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Irritable bowel syndrome (IBS) is a common multifactorial condition that affects the large intestine and is characterized by chronic and relapsing abdominal pain and altered bowel habit. IBS is due to a combination of genetic, environmental and dietary factors. It's usually a lifelong problem very frustrating to live with and can have a big impact on quality of life, as single-agent therapy rarely relieves bothersome symptoms for all patients. The objective of this study was to analyze the approaches and solutions that address the social and health unmet needs of patients with IBS. A qualitative approach was adopted in the current study to identify and specify key digital solution and high impact user scenarios applied to IBS patients, through an adaptation of the "Blueprint on Digital Transformation in Health and Care in an Ageing Society" persona methodology. A Survey was administered to a group of patients in anonymous form. The theoretical elaboration IBS personas was developed through an interdisciplinary Focus Group, which also mapped the pathway for the patient's management. Three main needs were identified to be met to improve IBS patient's lifestyle: access to psychological support, mHealth solutions supporting diet and adapted physical activity, and homebased digital health support. mHealth intervention has been identified for diet adherence, physical exercise and psychological well-being. The process has been mapped and adapted to integrate the new solutions into the care pathway. Further research is needed to evaluate how mHealth services enable IBS patients to manage their conditions and improve their quality of life. KEY WORDS: Digital Health, Irritable bowel syndrome, mHealth, Nutrition, Physical activity, Psychological support.La sindrome dell’intestino irritabile (IBS) è una condizione multifattoriale comune che colpisce l’intestino crasso ed è caratterizzata da dolore addominale cronico e recidivante e alterazione delle abitudini intestinali. L’IBS è dovuta a una combinazione di fattori genetici, ambientali e dietetici. Di solito è un problema che permane per tutta la vita, molto frustrante per conviverci e può avere un grande impatto negativo sulla qualità della vita, poiché la terapia con un solo farmaco raramente allevia i sintomi fastidiosi per tutti i pazienti. L’obiettivo di questo studio era di analizzare gli approcci e le soluzioni che affrontano i bisogni sociali e sanitari insoddisfatti dei pazienti con IBS. Nel presente studio è stato adottato un approccio qualitativo per identificare e specificare la soluzione digitale chiave e gli scenari utente ad alto impatto applicati ai pazienti con IBS, attraverso un adattamento al singolo della metodologia “Blueprint on Digital Transformation in Health and Care in an Aging Society”. Un sondaggio è stato somministrato a un gruppo di pazienti in forma anonima. L’elaborazione teorica IBS personale è stata sviluppata attraverso un Focus Group interdisciplinare, che ha anche tracciato il percorso per la gestione del paziente. Sono state identificate tre esigenze principali da soddisfare per migliorare lo stile di vita dei pazienti affetti da IBS: accesso al supporto psicologico, soluzioni di mHealth a supporto della dieta e dell’attività fisica adattata e supporto sanitario digitale domiciliare. L’intervento mHealth è stato identificato per l’aderenza alla dieta, l’esercizio fisico e il benessere psicologico. Il processo è stato mappato e adattato per integrare le nuove soluzioni nel percorso assistenziale. Sono necessarie ulteriori ricerche per valutare in che modo i servizi di mHealth consentano ai pazienti con IBS di gestire le loro condizioni e migliorare la loro qualità di vita.

Background : Irritable bowel syndrome (IBS) is a common multifactorial condition that affects the large intestine and is characterized by chronic and relapsing abdominal pain and altered bowel habit. IBS is due to a combination of genetic, environmental and dietary factors. It's usually a lifelong problem very frustrating to live with and can have a big impact on quality of life, as single-agent therapy ra: Objective to analyze the approaches and solutions that address the social and health unmet needs of patients with IBS. Design: A quantitative-qualitative approach was adopted in the current study to identify and specify key digital solution and high impact user scenarios applied to IBS patients, through an adaptation of the “Blueprint on Digital Transformation in Health and Care in an Ageing Society” persona methodology. Settings: Digital health solutions bring the potential of supporting health interventions through mobile apps, wearable devices, telemedicine. Patients: A Survey was administered to a group of patients in an anonymous form, and no need for Medical Ethical Committee approval was identified. Interventions. The theoretical elaboration IBS personas was developed through an interdisciplinary Focus Group, which also mapped the pathway for the patient's management. Main Outcome : Three main needs were identified to be met to improve IBS patient’s lifestyle: access to psychological support, mHealth solutions supporting diet and adapted physical activity, and home-based digital health support. mHealth intervention has been identified for diet adherence, physical exercise and psychological well-being. The process has been mapped and adapted to integrate the new solutions into the care pathway. Limitation: Further research is needed to evaluate how mHealth services enable IBS patients to manage their conditions and improve their quality of life. Conclusion The person-centered approach was implemented through a multidisciplinary Focus group that enabled the identification of the need for a mHealth intervention

A business model development process that aims to involve stakeholders is faced with the challenge of communicating a complex subject matter to a non-expert audience with the aim of empowering them to make informed design suggestions or decisions. This chapter presents an approach to these challenges. It consists of two elements, building on each other. The first element is a method and toolkit for the assessment of socio-economic impacts in health, care and ageing, called ASSIST. The second element is a simulation tool based on real-life data that allows building an integrated care service and modelling how it responds to changes in economic factors. This second element we call the ASSIST Service Implementation Simulator. Both elements will be described in the following.

Background:\ud Evidence shows that the implementation of Information and Communication Technologies (ICT) enabled services supporting integrated dementia care represents an opportunity that faces multi-pronged challenges. First, the provision of dementia support is fragmented and often inappropriate. Second, available ICT solutions in this field do not address the full spectrum of support needs arising across an individual’s whole dementia journey. Current solutions fail to harness the potential of available validated e-health services, such as telehealth and telecare, for the purposes of dementia care. Third, there is a lack of understanding of how viable business models in this field can operate. The field comprises both professional and non-professional players that interact and have roles to play in ensuring that useful technologies are developed, implemented and used.\ud \ud Methods:\ud Starting from a literature review, including relevant pilot projects for ICT-based dementia care, we define the major requirements of a system able to overcome the limitations evidenced in the literature, and how this system should be integrated in the socio-technical ecosystem characterizing this disease. From here, we define the DEDICATE architecture of such a system, and the conceptual framework mapping the architecture over the requirements. \ud \ud Results:\ud We identified three macro-requirements, namely the need to overcome: deficient technology innovation, deficient service process innovation, and deficient business models innovation. The proposed architecture is a three level architecture in which the center (data layer) includes patients’ and informal caregivers’ preferences, memories, and other personal data relevant to sustain the dementia journey, is connected through a middleware (service layer), which guarantees core IT services and integration, to dedicated applications (application layer) to sustain dementia care (Formal Support Services, FSS), and to existing formal care infrastructures, in order to guarantee care coordination (Care Coordination Services, CCS).\ud \ud Conclusions:\ud The proposed DEDICATE architecture and framework envisages a feasible means to overcome the present barriers by: (1) developing and integrating technologies that can follow the patient and the caregivers throughout the development of the condition, since the early stages in which the patient is able to build up preferences and memories will be used in the later stages to maximise personalization and thereby improve efficacy and usability (technology innovation); (2) guaranteeing the care coordination between formal and informal caregivers, and giving an active yet supported role to the latter (service innovation); and (3) integrating existing infrastructures and care models to decrease the cost of the overall care pathway, by improving system interoperability (business model innovation).

Care authorities across Europe often experience the need for capacity building and technical support for the successful implementation of integrated care programmes, and for ultimately achieving the “quadruple aim” of integrated care system performance. A number of challenges are however impeding the implementation of better joined-up care delivery practices in concrete care settings, including: • Coping with complexity – the challenge of contextualising generic models for implementation purposes, • Focussing the stakeholders’ joint efforts – the challenge to arrive at a “common narrative”, • Exploiting digital solutions for supporting integrated care delivery - the challenge of pursuing a multi-pronged innovation approach, • Capitalising on existing knowledge and tools – the challenge of exploiting available evidence for practical implementation purposes. The European project VIGOUR (“Evidence-based Guidance to Scale-up Integrated Care in Europe”), co-funded by the European Union’s Health Programme, is designed to guide and support 16 care authorities across seven European countries in progressing the implementation of sustainable models for care integration. A contextualised and targeted approach to scale In view of diverse framework conditions within which integrated care service delivery will be implemented, the service integration strategy pursued needs to be flexible in terms of service process and technology deployment. Thus, regions will be supported through a staged process of analysis, advice and capacity building, comprising three distinct methodological steps. Ambition Focusing: Regions start with a conceptual focussing of their initial scaling-up ambition. A number of service integration aspects are addressed: • What is the point of departure? • Where does each region want to get to? • What are the expected impacts? Self-Assessment: Following the ambition focusing, each region works on examining strengths and weaknesses of the envisaged care integration approach by means of a SWOT analysis. Depending on the given framework conditions, a range of different factors potentially impede the successful implementation of the ambition by means of a fully up-and running pilot scheme. Equally, diverse supportive capacities are potentially available for putting the currently envisaged care integration approach into practice, albeit these may not yet have been considered in a systematic way. As a tangible output, the analysis will help to identify: • Potentials for further optimizing the envisaged approach, • Local circumstances that may make it difficult to practically implement the initially stated ambition, • Options available for addressing any identified “road blockers” for the implementation, • Definition of meaningful assessment criteria. Operational Planning: A planning framework will be developed and applied, resulting in a structured initial implementation plan for each region. It will include a revised set of priority integration targets (ambitions, activities, interventions) together with a map of the interests of all stakeholders in respect of each priority activity. Conclusions and next steps Regions will be guided by targeted support measures relying on a contextualised consolidation of the evidence base currently available. This comprises different steps, including matching the available evidence against the initial scaling-up plans, and targeted support mechanisms such as twinning.

The quest for more integrated care is not in itself new, but recent technology developments have nourished hopes that application of advanced digital solutions can make a major contribution to better joined-up care delivery, in particular to those suffering from chronic conditions. However, in contrast, with an enormous breadth of research activities, few instances of routine application of integrated eCare have yet emerged. This raises the question whether the concept of digitally-supported care delivery is indeed a present-day reality transforming traditionally separated care systems or just a hyped-up vision of what could be. Based on a review of recent evidence, including lessons learned from pilot implementations in different countries, the authors argue that the inherent properties of digital technologies do not by themselves lead to better-integrated care delivery. Rather, a reasonable implementation strategy needs to take account of the fact that desired end user support is not delivered by such technologies alone, but by socio-technical systems. An implementation approach that pays simultaneous attention to the stakeholders involved, to the particular working models of the different care actors, and to the technologies to be employed is shown to considerably increase the likelihood of achieving positive impacts on different levels, even if risks and uncertainty cannot be completely avoided.

When developing and implementing integrated care services, decision makers need to create complex business models involving many stakeholders, both for-profit and non-profit, and rely on reimbursement from statutory health and social care bodies as well as on other revenue streams. The needs of these stakeholders have to be identified and duly balanced within the framework of what is possible. This requires the handling of a large amount of economic data, the capacity to anticipate future developments, and creativity in dealing with unintended consequences. Furthermore, the development of a business model is likely to involve stakeholders that are not economic experts. We present a combined approach to business model development that allows stakeholders to get acquainted with economic assessments through active learning and to carry out their own assessment and business model development.

Die gesundheitspolitische Debatte uber eine verbesserte Kooperation unterschiedlicher Akteure im Gesundheitswesen ist keineswegs auf das deutsche Gesundheitssystem beschrankt. In vielen europaischen Landern wird derzeit ein Fachdiskurs daruber gefuhrt, wie bestehende Silostrukturen in der gesundheitlichen und pflegerischen Versorgung der Bevolkerung uberwunden werden konnen (Struijs et al. 2015).

Background & objectives: The implementation of ICT-supported, integrated health and social care services is effort-intensive. There is a number of reasons for that, all of which are well understood on a conceptual level (see Goodwin and Alonso (2014) and Leutz (1999)). Hard data underpinning these challenges and pointing to possible solutions are rare, impacting negatively on attempts to scale up ICT-supported services in the field (Billings et al., 2013). One key topic in this regard addressed in literature concerns the necessity to duly consider efforts required for the development of both the IT- and the human infrastructure of a service (see Kubitschke et al. (2014), Kubitschke et al. (2010)). But practical experiences suggest that this necessity is not yet fully shared among those involved in the development and implementation of integrated services, who seem to underestimate the role of staff efforts compared to costs for hard- and software. Based on the results of several cost-benefit analyses, this presentation intends to show that staff costs actually make up a majority of of the implementation cost in integrated care and therefore deserve to receive more attention.Approach & methods: From 2008 to 2014, two EU-funded projects (CommonWell (2012), INDEPENDENT (2013)) developed and piloted ten integrated services in nine European regions. Service models ranged from call forwarding and data exchange between call centres to early-supported discharge of COPD patients and support services for patients with Alzheimer and their informal carers. Socio-economic impact assessments based on cost-benefit analysis and following an approach described in Hammerschmidt and Meyer (2014) were carried out for all ten services. A re-analysis of these assessments was carried out to determine the share of staff cost compared to hard- and software cost for all services.Results: A comparative analysis of the findings across all services determined that, on average, the total cost of service implementation and operation are made up of 25.3% costs related to hard- and software and 74.7% related to staff efforts, i.e. working time invested in the setting up and operation of a service.Discussion & conclusion: Experiences from the application of the cost-benefit analysis approach at the pilot sites suggest that one reason for this underestimation of staff efforts is to be seen in commonly used approaches for economic assessments as well as accounting systems that do not capture actual staff cost, ideally on a per-case basis. Another reason seems to lie in the consideration of personnel as a readily available asset. This point of view is especially pronounced among (public) providers working on the basis of annual budgets, even if it can also be met in pay-per-service systems. The problem arises whenever additional staff time is considered only in those cases where the total number of staff needs to be increased but not where new tasks are added to the workload of staff already in place. Compared to this, costs for hard- and software usually need to be budgeted specifically for the implementation of the new service. Potentially, this requires effort-intensive negotiations and achieving buy-in from higher tiers in the hierarchy, for which reasons people seem to be much more aware of those costs. As long as the full role of staff efforts in the overall cost structure of a service stays under the radar of those responsible for its implementation, there are serious risks to the sustained operation of the service. Prolonged and unnoticed overburdening of staff can counter any positive effects on service efficiency as well as lead to decreased outcome quality and dissatisfaction among patients or clients. The situation can be aggravated by reductions in personnel budgets made on the basis of assumed (but not realized) efficiency improvements. The present findings suggest that awareness raising for the role of staff efforts among those involved in the implementation of integrated e-care services (service providers, payers, policy makers) should receive increased attention. Furthermore, the more widespread use of analytical methods for economic assessments measuring actual staff efforts per case would allow an early detection of the associated risks, ideally already at the service design stage.References:1- Billings, J., Carretero, S., Kagialaris, G., Mastroyiannakis, T. & Meriläinen-Porras, S. The Role of Information Technology in Long-Term Care for Older People. In: LEICHSENRING, K., BILLINGS, J. & NIES, H. (eds.) Long-Term Care in Europe - Improving Policy and Practice. Palgrave Macmillan; 2013.2- COMMONWELL. CommonWell - Common Platform Services for Ageing Well in Europe; 2012. [Online]. Available from: http://www.commonwell.eu/.3- Goodwin, N. & Alonso, A. Understanding Integrated Care: The Role of Information and Communication Technology. In: Meyer, I., Müller, S. & Kubitschke, L. (eds.) Achieving Effective Integrated E-Care Beyond the Silos. Hershey, PA: IGI Global; 2014.4- Hammerschmidt, R. & Meyer, I. Socio-economic impact assessment and business models for integrated eCare. In: Meyer, I., Müller, S. & Kubitschke, L. (eds.) Achieving Effective Integrated E-Care Beyond the Silos. Hershey, PA: IGI Global; 2014.5- Independent. Independent - Ict Enabled Service Integration for Independent Living; 2013. [Online]. Available from: http://www.independent-project.eu/.6- Kubitschke, L., Müller, S. & Meyer, I. Do all roads lead to Rome? Models for integrated eCare services in Europe. In: Meyer, I., Müller, S. & Kubitschke, L. (eds.) Achieving Effective Integrated E-Care Beyond the Silos. Hershey, PA: IGI Global; 2014.7- Kubitschke, L., Stroetmann, K., Robinson, S., Stroetmann, V. N., Cullen, K. & Mcdaid, D. How can telehealth help in the provision of integrated care? In: who regional office for europe and european observatory on health systems and policies (ed.) Health Systems and Policy Analysis. Copenhagen: WHO Regional Office for Europe and European Observatory on Health Systems and Policies; 2010.8- Leutz, W. Five laws for integrating medical and social services: Lessons from the United States and the United Kingdom. The Milbank Quarterly; 1999;77(1):77-110.

The call for better joined-up service delivery, particularly to those suffering from chronic conditions, traces back as far as into the 1950s. However, a disjointed care provision split into multiple service silos prevails. In the present chapter, the authors present lessons from practice, particularly from two recent pilot projects, INDEPENDENT and SmartCare, to show what can be achieved through the use of ICT-supported, integrated care and to show how it can be achieved under given framework conditions. The guiding question is which roads will actually lead to Rome and which will not. By simply adding ICT to current care practices one will most likely not end up with better care. Rather, the authors argue that a multi-pronged innovation approach needs to be pursued, one that simultaneously pays attention to the stakeholders involved, to the particular working models of the different care actors, and to the technologies to be employed. Using such an approach is shown to considerably increase the likelihood of achieving positive impacts on different levels, even if risks and uncertainty cannot be completely avoided.

When developing and implementing integrated care services spanning across established organisational boundaries, decision makers frequently need to create new business models involving diverse stakeholders, both profit and non-profit. These may rely on reimbursement from statutory health and social care bodies as well as on other revenue streams. In practice, the needs of a wide range of stakeholders may need to be identified and duly balanced within the framework of what is possible, e.g. in relation to legislation and regulation. Achieving service integration within day-to-day practice therefore often requires joint planning – sometimes tough bargaining - by many stakeholders potentially concerned. Not at least, a certain amount of “looking into the future” will be necessary, that is anticipating developments, testing different service deployment scenarios and seeing how they respond to changes in patient populations, changes in reimbursement regimes and changes to other factors.If economic modelling of service integration is to be done in an evidence-based manner, a large amount of data on economic and other impacts, both positive (benefits) and negative (costs), thus needs to be handled and systematically brought to bear on the development of an economic case for the desired service integration. Other than merely managerial staff and accountants will most likely need to be involved as well. Care professionals, IT staff, call centre personnel and others can be holders of valuable information in relation to work processes, the actual impacts of process innovation within day-to-day practices as well as acceptability new solutions by staff and/or service clients/patients. While a narrower economic viewpoint might tend to exclude such factors from a business model, they are in reality just as crucial to success as immediately monetary factors such as revenues (see for example (Meyer et al., 2011), (Goodwin and Alonso, 2014) or (Rigby, 2014)).Taking a strictly interactive format, the workshop will enable participants to gain hands-on experiences in service related economic modelling. In particular, workshop participants will get acquainted with economic assessments through an “active learning” approach (Bonwell and Eison, 1991) enabling them to carry out their own assessment and business model development. For this purpose the so-called “Service Implementation Simulator – Integrated eCare” will be used. This tool was created in the framework of the SmartCare project (SmartCare, 2015) to support stakeholders in health and social care when it comes to establishing sustainable economic models for integrated care services currently under development. Since the Simulator is filled with data already, workshop participants can instantly delve into understanding the economic characteristics of an example case and begin modifying data to see how the sustainability model of the service reacts to changes in costs and benefits. While doing this, they will also be made acquainted with the functionalities of an open-source software tool (ASSIST) publicly available for service related business modelling and the underlying methodological assumptions (Hammerschmidt and Meyer, 2014).In didactic regard, this approach will allow workshop participants to get into immediate contact with the content-related aspects of the assessment, while (initially) by-passing methodological questions and the need for data collection. The Simulator is provided with guidance material containing a number of lessons to be learned by the workshop participants. These lessons are designed to make the workshop participants acquainted with the open-source software tool and then to carry out a series of ever more complex tasks. These tasks take the workshop participants on a journey of first understanding how the service works in economic terms and second identifying and then solving a number of problems that were built into the service’s sustainability model. Each lesson in the guidance begins with a description of the problem, followed by a series of ever more concrete hints as to how the problem might be solved. The lessons are generally designed to be solved by working alone, but a group setting can also be used. The latter can be considered particularly useful for those lessons where no single solution exists, but there are rather alternative options, each with its own advantaged and disadvantages. Since the Simulator carries out all calculations on-the-fly, the impact of any solution on the relevant key performance measures can be checked by the workshop participants immediately and without need of feedback from a “teacher”.References:1- Meyer, I., Müller, S. & Kubitschke, L. AAL markets – knowing them, reaching them. Evidence from European research. In: Augusto, J. C., Huch, M., Kameas, A., Maitland, J., Mccullagh, P. J., Roberts, J., Sixsmith, A. & Wichert, R. (eds.) Handbook of Ambient Assisted Living. Technology for Healthcare, Rehabilitation and Well-being.: IOS Press. 2011.2- Goodwin, N. & Alonso, A. Understanding Integrated Care: The Role of Information and Communication Technology. In: Meyer, I., Müller, S. & Kubitschke, L. (eds.) Achieving Effective Integrated E-Care Beyond the Silos. Hershey, PA: IGI Global. 2014.3- Rigby, M. The Core Vision of Person-Centred Care in a Modern Information-Based Society. In: Meyer, I., Müller, S. & Kubitschke, L. (eds.) Achieving Effective Integrated E-Care Beyond the Silos. Hershey, PA: IGI Global. 2014.4- Bonwell, C. & Eison, J. Active Learning: Creating Excitement in the Classroom AEHE-ERIC Higher Education Report No. 1. Washington, D.C.: Jossey-Bass. 1991.5- SMARTCARE. Service Implementation Simulator – Integrated eCare. 2015. Available from: http://pilotsmartcare.eu/outcomes/service-implementation-simulator/6- Hammerschmidt, R. & Meyer, I. Socio-economic impact assessment and business models for integrated eCare. In: Meyer, I., Müller, S. & Kubitschke, L. (eds.) Achieving Effective Integrated E-Care Beyond the Silos. Hershey, PA: IGI Global. 2014.

Unsynchronised social and health care service delivery leads to inefficiencies, duplication of resources and reduced levels of quality of care. Older people are particularly affected by this situation. They often need both types of services, such as support with daily living activities and chronic disease management. ICT has the potential to support integrated service delivery to achieve high quality independent living and wellbeing for older people across Europe and elsewhere. Against this background, the presentation will demonstrate experiences and results derived from the development and piloting of ICT-supported integrated care services in eight sites across Europe, namely Dublin, Hull, Milton Keynes, Malaga, Veldhoven, Geldrop, Eindhoven and Bielefeld. Through innovative usage of ICT, current ‘silos’ in service delivery are broken up to allow for cooperation across relevant care sectors and participation of family members. The integrated services are to support the effective management of chronic diseases, and to address issues which affect independence, such as reduced agility, vision or hearing, in order to significantly improve the quality of life for older people and their carers. A dedicated programme of service process innovation complemented by adaptation of technology is being pursued in order to develop an integrated digital support infrastructure and related services: using appropriate existing technology to provide as many older people as possible with digital access to support services they needaugmenting and opening sectoral care platforms to enable coordinated cross-sector support deliveryadopting a clearly demand-driven inclusive approach and avoiding a technology ‘push’. Wider deployment of the services is supported by a dedicated programme of socio-economic service evaluation. The evaluation framework utilises a multi-method and multi-perspective approach, involving end users, family carers, service provider staff and key informants at corporate level. Triangulation is used to cross-reference data from different sources in order to maximize the reliability and robustness of conclusions drawn from the evaluation. Based on an overall framework taking into account themes such as integration, user outcomes, staff impact, organisational impact, technology, implementation and overall satisfaction, the specifics of each site are taken into account in operationally applying the overall framework in each case. The designs to be employed at each site have been developed to be as robust as possible, taking into account the constraints of the realities of the interventions. The evaluation is accompanied by a business case modelling approach that builds largely on a cost-benefit analysis covering the service development and implementation activities as well as the pilots and modelling the further deployment of services in each of the pilot sites. The presentation builds upon experiences gained within the framework of two European projects, CommonWell and INDEPENDENT. They are both co-funded under the EU’s Competitiveness and Innovation Framework Programme (CIP) focus on better joining-up of formal social/healthcare services and strengthening participation of the so-called ‘third sector’.

We have carried out a survey of elderly people in Europe relating to e-health and telemedicine issues. Telephone-based interview techniques were used in 13 countries and face-to-face interviews were used in Ireland and Portugal, where there are significant numbers of houses without telephones. Altogether 9661 interviews were performed. Most respondents (65%) lived in rural areas or small towns; the remainder lived in suburban areas or large towns. Virtually all respondents (98%) had access to a television set. About 30% received cable television and 13% had access to digital television. Almost half (48%) had access to mobile phones (with 42% actually using them), 36% had access to PCs (with 27% being active users) and 22% had access to the Internet (with 17% being active users). The respondents showed interest in various e-health applications, although this declined considerably with age. The survey showed that the older people get, the more they depend on medical and social care, and the more they tend to live alone, without a family member to look after them. Policy measures relating to infrastructure as well as training, education and awareness activities will be required to avoid a ‘medical divide’ between those senior citizens who have access to advanced medical advice and services and those who do not.