Leader: Eleonora Meli (Istat); Other collaborator(s): UNIMOL
Inner areas are defined as those at an intermediate, peripheral or ultra-peripheral distance from large and medium-sized urban centers, and from their associated infrastructures (hospitals and public transportation). Around 13.5 million people live there (22% of the Italian population) and the proportion of older people is higher compared to the rest of the country since they are characterized by scarce migrants inflows and younger people emigration to urban areas. The combination of high presence of older people and isolation makes planning efficient care services particularly hard. This task aims to build up from previous data from qualitative studies run in Molise a comprehensive model of care for older people with disabilities living in inner areas with innovative solutions to keep people in place such as care homes in the town center and shared carers.
Brief description of the activities and of the intermediate results:
The information content of the new survey 'Families and Social Subjects' has been defined, and the activity will be conducted from May 2024. The research activity ensured that the questions regarding the perception of functional limitations, social isolation, and psychological well-being were harmonised with those of other ISTAT surveys, allowing for comparison and validation of the produced estimates. Functionality and comprehension tests on the new electronic questionnaire were also conducted. This questionnaire will be administered to a representative sample of the population residing in Italy, allowing us to capture care needs as well as the availability of informal caregivers for age-related issues. As ageing is a complex phenomenon with varied characteristics, the likelihood of receiving assistance, considering both individual traits (such as age, gender, marital status, parenthood, etc.) and municipal characteristics (inner or central location, geographical area, etc.), was also examined. To disentangle the factors associated with receiving or not receiving assistance, all forms of aid (informal, formal, and paid) using data from the Families and Social Subjects surveys conducted in 1998, 2003, 2009, and 2016 were also analysed. This approach provides a temporal perspective on the phenomenon. The results will be presented at the Age-It General Assembly in Venice on May 22. A joint paper with Prof. Marco Albertini and Prof. Cecilia Tomassini entitled "Living in the Italian Inner Areas: the support network of childless older people will be presented.
The information content of the new survey 'Families and Social Subjects' has been continued, and the activity has been regarded the study of the perception of functional limitations, social isolation, and psychological well-being. They have been harmonised with ISTAT surveys, in order to compèare and validate of the produced estimates. Functionality and comprehension tests on the new electronic questionnaire have been also continued. The results have been presented at the Age-It General Assembly in Venice on May 22. A joint paper with Prof. Marco Albertini and Prof. Cecilia Tomassini entitled "Living in the Italian Inner Areas: the support network of childless older people” is in press.
To highlight the most significant factors influencing the living conditions of people over 65 based on the territory where they reside, we developed a study titled "The Support Network for People Aged 65 and Over Who Have No Children. " This research analyzes, for the first time, whether and to what extent help exchanges are influenced by the urban or rural character of the Italian municipalities in which individuals live. The analysis focuses on trends over time regarding the availability of a support network and the urban or rural characteristics of municipalities. These factors are considered along with other individual socio-economic and demographic variables to provide a comprehensive view of family and territorial dynamics.
As part of the data collection activities for new and more up-to-date datasets on ageing and care relationships, starting in May 2024, Istat conducted a new edition of the Families and Social Subjects sample survey. This edition included a dual sample component: more than 44,000 individuals were selected for the cross-sectional survey, while over 16,000 individuals who had participated in the 2016 edition were involved in the longitudinal component.
In September 2024, the Families and Social Subjects survey was concluded. More than 60% of the individuals sampled for the cross-sectional component were reached. For the longitudinal component, almost 40% of the individuals who participated in the 2016 survey responded to the Panel survey. To ensure robust and comparable estimates, we are working on calibrating the carry-over coefficients to align with the target population. We calculate benchmark totals based on gender, age group, citizenship, educational qualification, and employment status.
As part of the data collection activities for new and more up-to-date datasets on ageing and care relationships, starting in May 2024, Istat conducted a new edition of the Families and Social Subjects sample survey. This edition included a dual sample component: more than 44,000 individuals were selected for the cross-sectional survey, while over 16,000 individuals who had participated in the 2016 edition were involved in the longitudinal component. In September 2024, the Families and Social Subjects survey was concluded. More than 60% of the individuals sampled for the cross-sectional component were reached. For the longitudinal component, almost 40% of the individuals who participated in the 2016 survey responded to the Panel survey. To ensure robust and comparable estimates, we are working on calibrating the carry-over coefficients to align with the target population. We calculate benchmark totals based on gender, age group, citizenship, educational qualification, and employment status.
As part of our program activities, we analyzed demographic and socio-structural trends affecting long-term care (LTC) capacity in Italy. Italy currently leads Europe in population ageing, exhibiting the highest share of individuals aged 65 and 75 and over. Despite gains in life expectancy, improvements in healthy life years have been limited: at age 65, Italians experience approximately nine years of healthy life expectancy, below the European average (Long-Term Care Report). Throughout the reporting period, we assessed the implications of fertility decline and increasing childlessness for future care availability. Fertility rates have continued to decrease following the 2008 economic recession, and childlessness has reached 20% among women born in the 1970s. Projections indicate that by 2040 one-fifth of older Italians will not have children to rely on for informal support. This demographic shift is expected to intensify pressure on formal care systems and informal support networks.
Drawing on microdata from the ISTAT *Family and Social Subjects* survey (2016), we conducted analyses demonstrating that older adults without children are at substantially higher risk of care gaps. Our results show that their likelihood of receiving either informal or formal support is between 15% and 20%, compared with nearly 80% among older parents. Moreover, this disparity has widened across the early 21st century, highlighting a growing area of social vulnerability. In parallel, we examined internal migration patterns and territorial inequalities in ageing. Italy has experienced sustained internal migration flows from rural and mountainous regions toward major urban centers. These “inner areas” are characterized by out-migration of younger cohorts, limited inflows of immigrant workers, and progressive contraction of essential public services (e.g., hospitals, general practitioners, schools). As a result, they face accelerated population ageing combined with a shrinking availability of both formal and informal care resources. Based on our monitoring activities, we identify a “triple care deficit” emerging in these communities, driven by:
Recognizing the importance of timely evidence for policy planning and territorial equity, we have developed a “multidimensional LTC risk index” as part of the Age-It program. This index integrates granular information from population registers, household surveys, and administrative databases. Its aim is to systematically monitor the mismatch between evolving care needs and care-provision potential, supporting public institutions in prioritizing interventions and preventing further depopulation in vulnerable territories.
In this period, the task produced the preliminary Findings from the 2024 “Families and Social Subjects” Survey. The data collected in the new “Families and Social Subjects” survey, conducted between May and September 2024, have been partially validated. Notably, the innovations introduced in the electronic questionnaire—specifically within the sections concerning support provided and support received — have significantly enriched the information gathered. A major improvement stems from the shift away from the paper-based questionnaire previously used (up to 2016). Under the earlier survey design, respondents could report information only about the single most important form of support they had either given or received. In contrast, the 2024 edition expanded the scope of data collection to include the three most important types of support, both provided and received, according to each respondent. This enhancement enables a more detailed characterization of support relationships. It allows us to better assess the impact of support on both caregivers and care recipients, and to accurately identify both the providers and beneficiaries of the reported support. As a result, the new survey cycle offers a more comprehensive and distinguished understanding of family and social support dynamics. Compared with the results from 2016, the 2024 data show an increase in the share of individuals who, in the four weeks preceding the interview, provided unpaid support to non-cohabiting persons. The types of support considered include financial assistance; healthcare-related help (such as administering injections or dressing wounds); caregiving or personal assistance for adults (including help with bathing, dressing, or eating); caregiving or assistance for children; domestic tasks (such as cleaning, ironing, shopping, or meal preparation); companionship, accompaniment, or hosting; administrative support (for example, going to the post office or bank on behalf of someone); help with work performed outside the home; academic support; provision of food or clothing; assistance with internet use or digital tools; as well as other forms of informal help. This broadening of the support categories allows for a more accurate and detailed measurement of informal care and mutual assistance networks. The observed increase suggests a strengthening of informal support mechanisms within communities, potentially reflecting both a growing awareness of social solidarity and changing needs linked to demographic and socio-economic dynamics. Further analysis will investigate the underlying drivers of this trend and its implications for social policies and care systems.