Francesco Barbabella

Background: Intensive rehabilitation is one of the most important aspects of care for people with stroke, and there is evidence that it leads to better recovery and higher levels of independence. However, pressure on resources in government funded secondary and primary healthcare settings means that for many people with stroke, intense rehabilitation is not available. Effective and efficient ways of increasing rehabilitation intensity, engagement, and motivation for rehabilitation are needed; as well as innovative treatment approaches that enable people with stroke to self-manage this rehabilitation. Technology offers a solution; virtual reality (VR) computer games have the potential to enhance engagement, improve adherence, and outcomes in stroke rehabilitation therapy. However, their integration into current health care pathways needs to be tested. Aims: The aim of the trial is to test the feasibility of incorporating VR computer games into a stroke rehabilitation system called 'MAGIC-GLASS', and its integration into the current care pathway for people with stroke. Design: Multicenter, prospective uncontrolled, pre-post intervention study. Setting: Participants will be recruited from Stroke Services, GP Practices or via Stroke Support Groups, and the intervention will be carried out in the hospital setting, or at home after discharge. Population: Adults (18 years) who have had a stroke. Interventions: Magic Glass is a clinician facilitated VR-based stroke rehabilitation system. Clinical facilitation includes a minimum of one initial face-to-face contact followed by up to 13 weekly/fortnightly remote contacts (to month six) with a clinician. Outcomes: The usability and acceptability of the intervention; process and resource requirements for the new care pathway; changes in clinical outcomes and potential cost-effectiveness of the solution will be measured to assess change from baseline to six months post intervention. Sample size: In order to have 50 patients in the subgroups identified (time since stroke; severity of stroke; age) we plan to recruit 300 participants, 150 in Northern Ireland and 150 in Italy. Fifty is considered the optimal sample size for this feasibility analysis. Duration: 18 months. Follow up will be post intervention (up to six months post entry into the study). The nested qualitative study will start once the first cohort of participants has completed and will continue throughout the intervention period.

Background Many studies investigated factors associated with overuse of Emergency Department (ED) by older people. However, there is little evidence of how a better access to long-term care services can affect ED visit rates. Therefore, we estimated the association between ED use and contextual (distance to closest ED), need (priority level at admission and care deprivation), predisposing (socio-economic conditions) and enabling factors (availability of health services) at the municipal level. Methods We investigated ED visit rates by comparing the older population (aged 75 and more) to those aged less than 75 years among 233 municipalities and 13 health districts in the Marche Region, Central Italy. Administrative data were enriched by spatial dimensions. The outcomes were analysed using t-tests and ANOVA, while OLS and multilevel regressions have been used to identify independent correlates of ED visit rates. Results Mean ED visit rate was 56.3% and 25.3% among older people and the rest of the population (< 75 years), respectively. The multivariate analysis for older people showed that the presence of an ED within the municipality and living alone were positively associated with ED use, whereas greater availability of nursing homes was negatively associated. For general population (< 75 years), distance to closest ED, economic deprivation and bigger hospitals were negatively associated with ED visits. Conclusions Our study shows that interventions to reduce frequent ED use by older people should include the availability of long-term care facilities in the area. As population ageing is progressing, our results suggest that investing in alternative care options for older people with long-term care needs might have the beneficial impact of reducing the overall ED rates and improving quality and appropriateness of care.

L'assistenza domiciliare: una comparazione con altri paesi europei Le caratteristiche dell'assistenza domiciliare per anziani in Italia e le sue criticità sono al centro dell'articolo che offre riflessioni a partire dall'analisi dei dati istituzionali riferiti anche ad altri Paesi europei. Da tale comparazione, inoltre, gli autori traggono spunto per proporre una serie di insegnamenti per il sistema italiano di Long-Term Care. La domanda di assistenza domiciliare in Italia e le sue criticità In Italia oltre l'80% delle persone non autosufficienti che vivono a casa è ultrasessantacinquenne, circa 2,5 milioni di anziani (ISTAT, 2014). Si stima che oltre un quinto delle persone con 65 anni e più abbia limitazioni funzionali gravi da necessitare assistenza personale a casa (20,1%) o in strutture residenziali quali residenze sanitarie assistenziali (RSA), residenze protette e altre analoghe (1,7%) (ISTAT 2019a, 2019b, 2019c). Le indagini ISTAT sugli anziani non autosufficienti che vivono a casa considerano come persone con limitazioni funzionali gravi (e dunque da considerarsi non autosufficienti) quelle che riportano una difficoltà massima in almeno una delle seguenti dimensioni della vita quotidiana: costrizione a letto, su sedia o in abitazione (confinamento); limitazioni nelle funzioni della vita quotidiana, incluse la maggior parte delle attività della vita quotidiana (activities of daily living, ADL); problemi nel camminare, usare le scale e raccogliere oggetti da terra (limitazioni nel movimento); difficoltà della comunicazione (limitazioni di vista, udito e parola). Tali limitazioni richiedono un'assistenza continuativa e di lungo termine da parte di altre persone per essere compensate, nonché per porre l'anziano assistito nella condizione di poter continuare a vivere una vita dignitosa e con una qualità della vita accettabile. In particolare, i bisogni specifici degli anziani non autosufficienti possono essere inquadrati in due tipologie: bisogni socio-assistenziali: le limitazioni funzionali possono impedire o circoscrivere le azioni che la persona anziana può compiere su se stessa, sull'ambiente circostante e per interagire con gli altri. I bisogni socio-assistenziali si configurano dunque non solo come quelli emergenti dalle difficoltà oggettive di compiere le ADL e le attività strumentali della vita quotidiana (instrumental activities of daily living, IADL), ma anche quelli relativi alla scarsa mobilità generale (abilità nel muoversi in ambienti domestici, esterni o tramite mezzi di trasporto), alla mancata possibilità di incontrare e comunicare con altre persone e di accedere a servizi (sia generali, quali l'acquisto di beni di prima necessità, sia specifici, come il reperimento dei farmaci prescritti);

Introduction: Long-term care (LTC) is organized in a fragmented manner. Payer agencies (PA) receive LTC funds from the agency collecting funds, and commission services. Yet, distributional equity (DE) across PAs, a precondition to geographical equity of access to LTC, has received limited attention. We conceptualize that LTC systems promote DE when they are designed to set eligibility criteria nationally (vs. locally); and to distribute funds among PAs based on needs-formula (vs. past-budgets or government decisions). Objectives: This crosscountry study highlights to what extent different LTC systems are designed to promote DE across PAs, and the parameters used in allocation formulae. Methods: Qualitative data were collected through a questionnaire filled by experts from 17 OECD countries. ଝ EURO B

This article illustrates the implications of two recent trends on family carers' health: the employment of home-based migrant care workers; and the provision of web-based supports. The main factors traditionally associated with carers' health are used to analyse the results of a six-country study via a multilevel linear regression. Attention will be dedicated to the role of migrant care workers, who are often hired by private households to provide eldercare. Finally, web-based services for carers will be investigated by considering InformCare, a recently implemented European platform tested on a sample of carers from three countries (Germany, Italy and Sweden).

Currently, an estimated 50 million people in the European Union live with multiple chronic diseases (multimorbidity) and this number is expected to further increase in the near future. As multimorbidity deeply impacts on people&#39;s quality of life-physically, but also mentally and socially-, there is a growing demand for multidisciplinary care that is tailored to the specific health and social needs of these people. Integrated care programmes have the potential to adequately respond to the comprehensive needs of people with multimorbidity by taking a holistic approach while making efficient use of resources. Such programmes are characterized by providing patient centred, proactive and coordinated multidisciplinary care, using new technologies to support patients&#39; self-management and improve collaboration between caregivers. In order to inform policymakers, managers and professionals working in health and social care as well as patients&#39; and informal carers&#39; representat...

ABSTRACT Extensive research in the field of ambient assisted living (AAL) provides profound knowledge about the design of AAL systems. However, more generic design characteristics for user interaction have not been formalized for this domain yet. Thus, we propose to develop a domain specific taxonomy for the design of user interaction in AAL systems. We adopted a systematic taxonomy development approach that combines an empirical and a pseudo-conceptual strategy. Six co-researchers from different disciplines conduct the iterative research process. Next to AAL systems existing taxonomies in the field of human-computer interaction are analyzed following the Delphi method. In this paper we present our research process and preliminary results from the first iteration. The final taxonomy allows classification and should support the analysis of user interaction utilized in AAL systems. Furthermore, it can deal as a practical design guideline.

ABSTRACT Although it is internationally acknowledged that ICT-based systems have the potential to provide costeffective services, their deployment is still limited. Through the User Centred Design, it is possible to draw up information on key concepts, such as attitude towards technology, acceptance and usability of any new products. The collected information will serve for the technological development on one side, and for the Impact Assessment Analysis on the other one, that will describe the future path of the devices. The paper describes in details the most important metrics—attitude towards technology, usability and accessibility—for conducting a prompt evaluation of a new device for the older people, suggesting common guidelines and critical issues to solve.