Final Report Summary - MOPACT (MOBILISING THE POTENTIAL OF ACTIVE AGEING IN EUROPE)
Executive Summary:
MOPACT was one of Europe’s most ambitious projects and focused on providing practical, evidence-based, responses to the grand challenge of population ageing. The project concluded successfully by doing everything it said it would and more. Now the MOPACT database contains a massive battery of material, all of which is accessible for policy makers, practitioners, product producers and citizens, and the key elements of which are presented in lay terms. This database must be exploited fully by Europe in the noble and economically essential endeavour to ensure that longevity is transformed into an asset rather than a burden.
MOPACT was unique in five ways. First, its scope was more ambitious than previous Framework projects. This was necessitated by the scale of the the ageing challenge and the need, in responding to it, to transcend the common segmentation of the issue. Linked to this, secondly, was the very wide multidisciplinary collaboration within the project – every relevant discipline from biology to design. Third, there was an explicit focus on social innovation, which has been much discussed but rarely pinned down concretely. MOPACT did this and the SI portal provides many examples of good practice. Fourth, the project prioritised the New Member States, because it is there that most concerted action is needed. This prioritisation took place throughout the project. Fifth, from the outset MOPACT was dedicated to maximising the impact of its science on society. This included the novel integration of stakeholders into the research process across the project, to ensure practical relevance on top of scientific quality. These special aspects of MOPACT provide a model for future projects.
Given the complexity of the project the summary of findings contained in this report is necessarily partial and fuller information is available in the deliverables, including lay summaries of the key findings, and in a forthcoming book. A summary of the summary is even more problematic:
➢ The evidence for an explicit focus, including national programmes, on healthy life expectancy across the life course is overwhelming. An emphasis on physical activity and diet is essential (and far more important than genetics).
➢ Pension system sustainability can be guaranteed by a close relationship between pension ages and life expectancy, but this emphasises the critical importance of the first point.
➢ Longer working lives depend on better organisation of working time over the life course, improving the quality of work environments and job training for all ages.
➢ The growth of the very elderly population (80+) calls for specially tailored active ageing measures (to sustain fitness) and, in many countries, a coherent model of long term care.
➢ The potential of the silver economy is untapped in many EU countries.
This taster of the riches in the MOPACT library should be sufficient to indicate the massive potential of this huge scientific effort to assist Europe in making longevity an asset. MOPACT was a brilliant project. It comprised many of the leading European scientists in this field, working concertedly to common objectives. The successful outcomes are a testament to their quality and their team working. We also had excellent support from our Commission project officers.
Project Context and Objectives:
The starting point for this ambitious collaborative project was the goals set by Horizon 2020 concerning the demographic challenge facing Europe, the necessity of improving lifelong health and well-being for all and the promotion of social innovation and that of the European Innovation Partnership on Active and Healthy Ageing (EIPAHA) to raise average healthy life expectancy in Europe. MOPACT was framed on the basis of a conviction that Europe requires a new paradigm of ageing if it is to respond adequately to these challenges in the context of open-ended longevity. Also, this paradigm must be embedded into responses to ageing at all levels – micro, meso and macro – if it is to be effective. This means a new paradigm of active and healthy ageing (hereafter active ageing) that rejects the deficit model of old age as a definite period of economic dependency.
The mission of MOPACT was to concentrate the highest possible quality of scientific analyses into the development of innovative policies and approaches that can assist public authorities and other key actors at all levels in Europe to make longevity an asset for social and economic development.
MOPACT had five specific project-wide objectives:
1. TO CONDUCT THE MOST COMPREHENSIVE REVIEW TO DATE OF THE SOCIAL AND ECONOMIC CHALLENGES OF AGEING. Using a variety of social science methods MOPACT reviewed the available evidence and modelled alternative future scenarios – with regard especially to biological ageing, retirement behaviour, pensions, health and social care, the built and technological environmental and social participation –and realised the potential for interventions to produce beneficial outcomes for people as they age and for society as a whole.
2. TO COLLECT AND ANALYSE SOCIAL INNOVATIONS AND POLICY INITIATIVES. MOPACT conducted a comprehensive global search for social innovations and policy initiatives that have proven success in promoting the experience of active ageing in a sustainable way. These formed the basis of a web based display and social media projections, and complemented and extended such work implemented by various EU stakeholders during the European Year for Active Ageing and Solidarity between Generations 2012 (hereafter EY2012). The European Active Ageing resource is an easy to access web-site with both examples of successful active ageing initiatives and social innovations aimed at promoting active ageing, with links to other related web-sites (WHO, EC, Eurofound).
3. TO MAP THE STEPS REQUIRED TO REALISE ACTIVE AGEING IN EUROPE AND TO PROPOSE INNOVATIVE WAYS OF DOING SO. The results from objectives 1 and 2 were used, via an iterative process involving relevant stakeholders, to explore and publish scenarios, containing specific steps, by which longevity can be made an asset for economic and social development using combinations of policy levers, commercial and third sector innovations and civil society initiatives. These scenarios reflected differences between Member States, for example in healthy life expectancy and financial context. New paradigms of ageing and active ageing will be major products, which includes an initial definition of active ageing.
4. STAKEHOLDER ENGAGEMENT. The shared conviction of the MOPACT partners was that scientific research alone could not deliver a fully adequate response to the Call and the societal challenges behind it. The challenges were so immense that all relevant stakeholders (or research users) were engaged proactively in this endeavour. Therefore, in each work package, key end users and stakeholders, such as policy makers, practitioners, product producers, designers and older people were involved throughout.
5. TO UNDERTAKE THE WIDE AND EFFECTIVE KNOWLEDGE TRANSFER AND DISSEMINATION OF THE WORK OF MOPACT. The project placed the highest priority on the impact of its work and specifically targeted audiences that could implement the proposed scenarios, such as policy makers at national, regional and local levels, but also the social partners and the general public of Europe, to enhance their role in contributing to active ageing.
Nine scientific work packages each worked to gather the evidence to inform the ambitious policy goals, as follows:
WP1 - ACTIVE AGEING AS AN ASSET: One of the core endeavours of the MOPACT project was to operationalise the concept of active ageing and generate an evidence base for a new optimistic paradigm of ageing. The core tasks of this work package included synthesizing work of all work packages and developing strategies for active ageing. In line with these goals, a three-step process was undertaken in developing strategies to promote active ageing:
1. To measure the extent and potential of active ageing across EU countries in all its multidimensional forms;
2. To identify a combination of macro, meso and micro actions necessary to promote active ageing, in particular by enhancing healthy life expectancy (and thus help achieve the goals of Horizon 2020 and EIP-AHA) and empowering older people and their communities;
3. To engage with diverse stakeholders to gain insights about future socially innovative strategies to address challenges associated with population ageing.
WP2 – THE ECONOMIC CONSEQUENCES OF AGEING: the overarching aim was to conduct the economic analyses necessary for Europe to begin to make longevity an asset with the following objectives:
• To provide a state-of-the-art review of the studies on the economic effects of population ageing from the points of view of individuals and their families, public finances and the economies of Member Countries and the EU.
• To update, improve and expand projections of the future demographic trends of selected Member Countries, especially the household structures and mortality rates at old age.
• To study how policies aimed to fully utilise the potential of older age groups affects the projected economic development and public finances. The influence of policies on formal and informal labour supply, saving behaviour and consumption choices are analysed using numerical life-cycle framework.
• To quantify the economic consequences of the demographic transition for the structure of consumption demand, the national production structure and foreign trade of EU using a multi-country OLG model. To study how education and tax policies affects these trends.
WP3 – EXTENDING WORKING LIVES: aimed to produce innovative scenarios on how to keep older workers longer in working life and to intensify their lifelong learning activities successfully and sustainably, by identifying highly innovative “best practices”. These were ideally combinations of different strategies engaging a diverse set of public, private and third-sector stakeholders with a focus on both paid and informal work. The research aimed to cover selection of EU countries to reflect the major welfare regimes (Scandinavian (DK, FI), Liberal (UK), Conservative (BE, DE, NL), Mediterranean (IT, ES), Transitional (PL, CZ )), while also drawing on innovative solutions from outside the EU (e.g. US, Singapore, Japan, and Australia). A final objective was to put special emphasis on the corporate level (with particular interest in SMEs).
WP4 - PENSION SYSTEMS, SAVINGS AND FINANCIAL EDUCATION: aimed to create the knowledge base to ensure pension adequacy and pension system sustainability in the era of increasing longevity, demand for life-cycle financial planning and fiscal austerity. The research objectives were to review and propose practical actions on three aspects that are crucial in the delivery of adequate, sustainable and safe pensions in Europe: (i) intragenerational equity: supporting groups who are vulnerable in older age; (ii) intergenerational risk sharing and private pensions; (iii) effective communication of pension risks and expectations in providing incentives for savings and rational portfolio behaviour. This was to be accomplished by addressing policy makers, government agencies on social security, pension providers and insurance companies.
WP5 - HEALTH AND WELL-BEING: aimed to provide insights, and propose innovations, in factors driving both healthy life expectancy and social engagement of older people. It has a particular focus on mechanisms at the micro, meso and macro level that are likely to foster socially productive and satisfying lives in older people in poor health:
• Healthy lifestyles and psychosocial conditions during the life course and at present (micro)
• Availability and accessibility of health care services such as post-acute care and rehabilitation services, and the physical environment (meso)
• Policies and social innovations that facilitate effective social engagement and inclusion (macro).
• These mechanisms will be examined for specific population groups according to socio-economic status, marital status, and gender, and for older people with specific disabling diseases such as osteoarthritis.
WP6 – BIOGERONTOLOGY: the main aim was to emphasise the potential of biogerontological breakthroughs to support active ageing and the economic potential of procedures and intervention designed to offset the ageing process. The main intention was to strengthen the links and improve the flow of information between natural scientists/medics and other disciplines, especially the policy-related ones. Specific objectives were to: identify recent biogerontological findings suitable for translation; verify the suitability of presently used strategies to postpone/prevent ageing and age-related diseases, and organise continuous and wide-spread communication regarding biogerontological progress and its translation between scientists of different disciplines and various stakeholders.
WP7 - BUILT AND TECHNOLOGICAL ENVIRONMENT: addressed the fact that researchers as well as business consultants and politicians expect the growth of more and more innovative solutions which will benefit both the living conditions of old people and the prospects of relevant business firms and sectors. With respect to housing, mobility and transport and ICT this research sought out evidence of: promising “silver” innovations and future technological and organisational opportunities for such innovations; whether and how they can result in better products and services meeting the needs of ageing generations; whether, how and to which degree such innovations can and will result in new and growing market opportunities for the relevant firms and business sectors. In addition, the research objectives included a review of barriers to a broad deployment and diffusion of successful and promising “silver” products and services, and identification of which strategies and policies can be recommended to firms and policy makers to encourage them to strengthen all activities which profit from better meeting the needs of older generations.
WP8 – SOCIAL SUPPORT AND LONG-TERM CARE: aimed to understand the key, innovative factors which can transform ageing-related social support and long-term care into crucial drivers of sustainable socio-economic progress. In addition, the research planned to systematically involve relevant stakeholders in identifying relevant drivers for policy change, social capital-building and innovation in the delivery of social support and long-term care. Finally, consideration would be given on how to use this information to build future scenarios of how integrated, age-friendly approaches can be realistically implemented to ensure active ageing in the context of social support and long-term care.
WP9 – ENHANCING ACTIVE CITIZENSHIP: aimed to create the knowledge base for enhancing the political participation of senior citizens, and improving the capacity of adapting to change. To accomplish this, the research objectives were to:
• Map age-based distribution of preferences with regard to the distribution of public resources, and understand how this is influenced by ageing processes.
• Assess the receptivity of stakeholders, namely senior citizens, to the different policy proposals identified by our consortium as promoting a new paradigm of active ageing.
• Chart the different patterns of participation of senior citizens in various levels of policy-making and investigate its socio-economic correlates.
• Identify ways of promoting positive representations of senior citizens, which may booster social and behavioural processes that promote their empowerment and overcome the stigmatising representations about senior citizens that can create an obstacle /disincentive to their civic participation.
• Identify good practices and promising approaches in successfully advancing effective senior citizens participation in policy-making processes.
These research activities were supported by additional workstreams supporting dissemination, notably through implementing a series of Stakeholder Forums which provided, at three key points in the project, an opportunity for non-research stakeholders a chance to review and feedback on the project’s key findings and policy messages.
Project Results:
ANY FIGURES AND TABLES MENTIONED HERE ARE LOCATED IN THE ADDITIONAL ATTACHMENT
WP1 - ACTIVE AGEING AS AN ASSET
The evidence on active ageing reported was drawn from the Active Ageing Index, calculated for all EU countries using the latest data available. To analyse differences and draw out policy implications the AAI results were categorised into three groups of EU countries: High-, Low- and Middle- scoring countries (Figure 1). Sweden, Denmark, the Netherlands, the United Kingdom, Finland and Ireland were the high-scoring countries. Then there are nine countries that cluster together as the middle-score countries: Belgium, The Czech Republic, Germany, Estonia, France, Italy, Luxembourg, Cyprus and Austria. The remaining thirteen countries were categorised as low-score countries: Bulgaria, Greece, Spain, Latvia, Lithuania, Hungary, Malta, Poland, Portugal, Romania, Slovakia, Slovenia and Croatia. Table 1 (attached) schematically presented the focal areas collected in the AAI and mapped them onto the core areas covered in different work packages within the MOPACT project. The analysis furthermore incorporated research findings conducted in other work packages in the MOPACT project and where necessary relied on further available secondary resources.
SYNTHESISING
The multidisciplinary research work of MOPACT was undertaken in nine work packages. These work packages together provided a rich array of scientific findings, which were synthesised in WP1. The synthesizing work was carried out mainly through interactions with the WP leaders in WP1 brainstorming sessions as well as during the MOPACT Forum and General Assembly meetings.
Key findings drawn from the work undertaken across the nine research WPs can be summarised as:
1. The multifaceted and aggregative form of active ageing has been rising in the EU countries, despite the economic downturn and austerity in many of the EU countries.
2. One of the future challenges facing European societies is a fast rising proportion of people aged 80+ who live alone. It is therefore important to look into the special needs and aspirations of this specific group of the population in improving their experiences of active and healthy ageing.
3. A specific challenge is to (continue to) introduce measures that increase healthy life expectancy alongside the rising life expectancy; greater emphasis needs to be placed on social engagement of older people (especially for those with limiting health) and early life interventions that improves lifestyle factors. A strong coherent thread of findings suggest that interventions that extend healthy lifespan include ‘dietary restrictions’ of various kinds.
4. To improve and define new early intervention strategies, it is vital to develop excellent translation practices.
5. Long term care has been increasingly acknowledged as a social risk, however important distinctions are necessary between health and social care and between formal and informal care. A coherent policy design for the provision of long term care is needed in many EU countries.
6. Fiscal sustainability and pension income adequacy (old age poverty) will remain a challenge in many EU countries, especially for Greece and also for many of the Central European countries. In this respect, universal minimum pension (the so-called social pensions) is considered a powerful policy instrument to enhance income adequacy and independent living for future retirees.
7. In the pursuit of longer working careers, the observations so far suggest that the actuarially fair adjustments are not enough and effective incentives are needed to keep constant the ratio of working years and retirement years. A better organisation is required of working time over the whole of the life course, supplemented by improvements in the quality of work environment, better work-life balance and on-the-job training.
8. Measures to tap the unfulfilled potential of the ICT use is found to be most effective in promoting active and healthy ageing. An increasingly greater use of the ICT by the current and future generation of older people will offer great scope for innovations and improving their cost effectiveness in the future.
9. Silver economy potential has largely gone untapped in many countries, due to low user involvement and administrative constraints.
A longer report, drawing together these findings with additional outcomes from WP1 was submitted as a deliverable.
REVIEWING EMPIRICAL EVIDENCE
The evidence drawn from the Active Ageing Index (AAI) was analysed to highlight variations across countries and explored the extent to which these differences were associated with differences in public policies, perceptions, cultures and institutions. In addition, we built an individual level composite indicator of active ageing using the SHARE dataset, which had one great advantage over the AAI as it allowed us to compare inequality of active ageing across the included countries.
Two types of additional indicators were also considered in the analysis: the prospective indicators which review the past life experiences (the life course effect); and the retrospective indicators which connects current life experiences with the prospect of active and healthy ageing outcomes in old age. The enabling environments domain contributes strongly to capacity of active and healthy ageing, and this aspect was duly taken into account in the AAI.
The evidence on active ageing reported within MOPACT was drawn, in the first instance, from the AAI and therefore covered all 28 European Union countries across three annual data points. Further analyses were undertaken by looking at the differences between men and women’s active ageing scores, and the differences between different age groups of older people. This evidence pointed to inequities in experiences of active and healthy ageing within EU countries as well as between them.
The AAI did not as yet use the prospective indicators (i.e. how the future older people might do in terms of active ageing) or the retrospective indicators (i.e. how past life course experiences have led to certain outcomes in old age). Additional information on prospective indicators for the younger age groups is also provided to point towards the determinants of active ageing. In line with the above discussion, 12 prospective indicators were identified in Table 1.1 attached. The inclusion of the external physical and social factors (the enabling environment) contributed strongly to capacity of active and healthy ageing, and this aspect was taken into account in the AAI. In this way, the AAI goes beyond assessing how active ageing is determined by personal intrinsic factors. The domain ‘capacity and enabling environment’ takes into account the following aspects:
• Human capital by indicators such as education and lifelong learning
• Health capital by remaining life expectancy and the healthy life expectancy as well as mental well-being
• Social capital as captured by educational attainment, access to Information and Communication Technology (ICT) and social connectedness
This domain can therefore be presented as a prerequisite condition for the outcomes in the first three domains.
The trends of population ageing and inequality are major concerns for the advanced economies. Some key evidence was presented that brought together the experiences of active ageing of older people and the inequality among them for selected European countries. On the whole, results of the micro (individual) AAI showed consistency with the findings of the macro AAI, however no large gender differences were observed in the micro AAI. The main finding was that countries with a higher level of active ageing tended to have a more equal distribution of active ageing. As with measures of income inequality, it was important to look beyond averages and pay particular attention to reducing inequalities. Three important observations can be made here:
• Countries that have achieved higher active ageing outcomes have also been able to keep the inequality in active ageing experiences low.
• Helping the most vulnerable people in countries with low active ageing will also improve equality across member states.
• The experience of active ageing has become more equal in the period from 2004 to 2011 in the selected nine EU countries where data was available for this time period.
CONDUCTING A GLOBAL SURVEY OF SOCIAL INNOVATIONS AND OTHER INITIATIVES
The purpose of this task was to provide an overview of the global survey of social innovations for active ageing. The survey generated a database of 150 social innovations and other interventions which support active ageing. It gave an indication of the types of social innovations being developed and tested across the EU countries, and also the lessons that could be learned and provided inspiring ideas for others to build upon.
The process of reviewing and evaluating social innovations focused on four scorecard domains – social and economic impact, sustainability, tolerance and implementation. The AAI provided a framework for broadly categorising social innovations although many are likely to have effects across several indicators within each domain or across more than one domain. For example, many social innovations are highly likely to contribute to stronger social connectedness although that may not be the principal aim of the project. Social innovations were grouped by the primary aim of the project in relation to the AAI domain for analytical convenience while recognising that many will had effects across more than one indicator or domain. A section of the website was dedicated to the Social Innovations Database; innovations were classified in three ways to allow maximum flexibility in browsing: by MOPACT research theme; by country, and; by AAI domain. A number of other work packages undertook assessments of other social innovations or interventions to identify good practice in their specialist areas; these were kept separate from the database, but integrated into the online portal.
WP2 - ECONOMIC CONSEQUENCES OF AGEING
The study on the household projections had the following steps:
• Preparatory work was undertaken on the Dutch stochastic household forecasts, specifically on approximate analytic expressions for the correlations of household shares across household positions, between men and women, and between neighbouring ages. Work done on dimension reduction of household shares. First simulations of probabilistic household projection (PHP) were completed, based on dimension reduction by Brass’ logit model for household shares. Data on household dynamics from Germany obtained from Generations and Gender Survey Waves 1 and 2. Occurrence–exposure rates for household dynamics in Germany were estimated. Approximate expressions were derived for variances and covariances of household shares, based on estimated variances of hierarchical shares in logit scale. Final stochastic simulations of future household developments in Denmark, Finland, Germany, Netherlands, and Norway were completed and reported.
Systematic descriptive study of mortality trends in female and male mortality was carried out for the following 23 countries (or areas) and reported: AUT, BEL, CZE, DEN, EGER, EST, FIN, FRA, HUN, IRE, ITA, LAT, LIT, NET, NOR, POL, POR, SLK, SPA, SWE, SWI, UK, WGER.
• Survival from birth to 65, and expected years in ages 65-99 were computed. Loglinear models were fitted, remaining life expectancy in ages 100+ was estimated. Countries were found to fall into three categories: (1) Former Socialist countries, (2) Egalitarian countries, (3) Traditional countries. The latter division closely matches a division into Social Democratic and Corporatist countries that has been discussed in the social policy literature. Graphics were produced by six regions defined by geographic proximity (Nordic, Atlantic, Mediterranean, Central European, Baltic, Eastern), by the three abovementioned groups, for all countries individually.
• Bilinear models were first fitted to data from Finland in three ways: for mortality rates, as in the Lee-Carter approach, for survival probabilities using logistic- and normal score transformations. The latter are referred to as Brass and Wang transformation, in the literature.
• Then, the models were generalized to a form that considers the dependence of the estimates of the heteroscedasticity and autocorrelation of the data. These models are new. The models were generalized for handling multiple populations jointly. This formulation is also new. The definition of the concept of convergence was developed in a novel way. This formulation separates the possibility that the difference between females and males is stationary (rapid convergence), and the case on which the sexes drift apart, but sufficiently slowly so that the decline still leads to a convergence (slow convergence). The work will be reported in an academic journal.
Two studies looked into alternative measures of population ageing and their use to illustrate the policy challenge, alternative scenarios and policy implications.
• One looked at prospective measures of ageing – essentially assuming that the pension age is linked to life expectancy. This revealed a much more modest challenge related to future population ageing. This implied increasing the length of working lives substantially as longevity increases; some countries may have to extend working lives beyond what additional longevity gains would suggest.
• Population projections and National Transfer Accounts data – with age specific public transfers – were combined for 7 European countries and used to evaluate the quantitative impact of ageing on public finances until 2040 and to compare it to projected demographic dependency ratios.
• Public finance impact of changes in three key indicators (net immigration, healthy ageing and longer working lives) related to the policy responses to population ageing were simulated. This was done by linking age-specific public health transfers and labour market participation rates to changes in mortality.
• The study showed that the old age dependency ratio overestimates the fiscal costs of ageing even holding the retirement age fixed. This was mostly because fiscal transfers to young cohorts are declining as societies are ageing. The study further explored the fiscal impact of a healthy ageing scenario, where health care transfers are linked to mortality rather than age, and found that this reduced the fiscal implications noticeably, but not substantially.
A simulation study was carried out to illustrate the contributions of the three separate drivers of demographic transition (fertility, mortality, and migration) on public finances.
- Realizations of a stochastic population projection were used as inputs in a numerical overlapping model calibrated to the Finnish economy. By using decompositions, the study aimed at gains on pedagogic aspects and intuition while giving up as little as possible on quantitative realism.
- The dynamics of the fiscal position are complicated by the fact that different vital rates influence different items of the public expenditure and tax bases with different timing. Mortality changes affect health and long-term care financing relatively quickly. Fertility variation has mainly expenditure effects during the coming decades, before the impact on tax bases grow, while migration affects the number of taxpayers already in the first decades. Age structure movements are slow to appear and can be foreseen to some extent, but with declining accuracy as the forecast horizon increases, because surprises in all vital rates will occur.
A simulation analysis was performed to investigate whether a transition from back-loaded (EET regime) to front-loaded (TEE regime) taxation of pensions is feasible and efficient in increasing the resilience of public finances against variation in longevity.
- The transitions were simulated with a numerical overlapping generations model calibrated to the Finnish economy, using stochastic mortality projections as inputs.
-The results showed that in a traditional pension scheme with no automatic longevity rules, such as life expectancy adjustment of pensions or a link between life expectancy and retirement age, the tax regime shift can be used to improve public finances. Diminished private saving and weaker labour supply incentives are among the downsides. Especially the latter makes the reform welfare-reducing, if the improvement in state finances is not used to relieve taxation of labour.
-In an automatically adjusting pension scheme, the tax regime shift is not so efficient, but neither is it so necessary.
Multi-country simulation analysis on impacts of ageing and policies related to on-the-job training and taxation were performed:
• The existing simulation model was updated to split up the EU region into three blocks: Northern EU, Southern EU and Eastern EU. A population data base was derived to replicate the UN population projection for the three regions.
• Multi-country models with endogenous human capital were calibrated and tested. Since it was not feasible to implement endogenous human capital in the seven-region model, a similar ageing process was simulated in a two-region model and compared the results with exogenous and with endogenous human capital.
• Alternative tax and social security reforms such as a move from income to consumption taxation, alternative strategies of public debt reduction as well as the move towards more pension funding or more pension progressivity were simulated. The results with and without human capital were compared.
A simulation study on the employment, welfare, and distributional effects of the 2017 pension reform in Finland was performed with a stochastic life cycle model.
• The life cycle model of labour supply was calibrated to the Finnish data and features a detailed description of pension benefit rules, income taxation, and unemployment insurance in Finland. The model accounts for systematic differences in average age-wage profiles, disability risk, and mortality across groups that differ by gender and education as well within group heterogeneity resulting from idiosyncratic wage uncertainty.
• Pension reforms that consist of abolishing early retirement schemes and increasing the eligibility age for earnings-related old-age pension were simulated.
• It was shown that this type of reforms may even reduce lifetime welfare inequalities. There are several reasons for this. For one thing, those with the lowest lifetime income are often long-term disability pension retirees and the reforms considered do not decrease disability benefits. In Finland, low-wage workers are also relatively well protected against unemployment risk and old-age poverty by the progressive unemployment insurance scheme and national pension that is tested against earnings-related pensions. More generally, the results highlight the importance of considering other elements of the social security system when analysing the distributional effects of pension reforms.
The simulation results of the stochastic life cycle model were used in a numerical overlapping model calibrated to the Finnish economy to detect the general equilibrium and fiscal sustainability implications of the 2017 pension reform, which linked retirement age to life expectancy.
WP3 - EXTENDING WORKING LIVES
WP 3 consisted of 5 tasks. In the first task, for each of the partner countries a country report was been written. These reports consisted of two main chapters, (1) Extending working lives and (2) LifeLong Learning. The reports covered all aspects and determinants of longer working lives considered relevant, since these reports were the basis of the Conceptual Framework, which provides an overview over the research field, structures the topic and depicts the relationships between different factors. The Conceptual Framework covers 50 pages and is described as “the most comprehensive” (Hasselhorn/Apt 2015: 22, ‘Understanding Employment Participation of Older Workers: Creating a knowledge base for future labour market challenges’ for the German Federal Ministry of Labour and Social Affairs and the JPI ‘More Years, Better Lives’) amongst three conceptual frameworks discussed by the authors. The core of the Conceptual Framework is a circular structure of different areas affecting the length of working life, where the outer circles contain major developments like demographic change, the economic situation/crisis etc., affecting national and supranational policies as well as meso level actions by employers, social partners, NGOs and various other stakeholders, which in turn affect via various steps individual retirement behaviour.
In another task three reports were delivered, one summarised around 150 meso level measures in the 13 countries. The report was structured according to country and within each country according to measures aimed at the supply side of labour and at the demand side of labour. The supply side contained activities that enable older people to work, i.e. it is closely related to the concepts of workability and employability. The demand side contained primarily ideas that, if put into practice, would incentivise employers to hire and retain older workers. Although a considerable number of companies mentioned is larger than SMEs, reflecting the general situation of more widespread age management measures at large companies due to bigger HR departments, more resources etc., there was also a considerable number of remarkable and innovative measures at SME level. Further, researchers were asked to estimate if measures reported are transferable to other companies, partly in different sectors of different countries, and especially measures at SME level seem to be transferable, since they come with low preconditions. This report confirmed a finding from the initial task that the term ‘social innovation’ or just ‘innovation’ is used differently between actors and countries and was not very helpful. One expert interviewed in already stated that ‘innovative’ was not relevant, since whatever works, works. The 150 cases were the basis for the selection of cases for in-depth case studies in a future task (see below).
A National Policy Report provided an introductory overview of policies and effects and comparative research. The main part covered policies and their effects (if assessed) and was structured according to country, and within each country chapter, according to topic. Topics included pensions, early retirement, work after retirement / silver work, unemployment, part-time work/part-time pensions, health/disability, self-employment, employment protection, wage subsidies, life-cycle approaches and age discrimination legislation. The concluding chapter embeds the topic of policies and welfare state reforms into the general welfare state literature. The country-specific chapters showed that numerous reforms have been initiated in the last years, especially in the three main exit routes pensions, unemployment and disability, and available analyses show or predict (this in the case of pension reforms not yet fully implemented) that these reforms indeed increase employment rates. The report was not focused on side effects such as rising inequality or, related to this, rising relative poverty, work despite adverse health circumstances etc.
A further report summarised the situation in training and further training and, like both other reports provided an overview which was used for interviews in Task 3. The report was related to the country reports in the first task, as measures by organisations/companies in the field of training are affected by national circumstances. In Task 3 one report was delivered based on 20 in-depth case studies and one summary of measures of 16 companies in one sphere of activity (reconciliation of paid work and private care in Germany). This showed how best practice measures were arranged (Description), put into practice (Implementation), if, how and under which circumstances these measures could be imitated by other companies/organisations/social partners/public bodies (Transferability) and in which manner these measures can be considered innovative (innovation). The cases were sorted by sphere of activity: Health (and work despite health problems), lifelong learning, work after retirement age, flexible working times, reconciliation of paid work and family, unemployment, self-employment, awareness campaigns, and recruitment/labour demand. In contrast to common ‘Best Practice’ reports, the reports showed how exemplary measures came into being (as far as information is available) and if and under which conditions these measures are transferable/imitable and therefore can serve as guidelines/recommendations for other actors (companies/ organisations/ social partners/public bodies). Experiences with case studies gave insights into possible starting points for effective interventions. For example, a focus on key actors´ attitudes and capabilities can be expedient. This also applies to local collaborations or externally provided incentives.
Further reports were delivered - Drivers and Barriers to Innovation was based on in-depth country reports and was structured according to supply side and demand side. The supply side consisted of (1) workability/employability (motivations, health, life-cycle orientation, lifelong learning), (2) self-employment and (3) work beyond legal retirement age. The demand side consisted of (1) financial incentives for the employment of older workers (public, non-public) and (2) non-financial incentives (also public, non-public).
The Report on Secondary Analyses contained three papers based on secondary analyses. The first paper explored the interaction between individual and institutional factors on participation in non-formal learning in 50-64 age group in 19 European countries. One finding was that higher statutory retirement age is related to higher participation in non-formal learning in the 50-64 age group, but the result is not straightforward. The second paper covered 6 European countries and depicts the frequency and the determinants of older worker labour supply. Based on a survey at company level, it was shown to which degree and affected by which company traits companies try to retain their workers until or beyond legal retirement age or re-hire retired former workers. The third paper assessed the maximum effects of high work satisfaction on longer working lives. Effects are in the sphere of some months and therefore not huge (in contrast e.g. to pension reforms´ projected effects), but possibly effects are underestimated and secondly effects result from actions without negative side effects on older people.
The final report in this series covered the topic of older people unemployment, which is a considerable problem for employment amongst the elderly in some European countries. The rates have risen in most countries (2006-2014) and the report showed policy reforms and effects in this area, largely based on financial incentives.
In the next tasks, two reports were delivered relating to strategies for extending working lives, raising older workers´ employment rates and intensifying LifeLong Learning in later working life and Final Country Reports. The former summarised WP 3 findings and provided political suggestions, explicitly as well as implicitly. The report was strongly solution-driven in order to foster the project´s practical impact. The latter consisted of 11 in-depth country reports based on previous research.
WP4 - PENSION SYSTEMS, SAVINGS AND FINANCIAL EDUCATION
The key issue in this work package was how to improve the pension system to ensure adequate income for all at old age, and in particular how – mandatory and voluntary - private pension savings can contribute to this. With governments curtailing the role they play in the provision of old age financing (in pensions but in long term care as well), the questions how private pension savings can be optimized become all the more important.
There were three tasks in this work package:
I. intragenerational equity: supporting groups who are vulnerable in older age;
II. intergenerational risk sharing and private pensions;
III. effective communication of pension risks, and expectations in providing incentives for savings and rational portfolio behaviour
The main achievements on the three tasks were the following:
i. Intragenerational equity
Many countries have recently faced pension reforms e.g. from defined benefit (DB) to defined contribution (DC) schemes and from mandatory funded pension schemes to system where more choice options are available. Four papers were written on the impact of these reforms on in equality during retirement and the role of private savings in keeping up pension adequacy. In particular pension reforms have been analyses in five European countries: Estonia, Hungary, Finland, Poland and the Netherlands. One possibility to foster private pensions across Europe is the development of a common standard for personal pension plans. One of the deliverables focussed on the scope for personal pension plans in Estonia, Hungary, Finland, Denmark and the Netherlands. This paper was finished in November 2015 after incorporating the current policy debate on Pan-European Personal Pension Products (PEPPs). As a complement to this paper another deliverable contributed to the idea PEPPs by working out how personal pensions can be combined with collective risk sharing.
All papers have been presented and discussed at the Netspar International Pension Workshop in January 2015.
ii. Intergenerational risk sharing
The key issue in this task was how to ensure stable incomes for elderly in a world that faces increasing demographic and financial risk, and where population ageing erodes the basis of younger generations who can bear these risks. The challenge has increased markedly in the last decades due to volatile financial markets, falling interest rates and the withdrawal of employers and external insurers as risk bearers of systematic financial and longevity risks.
Bovenberg & Nijman (2015) developed the concept of Personal Pension with Risk sharing (PPR) which aims to combine the best of defined benefit and defined contribution pension systems. By unbundling the different functions of pensions – i.e. investment, saving, insurance and risk-sharing - PPRs allow risk management and (dis)saving to be customized to the specific features of heterogeneous individuals. Moreover, PPRs allow investment risks to be combined with longevity insurance. The improve design in the PPR also deepens the internal markets for financial and insurance products while at the same time accommodating the diverse traditions of countries in terms of occupational pension provision. Finally, the PPR reconciles financial, fiscal and macroeconomic stability with growth by increasing the supply of long-term risk-bearing and illiquid capital, complementing public retirement provision, reducing the interest-rate sensitivity of pensions and smoothing shocks.
Bijlsma, Van Ewijk and Haaijen (2014, revised 2017) elaborated in a subsequent deliverable the idea that private pensions contribute to deeper capital markets and thereby fostering risk sharing and long-term investment at the aggregate level, and helping to put Europe back on the path of sustainable growth. This paper presents new empirical evidence for such an alleged positive impact of pension savings on economic growth. It studies the effect of pension assets on economic growth for OECD countries for the period 2001-2011. Unlike the standard cross-country growth regressions, it focuses on one specific transmission mechanism for the impact on pension savings on economic growth, namely the access of firms to external finance for their investment needs. Doing so, the authors find a statistically significant positive effect of pension wealth on growth. An increase in pension assets (% GDP) by one standard deviation of 40 percentage points for increases growth for an average sector by 0.24 percentage points. This relationship did not markedly change during the crisis; it is a structural relationship over longer time horizons.
Both papers have been presented during policy seminars at Bruegel in Brussels in March 2015 and October 2013 respectively.
Two other deliverables within this task investigated different types of risks, viz. those related to life expectancy and those emerging from financial markets. One analysed the impact of working and living longer on pension incomes in five European countries and assess the impact of on the financial well-being of the elderly in these countries. The paper showed the diversity of the policy measures taken in the various countries. Furthermore, the authors analysed the financial incentives to work longer and to postpone claiming pension benefit in the five countries and we addressed the question, how attractive these options are.
The other deliverable measured how financial shocks - equity market, interest rate or inflation shocks - affect different generations of participants in individual and collective pension schemes and to explore the effects of risk-sharing rules in collective pension plans. The authors showed that an individual pension scheme, by using a life cycle investment strategy, can largely replicate the allocation of traded risks across generations of a collective pension scheme that gradually adjusts pensions after financial shocks. In schemes with individual accounts, risk sharing is limited to risks traded on financial markets. Collective schemes additionally can shift financial risk to generations that will participate in the future, whereas individual accounts cannot. In the current institutional setting this shift of traded risk in collective contracts to future generations is limited. Collective pension schemes are able to reallocate non-traded risks, such as inflation risk or macro longevity risk, among the participants to obtain a more efficient distribution of risk across generations.
iii. Effective communication of pension risks and expectations in providing incentives for savings and rational portfolio behaviour.
Individuals are increasingly bearing greater responsibility for their own financial well-being during retirement. People face more and more decisions on how much to save for retirement, on how to allocate retirement wealth and on what insurance products to buy. However, individuals find it very hard to navigate financial and insurance markets, and the consequences of mistakes can be substantial. This raises the question how we can promote efficient life cycle financial planning in a cost-effective manner. Deliverable 4.05 explored how pension plans can best communicate, and frame risk and project pension benefits and replacement rates in order to help individuals make good saving, investment and reporting standards for pension funds and individual pension plans. As a complement to this research the working paper that proposed a method for projecting pension benefits, deriving from DC pension plans and other funded products, at retirement. The projections highlighted how the current choice of asset allocation impacts on future potential retirement outcomes. The latter were compared with a money-back benchmark so as to clarify the trade-off between risk and return. After the initial projections, the pension plan revises its forecasts of retirement benefits on a yearly basis as a function of its own realized returns. Previous shorter-term projections are also compared to shorter-term ex-post performance. This simple method is a step towards an industry-reporting standard that responds to regulators’ quest for helping investors monitor the risk of their future pension.
Two further papers were written, the first presented an intertemporal consumption model of investment in financial literacy. Consumers benefit from such investment because financial literacy allows them to increase the returns on wealth. Since literacy depreciates over time and has a cost in terms of current consumption, the model delivers an optimal investment in literacy. Furthermore, literacy and wealth are determined jointly, and are positively correlated over the life cycle. The model implies that the stock of financial literacy early in life is positively correlated with the stocks of literacy and wealth later in life. Using microeconomic and aggregate data, the paper finds strong support for these predictions.
The second paper analysed the role played by financial literacy in savings decisions and wealth decumulation. The broad evidence showed that (elderly) households do not decumulate their assets as they age, contradicting the standard life-cycle theory, which predicts that households should decumulate their assets in order to keep their consumption smooth. In particular, older people seem to be very attached to il-liquid assets, such as housing wealth, which is far more difficult to liquidate and use in case of unexpected shocks and for consumption smoothing. Using the SHARE (Survey of Health, Ageing, and Retirement in Europe) survey, the authors try to detect whether more financial literacy brings about more optimal behaviour from a life-cycle perspective. They look at the impact of financial literacy on three different dimensions of savings decisions: an unbalanced portfolio with excessive weight assigned to illiquid assets, the optimal consumption path, and wealth decumulation. According to these findings, higher financial literacy substantially reduces the portfolio imbalance of people aged 50+ by reducing the weight of housing wealth over total net worth. In addition, higher financial literacy is responsible for a more optimal consumption path and, in particular for men, for both net worth and housing wealth decumulation.
All papers in the task have been presented at the workshop in Italy in 2016 and during the International Pension Workshop (IPW) organised by Netspar in Leiden, 2017. During the last workshop there was a special MOPACT session with an interesting exchange of research in this work package and other work packages. During this same IPW a special policy session was organised where important results on the macroeconomic aspects and literacy of the research in this work package were presented to a forum of policymakers and practitioners.
WP 5 - HEALTHY AGEING AND WELL BEING
Main results of this WP included:
• During the period 2005-12 increases in life expectancy in the EU were not accompanied by increases in healthy life expectancy, contrary to the intentions of Horizon 2020.
• While social participation is lower among older people in poor health than those in good health, its determinants are generally the same in both groups. So similar approaches can be taken to promote participation in both groups, although specific factors must be taken into account for those in poor health, such as depressed mood and lack of transportation.
• While policy makers tend to emphasise labour market participation, it is important to facilitate the combination of paid work with other activities such as volunteering and informal care giving.
• Increasing social participation makes a very minor contribution to HLE (0.0 to 0.1 years), but it is valuable for social inclusion and needs to be promoted. More research on alternatives to raise HLE is needed to guide policy.
RESULTS SUMMARY
Life expectancy (LE) was compared to healthy life expectancy. Healthy life expectancy was expressed in healthy life years (HLY), which was defined in this study as the number of years that a person is expected to continue to live without activity limitations. Overall, life expectancy at age 65 in 27 EU countries increased between 2007 and 2010 by 0.6 years for men and 0.5 years for women. At the same time, healthy life expectancy (HLY) decreased by 0.2 years for men and women. Similar trends were observed for LE and HLY at ages 50 and 85. At the same time, results showed a large variety between the countries in healthy life expectancy and trends in healthy life expectancy. The three countries with the largest number of unhealthy life years were Slovakia, Portugal, and Germany.
Trends were also reported for the prevalence of important health indicators: chronic morbidity, i.e. the self-reported presence of one or more longstanding illnesses, and activity limitations, i.e. the extent to which older people reported to be limited in activities that people usually do. Overall, the trend in morbidity prevalence for men and women has been increasing between 2007 and 2011, in particular in the older age groups. Trends in the prevalence of severe activity limitations have been relatively stable for men and women across all age groups. Again, results across countries showed large differences.
In the next task, social participation in 6 domains was studied in older people with and without health limitations. The 6 domains were - volunteering, informal caregiving, labour participation, educational activities, leisure activities, religious activities. Health limitations were defined as multi morbidity, with is a complex medical condition. Across types of participation, findings showed considerable differences in the level of participation between those with and without multimorbidity, in favour of the group in better health. However, determinants of social participation appeared to be quite similar between those with and without multimorbidity. In both groups, and across the different types of participation, factors that were associated with a higher level of participation included a higher socioeconomic status, a larger social network, being active in other types of participation (but not labour market participation) and having better physical and psychological health. If differences were observed between multimorbidity groups, this was often related to opportunity structures (for example indicated by income level, home ownership) being more important for the participation of those without multimorbidity, as compared to the older people with multimorbidity. At the same time, findings indicated that transportation possibly was more relevant for the level of leisure participation of those with multiorbidity. Other findings were quite specific for the type of social participation. For example, being married in those with multimorbidity was associated with a higher level of caregiving, but being single was associated with a higher level of volunteering activity. Also, mental health problems affected labour market participation and volunteering to a greater extent in those with multimorbidity than in their healthy peers. Overall, the results show that health status does influence older people’s level of participation, but the level of health should only be a minor factor in designing intervention strategies.
In the countries that were selected for the study – Austria, Estonia, the Netherlands and Poland – altogether 48 private projects (social innovations) were found that foster participation of older people in volunteering, informal caregiving and leisure activities. In general it was found that only few projects targeted people with health limitations. Instead, projects are often open for all older people, with or without health limitations. The underlying assumption of the projects is that almost all older people have some form of health limitation and there is no need to separate people based on their disease or disability. Many of the success factors, barriers and preconditions that were identified in the four countries overlapped. For example, financial sustainability was a concern for many of the projects. Therefore, the projects were dependent on volunteers for the organizations of activities. Some factors were specific for each country, as they are closely related to the culture of economic conditions in the countries. In that case the most successful approach differs per country, for example strategies to motivate volunteers.
Across the four countries that were studied - Austria, Italy, Poland and the Netherlands - policies that most explicitly address the social participation of older people concern labour market policies. Pension reforms have primarily been put in place to offset budgetary constraints related to the ageing of the population. These measures indeed increase the labour market participation of older people. The labour market is also a field where regulations are directed specifically towards people with disabilities. To avoid competition between different social participation roles, recommendations concern the offering of regulations by employers to combine for example working with caring or volunteer work.
To a lesser extent, policies and regulations exist in these other ‘productive’ participation domains: caregiving and volunteering. Policies and services in these domains are often not targeted at older people or those with disabilities. Recommendations regarding these types of activities are (1) the availability of appropriate respite care for informal carers and (2) the availability of funds for hiring volunteer coordinators, who support and train all unpaid workers, especially those with poor health. Leisure activities that are more consumptive, such as social network activities, education and sports, are performed in the personal sphere, and as such have the least interference from policies. However, to enable older people to become or stay socially engaged, they do need sufficient financial means and appropriate services (e.g. transportation), in particular the group of older people with health problems.
A formal framework was developed to perform scenario analyses of increases in social participation among older individuals with multimorbidity and the effect on healthy life expectancy. This was based on estimates of the effect of different forms of social participation (volunteering, informal caregiving, labour participation, educational activities, leisure activities, religious activities) on disability derived from the empirical literature and own estimates using SHARE data. We found that generic increases in social participation of older individuals with multimorbidity are not an effective way to improve healthy life expectancy. Increases in the social participation rate of older individuals with multimorbidity only have a very modest effect on healthy life expectancy. The baseline scenario results in improvements of healthy life expectancy of 0.0 years. Even scenarios with very high increases in social participation rates and high estimates of the effects of social participation on disability, result in an improvement of healthy life expectancy of 0.0 to 0.1 years at best.
Given the ageing of the population, and the increasing prevalence of chronic diseases, focusing on social participation among older individuals with multimorbidity is of importance. However, its effect on average years spent without disability is limited. Given the size of the challenge, substantial increases in healthy life expectancy cannot be expected to come from a single intervention alone but will have to be the result of combined efforts on several fronts.
WP6 – BIOGERONTOLOGY
The main objective of this work package was to emphasise the potential of biogerontological breakthroughs to support healthy and active ageing, and the economic potential of procedures and interventions designed to retard the ageing process. Our main intention is to strengthen the links and improve the flow of information between basic scientists/physicians and other disciplines attributable to ageing.
Accumulating evidence showed that ageing was not inevitably linked with the development of chronic diseases. In addition, only 20-25% of healthy life expectancy is genetically predetermined; lifestyle and environment play a major role. Consequently, age-associated accumulation of molecular and cellular damage can be prevented or greatly delayed by lifestyle interventions. Infections play a major role in morbidity and mortality of the elderly. Nevertheless, a life course perspective in vaccination is missing from the public health agenda. Sex/gender-related factors also play an important role in protection against disease.
The best established strategy to delay ageing is dietary restriction with optimal nutrition. Energy intake and expenditure, meal frequency and timing, protein intake, diet quality, and gut microbiome have an impact on health and longevity.
Following a general literature review to summarise the progress in biogerontology over the past 10 years UIBK compiled a list of potential topics to be investigated in more detail e.g. sarcopenia and physical exercise, nutrition and diet, telomere biology, oxidative stress, endocrinological ageing, and immunosenescence.
UNIBS focused on the effects of diet on healthy ageing and longevity and summarised the information in eight review articles (Cava & Fontana, 2013; Rizza et al., 2014; Fontana & Hu, 2014; Mattson et al. 2014, Fontana & Partridge 2015; Spelta et al. 2015, Most et al. 2016; Bertozzi et al., 2017). Since 1935 when McCay first published that food restriction without malnutrition expanded the lifespan in rats, several research groups have shown that restriction of caloric intake without malnutrition extends lifespan as well as health span in yeasts, fruit flies, nematode worms, fish, hamsters, rats, and mice. Recent data from non-human primates suggests that not only the calorie intake but the diet composition in particular is important in promoting health and longevity. In addition to caloric intake and diet composition, frequency, circadian timing of meals and intermittent energy restriction periods seem to improve health indicators and counteract disease processes. Nutritional modulation of the microbiome can also be important, and there are long-term, including inter-generational, effects of diet.
Infections account for a substantial part of mortality in elderly above 65 years of age. With ageing of the immune system the susceptibility for infectious diseases increases and the efficacy of vaccination decreases. However, there exist biological and socio-economic inequalities in infectious disease susceptibility that contribute to differences in healthy life years and life expectancy between men and women and across EU member states.
UIBK summarised how sex steroid hormones affect the immune system and how changing sex steroid hormone levels during ageing (e.g. menopause) may influence vaccine efficacy and susceptibility to infectious diseases. In animal models hormone replacement therapy – estradiol in particular – could revert some of the age-related immune defects. Studies in humans on the effects of hormone replacement therapy on the immune system are scarce (Giefing-Kröll et al. 2015). However, despite these biological differences, there are areas where immediate intervention would be possible. Not only vaccinations in the elderly are required to protect these from disease, but regular booster immunisation earlier in life is needed to maintain protective antibody titers when the immune system is still fully functional. Incidence of vaccine-preventable diseases is not distributed homogenously across Europe and also coverage rates vary considerably across EU member states. Vaccine policies are not consistent across EU member states and often specific recommendations for adult vaccination are missing. In addition to reduction of out of pocket costs reminder strategies for patients and health care providers regarding vaccination due date could help to increase vaccine coverage in the adult population. More public education on the risks and benefits of vaccination could increase compliance with vaccination guidelines
For the translation and implementation of biogerontological findings, it was critical to understand how to communicate new developments (diet, physical and cognitive training, vaccination, devices etc.) to end-users and stakeholders and how to overcome translational barriers.
As a model system ARU/CranU were examining telecare and telehealth devices, i.e. any piece of equipment, gadget or technology that supports independence in older age, in the development of suitable products to help individuals live at home for longer. Utilising this focus group methodology, individuals provided their views on existing products and a prototype telehealth device that was under development. 27 individuals participated in two user focus groups. All were over the age of 60, and some were over 85. Selected devices were available for proper handling, which was initially tested within a small pilot group. Through handling of the devices and contextual inquiry the groups were established and run to understand the barriers to device adoption and to identify better-targeted interventions to meet user needs. Additionally, 27 telephone interviews were conducted with key supply chain players to ascertain their views on putative barriers to uptake of these devices. A semi-structured interview guide was used. The focus groups and the interviews were audio-recorded and then transcribed verbatim, with the data handled within NVivo 10 and analysed using a thematic approach. The study suggested that few telehealthcare devices were developed based on the principles of user-centred design. As a result many were non-intuitive, with the majority of the focus group participants not recognising the purpose of the devices from their appearance alone. Expert interviewees argued that this lack of user-centred design resulted in unused products and products that failed to successfully meet end-user needs.
The results of the work performed in the first two tasks were categorised according to importance and feasibility for translation to support active and healthy ageing and to generate new procedures and interventions to postpone the onset of or prevent disease.
We made several attempts to organise a meeting to share state-of-the-art biogerontological knowledge with stakeholders and scientists from other disciplines in different locations and settings. In the end, such a meeting as originally planned could not take place due to organisational and financial limitations. However, we conducted multiple other activities, as listed below, to fulfil this task in organising continuous and wide-spread communication regarding biogerontological progress and its translation between scientists of different disciplines and various stakeholders. These activities included meetings with general public and stakeholders (including open days “Lange Nacht der Forschung” in Innsbruck and in Salzburg); communication with general public and stakeholders via media including TV, radio, newspapers and internet; presentation of biogerontological research to the scientific community: 138 articles and 210 presentations on conferences, symposia etc.
In addition to the activities above, by 2016, PLUS has put emphasis on establishing a University-wide interdisciplinary network dealing with gerontological research and training, yet also providing information to the public. The immediate goals are to raise awareness amongst students who wish to focus on ageing both at the scientific level as well as after graduation when joining industry, public services and further training and teaching. The Geronto_Network is currently defining means and measures to implement an interdisciplinary training programme at the Masters level as well as postgraduate courses which besides Biogerontology shall include social aspects, psychology, communication and law/politics. These emphases are currently compiled in a book which is published in spring 2017 with Springer International. Cooperation with Universities at the national level such as Innsbruck as well as in Europe with Centres such as Bologna or Amsterdam are being discussed with colleagues in the field. Similar to training of PhD students in Biogerontology in Innsbruck, which runs very successfully ever since 15 years, the University of Salzburg has started a structured Doctoral Training Programme in 2016/17. Twelve Students have been enrolled on this specialised course. This training programme prepares a students' summer school together with the 14th International Conference on the Neurobiology of Aging at Bregenz taking place in July 2018.
We highlighted the importance of a life-course approach to healthy ageing in our report -Future scenarios on biogerontological translation. Biogerontology is important at every stage of life beginning already very early in life. Hence interventions when applied early unfold higher potentials to prevent physical degeneration and decline in cognitive function. A life course perception on ageing and risk of developing age-related diseases is essential: body functions, plasticity and thus the possibility to intervene decrease with age while concomitantly damage increases. Interventions in adults, especially those at risk can be beneficial to certain degrees. Notably screening in middle-aged reduces the risk for non-communicable diseases; however, interventions in adolescents and young adults could be made more effective and are believed to reduce the disease risk in the following generations.
The developmental period is highly plastic as it greatly responds to environmental conditions and allows fine-tuning of gene expression through epigenetic regulation primarily to improve reproductive capacity and sustain life-long health. This is especially true for the prenatal and early postnatal stages during tissue development but extends to childhood and puberty for some tissues such as the brain and reproductive system. During this developmental period the organism is highly sensitive to environmental factors such as nutrients, environmental toxins, chemicals, drugs and infections. Interference with this epigenetic regulation is implicated in disease development later in life including major public health problems: obesity, diabetes, hypertension, cardiovascular disease, asthma and allergy, immune and autoimmune diseases, neurodevelopmental and neurodegenerative diseases, precocious puberty, infertility, some cancer types, osteoporosis, depression, schizophrenia and sarcopenia.
In addition to lifestyle interventions such as fasting regimes, caloric restriction or exercise a limited number of pharmacological interventions have sound evidence to promote health span including spermidine, resveratrol, metformin and rapamycin.
Based on biogerontological and epidemiological findings, the report elucidated which type of interventions are needed at which stage of life to preserve health and prevent or ameliorate disease.
WP7 - BUILT & TECHNOLOGICAL ENVIRONMENT
This WP consisted of several sub-tasks- Innovation Prospects Report – The report identified current trends in ICT, housing and mobility in Europe; Research protocol – The protocol defined the methods used in this task; Case Study Hand-out – The hand-outs compromised the results of the case studies; International Workshop and Trend reports / Policy and Business recommendations – The trend reports gave recommendations on improving the transfer process from social sciences to industrial and political stakeholders.
Innovation prospect reports, provided the basis for the subsequent tasks. For each of the three areas (housing, mobility and ICT with a focus on health), a non-systematic literature analysis and secondary data analysis was conducted. In many cases, technology was not only used by older persons themselves but also by their families, relatives and friends as well as professionals (e.g. caring staff). This makes it very complex to design technologies fitting into various contexts. Taking telecare and telehealth as examples, different aspects can be identified that affect the adoption, implementation and use of technology. These can be grouped into technical, social, economic and regulative dimensions, each covering multiple aspects. The literature analysis that was conducted as a part of MoPAct within the field of telecare and telehealth revealed that barriers exist within the following domains (see figure1). The domain ‘acceptance’ was identified as the most dominant one, followed by financial and technical challenges. Factors that lead to non-acceptance – and non-use – cover multiple aspects. This includes safety concerns, e.g. about data security, a lack of trust, e.g. caused by poorly designed pilots, the general reluctance to telehealth and telecare, the feeling of stigmatization, generally low expectations, restrictions of autonomy, the fear of nursing staff being replaced by technology, a perceived increase of workload, the disruption of services and routines, the capability to understand the technology due to poor ICT skills or cognitive impairments, etc.
According to mobility, policies on European Union level and on national level for the five selected countries were analysed. Environmental aspects were predominantly mentioned in these policies. A more frequent usage of public transport helps to decrease emissions. Considering mobility and ageing the accessibility of public transport is the main aspect that needs to be tackled for an independent living and to facilitate social inclusion for older people. Projects in this field do not only focus explicitly on mobility and ageing but also include the target groups of people with impaired or reduced mobility or people with disabilities. The setting is usually urban even though national policies often point out the challenge to also supply rural areas with transportation options. Overlap with ICT is mainly seen in navigation and information systems. Housing plays a role in the door-to-door mobility. The car mobility of older people is only a limited issue of policy. At European level, emergency call systems and reducing the number of accidents are discussed. The elderly prefer the car for their mobility and they drive in all countries as long as they can. The public debate is dominated at the time by the electric mobility and the saving of fuel.
For the area of housing we analysed the social structure of housing using the European Quality of Life Survey (wave 2011). The results show that the living conditions of the elderly vary intensively among the different countries (regarding the ownership structure, the area people are living in, problems with accommodation, access to different facilities in the neighbourhood and health status). We found high variance in and between the countries that hint towards very different needs of the elderly regarding their housing situation and quite different existing policies / interactions with the institutional structure of the housing and social service systems in the observed countries. We identified four fields of action (accessibility in and around the accommodation, ambient assisted living, shared housing, age-friendly neighbourhoods) we see as crucial to allow the elderly to realize active and healthy ageing in their (kn)own accommodation and neighbourhood. Staying at home is what most people wish even and / or especially when in need of support and care. Besides realizing the will of the elderly this has further advantages regarding especially the financing of care and the continuity for private landlords regarding their tenants. This common interest of the different stakeholders provides an important opportunity for coalitions in order to circumvent existing barriers regarding the implementation of new solutions. Nevertheless, this has not yet happened in all the countries. While Finland and the United Kingdom seem to be "forerunners", especially Poland is rather a "laggard" regarding the above mentioned issues. This is especially striking as the problems of the elderly regarding housing are especially pronounced in Poland.
The case studies task underlined that different aspects of built and technological environments are closely linked to each other. ICT-based devices and services were found in the context of housing, health and mobility, this trend will continue in the near future. The case studies showed that this asks for user-friendly approaches combining information policies and trainings. The integration of volunteers – ideally peers – is identified as a concept or element that increases the awareness and acceptance of new products and services but also the chance of sustainability. Moreover, it supports the active participation in society. User-integration is not only relevant at the beginning of the innovation process but also as a constant theme. Furthermore, the cooperation of multiple stakeholders is essential to develop and implement (advanced) approaches. In turn, this asks for measures to increase awareness of the user’s needs but also of solutions that already exist. In total, we conducted 13 case studies. The cases were selected and analysed using the research protocol. Key inclusion criteria were:
-Involvement of the end-users into the innovation process;
-The sustainability of the project/initiative;
-Addressed market barriers;
-Transferability of the project or certain parts.
Parallel, a survey on older drivers in several European countries was conducted. The questionnaire contained 11 items. The following characteristics of cars were sorted according to importance from the perspective of view of elderly drivers: supporting function of car seats, instruments and operating elements, peripheral and rear vision, solid lateral guiding of car seats and getting in and out of a car. The responses of older motorists with respect to the driving assistant-systems were mixed and it reflected the fact that little is known about these systems. In this survey, the emergency braking system, a navigation system and a parking assistant were rated highest.
A subsequent task included a Delphi survey on barriers to the uptake of ICT-based technology for older persons and an international workshop to discuss the results of the survey and previous tasks. During the first round of the survey, the experts were asked to rate the named barriers and add new ones in case they felt that something was missing. Moreover, they were asked to provide solutions to those barriers. (see table in attached doc).
Moreover, the results of the survey showed that after the first round, agreement of the participants increased significantly considering economic barriers. Interestingly, nearly all items in this domain were rated as less important barriers during the second round of the survey. This is especially true considering the items affordability by end users, missing reimbursement schemes, lack of private funding and lack of public funding. Moreover, the item affordability by end users received the highest level of agreement within the survey. A high degree of consensus was also achieved with respect to technical barriers and the items access to broadband connections, a lack of interoperability and usability issues and within the domain entitled acceptance and the items fear of misuse of personal data among elderly users and missing evidence (e.g. considering the benefits of telehealth).
Concerning the solutions to tackle these barriers, the survey revealed multiple approaches that were discussed during the international workshop: Workshops and training of older users but also professional users were seen as essential to promote technology and to overcome the “lack of awareness”. Peer support, e.g. older persons helping each other to deal with new technologies, were rated as promising approaches and should be focused on. Technology alone should not be the centre of attention. The deficits in care must be the starting point for intervention (e.g. regarding assistance and care). Therefore, the elderly who are affected need social assistance first and must then be integrated into a local care system with technological assistances. While an increase of public funding was mentioned as a way to tackle the deployment gap, this was controversially discussed. A way to secure funding of new products and services was seen in venture capital. If private investors find the market promising, they will start to invest money in it. However, up to date a common European market is missing and is seemed not clear if there will be one in the near future.
TREND REPORTS/ POLICY AND BUSINESS RECOMMENDATIONS
The most fundamental aspect is to raise awareness on new, but also existing products and services. This included not only older persons as primary users, but also secondary users like care staff. If upscaling of assistive technologies should be achieved within the nearest future, ‘marketing’ needs to be tackled. To increase acceptance among older persons, participatory design approaches are a key aspect, especially within research projects. It needs to be clear how users should be included (e.g. how many, where, at which point, in which ways). Another aspect that needs to be mentioned is the evaluation of the evidence-base to understand which approaches work, in which specific contexts, and for which target populations. Frameworks are needed for the evaluation of projects, products and initiatives covering economical, technical, legal and social aspects. The re-emerging concept of the Silver Economy counts on ICT for supporting active and healthy ageing and generating economic growth. This bears the risk of increasing the digital gap. Attention needs to be paid to increase the ICT-skills and to offer support. This asks for new models of service delivery.
WP8 - SOCIAL SUPPORT AND LONG-TERM CARE
Partners from Austria, Estonia, Germany, Hungary, Italy, Portugal, Romania gathered a large amount of information (also including neighbouring countries) by involving a number of relevant stakeholders, experts and representatives of users over the past two years of research activities and policy analyses. Research encompassed an overview of different care regimes regarding governance and financing of LTC, patterns of care needs and coverage as well as the identification of examples of socially innovative practice. Of the 62 innovative initiatives 16 were then selected for an in-depth analysis of relevant key factors, drivers and barriers for social innovation in LTC. After discussion and validation through more than 20 expert interviews and 15 focus groups with representatives of long-term care facilities and services, carers’ associations, local/regional administration, relevant NGOs/local associations, hospitals, research, nursing schools and health insurance companies (carried out by all country teams) the results of this analysis were published in a second report. As a result, this workpackage resulted in a number of new insights and products for dissemination and further research.
The Nordic countries and the Netherlands that were first to acknowledge LTC as a social risk that calls for solidarity and universal coverage, a range of countries with a ‘Standard caremix’ joined these ‘early movers’ as they started to implement instruments to fund and develop LTC towards the end of the last century. The Mediterranean countries have been coined ‘family-based’ as the (legal) responsibilities of families to provide care are most important, even if also in all other countries family care and subsidiarity principles remain the backbone of LTC provision. Finally, during the transition from communist regimes to market economies most Central and Eastern European countries have undergone profound changes in social security systems. Due to the complexity of LTC, the lack of political will and resources, LTC often remained a non-priority in this cluster of countries, a hidden if not ‘forgotten’ area. The notable similarities between the countries of each cluster do not preclude specific idiosyncrasies and differences, especially in terms of care demand, policy approaches, funding mechanisms or the levels of (de)familisation and commodification of care. For the purpose of this study LTC has been defined by considering a number of criteria to focus on the continuity of social and health care with the aim to overcome barriers at the interfaces between social and health care, and between formal and informal care. Given the nascent state of its development, LTC is an area with a wide range of opportunities for processes of ‘social innovation’ in terms of “new ideas (products, services and models) that simultaneously meet social needs (more effectively than alternatives) and create new social relationships or collaborations” (European Commission, 2011).
A new concept of ‘care regimes’: in order to contextualise findings and to do justice to the huge differences within and between EU Member States it was necessary to elaborate on existing concepts of ‘care regimes’ (see attached document).
Key Finding 1 - Expansion of LTC services
LTC at the interface between health and social care, and between formal and informal care represents a strong case for social investment to extend the infrastructure both in quantitative and in qualitative terms. Even though the expansion of services as such cannot be seen as social innovation, a large number of initiatives can be identified that combine new approaches, new relationships between stakeholders or new technological applications to reduce gaps in access for marginalised target groups, professionalisation, information and communication. The potential for improvement through service expansion therefore consists in the following:
• A better definition of target groups in need of LTC would avoid under supply, inappropriate or in some cases even oversupply. Users should get needs-based access independently from the origin of their disability because different regulations for specific age groups, diseases or disabilities are causing a lack of coverage and appropriate support.
• Acknowledgement of informal carers as a specific target group for support measures would facilitate a better work-life-care balance for carers at working age, and older carers (spouses) could be prevented from strain that may cause that they end up in needing LTC services themselves.
• A better balance of service provision between metropolitan and rural areas, e.g. by means of appropriate financial incentives for municipalities and professional interventions at the local level, could avoid undersupply and re-strengthen social ties in rural areas.
• In many Member States there is a rising need for considering ageing citizens who are foreign-born as a target group for LTC services to avoid social exclusion.
• The role of the EU in such processes could be, apart from providing funding opportunities, to promote the usage of ICT and assistive technologies in LTC delivery, to ensure mechanisms for promoting LTC across all types of care regimes and to gather appropriate data for analysing supply and demand across Europe.
Key Finding 2 - Re-orienting Europe’s LTCsystems towards community-based care
The potential for Social Innovation Community-based care entails a model of care in which the locality – with its disparate stakeholders working together – serves as the nexus of support and care provision, and in which the confluence of formal and informal support and care, including volunteer services, is a central principle. Essentially, community-based care is one approach to meeting the needs of users receiving community care, i.e. care at home; an approach that emphasises person-centred care and the complementing of formal care services by making the most of resources and networks available in the user’s local environment.
A clear distinction emerges between those countries that have already pushed for fully realised community-based care innovations (Care-mix, Universal), and those in which there remain considerable opportunities to do so (CEE, Family-based). Even among the former, community-based care models have not yet become mainstream practice and tend to be isolated to specific localities and regions. Transferability of best practices in this area is hampered by existing framework conditions that require concerted reforms at the national, regional and local levels.
National-level recommendations:
• Endow local governments with the authority to plan and coordinate care services, with at least partial long-term funding support coming from national sources;
• Incentivise civil society organisations and grassroots initiatives with financial support that extends beyond the traditional duration of pilot programmes (approx. 5 years);
• Incorporate systematic evaluation and a strategy for eventual scaling-up into innovation programmes receiving public funding.
Institutional-level recommendations:
• Develop community networks and create time and space for mediation and negotiation with all stakeholders involved;
• Service planning based on needs assessment involving users from within the community;
• Recruitment of personnel and volunteers from within the community;
• Incorporating solidarity, social participation and building on common social values as core principles.
Key Finding 3 - The potential of integrating and coordinating LTC
Criticism about fragmentation hampering the appropriate delivery of long-term care, as underlined in the relevant literature, has been repeated in expert interviews and focus group discussions. The potential for social innovation and policy measures to foster active ageing by coordination and integration therefore consists in improving independent living of older people at home by inclusive strategies involving new types of stakeholders, coordinating existing (or new and additional) services (e.g. case management) and improving the infrastructure such as the built environment as well as information and communication technology (ICT).
Recommendations
At the macro-level it is necessary to strike a balance between national framework legislation (funding, standard setting, controlling) and the local settings in which services, facilities and care relations are being organised and delivered. National governments need to embrace the concept of ‘social investment’, in particular in those countries where social support and LTC policies have not yet been fully implemented. First steps towards national strategies need to be underpinned by a profound intersectorial dialogue to shape appropriate national framework conditions and by tangible ‘Social Innovation Funds for LTC’. In this connection, coordination between national authorities and EU funding opportunities needs to be enhanced as initiatives by local partnerships based on funding by EU programmes often do not find subsequent financial backing at the national level beyond the pilot phase. On the meso- and micro-level, apart from the fundamental issues of stakeholder involvement and citizens’ participation, the following recommendations for realising active ageing and social innovations that address issues of coordination and integration were deduced from the analysis of expert interviews and focus groups with relevant stakeholders in the participating countries:
• A focus must be put on ‘the local’, e.g. by activating and building on local resources and existing networks to promote the development of dedicated LTC structures;
• Information and consultation structures should be integrated under one roof (‘one-stop shop’ principle) based on inter-sectorial data systems;
• Bundling information at the interfaces must be professionalised by implementing new job profiles (e.g. case managers, network coordinators, social animators and mediators);
• The scope of LTC and integration needs to be extended by addressing new societal challenges in the community towards general issues related to ageing and intergenerational exchange including ICT applications, built environment, transport and employment.
By considering these features, investing in LTC policies offers major potentials to national and EU strategic objectives concerning growth, (female) labour market participation and the reduction of poverty and social exclusion.
Key Finding 4 - Social innovation in the area of employment in LTC
Priority areas for social innovation in LTC employment
-TRAINING: ‘Specialised training’ for LTC workers; ‘Integrated training’ for formal carers’ profiles; national or local programmes for (further) qualification of formal and informal carers; web-based e-learning
-PROFESSIONAL PROGRAMMES: Recognition and regulation of household-based privately hired (migrant) care workers’ profiles and skills (including qualification); development of specialised LTC professional profiles; differentiation of professional LTC profiles
-GOVERNANCE AND REGULATION: Formal professional profiles specialised in integrated LTC (including migrant care workers); multidisciplinary teams (case management); new stakeholders in LTC governance, including employment (main challenge: how to involve different stakeholders’ groups into the policy decision-making process).
-NETWORKS AND STAKEHOLDERS: For-profit and non-profit organisations/NGOs as providers of training programmes and new types of LTC services; mixed networks (private and public) involving local institutions and private (for-profit and non-profit) organisations to promote LTC employment and training; a more systematic involvement of care recipients and informal carers.
‘Enablers’ of social innovation in the LTC employment sector:
MACRO LEVEL: Propensity to ‘professionalisation of care’ by investing appropriate resources to remunerate LTC providers; recognition of the crucial role played by privately hired (migrant) care workers in LTC, in particular in family-based care regimes, by implementing nation-wide programmes to fight undeclared work, support quality care provision (e.g. accreditation) and prevent care drain in migrants’ countries of origin; adoption of specific national programmes or reforms to train family carers and low-skilled (migrant) care workers, e.g. via web-based e-learning initiatives; mainstreaming LTC policies, also by involving for-profit and non-profit providers in quasi-markets of care.
MICRO-MESO LEVEL: Positive attitude of local LTC organisations to join forces, e.g. to achieve better terms in working and employment conditions of LTC staff (e.g. federations of non-profit organisations); inclination to develop and disseminate grass-root initiatives to tackle local LTC needs; presence of local projects and programmes to integrate migrant carers into local formal care provision; development of age-friendly environments; adoption of ICT and new technologies in the delivery of LTC at local level, accompanied by appropriate training of professionals involved.
WP9 - ENHANCING ACTIVE CITIZENSHIP
The main results of this WP are:
• While preferences for spending depend on age and cohort, we found no evidence of an up-coming generational conflict over public resources in the medium term;
• Strong support among stakeholders for MoPACT’s key policy-proposals, namely for establishing mandatory senior advisory bodies at the local level, for linking the retirement age to longevity, and the need to provide more information about pensions. Split in the support for the idea of adopting differentiated retirement ages;
• As people enter retirement, there was a tendency to abandon employment-related civic society organisations (trade unions, professional associations). Otherwise, civic engagement seemed to remain stable over the lifecycle;
• Perceived violations of prescriptive norms elicited negative stereotypes concerning the seniors’ contribution to the economy. Violations of the succession norm (making jobs available for the young) increased the likelihood to support spending on the education, i.e. on the young;
• While a comprehensive approach is required, policy-makers should consider the introduction of the right to representation for seniors at the local level, or seniors’ participatory budgets, as options for promoting the involvement of seniors in policy-making.
The first task aimed to assess to what degree population ageing is likely to change policy preferences in European countries, namely with regards those policies where a priori the largest effects would be expected such as pensions or education. With this in mind, we started by conducting a comprehensive review of the literature on how policy preferences evolve with age. Subsequent to this, we explored a set of comparative European surveys (ESS, SHARE, ISSP) to assess how spending preferences will look like in 2040 given the changes in the age structure of the population.
Potential changes in the (aggregate) policy preferences due to demographic ageing were tested under three, competing, assumptions. First, we tested the assumption that policy preferences vary with individuals’ age. This was done by reweighting the population weights in each survey to match the population composition in 2040. Our analysis found only very small changes in aggregate preferences due to population ageing. Then, we tested the assumption that policy-preference remain constant over the life-cycle. This was done by pooling data from 4 waves of the ISSP survey to build a synthetic cohort panel (Deaton, 1985; Verbeek, 2008; Jæger, 2013). This allowed us to track how the (average) policy preferences of birth cohorts evolve over time. For the two countries for which there was data for the 4 waves (UK and Germany) our analysis did not find any significant changes in preferences.
Finally, and still making use of the ISSP synthetic cohort panel, we projected the expected changes in the aggregate preferences under the assumption that cross-individual variations reflect both age and cohort-effects, i.e. that cohorts display the same preference pattern over time but that different events throughout the life cycle might alter policy preferences. Our analysis suggested that, in the UK, the drop in support is stronger in policies that benefit primarily the younger (education and unemployment benefits). However, an analysis of cohort specific preferences showed that it is unlikely that this shift reflects changes in the age structure in the country. On the other hand, in Germany we only projected a strong increase in support for spending in education – which reinforces the idea that demographic ageing will not significantly impact on the distribution of preferences for social spending in the future.
The next task aimed to take hold of the receptivity of stakeholders to some of the key policy proposals that the MoPACT consortium identified as promoting active ageing. With this in mind, we conducted a survey among a wide set of stakeholders. The survey was disseminated using the substantial network of AGE-platform, and other relevant networks available to the team. We found wide agreement on policies related to creation of (mandatory) advisory senior bodies, providing more training for (formal and informal) care workers and better provision of information on pensions. Furthermore, 4 out of 5 stakeholders seemed to support linking retirement age to longevity. However, there was little consensus as to how an increase in the retirement age should be implemented. In fact, there was an almost even split between stakeholder in the support to the idea that pension ages should be differentiated between socio-economic groups. Finally, there was little support for the idea of financing an increase in age related public spending through general consumption taxes.
Task 3 had two aims. The first was to chart variations in level of civic engagement of seniors across Europe, and to what degree this differed from that of the younger cohorts? With this in mind, and building on framework put forward by Hoskins and Mascherini (2009), we explored a set of European data sources (ESS, EVS and SHARE) to assess how active citizenship for older people varies throughout Europe, both cross-sectionally and over time. We started by building composite indexes to measure cross-country differences in active citizenship, both in the whole population and in those age 60+. This exercise revealed that cross-national differences in the civic engagement the senior population mirrors broader patterns of political participation. Among the 19 EU countries for which comparable data is available, Sweden, Norway and Denmark display the highest levels of active citizenship for the population aged 60+. On the other extreme, Poland, Hungary and Portugal are the countries where seniors are the least involved in civic life.
With the view to further explore differences in active citizenship across generations, we then created a composite indicator that compares the political engagement of seniors in a given country with that of their younger counterparts. Applying this methodology, we found that Austria and Norway, which previously ranked as the countries with the highest levels of active citizenship, the civic engagement of seniors was well below that of the younger generations. In contrast, France and Great Britain, now rank as the countries where level of active citizenship of those 60+, compared to that of the younger cohorts, is the highest.
The second aim of this task was to assess if entering old age may signify a withdrawal from the civic sphere? With this in mind, we ran two (complementary) studies. In the first study, we used data from European Values Survey to build a pseudo-panel. This allowed us to track changes in the level and type of political participation of groups of individuals with a set of common characteristics (year of and country of birth) over time, while accounting for the impact of other relevant (and time-variant) factors, such as income, education, or changes in family (marriage, children) or work life (in education, in work, in retirement). We found that, if we considered the full range of activities covered (involvement in political parties, participation in community organisations, in employment-related civil society organisations and other civil society organisations) the transition to retirement was associated with a drop in the level of civic engagement. However, this should not be seen as evidence of a processo of political disengagement. Instead, it reflects the abandonment of employment-related civil society organisations as individuals leave the labour market. Participation in other domains of civic life seems to remain stable even after retirement.
In the second study, we looked specifically at the potential crowding-out effect of the provision of informal family care to older relatives on active citizenship. Building on data from waves 1 and 2 of the Survey of Health, Ageing and Retirement in Europe (SHARE), we showed that rather than imposing a crowding-out effect, providing care informal family care outside the household was correlated with higher levels of active citizenship. However, this is less true for women, who have fewer opportunities than men to be active in other domains of social social life.
Bearing in mind that negative stereotypes can act as an important obstacle to the participation of seniors in the civic sphere (Swift et al, 2017), we sought to identify the mechanisms that reinforce negative stereotypes about seniors, and find ways to reverse them. Two complementary studies were conducted. In the first study, we ran experimental studies involving young respondents in Portugal (115) and the UK (207), to test if the violation of norms concerning the use of public resources (pensions, healthcare) by seniors (consumption norm) by seniors, the availability of jobs for younger generations (succession norm), and what should be the typical lifestyles of seniors (identity norm) (North and Fiske, 2013) elicits negative stereotypes and attitudes towards seniors. The results of the experimental studies suggested that, for both Portugal and the UK, violations of these prescriptive norms do not seem to impact on evaluations of seniors in terms of warmth (Fiske et al, 2002). However, In the Portuguese study, results suggested that the violations of the succession norm strengthen negative evaluations of seniors in terms of their competence. This finding, however, is not validated by the UK study. The experimental studies also suggested that the perceived violation of the consumption, succession and identity prescriptive norms seemed to elicit negative stereotypes concerning the seniors’ contribution to the economy. In contrast, no effect was seen on representations of seniors concerning their contribution to social customs and way of life. Finally, the experimental studies conducted in these two countries seemed to suggest that perceived violations of the succession norm increased the likelihood to support spending on education - which favoured the younger generations, at the expense of the older generations.
In the second study, we conducted a content analysis of a random sample of articles published in a set of leading newspapers in Portugal (Correio da Manhã, Público, Jornal de Negócios) and the UK (The Guardian, The Times, The Daily Mirror, The Daily Mail, The Financial Times) to assess to what degree print media helps to (re)inforce prescriptive norms about seniors. Our analysis suggested that the succession, consumption or identify norms are not as salient as are more general representations of seniors in terms of warmth and competence. Second, we found that prescriptive norms about how seniors should behave in society were more salient in UK media. Thirdly, and also importantly, our analysis showed that, both in the UK and in Portuguese media, the consumption norm was much more salient than the succession or identity norms. Finally, our results seemed to indicate that, rather than genre or political orientation, the target audience of the newspaper – i.e. if it targets seniors or younger audiences - explains variations in the salience of prescriptive norms about the role of seniors in society.
The final task aimed to identify best-practices and promising approaches in advancing the effective participation of senior citizens in policy-making. We conducted a comprehensive search of national/regional/local participatory initiatives in Europe. Having listed 80 initiatives, systematic information about 35 was compiled. Building on this, we were able to establish a taxonomy of participatory approaches, consisting of:
• consultative approach in decision-making (28 cases);
• consultative approach in policy-implementation (6 cases);
• co-decisional approach in decision-making (2 cases);
• co-decisional approach in policy-implementation (1 case).
With the view to further understand the factors that can boost/hinder the involvement of seniors in policy-making, we conducted three peer-review seminars designed to gain deeper knowledge about the initiatives we identified as three best-practices in the involvement of seniors in policy-making:
• the “Seniors’ Participatory Budget”, in Alfândega da Fé (Portugal);
• the “Senior Citizens’ Councils”, in Denmark;
• the “Partnership for Older People Programme”, in Dorset (UK).
Building on these peer-reviews, we identified a set of Policy Guidelines for promoting the participation of seniors in policy-making:
• ‘Commitment is Paramount’. Participation needs public statements of commitments between political authorities and civil society;
• ‘Beware of Diversity’. Political authorities should take into consideration the ways senior citizens from different social backgrounds - not only of highly-educated citizens – and different ages – as the older senior citizens aged +80 – can have access and participate to the initiative;
• ‘Acknowledge the Benefit of Good Communication’. Civil society should have the chance to be informed about the state of the art of the policies to be debated, and should also be regularly updated about the advancement of the participatory process;
• ‘Be Comprehensive in Your Approach’. Political authorities should make sure that participatory initiatives are sustained by broader institutional changes aimed at overcoming entrenched bureaucratic processes and addressed to improve open public data systems;
• ‘Invest in Training’. The agencies in charge of the organisation of participatory initiatives should invest in the training of the actors involved in the process.
Potential Impact:
The potential impact of MOPACT lies in its core policy messages which were generated in the last year of the project, which are summarised in the widely disseminated policy briefs. The motivation for the project itself seeks to accomplish a fundamental change in society, to establish a new approach to ageing in Europe: making longevity an asset.
The final policy briefs of MOPACT directly address this potential impact, and provide an evidence base for interventions and policy to help accomplish this fundamental shift, which can be achieved by adopting a life course-based strategy for active ageing. This new vision of a society in which ageing is understood as an asset, not a burden, is described below, followed by summaries of the specialised recommendations from each of the work packages.
Summary:
• MoPAct provides a new vision of ageing in which longevity is considered as an asset for social and economic development.
• Active ageing has been rising across EU Member States.
• The Central European countries face the greatest challenges in adopting active ageing strategies.
• Risks of social exclusion in later life are increasing, especially with regard to frailty, which emphasises the need for a comprehensive approach to active ageing.
• Ageing is not inevitably linked to the development of chronic diseases many of which can be prevented.
• While the EU has been a major source of support for research in this field, more is still required.
• MoPAct provides a new vision of ageing in which longevity is being considered an asset for social and economic development.
Why active ageing? MoPAct adopted the comprehensive life course definition of active ageing proposed by the European Road Map for Ageing Research (http://futurage.group.shef.ac.uk/roadmap.html). Active ageing is a comprehensive strategy to maximise participation, healthy life expectancy and well-being as people age. It should operate simultaneously at the individual (lifestyle), organisational (management) and societal (policy) levels and at all stages of the life course. Realising active ageing was at the core of MoPAct’s research programme. It rests on two pillars: pperationalisation of the concept of active ageing by using the Active Ageing Index as its starting point, and developing active ageing strategies with high-level scientific research and stakeholder engagements. The aim has been to translate research findings to maximize the impact on the lives of people and on the sustainability of public welfare systems. This policy brief summarises policy knowledge drawn from MoPAct and points to prerequisites and public policy priorities for realising active ageing in Europe.
Policy-relevant knowledge synthesised from MOPACT
MoPAct was a major multi-disciplinary research project, which built on the FUTURAGE Road Map. It placed emphasis on the so-called New Member States of Central Europe, because they are among the least economically developed countries of the EU bloc and the speed of population is fastest in these countries.
Key policy relevant findings from MoPAct are:
I. Active ageing has been rising across the EU Member States in the recent past
The evidence drawn from the analysis of the Active Ageing Index offers a clear sign of a change that there is now a greater emphasis on active ageing strategies across Europe. Still, there remains a significant scope for further improvement, even in countries which have had a greater success in promoting active ageing. For most countries the changes for both men and women showed improvement although with a significant gender gap in almost all countries. Moreover, all other things being equal, the individual level experiences of active ageing have become more equal across subgroups in the recent past (for the nine countries where data is available to undertake overtime comparison during the period from 2004 to 2013). Further analysis shows that a higher experience of active ageing is correlated with a higher quality of life of older people. Likewise, the relationship between active ageing and per capita wealth is also significantly positive. Thus, active ageing does not imply a worsening of older people’s quality of life and it brings real benefits to the economy.
II. Greater challenges are observed for Central European countries
Active ageing in central European countries is typically low, reflective of weaker institutional capacity and enabling environment for active ageing in these countries. In particular, social participation of older population is markedly low. Employment among older persons is relatively high which reflects inadequate levels of pension income constraining people to remain longer in employment. When the problem of pension income adequacy is addressed, the higher levels of employment (especially among people over retirement age) will not be sustainable without further supportive policy initiatives improving work environment and incentives for longer working careers. The central European countries with low active ageing outcomes also show higher inequality across subgroups. This finding also means that helping the most vulnerable in EU Member States with low active ageing will go a long way towards supporting more equality across Member States.
III. Greater risks of social exclusion are forthcoming in older age
Overall, life expectancy at age 65 in EU countries increased, but healthy life expectancy decreased marginally. Similar trends were observed at age 50 and at age 85. Evidence also points to a large variety between the countries in healthy life expectancy and trends in healthy life expectancy. These findings imply that greater time will be spent in the future in a health status that requires specialised care and support. One other source of greater risks of social exclusion in the future is a change in the age structure of the European population, with rising proportion of one-person families. Number of people 80+ living alone will be at least two-fold in 25 years (in the five countries studied). Individuals and societies should be prepared for the increased economic and social risks of living alone in later life.
IV. Ageing is not inevitably linked to development of chronic diseases
MoPAct evidence points to the fact that only 20-25% of healthy life expectancy is pre-determined by genes. In fact, age associated molecular and cellular damage can be prevented or greatly delayed by lifestyle interventions (e.g. dietary manipulations) and by enabling environments (e.g. knowledge of nutrition, facilities for exercise, timely vaccination). Social investments are required in earlier phases of life to maximize healthy part of longevity which is subsequently responsible for a variety of activities in later life.
V. The EU institutions have been playing an important role in supporting research and innovations but more is required.
The funding for MoPAct has generated strong scientific evidence to inform public policy priorities for active ageing in Europe. Strong political commitments from national and EU-level policymaking institutions are now required for social policy reforms in realising active ageing at all ages. MoPAct provides a new vision of ageing in which longevity is being considered an asset for social and economic development. Similar multidisciplinary projects on active ageing require further funding and translational research towards formulation of strategies.
Five prerequisites for realising active ageing in Europe
• First, the optimistic paradigm of ageing needs to be promoted, viewing older people as agents of change, and with social and economic rights.
• Second, a life course perspective needs to be adopted, putting a strong emphasis on active ageing at all ages.
• Third, the heterogeneity among older persons needs to be appreciated. In the process, the active ageing strategies needs to be made relevant for all and not reduced to elites who are better educated and enjoy good health in later life.
• Fourth, the multidimensionality of active ageing must capture all its aspects of economic and social activities. Active ageing should not be reduced to the idea of longer working careers but also social engagement, independent living and security.
• Fifth, in devising active ageing strategies, it is essential to take account of diversity in the institutional capacities and enabling environments for active ageing across EU Member States.
Major policy priorities and instruments
MoPAct points to the various top level policy goals in Europe. Below these goals are mentioned along with description of policy reforms necessary.
Goal 1 - Ensuring economic and social sustainability: The key to economic sustainability is linking retirement ages to life expectancy. This strategy will also contribute to reducing inequalities in pension income outcomes across different socioeconomic classes. To extend working lives, it is essential to coordinate public policy with work-place human resource policies. Furthermore, interventions need to be tailored to match the state of readiness in each country and organisation. To stimulate private savings, the provision of information and financial literacy is not enough, people also need specific guidance in changing their savings behaviours.
All policy reforms towards financial sustainability must keep in sight the goal of maintaining pension income adequacy.
Goal 2 - Promoting health and well-being in later life: Urgent actions are required in countries where the gap between life expectancy and healthy life is largest: Slovakia, Portugal, Germany, Slovenia, Estonia, Spain, and France. The classic public health interventions are required in all EU Member States to promote health outcomes in later life, in particular promoting nutritional diet, exercise, and vaccination. Social investment type early life interventions are required in increasing healthy life expectancy so as to keep pace with rising life expectancy and reduce dependency in later life.
Goal 3 - Provision of adequate person-centred long-term care: Interventions are required on several fronts in improving the long term care services: expanding existing services where the provision is inadequate; greater coordination and integration of health and social care services; innovative design and implementation of community care, and; employment and professional training of carers. In this respect, there is a clear divide between Member States in their readiness for and implementation of much needed social innovations in long term care. Therefore, there is a greater scope for knowledge sharing between the frontrunner countries and others.
Goal 4 - Adopt modern technologies for efficiency and effectiveness: ICT-based assistive technologies have huge potential for active ageing and the silver economy, but the deployment gap needs to be reduced. The key barrier for an effective deployment is lack of awareness and acceptance among users. Furthermore, public subsidies are required to incentivise take up of the ICT-based assistive technologies. These barriers need to be tackled with urgency.
Goal 5 - Engagement of older persons in social, cultural and civic activities: Active ageing strategies should pay particular attention to promotion of social engagements and cultural and civic activities in later life. Special emphasis needs to be placed on lifelong learning activities. Greater participation of older persons requires commitments between political authorities and civil society. For instance, there is a need to create local advisory bodies in all Member States to represent the views of seniors. The heterogeneity of older people (age, education, gender, class, culture) has to be taken into account if participation initiatives are to be successful.
*ECONOMIC EFFECTS OF POPULATION AGEING*
Policy priority Adjust pension policy to longevity changes so that the ratio of working years to retirement years is maintained in countries with high employment rates for older workers and increased in other countries.
Summary:
• Individuals should be informed about the increased economic risks of living alone and longer than expected and societies should provide for multiplication of the numbers of elderly citizens in one person households.
• Alternative measures indicate that the challenge of population ageing is less immense than traditional chronological measures would suggest, but also that substantial increases in the length of working lives are necessary to maintain current economic dependency ratios and to address the public finance challenges of ageing.
• Linking retirement ages to life expectancy extends working lives markedly. The distributional effects are not as negative as often suggested. In fact, such a policy may well reduce lifetime welfare inequalities, at least in countries with a relatively comprehensive overall social security system.
*EXTENDING WORKING LIVES*
Policy priority Public policies on extending working lives must be joined-up with policies and actions at the workplace.
Summary: Policies primarily (or even exclusively) aiming at working longer through financial incentives are of very limited success if not strategically linked to work place related HR policies. In ‘laggard’ (Central and Eastern European) countries external incentives and support (e.g. legal incentives, professional advice) are needed most. Attitudes and values are playing a prominent role. In ‘front runner’ countries (e.g. Germany), health, skills and working conditions are the most significant points of departure. In organisations the concepts of workability and employability are the best points of departure for designing policies and measures. The concepts of age-management and life-cycle oriented HR policies need to be adapted accordingly.
*IMPROVING PRIVATE PENSIONS AND RETIREMENT PLANNING*
Policy priority Well designed private pensions are needed to supplement public pensions, aiming at customising retirement income to individual needs, optimally allocating systemic risks, and contributing to deeper EU capital markets and thereby higher economic growth.
Summary: Private pensions are needed to supplement public pay-as-you-go pensions which are under pressure due to population ageing and the financial crisis. Funded private retirement savings can help create a deeper, more integrated European capital market, thereby enhancing macroeconomic stability and economic growth. The design of private pensions can be improved by customization of pensions to individual needs, by optimising (collective) risksharing over the lifecycle, and encouraging EU wide portability through e.g. the development of Pan European Pension Products (PEPPs). Information campaigns or financial education programs are not sufficient for realizing adequate private retirement planning. Development of choice architecture is essential, that is offering products and choices in a way that helps consumers to transform intentions into appropriate actions and decisions. This supports the choice process but does not reduce choice opportunities or the consumers’ final responsibility for their own pension provisions.
*HEALTH & WELLBEING*
Policy priority Prevent disability! Meaning: chronic diseases are here to stay, but this does not mean that you cannot live a satisfying life. However, this will become more difficult with increasing disability
Summary:
• During the period of study, 2005-2012, increases in life expectancy at EU-level were not accompanied by increases in healthy life expectancy. The three countries with the largest number of unhealthy life years were Slovakia, Portugal, and Germany.
• Social participation is lower in older people in poor health than in those in good health. Yet, the determinants of social participation are generally the same in both groups. Thus, generally similar measures to promote social participation for older people in good and poor health are recommended. Meanwhile, a few factors proved extra barriers for participation in older people in poor health: depressive mood and lack of transportation.
• Governments have high expectations of private initiatives in the social care sector. It is important that the policy infrastructure supports these initiatives. For example, the funding system should be made better accessible to small organizations, and public transportation services need to be in place for older people with health limitations.
• Different types of social activities compete with each other for time. Regarding policy measures, emphasis has been on labour market participation. However, it is important to facilitate the combination of paid work with other activities such as volunteering and informal caregiving.
• An increase in social participation levels has a very limited contribution to healthy life expectancy (HLE) (0.0 to 0.1 years), and thus will not greatly contribute to the EU goal of increasing HLE by two years in 2020. Regardless, social participation is valuable for society, so it is important that governments facilitate social participation, for older citizens in both good and poor health. More research on alternatives to raise HLE is needed to guide policy.
*BIOGERONTOLOGY: A NOVEL TOOL TO STAY HEALTHY IN OLD AGE*
Policy priority Healthy lifestyle interventions in particular regarding nutrition and vaccination need to be implemented early in life with a lifecourse perspective.
Summary: Accumulating evidence from experimental studies shows that aging is not inevitably linked with the development of chronic diseases. Only 20-25% of healthy life expectancy (HLE) is predetermined by genes; lifestyle and environment play a major role. Age-associated accumulation of molecular and cellular damage can be prevented or greatly delayed by lifestyle interventions e.g. dietary manipulations. Classical strategies (e.g. nutrition, exercise, vaccination) require broad communication to public and novel strategies (e.g. dietary interventions, novel drugs, stem cells) need successful translation from the understanding of molecular mechanism to animal models to the clinical setting. To be successful interventions need to be started early
in life with a life-course perspective.
*BUILT & TECHNOLOGICAL ENVIRONMENT*
Policy priority Plug the deployment gap by creating a platform to encourage business-user collaboration, and focus on the needs of less disadvantaged older people.
Key findings: ICT-based assistive technologies within the fields of mobility, housing and health have a huge potential for active and healthy ageing and offer many opportunities for “success stories” in the emerging Silver Economy. Considering assistive technologies for older persons, Europe and its member states face a ‘deployment-gap’ – the mismatch between R&D efforts on the one hand and policymaker’s expectations and implementation success on the other hand. However, to unlock the full potential of innovative ICT-based solutions, several barriers have to be addressed. The most dominant are: The lack of awareness and acceptance among the users, missing reimbursement and a lack of evidence. There are many good practices and social innovations in European countries that can help to overcome these barriers, in particular focusing on the issue of user acceptance. Differences among the European countries in terms of ICT uptake and literacy/skills can be a chance for policy learning and knowledge transfer, but ask for more country-specific approaches.
*POTENTIALS FOR ACTIVE AGEING BY SOCIAL INNOVATION IN LONG-TERM CARE AND SOCIAL SUPPORT*
Policy priority Recognise that innovations and investment in LTC constitute an asset for ageing societies by contributing to employment, reducing poverty and inequality, strengthening inter-generational balance, and eventually to efficiency gains in public expenditure on health and social care.
Summary: There is an urgent need and a strong potential for innovation in the following four areas within LTC: a) expansion of services, b) coordination and integration of services, c) implementation of community-based care, and d) employment and professional training. Among the countries reviewed as part of this research, there is a clear divide in terms of the presence of framework conditions (i.e. incentive structure) for promoting innovation within these four areas in LTC. This translates into ‘frontrunner’ countries (e.g. DE, NL, AT) that have made strides towards scaling-up complex, partly integrated service innovations, and ‘laggard’ countries (HU, RO, ET) where innovations tend to be less complex, operate on a small-scale often without public support, and are vertical or isolated interventions. EU institutions have an important role to play in supporting Member States by fostering transfer of knowledge between countries, and in promoting national frameworks for improving LTC by embedding incentives for innovation that take a longer term perspective.
*PROMOTING THE PARTICIPATION OF SENIORS IN POLICY-MAKING*
Policy priority: Legislate to create local advisory bodies to represent the views of seniors on key issues such as primary healthcare, long-term care, transport and urban mobility.
Summary: The involvement of seniors in policy-making in Europe is more common at the local level, but seniors are less likely to be involved in the implementation of services. The involvement of seniors in policy-making is mostly done through the creation of consultative bodies (ex. Seniors’ Councils or Seniors’ Forums). The direct engagement of senior citizens is less frequent, and it is more common that initiatives involve individual (elected or nominated) delegates or representative organisations.
*SOCIAL INNOVATION AND ACTIVE AGEING*
Policy priority Adopt a systematic evidence-based approach to both social innovation and active ageing.
Summary: Social Innovation can be defined generally as the development and implementation of novel ideas to meet social needs and create new social relationships that empower people. Social Innovation is an elusive concept which, despite widespread currency, has very little evidence to have supported a systematic change. The evidence-base requires urgent attention. Despite the absence of systematic evidence there are plenty of examples of promising social innovations in the field of active ageing. Those innovations that have gone beyond the stage of mere prompts or a proposal require closer examination with regard to impact and potential for scaling-up. It is also important to acknowledge the social, cultural, economic and political context in matters of social innovation as these factors strongly influence what social innovations can be attempted and to what extend they will succeed. MoPAct developed an easy to apply assessment method with which to judge the quality and sustainability of social innovations. A global search was undertaken to identify 150 examples of promising innovations for inclusion in the project’s database. Active ageing is also an elusive concept and needs to take a consistent, life course oriented, definition. The focus is on social innovations that recognise that older people are a resource and longevity a valuable asset to society.
MAIN DISSEMINATION ACTIVITIES
As one of the five project-wide objectives of the MOPACT, the dissemination activities were built into the project in a specific work package. The core part of this were four European events to reach out to non-scientific audiences: three Stakeholder Forums and the final conference.
The three Stakeholder Forums took place at the end of project years 1, 2 and 3, and ensured that the project findings, plans – and in the third Forum, the initial policy messages – were interrogated by an audience of older people, their representatives, charities, other civil society organisations, policy makers and practitioners. At each Forum participants were asked to use their expertise to help shape the next stage of the project and to identify overlaps, missing elements, provide up-to-date insight from a wide range of interests and countries. This had the dual benefit of generating input to the project, and, at an early stage, ensuring the message and activities of MOPACT were shared widely. The fourth event, the final project conference, was planned to reach a wide ranging audience of non-academics from across the Member States – in person and via an online webcast - to launch the policy briefs.
Continually through the life of the project multiple modes of dissemination were used to reach the widest possible audience, with Twitter proving particularly effective and complementing the project website (containing a full repository of MOPACT knowledge), Facebook, emails, leaflets and direct networking at conferences and events. In addition each work package reached out to its own academic audiences before and after the research process through workshops, seminars and conferences. The full list of 250 dissemination activities has been provided separately.
List of Websites:
http://mopact.group.shef.ac.uk/
Professor Alan Walker - a.c.walker@sheffield.ac.uk - +44 (0)114 222 6466
MOPACT was one of Europe’s most ambitious projects and focused on providing practical, evidence-based, responses to the grand challenge of population ageing. The project concluded successfully by doing everything it said it would and more. Now the MOPACT database contains a massive battery of material, all of which is accessible for policy makers, practitioners, product producers and citizens, and the key elements of which are presented in lay terms. This database must be exploited fully by Europe in the noble and economically essential endeavour to ensure that longevity is transformed into an asset rather than a burden.
MOPACT was unique in five ways. First, its scope was more ambitious than previous Framework projects. This was necessitated by the scale of the the ageing challenge and the need, in responding to it, to transcend the common segmentation of the issue. Linked to this, secondly, was the very wide multidisciplinary collaboration within the project – every relevant discipline from biology to design. Third, there was an explicit focus on social innovation, which has been much discussed but rarely pinned down concretely. MOPACT did this and the SI portal provides many examples of good practice. Fourth, the project prioritised the New Member States, because it is there that most concerted action is needed. This prioritisation took place throughout the project. Fifth, from the outset MOPACT was dedicated to maximising the impact of its science on society. This included the novel integration of stakeholders into the research process across the project, to ensure practical relevance on top of scientific quality. These special aspects of MOPACT provide a model for future projects.
Given the complexity of the project the summary of findings contained in this report is necessarily partial and fuller information is available in the deliverables, including lay summaries of the key findings, and in a forthcoming book. A summary of the summary is even more problematic:
➢ The evidence for an explicit focus, including national programmes, on healthy life expectancy across the life course is overwhelming. An emphasis on physical activity and diet is essential (and far more important than genetics).
➢ Pension system sustainability can be guaranteed by a close relationship between pension ages and life expectancy, but this emphasises the critical importance of the first point.
➢ Longer working lives depend on better organisation of working time over the life course, improving the quality of work environments and job training for all ages.
➢ The growth of the very elderly population (80+) calls for specially tailored active ageing measures (to sustain fitness) and, in many countries, a coherent model of long term care.
➢ The potential of the silver economy is untapped in many EU countries.
This taster of the riches in the MOPACT library should be sufficient to indicate the massive potential of this huge scientific effort to assist Europe in making longevity an asset. MOPACT was a brilliant project. It comprised many of the leading European scientists in this field, working concertedly to common objectives. The successful outcomes are a testament to their quality and their team working. We also had excellent support from our Commission project officers.
Project Context and Objectives:
The starting point for this ambitious collaborative project was the goals set by Horizon 2020 concerning the demographic challenge facing Europe, the necessity of improving lifelong health and well-being for all and the promotion of social innovation and that of the European Innovation Partnership on Active and Healthy Ageing (EIPAHA) to raise average healthy life expectancy in Europe. MOPACT was framed on the basis of a conviction that Europe requires a new paradigm of ageing if it is to respond adequately to these challenges in the context of open-ended longevity. Also, this paradigm must be embedded into responses to ageing at all levels – micro, meso and macro – if it is to be effective. This means a new paradigm of active and healthy ageing (hereafter active ageing) that rejects the deficit model of old age as a definite period of economic dependency.
The mission of MOPACT was to concentrate the highest possible quality of scientific analyses into the development of innovative policies and approaches that can assist public authorities and other key actors at all levels in Europe to make longevity an asset for social and economic development.
MOPACT had five specific project-wide objectives:
1. TO CONDUCT THE MOST COMPREHENSIVE REVIEW TO DATE OF THE SOCIAL AND ECONOMIC CHALLENGES OF AGEING. Using a variety of social science methods MOPACT reviewed the available evidence and modelled alternative future scenarios – with regard especially to biological ageing, retirement behaviour, pensions, health and social care, the built and technological environmental and social participation –and realised the potential for interventions to produce beneficial outcomes for people as they age and for society as a whole.
2. TO COLLECT AND ANALYSE SOCIAL INNOVATIONS AND POLICY INITIATIVES. MOPACT conducted a comprehensive global search for social innovations and policy initiatives that have proven success in promoting the experience of active ageing in a sustainable way. These formed the basis of a web based display and social media projections, and complemented and extended such work implemented by various EU stakeholders during the European Year for Active Ageing and Solidarity between Generations 2012 (hereafter EY2012). The European Active Ageing resource is an easy to access web-site with both examples of successful active ageing initiatives and social innovations aimed at promoting active ageing, with links to other related web-sites (WHO, EC, Eurofound).
3. TO MAP THE STEPS REQUIRED TO REALISE ACTIVE AGEING IN EUROPE AND TO PROPOSE INNOVATIVE WAYS OF DOING SO. The results from objectives 1 and 2 were used, via an iterative process involving relevant stakeholders, to explore and publish scenarios, containing specific steps, by which longevity can be made an asset for economic and social development using combinations of policy levers, commercial and third sector innovations and civil society initiatives. These scenarios reflected differences between Member States, for example in healthy life expectancy and financial context. New paradigms of ageing and active ageing will be major products, which includes an initial definition of active ageing.
4. STAKEHOLDER ENGAGEMENT. The shared conviction of the MOPACT partners was that scientific research alone could not deliver a fully adequate response to the Call and the societal challenges behind it. The challenges were so immense that all relevant stakeholders (or research users) were engaged proactively in this endeavour. Therefore, in each work package, key end users and stakeholders, such as policy makers, practitioners, product producers, designers and older people were involved throughout.
5. TO UNDERTAKE THE WIDE AND EFFECTIVE KNOWLEDGE TRANSFER AND DISSEMINATION OF THE WORK OF MOPACT. The project placed the highest priority on the impact of its work and specifically targeted audiences that could implement the proposed scenarios, such as policy makers at national, regional and local levels, but also the social partners and the general public of Europe, to enhance their role in contributing to active ageing.
Nine scientific work packages each worked to gather the evidence to inform the ambitious policy goals, as follows:
WP1 - ACTIVE AGEING AS AN ASSET: One of the core endeavours of the MOPACT project was to operationalise the concept of active ageing and generate an evidence base for a new optimistic paradigm of ageing. The core tasks of this work package included synthesizing work of all work packages and developing strategies for active ageing. In line with these goals, a three-step process was undertaken in developing strategies to promote active ageing:
1. To measure the extent and potential of active ageing across EU countries in all its multidimensional forms;
2. To identify a combination of macro, meso and micro actions necessary to promote active ageing, in particular by enhancing healthy life expectancy (and thus help achieve the goals of Horizon 2020 and EIP-AHA) and empowering older people and their communities;
3. To engage with diverse stakeholders to gain insights about future socially innovative strategies to address challenges associated with population ageing.
WP2 – THE ECONOMIC CONSEQUENCES OF AGEING: the overarching aim was to conduct the economic analyses necessary for Europe to begin to make longevity an asset with the following objectives:
• To provide a state-of-the-art review of the studies on the economic effects of population ageing from the points of view of individuals and their families, public finances and the economies of Member Countries and the EU.
• To update, improve and expand projections of the future demographic trends of selected Member Countries, especially the household structures and mortality rates at old age.
• To study how policies aimed to fully utilise the potential of older age groups affects the projected economic development and public finances. The influence of policies on formal and informal labour supply, saving behaviour and consumption choices are analysed using numerical life-cycle framework.
• To quantify the economic consequences of the demographic transition for the structure of consumption demand, the national production structure and foreign trade of EU using a multi-country OLG model. To study how education and tax policies affects these trends.
WP3 – EXTENDING WORKING LIVES: aimed to produce innovative scenarios on how to keep older workers longer in working life and to intensify their lifelong learning activities successfully and sustainably, by identifying highly innovative “best practices”. These were ideally combinations of different strategies engaging a diverse set of public, private and third-sector stakeholders with a focus on both paid and informal work. The research aimed to cover selection of EU countries to reflect the major welfare regimes (Scandinavian (DK, FI), Liberal (UK), Conservative (BE, DE, NL), Mediterranean (IT, ES), Transitional (PL, CZ )), while also drawing on innovative solutions from outside the EU (e.g. US, Singapore, Japan, and Australia). A final objective was to put special emphasis on the corporate level (with particular interest in SMEs).
WP4 - PENSION SYSTEMS, SAVINGS AND FINANCIAL EDUCATION: aimed to create the knowledge base to ensure pension adequacy and pension system sustainability in the era of increasing longevity, demand for life-cycle financial planning and fiscal austerity. The research objectives were to review and propose practical actions on three aspects that are crucial in the delivery of adequate, sustainable and safe pensions in Europe: (i) intragenerational equity: supporting groups who are vulnerable in older age; (ii) intergenerational risk sharing and private pensions; (iii) effective communication of pension risks and expectations in providing incentives for savings and rational portfolio behaviour. This was to be accomplished by addressing policy makers, government agencies on social security, pension providers and insurance companies.
WP5 - HEALTH AND WELL-BEING: aimed to provide insights, and propose innovations, in factors driving both healthy life expectancy and social engagement of older people. It has a particular focus on mechanisms at the micro, meso and macro level that are likely to foster socially productive and satisfying lives in older people in poor health:
• Healthy lifestyles and psychosocial conditions during the life course and at present (micro)
• Availability and accessibility of health care services such as post-acute care and rehabilitation services, and the physical environment (meso)
• Policies and social innovations that facilitate effective social engagement and inclusion (macro).
• These mechanisms will be examined for specific population groups according to socio-economic status, marital status, and gender, and for older people with specific disabling diseases such as osteoarthritis.
WP6 – BIOGERONTOLOGY: the main aim was to emphasise the potential of biogerontological breakthroughs to support active ageing and the economic potential of procedures and intervention designed to offset the ageing process. The main intention was to strengthen the links and improve the flow of information between natural scientists/medics and other disciplines, especially the policy-related ones. Specific objectives were to: identify recent biogerontological findings suitable for translation; verify the suitability of presently used strategies to postpone/prevent ageing and age-related diseases, and organise continuous and wide-spread communication regarding biogerontological progress and its translation between scientists of different disciplines and various stakeholders.
WP7 - BUILT AND TECHNOLOGICAL ENVIRONMENT: addressed the fact that researchers as well as business consultants and politicians expect the growth of more and more innovative solutions which will benefit both the living conditions of old people and the prospects of relevant business firms and sectors. With respect to housing, mobility and transport and ICT this research sought out evidence of: promising “silver” innovations and future technological and organisational opportunities for such innovations; whether and how they can result in better products and services meeting the needs of ageing generations; whether, how and to which degree such innovations can and will result in new and growing market opportunities for the relevant firms and business sectors. In addition, the research objectives included a review of barriers to a broad deployment and diffusion of successful and promising “silver” products and services, and identification of which strategies and policies can be recommended to firms and policy makers to encourage them to strengthen all activities which profit from better meeting the needs of older generations.
WP8 – SOCIAL SUPPORT AND LONG-TERM CARE: aimed to understand the key, innovative factors which can transform ageing-related social support and long-term care into crucial drivers of sustainable socio-economic progress. In addition, the research planned to systematically involve relevant stakeholders in identifying relevant drivers for policy change, social capital-building and innovation in the delivery of social support and long-term care. Finally, consideration would be given on how to use this information to build future scenarios of how integrated, age-friendly approaches can be realistically implemented to ensure active ageing in the context of social support and long-term care.
WP9 – ENHANCING ACTIVE CITIZENSHIP: aimed to create the knowledge base for enhancing the political participation of senior citizens, and improving the capacity of adapting to change. To accomplish this, the research objectives were to:
• Map age-based distribution of preferences with regard to the distribution of public resources, and understand how this is influenced by ageing processes.
• Assess the receptivity of stakeholders, namely senior citizens, to the different policy proposals identified by our consortium as promoting a new paradigm of active ageing.
• Chart the different patterns of participation of senior citizens in various levels of policy-making and investigate its socio-economic correlates.
• Identify ways of promoting positive representations of senior citizens, which may booster social and behavioural processes that promote their empowerment and overcome the stigmatising representations about senior citizens that can create an obstacle /disincentive to their civic participation.
• Identify good practices and promising approaches in successfully advancing effective senior citizens participation in policy-making processes.
These research activities were supported by additional workstreams supporting dissemination, notably through implementing a series of Stakeholder Forums which provided, at three key points in the project, an opportunity for non-research stakeholders a chance to review and feedback on the project’s key findings and policy messages.
Project Results:
ANY FIGURES AND TABLES MENTIONED HERE ARE LOCATED IN THE ADDITIONAL ATTACHMENT
WP1 - ACTIVE AGEING AS AN ASSET
The evidence on active ageing reported was drawn from the Active Ageing Index, calculated for all EU countries using the latest data available. To analyse differences and draw out policy implications the AAI results were categorised into three groups of EU countries: High-, Low- and Middle- scoring countries (Figure 1). Sweden, Denmark, the Netherlands, the United Kingdom, Finland and Ireland were the high-scoring countries. Then there are nine countries that cluster together as the middle-score countries: Belgium, The Czech Republic, Germany, Estonia, France, Italy, Luxembourg, Cyprus and Austria. The remaining thirteen countries were categorised as low-score countries: Bulgaria, Greece, Spain, Latvia, Lithuania, Hungary, Malta, Poland, Portugal, Romania, Slovakia, Slovenia and Croatia. Table 1 (attached) schematically presented the focal areas collected in the AAI and mapped them onto the core areas covered in different work packages within the MOPACT project. The analysis furthermore incorporated research findings conducted in other work packages in the MOPACT project and where necessary relied on further available secondary resources.
SYNTHESISING
The multidisciplinary research work of MOPACT was undertaken in nine work packages. These work packages together provided a rich array of scientific findings, which were synthesised in WP1. The synthesizing work was carried out mainly through interactions with the WP leaders in WP1 brainstorming sessions as well as during the MOPACT Forum and General Assembly meetings.
Key findings drawn from the work undertaken across the nine research WPs can be summarised as:
1. The multifaceted and aggregative form of active ageing has been rising in the EU countries, despite the economic downturn and austerity in many of the EU countries.
2. One of the future challenges facing European societies is a fast rising proportion of people aged 80+ who live alone. It is therefore important to look into the special needs and aspirations of this specific group of the population in improving their experiences of active and healthy ageing.
3. A specific challenge is to (continue to) introduce measures that increase healthy life expectancy alongside the rising life expectancy; greater emphasis needs to be placed on social engagement of older people (especially for those with limiting health) and early life interventions that improves lifestyle factors. A strong coherent thread of findings suggest that interventions that extend healthy lifespan include ‘dietary restrictions’ of various kinds.
4. To improve and define new early intervention strategies, it is vital to develop excellent translation practices.
5. Long term care has been increasingly acknowledged as a social risk, however important distinctions are necessary between health and social care and between formal and informal care. A coherent policy design for the provision of long term care is needed in many EU countries.
6. Fiscal sustainability and pension income adequacy (old age poverty) will remain a challenge in many EU countries, especially for Greece and also for many of the Central European countries. In this respect, universal minimum pension (the so-called social pensions) is considered a powerful policy instrument to enhance income adequacy and independent living for future retirees.
7. In the pursuit of longer working careers, the observations so far suggest that the actuarially fair adjustments are not enough and effective incentives are needed to keep constant the ratio of working years and retirement years. A better organisation is required of working time over the whole of the life course, supplemented by improvements in the quality of work environment, better work-life balance and on-the-job training.
8. Measures to tap the unfulfilled potential of the ICT use is found to be most effective in promoting active and healthy ageing. An increasingly greater use of the ICT by the current and future generation of older people will offer great scope for innovations and improving their cost effectiveness in the future.
9. Silver economy potential has largely gone untapped in many countries, due to low user involvement and administrative constraints.
A longer report, drawing together these findings with additional outcomes from WP1 was submitted as a deliverable.
REVIEWING EMPIRICAL EVIDENCE
The evidence drawn from the Active Ageing Index (AAI) was analysed to highlight variations across countries and explored the extent to which these differences were associated with differences in public policies, perceptions, cultures and institutions. In addition, we built an individual level composite indicator of active ageing using the SHARE dataset, which had one great advantage over the AAI as it allowed us to compare inequality of active ageing across the included countries.
Two types of additional indicators were also considered in the analysis: the prospective indicators which review the past life experiences (the life course effect); and the retrospective indicators which connects current life experiences with the prospect of active and healthy ageing outcomes in old age. The enabling environments domain contributes strongly to capacity of active and healthy ageing, and this aspect was duly taken into account in the AAI.
The evidence on active ageing reported within MOPACT was drawn, in the first instance, from the AAI and therefore covered all 28 European Union countries across three annual data points. Further analyses were undertaken by looking at the differences between men and women’s active ageing scores, and the differences between different age groups of older people. This evidence pointed to inequities in experiences of active and healthy ageing within EU countries as well as between them.
The AAI did not as yet use the prospective indicators (i.e. how the future older people might do in terms of active ageing) or the retrospective indicators (i.e. how past life course experiences have led to certain outcomes in old age). Additional information on prospective indicators for the younger age groups is also provided to point towards the determinants of active ageing. In line with the above discussion, 12 prospective indicators were identified in Table 1.1 attached. The inclusion of the external physical and social factors (the enabling environment) contributed strongly to capacity of active and healthy ageing, and this aspect was taken into account in the AAI. In this way, the AAI goes beyond assessing how active ageing is determined by personal intrinsic factors. The domain ‘capacity and enabling environment’ takes into account the following aspects:
• Human capital by indicators such as education and lifelong learning
• Health capital by remaining life expectancy and the healthy life expectancy as well as mental well-being
• Social capital as captured by educational attainment, access to Information and Communication Technology (ICT) and social connectedness
This domain can therefore be presented as a prerequisite condition for the outcomes in the first three domains.
The trends of population ageing and inequality are major concerns for the advanced economies. Some key evidence was presented that brought together the experiences of active ageing of older people and the inequality among them for selected European countries. On the whole, results of the micro (individual) AAI showed consistency with the findings of the macro AAI, however no large gender differences were observed in the micro AAI. The main finding was that countries with a higher level of active ageing tended to have a more equal distribution of active ageing. As with measures of income inequality, it was important to look beyond averages and pay particular attention to reducing inequalities. Three important observations can be made here:
• Countries that have achieved higher active ageing outcomes have also been able to keep the inequality in active ageing experiences low.
• Helping the most vulnerable people in countries with low active ageing will also improve equality across member states.
• The experience of active ageing has become more equal in the period from 2004 to 2011 in the selected nine EU countries where data was available for this time period.
CONDUCTING A GLOBAL SURVEY OF SOCIAL INNOVATIONS AND OTHER INITIATIVES
The purpose of this task was to provide an overview of the global survey of social innovations for active ageing. The survey generated a database of 150 social innovations and other interventions which support active ageing. It gave an indication of the types of social innovations being developed and tested across the EU countries, and also the lessons that could be learned and provided inspiring ideas for others to build upon.
The process of reviewing and evaluating social innovations focused on four scorecard domains – social and economic impact, sustainability, tolerance and implementation. The AAI provided a framework for broadly categorising social innovations although many are likely to have effects across several indicators within each domain or across more than one domain. For example, many social innovations are highly likely to contribute to stronger social connectedness although that may not be the principal aim of the project. Social innovations were grouped by the primary aim of the project in relation to the AAI domain for analytical convenience while recognising that many will had effects across more than one indicator or domain. A section of the website was dedicated to the Social Innovations Database; innovations were classified in three ways to allow maximum flexibility in browsing: by MOPACT research theme; by country, and; by AAI domain. A number of other work packages undertook assessments of other social innovations or interventions to identify good practice in their specialist areas; these were kept separate from the database, but integrated into the online portal.
WP2 - ECONOMIC CONSEQUENCES OF AGEING
The study on the household projections had the following steps:
• Preparatory work was undertaken on the Dutch stochastic household forecasts, specifically on approximate analytic expressions for the correlations of household shares across household positions, between men and women, and between neighbouring ages. Work done on dimension reduction of household shares. First simulations of probabilistic household projection (PHP) were completed, based on dimension reduction by Brass’ logit model for household shares. Data on household dynamics from Germany obtained from Generations and Gender Survey Waves 1 and 2. Occurrence–exposure rates for household dynamics in Germany were estimated. Approximate expressions were derived for variances and covariances of household shares, based on estimated variances of hierarchical shares in logit scale. Final stochastic simulations of future household developments in Denmark, Finland, Germany, Netherlands, and Norway were completed and reported.
Systematic descriptive study of mortality trends in female and male mortality was carried out for the following 23 countries (or areas) and reported: AUT, BEL, CZE, DEN, EGER, EST, FIN, FRA, HUN, IRE, ITA, LAT, LIT, NET, NOR, POL, POR, SLK, SPA, SWE, SWI, UK, WGER.
• Survival from birth to 65, and expected years in ages 65-99 were computed. Loglinear models were fitted, remaining life expectancy in ages 100+ was estimated. Countries were found to fall into three categories: (1) Former Socialist countries, (2) Egalitarian countries, (3) Traditional countries. The latter division closely matches a division into Social Democratic and Corporatist countries that has been discussed in the social policy literature. Graphics were produced by six regions defined by geographic proximity (Nordic, Atlantic, Mediterranean, Central European, Baltic, Eastern), by the three abovementioned groups, for all countries individually.
• Bilinear models were first fitted to data from Finland in three ways: for mortality rates, as in the Lee-Carter approach, for survival probabilities using logistic- and normal score transformations. The latter are referred to as Brass and Wang transformation, in the literature.
• Then, the models were generalized to a form that considers the dependence of the estimates of the heteroscedasticity and autocorrelation of the data. These models are new. The models were generalized for handling multiple populations jointly. This formulation is also new. The definition of the concept of convergence was developed in a novel way. This formulation separates the possibility that the difference between females and males is stationary (rapid convergence), and the case on which the sexes drift apart, but sufficiently slowly so that the decline still leads to a convergence (slow convergence). The work will be reported in an academic journal.
Two studies looked into alternative measures of population ageing and their use to illustrate the policy challenge, alternative scenarios and policy implications.
• One looked at prospective measures of ageing – essentially assuming that the pension age is linked to life expectancy. This revealed a much more modest challenge related to future population ageing. This implied increasing the length of working lives substantially as longevity increases; some countries may have to extend working lives beyond what additional longevity gains would suggest.
• Population projections and National Transfer Accounts data – with age specific public transfers – were combined for 7 European countries and used to evaluate the quantitative impact of ageing on public finances until 2040 and to compare it to projected demographic dependency ratios.
• Public finance impact of changes in three key indicators (net immigration, healthy ageing and longer working lives) related to the policy responses to population ageing were simulated. This was done by linking age-specific public health transfers and labour market participation rates to changes in mortality.
• The study showed that the old age dependency ratio overestimates the fiscal costs of ageing even holding the retirement age fixed. This was mostly because fiscal transfers to young cohorts are declining as societies are ageing. The study further explored the fiscal impact of a healthy ageing scenario, where health care transfers are linked to mortality rather than age, and found that this reduced the fiscal implications noticeably, but not substantially.
A simulation study was carried out to illustrate the contributions of the three separate drivers of demographic transition (fertility, mortality, and migration) on public finances.
- Realizations of a stochastic population projection were used as inputs in a numerical overlapping model calibrated to the Finnish economy. By using decompositions, the study aimed at gains on pedagogic aspects and intuition while giving up as little as possible on quantitative realism.
- The dynamics of the fiscal position are complicated by the fact that different vital rates influence different items of the public expenditure and tax bases with different timing. Mortality changes affect health and long-term care financing relatively quickly. Fertility variation has mainly expenditure effects during the coming decades, before the impact on tax bases grow, while migration affects the number of taxpayers already in the first decades. Age structure movements are slow to appear and can be foreseen to some extent, but with declining accuracy as the forecast horizon increases, because surprises in all vital rates will occur.
A simulation analysis was performed to investigate whether a transition from back-loaded (EET regime) to front-loaded (TEE regime) taxation of pensions is feasible and efficient in increasing the resilience of public finances against variation in longevity.
- The transitions were simulated with a numerical overlapping generations model calibrated to the Finnish economy, using stochastic mortality projections as inputs.
-The results showed that in a traditional pension scheme with no automatic longevity rules, such as life expectancy adjustment of pensions or a link between life expectancy and retirement age, the tax regime shift can be used to improve public finances. Diminished private saving and weaker labour supply incentives are among the downsides. Especially the latter makes the reform welfare-reducing, if the improvement in state finances is not used to relieve taxation of labour.
-In an automatically adjusting pension scheme, the tax regime shift is not so efficient, but neither is it so necessary.
Multi-country simulation analysis on impacts of ageing and policies related to on-the-job training and taxation were performed:
• The existing simulation model was updated to split up the EU region into three blocks: Northern EU, Southern EU and Eastern EU. A population data base was derived to replicate the UN population projection for the three regions.
• Multi-country models with endogenous human capital were calibrated and tested. Since it was not feasible to implement endogenous human capital in the seven-region model, a similar ageing process was simulated in a two-region model and compared the results with exogenous and with endogenous human capital.
• Alternative tax and social security reforms such as a move from income to consumption taxation, alternative strategies of public debt reduction as well as the move towards more pension funding or more pension progressivity were simulated. The results with and without human capital were compared.
A simulation study on the employment, welfare, and distributional effects of the 2017 pension reform in Finland was performed with a stochastic life cycle model.
• The life cycle model of labour supply was calibrated to the Finnish data and features a detailed description of pension benefit rules, income taxation, and unemployment insurance in Finland. The model accounts for systematic differences in average age-wage profiles, disability risk, and mortality across groups that differ by gender and education as well within group heterogeneity resulting from idiosyncratic wage uncertainty.
• Pension reforms that consist of abolishing early retirement schemes and increasing the eligibility age for earnings-related old-age pension were simulated.
• It was shown that this type of reforms may even reduce lifetime welfare inequalities. There are several reasons for this. For one thing, those with the lowest lifetime income are often long-term disability pension retirees and the reforms considered do not decrease disability benefits. In Finland, low-wage workers are also relatively well protected against unemployment risk and old-age poverty by the progressive unemployment insurance scheme and national pension that is tested against earnings-related pensions. More generally, the results highlight the importance of considering other elements of the social security system when analysing the distributional effects of pension reforms.
The simulation results of the stochastic life cycle model were used in a numerical overlapping model calibrated to the Finnish economy to detect the general equilibrium and fiscal sustainability implications of the 2017 pension reform, which linked retirement age to life expectancy.
WP3 - EXTENDING WORKING LIVES
WP 3 consisted of 5 tasks. In the first task, for each of the partner countries a country report was been written. These reports consisted of two main chapters, (1) Extending working lives and (2) LifeLong Learning. The reports covered all aspects and determinants of longer working lives considered relevant, since these reports were the basis of the Conceptual Framework, which provides an overview over the research field, structures the topic and depicts the relationships between different factors. The Conceptual Framework covers 50 pages and is described as “the most comprehensive” (Hasselhorn/Apt 2015: 22, ‘Understanding Employment Participation of Older Workers: Creating a knowledge base for future labour market challenges’ for the German Federal Ministry of Labour and Social Affairs and the JPI ‘More Years, Better Lives’) amongst three conceptual frameworks discussed by the authors. The core of the Conceptual Framework is a circular structure of different areas affecting the length of working life, where the outer circles contain major developments like demographic change, the economic situation/crisis etc., affecting national and supranational policies as well as meso level actions by employers, social partners, NGOs and various other stakeholders, which in turn affect via various steps individual retirement behaviour.
In another task three reports were delivered, one summarised around 150 meso level measures in the 13 countries. The report was structured according to country and within each country according to measures aimed at the supply side of labour and at the demand side of labour. The supply side contained activities that enable older people to work, i.e. it is closely related to the concepts of workability and employability. The demand side contained primarily ideas that, if put into practice, would incentivise employers to hire and retain older workers. Although a considerable number of companies mentioned is larger than SMEs, reflecting the general situation of more widespread age management measures at large companies due to bigger HR departments, more resources etc., there was also a considerable number of remarkable and innovative measures at SME level. Further, researchers were asked to estimate if measures reported are transferable to other companies, partly in different sectors of different countries, and especially measures at SME level seem to be transferable, since they come with low preconditions. This report confirmed a finding from the initial task that the term ‘social innovation’ or just ‘innovation’ is used differently between actors and countries and was not very helpful. One expert interviewed in already stated that ‘innovative’ was not relevant, since whatever works, works. The 150 cases were the basis for the selection of cases for in-depth case studies in a future task (see below).
A National Policy Report provided an introductory overview of policies and effects and comparative research. The main part covered policies and their effects (if assessed) and was structured according to country, and within each country chapter, according to topic. Topics included pensions, early retirement, work after retirement / silver work, unemployment, part-time work/part-time pensions, health/disability, self-employment, employment protection, wage subsidies, life-cycle approaches and age discrimination legislation. The concluding chapter embeds the topic of policies and welfare state reforms into the general welfare state literature. The country-specific chapters showed that numerous reforms have been initiated in the last years, especially in the three main exit routes pensions, unemployment and disability, and available analyses show or predict (this in the case of pension reforms not yet fully implemented) that these reforms indeed increase employment rates. The report was not focused on side effects such as rising inequality or, related to this, rising relative poverty, work despite adverse health circumstances etc.
A further report summarised the situation in training and further training and, like both other reports provided an overview which was used for interviews in Task 3. The report was related to the country reports in the first task, as measures by organisations/companies in the field of training are affected by national circumstances. In Task 3 one report was delivered based on 20 in-depth case studies and one summary of measures of 16 companies in one sphere of activity (reconciliation of paid work and private care in Germany). This showed how best practice measures were arranged (Description), put into practice (Implementation), if, how and under which circumstances these measures could be imitated by other companies/organisations/social partners/public bodies (Transferability) and in which manner these measures can be considered innovative (innovation). The cases were sorted by sphere of activity: Health (and work despite health problems), lifelong learning, work after retirement age, flexible working times, reconciliation of paid work and family, unemployment, self-employment, awareness campaigns, and recruitment/labour demand. In contrast to common ‘Best Practice’ reports, the reports showed how exemplary measures came into being (as far as information is available) and if and under which conditions these measures are transferable/imitable and therefore can serve as guidelines/recommendations for other actors (companies/ organisations/ social partners/public bodies). Experiences with case studies gave insights into possible starting points for effective interventions. For example, a focus on key actors´ attitudes and capabilities can be expedient. This also applies to local collaborations or externally provided incentives.
Further reports were delivered - Drivers and Barriers to Innovation was based on in-depth country reports and was structured according to supply side and demand side. The supply side consisted of (1) workability/employability (motivations, health, life-cycle orientation, lifelong learning), (2) self-employment and (3) work beyond legal retirement age. The demand side consisted of (1) financial incentives for the employment of older workers (public, non-public) and (2) non-financial incentives (also public, non-public).
The Report on Secondary Analyses contained three papers based on secondary analyses. The first paper explored the interaction between individual and institutional factors on participation in non-formal learning in 50-64 age group in 19 European countries. One finding was that higher statutory retirement age is related to higher participation in non-formal learning in the 50-64 age group, but the result is not straightforward. The second paper covered 6 European countries and depicts the frequency and the determinants of older worker labour supply. Based on a survey at company level, it was shown to which degree and affected by which company traits companies try to retain their workers until or beyond legal retirement age or re-hire retired former workers. The third paper assessed the maximum effects of high work satisfaction on longer working lives. Effects are in the sphere of some months and therefore not huge (in contrast e.g. to pension reforms´ projected effects), but possibly effects are underestimated and secondly effects result from actions without negative side effects on older people.
The final report in this series covered the topic of older people unemployment, which is a considerable problem for employment amongst the elderly in some European countries. The rates have risen in most countries (2006-2014) and the report showed policy reforms and effects in this area, largely based on financial incentives.
In the next tasks, two reports were delivered relating to strategies for extending working lives, raising older workers´ employment rates and intensifying LifeLong Learning in later working life and Final Country Reports. The former summarised WP 3 findings and provided political suggestions, explicitly as well as implicitly. The report was strongly solution-driven in order to foster the project´s practical impact. The latter consisted of 11 in-depth country reports based on previous research.
WP4 - PENSION SYSTEMS, SAVINGS AND FINANCIAL EDUCATION
The key issue in this work package was how to improve the pension system to ensure adequate income for all at old age, and in particular how – mandatory and voluntary - private pension savings can contribute to this. With governments curtailing the role they play in the provision of old age financing (in pensions but in long term care as well), the questions how private pension savings can be optimized become all the more important.
There were three tasks in this work package:
I. intragenerational equity: supporting groups who are vulnerable in older age;
II. intergenerational risk sharing and private pensions;
III. effective communication of pension risks, and expectations in providing incentives for savings and rational portfolio behaviour
The main achievements on the three tasks were the following:
i. Intragenerational equity
Many countries have recently faced pension reforms e.g. from defined benefit (DB) to defined contribution (DC) schemes and from mandatory funded pension schemes to system where more choice options are available. Four papers were written on the impact of these reforms on in equality during retirement and the role of private savings in keeping up pension adequacy. In particular pension reforms have been analyses in five European countries: Estonia, Hungary, Finland, Poland and the Netherlands. One possibility to foster private pensions across Europe is the development of a common standard for personal pension plans. One of the deliverables focussed on the scope for personal pension plans in Estonia, Hungary, Finland, Denmark and the Netherlands. This paper was finished in November 2015 after incorporating the current policy debate on Pan-European Personal Pension Products (PEPPs). As a complement to this paper another deliverable contributed to the idea PEPPs by working out how personal pensions can be combined with collective risk sharing.
All papers have been presented and discussed at the Netspar International Pension Workshop in January 2015.
ii. Intergenerational risk sharing
The key issue in this task was how to ensure stable incomes for elderly in a world that faces increasing demographic and financial risk, and where population ageing erodes the basis of younger generations who can bear these risks. The challenge has increased markedly in the last decades due to volatile financial markets, falling interest rates and the withdrawal of employers and external insurers as risk bearers of systematic financial and longevity risks.
Bovenberg & Nijman (2015) developed the concept of Personal Pension with Risk sharing (PPR) which aims to combine the best of defined benefit and defined contribution pension systems. By unbundling the different functions of pensions – i.e. investment, saving, insurance and risk-sharing - PPRs allow risk management and (dis)saving to be customized to the specific features of heterogeneous individuals. Moreover, PPRs allow investment risks to be combined with longevity insurance. The improve design in the PPR also deepens the internal markets for financial and insurance products while at the same time accommodating the diverse traditions of countries in terms of occupational pension provision. Finally, the PPR reconciles financial, fiscal and macroeconomic stability with growth by increasing the supply of long-term risk-bearing and illiquid capital, complementing public retirement provision, reducing the interest-rate sensitivity of pensions and smoothing shocks.
Bijlsma, Van Ewijk and Haaijen (2014, revised 2017) elaborated in a subsequent deliverable the idea that private pensions contribute to deeper capital markets and thereby fostering risk sharing and long-term investment at the aggregate level, and helping to put Europe back on the path of sustainable growth. This paper presents new empirical evidence for such an alleged positive impact of pension savings on economic growth. It studies the effect of pension assets on economic growth for OECD countries for the period 2001-2011. Unlike the standard cross-country growth regressions, it focuses on one specific transmission mechanism for the impact on pension savings on economic growth, namely the access of firms to external finance for their investment needs. Doing so, the authors find a statistically significant positive effect of pension wealth on growth. An increase in pension assets (% GDP) by one standard deviation of 40 percentage points for increases growth for an average sector by 0.24 percentage points. This relationship did not markedly change during the crisis; it is a structural relationship over longer time horizons.
Both papers have been presented during policy seminars at Bruegel in Brussels in March 2015 and October 2013 respectively.
Two other deliverables within this task investigated different types of risks, viz. those related to life expectancy and those emerging from financial markets. One analysed the impact of working and living longer on pension incomes in five European countries and assess the impact of on the financial well-being of the elderly in these countries. The paper showed the diversity of the policy measures taken in the various countries. Furthermore, the authors analysed the financial incentives to work longer and to postpone claiming pension benefit in the five countries and we addressed the question, how attractive these options are.
The other deliverable measured how financial shocks - equity market, interest rate or inflation shocks - affect different generations of participants in individual and collective pension schemes and to explore the effects of risk-sharing rules in collective pension plans. The authors showed that an individual pension scheme, by using a life cycle investment strategy, can largely replicate the allocation of traded risks across generations of a collective pension scheme that gradually adjusts pensions after financial shocks. In schemes with individual accounts, risk sharing is limited to risks traded on financial markets. Collective schemes additionally can shift financial risk to generations that will participate in the future, whereas individual accounts cannot. In the current institutional setting this shift of traded risk in collective contracts to future generations is limited. Collective pension schemes are able to reallocate non-traded risks, such as inflation risk or macro longevity risk, among the participants to obtain a more efficient distribution of risk across generations.
iii. Effective communication of pension risks and expectations in providing incentives for savings and rational portfolio behaviour.
Individuals are increasingly bearing greater responsibility for their own financial well-being during retirement. People face more and more decisions on how much to save for retirement, on how to allocate retirement wealth and on what insurance products to buy. However, individuals find it very hard to navigate financial and insurance markets, and the consequences of mistakes can be substantial. This raises the question how we can promote efficient life cycle financial planning in a cost-effective manner. Deliverable 4.05 explored how pension plans can best communicate, and frame risk and project pension benefits and replacement rates in order to help individuals make good saving, investment and reporting standards for pension funds and individual pension plans. As a complement to this research the working paper that proposed a method for projecting pension benefits, deriving from DC pension plans and other funded products, at retirement. The projections highlighted how the current choice of asset allocation impacts on future potential retirement outcomes. The latter were compared with a money-back benchmark so as to clarify the trade-off between risk and return. After the initial projections, the pension plan revises its forecasts of retirement benefits on a yearly basis as a function of its own realized returns. Previous shorter-term projections are also compared to shorter-term ex-post performance. This simple method is a step towards an industry-reporting standard that responds to regulators’ quest for helping investors monitor the risk of their future pension.
Two further papers were written, the first presented an intertemporal consumption model of investment in financial literacy. Consumers benefit from such investment because financial literacy allows them to increase the returns on wealth. Since literacy depreciates over time and has a cost in terms of current consumption, the model delivers an optimal investment in literacy. Furthermore, literacy and wealth are determined jointly, and are positively correlated over the life cycle. The model implies that the stock of financial literacy early in life is positively correlated with the stocks of literacy and wealth later in life. Using microeconomic and aggregate data, the paper finds strong support for these predictions.
The second paper analysed the role played by financial literacy in savings decisions and wealth decumulation. The broad evidence showed that (elderly) households do not decumulate their assets as they age, contradicting the standard life-cycle theory, which predicts that households should decumulate their assets in order to keep their consumption smooth. In particular, older people seem to be very attached to il-liquid assets, such as housing wealth, which is far more difficult to liquidate and use in case of unexpected shocks and for consumption smoothing. Using the SHARE (Survey of Health, Ageing, and Retirement in Europe) survey, the authors try to detect whether more financial literacy brings about more optimal behaviour from a life-cycle perspective. They look at the impact of financial literacy on three different dimensions of savings decisions: an unbalanced portfolio with excessive weight assigned to illiquid assets, the optimal consumption path, and wealth decumulation. According to these findings, higher financial literacy substantially reduces the portfolio imbalance of people aged 50+ by reducing the weight of housing wealth over total net worth. In addition, higher financial literacy is responsible for a more optimal consumption path and, in particular for men, for both net worth and housing wealth decumulation.
All papers in the task have been presented at the workshop in Italy in 2016 and during the International Pension Workshop (IPW) organised by Netspar in Leiden, 2017. During the last workshop there was a special MOPACT session with an interesting exchange of research in this work package and other work packages. During this same IPW a special policy session was organised where important results on the macroeconomic aspects and literacy of the research in this work package were presented to a forum of policymakers and practitioners.
WP 5 - HEALTHY AGEING AND WELL BEING
Main results of this WP included:
• During the period 2005-12 increases in life expectancy in the EU were not accompanied by increases in healthy life expectancy, contrary to the intentions of Horizon 2020.
• While social participation is lower among older people in poor health than those in good health, its determinants are generally the same in both groups. So similar approaches can be taken to promote participation in both groups, although specific factors must be taken into account for those in poor health, such as depressed mood and lack of transportation.
• While policy makers tend to emphasise labour market participation, it is important to facilitate the combination of paid work with other activities such as volunteering and informal care giving.
• Increasing social participation makes a very minor contribution to HLE (0.0 to 0.1 years), but it is valuable for social inclusion and needs to be promoted. More research on alternatives to raise HLE is needed to guide policy.
RESULTS SUMMARY
Life expectancy (LE) was compared to healthy life expectancy. Healthy life expectancy was expressed in healthy life years (HLY), which was defined in this study as the number of years that a person is expected to continue to live without activity limitations. Overall, life expectancy at age 65 in 27 EU countries increased between 2007 and 2010 by 0.6 years for men and 0.5 years for women. At the same time, healthy life expectancy (HLY) decreased by 0.2 years for men and women. Similar trends were observed for LE and HLY at ages 50 and 85. At the same time, results showed a large variety between the countries in healthy life expectancy and trends in healthy life expectancy. The three countries with the largest number of unhealthy life years were Slovakia, Portugal, and Germany.
Trends were also reported for the prevalence of important health indicators: chronic morbidity, i.e. the self-reported presence of one or more longstanding illnesses, and activity limitations, i.e. the extent to which older people reported to be limited in activities that people usually do. Overall, the trend in morbidity prevalence for men and women has been increasing between 2007 and 2011, in particular in the older age groups. Trends in the prevalence of severe activity limitations have been relatively stable for men and women across all age groups. Again, results across countries showed large differences.
In the next task, social participation in 6 domains was studied in older people with and without health limitations. The 6 domains were - volunteering, informal caregiving, labour participation, educational activities, leisure activities, religious activities. Health limitations were defined as multi morbidity, with is a complex medical condition. Across types of participation, findings showed considerable differences in the level of participation between those with and without multimorbidity, in favour of the group in better health. However, determinants of social participation appeared to be quite similar between those with and without multimorbidity. In both groups, and across the different types of participation, factors that were associated with a higher level of participation included a higher socioeconomic status, a larger social network, being active in other types of participation (but not labour market participation) and having better physical and psychological health. If differences were observed between multimorbidity groups, this was often related to opportunity structures (for example indicated by income level, home ownership) being more important for the participation of those without multimorbidity, as compared to the older people with multimorbidity. At the same time, findings indicated that transportation possibly was more relevant for the level of leisure participation of those with multiorbidity. Other findings were quite specific for the type of social participation. For example, being married in those with multimorbidity was associated with a higher level of caregiving, but being single was associated with a higher level of volunteering activity. Also, mental health problems affected labour market participation and volunteering to a greater extent in those with multimorbidity than in their healthy peers. Overall, the results show that health status does influence older people’s level of participation, but the level of health should only be a minor factor in designing intervention strategies.
In the countries that were selected for the study – Austria, Estonia, the Netherlands and Poland – altogether 48 private projects (social innovations) were found that foster participation of older people in volunteering, informal caregiving and leisure activities. In general it was found that only few projects targeted people with health limitations. Instead, projects are often open for all older people, with or without health limitations. The underlying assumption of the projects is that almost all older people have some form of health limitation and there is no need to separate people based on their disease or disability. Many of the success factors, barriers and preconditions that were identified in the four countries overlapped. For example, financial sustainability was a concern for many of the projects. Therefore, the projects were dependent on volunteers for the organizations of activities. Some factors were specific for each country, as they are closely related to the culture of economic conditions in the countries. In that case the most successful approach differs per country, for example strategies to motivate volunteers.
Across the four countries that were studied - Austria, Italy, Poland and the Netherlands - policies that most explicitly address the social participation of older people concern labour market policies. Pension reforms have primarily been put in place to offset budgetary constraints related to the ageing of the population. These measures indeed increase the labour market participation of older people. The labour market is also a field where regulations are directed specifically towards people with disabilities. To avoid competition between different social participation roles, recommendations concern the offering of regulations by employers to combine for example working with caring or volunteer work.
To a lesser extent, policies and regulations exist in these other ‘productive’ participation domains: caregiving and volunteering. Policies and services in these domains are often not targeted at older people or those with disabilities. Recommendations regarding these types of activities are (1) the availability of appropriate respite care for informal carers and (2) the availability of funds for hiring volunteer coordinators, who support and train all unpaid workers, especially those with poor health. Leisure activities that are more consumptive, such as social network activities, education and sports, are performed in the personal sphere, and as such have the least interference from policies. However, to enable older people to become or stay socially engaged, they do need sufficient financial means and appropriate services (e.g. transportation), in particular the group of older people with health problems.
A formal framework was developed to perform scenario analyses of increases in social participation among older individuals with multimorbidity and the effect on healthy life expectancy. This was based on estimates of the effect of different forms of social participation (volunteering, informal caregiving, labour participation, educational activities, leisure activities, religious activities) on disability derived from the empirical literature and own estimates using SHARE data. We found that generic increases in social participation of older individuals with multimorbidity are not an effective way to improve healthy life expectancy. Increases in the social participation rate of older individuals with multimorbidity only have a very modest effect on healthy life expectancy. The baseline scenario results in improvements of healthy life expectancy of 0.0 years. Even scenarios with very high increases in social participation rates and high estimates of the effects of social participation on disability, result in an improvement of healthy life expectancy of 0.0 to 0.1 years at best.
Given the ageing of the population, and the increasing prevalence of chronic diseases, focusing on social participation among older individuals with multimorbidity is of importance. However, its effect on average years spent without disability is limited. Given the size of the challenge, substantial increases in healthy life expectancy cannot be expected to come from a single intervention alone but will have to be the result of combined efforts on several fronts.
WP6 – BIOGERONTOLOGY
The main objective of this work package was to emphasise the potential of biogerontological breakthroughs to support healthy and active ageing, and the economic potential of procedures and interventions designed to retard the ageing process. Our main intention is to strengthen the links and improve the flow of information between basic scientists/physicians and other disciplines attributable to ageing.
Accumulating evidence showed that ageing was not inevitably linked with the development of chronic diseases. In addition, only 20-25% of healthy life expectancy is genetically predetermined; lifestyle and environment play a major role. Consequently, age-associated accumulation of molecular and cellular damage can be prevented or greatly delayed by lifestyle interventions. Infections play a major role in morbidity and mortality of the elderly. Nevertheless, a life course perspective in vaccination is missing from the public health agenda. Sex/gender-related factors also play an important role in protection against disease.
The best established strategy to delay ageing is dietary restriction with optimal nutrition. Energy intake and expenditure, meal frequency and timing, protein intake, diet quality, and gut microbiome have an impact on health and longevity.
Following a general literature review to summarise the progress in biogerontology over the past 10 years UIBK compiled a list of potential topics to be investigated in more detail e.g. sarcopenia and physical exercise, nutrition and diet, telomere biology, oxidative stress, endocrinological ageing, and immunosenescence.
UNIBS focused on the effects of diet on healthy ageing and longevity and summarised the information in eight review articles (Cava & Fontana, 2013; Rizza et al., 2014; Fontana & Hu, 2014; Mattson et al. 2014, Fontana & Partridge 2015; Spelta et al. 2015, Most et al. 2016; Bertozzi et al., 2017). Since 1935 when McCay first published that food restriction without malnutrition expanded the lifespan in rats, several research groups have shown that restriction of caloric intake without malnutrition extends lifespan as well as health span in yeasts, fruit flies, nematode worms, fish, hamsters, rats, and mice. Recent data from non-human primates suggests that not only the calorie intake but the diet composition in particular is important in promoting health and longevity. In addition to caloric intake and diet composition, frequency, circadian timing of meals and intermittent energy restriction periods seem to improve health indicators and counteract disease processes. Nutritional modulation of the microbiome can also be important, and there are long-term, including inter-generational, effects of diet.
Infections account for a substantial part of mortality in elderly above 65 years of age. With ageing of the immune system the susceptibility for infectious diseases increases and the efficacy of vaccination decreases. However, there exist biological and socio-economic inequalities in infectious disease susceptibility that contribute to differences in healthy life years and life expectancy between men and women and across EU member states.
UIBK summarised how sex steroid hormones affect the immune system and how changing sex steroid hormone levels during ageing (e.g. menopause) may influence vaccine efficacy and susceptibility to infectious diseases. In animal models hormone replacement therapy – estradiol in particular – could revert some of the age-related immune defects. Studies in humans on the effects of hormone replacement therapy on the immune system are scarce (Giefing-Kröll et al. 2015). However, despite these biological differences, there are areas where immediate intervention would be possible. Not only vaccinations in the elderly are required to protect these from disease, but regular booster immunisation earlier in life is needed to maintain protective antibody titers when the immune system is still fully functional. Incidence of vaccine-preventable diseases is not distributed homogenously across Europe and also coverage rates vary considerably across EU member states. Vaccine policies are not consistent across EU member states and often specific recommendations for adult vaccination are missing. In addition to reduction of out of pocket costs reminder strategies for patients and health care providers regarding vaccination due date could help to increase vaccine coverage in the adult population. More public education on the risks and benefits of vaccination could increase compliance with vaccination guidelines
For the translation and implementation of biogerontological findings, it was critical to understand how to communicate new developments (diet, physical and cognitive training, vaccination, devices etc.) to end-users and stakeholders and how to overcome translational barriers.
As a model system ARU/CranU were examining telecare and telehealth devices, i.e. any piece of equipment, gadget or technology that supports independence in older age, in the development of suitable products to help individuals live at home for longer. Utilising this focus group methodology, individuals provided their views on existing products and a prototype telehealth device that was under development. 27 individuals participated in two user focus groups. All were over the age of 60, and some were over 85. Selected devices were available for proper handling, which was initially tested within a small pilot group. Through handling of the devices and contextual inquiry the groups were established and run to understand the barriers to device adoption and to identify better-targeted interventions to meet user needs. Additionally, 27 telephone interviews were conducted with key supply chain players to ascertain their views on putative barriers to uptake of these devices. A semi-structured interview guide was used. The focus groups and the interviews were audio-recorded and then transcribed verbatim, with the data handled within NVivo 10 and analysed using a thematic approach. The study suggested that few telehealthcare devices were developed based on the principles of user-centred design. As a result many were non-intuitive, with the majority of the focus group participants not recognising the purpose of the devices from their appearance alone. Expert interviewees argued that this lack of user-centred design resulted in unused products and products that failed to successfully meet end-user needs.
The results of the work performed in the first two tasks were categorised according to importance and feasibility for translation to support active and healthy ageing and to generate new procedures and interventions to postpone the onset of or prevent disease.
We made several attempts to organise a meeting to share state-of-the-art biogerontological knowledge with stakeholders and scientists from other disciplines in different locations and settings. In the end, such a meeting as originally planned could not take place due to organisational and financial limitations. However, we conducted multiple other activities, as listed below, to fulfil this task in organising continuous and wide-spread communication regarding biogerontological progress and its translation between scientists of different disciplines and various stakeholders. These activities included meetings with general public and stakeholders (including open days “Lange Nacht der Forschung” in Innsbruck and in Salzburg); communication with general public and stakeholders via media including TV, radio, newspapers and internet; presentation of biogerontological research to the scientific community: 138 articles and 210 presentations on conferences, symposia etc.
In addition to the activities above, by 2016, PLUS has put emphasis on establishing a University-wide interdisciplinary network dealing with gerontological research and training, yet also providing information to the public. The immediate goals are to raise awareness amongst students who wish to focus on ageing both at the scientific level as well as after graduation when joining industry, public services and further training and teaching. The Geronto_Network is currently defining means and measures to implement an interdisciplinary training programme at the Masters level as well as postgraduate courses which besides Biogerontology shall include social aspects, psychology, communication and law/politics. These emphases are currently compiled in a book which is published in spring 2017 with Springer International. Cooperation with Universities at the national level such as Innsbruck as well as in Europe with Centres such as Bologna or Amsterdam are being discussed with colleagues in the field. Similar to training of PhD students in Biogerontology in Innsbruck, which runs very successfully ever since 15 years, the University of Salzburg has started a structured Doctoral Training Programme in 2016/17. Twelve Students have been enrolled on this specialised course. This training programme prepares a students' summer school together with the 14th International Conference on the Neurobiology of Aging at Bregenz taking place in July 2018.
We highlighted the importance of a life-course approach to healthy ageing in our report -Future scenarios on biogerontological translation. Biogerontology is important at every stage of life beginning already very early in life. Hence interventions when applied early unfold higher potentials to prevent physical degeneration and decline in cognitive function. A life course perception on ageing and risk of developing age-related diseases is essential: body functions, plasticity and thus the possibility to intervene decrease with age while concomitantly damage increases. Interventions in adults, especially those at risk can be beneficial to certain degrees. Notably screening in middle-aged reduces the risk for non-communicable diseases; however, interventions in adolescents and young adults could be made more effective and are believed to reduce the disease risk in the following generations.
The developmental period is highly plastic as it greatly responds to environmental conditions and allows fine-tuning of gene expression through epigenetic regulation primarily to improve reproductive capacity and sustain life-long health. This is especially true for the prenatal and early postnatal stages during tissue development but extends to childhood and puberty for some tissues such as the brain and reproductive system. During this developmental period the organism is highly sensitive to environmental factors such as nutrients, environmental toxins, chemicals, drugs and infections. Interference with this epigenetic regulation is implicated in disease development later in life including major public health problems: obesity, diabetes, hypertension, cardiovascular disease, asthma and allergy, immune and autoimmune diseases, neurodevelopmental and neurodegenerative diseases, precocious puberty, infertility, some cancer types, osteoporosis, depression, schizophrenia and sarcopenia.
In addition to lifestyle interventions such as fasting regimes, caloric restriction or exercise a limited number of pharmacological interventions have sound evidence to promote health span including spermidine, resveratrol, metformin and rapamycin.
Based on biogerontological and epidemiological findings, the report elucidated which type of interventions are needed at which stage of life to preserve health and prevent or ameliorate disease.
WP7 - BUILT & TECHNOLOGICAL ENVIRONMENT
This WP consisted of several sub-tasks- Innovation Prospects Report – The report identified current trends in ICT, housing and mobility in Europe; Research protocol – The protocol defined the methods used in this task; Case Study Hand-out – The hand-outs compromised the results of the case studies; International Workshop and Trend reports / Policy and Business recommendations – The trend reports gave recommendations on improving the transfer process from social sciences to industrial and political stakeholders.
Innovation prospect reports, provided the basis for the subsequent tasks. For each of the three areas (housing, mobility and ICT with a focus on health), a non-systematic literature analysis and secondary data analysis was conducted. In many cases, technology was not only used by older persons themselves but also by their families, relatives and friends as well as professionals (e.g. caring staff). This makes it very complex to design technologies fitting into various contexts. Taking telecare and telehealth as examples, different aspects can be identified that affect the adoption, implementation and use of technology. These can be grouped into technical, social, economic and regulative dimensions, each covering multiple aspects. The literature analysis that was conducted as a part of MoPAct within the field of telecare and telehealth revealed that barriers exist within the following domains (see figure1). The domain ‘acceptance’ was identified as the most dominant one, followed by financial and technical challenges. Factors that lead to non-acceptance – and non-use – cover multiple aspects. This includes safety concerns, e.g. about data security, a lack of trust, e.g. caused by poorly designed pilots, the general reluctance to telehealth and telecare, the feeling of stigmatization, generally low expectations, restrictions of autonomy, the fear of nursing staff being replaced by technology, a perceived increase of workload, the disruption of services and routines, the capability to understand the technology due to poor ICT skills or cognitive impairments, etc.
According to mobility, policies on European Union level and on national level for the five selected countries were analysed. Environmental aspects were predominantly mentioned in these policies. A more frequent usage of public transport helps to decrease emissions. Considering mobility and ageing the accessibility of public transport is the main aspect that needs to be tackled for an independent living and to facilitate social inclusion for older people. Projects in this field do not only focus explicitly on mobility and ageing but also include the target groups of people with impaired or reduced mobility or people with disabilities. The setting is usually urban even though national policies often point out the challenge to also supply rural areas with transportation options. Overlap with ICT is mainly seen in navigation and information systems. Housing plays a role in the door-to-door mobility. The car mobility of older people is only a limited issue of policy. At European level, emergency call systems and reducing the number of accidents are discussed. The elderly prefer the car for their mobility and they drive in all countries as long as they can. The public debate is dominated at the time by the electric mobility and the saving of fuel.
For the area of housing we analysed the social structure of housing using the European Quality of Life Survey (wave 2011). The results show that the living conditions of the elderly vary intensively among the different countries (regarding the ownership structure, the area people are living in, problems with accommodation, access to different facilities in the neighbourhood and health status). We found high variance in and between the countries that hint towards very different needs of the elderly regarding their housing situation and quite different existing policies / interactions with the institutional structure of the housing and social service systems in the observed countries. We identified four fields of action (accessibility in and around the accommodation, ambient assisted living, shared housing, age-friendly neighbourhoods) we see as crucial to allow the elderly to realize active and healthy ageing in their (kn)own accommodation and neighbourhood. Staying at home is what most people wish even and / or especially when in need of support and care. Besides realizing the will of the elderly this has further advantages regarding especially the financing of care and the continuity for private landlords regarding their tenants. This common interest of the different stakeholders provides an important opportunity for coalitions in order to circumvent existing barriers regarding the implementation of new solutions. Nevertheless, this has not yet happened in all the countries. While Finland and the United Kingdom seem to be "forerunners", especially Poland is rather a "laggard" regarding the above mentioned issues. This is especially striking as the problems of the elderly regarding housing are especially pronounced in Poland.
The case studies task underlined that different aspects of built and technological environments are closely linked to each other. ICT-based devices and services were found in the context of housing, health and mobility, this trend will continue in the near future. The case studies showed that this asks for user-friendly approaches combining information policies and trainings. The integration of volunteers – ideally peers – is identified as a concept or element that increases the awareness and acceptance of new products and services but also the chance of sustainability. Moreover, it supports the active participation in society. User-integration is not only relevant at the beginning of the innovation process but also as a constant theme. Furthermore, the cooperation of multiple stakeholders is essential to develop and implement (advanced) approaches. In turn, this asks for measures to increase awareness of the user’s needs but also of solutions that already exist. In total, we conducted 13 case studies. The cases were selected and analysed using the research protocol. Key inclusion criteria were:
-Involvement of the end-users into the innovation process;
-The sustainability of the project/initiative;
-Addressed market barriers;
-Transferability of the project or certain parts.
Parallel, a survey on older drivers in several European countries was conducted. The questionnaire contained 11 items. The following characteristics of cars were sorted according to importance from the perspective of view of elderly drivers: supporting function of car seats, instruments and operating elements, peripheral and rear vision, solid lateral guiding of car seats and getting in and out of a car. The responses of older motorists with respect to the driving assistant-systems were mixed and it reflected the fact that little is known about these systems. In this survey, the emergency braking system, a navigation system and a parking assistant were rated highest.
A subsequent task included a Delphi survey on barriers to the uptake of ICT-based technology for older persons and an international workshop to discuss the results of the survey and previous tasks. During the first round of the survey, the experts were asked to rate the named barriers and add new ones in case they felt that something was missing. Moreover, they were asked to provide solutions to those barriers. (see table in attached doc).
Moreover, the results of the survey showed that after the first round, agreement of the participants increased significantly considering economic barriers. Interestingly, nearly all items in this domain were rated as less important barriers during the second round of the survey. This is especially true considering the items affordability by end users, missing reimbursement schemes, lack of private funding and lack of public funding. Moreover, the item affordability by end users received the highest level of agreement within the survey. A high degree of consensus was also achieved with respect to technical barriers and the items access to broadband connections, a lack of interoperability and usability issues and within the domain entitled acceptance and the items fear of misuse of personal data among elderly users and missing evidence (e.g. considering the benefits of telehealth).
Concerning the solutions to tackle these barriers, the survey revealed multiple approaches that were discussed during the international workshop: Workshops and training of older users but also professional users were seen as essential to promote technology and to overcome the “lack of awareness”. Peer support, e.g. older persons helping each other to deal with new technologies, were rated as promising approaches and should be focused on. Technology alone should not be the centre of attention. The deficits in care must be the starting point for intervention (e.g. regarding assistance and care). Therefore, the elderly who are affected need social assistance first and must then be integrated into a local care system with technological assistances. While an increase of public funding was mentioned as a way to tackle the deployment gap, this was controversially discussed. A way to secure funding of new products and services was seen in venture capital. If private investors find the market promising, they will start to invest money in it. However, up to date a common European market is missing and is seemed not clear if there will be one in the near future.
TREND REPORTS/ POLICY AND BUSINESS RECOMMENDATIONS
The most fundamental aspect is to raise awareness on new, but also existing products and services. This included not only older persons as primary users, but also secondary users like care staff. If upscaling of assistive technologies should be achieved within the nearest future, ‘marketing’ needs to be tackled. To increase acceptance among older persons, participatory design approaches are a key aspect, especially within research projects. It needs to be clear how users should be included (e.g. how many, where, at which point, in which ways). Another aspect that needs to be mentioned is the evaluation of the evidence-base to understand which approaches work, in which specific contexts, and for which target populations. Frameworks are needed for the evaluation of projects, products and initiatives covering economical, technical, legal and social aspects. The re-emerging concept of the Silver Economy counts on ICT for supporting active and healthy ageing and generating economic growth. This bears the risk of increasing the digital gap. Attention needs to be paid to increase the ICT-skills and to offer support. This asks for new models of service delivery.
WP8 - SOCIAL SUPPORT AND LONG-TERM CARE
Partners from Austria, Estonia, Germany, Hungary, Italy, Portugal, Romania gathered a large amount of information (also including neighbouring countries) by involving a number of relevant stakeholders, experts and representatives of users over the past two years of research activities and policy analyses. Research encompassed an overview of different care regimes regarding governance and financing of LTC, patterns of care needs and coverage as well as the identification of examples of socially innovative practice. Of the 62 innovative initiatives 16 were then selected for an in-depth analysis of relevant key factors, drivers and barriers for social innovation in LTC. After discussion and validation through more than 20 expert interviews and 15 focus groups with representatives of long-term care facilities and services, carers’ associations, local/regional administration, relevant NGOs/local associations, hospitals, research, nursing schools and health insurance companies (carried out by all country teams) the results of this analysis were published in a second report. As a result, this workpackage resulted in a number of new insights and products for dissemination and further research.
The Nordic countries and the Netherlands that were first to acknowledge LTC as a social risk that calls for solidarity and universal coverage, a range of countries with a ‘Standard caremix’ joined these ‘early movers’ as they started to implement instruments to fund and develop LTC towards the end of the last century. The Mediterranean countries have been coined ‘family-based’ as the (legal) responsibilities of families to provide care are most important, even if also in all other countries family care and subsidiarity principles remain the backbone of LTC provision. Finally, during the transition from communist regimes to market economies most Central and Eastern European countries have undergone profound changes in social security systems. Due to the complexity of LTC, the lack of political will and resources, LTC often remained a non-priority in this cluster of countries, a hidden if not ‘forgotten’ area. The notable similarities between the countries of each cluster do not preclude specific idiosyncrasies and differences, especially in terms of care demand, policy approaches, funding mechanisms or the levels of (de)familisation and commodification of care. For the purpose of this study LTC has been defined by considering a number of criteria to focus on the continuity of social and health care with the aim to overcome barriers at the interfaces between social and health care, and between formal and informal care. Given the nascent state of its development, LTC is an area with a wide range of opportunities for processes of ‘social innovation’ in terms of “new ideas (products, services and models) that simultaneously meet social needs (more effectively than alternatives) and create new social relationships or collaborations” (European Commission, 2011).
A new concept of ‘care regimes’: in order to contextualise findings and to do justice to the huge differences within and between EU Member States it was necessary to elaborate on existing concepts of ‘care regimes’ (see attached document).
Key Finding 1 - Expansion of LTC services
LTC at the interface between health and social care, and between formal and informal care represents a strong case for social investment to extend the infrastructure both in quantitative and in qualitative terms. Even though the expansion of services as such cannot be seen as social innovation, a large number of initiatives can be identified that combine new approaches, new relationships between stakeholders or new technological applications to reduce gaps in access for marginalised target groups, professionalisation, information and communication. The potential for improvement through service expansion therefore consists in the following:
• A better definition of target groups in need of LTC would avoid under supply, inappropriate or in some cases even oversupply. Users should get needs-based access independently from the origin of their disability because different regulations for specific age groups, diseases or disabilities are causing a lack of coverage and appropriate support.
• Acknowledgement of informal carers as a specific target group for support measures would facilitate a better work-life-care balance for carers at working age, and older carers (spouses) could be prevented from strain that may cause that they end up in needing LTC services themselves.
• A better balance of service provision between metropolitan and rural areas, e.g. by means of appropriate financial incentives for municipalities and professional interventions at the local level, could avoid undersupply and re-strengthen social ties in rural areas.
• In many Member States there is a rising need for considering ageing citizens who are foreign-born as a target group for LTC services to avoid social exclusion.
• The role of the EU in such processes could be, apart from providing funding opportunities, to promote the usage of ICT and assistive technologies in LTC delivery, to ensure mechanisms for promoting LTC across all types of care regimes and to gather appropriate data for analysing supply and demand across Europe.
Key Finding 2 - Re-orienting Europe’s LTCsystems towards community-based care
The potential for Social Innovation Community-based care entails a model of care in which the locality – with its disparate stakeholders working together – serves as the nexus of support and care provision, and in which the confluence of formal and informal support and care, including volunteer services, is a central principle. Essentially, community-based care is one approach to meeting the needs of users receiving community care, i.e. care at home; an approach that emphasises person-centred care and the complementing of formal care services by making the most of resources and networks available in the user’s local environment.
A clear distinction emerges between those countries that have already pushed for fully realised community-based care innovations (Care-mix, Universal), and those in which there remain considerable opportunities to do so (CEE, Family-based). Even among the former, community-based care models have not yet become mainstream practice and tend to be isolated to specific localities and regions. Transferability of best practices in this area is hampered by existing framework conditions that require concerted reforms at the national, regional and local levels.
National-level recommendations:
• Endow local governments with the authority to plan and coordinate care services, with at least partial long-term funding support coming from national sources;
• Incentivise civil society organisations and grassroots initiatives with financial support that extends beyond the traditional duration of pilot programmes (approx. 5 years);
• Incorporate systematic evaluation and a strategy for eventual scaling-up into innovation programmes receiving public funding.
Institutional-level recommendations:
• Develop community networks and create time and space for mediation and negotiation with all stakeholders involved;
• Service planning based on needs assessment involving users from within the community;
• Recruitment of personnel and volunteers from within the community;
• Incorporating solidarity, social participation and building on common social values as core principles.
Key Finding 3 - The potential of integrating and coordinating LTC
Criticism about fragmentation hampering the appropriate delivery of long-term care, as underlined in the relevant literature, has been repeated in expert interviews and focus group discussions. The potential for social innovation and policy measures to foster active ageing by coordination and integration therefore consists in improving independent living of older people at home by inclusive strategies involving new types of stakeholders, coordinating existing (or new and additional) services (e.g. case management) and improving the infrastructure such as the built environment as well as information and communication technology (ICT).
Recommendations
At the macro-level it is necessary to strike a balance between national framework legislation (funding, standard setting, controlling) and the local settings in which services, facilities and care relations are being organised and delivered. National governments need to embrace the concept of ‘social investment’, in particular in those countries where social support and LTC policies have not yet been fully implemented. First steps towards national strategies need to be underpinned by a profound intersectorial dialogue to shape appropriate national framework conditions and by tangible ‘Social Innovation Funds for LTC’. In this connection, coordination between national authorities and EU funding opportunities needs to be enhanced as initiatives by local partnerships based on funding by EU programmes often do not find subsequent financial backing at the national level beyond the pilot phase. On the meso- and micro-level, apart from the fundamental issues of stakeholder involvement and citizens’ participation, the following recommendations for realising active ageing and social innovations that address issues of coordination and integration were deduced from the analysis of expert interviews and focus groups with relevant stakeholders in the participating countries:
• A focus must be put on ‘the local’, e.g. by activating and building on local resources and existing networks to promote the development of dedicated LTC structures;
• Information and consultation structures should be integrated under one roof (‘one-stop shop’ principle) based on inter-sectorial data systems;
• Bundling information at the interfaces must be professionalised by implementing new job profiles (e.g. case managers, network coordinators, social animators and mediators);
• The scope of LTC and integration needs to be extended by addressing new societal challenges in the community towards general issues related to ageing and intergenerational exchange including ICT applications, built environment, transport and employment.
By considering these features, investing in LTC policies offers major potentials to national and EU strategic objectives concerning growth, (female) labour market participation and the reduction of poverty and social exclusion.
Key Finding 4 - Social innovation in the area of employment in LTC
Priority areas for social innovation in LTC employment
-TRAINING: ‘Specialised training’ for LTC workers; ‘Integrated training’ for formal carers’ profiles; national or local programmes for (further) qualification of formal and informal carers; web-based e-learning
-PROFESSIONAL PROGRAMMES: Recognition and regulation of household-based privately hired (migrant) care workers’ profiles and skills (including qualification); development of specialised LTC professional profiles; differentiation of professional LTC profiles
-GOVERNANCE AND REGULATION: Formal professional profiles specialised in integrated LTC (including migrant care workers); multidisciplinary teams (case management); new stakeholders in LTC governance, including employment (main challenge: how to involve different stakeholders’ groups into the policy decision-making process).
-NETWORKS AND STAKEHOLDERS: For-profit and non-profit organisations/NGOs as providers of training programmes and new types of LTC services; mixed networks (private and public) involving local institutions and private (for-profit and non-profit) organisations to promote LTC employment and training; a more systematic involvement of care recipients and informal carers.
‘Enablers’ of social innovation in the LTC employment sector:
MACRO LEVEL: Propensity to ‘professionalisation of care’ by investing appropriate resources to remunerate LTC providers; recognition of the crucial role played by privately hired (migrant) care workers in LTC, in particular in family-based care regimes, by implementing nation-wide programmes to fight undeclared work, support quality care provision (e.g. accreditation) and prevent care drain in migrants’ countries of origin; adoption of specific national programmes or reforms to train family carers and low-skilled (migrant) care workers, e.g. via web-based e-learning initiatives; mainstreaming LTC policies, also by involving for-profit and non-profit providers in quasi-markets of care.
MICRO-MESO LEVEL: Positive attitude of local LTC organisations to join forces, e.g. to achieve better terms in working and employment conditions of LTC staff (e.g. federations of non-profit organisations); inclination to develop and disseminate grass-root initiatives to tackle local LTC needs; presence of local projects and programmes to integrate migrant carers into local formal care provision; development of age-friendly environments; adoption of ICT and new technologies in the delivery of LTC at local level, accompanied by appropriate training of professionals involved.
WP9 - ENHANCING ACTIVE CITIZENSHIP
The main results of this WP are:
• While preferences for spending depend on age and cohort, we found no evidence of an up-coming generational conflict over public resources in the medium term;
• Strong support among stakeholders for MoPACT’s key policy-proposals, namely for establishing mandatory senior advisory bodies at the local level, for linking the retirement age to longevity, and the need to provide more information about pensions. Split in the support for the idea of adopting differentiated retirement ages;
• As people enter retirement, there was a tendency to abandon employment-related civic society organisations (trade unions, professional associations). Otherwise, civic engagement seemed to remain stable over the lifecycle;
• Perceived violations of prescriptive norms elicited negative stereotypes concerning the seniors’ contribution to the economy. Violations of the succession norm (making jobs available for the young) increased the likelihood to support spending on the education, i.e. on the young;
• While a comprehensive approach is required, policy-makers should consider the introduction of the right to representation for seniors at the local level, or seniors’ participatory budgets, as options for promoting the involvement of seniors in policy-making.
The first task aimed to assess to what degree population ageing is likely to change policy preferences in European countries, namely with regards those policies where a priori the largest effects would be expected such as pensions or education. With this in mind, we started by conducting a comprehensive review of the literature on how policy preferences evolve with age. Subsequent to this, we explored a set of comparative European surveys (ESS, SHARE, ISSP) to assess how spending preferences will look like in 2040 given the changes in the age structure of the population.
Potential changes in the (aggregate) policy preferences due to demographic ageing were tested under three, competing, assumptions. First, we tested the assumption that policy preferences vary with individuals’ age. This was done by reweighting the population weights in each survey to match the population composition in 2040. Our analysis found only very small changes in aggregate preferences due to population ageing. Then, we tested the assumption that policy-preference remain constant over the life-cycle. This was done by pooling data from 4 waves of the ISSP survey to build a synthetic cohort panel (Deaton, 1985; Verbeek, 2008; Jæger, 2013). This allowed us to track how the (average) policy preferences of birth cohorts evolve over time. For the two countries for which there was data for the 4 waves (UK and Germany) our analysis did not find any significant changes in preferences.
Finally, and still making use of the ISSP synthetic cohort panel, we projected the expected changes in the aggregate preferences under the assumption that cross-individual variations reflect both age and cohort-effects, i.e. that cohorts display the same preference pattern over time but that different events throughout the life cycle might alter policy preferences. Our analysis suggested that, in the UK, the drop in support is stronger in policies that benefit primarily the younger (education and unemployment benefits). However, an analysis of cohort specific preferences showed that it is unlikely that this shift reflects changes in the age structure in the country. On the other hand, in Germany we only projected a strong increase in support for spending in education – which reinforces the idea that demographic ageing will not significantly impact on the distribution of preferences for social spending in the future.
The next task aimed to take hold of the receptivity of stakeholders to some of the key policy proposals that the MoPACT consortium identified as promoting active ageing. With this in mind, we conducted a survey among a wide set of stakeholders. The survey was disseminated using the substantial network of AGE-platform, and other relevant networks available to the team. We found wide agreement on policies related to creation of (mandatory) advisory senior bodies, providing more training for (formal and informal) care workers and better provision of information on pensions. Furthermore, 4 out of 5 stakeholders seemed to support linking retirement age to longevity. However, there was little consensus as to how an increase in the retirement age should be implemented. In fact, there was an almost even split between stakeholder in the support to the idea that pension ages should be differentiated between socio-economic groups. Finally, there was little support for the idea of financing an increase in age related public spending through general consumption taxes.
Task 3 had two aims. The first was to chart variations in level of civic engagement of seniors across Europe, and to what degree this differed from that of the younger cohorts? With this in mind, and building on framework put forward by Hoskins and Mascherini (2009), we explored a set of European data sources (ESS, EVS and SHARE) to assess how active citizenship for older people varies throughout Europe, both cross-sectionally and over time. We started by building composite indexes to measure cross-country differences in active citizenship, both in the whole population and in those age 60+. This exercise revealed that cross-national differences in the civic engagement the senior population mirrors broader patterns of political participation. Among the 19 EU countries for which comparable data is available, Sweden, Norway and Denmark display the highest levels of active citizenship for the population aged 60+. On the other extreme, Poland, Hungary and Portugal are the countries where seniors are the least involved in civic life.
With the view to further explore differences in active citizenship across generations, we then created a composite indicator that compares the political engagement of seniors in a given country with that of their younger counterparts. Applying this methodology, we found that Austria and Norway, which previously ranked as the countries with the highest levels of active citizenship, the civic engagement of seniors was well below that of the younger generations. In contrast, France and Great Britain, now rank as the countries where level of active citizenship of those 60+, compared to that of the younger cohorts, is the highest.
The second aim of this task was to assess if entering old age may signify a withdrawal from the civic sphere? With this in mind, we ran two (complementary) studies. In the first study, we used data from European Values Survey to build a pseudo-panel. This allowed us to track changes in the level and type of political participation of groups of individuals with a set of common characteristics (year of and country of birth) over time, while accounting for the impact of other relevant (and time-variant) factors, such as income, education, or changes in family (marriage, children) or work life (in education, in work, in retirement). We found that, if we considered the full range of activities covered (involvement in political parties, participation in community organisations, in employment-related civil society organisations and other civil society organisations) the transition to retirement was associated with a drop in the level of civic engagement. However, this should not be seen as evidence of a processo of political disengagement. Instead, it reflects the abandonment of employment-related civil society organisations as individuals leave the labour market. Participation in other domains of civic life seems to remain stable even after retirement.
In the second study, we looked specifically at the potential crowding-out effect of the provision of informal family care to older relatives on active citizenship. Building on data from waves 1 and 2 of the Survey of Health, Ageing and Retirement in Europe (SHARE), we showed that rather than imposing a crowding-out effect, providing care informal family care outside the household was correlated with higher levels of active citizenship. However, this is less true for women, who have fewer opportunities than men to be active in other domains of social social life.
Bearing in mind that negative stereotypes can act as an important obstacle to the participation of seniors in the civic sphere (Swift et al, 2017), we sought to identify the mechanisms that reinforce negative stereotypes about seniors, and find ways to reverse them. Two complementary studies were conducted. In the first study, we ran experimental studies involving young respondents in Portugal (115) and the UK (207), to test if the violation of norms concerning the use of public resources (pensions, healthcare) by seniors (consumption norm) by seniors, the availability of jobs for younger generations (succession norm), and what should be the typical lifestyles of seniors (identity norm) (North and Fiske, 2013) elicits negative stereotypes and attitudes towards seniors. The results of the experimental studies suggested that, for both Portugal and the UK, violations of these prescriptive norms do not seem to impact on evaluations of seniors in terms of warmth (Fiske et al, 2002). However, In the Portuguese study, results suggested that the violations of the succession norm strengthen negative evaluations of seniors in terms of their competence. This finding, however, is not validated by the UK study. The experimental studies also suggested that the perceived violation of the consumption, succession and identity prescriptive norms seemed to elicit negative stereotypes concerning the seniors’ contribution to the economy. In contrast, no effect was seen on representations of seniors concerning their contribution to social customs and way of life. Finally, the experimental studies conducted in these two countries seemed to suggest that perceived violations of the succession norm increased the likelihood to support spending on education - which favoured the younger generations, at the expense of the older generations.
In the second study, we conducted a content analysis of a random sample of articles published in a set of leading newspapers in Portugal (Correio da Manhã, Público, Jornal de Negócios) and the UK (The Guardian, The Times, The Daily Mirror, The Daily Mail, The Financial Times) to assess to what degree print media helps to (re)inforce prescriptive norms about seniors. Our analysis suggested that the succession, consumption or identify norms are not as salient as are more general representations of seniors in terms of warmth and competence. Second, we found that prescriptive norms about how seniors should behave in society were more salient in UK media. Thirdly, and also importantly, our analysis showed that, both in the UK and in Portuguese media, the consumption norm was much more salient than the succession or identity norms. Finally, our results seemed to indicate that, rather than genre or political orientation, the target audience of the newspaper – i.e. if it targets seniors or younger audiences - explains variations in the salience of prescriptive norms about the role of seniors in society.
The final task aimed to identify best-practices and promising approaches in advancing the effective participation of senior citizens in policy-making. We conducted a comprehensive search of national/regional/local participatory initiatives in Europe. Having listed 80 initiatives, systematic information about 35 was compiled. Building on this, we were able to establish a taxonomy of participatory approaches, consisting of:
• consultative approach in decision-making (28 cases);
• consultative approach in policy-implementation (6 cases);
• co-decisional approach in decision-making (2 cases);
• co-decisional approach in policy-implementation (1 case).
With the view to further understand the factors that can boost/hinder the involvement of seniors in policy-making, we conducted three peer-review seminars designed to gain deeper knowledge about the initiatives we identified as three best-practices in the involvement of seniors in policy-making:
• the “Seniors’ Participatory Budget”, in Alfândega da Fé (Portugal);
• the “Senior Citizens’ Councils”, in Denmark;
• the “Partnership for Older People Programme”, in Dorset (UK).
Building on these peer-reviews, we identified a set of Policy Guidelines for promoting the participation of seniors in policy-making:
• ‘Commitment is Paramount’. Participation needs public statements of commitments between political authorities and civil society;
• ‘Beware of Diversity’. Political authorities should take into consideration the ways senior citizens from different social backgrounds - not only of highly-educated citizens – and different ages – as the older senior citizens aged +80 – can have access and participate to the initiative;
• ‘Acknowledge the Benefit of Good Communication’. Civil society should have the chance to be informed about the state of the art of the policies to be debated, and should also be regularly updated about the advancement of the participatory process;
• ‘Be Comprehensive in Your Approach’. Political authorities should make sure that participatory initiatives are sustained by broader institutional changes aimed at overcoming entrenched bureaucratic processes and addressed to improve open public data systems;
• ‘Invest in Training’. The agencies in charge of the organisation of participatory initiatives should invest in the training of the actors involved in the process.
Potential Impact:
The potential impact of MOPACT lies in its core policy messages which were generated in the last year of the project, which are summarised in the widely disseminated policy briefs. The motivation for the project itself seeks to accomplish a fundamental change in society, to establish a new approach to ageing in Europe: making longevity an asset.
The final policy briefs of MOPACT directly address this potential impact, and provide an evidence base for interventions and policy to help accomplish this fundamental shift, which can be achieved by adopting a life course-based strategy for active ageing. This new vision of a society in which ageing is understood as an asset, not a burden, is described below, followed by summaries of the specialised recommendations from each of the work packages.
Summary:
• MoPAct provides a new vision of ageing in which longevity is considered as an asset for social and economic development.
• Active ageing has been rising across EU Member States.
• The Central European countries face the greatest challenges in adopting active ageing strategies.
• Risks of social exclusion in later life are increasing, especially with regard to frailty, which emphasises the need for a comprehensive approach to active ageing.
• Ageing is not inevitably linked to the development of chronic diseases many of which can be prevented.
• While the EU has been a major source of support for research in this field, more is still required.
• MoPAct provides a new vision of ageing in which longevity is being considered an asset for social and economic development.
Why active ageing? MoPAct adopted the comprehensive life course definition of active ageing proposed by the European Road Map for Ageing Research (http://futurage.group.shef.ac.uk/roadmap.html). Active ageing is a comprehensive strategy to maximise participation, healthy life expectancy and well-being as people age. It should operate simultaneously at the individual (lifestyle), organisational (management) and societal (policy) levels and at all stages of the life course. Realising active ageing was at the core of MoPAct’s research programme. It rests on two pillars: pperationalisation of the concept of active ageing by using the Active Ageing Index as its starting point, and developing active ageing strategies with high-level scientific research and stakeholder engagements. The aim has been to translate research findings to maximize the impact on the lives of people and on the sustainability of public welfare systems. This policy brief summarises policy knowledge drawn from MoPAct and points to prerequisites and public policy priorities for realising active ageing in Europe.
Policy-relevant knowledge synthesised from MOPACT
MoPAct was a major multi-disciplinary research project, which built on the FUTURAGE Road Map. It placed emphasis on the so-called New Member States of Central Europe, because they are among the least economically developed countries of the EU bloc and the speed of population is fastest in these countries.
Key policy relevant findings from MoPAct are:
I. Active ageing has been rising across the EU Member States in the recent past
The evidence drawn from the analysis of the Active Ageing Index offers a clear sign of a change that there is now a greater emphasis on active ageing strategies across Europe. Still, there remains a significant scope for further improvement, even in countries which have had a greater success in promoting active ageing. For most countries the changes for both men and women showed improvement although with a significant gender gap in almost all countries. Moreover, all other things being equal, the individual level experiences of active ageing have become more equal across subgroups in the recent past (for the nine countries where data is available to undertake overtime comparison during the period from 2004 to 2013). Further analysis shows that a higher experience of active ageing is correlated with a higher quality of life of older people. Likewise, the relationship between active ageing and per capita wealth is also significantly positive. Thus, active ageing does not imply a worsening of older people’s quality of life and it brings real benefits to the economy.
II. Greater challenges are observed for Central European countries
Active ageing in central European countries is typically low, reflective of weaker institutional capacity and enabling environment for active ageing in these countries. In particular, social participation of older population is markedly low. Employment among older persons is relatively high which reflects inadequate levels of pension income constraining people to remain longer in employment. When the problem of pension income adequacy is addressed, the higher levels of employment (especially among people over retirement age) will not be sustainable without further supportive policy initiatives improving work environment and incentives for longer working careers. The central European countries with low active ageing outcomes also show higher inequality across subgroups. This finding also means that helping the most vulnerable in EU Member States with low active ageing will go a long way towards supporting more equality across Member States.
III. Greater risks of social exclusion are forthcoming in older age
Overall, life expectancy at age 65 in EU countries increased, but healthy life expectancy decreased marginally. Similar trends were observed at age 50 and at age 85. Evidence also points to a large variety between the countries in healthy life expectancy and trends in healthy life expectancy. These findings imply that greater time will be spent in the future in a health status that requires specialised care and support. One other source of greater risks of social exclusion in the future is a change in the age structure of the European population, with rising proportion of one-person families. Number of people 80+ living alone will be at least two-fold in 25 years (in the five countries studied). Individuals and societies should be prepared for the increased economic and social risks of living alone in later life.
IV. Ageing is not inevitably linked to development of chronic diseases
MoPAct evidence points to the fact that only 20-25% of healthy life expectancy is pre-determined by genes. In fact, age associated molecular and cellular damage can be prevented or greatly delayed by lifestyle interventions (e.g. dietary manipulations) and by enabling environments (e.g. knowledge of nutrition, facilities for exercise, timely vaccination). Social investments are required in earlier phases of life to maximize healthy part of longevity which is subsequently responsible for a variety of activities in later life.
V. The EU institutions have been playing an important role in supporting research and innovations but more is required.
The funding for MoPAct has generated strong scientific evidence to inform public policy priorities for active ageing in Europe. Strong political commitments from national and EU-level policymaking institutions are now required for social policy reforms in realising active ageing at all ages. MoPAct provides a new vision of ageing in which longevity is being considered an asset for social and economic development. Similar multidisciplinary projects on active ageing require further funding and translational research towards formulation of strategies.
Five prerequisites for realising active ageing in Europe
• First, the optimistic paradigm of ageing needs to be promoted, viewing older people as agents of change, and with social and economic rights.
• Second, a life course perspective needs to be adopted, putting a strong emphasis on active ageing at all ages.
• Third, the heterogeneity among older persons needs to be appreciated. In the process, the active ageing strategies needs to be made relevant for all and not reduced to elites who are better educated and enjoy good health in later life.
• Fourth, the multidimensionality of active ageing must capture all its aspects of economic and social activities. Active ageing should not be reduced to the idea of longer working careers but also social engagement, independent living and security.
• Fifth, in devising active ageing strategies, it is essential to take account of diversity in the institutional capacities and enabling environments for active ageing across EU Member States.
Major policy priorities and instruments
MoPAct points to the various top level policy goals in Europe. Below these goals are mentioned along with description of policy reforms necessary.
Goal 1 - Ensuring economic and social sustainability: The key to economic sustainability is linking retirement ages to life expectancy. This strategy will also contribute to reducing inequalities in pension income outcomes across different socioeconomic classes. To extend working lives, it is essential to coordinate public policy with work-place human resource policies. Furthermore, interventions need to be tailored to match the state of readiness in each country and organisation. To stimulate private savings, the provision of information and financial literacy is not enough, people also need specific guidance in changing their savings behaviours.
All policy reforms towards financial sustainability must keep in sight the goal of maintaining pension income adequacy.
Goal 2 - Promoting health and well-being in later life: Urgent actions are required in countries where the gap between life expectancy and healthy life is largest: Slovakia, Portugal, Germany, Slovenia, Estonia, Spain, and France. The classic public health interventions are required in all EU Member States to promote health outcomes in later life, in particular promoting nutritional diet, exercise, and vaccination. Social investment type early life interventions are required in increasing healthy life expectancy so as to keep pace with rising life expectancy and reduce dependency in later life.
Goal 3 - Provision of adequate person-centred long-term care: Interventions are required on several fronts in improving the long term care services: expanding existing services where the provision is inadequate; greater coordination and integration of health and social care services; innovative design and implementation of community care, and; employment and professional training of carers. In this respect, there is a clear divide between Member States in their readiness for and implementation of much needed social innovations in long term care. Therefore, there is a greater scope for knowledge sharing between the frontrunner countries and others.
Goal 4 - Adopt modern technologies for efficiency and effectiveness: ICT-based assistive technologies have huge potential for active ageing and the silver economy, but the deployment gap needs to be reduced. The key barrier for an effective deployment is lack of awareness and acceptance among users. Furthermore, public subsidies are required to incentivise take up of the ICT-based assistive technologies. These barriers need to be tackled with urgency.
Goal 5 - Engagement of older persons in social, cultural and civic activities: Active ageing strategies should pay particular attention to promotion of social engagements and cultural and civic activities in later life. Special emphasis needs to be placed on lifelong learning activities. Greater participation of older persons requires commitments between political authorities and civil society. For instance, there is a need to create local advisory bodies in all Member States to represent the views of seniors. The heterogeneity of older people (age, education, gender, class, culture) has to be taken into account if participation initiatives are to be successful.
*ECONOMIC EFFECTS OF POPULATION AGEING*
Policy priority Adjust pension policy to longevity changes so that the ratio of working years to retirement years is maintained in countries with high employment rates for older workers and increased in other countries.
Summary:
• Individuals should be informed about the increased economic risks of living alone and longer than expected and societies should provide for multiplication of the numbers of elderly citizens in one person households.
• Alternative measures indicate that the challenge of population ageing is less immense than traditional chronological measures would suggest, but also that substantial increases in the length of working lives are necessary to maintain current economic dependency ratios and to address the public finance challenges of ageing.
• Linking retirement ages to life expectancy extends working lives markedly. The distributional effects are not as negative as often suggested. In fact, such a policy may well reduce lifetime welfare inequalities, at least in countries with a relatively comprehensive overall social security system.
*EXTENDING WORKING LIVES*
Policy priority Public policies on extending working lives must be joined-up with policies and actions at the workplace.
Summary: Policies primarily (or even exclusively) aiming at working longer through financial incentives are of very limited success if not strategically linked to work place related HR policies. In ‘laggard’ (Central and Eastern European) countries external incentives and support (e.g. legal incentives, professional advice) are needed most. Attitudes and values are playing a prominent role. In ‘front runner’ countries (e.g. Germany), health, skills and working conditions are the most significant points of departure. In organisations the concepts of workability and employability are the best points of departure for designing policies and measures. The concepts of age-management and life-cycle oriented HR policies need to be adapted accordingly.
*IMPROVING PRIVATE PENSIONS AND RETIREMENT PLANNING*
Policy priority Well designed private pensions are needed to supplement public pensions, aiming at customising retirement income to individual needs, optimally allocating systemic risks, and contributing to deeper EU capital markets and thereby higher economic growth.
Summary: Private pensions are needed to supplement public pay-as-you-go pensions which are under pressure due to population ageing and the financial crisis. Funded private retirement savings can help create a deeper, more integrated European capital market, thereby enhancing macroeconomic stability and economic growth. The design of private pensions can be improved by customization of pensions to individual needs, by optimising (collective) risksharing over the lifecycle, and encouraging EU wide portability through e.g. the development of Pan European Pension Products (PEPPs). Information campaigns or financial education programs are not sufficient for realizing adequate private retirement planning. Development of choice architecture is essential, that is offering products and choices in a way that helps consumers to transform intentions into appropriate actions and decisions. This supports the choice process but does not reduce choice opportunities or the consumers’ final responsibility for their own pension provisions.
*HEALTH & WELLBEING*
Policy priority Prevent disability! Meaning: chronic diseases are here to stay, but this does not mean that you cannot live a satisfying life. However, this will become more difficult with increasing disability
Summary:
• During the period of study, 2005-2012, increases in life expectancy at EU-level were not accompanied by increases in healthy life expectancy. The three countries with the largest number of unhealthy life years were Slovakia, Portugal, and Germany.
• Social participation is lower in older people in poor health than in those in good health. Yet, the determinants of social participation are generally the same in both groups. Thus, generally similar measures to promote social participation for older people in good and poor health are recommended. Meanwhile, a few factors proved extra barriers for participation in older people in poor health: depressive mood and lack of transportation.
• Governments have high expectations of private initiatives in the social care sector. It is important that the policy infrastructure supports these initiatives. For example, the funding system should be made better accessible to small organizations, and public transportation services need to be in place for older people with health limitations.
• Different types of social activities compete with each other for time. Regarding policy measures, emphasis has been on labour market participation. However, it is important to facilitate the combination of paid work with other activities such as volunteering and informal caregiving.
• An increase in social participation levels has a very limited contribution to healthy life expectancy (HLE) (0.0 to 0.1 years), and thus will not greatly contribute to the EU goal of increasing HLE by two years in 2020. Regardless, social participation is valuable for society, so it is important that governments facilitate social participation, for older citizens in both good and poor health. More research on alternatives to raise HLE is needed to guide policy.
*BIOGERONTOLOGY: A NOVEL TOOL TO STAY HEALTHY IN OLD AGE*
Policy priority Healthy lifestyle interventions in particular regarding nutrition and vaccination need to be implemented early in life with a lifecourse perspective.
Summary: Accumulating evidence from experimental studies shows that aging is not inevitably linked with the development of chronic diseases. Only 20-25% of healthy life expectancy (HLE) is predetermined by genes; lifestyle and environment play a major role. Age-associated accumulation of molecular and cellular damage can be prevented or greatly delayed by lifestyle interventions e.g. dietary manipulations. Classical strategies (e.g. nutrition, exercise, vaccination) require broad communication to public and novel strategies (e.g. dietary interventions, novel drugs, stem cells) need successful translation from the understanding of molecular mechanism to animal models to the clinical setting. To be successful interventions need to be started early
in life with a life-course perspective.
*BUILT & TECHNOLOGICAL ENVIRONMENT*
Policy priority Plug the deployment gap by creating a platform to encourage business-user collaboration, and focus on the needs of less disadvantaged older people.
Key findings: ICT-based assistive technologies within the fields of mobility, housing and health have a huge potential for active and healthy ageing and offer many opportunities for “success stories” in the emerging Silver Economy. Considering assistive technologies for older persons, Europe and its member states face a ‘deployment-gap’ – the mismatch between R&D efforts on the one hand and policymaker’s expectations and implementation success on the other hand. However, to unlock the full potential of innovative ICT-based solutions, several barriers have to be addressed. The most dominant are: The lack of awareness and acceptance among the users, missing reimbursement and a lack of evidence. There are many good practices and social innovations in European countries that can help to overcome these barriers, in particular focusing on the issue of user acceptance. Differences among the European countries in terms of ICT uptake and literacy/skills can be a chance for policy learning and knowledge transfer, but ask for more country-specific approaches.
*POTENTIALS FOR ACTIVE AGEING BY SOCIAL INNOVATION IN LONG-TERM CARE AND SOCIAL SUPPORT*
Policy priority Recognise that innovations and investment in LTC constitute an asset for ageing societies by contributing to employment, reducing poverty and inequality, strengthening inter-generational balance, and eventually to efficiency gains in public expenditure on health and social care.
Summary: There is an urgent need and a strong potential for innovation in the following four areas within LTC: a) expansion of services, b) coordination and integration of services, c) implementation of community-based care, and d) employment and professional training. Among the countries reviewed as part of this research, there is a clear divide in terms of the presence of framework conditions (i.e. incentive structure) for promoting innovation within these four areas in LTC. This translates into ‘frontrunner’ countries (e.g. DE, NL, AT) that have made strides towards scaling-up complex, partly integrated service innovations, and ‘laggard’ countries (HU, RO, ET) where innovations tend to be less complex, operate on a small-scale often without public support, and are vertical or isolated interventions. EU institutions have an important role to play in supporting Member States by fostering transfer of knowledge between countries, and in promoting national frameworks for improving LTC by embedding incentives for innovation that take a longer term perspective.
*PROMOTING THE PARTICIPATION OF SENIORS IN POLICY-MAKING*
Policy priority: Legislate to create local advisory bodies to represent the views of seniors on key issues such as primary healthcare, long-term care, transport and urban mobility.
Summary: The involvement of seniors in policy-making in Europe is more common at the local level, but seniors are less likely to be involved in the implementation of services. The involvement of seniors in policy-making is mostly done through the creation of consultative bodies (ex. Seniors’ Councils or Seniors’ Forums). The direct engagement of senior citizens is less frequent, and it is more common that initiatives involve individual (elected or nominated) delegates or representative organisations.
*SOCIAL INNOVATION AND ACTIVE AGEING*
Policy priority Adopt a systematic evidence-based approach to both social innovation and active ageing.
Summary: Social Innovation can be defined generally as the development and implementation of novel ideas to meet social needs and create new social relationships that empower people. Social Innovation is an elusive concept which, despite widespread currency, has very little evidence to have supported a systematic change. The evidence-base requires urgent attention. Despite the absence of systematic evidence there are plenty of examples of promising social innovations in the field of active ageing. Those innovations that have gone beyond the stage of mere prompts or a proposal require closer examination with regard to impact and potential for scaling-up. It is also important to acknowledge the social, cultural, economic and political context in matters of social innovation as these factors strongly influence what social innovations can be attempted and to what extend they will succeed. MoPAct developed an easy to apply assessment method with which to judge the quality and sustainability of social innovations. A global search was undertaken to identify 150 examples of promising innovations for inclusion in the project’s database. Active ageing is also an elusive concept and needs to take a consistent, life course oriented, definition. The focus is on social innovations that recognise that older people are a resource and longevity a valuable asset to society.
MAIN DISSEMINATION ACTIVITIES
As one of the five project-wide objectives of the MOPACT, the dissemination activities were built into the project in a specific work package. The core part of this were four European events to reach out to non-scientific audiences: three Stakeholder Forums and the final conference.
The three Stakeholder Forums took place at the end of project years 1, 2 and 3, and ensured that the project findings, plans – and in the third Forum, the initial policy messages – were interrogated by an audience of older people, their representatives, charities, other civil society organisations, policy makers and practitioners. At each Forum participants were asked to use their expertise to help shape the next stage of the project and to identify overlaps, missing elements, provide up-to-date insight from a wide range of interests and countries. This had the dual benefit of generating input to the project, and, at an early stage, ensuring the message and activities of MOPACT were shared widely. The fourth event, the final project conference, was planned to reach a wide ranging audience of non-academics from across the Member States – in person and via an online webcast - to launch the policy briefs.
Continually through the life of the project multiple modes of dissemination were used to reach the widest possible audience, with Twitter proving particularly effective and complementing the project website (containing a full repository of MOPACT knowledge), Facebook, emails, leaflets and direct networking at conferences and events. In addition each work package reached out to its own academic audiences before and after the research process through workshops, seminars and conferences. The full list of 250 dissemination activities has been provided separately.
List of Websites:
http://mopact.group.shef.ac.uk/
Professor Alan Walker - a.c.walker@sheffield.ac.uk - +44 (0)114 222 6466
