Papers by GEORGIA CASANOVA
Quality Assurance Policies and Indicators for Long-Term Care in the European Union, Country Report: Italy. ENEPRI Research Report No. 102, February 2012
In Italy, regions are at the centre of the system providing long-term care services, which typica... more In Italy, regions are at the centre of the system providing long-term care services, which typically include residential services, formal home care and monetary benefits. The regions define their own policies for the provision of care, ranging from needs assessment and monitoring tools to the accreditation of service providers. Quality assurance policies are primarily directed at residential services and formal home care, but as this research report highlights, there are many differences across regions.
Value-Based Healthcare Delivery: A Scoping Review
International Journal of Environmental Research and Public Health
Healthcare systems are transforming from the traditional volume-based model of healthcare to a va... more Healthcare systems are transforming from the traditional volume-based model of healthcare to a value-based model of healthcare. Value generation in healthcare is about emphasising the health outcomes achieved by patients and organisations while maintaining an optimal relationship with costs. This scoping review aimed to identify the key elements and outcomes of implementing value-based healthcare (VBHC). The review process included studies published from 2013 to 2023 in four different databases (SpringerLink, PubMed, ProQuest and Scopus). Of the 2801 articles retrieved from the searches, 12 met the study’s inclusion criteria. A total of 11 studies referred to value as the relationship between the outcomes achieved by patients and the costs of achieving those outcomes. Most of the studies highlighted the presence of leadership, the organisation of care into integrated care units, the identification and standardisation of outcome measures that generate value for the patient, and the i...
Background: In the last decades, the relationship between social networking sites (SNSs) and olde... more Background: In the last decades, the relationship between social networking sites (SNSs) and older people's loneliness is gaining specific relevance. Studies in this field are often based on qualitative methods to study in-depth self-perceived issues, including loneliness and well-being, or quantitative surveys to report the links between information and communication technologies (ICTs) and older people's well-being or loneliness. However, these nonexperimental methods are unable to deeply analyze the causal relationship. Moreover, the research on older people's SNS use is still scant, especially regarding its impact on health and well-being. In recent years, the existing review studies have separately focused their attention on loneliness and social isolation of older people or on the use of ICTs and SNSs in elderly populations without addressing the relationship between the former and the latter. This thorough qualitative review provides an analysis of research performed using an experimental or quasi-experimental design that investigates the causal effect of ICT and SNS use on elderly people's well-being related to loneliness. Objective: The aims of this review are to contrast and compare research designs (sampling and recruitment, evaluation tools, interventions) and the findings of these studies and highlight their limitations. Methods: Using an approach that integrates the methodological framework for scoping studies and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews, we identified 11 articles that met our inclusion criteria. A thematic and content analysis was performed based on the ex post categorization of the data on the selected studies, and the data were summarized in tables. Results: The analysis of the selected articles showed that: (1) ICT use is positively but weakly related to the different measures of older people's well-being and loneliness, (2) overall, the studies under review lack a sound experimental design, (3) the main limitations of these studies lie in the lack of rigor in the sampling method and in the recruitment strategy. Conclusions: The analysis of the reviewed studies confirms the existence of a beneficial effect of ICT use on the well-being of older people in terms of reduced loneliness. However, the causal relationship is often found to be weak. This review highlights the need to study these issues further with adequate methodological rigor.
Key Drivers and Barriers of Social Innovation in Long Term Care: Lessons from the Italian Case
Dutch Crossing: Journal of Low Countries Studies, Jul 12, 2016
Research Square (Research Square), Dec 20, 2022
Background Long-term care (LTC), poverty, and socioeconomic deprivation are globally signi cant s... more Background Long-term care (LTC), poverty, and socioeconomic deprivation are globally signi cant social issues. Ongoing population aging trends and the recent social and health emergencies caused by the COVID-19 pandemic crisis have highlighted the need for macro-level LTC and welfare system sustainability strategies. At the micro level, the relationship between LTC needs and the risk of socioeconomic deprivation and poverty should be taken into account to promote more targeted and innovative policies worldwide. This scoping review explores the relationship between LTC needs, the health status of older people, and the risk of socioeconomic deprivation for their families in order to understand how the literature interprets these concepts and the relationship between them and to identify any potential gaps in this regard. Methods The methodology considers different relevant sources: a) the guidelines for ScR proposed by Lockwood et al. [1]; b) the Munn et al. [2] recommendations; c) the PRISMA guideline for Scoping Reviews [3]; and d) the Joanna Briggs Institute (JBI) checklist [4]; Sixty-three papers are included in the frequency analysis of 9 identi ed categories to respond of aims. Results The ndings reveal the existence of a debate that seeks to understand the different characteristics of the relationship between the investigated issues. Speci c targets (such as older people, caregivers, and households) are used to identify LTC needs, while material deprivation or poverty is used to determine the conditions of deprivation. Relevant gaps in the literature are identi ed in terms of the concepts and approaches of the studies analyzed. The results indicate that the reciprocal relationship between LTC needs, supply, and the risk of socioeconomic deprivation is understudied. Conclusions The simpli cation strategy used in many studies to reduce the relationship's complexity precludes an indepth analysis and debate on some relevant aspects, including the crucial two-way relationship between LTC needs/supply and the risk of socioeconomic deprivation. Future studies should focus on the causal relationship between the two phenomena and identify any internal factors that may be involved. This study was conducted within the framework of the Family International Monitor (FIM) and the SEreDIPE project (Horizon 2020 MSCA-IF-2019 Grant Agreement No. 888102). Using a multidimensional perspective of the concepts "family" and "deprivation" [32], both projects are concerned with familial material and social deprivation, with a particular focus on care needs. 2 Methods To ensure the highest possible standards of reporting, this ScR is based on a methodology that considers the recommendations formulated by the following relevant sources: a) the guidelines for ScR proposed by Lockwood et al. [1]; b) the Munn et al. [2] recommendations; c) the PRISMA guideline for Scoping Reviews [3]; and d) the Joanna Briggs Institute (JBI) checklist [4]. The chosen guidelines are coherent and non-overlapping, as possible risks in this regard (e.g., Lockwood including suggestions from PRISMA guidelines and the JBI checklist) have been adequately considered. The full details of this study protocol are described in Martarelli et al. [33]. By combining these methods, it is ensured that the review's path remains linear and focused, in accordance with Lockwood and Munn's recommendations, while the PRISMA and JBI approaches concurrently limit the loss of potentially useful papers on the topic. Moreover, speci c guidelines support different aspects, such as the suitability of chosen methods (JBI checklist) and the analysis of data (PRISMA). Lastly, the incorporation of these suggestions enabled the authors to consider the pre-planning phase as the starting point for the design of the ScR study protocol. This allowed the authors to focus on a complex and multidimensional issue, such as the relationship between LTC needs and care strategies and the risk of SED. Figure 1 depicts the ScR's owchart. 2.1 Pre-planning Lockwood and colleagues [1] point out that pre-planning is the phase that determines a review project's success. The brainstorming and brief preliminary research conducted during this phase enabled the authors to clarify the conceptual framework, determine speci c research questions, and identify the set of keywords necessary to implement the search.
PLOS ONE, Aug 31, 2022
Major global problems such as population ageing, long-term care and the socioeconomic burden of c... more Major global problems such as population ageing, long-term care and the socioeconomic burden of chronically ill older people and their families are urgent issues. Research in this field contributes to the growing international literature on health-related quality-of-life instruments, but little is known about the links between the related variables. Thus, the scoping review this protocol refers to plans to examine the socioeconomic consequences of older people's poor health on their economic conditions and their families. In particular, the main aims are: a) to map the main concepts that characterize the body of the reference literature; b) to identify conceptual gaps or unexplored research areas to be addressed; c) to illuminate the difficulties that affect a large number of families with older members to care for, with particular attention to the concept of socioeconomic deprivation, which includes material living conditions as well as social aspects (e.g. in the form of loneliness experienced as a consequence of health disorders). This protocol paper fulfils the purpose of clarifying the planned methodological phases, including the sub-phases, and listing the techniques used. A threestep approach is being applied, consisting of: pre-planning phase, protocol phase, and conduction and reporting phase. The preliminary stages of the protocol design are part of a dedicated project within the Open Science Framework platform and included in a Research Square preprint. This proposed project will contribute to multidisciplinary research on the connections between ill health and poverty, and could support critical reflections on the current evidence and guide future policies to alleviate this double burden.
International Journal of Environmental Research and Public Health
Background: Dementia is a priority for global public health. The management of behavioral and psy... more Background: Dementia is a priority for global public health. The management of behavioral and psychological symptoms of dementia (BPSD) is one of the highest ongoing challenges and needs new approaches. The special care unit for people with dementia and BPSD (SCU-B) is viewed in this context as a further medical intervention. Aim: this study aims to explore SCU-B units in order to describe their main characteristics in relation to different implementation contexts, identify the characteristics of their replicability, and examine the social innovation elements promoted by SCU-B units. Method: This qualitative study is based on focus groups (FGs) and interviews involving nine international centers. Five of the centers have a memory clinic unit and SCU-B, compared with six that only have a memory clinic unit. A total number of 18 FGs were held, which altogether involved 164 participants. All data were transcribed verbatim and analyzed by means of a content analysis and a SWOT (strength...
Netherlands), and Juliette Malley, LSE-PSSRU (the UK). ENEPRI Research Reports present the findin... more Netherlands), and Juliette Malley, LSE-PSSRU (the UK). ENEPRI Research Reports present the findings and conclusions of research undertaken in the context of research projects carried out by a consortium of ENEPRI member institutes. This report is a contribution to Work Package 3 of the ANCIEN project, which focuses on the future of long-term care for the elderly in Europe, funded by the European Commission under the 7 th Framework Programme (FP 7 Health-2007-3.2.2, Grant no. 223483). See back page for more information. The views expressed are attributable only to the authors in a personal capacity and not to any institution with which they are associated. The results and conclusions of this paper are those of the authors and are not attributable to Eurostat, the European Commission or any of the national authorities whose data have been used.
Association of socioeconomic deprivation with opioid prescribing in primary care in England: a spatial analysis
Journal of Epidemiology and Community Health, 2020
BackgroundThe increasing trends in opioid prescribing and opioid-related deaths in England are co... more BackgroundThe increasing trends in opioid prescribing and opioid-related deaths in England are concerning. A greater understanding of the association of deprivation with opioid prescribing is needed to guide policy responses and interventions.MethodsThe 2018/2019 English national primary care prescribing data were analysed spatially. Prescribing of opioids in general practice was quantified by defined daily doses (DDD) and attributed to 32 844 lower layer super output areas (LSOAs), the geographical units representing ~1500 people. Linear regression was used to model the effect of socioeconomic deprivation (quintiles) on opioid prescribing while accounting for population demographics and the prevalence of specific health conditions. Adjusted DDD estimates were compared at each deprivation level within higher organisational areas (Clinical Commissioning Groups, CCGs).ResultsIn total, 624 411 164 DDDs of opioids were prescribed. LSOA-level prescribing varied between 1.7 and 121.04 DDD...
Long-term care needs and the risk of household poverty across Europe: A comparative secondary data study
Population ageing and rising poverty are two of the most pressing issues today, even in Western E... more Population ageing and rising poverty are two of the most pressing issues today, even in Western European nations. In parallel, the risk of poverty is also growing as a result of the recent global economic crisis and the COVID-19 containment measures, which have reduced individual and collective productivity and had a negative impact on household income. This study intends to explore the relationship between long-term care (LTC) needs and the risk of poverty at the household level in eight European countries selected to represent the different care regimes in Europe. The main international databases were scoured for study variables. These variables were categorized according to the following conceptual areas: home care, residential care, health expenditure, service coverage, cash benefits, private services, population, family, education, employment, poverty, disability and care recipients, and life expectancy. The statistical analyses were conducted as described hereafter: analysis o...
Sustainability, 2022
TC and socio-economic deprivation of families are two relevant issues in international debate. Th... more TC and socio-economic deprivation of families are two relevant issues in international debate. The economic or time investment made by families in caregiving has an impact on the socio-economic status of family members in terms of economic means and social inclusion. This study analyzes the practices that are supported by home LTC, examining their characteristics, identifying their strengths, weaknesses, drivers, and barriers, as well as identifying social innovation aspects. The study provides a qualitative interpretative comparison of 22 practices from eight countries, representing the four LTC care models existing in Europe. Cross-studies aid in the development of sustainable policies. The study highlights the differences and similarities between selected practices. The results indicate the effectiveness of integrative and coordination strategies at the macro, meso, and micro levels for the development of supportive policies for family members with burdens of care. Nevertheless, ...
Sustainability, 2022
Long-Term Care (LTC) for older people in need of care is a critical issue affecting the quality o... more Long-Term Care (LTC) for older people in need of care is a critical issue affecting the quality of life of family caregivers (as well as older people), encompassing both negative and positive caregiving experiences. Providing support to family caregivers is essential because they play a crucial role in sharing the societal burden of LTC for the growing frail older population. By presenting the results of a survey carried out in 2019–2020 in Central Italy, this study aims to describe the characteristics and estimate by a multivariate logistic model the correlates of depressive symptoms in 369 primary caregivers of dependent older people. Caregivers are mostly women who provide a high amount of care in terms of weekly hours as a result of insufficient assistance from public or private care services. More than half of the sample show depressive symptoms, indicating a fairly serious situation. Perceived burden is a strong predictor of depression. The findings offer suggestions and polic...
Psychology and Aging, 2018
Few longitudinal studies have explored the impact of loneliness on social engagement. We investig... more Few longitudinal studies have explored the impact of loneliness on social engagement. We investigated whether loneliness would result in decreased social engagement over time among older adults, and also whether the converse, that low levels of social engagement would predict increases in loneliness, held. Additionally, we explored potential mechanisms (specifically, memory and depressive symptomatology as mediators) in the bidirectional relationship/s between loneliness and social engagement. Data from 4,714 adults aged over 50, participating in waves 3, 4, and 5 of the English Longitudinal Study of Ageing (between 2006-2011), were analysed using bivariate dual change scores within Structural Equation Models. Higher levels of loneliness were inversely associated with social engagement over time, while high levels of social engagement were inversely associated with loneliness over time. To address the second aim, Structural Equation Modelling was used to evaluate potential mediators of the bidirectional relationships between loneliness and changes in social engagement. Depressive symptomatology, semantic memory, and episodic memory were found to partially mediate the relationship between loneliness measured at baseline and social engagement four years later. In addition, these variables also partially mediated the relationship between social engagement at baseline and loneliness four years later. Comparing the two models, that which proposed a pathway from loneliness to social engagement (as mediated by depressive symptoms and memory) provided a better fit to the data. Implications for theories of loneliness are discussed.
International Journal of Environmental Research and Public Health, 2020
Austerity measures on services provision, introduced due to recent economic crises, have stimulat... more Austerity measures on services provision, introduced due to recent economic crises, have stimulated the search for innovative welfare solutions, including options that are not directly or entirely funded by public sources. In Italy, recent legislation has promoted the development of occupational welfare (OW) measures, aimed at strengthening the supply of services to support employees with informal (elder) care responsibilities. This paper aims to describe how the newly introduced OW schemes might innovate existing care arrangements, by identifying their impact on the different actors involved in home care provision (care recipients, family carers, home care service providers and migrant care workers), as well as at a macro level in terms of promoting social innovation. The international relevance of the Italian case comes from the fact that it is one of the more representative familistic care regimes, largely characterized by home care provided by informal carers and migrant care wo...
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Papers by GEORGIA CASANOVA