Design for digital ecosystems and telemedicine services to improve the quality of care pathways for frail older adults.
Authors: Tosi Francesca , Becchimanzi Claudia , Pistolesi Mattia 
Published: June 2024

Global population aging is one of the most critical factors in the coming decades (Eurostat, 2019). In Italy, international trends are confirmed: the average age of residents, which was 32 in 1952, increased to 46.2 years at the beginning of 2022 (Istat, 2022). The overall effects of aging on the health and welfare system are considerable. Indeed, with ageing is associated with an increase in chronic pathological conditions, co-morbidities, or the inability to perform basic daily activities independently, and this leads to an increase in the care and assistance needs of the elderly. The European health interview survey (2019) finds that there in Italy there are about 4.6 million elderly people with severe or moderate difficulties in ADLs (Activities of Daily Living) and IADLs (Instrumental Activities of Daily Living), such that they need help and support to carry them out. However, the need for help is not always fully met: more than 2 million people over 65 with impaired independence do not feel adequately helped (Istat, 2022b).A distinctive factor of the new generation of elders is their approach to technologies, a factor that can greatly expand the possibilities of access to care and assistance, communication and information services (Istat, 2019). To provide, as far as possible, the continuity of care and assistance people need, telemedicine services can ensure safe and efficient care pathways while maintaining a strong patient-physician relationship. For example, in Italy before the health emergency caused by the Covid-19 virus, the use of telemedicine services was very limited. The pandemic emergency accelerated the diffusion of telemedicine applications and services, especially aimed at bridging the difficulties of performing health care services in person and minimizing hospital admissions when unnecessary. Before that time, home-based telemedicine services were used for the management of asthma, hypertension, pulmonary disease, and congestive heart failure (Chan et al., 2003; Benatar et al., 2003; Maiolo et al., 2003; Hersh et al., 2006; Panicacci et al., 2021).Digital technologies are thus a resource to support care and assistance at home. Design, and in particular the Human-Centred Design approach, can have a crucial role both in understanding the elderly population's needs and in translating these needs into digital products that are more suitable and relevant to their purpose.This article presents the first results of the research conducted by the Laboratory of Ergonomics & Design (LED) of the University of Florence as part of Spoke 3 of the project "THE - Tuscany Health Ecosystem" of the PNRR (National Recovery and Resilience Plan), funded by the Italian government with Next Generation EU funds - Mission 4 (Education and Research) - Component 2 "From Research to Enterprise". The THE project involves the participation of 22 partners including universities, research centers and companies in the Tuscany Region, organized in 10 Spokes. The goal is to develop guidelines for the design of interfaces and products for telemedicine services in digital diagnosis and therapy for neurodegenerative diseases.This article will discuss the research questions, applied research methodology, results and future developments.