Dalarna University's logo and link to the university's website

BACKGROUND: Co-design is increasingly used to involve older adults in the development of digital tools, yet less attention has been given to how to engage them effectively in these processes. Older adults represent a highly diverse population, but co-design practices often overlook this heterogeneity and rely on limited representation. Similarly, co-design approaches vary widely in structure and degree of user involvement. While evaluations often focus on outcomes such as usability and technical performance, fewer studies explore the value of participation itself.

AIM: This study evaluates the process of a 5-day online design sprint where participants, including older adults, healthcare and technology professionals, researchers, facilitators and business representatives, collaborated to develop housing-related digital support tools.

METHODS: A hybrid thematic analysis process links process documentation and participant reflections with value-based frameworks to examine how different elements of the process created or inhibited value for participants.

RESULTS: The findings highlight how the structure of the design sprint, together with specific facilitation practices, fostered respectful dialogue, trust, autonomy and a sense of ownership among participants. The evaluation describes how the process satisfied participants' collectively prioritised values, and their individual needs.

CONCLUSIONS: The study highlights that co-design is not a neutral method, but a practice with social, ethical and emotional consequences. Effective facilitation is essential to support agency, ensure psychological safety and promote authentic collaboration. Recognising the heterogeneity of older adults and aligning facilitation strategies with participants' values and needs can enhance both the relevance of digital innovations and the meaningfulness of the co-design experience itself.

PATIENT AND PUBLIC CONTRIBUTION: The project was supported by a reference group that was actively involved throughout. The group included, for instance, representatives from the municipality, regional authorities and a pensioners' organisation.

Despite well-documented health benefits, outdoor stays remain limited for older adults living in residential care facilities (RCFs) across Europe. This position paper compares governance, policy, and research in the Netherlands, Finland, and Sweden, identifying key barriers, particularly for persons experiencing physical or cognitive decline. Drawing on three theoretical models, the paper highlights a persistent gap between evidence and practice, and calls for the establishment of legal rights, national strategies, and international guidelines to ensure equitable access to outdoor stays. Contact with nature and outdoor stays should be recognized not as optional amenities, but as fundamental human needs in later life. © 2026 The Author(s). Published with license by Taylor & Francis Group, LLC.

Background/Objectives: The growing number of older adults with complex healthcare needs increases demand for homecare services, while a shrinking workforce often lacks skills for advanced tasks. Digital health is seen as a promising tool to address these challenges. This study explored Swedish homecare professionals’ perceptions of the potential use of digital twins in daily work. Methods: Four focus group discussions were conducted with 31 homecare professionals; two groups each in one urban/rural and one rural municipality. Data were analyzed using inductive content analysis. Results: Three main themes emerged: (i) Perceptions of digital twins as support for older adults, including needs-based, individualized care and proactive support enabling preventive measures; (ii) Perceptions of digital twins as support for professionals, including a better work environment through streamlined tasks and flows and enhanced planning and assessment; and (iii) Concerns about digital twins, focusing on ethical and social issues and limited understanding, which were related to monitoring aspects, the importance of physical visits, and how the technology works. Conclusions: Digital twins are perceived by professionals to have the potential to improve homecare services by supporting both older adults and professionals; however, further research is needed to address concerns and practical implications.

Background: Age-friendly environments are increasingly recognised as essential for supporting participation, autonomy, and healthy ageing. In residential care facilities (RCFs) for older adults, the built environment interacts with organisational practices to shape opportunities for person-centred care and rehabilitation. However, limited knowledge exists regarding how architectural configurations influence access to immediate outdoor environments.

Aim: To examine how storey configuration (single- versus multi-storey) and number of transition points were associated with opportunities for immediate access to outdoor environments within and adjacent to RCFs.

Methods: A multi-methods design was used, comprising national mapping of storey configuration of 1,603 Swedish RCFs, mapping of transition points at three RCFs, and walking interviews with twelve older adults and eleven care workers.

Results: Single-storey RCFs involved fewer transition points between indoor and outdoor environments, shaping opportunities for immediate outdoor access. In contrast, multi-storey RCFs required additional transitions, including corridors, elevators, and stairs, which increased dependence on care workers and constrained opportunities for outdoor engagement. Architectural conditions interacted with organisational routines, shaping older adults' opportunities for outdoor access and the practical possibilities for outdoor person-centred care and rehabilitation.

Conclusions: Storey configuration and number of transition points constitute structural conditions that shape outdoor access in RCFs. These findings have implications for age-friendly design and planning of RCFs as well as for person-centred care and rehabilitation.

Objectives: Oral health-related quality of life (OHRQoL) reflects the impact of oral health on daily activities. Understanding how OHRQoL varies by age and gender among older adults remains limited and inconsistent. This study aimed to investigate differences in OHRQoL by age and gender among home-dwelling older adults.

Methods: A stratified random sample (2%) of individuals aged 65-85 years from a Swedish region was selected by gender and age (N = 1344). Data collection included self-reported oral health measurements and health behaviours complemented by socioeconomic factors from the national register. OHRQoL was assessed by the validated 9-item Oral Impact on Daily Performance (OIDP) instrument. Beta-binomial regression models were used to analyse the proportion of affected OIDP items across gender- and age groups adjusted for smoking status, income, general health status, toothbrushing frequency and dental care type. The estimates are reported as proportion ratios (PRs) with 95% confidence intervals (CIs).

Results: The response rate was 62.1% (n = 834), and 32.9% (n = 270) reported impaired OHRQoL. The unadjusted model showed no overall gender difference in the proportion of affected OIDP items. In the adjusted model, women in all older age groups (70-74 years: PRs = 0.53 [0.35-0.81]; 75-79: PRs = 0.65 [0.44-0.96]; 80-85: PRs = 0.49 [0.31-0.77]), and men aged 75-79 years (PRs = 0.55 [0.34-0.88]) reported a lower OIDP burden than those aged 65-69 years. Poorer self-reported general health, lower income and use of public or nonregular dental care were associated with higher OIDP burden.

Conclusion: OHRQoL varied by gender, age, income, self-perceived health and dental care regularity in this sample. Lower OIDP burden was observed among older participants, particularly women. These findings underscore the complexity of OHRQoL and suggest age- and gender differences in how older adults perceive, interpret and report oral health impacts.

Background: Research consistently demonstrates that access to nature plays a significant role in supporting health and wellbeing, particularly among older adults and individuals experiencing illness. Research reviews show that treatment interventions in outdoor environments have positive effects on older adults’ health, quality of life, and physical capacity, that socialization and cognitive ability are promoted, and that stress and depression can be reduced. Despite this knowledge, there is currently no national strategy for access to outdoor environments and outdoor stays at residential care facilities for older adults in Sweden.

Purpose: The purpose of this paper is to propose a national strategy, along with ideas for implementation, developed through a collaborative workshop process.

Methods: The study comprised three collaborative digital workshops, i.e., participants worked with the researchers leading the process. The participants were purposefully sampled and included researchers and representatives from relevant authorities and organizations, as well as stakeholders, practitioners, and key players in residential care facilities for older adults. Five researchers oversaw the iterative process, which lasted for one and a half years. Workshop 1 established a shared foundation and generated initial inputs, which informed the development of a draft proposal. This draft was refined through feedback and discussions in Workshop 2 and further elaborated in Workshop 3 with a focus on implementation strategies. Thus, the research team synthesized the outcomes from all workshops through an iterative process, resulting in the final version of the national strategy proposal.

Results: The results present visions and proposals structured around four policy areas: 1. Outdoor stays; 2. Outdoor care and rehabilitation; 3. The outdoor environment; 4. Knowledge transfer. The results contain detailed descriptions for each of the policy areas, as well as proposals for how to realize the policy areas in a Swedish context.

Discussion: We do not know of any country that has developed a similar national strategy, and therefore, in the final part of this paper, we discuss the generalizability of the strategy, as well as how it relates to person-centered care. 

Objectives: A growing number of frail older adults live at home, placing increasing demands on health and social care systems. Digital twins may improve homecare services and support person-centred and integrated care. This study investigated older adults' experiences of homecare and their perspectives on the potential use of digital twins in homecare.

Methods: An exploratory, two-stage qualitative study was conducted with 14 older adults from two Swedish municipalities. In the first stage, semi-structured interviews explored participants' experiences of homecare. In the second stage, the same participants took part in either a semi-structured interview or a focus group discussion regarding their views on digital twins, with participants choosing their preferred format. Reflexive thematic analysis was used to interpret the data.

Results: The analysis generated one main theme, Navigating uncertainty and possibility in digital twin-supported homecare, with four sub-themes, Challenges in understanding and accepting digital twins, Concerns about privacy and ethics, Opportunities for safety and prevention, and Potential effects on daily routines. Participants struggled to comprehend the nature of digital twins. Concerns about their potential use in homecare included ethical issues, impacts on privacy, and reduced social interaction with homecare staff. However, participants also identified potential benefits of digital twins, such as more responsive services, improved scheduling, and enhanced safety through monitoring and predictive functions.

Conclusion: This study highlights the potential of digital twins in homecare from the perspective of older adults. While digital twins offer opportunities, integrating them into homecare services is complex and requires addressing the concerns raised by participants.

INTRODUCTION: Ageing right care(fully) is a transnational research study which explores and maps an understanding of the care pathways between ageing in place and hospital at home policy and practices for older adults in Israel, the Netherlands and Sweden. The countries are suited to be compared where they have growing, ageing populations, a focus on healthcare reform and several policies to reduce the cost of care for older populations. Ageing in place is a government-led policy that is often associated with choice; however, there is a recent debate about whether ageing in place is a universal desire for all older adults. Research shows that the care pathway between the hospital and the home, associated with ageing in place, can impact well-being, especially if the built, social and technological environments do not meet the healthcare needs and preferences of older adults. This is significant as new programmes for digital hospital at home innovations are being developed as part of a global transformation in healthcare systems. The aim of the study is to compare different approaches to ageing in place and hospital at home care in different regions. The multiapproach study explores the demographics, policy structure, decision-making process and the crucial role of the built, social and technological environments along the hospital to home care pathways of older adults.

METHODS AND ANALYSIS: The mixed-method, comparative study includes a new multienvironment theoretical contribution explored across a three-phase research method to understand the care pathways of older adults ageing in place receiving hospital at home care. The first phase compares each country's population and policy structures relating to ageing in place, hospital discharge, home hospitalisation and at-home care for older adults. The second phase maps patient journeys of older adults living in each country through the perspective of the older adult, caregivers and care professionals. The third phase explores the synergies between the knowledge gained through phases 1 and 2-from a policy and a personal level-and mobilises the knowledge into policy recommendations and implementation guidelines.

ETHICS AND DISSEMINATION: The comparative study has been approved by the Sheba Medical Centre in Israel (SMC-1330-24), the Ethics Committee of Tel Aviv University (0009216-2), the Humanities and Social Science Ethics Committee at the University of Twente in the Netherlands (240040) and the Swedish Ethical Review Authority (Dnr 2024-07569-01). The results will be shared with end-users, including citizens, carers, healthcare policymakers, planners, architects and designers, through social media, publications, workshops and international conferences. This future-focused research approach will allow stakeholders to rethink and imagine ways that health and care systems can be personalised and responsive to the future needs of older adult populations.

Suitable housing is essential for older adults at risk of deteriorating health, yet housing decision support is often lacking. A 5-day co-design sprint was conducted to develop digital prototypes supporting informed housing decisions. Key stakeholders including older adults, healthcare professionals, and technology- and architecture professionals participated. Notes from observations and textual content of the prototypes were thematically analyzed. Four prototypes were created and summarized in the themes: tailored to individual needs and preferences, comprehensive palette of choices, multifaceted information accessibility, and connections to the outer social world. The findings contribute to further development of evidence-based decision support related to housing.

The ageing population is anticipated to encounter several challenges related to sustainability. While policies such as ageing in place can benefit older adults in terms of familiarity and independence, these policies can also lead to increased social isolation. To facilitate ageing in the right place, it is crucial to understand how the design of environments promotes social sustainability. This article presents a scoping review of empirical research focused on the characteristics of housing and surrounding environments that support social integration, cohesion and participation of older adults. The search strategy was conducted in five databases, resulting in 20,477 articles. After screening 7,550 titles and abstracts based on predetermined inclusion and exclusion criteria, 19 articles were selected. The findings of these articles are presented across three themes: (1) housing environments, (2) environments beyond the home and (3) the social environment. Although there is no one-size-fits-all housing model for older adults, the authors suggest that ageing in place policies should be reconceptualized as ageing in ‘places’ and ‘spaces’, emphasizing the diversity of social needs of older adults. Understanding the environmental characteristics, the role of accessible and safe environments beyond the home, and how people and culture support a sense of belonging provides a policy direction for how to design socially sustainable environments for older adults in the future.