Digital ageing in Europe: a comparative analysis of Italian, Finnish and Swedish national policies on eHealth

Abstract Ageing Europeans are today healthier than previous generations and often manage to live independently up to a high age. The proportion of people 80 years of age and older has increased significantly, and with high age the risk of multi-illness and dementia increases. Strong urbanisation processes have changed the demographic structure in rural areas, and young women and men have migrated towards the urban areas to study and work, while older persons have remained behind. This demographic challenge of increasing numbers of persons older than 80 years with care needs living in remote rural areas has become a major European social problem. In tackling this dilemma, many European countries have high expectations for eHealth, digitalisation and welfare technology. In this comparative study of policy debates in Italy, Finland and Sweden, we analyse how – between 2009 and 2019 – the issues of eHealth have been articulated in national and regional policies of the three countries with deep differences in terms of digitalisation and health systems, but with similar ageing populations. We identify in the documents three core topics – the role of technology, the rural issue and responsibility for care. These topics are treated in the documents with differences and similarities between the three countries. Beyond the differences and similarities, the documents reveal both a certain techno-enthusiasm about the role of eHealth in the life of the older adults as well as a limited understanding of the complexity (relationally as well as spatially) of the digital landscape of caring for older adults.

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Spreading Telehealth for Older Adults in Rural Areas Through Network of Geriatric Interprofessional Teams

Innovation in Aging ◽

10.1093/geroni/igaa057.2885 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 796-796

Author(s):

Steven Barczi ◽

Megan Gately ◽

Lauren Welch ◽

Kathryn Nearing ◽

Stephen Thielke ◽

...

Keyword(s):

Older Adults ◽

Rural Areas ◽

Urban Areas ◽

Care Needs ◽

Community Based ◽

Team Care ◽

Geriatric Consultation ◽

Complex Care Needs ◽

Nursing Professionals ◽

Community Based Services

Abstract Older adults living in rural areas have limited access to geriatrics interprofessional team care. In the Veteran healthcare system, geriatric teams such as geriatricians, nursing professionals, social workers, pharmacists and psychologists, located in urban areas link up with rural clinics to provide geriatric consultation remotely through clinical video telehealth and other means in the project GRECC Connect. Since its inception in 2014, the service has now grown to 16 geriatric teams offering consultation to over 100 clinic sites serving older rural Veterans. GRECC Connect delivered over 2,000 consultations in 2019, meeting complex care needs by identifying and linking geriatric services and management to patients with geriatric syndromes. The network of established geriatric teams, local champions and a shared Electronic Health Record facilitated the spread, while ongoing effort to build and maintain relationships between consultants and local rural provider teams and other community based services are important for ongoing success.

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Bypassing primary care facilities: health-seeking behavior of middle age and older adults in China

BMC Health Services Research ◽

10.1186/s12913-021-06908-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Changle Li ◽

Zhuo Chen ◽

M. Mahmud Khan

Keyword(s):

Older Adults ◽

Primary Care ◽

Health System ◽

Rural Areas ◽

Urban Areas ◽

Chinese Patients ◽

Care Needs ◽

Healthcare Facilities ◽

Primary Health ◽

Care Facilities

Abstract Background With economic development, aging of the population, improved insurance coverage, and the absence of a formal referral system, bypassing primary healthcare facilities appear to have become more common. Chinese patients tend to visit the secondary or tertiary healthcare facilities directly leading to overcrowding at the higher-level facilities. This study attempts to analyze the factors associated with bypassing primary care facilities among patients of age 45 years or older in China. Methods Random effects logistic models were used to examine bypassing of primary health facilities among rural-urban patients. Data from 2011 to 2015 waves of the China Health and Retirement Longitudinal Study were used. Results Two in five older patients in China bypass primary health centers (PHC) to access care from higher-tier facilities. Urban patients were nearly twice as likely as rural patients to bypass PHC. Regardless of rural-urban residence, our analysis found that a longer travel time to primary facilities compared to higher-tier facilities increases the likelihood of bypassing. Patients with higher educational attainment were more likely to bypass PHCs. In rural areas, patients who reported their health as poor or those who experienced a recent hospitalization had a higher probability of bypassing PHC. In urban areas, older adults (age 65 years or older) were more likely to bypass PHC than the younger group. Patients with chronic conditions like diabetes also had a higher probability of bypassing. Conclusions The findings indicate the importance of strengthening the PHCs in China to improve the efficiency and effectiveness of the health system. Significantly lower out-of-pocket costs at the PHC compared to costs at the higher tiers had little or no impact on increasing the likelihood of utilizing the PHCs. Improving service quality, providing comprehensive person-centered care, focusing on family health care needs, and providing critical preventive services will help increase utilization of PHCs as well as the effectiveness and efficiency of the health system.

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A Study Of Expansion Of The Fmcg Market Across Rural Areas

Restaurant Business ◽

10.26643/rb.v118i8.7094 ◽

2019 ◽

Vol 118 (8) ◽

pp. 142-151

Author(s):

Dr. Udayagiri Raghunath ◽

Dr. V.Venkateswara Rao

Keyword(s):

Rural Areas ◽

Urban Areas ◽

Customer Choice ◽

Income Levels ◽

Rural Markets ◽

Urban Markets ◽

Tv Media ◽

Rural Clients ◽

Tv Watching

The corporate companies dealing with FMCG products have started focusing on rural markets as the urban markets have become saturated and highly competitive. Capturing the rural markets brings forth a whole new set of challenges as it is laborious to break in. This market presents the companies with gamut challenges on a new dimension which demand entirely different strategies as compared to the ones used in urban areas. Studying the rural markets for rural markets has become crucial more than ever. It is an objective learning, psychiatry of dispersion, impact of the FMCG in rural areas. This research uses diverse utensils, procedure toward analyze composed records. Several of the features used in analyzing the data are the consumer characteristics like educational qualifications, professions they are in, and the income levels. The role of TV media advertising is also analyzed. Many deals and promotions advertised on TV are investigated. The scope of authority wield by publicity happening customer choice production has looked into. The different levels of media exposure and preferable TV watching times and their favorite programs considered while analyzing the data. The spending prototype of rural clients on FMCG is examined and further categorized based on their income levels, educational qualifications, and legal awareness of consumer act. All the analyzed data, results, and suggestions presented in the visual formats.

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Rural–Urban Differences in the Factors Affecting Depressive Symptoms among Older Adults of Two Regions in Myanmar

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18062818 ◽

2021 ◽

Vol 18 (6) ◽

pp. 2818

Author(s):

Yuri Sasaki ◽

Yugo Shobugawa ◽

Ikuma Nozaki ◽

Daisuke Takagi ◽

Yuiko Nagamine ◽

...

Keyword(s):

Older Adults ◽

Middle School ◽

Depressive Symptoms ◽

Rural Areas ◽

Urban Areas ◽

Depression Scale ◽

Wealth Index ◽

School Level ◽

Cross Sectional ◽

Middle School Level

The aim of the study was to investigate rural–urban differences in depressive symptoms in terms of the risk factors among older adults of two regions in Myanmar to provide appropriate intervention for depression depending on local characteristics. This cross-sectional study, conducted between September and December, 2018, used a multistage sampling method to recruit participants from the two regions, for face-to-face interviews. Depressive symptoms were assessed using the 15-item version of the Geriatric Depression Scale (GDS). Depressive symptoms were positively associated with living in rural areas (B = 0.42; 95% confidence interval (CI): 0.12,0.72), female (B = 0.55; 95% CI: 0.31,0.79), illness during the preceding year (B = 0.68; 95% CI: 0.45,0.91) and non-Buddhist religion (B = 0.57; 95% CI: 0.001,1.15) and protectively associated with education to middle school level or higher (B = −0.61; 95% CI: −0.94, −0.28) and the frequency of visits to religious facilities (B = −0.20; 95% CI: −0.30, −0.10). In women in urban areas, depressive symptoms were positively associated with illness during the preceding year (B = 0.78; 95% CI: 0.36, 1.20) and protectively associated with education to middle school level or higher (B = −0.67; 95% CI: −1.23, −0.11), middle or high wealth index (B = −0.92; 95% CI: −1.59, −0.25) and the frequency of visits to religious facilities (B = −0.20; 95% CI: −0.38, −0.03). In men in rural areas, illness during the preceding year was positively associated with depressive symptoms (B = 0.87; 95% CI: 0.33, 1.42). In women in rural areas, depressive symptoms were positively associated with illness during the preceding year (B = 0.83; 95% CI: 0.36, 1.30) and protectively associated with primary education (B = −0.62; 95% CI: −1.12, −0.12) and the frequency of visits to religious facilities (B = −0.44; 95% CI: −0.68, −0.21). Religion and wealth could have different levels of association with depression between older adults in the urban and rural areas and men and women. Interventions for depression in older adults should consider regional and gender differences in the roles of religion and wealth in Myanmar.

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Ecological Connectivity in Agricultural Green Infrastructure: Suggested Criteria for Fine Scale Assessment and Planning

Land ◽

10.3390/land10080807 ◽

2021 ◽

Vol 10 (8) ◽

pp. 807

Author(s):

Simone Valeri ◽

Laura Zavattero ◽

Giulia Capotorti

Keyword(s):

Land Cover ◽

Green Infrastructure ◽

Rural Areas ◽

Urban Areas ◽

Landscape Heterogeneity ◽

Agricultural Landscapes ◽

Spatial Pattern Analysis ◽

Fine Scale ◽

Unique Type

In promoting biodiversity conservation and ecosystem service capacity, landscape connectivity is considered a critical feature to counteract the negative effects of fragmentation. Under a Green Infrastructure (GI) perspective, this is especially true in rural and peri-urban areas where a high degree of connectivity may be associated with the enhancement of agriculture multifunctionality and sustainability. With respect to GI planning and connectivity assessment, the role of dispersal traits of tree species is gaining increasing attention. However, little evidence is available on how to select plant species to be primarily favored, as well as on the role of landscape heterogeneity and habitat quality in driving the dispersal success. The present work is aimed at suggesting a methodological approach for addressing these knowledge gaps, at fine scales and for peri-urban agricultural landscapes, by means of a case study in the Metropolitan City of Rome. The study area was stratified into Environmental Units, each supporting a unique type of Potential Natural Vegetation (PNV), and a multi-step procedure was designed for setting priorities aimed at enhancing connectivity. First, GI components were defined based on the selection of the target species to be supported, on a fine scale land cover mapping and on the assessment of land cover type naturalness. Second, the study area was characterized by a Morphological Spatial Pattern Analysis (MSPA) and connectivity was assessed by Number of Components (NC) and functional connectivity metrics. Third, conservation and restoration measures have been prioritized and statistically validated. Notwithstanding the recognized limits, the approach proved to be functional in the considered context and at the adopted level of detail. Therefore, it could give useful methodological hints for the requalification of transitional urban–rural areas and for the achievement of related sustainable development goals in metropolitan regions.

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Decomposing Urban-rural Differences in Multimorbidity Among Older Adults in India: A Study Based on Lasi Data

10.21203/rs.3.rs-701569/v1 ◽

2021 ◽

Author(s):

Shekhar Chauhan ◽

Shobhit Srivast ◽

Pradeep Kumar ◽

Ratna Patel

Keyword(s):

Older Adults ◽

Rural Areas ◽

Urban Areas ◽

Decomposition Analysis ◽

The Public ◽

Analysis Techniques ◽

Ageing Study ◽

Urban Rural ◽

The Difference ◽

Urban And Rural Areas

Abstract Background: Multimorbidity is defined as the co-occurrence of two or more than two diseases in the same person. With rising longevity, multimorbidity has become a prominent concern among the older population. Evidence from both developed and developing countries shows that older people are at much higher risk of multimorbidity, however, urban-rural differential remained scarce. Therefore, this study examines urban-rural differential in multimorbidity among older adults by decomposing the risk factors of multimorbidity and identifying the covariates that contributed to the change in multimorbidity.Methods: The study utilized information from 31,464 older adults (rural-20,725 and urban-10,739) aged 60 years and above from the recent release of the Longitudinal Ageing Study in India (LASI) wave 1 data. Descriptive, bivariate, and multivariate decomposition analysis techniques were used.Results: Overall, significant urban-rural differences were found in the prevalence of multimorbidity among older adults (difference: 16.3; p<0.001). Moreover, obese/overweight and high-risk waist circumference were found to narrow the difference in the prevalence of multimorbidity among older adults between urban and rural areas by 8% and 9.1%, respectively.Conclusion: There is a need to substantially increase the public sector investment in healthcare to address the multimorbidity among older adults, more so in urban areas, without compromising the needs of older adults in rural areas.

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Comparison of The Risk Factors For Falls Among Older Adults Between Urban and Rural Areas of Shantou City, China

10.21203/rs.3.rs-72830/v1 ◽

2020 ◽

Author(s):

Xiaodong Chen ◽

Zeting Lin ◽

Ran Gao ◽

Yijian Yang ◽

Liping Li

Keyword(s):

Risk Factors ◽

Older Adults ◽

Fall Prevention ◽

Rural Areas ◽

Urban Areas ◽

Multivariable Analysis ◽

Living Environment ◽

Balance Function ◽

Urban And Rural Areas ◽

Risk Factors For Falls

Abstract Background: To investigate the prevalence of falls and risk factors among older adults in urban and rural areas and to facilitate the design of fall prevention interventions.Methods: We used cluster random sampling to investigate the sociodemographic information, living habits, medical history, and falls among 649 older adult participants. Univariable and multivariable logistic regression was used to examine fall risk factors in urban and rural areas.Results: The fall rate and rate of injury from falls among older adults in urban areas were 27.3% and 18.6%, respectively, which were higher than those in rural areas (17.0% and 12.2%; P<0.05). Multivariable analysis showed that the risk factors for falls among urban older adults included a high school or below education level (OR=3.737, 95% CI: 1.503~9.291); diabetes medicine use (OR=4.518, 95% CI: 1.228~16.626); incontinence (OR=8.792, 95% CI: 1.894~40.824); lack of fall prevention education (OR = 11.907, 95% CI: 1.321～107.354); and reduced balance function (OR = 3.901, 95% CI: 1.894~7.815). The risk factors among rural older adults included a previous nonfarming occupation (OR=2.496, 95% CI: 1.416~4.398); incontinence (OR =11.396, 95% CI: 1.901~68.327); poor living environment (OR=3.457, 95% CI: 1.488~8.033); and reduced balance function (OR =4.260, 95% CI: 2.361~7.688).Discussion: The rate of falls among older adults in urban areas is higher than that in rural areas of Shantou City. Fall prevention in urban areas should target older adults with low education and modify the diabetes medication use. Interventions should focus on improving the home environment of older adults in rural areas.

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subsistence production (where in the colonial period mainly extra-economic factors such as forced cultivation or forced labour caused the integration of the peasantry in the market exchange). Socialist development was there-fore strongly identified with modernising through the rapid expansion of the state sector, that is, nationalisation and mechanisation on an ever-increasing scale. The peasantry would be gradually absorbed within this expanding sector, and hence, at first, the role of the peasantry was seen as essentially passive with its transformation mainly centring on social aspects. As such, the policy of communal villages became virtually a habitational concept (and was in actual fact the responsibility of the national directorate of housing): a question of social infrastructures (water supplies, schools, etc.) within a concept of communal life without concerning production and its transformation. This view conflicted heavily with the objective conditions in the rural areas characterised by a deep involvement of the peasantry in market relationships and their dependence on it either as suppliers of labour power or as cash crop producers. This contradiction became more obvious, when the balance of payments became a real constraint (in 1979) and, hence, the question of financing accumulation cropped up more strongly in practice. The peasantry as suppliers of cash crops, of food and of labour power to the state sectors occupied a crucial position in production and accumulation. However, the crucial question then becomes whether the peasantry only performs the role of supplying part of the accumulation fund or whether the peasantry itself is part and parcel of the process of transformation and hence that accumulation embraces as an integral part the transformation of peasant agriculture into more socialised forms of production. In other words, it poses the question whether the strategy is based on a primitive socialist accumulation on the basis of the peasantry (transferring the agrarian surplus to the develop-ment of the state sector), or whether accumulation includes the transformation of peasant agriculture. Clearly, the way this question is posed in practice will influence heavily the nature of the organisation of the exchange between the state sector and the peasantry. The proposition that the state sector can develop under its own steam (with or without the aid of external borrowing) cannot bypass this crucial question since, on the one hand, a considerable part of foreign exchange earnings and of the food supply to the towns depended on peasant production and, on the other, the very conditions of productivity and profitability in the agrarian state sector depended heavily on the organic link that existed.between labour supply and family agriculture. The monetary disequilibrium originating from the state sector has a severe impact on the organisation of the exchange between the state sector and the peasantry. First, the imbalance between the demand for and the supply of consumer commodities affected rural areas differently from urban areas. The reason was that in urban areas the rationing system guaranteed to each family a minimum quantity of basic consumer necessities at official prices. In the rural areas the principal form of rationing remained the queue! Hence, forced savings were distributed differently over urban and rural areas. Furthermore, the concentration of resources on the state sector also implied that the peasants'

The Agrarian Question in Socialist Transitions ◽

10.4324/9780203043493-29 ◽

2013 ◽

pp. 205-205

Keyword(s):

Rural Areas ◽

Urban Areas ◽

The State ◽

State Sector ◽

Crucial Question ◽

Peasant Agriculture ◽

Forced Labour ◽

Urban And Rural Areas ◽

Labour Power

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Environmental Characteristics Associated with Older Adults’ Social Participation: The Contribution of Sociodemography and Transportation in Metropolitan, Urban, and Rural Areas

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17228399 ◽

2020 ◽

Vol 17 (22) ◽

pp. 8399

Author(s):

Mélanie Levasseur ◽

Daniel Naud ◽

Jean-François Bruneau ◽

Mélissa Généreux

Keyword(s):

Older Adults ◽

Social Participation ◽

Public Transportation ◽

Rural Areas ◽

Urban Areas ◽

Social Deprivation ◽

Metropolitan Areas ◽

Secondary Data ◽

Local Environment ◽

Environmental Characteristics

Although social participation fosters older adults’ health, little is known about which environmental characteristics are related to greater participation in social activities. The Canadian Community Health Survey (n = 2737), a transportation survey, and multiple secondary data sources were used to identify the environmental characteristics associated with older Quebecers’ social participation according to living area. Greater social participation was associated with: (1) a higher concentration of older adults (IRR = 2.172 (95% CI 1.600, 2.948); p < 0.001), more kilometers traveled by paratransit (IRR = 1.714 (95% CI 1.286, 2.285); p < 0.01), a lack of medical clinics (IRR = 0.730 (95% CI 0.574, 0.930); p = 0.01), and more funded home adaptations (IRR = 1.170 (95% CI 1.036, 1.320); p = 0.01) in large metropolitan areas; (2) larger paratransit fleets (IRR = 1.368 (95% CI 1.044, 1.791); p = 0.02) and a lower density of road intersections (IRR = 0.862 (95% CI 0.756, 0.982); p = 0.03) in regular metropolitan areas; (3) less social deprivation (IRR = 1.162 (95% CI 1.025, 1.318); p = 0.02) in urban areas; and (4) a higher concentration of older populations (IRR = 2.386 (95% CI 1.817, 3.133); p < 0.001) in rural areas. According to these findings, social participation interventions should target the local environment—for example, by providing more social interaction opportunities for older adults living in younger neighborhoods and by improving access to public transportation, especially paratransit.

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Like Mother, like Son: Physical Activity, Commuting, and Associated Demographic Factors

Sustainability ◽

10.3390/su12145631 ◽

2020 ◽

Vol 12 (14) ◽

pp. 5631 ◽

Cited By ~ 1

Author(s):

Caroline Brand ◽

Cézane Priscila Reuter ◽

Arieli Fernandes Dias ◽

Jorge Mota ◽

Michael Duncan ◽

...

Keyword(s):

Physical Activity ◽

Rural Areas ◽

Urban Areas ◽

Skin Color ◽

Demographic Factors ◽

Active Commuting ◽

Cross Sectional ◽

The Relationship ◽

Living Area

A mother’s healthy conduct may lead to the healthy conduct of their children. Thus, this study aimed to verify the role of demographic factors in the relationship between mothers’ physical activity (PA) and commuting to work with children and adolescent’s PA and commuting to school. This cross-sectional study comprised 1421 children and adolescents aged 6 to 17 years and 1421 mothers, from Brazil. PA, commuting, socioeconomic status (SES), skin color/ethnicity, and living area were evaluated by questionnaire. Logistic binary regression models were used. Results indicated that mothers’ PA and commuting were associated with children and adolescent’s PA and commuting to school in crude and adjusted models. Considering the role of the demographic factors, an association was only observed for girls in the relationship between mother’s PA with children’s PA. In adolescents, an association was observed in both high/low SES, boys/girls, and rural/urban areas. Regarding children and adolescent active commuting to school, there was an association with mothers commuting. All demographic factors were strongly associated, except for rural areas. Therefore, mothers’ PA as well as commuting to work are associated with children and adolescent’s PA and commuting to school. Sex, living area, and SES are the related demographic factors.

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