This chapter sets out the INTERREG IVC contribution to tackling the consequences of demographic change in Europe. It presents the most important themes these projects have been working on and explores the policies and good practices implemented by them. It highlights common challenges and interesting or innovative practices or policies identified during the capitalisation work with special attention for those that are useful to other regions and projects in Europe dealing with demographic change. It ends with some recommendations that will be useful for policymakers at regional, national and European levels. More detailed information on the individual projects can be found in Annexe 2.
Table 3.1 shows the nine INTERREG IVC projects dealing with the consequences of demographic change and includes the aim of each project, the Lead Partner organisation and the status. Five projects have been finalised (15), and four are still running.
|Acronym||Aim of the Project||Lead Partner||Status|
|DART||To develop strategies to maintain the quality of life in declining and ageing regions.||Investitionsbank des Landes Brandenburg (DE)||Completed|
|ESF6 CIA||To capitalise on innovative approaches to demographic change and older workers.||Aufbauwerk Region Leipzig GmbH (DE)||Completed|
|PEOPLE*||To create opportunities for new employment and reinforce cohesion and well-being.||Junta of Andalucia (ES)||Completed|
|CREATOR*||To address economic development opportunities (for SMEs and in care services) that emerge from new needs of an increasingly ageing population.||County Administrative Board of Västerbotten (SE)||In progress|
|DAA||To combine design with social innovation to support innovative solutions for senior care.||City of Helsinki (FI)||In progress|
|CASA||To support innovative health solutions for the care of the elderly.||The Flemish Community, Brussels (BE)||In progress|
|INN.O.V.Age||To improve independent living of elderly people through eco-innovation.||Marche Regional Authority (IT)||In progress|
|PADIMA||To develop policies and strategies to prevent depopulation in mountain areas.||Province of Teruel (ES)||Completed|
|RTF||To develop policy recommendations addressing the main barriers that hinder the wider use of telemedicine.||Region of Southern Denmark (DK)||Completed|
The nine INTERREG IVC projects that are tackling the consequences of demographic change within the INTERREG IVC programme focus on issues like economic diversification, independent and assisted living, innovation in elderly (health) care, market development for regional SMEs, employment and silver economy, education and lifelong learning, (social) e-inclusion and maintaining public services and more in general on raising awareness.
In the further analysis these main themes have been combined in four common themes or main challenges in relation to dealing with demographic change: lifelong learning and the labour market, economic diversification (including SMEs), (new technologies for) independent living and (healthcare) services.
1. Solutions and Good Practices
This section explores some of the solutions and good practices from the selected INTERREG IVC projects. It is structured around four interlinked themes:
- Education, lifelong learning and the labour market;
- Economic diversification;
- Social services and healthcare;
- Independent living.
Figure 3.1 shows the themes that are addressed by each INTERREG IVC project on demographic change.
Fig. 3.1 INTERREG IVC project on demographic change and themes addressed
Source: Interpretation Pau 2013
The following paragraphs describe a short introduction to the theme and provide a few examples of Good Practices16 from the nine INTERREG IVC projects. The themes also form the basis of the thematic analysis in section 2 below.
1.1 Education, Lifelong Learning and the Labour Market
In the context of an ageing population (figure 3.2) and a reduction in the younger working age group, it is becoming increasingly important that older workers continue to work for a longer period. As people can expect to live 20 to 30 years beyond their retirement, extending working lives is not only an economic necessity, there is also evidence to show that continuing to work can improve older people’s social, mental and physical well-being.
Many good practices (see annex 3 for an overview) have been identified in INTERREG IVC projects that aim to address these challenges. Flexible working arrangements can help address identified skills shortages by encouraging a greater pool of talented people, including women returning to work after their maternity leave, those with care responsibilities, disabled people and skilled older workers wishing to remain in the workforce. Other aspects addressed by INTERREG IVC projects are self-employment and tackling gender inequalities.
Fig. 3.2: Population by age group – EU 27 (%), 2010-2060
A good example concerning gender inequalities is the equality in businesses programme IGUALEM, which aims to incorporate the principle of equal opportunities for women and men in companies, fostering new ways of planning work. Implemented within the PEOPLE mini-programme, the Women Institute of Andalusia, Spain organised training and seminars for companies to teach them how to implement the Equality Plan. The plan itself consists of several steps that are easy to adapt to be used in any region in Europe that wants to tackle gender inequalities. The figure below shows the steps that need to be taken to reach the equality plan.
Source: Women Institute Andalusia/Instituto Andaluz de la Mujer
Measures taken are, for example, ‘flexitime’ (in starting and finishing times) to make working hours compatible with school and nursery timetables, financing the expenses of caretaking (children, parents) during work that takes place outside working hours, and offering paid leave for medical visits and for accompanying children or dependent relatives.
Another example from the PEOPLE mini-programme is the sub-project Silver Academy, which focuses on the development of the local SME sector by providing a real enterprising alternative for those over 50; developing new business models and addressing unemployment among people over 50. The Silver Academy is implemented by Polish and UK partners in the project and has managed to develop new levels of engagement between universities and business networks for the benefit of people over 50. For example, South East England Chambers of Commerce together with the University of Surrey offered Silver Academy training programmes. Part of the strategy used was business mentoring, peer-to-peer mentoring and networking but also online and telephone support. It helped to direct individuals to the services and support materials available. The Silver Academy project in the UK resulted in 20 new businesses, and at least 13 existing businesses became more successful, while in Poland 8 new businesses were set up.
Particularly in areas of Europe where the population is shrinking, it is a huge challenge to maintain high-quality education systems. The objective is to increase educational innovations. These are needed for lifelong learning, long distance learning (e-learning) but also to tackle the mismatch between supply and demand on the labour market. One of the good practices on education comes from the Kainuu region in Finland developed in the DART project. It developed e-learning strategies in sparsely populated areas. Its aim was to promote the use of ICT in labour force training. Its focus is on implementing e-learning in degree-based training, improving e-learning skills and spreading good practices. Kainuu Vocational College succeeded in creating support models for e-learning that are now implemented in everyday practice. Enterprises are also involved, offering training places. In the same project Slovenia and Limburg developed centres for lifelong learning. In regions dealing with a population decline and a decreasing number of pupils/students and a shrinking labour market population, it is important to offer a sound climate for investors and to create or maintain attractive living conditions for the inhabitants. In the transition of a region with labour intensive industries towards a knowledge economy, it is essential to have an infrastructure for lifelong learning. In the Gorenjska region in Slovenia the aim was to give people a chance to gain, update and renew knowledge in an informal way. Various short education programmes and workshops are free of charge for participants and are adapted to different levels of education. They are run by qualified mentors, lecturers and counsellors. In Limburg an e-portfolio and criteria for effective active career/job management was developed and tested.
CAWA (Creative Approaches to Workforce Ageing, ESF6 CIA capitalisation project) developed the European Best Practice Guidelines related to the employment of older workers. The best practice guidelines were set up along three key themes complementing existing literature: employment transitions, working hours and work/life balance, work organisation and workplace design. Each partner selected several employment sectors and geographical regions and then engaged with the relevant employers, employment associations, trade unions and other bodies. In Austria for example, this was the metal industry and hotels, restaurants and tourism, while in the UK, CAWA looked at London bus drivers, gas engineering and public healthcare. The internal and external evaluation that was conducted showed significant differences at sectoral, regional and national levels and implied that solutions have to be specific and tailor-made according to the nature of local, regional and national labour markets as well as sectors. In addition, the practice highlighted the importance of introducing and promoting schemes for older workers developed in cooperation with trade union support.
1.2 Economic Diversification
Although not that many of the selected INTERREG IVC projects (see annexe 3) focus on economic diversification as such, it is regarded as an important theme for regions dealing with demographic change, especially for those dealing with population decline. The PADIMA project states in its final report on economic diversification: “Diversification of products, economic activities and markets is one of the key factors for regional and local economic development and for demographic growth. Territories should aim at diversifying their economic structure, rather than focusing exclusively on one or few sectorial specialisations in order to widen and multiply the opportunities of economic growth and to benefit from the several external economies arising from the presence and proximity of different kinds of economic activities.”
There is a differentiation to make here: at the single firm level, diversification is the introduction of new products and the access to new markets; at aggregate level, diversification refers to the sectoral composition of the economy (new/different sectors). In the latter case, it includes “businesses and entrepreneurs, both currently operating entrepreneurs and ‘new generation’ of entrepreneurs; decision-makers and politicians, whose strategies and decisions can better drive and stimulate the diversification process.” (17)
Maybe one of the most well-known examples is ‘green care’. The main objective is to promote the economic development of the agricultural sector by focusing on new services (health and care services). Within the PADIMA project, Buskerud County in Norway supported farmers to diversify their services and economy and the Province of Torino, Italy supported childcare farms that were initiated by COldiretti Torino (an organisation of agricultural entrepreneurs), called Agrischool for Infancy. The farm offers day care for children of 0 to 6 years old, and services in less favoured areas where essential services are not guaranteed. At the same time, it increased economic competitiveness and improved farmers’ incomes. Three farms were set up and several others are in process of being set up.
Another example is a good practice from Romania (DART project) that aims to stimulate the craft sector in the rural areas of the Centru Region. It financed investments in specific equipment and various promotion actions to support hand-made products, regional traditions and the active involvement of elderly people in the traditional economy market. The traditional economy sector is under pressure and without proper promotion and marketing action, it is impossible for artisans to maintain a living through their work.
What has not yet been mentioned here, but is of importance for economic diversification, is the fact that the long-term trend of a progressively ageing regional population also creates new economic development opportunities. Life expectancy after work now makes up a quarter of the years lived. Seniors of today are healthier and wealthier than ever, and are therefore consumers to be reckoned with. For example, leisure activities for people over 50 are on the increase, resulting in new opportunities for entrepreneurs. The Active 50+ Fair organised in Poznan, Wielkopolskie, Poland (sub-project RECO, CREATOR) promotes products, services and project for people over 50. The Fair presents companies that focus on the elderly and recognise the expectations of elderly consumers. It includes products and services in the field of health, work and education, travel, sports, beauty and lifestyle, passions, new technologies and media and finances. The ‘Active 50+’ fair is also a space for local and regional NGOs and public bodies that carry out projects for seniors and people over 50 in various areas such as home care, education, physical activity, culture and art, voluntary work, etc.
In addition, the growing demand for healthy ageing and people wishing to stay at home, and in general for home e-health combined with the general use of IT and Internet, offers new opportunities for SMEs. In the RTF project the partnership’s objective was to foster the involvement of SMEs and, through that involvement, to stimulate the deployment of telemedicine as well as stimulate economic growth and employment. One of the good practices was the OPI-LAB laboratory for public-private innovation in the field of e-health and assisted living in Denmark. Danish regions, the national board of social services, several municipalities, research institutions and private enterprises cooperated to develop new e-health and assisted living technologies, collect experiences and new knowledge as a basis for new public-private collaboration models, and exhibit and demonstrate the opportunities offered in this field.
The method for innovation creation in the DAA project, which started in 2012, is to combine the expertise of senior care specialists in cities with the expertise of service designers. The DAA project recognises that ‘innovations in technology, ICT, housing, procurement processes and public-private partnerships in the area of senior care all create major potential for Europe’s competitiveness’.
More good examples in relation to (care) services and independent living will be elaborated on in the following paragraphs.
“The silver economy (referring to the elderly workforce) and the white economy (referring to the economic opportunities of healthcare) could be new sources of growth together with opportunities from green economy activities, but there is a need to create an enabling environment by providing appropriate support to local governments and business.” (OECD 2012)
1.3 Social and Healthcare Services
In recent decades, peripheral (often rural) areas have in general experienced decreasing accessibility to services, while the opposite trends are evident in urban agglomerations, although cities in, for example, Eastern Germany, northern France and parts of the UK have also experienced a strong population decline resulting in services under pressure. Private stakeholders are hesitant to invest and operate in such areas due to low profitability. But in regions with a strong ageing population services are also under pressure with an increasing number of people needing access to (health) care and services. Against the backdrop of the ageing societies in all EU Member States, the topic of eldercare services increasingly registers at the European level, where several policy initiatives are being discussed. The huge number of demographic strategies available show how important eldercare services are.
As figure 3.1 shows, seven of the nine INTERREG IVC projects focus on social and care services and try to tackle related problems.
In the field of social services the good practice Citizen buses and future trends from Brandenburg, Germany (DART project) might prove to be a good example. The main objective of this project was to maintain mobility in sparsely populated areas with the help of voluntary engagement. This was done through offering transport solutions like citizen buses, grocery pick-up and drop-off services and also ‘combibuses’, which can be used for passenger transport, post and parcel services, banking, etc. Citizen buses operate along the local public transport routes.
In Poznan, the capital of Wielkopolska, Poland, and partner in CREATOR, The bridge was identified as a good practice. The bridge is a construction that helps less mobile elderly citizens to board or alight public transport. Poznan created a universal metal bridge, which can be operated both electronically and manually and installed directly underneath the door in buses in order to bridge the gap between a bus and the pavement at the bus stop. The gap between pavement and bus is a challenge for many older people and causes them to stop using public transport. Also by CREATOR, the Health exercise model for elderly people in Hämeenlinna, Finland was identified as a good practice. The model increases elderly people’s exercise in and near their homes and living environment. Through this programme, most of the elderly residents started exercising and improved their physical condition. At the same time, the residents benefited from an opportunity to get to know each other better. Some rural and sparsely populated areas of Asturias, Spain receive services from the breaking distance programme which delivers care to elderly in need of assistance and their families (home assistance, domestic services, accessible transport) and promotes social participation (for example library, workshops to promote active and healthy ageing) and volunteer work.
1.4 Independent Living
In 2020, the share of the population of those over age 65 will rise to 28 per cent. This will change the housing market and require new forms of housing to be developed. Or, as the CASA project phrases it on its website: “Demographic changes make it necessary to organise the care and housing of senior citizens and chronically ill in a smarter way, including the use of ICT. This also gives opportunities for innovative companies to develop new tools and services.”
Because people are living longer, there is a growing need for smarter homes that are better adapted to their needs. At the same time, individuals are increasingly suffering from long-term conditions, such as heart disease, diabetes and hypertension. Rather than keeping people in hospital or care homes, there is a growing realisation among many that it is better for individuals to remain in the comfort of their own homes. To give an example; the exchange of experience within the RTF project has resulted in the identification of 20 examples of regional good practices, and the transfer of these good practices to six participating regions, which have helped them to adapt the ongoing development and organisation of new telemedicine services. Besides this, it has helped to improve the planning of new telemedicine services for chronic patients with COPD, diabetes or CVD and to establish new centres of excellence in this field.
The majority of the elderly also want to remain in their familiar environment and to live as independently as possible – even if they need assistance and care. The Projects DAA, INN.O.V.Age, CASA, PEOPLE, CREATOR and RTF have or are still searching for smart solutions to deal with these matters.
As one of the partners in the INN.O.V.Age project, which aims to implement new policies for eco-independent living, the South East Health Technologies Alliance (SEHTA) has launched a UK Healthcare Innovation Hub – a centre of excellence where high-tech entrepreneurs, academics, researchers and policymakers can meet, network and develop new and innovative healthcare concepts. The purpose of the UK Innovation Hub is to act as a catalyst for bringing together people with the common interest of helping elderly people to live independently. A further goal is to ensure that the cost of healthcare is reduced while improving the levels of care that individuals receive. The good practice that is being implemented by SEHTA in INN.O.V.Age, the ICE-T model, targets SMEs with near-market solutions who are willing to match-fund their further development. The ICE-T model is a functional model for project specification, funding, evaluation and commercialisation, thereby enabling more rapid introduction into the products and services market.
Similarly, in SILHOUETTE, one of the sub-projects of CREATOR, the focus is on the use of ICT technologies to support the activities of elderly people. SILHOUETTE identified over 50 uses of ICT for the support of elderly people and for making people of this age group more aware of ICT. The Nordic Regions of Häme and Västerbotten offered and developed the most advanced solutions. These included smart cooking appliances such as Menumat. Menumat meal preparation equipment is a combination of a convection oven, a freezer, an intelligent shelving system and a control and steering unit. The control unit is a Linux machine with a wireless Internet connection. Meals are pre-ordered from the Menumat catering menu once a week or every second week. The meal equipment identifies what kind of meal is carried by each case. Meals can be selected by manually pulling out the appropriate case or choosing it from the list. The oven automatically identifies the meal and heats it up accordingly. The machine is equipped with a speaker and announces when the meal is ready. The oven shuts itself down automatically.
2. Thematic Analysis
This section presents an analysis of the lessons emerging from the INTERREG IVC projects and explores the implications for policies in European regions, taking into account the consequences of demographic change. The universal processes related to the demographic transition to structural low fertility on the one hand, and economic geographic processes of concentration and urbanisation on the other, lead to regional population decline in most European countries. Due to this universal nature of the underlying processes, solutions and practices aimed at dealing with these processes share substantial similarities, but different approaches can also be found.
The analysis is structured around the core questions at the heart of the capitalisation exercise, which were posed by the INTERREG IVC Joint Technical Secretariat (see introduction). The following paragraphs will look at common challenges among the INTERREG IVC projects, similar good practices and different solutions and interesting practices, policies and results that could be useful for other regions dealing with demographic change.
2.1 Common Challenges
Some common challenges encountered by the analysed projects are listed below.
Quality of Life
Regional population decline and ageing affect public services, housing and public infrastructure, but are difficult to adapt to quickly, leaving some people excluded. The main challenge is to maintain the liveability of areas and the quality of life for inhabitants even when in a situation of transition from growth to decline. To rise to the challenge, the Asturias region in Spain (CREATOR) developed a best practice guide on care homes for the elderly. It described a quality model for person-centred assistance, which focuses on moving from a system based on the person’s limitations to one centred on the person’s capacity and self-determination to improve his or her quality of life. Another example is the idea of the service manager in the DAA project. Services in the future will be produced more and more outside of the existing public service delivery network by private and third-sector service providers. A ‘service manager’ will mediate between client and services and integrate many new roles. In this way, the service manager will actively try to improve customers’ everyday lives.
It is well known that the use of modern information technologies in healthcare leads to numerous legal challenges, and sometimes legal issues are considered barriers to the development of telemedicine and e-health. But in other sectors, too, it might not be so easy to implement good practices. For example, the project ‘Agrischool for Infancy’ in Torino, Italy, had to overcome certain legal obstacles. The time to adapt the initiative within the current legislative framework was long. It succeeded because the project was local and all the stakeholders were involved (health agencies, farmers, public authorities, et cetera).
Some more advanced solutions and services have been piloted, but did not take off after the pilots mainly due to technical problems. There is still quite a lot of room for improving the use of well-being technologies in elderly care. Projects dealing with telecare or telemedicine such as RTF, CREATOR, INN.O.V.Age and PEOPLE (TCares) are also confronted with the conservatism of many healthcare providers and patients, who may fear the technology, thinking it decreases contact between patient and doctor.
From an industrial point of view, the lack of a clear economic model poses a challenge, and especially the economic conditions for the day-to-day use of telemedicine. This situation is clearly described in the French Auvergne Region18’s Good Practices Guidelines for telemedicine market development facilitation for SMEs at regional level : “All stakeholders agree that telemedecine needs innovation and the acceptance of risk, and that SMEs are capable of being the frontrunners in this regard, leading the way for other larger companies that would know how to expand the market. Yet an unstable market environment implies a high-level of risk for SMEs and, as a result, is an obstacle for the development of the telemedicine market. This is why the RTF proposal to produce a guide for involving SMEs in the telemedicine market is crucial; both for business development per se and for the development of the telemedicine market in general.”
Organisational and political changes in recent years have made it difficult to keep to initial plans. Constant changes and challenges in the ‘real world’ situation combined with bureaucratic rules on all government levels makes it difficult to adapt to changing ‘real world’ situations. The project PADIMA for example, was built on the opportunities that come with exchange within a European project but also on the assumption of steady economic growth in the European Union. The financial and economic crisis have however been a setback as implementing new methods is often dependent on the availability of investment.
In Europe, there are many different ways of organising healthcare. Some systems are organised at a national level, although most countries organise their healthcare at the regional level. These different organisational traditions mean transferring good practices among partners can be challenging. In addition, according to RTF, while there are many knowledge professionals in the field of telemedicine, decision-makers often lack adequate knowledge.
Lack of Time and Funding
The selection of good practices is often carried out using a very good integrative method. Problems arise, however, during the implementation phase because of a lack of time and funding. The same is true for the transfer of the good practices and policies, although some projects anticipated such problems at an early stage and took precautionary measures, such as holding transfer meetings with experts (DART) or working with a Transfer Task Force (CASA).
2.2 Similar Good Practices
Similarities can be found in all four main themes. Comparable good practices in the field of education, lifelong learning and the labour market, for example, are those in which the potential of the ageing workforce is employed. Older people and in particular ageing baby-boomers can look forward to many more years of healthy life, and they possess valuable skills and experience. More opportunities for active ageing will allow them to continue to contribute to society, even after retirement. DART, PEOPLE, CREATOR and ESF6 CIA include practices related to the ‘silver economy’: economic opportunities related to population ageing, especially regarding (technology) services for well-being and healthcare; and support the development of the local SME sector by providing a real enterprising alternative for people over 50. The good practice that is relatively easy to transfer to other regions is the Silver Academy, which offers free, expert support for the over-50 age group in setting up and making a success of running their own businesses: “the Silver Academy is helping this under-represented group to bring their valuable expertise and experience into the business world, motivating them to achieve their goals and develop new businesses” (PEOPLE). The Silver Academy is still running in the UK and Poland and has been transferred to Northern Hungary, where it has been selected as a good practice in one of CREATOR’s sub-projects (SILHOUETTE): Network of Elderly Experts in Northern Hungary. The main goal in the case of Northern Hungary is to “organise professional training programmes in as many fields of study as possible in order to offer multidisciplinary qualifications to the active over 50 citizens seeking further qualifications (e.g. computer science, European studies, social policy, environmental policy and well-being or healthcare)”. And by doing this to “create new levels of motivation through supporting materials, networking, or business mentoring”. The city of Wroclaw (Poland), started the Third Age University in the DART project to educate elderly people in the field of foreign languages, new technology, general knowledge, health, gerontology and the history of the region, with the aim of promoting a healthy lifestyle and the development of skills. In the Lower Silesia Region (Poland), unemployed women are encouraged to return to the labour market through the ‘be a successful woman’ project (DART). In the ESF6 CIA project (FILES), Western Greece provided vocational training for unemployed people, and in particular to women, and assisted them afterwards with finding a new job.
In DART, PEOPLE and CREATOR, opportunities for elderly people to improve their computer and ICT skills were identified as good practices. In PEOPLE, the Abruzzo region (Italy) selected the Informatics without borders project, which offers basic instruction in using and working with computers. In the CREATOR project, the Hämeenlinna region (Finland) offers free of charge or fee-based computer training schemes, which are tailored to the needs of the target group, while in Poznan (Poland), the Online Grandmas offers a two month computer course. In Central Bohemia (Czech Republic), people who are 40 years of age or older are offered computer skills for job seekers to improve their chances on the labour market, and in Galicia (Spain) computing skills and ICT training is provided as part of the active silver project (DART).
Many good practices for economic diversification were identified by PADIMA, which related to tourism, agriculture, art and culture, and regional branding. One example is the cultivation of truffles in the Valbrembana valley in the municipality of Bracca (Lombardy, Italy). This small rural village of only 750 inhabitants was at risk of depopulation due to a lack of job opportunities, especially for young people and women. At the same time, it was recognised that there was a strong potential for gastronomic tourism because of the rural traditional economy of cultivating truffles. The project’s aim was therefore to improve truffle cultivation to sustain this local economic sector. Promotional initiatives (in partnership with local restaurants), truffle cultivation (in partnership with local farmers) and education resulted in a business opportunity for the local community. In addition, using and promoting traditional local products is also part of a wider policy to promote the whole Valley of Valbrembana as a tourist destination.
DART also identified good practices related to traditional economy sectors like arts or handicrafts. Examples are the National multiannual programme for supporting artisans and craft activities in the Centru Region (Romania), the Against tide project for economic regeneration in Kiltimagh (Ireland) and the good practice Fit for taking over the management of a handicraft enterprise in Brandenburg (Germany). The latter tackles the problem of a mismatch between young, well-educated and skilled people who are leaving their region in search of a good job and a quick career in other parts of Germany or Europe and the growing number of owners of small handicraft enterprises who are looking for a successor. The Association of Craftsmen Niederlausitz District was confronted with the situation of more than 3 000 handicraft enterprises in Brandenburg facing a generation change. This project offers young craftsmen additional structured training to improve their skills to enable them to take over a handicraft enterprise.
Similar good practices in economic diversification focussing on new products and services for the elderly can be found in RTF, INN.O.V.Age and CREATOR (also see Annex 3). To give an example, the international Innovation Centre of Excellence in Telehealth and Telecare as part of DALLAS (Delivering assisted living lifestyles at scale) from the RTF project and initiated by the NHS 24 service in Scotland is similar to the ICE-T project from INN.O.V.Age. The Centre in Scotland focuses on research, innovation and exploitation by attracting both industrial and academic funding sources. In this way, it hopes to build a critical mass for international research and its exploitation. The research relates to policy, implementation, innovation and support for entrepreneurship. A key focus for the Innovation Centre will be on “the creation of new economic models that aim to synergize the public, private and voluntary sectors to create new opportunities for economic growth and job creation.” Since its launch, the International Centre for Excellence in Telecare (ICE-T) in the UK, a market-led approach to telecare and telehealth, has proven to be successful, with a dynamic network of more than 1 500 contacts in companies, medicine and academia in the UK and internationally. The initiative has also helped to raise more than £1.5 million for innovative businesses involved in the development and delivery of telecare and telehealth products and services.
DAA, INN.O.V.Age and CASA have just started to implement their projects but are already producing interesting methods. One of them is design-led innovations for senior care and active ageing from the DAA project. The method for generating innovation in DAA is to combine the expertise of senior care specialists in cities with the expertise of service designers. Similarly, e-inclusion of the CREATOR sub-project SILHOUETTE includes users in the design of new technology in order for them to be active and to direct the design to ensure a result that matches the elderly generation’s needs and priorities. It also ensures a result that is easy to use and does not require much learning and shows the elderly how to use technology.
In relation to independent living and social and (health) care services INN.O.V.Age, RTF, CREATOR, DART and PEOPLE identified several good practices on telecare and social services for people of all ages in regions dealing with population decline and pressure on these services. In TCares (PEOPLE), the Andalusian Service of Tele-assistance was identified as a good practice to improve the quality of life of elderly people using telecare services by providing them with company, security and rapid attention. Similar practices are identified in Asturias (Spain) and Hämeenlinna (Finland) in the SILHOUETTE sub-project of CREATOR. In INN.O.V.Age health services in a smart home for the daily care of the elderly after an operation are being developed by the Cyprus University of Technology together with the Paphos Chamber of Commerce and the Geroskipou Municipality. In relation to housing the Clúid Housing Association was formed as a direct response to the challenges arising from the changing demographic profile and growing proportion of older people in Ireland. Clúid has been developing housing for older people since the late 1990s in the form of sheltered purpose-built accommodation for elderly people who want to live independently in their own apartments or bungalows, yet benefit from a secure environment and visiting staff. Clúid ensures that alternative housing options are available to elderly people who have difficulty maintaining their previous accommodation, or are at risk of being inappropriately put into residential care.
2.3 Different Solutions to the Same Issue
Besides focusing on the 50+ employee, the ESF6 CIA project tackled the consequences of demographic change for the development of the labour market by focussing on the employers. Their work consisted of identifying what policies employers and employment related organisations need to adopt in order to extend the labour market participation of older workers. CAWA (Creative Approaches to Workforce Ageing) was carried out by four European partner institutions based in Spain, Austria, Sweden and the UK with further input from Bulgaria. The project partners had strong links to trade unions, employer organisations and regional authorities, facilitating multi-layered debates related to raising awareness of demographic change among policymakers and developing best practice guidelines. The result of the study was a conceptual framework to gain understanding of the push and pull factors associated with workforce ageing. The CAWA results conclude that the debate on an ageing workforce needs to focus on a deeper understanding by employers and policymakers of the work- and non-work-related identities of older workers.19 This type of action has recently been taken up by the PEOPLE mini-programme.
In relation to gender inequalities, the IGUALEM programme (PEOPLE mini-programme) worked on the incorporation of equal opportunities for women and men in companies by introducing flexible working times. ESF6 CIA and the GENERATIONS sub-project of CREATOR is also tackling aspects of working hours and work/life balance but in relation to the ageing workforce: “As workers grew older, the desire to match personal interests and family commitments with the need or desire to continue in work became apparent among workers in all sectors. (20)”
The pilot being implemented in Västerbotten, (Umeå municipality, Sweden) in the GENERATION sub-project of CREATOR is a departure survey sent to all permanent employees who have recently left their employment. One of the questions is whether the person is interested, for a shorter or longer period, in returning to Umeå municipality to work. The comments from the survey can be used to help the company to improve business activities and become a more attractive employer. This study is valuable because it gives the employer feedback that can contribute to a better working environment for current employees, who then may be willing to work longer. The practice is set up along with an enhanced annual meeting with employees between 57 and 62 years old where values, motivations and attitudes about continuing to work until the age of 67 are discussed. The aim is to become an attractive employer and solve some of the future recruitment needs.
Numerous different solutions to the growing need for healthcare services in the ageing society can be found among the nine INTERREG IVC projects. Some of them focus on the shrinking labour force in care-related sectors, others focus on innovative solutions in the provision of care and some promote healthy ageing and prevention. To give some examples, the PADIMA project identified the Health and Social Care College as a good practice. This college, situated in Dalarna (Sweden) was set up to attract more people to pursue education within the health and social care sector, thereby increasing employment possibilities and also improving the skills of those already working in the healthcare sector. Partners in Spain, Finland, Sweden, Poland and France are cooperating in the sub-project BIOLIFE (CREATOR) where good practices have been identified to “tackle challenges in relation to the needs of the ageing population regarding food. A nutritious daily diet is one factor that may assist the 55+ to maintain optimal levels of health and to prevent diseases. BIOLIFE break down this need in into a series of discrete items: food safety, food intake, nutrition, packaging, food delivery, eating and home service.” In Kainuu, Finland (DART) personal physical activity and nutrition counselling is combined in the TELIRANE project.
Regarding the development of SMEs within the field of ICT: RTF contributed to facilitating the development of the telemedicine market for regional SME’s. This involved the exchange of experience on initiatives that tackle barriers, such as procurement challenges and better access to finance for SMEs. The INTERREG IVC mini-programme CREATOR stimulates innovative, technology-intensive SMEs to develop specific products and services that meet the needs of an increasingly ageing population. Senior Act is a programme to help food companies develop new products for the elderly, while the Agnes project supports daily activities and social interaction through user-sensitive systems, providing opportunities for social innovation and new business opportunities.
2.4 Some innovative practices that are of interest to other regions
During the interviews with the project lead partners of the analysed INTERREG IVC projects, it became clear that some of the identified good practices could be of interest to the project partners and that some good practices could also attract further funding from the managing authorities. Although not always suitable for transferring to another region, innovative practices may function as triggers or inspiration for other European regions. In this section some of these good practices are discussed in more detail.
Due to its innovative character Glasade Gången, a day centre in Sweden (PEOPLE), generated a lot of interest both in Sweden and in and outside the EU. It also received numerous study visits. Glasade Gången is a day centre with activities for adults with learning disabilities. It consists of a restaurant and conference facilities. The model is based on the development of a public-private social cluster supported by the active participation of the City of Stockholm. Glasade Gången is expanding its operation and now also has a café and produces chocolate.
The Care Academy Parkstad in Limburg (the Netherlands) was one of the pilots in the DART project aimed at solving regional labour market problems in healthcare. It is a unique cooperative project between education and healthcare institutions in the fields of innovation in care, innovation in education for healthcare workers and strategic employment policy. The Care Academy is a multi-stakeholder initiative involving a Medical Centre, a Care Group, and three major schools in the region of South Limburg, a vocational school, the Zuyd University of Applied sciences and the Open University of the Netherlands. It is the fruit of local and regional authority plans for an innovative care industry. Its objectives include providing tailor-made educational programmes; realising and speeding up innovation in the care industry, as well as in educational programmes; knowledge sharing between systems used in education and between companies and education; and a research programme. The concept has now been applied to several regions in the Netherlands.
The Hedmark region in Norway (PADIMA) is in great need of new inhabitants and new jobs. A project was launched to make this mountainous region of Norway the ultimate destination for a horse-themed lifestyle, with a yearly horse festival, facilities for travelling by horse, horse-related occupations, riding arenas/halls, and an Agricultural College as a centre for horse related courses and education. One of the goals was to attract and keep women in the region. The horse project has increased the number of new inhabitants and has created new jobs for seasonal workers and for the owners to expand their businesses. Among other things, this has also brought advantages to veterinaries, fodder producers and teaching personnel. Horses as Driving Forces for Settlement, Occupation and Quality of Life shows how a cluster of excellence in tourism and animal breeding can create new economic prospects, financially supported by a public-private partnership.
In Saxony, Germany, the Supermarkets of generations project (DART) facilitates the independent living of the elderly through a fully accessible supermarket. Especially in ageing towns or areas with a high share of older people, retail trade companies should meet the needs of the ageing population. The German Retail Trade Association (Handelsverband Deutschland, HDE) implemented a certificate for ‘generation-friendly shopping’ in 2010 on the basis of this idea.
With regard to social services, the good practice Citizen buses and future trends from Brandenburg, Germany (DART) should be mentioned again (see 1.3), since the solution for local public transport in an area with a sparse population is of high interest: the citizen buses are driven by volunteers, which makes the project stand out, although over the last couple of years similar initiatives have been initiated throughout Europe.
The design-led innovations for senior care and active ageing from the DAA project should also be mentioned again here. Combining design with social innovation is a novel approach, and by doing so, the project contributes to creating innovative products and services with new opportunities for EU businesses. The partners learn from established innovative services and solutions, improve the innovation capacity of their city administrations, and improve public sector policies.
In the field of independent living the SILHOUETTE sub-project (CREATOR) looks for methods that facilitate and enhance the ability of elderly people to continue to live in their own homes as long as possible. The region of Lorraine (France), one of the partners in SILHOUETTE, has a well-established practice called carephone. The telecare for home safety connects the user to a network of close and trusted people as well as to emergency services. The contact between the client and the centre’s staff is led by a specialised operator from a hotline centre. The client can call the hotline centre at any time by simply pressing a trigger button (on a necklace or a wristwatch, as desired by the client). The client is then connected to an operator who listens and identifies his or her needs in order to provide the most appropriate response. Depending on the need, someone from the personal network (friends or family) and/or the patient's doctor is informed. If necessary, or in case of a lack of available people in the network, emergency services, for instance an ambulance, can be directly alerted.
Neighbourhood care (Buurtzorg) from Noord-Brabant (PEOPLE, DIVERSIA sub-project) is the development of an innovative, small-scale concept for home nursing and care in the Netherlands. It reintroduces the district nurse, in reaction to homecare being all about production, protocols and administration. It started out on a small scale, but the organisation Buurtzorg Nederland has expanded to 250 independent teams throughout the entire country. Buurtzorg Nederland is an organisation in which district nurses and district healthcare workers themselves have the authority. “Every team is responsible for its own clientele and is in close contact with family doctors and families. The teams are also responsible for their own financial results. The supporting office in Almelo is just that: supporting.” The Buurtzorg teams work from simple locations and the nurses, not the managers, are the pillars of the organisation.
The Campus for Generations in Brandenburg (Germany) is intended to help highly qualified elderly people improve their chances on the job market. But its objective is also to raise awareness of demographic change and the economic consequences, the professional situation and potential of the elderly and of well-educated unemployed people. The project addresses unemployed graduates that are at least 50 years old and who are citizens of the federal state of Brandenburg. How does it work? Together with students from the University of Potsdam, the participants are included in scientific and project work at the university. They work jointly in mixed groups of elderly and young people on innovative projects in collaboration with SMEs from Brandenburg. At the start of the qualification the strengths and motivations of all chosen participants are analysed. Based on the results and the participants’ job experience, the taskforce is connected with the regional companies. For small- and medium-sized enterprises in particular, such participation offers the possibility of discovering and using the potentials of the 50+ generation.
2.5 Interesting results useful for other regions dealing with demographic change
In this section, examples are given of projects that achieved particularly interesting results in terms of good practices transferred or policies improved that could be useful to the other projects dealing with demographic change and more generally to other local/regional authorities dealing with that topic.
From the limited list of good practices that have actually been transferred or policies actually improved (most of the projects are still in the process of identifying them), there are several interesting solutions that have been transferred between partners. These are just examples and do not give the complete picture of all transfers that took place. In the further analysis of the capitalisation on demographic change, this part will be extended in its analysis and elaborated upon in more detail and with many more examples.
Within the DART project, the service centre for lifelong learning from the Limburg region and the Campus of Generations project from Potsdam exchanged ideas together with the University of Innsbruck. As a result, the DART project developed a concept for the University of Potsdam for a Service Centre for education and lifelong learning within the Campus of Generations initiative (see also the previous paragraph).
The ESF6 CIA capitalisation project managed to transfer several good practices between regions, or managed to achieve the level of acceptance of developed action plans. One example is the Vocational training seminars for women and special target groups, which tries to match demand and supply on the labour market through the provision of training for unemployed people, in particular women, and assisting them afterwards in finding a new job. This good practice was transferred from Western Greece to Catalonia, Bulgaria and Saxony. In Catalonia, funds were allocated to implement similar pilots. In Bulgaria a ‘back to work’ grant scheme was set up by the Bulgarian Management Authority.
A couple of new EU initiatives have a similar focus to that of RTF both on the policy level and on the exchange of good practices in the field of eHealth. In contrast to their previous work, the RTF partnership focused on the development of policy recommendations for European regions to help them in their efforts to realise the potential of a wider implementation and deployment of telemedicine services at regional level; thereby improving patient care and healthcare system efficiency, as well as developing the market for regional SMEs. The policy recommendations were developed after identifying and analysing barriers at clinical, evaluation, strategy and market levels, and have been disseminated through different sources and via other projects across Europe. What is important to stress is that the project addresses the strategic challenges for regional health authorities instead of testing technological equipment, and how politicians need to think about a large-scale deployment of telemedicine services. One of the good practices in RTF, the telemedicine service of the Region of Southern Denmark in the field of COPD (the ‘Patient Briefcase’), allows hospitals to carry out consultations with COPD patients at home via Internet, mobile phone networks or via satellite technology. The patients are monitored for one week using daily 15 to 30 minute consultations, including measurements. Feedback to the service has been very positive – the technology is easy to use, while the service is personalised and flexible.23
On the issue of improved policies, the Malopolska region offers a good example. The region published a White Paper entitled Challenges for Malopolska in the context of demographic change on the basis of an interregional cooperation with regional experts from PEOPLE. This White Paper is a strategic document featuring indicators and policy recommendations to be undertaken by the region of Malopolska to address the challenges of their ageing population. The PEOPLE Report on regional ageing in Malopolska, drafted and approved in September 2011, became the basis for setting up the Malopolska Regional Ageing Strategy. This has been one of the most significant outputs of PEOPLE in the Malopolska Region. The document was translated into English and presented to the PEOPLE partnership.
Another good example provided by the PEOPLE project is that the Romanian Government adopted the introduction of a Health Card system, an ICMed good practice that has been promoted since 2009 through the PEOPLE project.
The Online Monitoring System that was developed by the PEOPLE project’s lead partner, the Ministry for Equality and Social Welfare of the Regional Government of Andalusia, was adopted by the General Directorate for Social Services and Attention to Drugs Addiction for monitoring the activities and certification of social programmes.
In this section, possible synergies among the nine INTERREG IVC projects and initiatives undertaken in other EU programmes is discussed in more detail. This is done first for the INTERREG IVC projects that have been completed. Because they are completed, the discussion mainly describes the relationships with other projects during the lifetime of the project itself and the projects that might have emerged from it. It then goes on to consider the possible synergies among the projects that are still running. Sometimes partners participating in several of these projects are mentioned by name. It is by no means a complete overview. Please refer to the map in Annexe 1 that shows all of the partners involved and cross-linkages in the nine projects.
At the DART midterm conference the INTERREG IVC-project CREATOR and the INTERREG IVB-project Best Agers played an active role in presenting their projects and joining a panel discussion, especially in regard to developing, promoting and disseminating strategies to face new challenges related to the ageing population. Best Agers focused on the inclusion of people over 50 in the labour market (including lifelong learning and business set-ups), and CREATOR focused on aspects such as the silver economy and the active and social lifestyle of seniors, including the use of ICT. Through these activities the partners found many relevant contacts for future cooperation.
DART’s experiences were used as input for setting up and establishing objectives for the INTERREG IVC Project TOURAGE (developing Senior Tourism in Remote Regions). In addition, one of DART’s partners, the Veneto Region, shared DART’s best practice collection with the Treviso province that was involved in the Q-Ageing project (INTERREG IVB Central Europe project) in particular on ageing and social services and is now implementing activities in HELPS – Housing and Home-care for the Elderly and vulnerable people and Local Partnership Strategies in Central European Cities.
DART’s overview of good practices and final report with specific thematic recommendations in the fields of economy, education, health and social services may be worthwhile to read and use as input for the projects still running and for those regions planning to set up new projects in the next programming period 2014-2020.
Some good working practices related to the management of an ageing workforce were developed under a previous European Social Fund Article 6 funding stream and the two-year ESF6 CIA project built on these. During its lifetime, ESF6 CIA cooperated with the INTERREG IVB project DCNOISE, especially through involvement of the RESOC-SERR in Flanders, with its focus on raising awareness among employers regarding the employment of people over 50.
During the project’s lifetime, PEOPLE did not exchange extensively with other INTERREG IVC projects, but the networking with regional organisations beyond the partnership resulted in more contact and partnerships. Part of the CASA partnership is a result of the PEOPLE project, and their activities are also closely related. CASA is part of the European Community of Regions for Assisted Living (CORAL), which relates to Ambient Assisted Living. This network became very active during the European Year for Active Ageing and Solidarity between Generations. Another INTERREG IVC project that emerged from PEOPLE is the MESSE project. This project shares the aim to improve the effectiveness of regional development policies for social entrepreneurship in Europe. The Veneto region (also partner in DART) is the lead partner of this project24.
PADIMA is able to share a wealth of knowledge and good practices with projects dealing with population decline in the fields of education and training, place marketing and economic diversification. On the basis of the findings on the three themes, PADIMA worked on improving regional policies against depopulation in mountain areas, including recommendations for integrated policies for other European regions. The final reports deliver a lot of input and suggestions for further cooperation, including for non-mountainous regions.
PADIMA partner Hedmark County Council (Norway) exchanged knowledge and experiences with two other IVC projects: I-Speed, which addresses the efficient use of ICT-based services, and Brain Flow, a mini-programme on measures and tools that minimise brain-drain while fostering brain-gain in border regions. One of the other PADIMA partners, the province of Torino (Italy), is also lead partner of DANTE: Digital Agenda for New Tourism Approach in European Rural and Mountain Areas.
The focus on telemedicine was shared with the sub-project of the PEOPLE project, TCares, and also with INN.O.V.Age and DART with regard to e-health solutions. The examples of Centres of Excellence (for example from the NHS 24 service, Scotland) provided input for the INNOHUBS pilots in INN.O.V.Age. There were also good opportunities to exchange knowledge with the INTERREG IVC IMMODI project which also brought in good practices and recommendations on e-health, like the exchange among health specialists through common electronic systems and the possibility to share and access patient’s electronic health records. The Regional Council of Auvergne, partner in RTF, also participated in IMMODI, ensuring the exchange of knowledge between the two projects.
Several RTF partners participated in the CASA project, such as National Health Service 24 (Scotland) and the region of Southern Denmark. The latter, as RTF’s lead partner, also participated in the project Renewing Health (funded under the ICT Policy Support Programme ) implementing large-scale real-life test beds for the validation and subsequent evaluation of innovative telemedicine services, using a patient-centred approach for the telemonitoring and treatment of chronic patients suffering from diabetes, COPD or CVD diseases.
There are synergies between the sub-projects SILHOUETTE and RTF in the field of ICT. RTF recommendations could be used to improve policies and the implementation and transfer of good practices. In relation to contributing to regional economic development, the Good Practices Guideline for the development of the telemedicine market for SMEs could also be shared. In addition, the INTERREG IVC project Health4Growth (with the participation of PADIMA partner the Province of Turin) could deliver valuable input to new approaches to improving cooperation between all health sector stakeholders and can offer solutions for regulatory problems that hinder the commercialisation of new technologies. Health4Growth is also working on finding options to make it easier for SMEs to access financing and to improve their management skills, creating good opportunities to share knowledge between the projects.
Several CREATOR partners, such as the Wielkopolska Region in Poland, are also involved in the CASA project.
As the projects themselves are well aware, a clear synergy exists between DAA, CASA and INN.O.V.Age. These three projects all started in 2012 and all deal with the consequences of an ageing society and are looking for smart solutions. The projects have been cooperating and sharing agendas since the capitalisation workshop in 2012 and are now organising a workshop together on innovative policies and solutions for Active Ageing at the Open DAYS 2013. Their objective is to exchange good practices and discuss innovative ways to respond to the challenge of an ageing population. Some partners, like the South East Health Technologies Alliance (SEHTA) participate in each of these projects. (25)
Besides this relationship, some aspects of the CREATOR mini-programme could also be shared, especially those on independent living and services. DART has many valuable good practices and policy recommendations on health and social services that could deliver input and should be taken into account.
The ongoing projects mainly focus on the consequences of ageing, which is also the theme of the Ambient Assisted Living (AAL) Joint Programme, certain projects supported by the INTERREG IVB programmes (see also Chapter 2) and the Information Communication Technologies Policy Support Programme (ICT-PSP), which includes ICT for health, ageing and inclusion. For example, the earlier mentioned project Renewing Health has gained enormous experience by assessing the impact of 21 telehealth services in nine European regions. On the theme of independent living, the following projects are worth looking at: Home Sweet Home, CommonWell (including integrating ICT based services) and the project DREAMING, which provides “solutions based on video, sensors, mobile communications and personal contact, to help the elderly and patients needing continuous care to live safely and independently in their homes instead of being in a care institution or hospital”. Several partners from DAA, CASA and IIN.O.V.Age also participate in the Jade project (7FP), which gives them the opportunity to share results from a more scientific angle.
Last but not least, the potential synergies with the capitalisation exercise on demographic change within the URBACT programme should be mentioned here. The final report ('From crisis to choice: re-imagining the future in shrinking cities'. Dr Hans Schlappa & Professor William J V Neill. May 2013) gives insight into strategies in the context of population decline in urban areas. The topics that it includes and that could be shared are: active citizenship and local leadership & adapting services and learning and employment issues. The Good Practice ‘Campus for Generations’ from the recently completed DART project is discussed in the URBACT final report, which also provides other good examples that may interest the INTERREG IVC projects presented in this study.
2.7 Specific Recommendations for the Projects
In this section, we make general recommendations applicable to all projects and specific recommendations to individual projects.
First of all, the main priority is to raise awareness of the consequences of demographic change before implementing the solutions. Is the problem shared among all stakeholders? Is the solution prioritised in regional plans? In the case of demographic change, it is important to realise it affects almost all policies: social, spatial, health, child and elderly care, but it also relates to legal issues and economic development. And it links with education and even place marketing. Integrating demographic change into all of these policies means stakeholders should first of all realise and accept that demographic change is an irreversible and structural process. Intensive communication to increase awareness of this is therefore of the utmost importance.
The next step is to involve a broad range of stakeholders; right from the beginning. What is perhaps most important in this respect is strong involvement of local stakeholders, both public and private (public-private partnership); regions must identify positive driving forces and look for support in the region to gain acceptance. In the development of a regional strategy, a combination of a top-down and bottom-up is a promising way to find good solutions. What needs to follow is strong cooperation among relevant partners, including the business and voluntary sectors.
To ensure that the regional strategy is implemented, strong ownership among the politicians is indispensable. There needs to be dialogue with the stakeholders that have the ability to actually implement the strategy, they must be kept informed and better still, involved from the outset. Strong compatibility with existing policies at local and supra-local level is a huge advantage – making implementation much easier.
It is also necessary that citizens and other users have a clear picture of the aims. The overall objective might be to prevent and mitigate the negative effects of the ageing process and maintain high standards of living, but in communication, it must be clear what this means for the user, the citizen or the entrepreneur. It means communication with well-targeted groups, such as female entrepreneurs, end-users, unemployed people over 50, etc.
Another prerequisite is to start with a detailed analysis of demographic statistics and of existing legal, administrative and financial preconditions. Is there sufficient financing from public and private funds (economic sustainability)? What are the legal barriers to developing technology? And so forth.
Regular, systematic evaluation and monitoring of the projects is important. PADIMA developed and implemented a systematic approach for evaluating project development, impact and dissemination of experiences and lessons. This must be developed in a very effective way, taking into account the specific characteristics of each project.
The DART project developed an indicator set and a regional observation monitor (demographic ‘early warning system’ DART monitor). These were tested with suitable demographic and social data from the various sub-regions, illustrating basic demographic changes in European regions over the course of time. The aim was to measure, to extrapolate and to compare regions and demographic change processes with each other. With these small-scale and highly condensed indicators for both demographic ageing and population decline (and selected indicators of social participation and quality of life), an accurate description of demographic change can be provided and can lead to practical and effective local policy measures in dealing with the consequences of demographic change.
For projects dealing with ageing in their regions, we recommend involving more active ageing experts but also more seniors, especially in the needs analysis phases (CREATOR, DAA).