Challenges and practices in promoting (ageing) employees working career in the health care sector - case studies from Germany, Finland and the UK.

BACKGROUND: The health and social care sector (HCS) is currently facing multiple challenges across Europe: against the background of ageing societies, more people are in need of care. Simultaneously, several countries report a lack of skilled personnel. Due to its structural characteristics, including a high share of part-time workers, an ageing workforce, and challenging working conditions, the HCS requires measures and strategies to deal with these challenges. METHODS: This qualitative study analyses if and how organisations in three countries (Germany, Finland, and the UK) report similar challenges and how they support longer working careers in the HCS. Therefore, we conducted multiple case studies in care organisations. Altogether 54 semi-structured interviews with employees and representatives of management were carried out and analysed thematically. RESULTS: Analysis of the interviews revealed that there are similar challenges reported across the countries. Multiple organisational measures and strategies to improve the work ability and working life participation of (ageing) workers were identified. We identified similar challenges across our cases but different strategies in responding to them. With respect to the organisational measures, our results showed that the studied organisations did not implement any age-specific management strategies but realised different reactive and proactive human relation measures aiming at maintaining and improving employees' work ability (i.e., health, competence and motivation) and longer working careers. CONCLUSIONS: Organisations within the HCS tend to focus on the recruitment of younger workers and/or migrant workers to address the current lack of skilled personnel. The idea of explicitly focusing on ageing workers and the concept of age management as a possible solution seems to lack awareness and/or popularity among organisations in the sector. The concept of age management offers a broad range of measures, which could be beneficial for both, employees and employers/organisations. Employees could benefit from a better occupational well-being and more meaningful careers, while employers could benefit from more committed employees with enhanced productivity, work ability and possibly a longer career.

Transition to retirement in the healthcare sector : Working conditions and attitudes of older workers.

BACKGROUND: The aging of societies will increase the need for healthcare services and lead to a growing number of older employees. These two developments are relevant in the healthcare sector (HCS), which is of rising societal and economic importance and at the same time employs many older people. OBJECTIVE: This article, which was written within the EXTEND project, investigates the working conditions and the prospective retirement age of older employees in the HCS in comparison to other sectors and explores what companies are doing to address the needs of this group. MATERIAL AND METHODS: The analysis was conducted as a mixed methods approach. The quantitative part was based on data derived from the Transitions and Old Age Potential (TOP) study in which older German employees were asked about their working conditions and retirement transitions. Matching techniques (coarsened exact matching) were used to investigate differences between sectors. The sample consisted of 114 employees aged between 55 and 65 years, working in the HCS and their statistical twins. The qualitative analysis was based on case studies in two inpatient care organizations and two hospitals in Germany. A total of 23 semistructured interviews with staff members and with representatives of the management were carried out and thematically analyzed. RESULTS: The results showed that older employees in the HCS do not expect to retire earlier but preferred to do so significantly more often. Furthermore, HCS employees are more likely to face physically burdensome working conditions than in other sectors of the economy. The case studies indicated that there are very diverse and unsystematic strategies in addressing and supporting older employees. DISCUSSION: Older employees in the HCS sector are employed in much harsher working conditions than their peers in other sectors. This must be kept in mind when trying to extend their working lives.

Differences in self-reported health between low- and high-income groups in pre-retirement age and retirement age. A cohort study based on the European Social Survey.

Using data from the European Social Survey 1 (2002) and 9 (2018) we show the development of self-rated health of older persons in 17 countries. We find a considerable increase of older persons reporting good or very good health between 2002 and 2018; this increase is similar in all groups examined. Absolute differences between income groups remained vastly stable. Further, in 2018 the high-income tercile of those between 65 and 80 years still reported better health than the low-income tercile of those between 49 and 64 years. Overall, self-rated health seems to have improved in Europe but there are still signs of a considerable gap between low-income groups and high-income groups.

Lewis-base-stabilized dichlorosilylene: a two-electron sigma-donor ligand.

The first structurally described cobalt(I) Lewis-base-stabilized silylene complex [Co(CO)(3){SiCl(2)(IPr)}(2)](+)[CoCl(3)(THF)](-) [1; IPr = 1,3-bis(2,6-diisopropylphenyl)imidazol-2-ylidene] was prepared by applying the two-electron sigma-donor ligand SiCl(2)(IPr) through coordination with Co(2)(CO)(8). The bonding situation between ligand SiCl(2)(IPr) and the cobalt(I) metal center in [Co(CO)(3){SiCl(2)(IPr)}(2)](+) of 1 was investigated by (1)H NMR and IR spectroscopy, single-crystal X-ray structural analysis, and density functional theoretical calculations.

The Use of Internet-Based Health and Care Services by Elderly People in Europe and the Importance of the Country Context: Multilevel Study.

BACKGROUND: Digital health care is becoming increasingly important, but it has the risk of further increasing the digital divide, as not all individuals have the opportunity, skills, and knowledge to fully benefit from potential advantages. In particular, elderly people have less experience with the internet, and hence, they are in danger of being excluded. Knowledge on the influences of the adoption of internet-based health and care services by elderly people will help to develop and promote strategies for decreasing the digital divide. OBJECTIVE: This study examined if and how elderly people are using digital services to access health and social care. Moreover, it examined what personal characteristics are associated with using these services and if there are country differences. METHODS: Data for this study were obtained from the Special Eurobarometer 460 (SB 460), which collected data on Europeans' handling of and attitudes toward digital technologies, robots, and artificial intelligence, including data on the use of internet-based health and social care services, among 27,901 EU citizens aged 15 years or older. Multilevel logistic regression models were adopted to analyze the association of using the internet for health and social care services with several individual and country-level variables. RESULTS: At the individual level, young age, high education, high social class, and living in an urban area were positively associated with a high probability of using internet-based health and social services. At the country level, the proportion of elderly people who participated in any training activity within the last month was positively associated with the proportion of elderly people using these services. CONCLUSIONS: The probability of using internet-based health and social services and their accompanying advantages strongly depend on the socioeconomic background. Training and educational programs might be helpful to mitigate these differences.

Participatory Design in Gerontechnology: A Systematic Literature Review.

Purpose of the Study: Participatory design (PD) is widely used within gerontechnology but there is no common understanding about which methods are used for what purposes. This review aims to examine what different forms of PD exist in the field of gerontechnology and how these can be categorized. Design and Methods: We conducted a systematic literature review covering several databases. The search strategy was based on 3 elements: (1) participatory methods and approaches with (2) older persons aiming at developing (3) technology for older people. Results: Our final review included 26 studies representing a variety of technologies designed/developed and methods/instruments applied. According to the technologies, the publications reviewed can be categorized in 3 groups: Studies that (1) use already existing technology with the aim to find new ways of use; (2) aim at creating new devices; (3) test and/or modify prototypes. The implementation of PD depends on the questions: Why a participatory approach is applied, who is involved as future user(s), when those future users are involved, and how they are incorporated into the innovation process. Implications: There are multiple ways, methods, and instruments to integrate users into the innovation process. Which methods should be applied, depends on the context. However, most studies do not evaluate if participatory approaches will lead to a better acceptance and/or use of the co-developed products. Therefore, participatory design should follow a comprehensive strategy, starting with the users' needs and ending with an evaluation if the applied methods have led to better results.

The transcatheter aortic valve implementation (TAVI)--a qualitative approach to the implementation and diffusion of a minimally invasive surgical procedure.

BACKGROUND: The transcatheter aortic valve implantation (TAVI), a minimally invasive surgical procedure to treat patients with severe symptomatic aortic stenosis, showed a rapid diffusion in Germany compared to the international level. The aim of this study is to identify and analyze factors affecting the implementation and diffusion of the procedure in hospitals using a qualitative application of the diffusion of innovations theory. METHODS: We conducted problem-centered interviews with cardiologists and cardiac surgeons working in German hospitals. The multi-level model "diffusion of innovations in health services organizations" developed by Greenhalgh et al. was used to guide the research. Data was analyzed using content and a thematic analysis. RESULTS: Among the ten participants who were interviewed, we found both barriers and facilitators related to the innovation itself, system readiness and antecedents, communication and influence, and the outer context. Key issues were the collaboration between cardiologists and cardiac surgeons, reimbursement policies, requirements needed to conduct the procedure, and medical advantages of the method. CONCLUSIONS: The findings show that there are multiple factors influencing the diffusion of TAVI that go beyond the reimbursement and cost issues. The diffusion of innovations model proved to be helpful in understanding the different aspects of the uptake of the procedure. A central theme that affected the implementation of TAVI was the collaboration and competition between involved medical departments: cardiology and cardiac surgery. Against this background, it seems especially important to moderate and coordinate the cooperation of the different medical disciplines.

Diabetes and atrial fibrillation: stratification and prevention of stroke risks.

BACKGROUND: Although evidence is not very clear, diabetes is assumed to be an independent risk factor for atrial fibrillation (AF). One reason for the lack of evidence could be that AF often is not detected due to its paroxysmal or asymptomatic character. A better understanding of the relationship between both diseases and improved detection of AF is necessary since the combination of both diseases dramatically increase the risk of strokes if not treated properly. METHODS: Available literature about diabetes as an independent risk factor for AF has been evaluated, and limitations of studies are discussed. RESULTS: Results from different trials and registers are contradictory concerning diabetes as an independent risk factor for AF. Reasons for these differences can be found in different study designs and neglecting patients with unknown AF. CONCLUSIONS: Due to the increasing burden of disease of diabetes and AF as common risk factors for stroke, a systematic screening for AF in diabetes patients could provide a better understanding of their correlation and personalized prevention strategies.