Trajectories in health, long-term care and wellbeing in old age
Authors:   , Gardeniers Maura Kyra Maria 
Published: January 2025

Western societies, including the Netherlands, are facing significant demographic changes due to aging populations. While life expectancy has risen, the years free of disability have not increased proportionately, leading to higher rates of chronic illnesses among older adults. Health outcomes vary based on factors such as gender, socioeconomic status, and chronic conditions, creating diverse care needs met through informal (unpaid family caregiving) or formal (paid professional) care. Unlike acute care, long-term care focuses on managing chronic conditions and maintaining quality of life.

In 2015, the Dutch government introduced major reforms to long-term care, tightening eligibility for institutional care and decentralizing home care to municipalities with reduced budgets. The reforms emphasized personal responsibility and informal caregiving, reshaping care delivery systems. This study examines how health, care use, and wellbeing have evolved since the reforms, focusing on health trajectories, care networks, caregiving impacts, and care sufficiency.

The study found that health remains the primary driver of care needs among older adults, with 10–20% consistently requiring substantial care. Post-reform, care increasingly shifted to informal networks or mixed arrangements combining informal and publicly paid care. Informal care, while essential, often negatively impacted caregivers’ wellbeing. Publicly paid care improved wellbeing for those with severe limitations.

Between 2012 and 2021, 85% of older adults reported their care needs as sufficiently met. However, sufficiency perceptions temporarily declined after the 2015 reforms, likely due to implementation challenges. By 2021, sufficiency levels recovered, suggesting early issues were transitional rather than systemic. Urban residents initially reported lower care sufficiency compared to rural residents, but these differences diminished over time. Education levels and the presence of enabling resources like income and social networks were also key factors influencing care sufficiency.

The study identified key disparities: lower-educated individuals and those with multiple chronic conditions faced higher risks of adverse health trajectories. Transitions in care networks were often triggered by health declines, underscoring the need for dynamic, responsive care systems.

The findings emphasize the importance of sustainable, inclusive care systems that support aging populations while addressing inequalities. Informal care is crucial but carries risks to caregiver wellbeing, particularly in the absence of adequate support. Publicly paid care, while effective for high-need individuals, benefits from fostering stronger relational bonds. Preventative measures such as promoting healthy lifestyles and fall prevention can reduce care demands.

The Andersen-Newman model provided a useful framework for understanding care needs, while Self-Determination Theory highlighted the importance of autonomy, relatedness, and competence in achieving wellbeing. Policymakers should continue promoting aging in place while recognizing the enduring role of nursing homes for those with intensive needs.

As populations age, integrating support for informal caregivers, addressing socioeconomic disparities, and investing in community-based care networks will be essential. Policymakers should also prioritize preventative health strategies to delay or reduce care needs, ensuring sustainable long-term care systems for future generations.