Fragility, Access to Services, and Inequalities: Launch of the DIFF Project for the Elderly Population

The DIFF research project – Inequalities in the Frail Elderly Population – has been launched by a multidisciplinary team from CERGAS – SDA Bocconi School of Management. The project aims to shed light on inequalities in access to healthcare and social care services among frail elderly individuals, with a focus on the Lombardy region and, in particular, the city of Milan.

Frailty is defined as a multidimensional condition – physical, psychological, and social – that makes individuals more vulnerable to health risks, loss of autonomy, and isolation. DIFF seeks to explore this condition and its consequences in relation to access to healthcare services.

The analysis aims to understand the dynamics of frailty by profiling the elderly population and examining the pathways of access (or lack thereof) to services, as well as the impact on health outcomes for the elderly. A distinctive feature of the project is its participatory approach: it directly involves elderly individuals, local communities, professionals, and policymakers, with the goal of building a shared understanding of frailty and the existing barriers to accessing services. Funded by Fondazione Cariplo, DIFF combines both qualitative and quantitative data and methodologies, analyzing data at both local and national levels. Some initial findings have already emerged from the first phase of the research.

Through analyses conducted via focus groups and interviews, determinants of frailty have been identified, associated with concepts such as loneliness, disadvantage, and lack of autonomy. Frailty is perceived as a multidimensional condition, linked to both individual factors (health, economic resources, family and social ties) and contextual factors (access to services, living environment, social prejudice). Furthermore, based on the evidence gathered, the research team identified four main frailty profiles within Milan's elderly population, each characterized by a different primary source of frailty: socio-health and economic frailty, emotional and relational frailty, frailty due to lack of access to services, and frailty related to contextual factors. This profiling represents a fundamental analytical tool for the next phases of the research, contributing to the reconstruction of access pathways to healthcare and social services and highlighting the structural inequalities affecting Milan’s frail elderly population.

These findings were further confirmed and enriched by a statistical survey conducted on a sample of residents over the age of 65 in Milan. The survey reveals a multifaceted relationship between the sociodemographic characteristics of the population (age, gender, marital status, and quality of the home environment) and the various dimensions (physical, psychological, and social) through which frailty manifests. While age and dissatisfaction with living conditions are associated with all components of frailty, the risk of psychological frailty is higher among women, whereas the risk of social frailty is linked to conditions of loneliness.

SDA Bocconi School of Management