The delegation of care to technological means
1Alpen Adria University, Austria; 2Inter-University Centre, for Technology, Work and Culture
European policy agendas address aging societies as one of the „grand challenges” of the future. The concern is often economic, but also questions of solidarity, inequality and exclusion come to mind. New solutions for safeguarding care for older people are much sought-after. In this paper, I will focus on e-health and related technologies of „assisted ambient living“. Such applications promise solutions for better medical care and the possibility to deliver assistance in familiar domestic environments. Living-at-home at old age rather than in a nursing home does not only suggest a higher quality of life, but also lower health care costs.
With an empirical study, I examine selected contexts of application of computer assisted health-monitoring technologies. Using scenario method, I analyse how stakeholders and health care specialists, frame the ways in which these technologies are expected to be beneficial and help to tackle challenges of future health care systems. Scenarios frame the criteria used for the assessment of technologies of “assisted ambient living”. In such a way they foreground economic growth, cost-benefit optimisation, technological innovation as well as living quality, health benefit and incentive of use. Aspects of social justice, inequalities and unintended adverse effects are, however, less prominent or even neglected criteria in the assessment of the delegation of care to technological means.
The paper will be relevant for “Aging in Europe” and addresses how the medical care for older people changes through the integration into capitalist economy and innovation policies.
eHealth policies for multimorbidity care in Europe: technologies, health outcomes and policy perspectives for ageing societies
1National Institute of Health and Science on Ageing (INRCA), Italy; 2Linnaeus University, Sweden
Older people with multimorbidity are in need for integrated and patient-centered care which can meet adequately their complex health needs. In the healthcare sector, the role of information and communication technologies (ICTs) for addressing multiple chronic conditions has increased enormously in the last decades across Europe, sustained by favorable research and policy trends. However, the implementation and impact of eHealth policies for multimorbidity care have not been assessed yet. Our study aimed at surveying eHealth practices addressing needs of people with multimorbidity, analysing implementation aspects and developing policy recommendations for overcoming current barriers. The work was part of the ICARE4EU project, co-funded by the Public Health Programme of the European Union. 101 high-potential programmes of integrated care for people with multimorbidity were selected in 31 European countries, with 84 of them including at least one eHealth solution. Most common services concerned electronic health records (EHRs) and tools for digital communication between care providers. Case study analysis of a sub-sample of programmes suggested that eHealth solutions for people with multimorbidity can contribute to: widening access to healthcare services; enhancing care coordination and integration; enabling patients’ self-management; and improving proactive and prevention strategies. Despite this potential, eHealth policies in Europe lacked a global and comprehensive vision for addressing the challenges and exploiting the potential at best. On this basis, a series of policy recommendations was developed for national and European policy makers.
Internet use among carers of people with dementia: a scoping review
Department of Nursing, Faculty of Health Sciences, Cyprus University of Technology, Cyprus
New technologies and social innovations are becoming promising tools in health care sector and provide a variety of services to support carers of people with chronic diseases. In Greece and Cyprus, the large percentage of the population over 60 years old are less literate in internet service use. The aim of the study is to discuss the profile and the factors influencing internet use among carers of people with dementia.MEDLINE, PUBMED, CiNAHL and PsychINFO databases were searched. Key questions of the review were: 1) What information/services do carers of people with dementia search on the internet?, 2) What are the factors influencing carers internet use? 3) What are the main topics of research concerning ICT interventions and carers of people with dementia? In total 84 papers have been reviewed and four main categories of research papers were identified: the profile of internet users and factors influencing use, ICT interventional studies assessing effectiveness, usability and acceptability studies, and concept mapping papers on the importance of ICT tools use. The majority of research focuses on effectiveness and acceptability of ICT interventions. The factors influencing the use of ICT interventions and internet use are not frequently addressed by researchers. Age, relationship with patient, the socioeconomic characteristics, education, hours of care play a role concerning the type and frequency of use. Carers search for health related information, legal and financial issues and care management information.The present study reveals the lack of research on the eHealth literacy field and carers of people with dementia. Carers’ training in eHealth literacy topics is an innovative field, which could assist the use of new techonlogies in Health sector.
The Impact of Selective Participation in eHealth Research on Inequality and Exclusion in Old Age
Linköping Universitet, Sweden
High expectations and large investments support research on innovative solutions for health delivered via information and communication technologies (ICTs). Several studies demonstrated promising results confirming the potentials of ICT-based tools in improving quality of life of older people with long-term conditions and their family caregivers. However, those tools are seldom implemented in clinical practice and patients' everyday life. Also, when they are available, they reach only a limited number of users. Part of the reason for this lacking inclusiveness can be attributed to how ICT-based tools are developed and tested. Particularly, little attention has been paid to the selective participation often occurring in the studies and its possible impact on the successive implementation phases, in terms of inequalities and social exclusion of those who were not represented. An analysis on social selectivity is conducted in four randomized controlled trial studies testing ICT-based tools for self-care for older people and family caregivers. The analysis is based on multivariate quantitative modeling and aims at quantifying effects of selective participation on the results of the interventions. Preliminary results suggested some participation biases are possible in the research process between individuals involved in the studies and those who were excluded, particularly in relation to: level of education, digital skills, attitudes towards ICT-based tools for health, health status. Several challenges face research and implementation of eHealth, among which is the risk of exacerbating social exclusion and inequalities for some groups. In order to promote better outcomes of the studies and guarantee equal provision of services, it is essential that research considers the heterogeneity of individuals targeted.