAPS), Edinmburgh (UK), June 12-15, 2024; https://epc2024.eaps.nl/uploads/241267
5) Cameli, E., Tomassini, C., e Lallo, C. (2024), Towards the identification of a systemic depopulation index: the case of Italy. Sustainability of elder care systems in an ageing society, Age-It Spoke5 Meeting, Termoli (CB, Italy), September 11-13, 2024; https://age-it.github.io/spoke5.github.io/#venue
6) Armenise, M., e Mantuano, M. (2024), A territorial perspective on hospital accessibility of the elderly population. Sustainability of elder care systems in an ageing society, Age-It Spoke5 Meeting, Termoli (CB, Italy), September 11-13, 2024; https://age-it.github.io/spoke5.github.io/#venue
7) Tomassini, C., e Lallo, C. (2024), Demography: challenges for IA. Advances in Artificial Intelligence, Lake Como School of Advanced Studies, Como, September 23-27, 2024; https://sites.google.com/unimib.it/advancesinai-2024/home
8) Lallo, C. (2024), How demography curves space beyond flat distances: towards the municipal potential frailty indices. Distances 3, Kyoto (Japan), November 15-16, 2024; https://iseas-kyoto.org/en/workshops/e6145
9) Lallo, C. (2024), Aree Interne e Assistenza nella Società Anziana: una proposta di indicatore delle criticità a livello comunale. Aree Interne, spopolamento e rigenerazione territoriale, ISMED-CNR, Universtà di Salerno, Fisciano (SA), Novemeber 26, 2024; https://www.ismed.cnr.it/evento/aree-interne-spopolamento-e-rigenerazione-territoriale/
10) Cameli, E. (2024), The impact of the National Strategy for Inner Areas (SNAI) on systemic depopulation: the case of Molise region. PhDExpo Unimol Innovazione e Ricerca Verso Nuovi Orizzonti, University of Molise, Campobasso, December 10, 2024; https://www3.unimol.it/ateneo/dettaglio-notizia/PhD-EXPO-2024
11) Di Renzo, N. (2024), The impact of public services availability on life courses of populations living in old and new Italian Inner Areas. PhDExpo Unimol Innovazione e Ricerca Verso Nuovi Orizzonti, University of Molise, Campobasso, December 10, 2024. https://www3.unimol.it/ateneo/dettaglio-notizia/PhD-EXPO-2024