Trends in the use of care among people aged 65–85 with cognitive impairment in the Netherlands

Abstract

Observation of long-term trends within countries is needed to increase insight into how policy initiatives are reflected in the use of care over time in addition to individual determinants of care use. In the past decades, Dutch care policies have favoured homecare and reduced the availability of institutional care which extended the care responsibilities of formal and informal care-givers at home. This study investigates the changes in the use of informal and formal homecare, community services and residential care among cognitively impaired older adults over time in the Netherlands. In addition, of special interest here are the associations of the presence of a spouse, other family members or social network with care use, and the interdependency between the use of different types of care. The study employs the Longitudinal Aging Study Amsterdam (LASA) covering the years 1992-2012, analysed with generalised estimating equations. The data consisted of 1,022 observations gathered from 813 respondents aged 65-85. The respondents were cognitively impaired according to the age-and education-standardised Mini-Mental State Examination score. The analyses took into account several individual determinants of care use. The use of informal care and residential care decreased while the use of formal homecare and community services remained the same. Simultaneously, the proportion of those who did not use the studied care types increased. The contribution of partners in informal care decreased. Informal care and formal homecare use increasingly became complementary services. The findings suggest that the decreases in informal care and residential care have not been replaced by other types of care, as reflected in the increased number of persons receiving no care. Care policies should not rely excessively on the availability of informal help and should guarantee adequate formal help, especially for those in high need.

Trends in informal and formal home help use among older adults with disabilities in Japan: From 1999 to 2017

“…For example, in Sweden, studies have indicated that a reduction in formal LTC use corresponded to an increase in informal LTC use (Johansson et al, 2003; Sundström et al, 2006). Studies in the Netherlands have found that in the context of governmental LTC restriction policy and decreased availability of informal care, a decrease in informal LTC use did not lead to an increase in formal LTC use; instead, it resulted in an increased number of people receiving no LTC (Aaltonen et al, 2020; Swinkels et al, 2016). A study in Britain indicated that informal LTC increased to compensate for a sizeable decline in in‐home formal LTC during the investigation period (Patsios, 2008).…”

“…Second, few studies have examined differences in the trends in LTC use by the characteristics of older adults with disabilities. Only one study has examined this issue (Aaltonen et al, 2020). In studies on LTC use in older adults, those with low functional capacity, who are living alone, are women and have a high income are associated with higher use of formal LTC than compared with those with high functional capacity, who are living with others, are men and have a low income (Blomgren et al, 2008; Katz et al, 2000).…”

Research on Disability Grading Based on ICF Functional Framework: Empirical Evidence From Zhejiang Province, China

“…First of all, regarding the evaluation indicators of incapacitated subjects (6)(7)(8), most studies use single-dimensional scales for measurement, such as the commonly used Barthel, Lawton, and Brody instrumental daily activity scales and the Katz Scale, and the international function/disability and health-grading ICF and InterRAI evaluation systems which are more commonly used in OECD countries (9,10). There are also studies based on activities of daily living (ADL) and instrumental activities of daily living (IADL) (11)(12)(13)(14). Secondly, in most studies, the macrosimulation prediction method and micro-simulation prediction method are used to study the transition probability of failure state.…”