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Active Ageing and Living Condition of Older Persons Across Italian Regions

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Abstract

The ageing of the population is reshaping a large part of the economic and social order, with pervasive and transversal consequences that reflect on production, consumption, labour, and especially on welfare. To govern a development of this kind, it is essential to have an innovative approach, capable of stimulating targeted and systematic policies, and capable of facing the structural change of ageing, transforming it from a burden to a resource for our society. Since the beginning of the new millennium, there has been a gradual attention to the phenomenon of demographic ageing at an international level, which has prompted the European Union to proclaim 2012 as the European Year for Active Ageing and Solidarity between Generations. Recommendations from the international organizations to individual countries on adopting active ageing policies led to the creation of the Active Ageing Index (AAI). Istat has extensively contributed to the AAI interacting with its international partners (UNECE and the European Commission).There is no doubt that AAI is a useful tool, both for measuring achieved progress in the area of active ageing, and for promoting the implementation and the evaluation of policies aimed at improving any potential aspect that does not show satisfactory results. AAI consists of four dimensions and 22 indicators. Using nationally representative data, it was first disseminated in Italy as the product of an experiment intended to provide overall and individual domain data on a subnational level placing Istat at the forefront among European statistical institutes.

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Notes

  1. Istituto Nazionale di Statistica - Istat 2019c Previsioni demografiche per sesso, età e regione (base 1.1.2018). In Demografia in cifre. Roma: Istat. http://demo.istat.it/

  2. Percentage ratio between the over sixty-five-year-olds and those aged 15–64 years.

  3. Percentage ratio between the over eighty-five-year-olds and those aged 50–64 years.

  4. The experimentation and subsequent application of AAI in Italy on a subnational level was carried out replicating the methodology consolidated by a group of expert on AAI (United Nations Economic Commission for Europe – UNECE 2018) with which Istat has extensively collaborated interacting with its international partners (Unece e the European Commission Commission), but in some cases it has meant choosing different statistical sources from those adopted at a European level. There is a twofold reason for this. The first concerns the statistical significance of the results in the context of a subnational analyses. The European surveys, in fact, provide for a limited sample of interviews for each country, in proportion to their demographic size, sufficient to give reliable estimates on a national level, but not on a regional level. (Zaidi et al. 2013.) For Italy, we move from hundreds of interviews for the European surveys on social aspects (Ess) to about 2 thousand 250 for the European survey on quality of life (Eqls). The other factor concerns the continuous availability of data and thus the replicability in time of AAI to monitor the results. The European survey on social aspects, the most frequent one, takes place every two years. The survey on quality of life is done every four year (the last one was in 2016), the Eurobarometre is an opinion survey on several issues which change for each edition. For Italy, the utmost care was taken in the choice of indicators taken from the national surveys, as similar as possible to the European ones to ensure robustness and replicability over time in the index. The majority of the indicators, therefore, coincide with the ones adopted for the construction of AAI, as they are taken for surveys harmonized at a European level: the survey on labour force (Lfs), the survey on income and life conditions (Eu-Silc), the mortality tables, the survey on health condition and use of health services (Ehis).

    The index differs only partially from the original for a small number of calculated indicators with data from national surveys in which small differences in the definition and the reference period can be found. Subsequently, appropriate weights suggested by the AAI expert group were applied to obtain both the domain points and the overall index. Ultimately, the deviation in the results is minimized and does not in any way affect the analyses conducted.

    There is no doubt that AAI represent a particularly useful tool, both for measuring the progress achieved on the front of active ageing, and for encouraging, through monitoring, the evaluation and implementation of policies aimed at improving any aspect which does not show satisfactory results. (Zaidi et al. (2018.) It is therefore an important contribution offered to policy makers so that they can make the necessary assessments – and the consequent actions – with a vision of the phenomenon, its manifestations and its problems, both at a national level, and above all, at a local level (Istituto Nazionale di Statistica - Istat 2020).

  5. Regional Law 22/2014 on the promotion of active ageing.

  6. The preponderant relative weight of the values associated with the autonomous province of Bolzano, together with the low sample size, leads to a leverage effect in the regressive model which generates estimates characterized by distorting components. The solution adopted was that of merging the autonomous provinces of Trento and Bolzano into the Trentino-Alto Adige region.

  7. Istat has developed a multidimensional approach to measure “Fair and sustainable wellbeing” (Bes) with the aim of integrating the information provided by indicators on economic activities with the fundamental dimensions to inequalities and sustainability. Numerous indicators have been identified in 12 fundamental domains, corresponding to the dimensions of well-being, of which a synthesis through composite indicators is offered with the publication of an annual report (Istituto Nazionale di Statistica - Istat Rapporto Bes 2019a).

  8. The indicator considers three macro areas, social services, infrastructure, mobility and two dimensions of reference, equipment/accessibility and effectiveness/satisfaction. https://www.istat.it/it/files/2018/04/12-domini-commissione-scientifica.pdf

  9. Until 2011 the minimum requirements for access to early retirement pension required at least 35 years of paid contributions and 61 years of age (the so-called quota 96). Subsequently, since 2012, the Fornero reform (l.214/2011), effectively abolished old age pension (possible only with the maximum contribution requirement), raised the retirement age and connected personal requirement and contributions to life expectancy.

  10. Istat adopts the classification of economic activities Ateco 2007, which is the national version of the European nomencalture Nace Rev.2. For occupation, Istat adopts the classification CP2011, based on the last version of international classification Isco (International standard classification of occupations).

  11. The data used to calculate the indicators considered for this domain come from two national Istat surveys, “Aspects of daily life” and “Family and Social subjects”. For both surveys, the organization of the sample allows for regional estimates. As for the indicators “Childcare” and “Assistance to adults”, there is no data for the years of interest, therefore data relating to 2003, 2009 and 2016, close in time to the reference years, have been used. Volunteering is an indicator available every year. Regarding political participation, it was considered appropriate to use a composite indicator, also available every year, capable of capturing multidimensional aspects of visible political participation, i.e. participation in which people are personally involved.

  12. The motivations and ways in which care work is provided for free by individuals in each social and cultural context has been analyzed in several studies. These works have made explicit the existing relationships between different forms of support for families to receive (Parsons 1943, Cox and Jakubson 1995, Litwak 1985).

    The interpretations can, in an extremely synthetic way, be reduced into three:

    1) replacement: the public offer fills the request for assistance that the families are unable to fulfill on their own.

    2) complementarity or support: the different form of help is provided simultaneously and collaboratively.

    3) hierarchical compensation: the forms of aid have a hierarchy where aid from the support networks is at the base level, followed by paid aid activated by families, in the even that these forms of aid are not sufficient or cannot be activated, formal aid from institutions intervenes. This theoretical framework is particularly useful for recording the forms of help that are implemented by families in the context of services available to them according to the welfare present in the territory to which they belong.

  13. In terms of hours of help distributed outside one’s family, totally equivalent to 264 thousand, more than 45% is absorbed by childcare (approximately 120,00 h), in second place is assistance to adults (over 57 thousand hours are spent), equal to one fifth of the total amount of hours (Meli, E. in Istituto Nazionale di Statistica - Istat 2020).

  14. Using a logistic regression model whose response variable is the probability for a person aged 55 and over to provide free help to other non-cohabitants, the explanatory variables used are of demographic nature (sex, age, marital status), socio-cultural (educational qualification, professional status, opinion on one’s own economic resources) and territorial (geographical distribution and type of municipality of residence), as well as a multiple involvement proxy (if it takes care of cohabitants) shows that even where the welfare state is more present and organized (as in Emilia-Romagna, Lombardy, Veneto, etc.), with a greater diffusion of services for families and children and also the number of users is conspicuous, this does not implicate a minor involvement of the informal networks, indeed the aid networks are activated equally and in a complementary way (Meli, E. in Istituto Nazionale di Statistica - Istat 2020).

  15. Are we better or worse than five years ago? A budget at the end of the legislature, which states: “Billions of cuts to the National Health Fund, containment of national funds intended for welfare and reduction of transfers to local authorities. The austerity policies and the choices of governments that followed in the seventeenth legislature resulted in a downsizing of the offer of welfare services that cannot be counterbalanced by the investment in the Inclusion Income (the Rei). Health, education, assistance, housing and even places of detention that contribute to the reintegration of prisoners should be universal rights, and not conditioned by the amount of resources available or by the place where one lives “(Sbilanciamoci 2018).

  16. Dedicating time for the common good, especially in a phase of life in which time freed from work, both paid work and that linked to the responsibilities of caring for adult children, progressively increases contributes significantly to the well-being of the elderly consolidating the perception of themselves as subjects still useful to others and protecting them from isolation. In fact, volunteering expands social networks with positive effects on various components of the quality of life, for the elderly (Mannarini et al. 2017).

  17. This gender difference is not surprising in the light of the family-centred structure of Italian welfare, in which women are more often called to perform care activities aimed at cohabitating and non-cohabiting family members. A commitment that often hinders their greater participation in community-oriented activities (Ferrera 1996; Cappadozzi and Fonović 2019).

  18. A possible explanation for these differences lies in the different organizational context in which the activities are performed, with the voluntary organizations of the Centre-North operating in a more structured way than those of the South (Cappadozzi, T. in Istituto Nazionale di Statistica - Istat 2020).

  19. In regard to the subjective repercussions of the activity carried out as perceived by the volunteers, 55.0% say they feel better about themselves, with a positive effect that increases with the age of the volunteers, rising from 47.7 of the volunteers between 55 and 59 to 59.0 of the over seventy-four year olds. 43.7% think that the activity carried out has broadened their network of acquaintances, a figure quite equally distributed among the volunteers. For 22.0%, their ability to relate to others has improved, above all for women (26.6%). One in four volunteers say the activity has changed their outlook, especially for women (29.5%), volunteers with lower secondary school education (30.5%) and island residents (32.7%); almost a fifth have developed greater civil and political awareness, especially among graduates (24.2%) and in the South (24.7%). Only 3.2% of volunteers believe that volunteering has not changed anything and just 1.9% say that it has brought more disadvantages than advantages (Cappadozzi, T. in Istituto Nazionale di Statistica - Istat 2020).

  20. In 2018 the direct participation diminishes and indirect forms of participation increase (Istituto Nazionale di Statistica - Istat 2018).

  21. The World Health Organization (WHO), through the global strategy and action plan on ageing and health adopted in 2016, outlines the necessary actions to guarantee everyone the possibility to live a long and healthy life (World Health Organization - WHO 2015). The strategy has five major objectives: to encourage countries to commit to action: to develop environments suitable for all ages; to align the health systems with the growing needs to the older population; to develop sustainable and equitable systems for long-term care; finally, to improve data, measurement and research to learn more and thus act towards healthy ageing. By adopting this strategy, countries will make a decisive contribution to the implementation of the 2030 agenda for sustainable development which, among its objectives, require that no one is left behind and that all human beings can realize their potential with dignity and equality in a healthy environment (Iannucci L., Istituto Nazionale di Statistica - Istat 2020).

  22. To understand whether the lengthening of life leads to a change in the state of health of the population – compromising the sustainability of the social welfare and health system – it is appropriate to analyze data that report on the quality of such survival. By focusing the analysis on the latest decade, a positive result emerges, as the evolution of survival recorded in this time frame is not accompanied by a decline of health conditions. The most recent data of 2018 attest that at 65 a man’s life expectancy is 19.3 years, of which he can live a third (7.5 years) in good health. Compared to 2009, the average healthy life of men at 65 (6 years) has increased by a year and a half, i.e. this gain fully integrates the achievement of the general life expectancy. Therefore, the complement of survival years spent in less than perfect health conditions remains constant (about 12 years). For women too, the increase in life expectancy at 65 goes hand in hand with the increase of life in good health. Compared to 2009, women aged 65 earned a total of one year: life expectancy, which was 21.5 years, in 2018 moved to 22.5 years. In the same period, healthy life expectancy at 65 increased by 1.3 years. This would attest that for women the health conditions still need to improve. With these results, especially for women, we are still far from affirming that the health conditions of the population are optimal, considering the small number of years in good health compared to those that remain to live. However, it is certainly a positive element that the increased survival gained does not take place at the expense of years of life in good health (Gargiulo, L., Istituto Nazionale di Statistica - Istat 2020).

  23. Indeed, older people who manage to stay active have the potential to contribute to society by extending their stay on the labour market or by participating in socio-familial life. From this point of view, policy for the third age should focus on encouraging older people to remain independent and healthy. The indicator for years in life in good health provides a measurement in this regards, showing that when a country absorbs a high proportion of healthy old people, that country is characterized by healthier and more participatory seniors, with less need to resort to medical-assistance facilities (Gargiulo, L., Istituto Nazioanle di Statistica - Istat 2020).

  24. Translation by Johanna Wedhal johanna.wedahl@gmail.com

Abbreviations

AAI:

Active Ageing Index

Bes:

Benessere equo e sostenibile

Ilo:

International labour office

Mipaa:

Madrid international plan of action on ageing

Oms/Who:

World Health Organization

Unece:

United nations economic commission for Europe

Onu:

Organization of the United Nations

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  1. ISTAT Istituto Nazionale di Statistica, Via C. Balbo 16, 00184, Rome, Italy

    Luciana Quattrociocchi, Mauro Tibaldi, Marco Marsili, Livio Fenga & Marco Caputi

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Quattrociocchi, L., Tibaldi, M., Marsili, M. et al. Active Ageing and Living Condition of Older Persons Across Italian Regions. Population Ageing 14, 91–136 (2021). https://doi.org/10.1007/s12062-020-09309-z

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