Care for people with multimorbidity requires an integrated approach in order to adequately meet their complex needs. In this respect eHealth could be of help. This paper aims to describe the implementation, as well as benefits and barriers of eHealth applications in integrated care programs targeting people with multimorbidity in European countries, including insights on older people 65+. Within the framework of the ICARE4EU project, in 2014, expert organizations in 24 European countries identified 101 integrated care programs based on selected inclusion criteria. Managers of these programs completed a related on-line questionnaire addressing various aspects including the use of eHealth. In this paper we analyze data from this questionnaire, in addition to qualitative information from six programs which were selected as 'high potential' for their innovative approach and studied in depth through site visits. Out of 101 programs, 85 adopted eHealth applications, of which 42 focused explicitly on older people. In most cases Electronic Health Records (EHRs), registration databases with patients' data and tools for communication between care providers were implemented. Percentages were slightly higher for programs addressing older people. eHealth improves care integration and management processes. Inadequate funding mechanisms, interoperability and technical support represent major barriers. Findings seems to suggest that eHealth could support integrated care for (older) people with multimorbidity.

Informal caregiving is the main source of care for older people in Europe. An enormous amount of responsibility and care activity is on the shoulders of family caregivers, who might experience problems in their psychological well-being and in reconciling caregiving and their personal sphere. In order to alleviate such burden, there is increasing interest and growing research in Europe on Web-based support addressing family caregivers and their needs. However, the level of development and penetration of innovative Web-based services for caregivers is still quite low and the access to traditional face-to-face services can be problematic for logistic, availability, and quality reasons. As part of the European project INNOVAGE, a pilot study was conducted for developing and testing a Web-based psychosocial intervention aimed at empowering family caregivers of older people in Italy, Sweden, and Germany. The program offered information resources and interactive services to enable both professional and peer support. A mixed-methods, sequential explanatory design was adopted. Caregivers' psychological well-being, perceived negative and positive aspects of caregiving, and social support received were assessed before and after the 3-month intervention. Poststudy, a subsample of users participated in focus groups to assist in the interpretation of the quantitative results. A total of 94 out of 118 family caregivers (79.7%) from the three countries used the Web platform at least once. The information resources were used to different extents in each country, with Italian users having the lowest median number of visits (5, interquartile range [IQR] 2-8), whereas German users had the highest number (17, IQR 7-66) (P<.001). The interactive services most frequently accessed (more than 12 times) in all countries were the social network (29/73, 40%) and private messages (27/73, 37%). The pretest-posttest analysis revealed some changes, particularly the slight worsening of perceived positive values of caregiving (Carers of Older People in Europe [COPE] positive value subscale: P=.02) and social support received (COPE quality-of-support subscale: P=.02; Multidimensional Scale of Perceived Social Support subscale: P=.04), in all cases with small effect size (r range -.15 to -.18). Focus groups were conducted with 20 family caregivers and the content analysis of discussions identified five main themes: online social support, role awareness, caregiving activities, psychological well-being, and technical concerns. The analysis suggested the intervention was useful and appropriate, also stimulating a better self-efficacy and reappraisal of the caregivers' role. The intervention seemed to contribute to the improvement of family caregivers' awareness, efficacy, and empowerment, which in turn may lead to a better self-recognition of their own needs and improved efforts for developing and accessing coping resources. A major implication of the study was the finalization and implementation of the InformCare Web platform in 27 European countries, now publicly accessible (www.eurocarers.org/informcare).

Active ageing is defined as the process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age. The design of active ageing policies intersects with different overarching societal challenges, especially ageing populations, social rights and sustainability. However, there are no previous attempts to review active ageing policies in the light of these challenges and the international policy objectives and targets that are guiding the international community. The aim of this study is to systematically identify, review and analyse all national and regional policies on active ageing adopted in Italy, by applying a conceptual framework derived from main international policy initiatives in the three areas. The research was conducted in two stages. First, a case study analysis was carried out per each relevant national institution and regional government. Standardised interviews were combined with policy document search, selection and analysis. Second, we performed a policy analysis in the light of a conceptual framework adopted. This latter was composed by nine policy domains, selected and integrated from principles and objectives of three overarching international frameworks on ageing—i.e., the Regional Implementation Strategy (RIS) commitments of the Madrid International Plan of Action on Ageing (MIPAA), social rights—i.e., the European Pillar of Social Rights and sustainability—i.e., the Sustainable Development Goals (SDGs) of the Agenda 2030 for Sustainable Development. Results pointed out that out of the identified nine policy fields, the major intervention areas by Italian policy makers concerned labour market participation, life-long learning, social and economic inequalities, health and well-being. Less attention had been given to issues such as gender and equal opportunities and sustainable cities. This systematic policy review is a milestone for understanding how active ageing policies contribute to address major societal challenges and what domains need further policy development.

People with multimorbidity, especially older people, have complex health and social needs, and require an integrated care approach. In this respect, eHealth could be of support. This paper aims to describe the implementation of eHealth technologies in integrated care programs for people with multimorbidity in Europe, and to analyse related benefits and barriers according to outcomes from ICARE4EU study and within the more general conceptual framework of the “10 e's” in eHealth by Gunther Eysenbach. In 2014, ICARE4EU project identified 101 integrated care programs in 24 European countries. Expert organizations and managers of the programs completed an on-line questionnaire addressing several aspects including the adoption of eHealth. Findings from this questionnaire were analyzed, by linking in particular benefits and barriers of eHealth with the “10 e's” by Eysenbach (Efficiency, Enhancing, Evidence-based, Empowerment, Encouragement, Education, Enabling, Extending, Ethics, and Equity). Out of 101 programs, 85 adopted eHealth tools, of which 42 focused explicitly on older people. eHealth could improve care integration/management, quality of care/life and cost-efficiency, whereas inadequate funding represents a major barrier. The “10 e's” by Eysenbach seem to show contact points with ICARE4EU findings, in particular when referring to positive aspects of eHealth such as Efficiency and Enhancing quality of care/life, although Empowerment/Education of patients, care Equity and Ethics issues seem crucial in this respect. Encouragement of a new relationship patient-health professional, and Enabling standardized exchange of electronic information, represent further aspects impacting integration/management of care. Aspects of eHealth, which emerged as benefits and barriers impacting integration/management of care, as well as cost-efficiency and quality of care/life, can be identified on the basis of both ICARE4EU findings and the “10 e's” in eHealth by Eysenbach. They could represent objectives of new policies for supporting the deployment of eHealth technologies within integrated care across Europe.

Introduction. eHealth applications have the potential to provide new integrated care services to patients with multimorbidity (MM), also supporting multidisciplinary care. The aim of this paper is to explore how widely eHealth tools have been currently adopted in integrated care programs for (older) people with MM in European countries, including benefits and barriers concerning their adoption, according to some basic health system characteristics. Materials and Methods. In 2014, in the framework of the ICARE4EU project, expert organizations in 24 European countries identified 101 integrated care programs. Managers of the selected programs completed an online questionnaire on several dimensions, including the use of eHealth. We analyzed data from this questionnaire, in addition to qualitative information from six innovative programs which were studied in depth through case study methodology, according to characteristics of national health systems: a national health model (financing system), overall strength of primary care (PC) (structure/service delivery process), and level of (de)centralization of health system (executive powers in a country). Results. 85 programs (out of 101) adopted at least one eHealth tool, and 42 of these targeted explicitly older people. In most cases, Electronic Health Records (EHRs) were used and some benefits emerged like improved care management and integration, although inadequate funding mechanisms represented a major barrier. The analysis by health system characteristics showed a greater adoption of eHealth applications in decentralized countries, in countries with a National Health Service (NHS) model, and in countries with a strong/medium level of PC development. Conclusions. Although in the light of some limitations, findings indicate a relation between implementation of care programs using eHealth tools and basic characteristics of health systems, with decentralization of a health system, NHS model, and strong/medium PC having a key role. However adaptations of European health systems seem necessary, in order to provide a more innovative and integrated care.

In ageing societies, active ageing (AA) has been recognized as a useful conceptual tool due to its holistic approach to social issues and recognised benefits from it at multiple levels (micro, meso and macro) for addressing demographic challenges. However, one of the main problems identified in relation to AA, is to turn into practice, at the policy making level, the many positive aspects that it promises at the conceptual level, as is demonstrated by the available evidence based on experiences carried out in some European countries. As an advancement in this field, through an original research experience carried out in Italy between 2019 and 2021, this study for the first time provides a model for producing recommendations for policy making and policy implementation in the field of AA, by managing the main problematic aspects related to the operationalization, at the policy making level, of the AA concept, with the potential for replication in other countries. The main challenges were identified, as well as the way to deal with them through a model, for a proper operationalization of the AA concept, based, among other aspects, on a solid international framework concerning this matter, on a mainstreaming ageing approach (at the public policy level) and on a wide stakeholder participation through co-decisional tools. A multi-level (national-regional-local) perspective was adopted to consider cultural and geographical diversity, among other challenges.