Comparable statistics in the area of care of dependent adults in the European Union : feasibility study : final report : July 2003.
Date: 2003-11-21
Institutions: Eurostat
Subjects: EU Member State, care for the elderly, care of people with disabilities, comparative analysis, dependant, dependence of elderly persons, feasibility study, population statistics

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Feasibility Study –
Comparable Statistics 
in the Area of Care of
Dependent Adults 
in the European Union

3

THEME 3
Population  
and social  
conditions

E U R O P E A N
C O M M I S S I O N

 
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© European Communities, 2003

Feasibility study

COMPARABLE STATISTICS IN THE AREA OF CARE

OF DEPENDENT ADULTS IN THE EUROPEAN UNION

Final report - July 2003

The  views  expressed  in  this  document  are  the  author's  and  do  not  necessarily  reflect  the
opinion of the European Commission.

Stefanos GRAMMENOS
CESEP, Rue de la Pacification, 65.
B-1000 BRUXELLES
Tel. : 
Fax:
E-Mail :

02/230.63.96
02/230.94.51
cesep@skynet.be

CONTENTS

Introduction

General context

PART A:

STATISTICS CONCERNING DEPENDENT PEOPLE

SECTION I: Characteristics of dependent people

Introduction
Ch. 1:  Number of dependent people
Ch. 2: Distribution by age group
Ch. 3: Nature of dependency
Ch. 4:  Nature of dependency by age group
Ch. 5:  Nature and degree of dependency
Ch. 6:  Nature of dependency, degree and age
Ch. 7:  Place of residence
Ch. 8: Dependency by type of residence
Discussion and recommendations

SECTION II: Informal care

Introduction
Ch. 1:  Characteristics of elderly people receiving informal care
Ch. 2:  Type of informal care
Ch. 3:  Distribution by sex and age of informal carers
Ch. 4:  Relationship of informal carers to persons cared for
Ch. 5:  Employment status of informal carers
Discussion and recommendations 

SECTION III: Formal care

Introduction
Ch. 1:  Formal care and type of residence
Ch. 2:  Type of formal care
Discussion and recommendations

General conclusions

PART B:

STATISTICAL METHODS AND SOURCES

Introduction
Presentation by country
B, DK, D, EL, E, F, IRL, I, L, NL, A, P, FIN, S, UK, OECD, Other
Summary of main sources

ANNEX A:

GLOSSARY

ANNEX B:

NOTE ON METHODOLOGY

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INTRODUCTION

Demographic  (ageing  of  the  population)  and  social  (promotion  of  active  participation  in  social  life)
developments  have  led  policy  makers  to  focus  more  on  the  needs  of  dependent  people  and  the  help
available to them. The current study aims to meet demands concerning the number and characteristics
of  adult  and  elderly  dependent  persons  and  to  make  proposals  concerning  the  elaboration  of
comparable statistics at a European level.

The report is divided in two parts. Part A presents the statistics and Part B describes the sources and
the methodologies of national surveys.

Part  A  presents  the  collected  data.  It  is  divided  into  three  sections.  Section  I  presents  the  main
characteristics of persons with long-term care needs. Section II presents information on informal care
and  Section  III  describes  formal  care.  At  the  end  of  each  section,  we  present  a  discussion  of  main
issues and present recommendations for future action.

The definition of ‘dependency’ by the different national surveys keeps a central role in this part.

Part B presents the sources and the methods. We have adopted a standardised presentation. A standard
form (fiche) describes each source of data and presents some comments.

An annex presents a glossary with the main terms and the classifications used.

A preliminary analysis of national data provides an estimation of the number of dependent people. As
national  statistics  are  not  strictly  comparable,  we  present  also  a  narrower  definition  of  dependency
based  on  self-care  needs.  The  data  reveals  that  the  rate  of  dependency  increases  sharply  with  age.
According to the narrow definition, one could advance that there are about 7 million adult and elderly
dependent  persons  in  the  EU.  The  study  gives  a  special  attention  to  'dependent  elderly  men  and
women (unable to look after themselves on a daily basis) over 75'.

The  study  analyses  extensively  the  nature  and  degree  of  dependency  in  the  Member  States.  As  we
could  expect,  people  with  self-care  dependency  are  less  numerous  than  people  with  dependencies
related to instrumental activities of daily living (housework, shopping, etc.).

This section concludes with a discussion on the best indicator to measure dependency and put forward
proposals  concerning  the  collection  of  comparable  data  at  the  EU  level.  The  EU  indicator  and
international classifications form the basis of the discussion.

Dependency  and  lack  of  support  might  lead  to  institutional  care.  Consequently,  the  distribution  of
dependent  persons  at  home  and  in  institutions  retains  our  attention.  Available  statistics  indicate  that
not all persons in institutions are dependent according to the narrow definition.

The  main  provider  of  help  is  the  family.  Women  are  more  numerous  than  men  in  providing  care  to
dependent  persons.  This  might  lead  to  a  conflict  between  work  and  dependency  care.  There  is  little
information  on  the  characteristics  of  care  providers.  Consequently,  we  make  a  certain  number  of
proposals for the collection of statistics concerning the needs of dependent persons living at home and
the characteristics of carers.

Formal care (notably professional, paid help) is another important pillar for keeping dependent people
in  the  community.  We  present  available  data  concerning  home  help  and  the  type  of  help  used  by
dependent  people  living  at  home.  Statistics  on  formal  care  are  rare.  Also,  existing  data  poses  a  big
problem of comparability across countries.

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The study aims to help to improve the collection and comparability of statistics concerning dependent
people and thus contributes in the elaboration of policies, which meet the demands of these persons.

In  certain  countries,  the  term  'care  dependent  person'  is  used;  in  other  countries,  we  use  the  term
'persons with long term care needs'. In the following we use them as alternatives to represent the same
concept.
For the sake of comparability, this study focus on statistics collected through surveys. Statistics from
administrative sources are only exceptionally used. Concerning administrative data, social security is
the  main  source  and  the  statistics  produced  concern  the  number  of  persons  receiving  dependency
allowances aiming to compensate for extra costs generated by long-term care needs. Professional help
and  care  is  thus  often  funded  by  social  security  and  welfare  systems.  Consequently,  in  presenting
formal help, a certain number of data refers to the number of beneficiaries of different long-term care
and assistance schemes.

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General context

Over  the  past  three  decades,  the  number  of  older  people  (aged  65  and  over)  in  the  European
Community has significantly risen. All the signs indicate that this trend will continue in the future, and
that in 2020 there will be approximately twice as many older people in the European Union as there
were in 1960.

This structural change favours new demands on our societies, in particular with regard to health care
and long-term care. Also, the fact that there are fewer children and more older people is changing the
structure of care needs.

In this scenario of changing and growing needs for care, informal care cannot be relied upon to fill the
gap.  According  to  available  information,  the  majority  of  informal  carers  are  women  (mothers,
daughters, etc.) and this raises questions concerning the relation between work and family life.

A project “Care work in Europe: Current Understandings and Future Directions (CARING)", financed
under  the  fifth  framework  programme  of  the  European  Community  for  research,  technology
development  and  demonstration  activities  (1998-2002)  aims  to  contribute  towards  development  of
good quality employment in caring services.

Guideline 18 in the Employment guidelines 2002 on gender equality concerns “Reconciling work and
family  life”.  The  main  objective  of  this  guideline  is  to  adopt  family-friendly  policies  in  order  for
women  and  men  to  be  able  to  reconcile  their  work  and  family  life.  The  reconciliation  of  work  and
family life is facilitated by the availability of care services for children and frail elderly people.

The Conclusions of the Lisbon summit of 23-24 March 2000 confirmed the need of making it easier to
reconcile  working  life  and  family  life.  Existing  statistics  covering  care  services  do  not  provide
information to monitor and follow the developments in this area. The purpose of this feasibility study
is to do an inventory and analyse the existing data sources in the Member States and finally to make
proposals for future developments.

The  study  focuses  on  elderly  people  with  a  special  interest  on    'dependent  elderly  men  and  women
(unable to look after themselves on a daily basis) over 75'.

In fact, the “Indicators on childcare and elderly care – coverage and targets set in 2002 NAPs” indicate
that Indicator EO c10 concerns:  “dependent elderly men and women (unable to look after themselves
on a daily basis) over 75: Breakdown by: living in specialised institutions; who have help (other than
the family) at home; and looked after by the family”.

The  definition  of  the  indicator  uses  a  certain  number  of  concepts,  which  have  to  be  clarified  before
establishing a quantitative measure. In fact, the terms ‘dependency’, ‘daily basis’, ‘help’ etc. are used
in  different  ways  by  the  Member  States.  Even  inside  a  Member  State  statistical  definitions  and
administrative definitions might differ significantly. Consequently, the discussion of these terms takes
an important place in the rest of the study.

The aim is not to promote research in this field but to use existing data and studies in order to establish
concepts, which can be measured in a practical and unequivocal way.

The ECHI project proposed a design for a set of European Community Health Indicators. It proposes a
list,  which  includes  notably,  chronic  disease,  functional  limitations,  activity  limitations  and  a  global
activity  limitations  indicator.  However,  the  general  approach  is  dominated  by  a  'health  status'
perspective.

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Recent  work  by  the  World  Health  Organisation  has  reoriented  the  policy  perspective.  The  new
International Classification of Functioning, Disability and Health (ICF) has abandoned the traditional
causality: impairment - disability- disadvantage and has taken into account social and environmental
factors. Activity (the execution of a task or action by an individual) and participation (involvement in
a life situation) play a central role in the new classification.

Thus, there is a tendency to broaden traditional concepts and include aspects, which take into account
needs for an active participation in society.

Furthermore,  'dependency'  must  be  differentiated  from  acute  sickness  and  temporary  limitations.
Dependency  raises  problems,  which  are  expected  to  be  long  standing.  Consequently,  they  require
different solutions compared to temporary problems.

In the following the term 'dependency' does not refer to dependency on social protection, neither does
it  to  the  ratio  of  retired  (or  inactive  people)  to  the  working  age  (or  active  population).  It  refers  to
physical, mental, communication, etc. dimensions that will be developed further later on.

This  means  that  the  terms  used  below  do  not  refer  to  national  social  protection  schemes  but  to
concepts  used  in  national  and  European  surveys.  Many  surveys  share  a  certain  number  of  common
elements  and  approaches.  This  common  trend  is  the  result  of  the  use  of  international  classifications
developed  notably  by  the  World  Health  Organisation.  Proposals  concerning  the  elaboration  of
comparable statistics make reference to the work done in the relevant international organisations.

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PART A

STATISTICS CONCERNING DEPENDENT PEOPLE

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SECTION I

CHARACTERISTICS OF DEPENDENT PEOPLE

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Introduction

This part presents the data identified in the Member States.

The main sources of statistics are:

-  Specific surveys on care dependency undertaken by the Member States
-  Health Interview Surveys
-  Other surveys including questions on related themes.

Most  surveys  on  care  dependency  are  related  to  disability  surveys.  Specific  surveys  on  care
dependency have been undertaken notably in France, Austria and the United Kingdom.

It is important to notice that age is an important criterion. There are an increasing number of surveys,
which makes a distinction between adults of a working age and the elderly people.

In  the  first  case,  the  dominant  aspect  is  (re)  integration  in  the  labour  market.  The  surveys  focus  on
work-disability. Reported statistics concern impairments, disabilities and exceptionally handicaps1. In
the  case  of  the  elderly  people,  the  labour  market  dimension  is  absent  and  focus  is  put  on  long-term
dependency. In this case, the survey aims to identify people who can do a certain number of activities
and those who cannot or need help.

In all cases, there is a clear distinction between a temporary limitation and a permanent dependency.
All  surveys  have  filtering  questions  in  order  to  identify  a  permanent  status  and  a  temporary  one.  Of
course  'permanent'  does  not  necessarily  mean  forever.  Both  in  social  security  and  in  statistical
approaches the term 'permanent' means a status/situation that is expected to last in general at least six
months or one year.

This does not mean that temporary dependencies are not important in quantitative terms. The sum of
all spells of temporary limitations might be important as it concerns the whole population.

Another  important  aspect  is  the  ageing  of  the  population,  which  raises  questions  very  different  from
those put by disability in general in terms of health care, nature of assistance, etc.

Health Interview Surveys (HIS) are an important source of data. However, a first limitation relates to
the classifications used. These surveys aim to collect information on health issues. Consequently, they
use medical classifications that are restrictive for our goal. In fact, dependency and care may refer not
only  to  health  problems  but  also  to  social  activities  (e.g.  go  out,  prepare  a  meal,  make  shopping,
communicate,  etc.).  Meanwhile,  a  certain  number  of  these  surveys  take  into  account  this  dimension.
They include questions concerning limitations on daily activities.

There  are  a  high  number  of  surveys,  which  include  questions  relating  to  dependency  and  long  term
care  of  the  elderly  people.  These  statistics  are  often  fragmentary  and  raise  many  problems  of
comparability. However, they present statistics in some interesting areas.

Surveys on Living Conditions and Time Budgets include questions concerning the time spent to take
care  of  a  dependent  person.  We  encounter  a  comparability  problem  across  countries,  as  well  as  a
second  problem  related  to  the  objectives  of  these  surveys.  The  statistics  report  the  time  spent  by  a
person to take care of someone. It does not present the number of persons cared for. The aim here is
more to identify the characteristics and needs of the carer rather than the person cared for.

1 See the International Classification of Impairments, Disabilities and Handicaps (ICIDH) in the Glossary.

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In general, the census 2000/2001includes questions on long-term care but the Member States have not
yet  published  statistics  on  long-term  care  needs  or  supply.  Also,  past  census  did  not  exploit  such
information.

It  is  important  to  note,  that  the  introduction  of  a  long-term  care  insurance  scheme  has  been  an
important  incentive  in  some  countries  for  the  development  of  statistics  on  care  dependent  elderly
people.

In the following, we present the main statistics identified in the Member States.

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Chapter 1

Number of dependent people

Statistics  on  disability  constitute  an  important  source  of  statistics  on  care  dependent  persons.  The
European Community Household Panel (ECHP) presents the number of persons who are hampered in
their daily activities by chronic physical or mental health problems, illness or disability.

However,  not  all  persons  with  a  disability  are  dependent  persons.  Notably,  persons  with  a  moderate
disability might experience little need for help or assistance from a third party. A best proxy for people
needing help in a wide sense might be 'severe' disability.

Concerning people aged 65 and over, about 21% of the population reports to be severely hampered in
their daily activities (ECHP, 1999). Prevalence of severe disability is only 8% for persons aged 16 and
over. This rate increases with age as will be developed in the next chapter. Table 1 presents the data
for the EU countries.

The prevalence of disability is different across countries and might be explained notably by:

- 
- 

- 
- 

subjective interpretations of the same question. In fact, the question is too general.
socio-economic  conditions  (poverty  levels,  working  conditions,  rural/urban  context,  family
ties, etc.).
linguistic/cultural interpretations of the same concepts,
etc.

The different waves of the ECHP provide estimates for severe limitations, which are generally stable,
except for Belgium, Denmark and the United Kingdom.

However, not all persons with a severe limitation might be considered dependent. A severe limitation
might indicate that some persons are doing a daily activity with some problems but do not necessarily
need help. This might affect the quality of life but in a strict sense does not necessarily imply a regular
and  permanent  help.    For  example  a  person  missing  an  arm  is  considered  in  most  Member  States  as
severely  disabled.  Still,  he  is  not  considered  as  a  dependent  person.  Similarly  diabetes  or  hearts
problems might restrict severely daily activities but do not always imply constant help. This however,
might  engender  a  need  for  occasional  help.  Consequently,  the  number  of  persons  with  severe
limitations might be used as an upper limit for the number of dependent people.

Comparability  across  countries  is  reduced  by  the  way  the  question  is  put.  In  fact,  the  degree  of
dependency has an important impact. As it will be discussed below, there are a high number of people
with  a  slight  need  for  long-term  care.  Their  inclusion  or  not  might  affect  significantly  the  reported
estimates. Furthermore, self-assessment is subjective and comparison across individuals difficult.

In general, surveys focusing on disability report higher rates. In fact, countries using the International
Classification  of  Impairments,  Disabilities  and  Handicaps  (ICIDH),  elaborated  by  the  World  Health
Organisation, centre on impairments or limitations, which do not always reveal a need for assistance.

Surveys using questions on Activities of Daily Living (ADL) limitations present statistics, which are
more  comparable.  In  fact,  comparability  is  always  enhanced  if  the  interview  uses  a  control  list  of
activities  rather  than  a  general  self-assessment  question.  However,  not  all  of  them  use  the  same
number of activities, as will be discussed later.

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Another important problem arises from the distinction between need for care and effective provision
of  care.  As  one  might  expect,  not  all  elderly  persons  with  a  long-term  care  need  receive  help  or
assistance. Consequently, the rate of elderly persons receiving care or assistance might be significantly
lower compared to the rate of the elderly persons with care needs.

Yet  from  another  point  of  view,  many  persons  without  need  of  help  receive  care  notably  from  the
family. Consequently, if we ask: "Did you receive help from the family, etc.", the reported rates might
be very high.

Other  factors  may  also  have  a  significant  impact  and  reduce  comparability  across  countries.  This
might include:

-  The organisation of care and assistance systems, and
-  Cultural factors and lifestyle modes.

In  many  countries,  the  provision  of  home  help  is  means  tested.  This  means  that  administrative  data
excludes  persons  with  high  resources.  Also,  social  welfare  statistics  often  include  the  number  of
beneficiaries of assistance, which might be only a few hours per month. This means that persons with
occasional need for help might be included in the reported statistics.

Also,  a  dependent  person  may  live  at  home  or  in  an  institution.  The  choice  of  residence  is  not
independent from dependency. Consequently, it is desirable to have a good representation of people in
institutions in the sample.

In order to avoid these problems, we have selected the data according to a certain number of criteria.
Of course, the quality of the data is the first criterion. Other criteria include:

- 
- 
- 
- 

data from surveys covering the whole population (e.g. inclusion of institutions)
clear reference to the concept of ‘need of help’,
a minimum regularity of the need or the assistance provided,
a permanent dependency (excluding acute sickness and short term severe disabilities).

Table  2  presents  the  main  findings.  Most  surveys  focus  on  elderly  people  but  a  certain  number  of
surveys report dependency for young adults.

For comparability reasons, we have separated large from more strict definitions of dependency. Wide
definitions  include  often  activities  of  daily  living  (washing,  dressing,  transfer  (to  or  from  a  bed  or
chair), going to the toilet, continence and eating) and instrumental activities of daily living (using the
telephone, shopping, food preparation, housekeeping, laundry, travel, responsibility for own medicine
and  ability  to  handle  finances).  Narrow  definitions  of  dependency  focus  on  activities  of  daily  living,
notably personal care. Furthermore, they require a significant, or continuous or regular need for help.

We  have  tried  to  construct  a  narrow  definition  using  personal  care  needs  and  a  wider  one  including
activities  of  daily  living  and  instrumental  activities  of  daily  living.  This  was  not  always  possible.  In
certain cases, we have released the severity of ADL limitations in order to present a wider definition.

Statistics generally cover people aged 65 and over. However, a certain number of surveys indicate that
approximately 4% of the total adult population might be considered as dependent. This percentage is
only indicative and is based on a relatively wide definition of dependency. For comparability reasons,
we  have  excluded  Denmark  as  the  reported  rate  in  table  2  gives  ‘restriction’  which  does  not  mean
necessarily a long term need for help.

The different surveys give a clear relation between age and dependency prevalence. Consequently, the
rates are much higher for the elderly persons. However, there is a high variation across countries for a

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given age group. For information, we could say that the representative proportion of persons aged 65
and over who are dependent ranges approximately from 15 % to 16%. The proportion for persons aged
75  and  over  is  approximately  25%  to  26%.  Data  for  Denmark  and  Austria  might  overestimate  the
number of dependent people. In fact, Denmark refers to limitations, while Austria gives intentionally a
large definition.

The narrow definition provides a rate of about 2% for the total adult population (see table 3). For the
age groups 65+ and 75+ there is a relatively big variation of prevalence.

The reported variations across countries require a deeper analysis of the methods and definitions used.
In the following, we present the more salient aspects.

Belgium

Table 2 presents the wide definition. The authors (B2) distinguish: self-dependent persons, moderately
care dependent, highly care dependent, and very highly care dependent. They use the Katz index (for
persons less than 75 years, they use an approximate Katz index):

- 
- 
- 
- 

Fully independent person: Katz index = 0.
Moderately care dependent: Katz index = 1 or 2.
Highly care dependent: Katz index = 3 or 4.
Very highly care dependent: Katz index = 5 or 6.

We retain all care dependent persons e.g. persons who are not fully self-dependent. The data includes
both persons in private households and in institutions. The estimation covers the Flemish Region.

For  comparison,  the  Belgian  Health  Interview  survey  gives  23%  for  the  age  group  65  and  over,  and
33%  for  75  and  over  (B1).  It  refers  to  'Persons  with  severe  limitations'  and  includes  persons  with  at
least  one  severe  limitation  among  the  following  ten  physical  functions:  getting  in  and  out  of  bed,
getting up sitting down, dressing/undressing, washing hands and face, eating and cutting food, going
to the toilet, urinary continence, walking, hearing and seeing. The rate for persons 75+ is much higher
than the estimate provided by the ECHP (1999) (see Table 1). However, the ECHP estimates for the
previous years were significantly higher.

The  narrow  definition  'Highly  care  dependent  (ADL)'  includes  only  highly  care  dependent,  and  very
highly care dependent people. Table 3 presents the data.

For comparison the proportion of people permanently bedridden, or from time to time and hampered at
least  from  time  to  time  in  daily  activities  is  3%  for  the  age  group  15+,  8%  for  65+  and  9%  for  75+
(B1).

Denmark

Table 2 presents the number of persons with a very restricting long-standing illness.

Germany

The wide definition includes persons with a continuous dependency, daily need for care or a need for
care several times a week. For comparison the number of registered disabled people aged 65 and over
was 26%. The ECHP (1998) gives 25% for severely disabled aged 65+.

The  narrow  definition  'Persons  needing  regular  care'  includes  persons  with  a  continuous  dependency
or a daily need for care.

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Continuous dependency includes persons who need help for all areas of body-care (leave the bed, use
the  toilet  etc.)  and  are  generally  immobile.  Continence,  eating  and  drinking  are  the  most  common
factors. Housework is entirely done by a third party.

Daily  need  for  care  includes  persons  who  need  help  for  daily  hygiene  (bath,  shower,  washing).
Mobility and movements of body-parts are restricted (getting dressed etc.). Persons need help in order
to do their housework.

Need for care several times a week includes persons who need help for some household-tasks, but are
in general still able to cook.

The long term care insurance scheme reports that 12% of people aged 65 and over are beneficiaries of
long term care as 23% of people aged 75 and over (1999, D1).

For  comparison,  in  1999,  there  were  3.405.470  severely  disabled  persons  (with  official  certification)
aged 65 and over. They were representing 26% of the same age group. Table 1 indicates that this rate
is equal to the prevalence given by the European Community Household Panel.

Greece

The  European  Community  Household  Panel  indicates  that  the  prevalence  of  limitations  (severely
hampered  persons)  by  age  group  in  Greece  follows  a  similar  path  as  the  EU  average.  Consequently,
we have estimated the dependency rate by exploiting the EU average (see GR1).

Spain

Disability is defined as limiting the human capacity to the point of making a person’s normal activity
impossible  or  extremely  difficult.  The  survey’s  definition  of  disability  is  based  on  the  International
Classification of Impairments, Disabilities and Handicaps (ICIDH).

The  wide  definition  presents  the  number  of  persons  with  performing  housework  limitations
(housework, shopping and supervising supplies and services).

The narrow definition gives the proportion of persons with caring for oneself limitation. We retained
persons with at least one of the following limitations:

-  Needs assistance for caring for personal hygiene (washing oneself and taking care of one’s

appearance),

-  Controlling bodily functions and needing assistance to use the toilet,
- 
- 

dressing, undressing, grooming,
eating, drinking.

In both cases, statistics include persons with severe disabilities and persons who can’t do the activity.

France

The  wide  definition  'Persons  dependent  for  at  least  one  Activity  of  Daily  Living'  covers  individuals
who answered that they did need help for at least one of the activities of daily living. The survey uses
the Katz-index that includes the activities washing, dressing, going to toilet and using it, lying / sitting
down  and  getting  up,  continence,  eat  already  prepared  meals.  The  survey  uses  the  International
classification of Impairments, Disabilities and Handicaps.

It  is  important  to  note  that  the  results  stem  from  a  survey  based  on  two  samples.  The  first  covers
persons in institutions and the second in private households.

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The  narrow  definition  'Persons  needing  significant  help'  includes  persons  who  have  to  restrict  their
activities  seriously,  or  are  not  autonomous  at  home  or  are  permanently  in  bed.  They  refer  to  daily
normal activities.

Ireland

An  overall  measure  of  independence  has  been  calculated  from  eight  categories  of  daily  activities
(IRL1), yielding four levels of ability to maintain independence in activities of daily living (ADL):

- 
- 

- 
- 

the person is completely self-sufficient
the person is reasonable self-sufficient and experiences some minor and even major difficulties
in performing ADL
the person is still self-sufficient but has many major difficulties in performing ADL
the person may be called ‘severely disabled’.

The wide definition covers people living in the community who are still self-sufficient but have many
major  difficulties  in  performing  ADL,  and  persons  who  are  classified  as  ‘severely  disabled’.  The
narrow definition reports only the number of older people who are considered ‘severely disabled’ with
ADL.

For comparison, the same survey reports that the proportion of older people usually needing help with
one or more daily tasks is about 12%.

The rate is higher compared to the percentage of people with a severe limitation given by the ECHP. It
is  important  to  note  that  the  latter  provides  a  rate  which  is  significantly  lower  compared  to  other
Member  States.  This  difference  is  not  related  to  an  age  composition  effect.  The  ECHP  might
underestimate the true value of severe disability.

National estimations (IRL1) indicate that we have to double the rate reported by the ECHP in order to
arrive at comparable results with national surveys.

Italy

The  index  measuring  the  lack  of  self-sufficiency  is  privileged  over  that  measuring  the  presence  of
handicaps.  Consequently,  reported  limitations  are  close  to  the  need  of  help.  The  survey  uses  the
International classification of Impairments, Disabilities and Handicaps.

The  wide  definition  'Persons  with  serious  Activities  of  Daily  Living  limitations'  includes  those  who
have the maximum degree of difficulty with the following activities: go to bed and get out of bed, sit
down in and get up from a chair, washing, dressing, take a shower or a bath and eating.

The narrow definition Table 3) includes persons confined in bed, in a chair or at home. Confinement at
home may be due both to physical and psychical problems.

Luxembourg

The socio-economic panel distinguishes five levels: complete autonomy, light loss of autonomy, loss
of autonomy but not problematic, serious dependency and severe dependency (L1).  Statistics on wide
definition present the last two levels (serious and severe dependency). It is important to note that the
statistics cover only persons who receive help. Consequently, needs might be higher.

Activities relate to: prepare a hot meal, shopping, climbing stairs, walk inside and outside home, carry
an object, take the bus or the train, washing oneself and does not forget to take his medicine.

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COMPARABLE STATISTICS IN THE AREA OF CARE OF DEPENDENT ADULTS IN THE EUROPEAN UNION

The  narrow  definition  presents  the  number  of  care  dependency  insurance  beneficiaries.  Benefits  are
granted to persons needing the assistance of a third party to do the essential daily activities (L2).

Netherlands

Table 2 presents the wide definition based on activities of daily living. The Activities of Daily Living
indicator  refers  to  limitations  in  carrying  out  general  daily  activities.    Since  1989  respondents  are
asked if they can: 'eat and drink', 'sit down in and get up from a chair', 'get into and out a bed', 'dress
and  undress',  'move  to  another  room  on  the  same  floor',  'walk  up  and  down  stairs',  'go  out  and  let
themselves  in  again',  'move  around  outside',  'wash  their  face  and  hands'  and  'wash  themselves
completely'. The figures present persons who are not able to do one or more of these activities or only
with great difficulty.

We  exclude  people  answering  ‘with  some  difficulty’  but  retain  persons  answering  ‘with  great
difficulty’.  This  includes  people  who  can  do  these  activities,  even  with  big  difficulties,  and
consequently  might  not  require  a  continuous  help.    These  rates  are  close  to  the  prevalence  of  severe
disability.

The Dutch statistics give also the OECD indicator. It refers to limitations in the ability to communicate
and  move  around  (follow  a  conversation,  read  small  print,  carry  an  object  weighing  five  kilos,  bend
down  and  pick  something  up  from  the  ground,  walk  for  400  meters  without  stopping).    The  figures
refer  to  people  who  reported  not  being  able  to  do  one  or  more  of  these  activities,  or  only  with  great
difficulty. This indicator gives 32% for people aged 65 and over. The inclusion of mobility limitations
increases  sharply  the  reported  rates.  This  rate  is  higher  than  the  prevalence  of  severe  disability
reported by the ECHP and lower than the prevalence of total disability.

The narrow definition includes people who can do the activities of daily living only with the help of
others.  The  indicator  refers  to  limitations  in  carrying  out  general  daily  activities  and  excludes
instrumental activities.

Austria

Data  refers  to  limitations  in  the  autonomous  performance  of  daily  activities  that  lead  to  a  need  for
regular or irregular care. A person that needs help for body-care activities at least several times a week
is  in  need  of  regular  care.  People  that  are  in  need  of  irregular  care  are  limited  for  some  body-care
activities and housework chores and need help at least once a week.

The  wide  definition  'Persons  requiring  help  (large  sense)'  defines  the  need  for  help  in  a  very  wide
sense including those persons that e.g. can’t iron anymore or that can’t bend down. Help is provided
from  time  to  time  or  in  case  of  a  need.  The  estimate  is  close  to  the  ECHP  estimate  for  severe
disabilities.

The narrow definition 'Persons requiring regular help (ADL)' includes persons who can no longer do
activities of daily living. Support and help is needed regularly.

Portugal

The wide definition 'Persons with severe mobility disabilities' covers persons with a severe reduction
or  limitation  concerning  personal  mobility  or  moving  objects.  Personal  mobility  includes  notably
locomotion, displacement and use of transport.

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COMPARABLE STATISTICS IN THE AREA OF CARE OF DEPENDENT ADULTS IN THE EUROPEAN UNION

The narrow definition 'Persons with severe ADL limitations' covers persons with a severe reduction or
limitation concerning activities of daily living and manual dexterity such as open/close doors, switch
on/off light, telephone, manipulate objects, etc.

Finland

The  wide  definition  refers  to  'Persons  who  feel  unable  to  fulfil  the  demands  of  everyday  life'.  The
answer  distinguishes:  never,  seldom,  every  now  and  then,  often  and  most  of  the  time.  The  data
presented here include ‘often’ and ‘most of the time’.

Sweden

The survey on living conditions (S1) produces different indicators for persons aged 65-84:

-  Persons with physical disability: 
-  Cannot take a short walk at a fairly quick pace: 
-  Needs help with grocery shopping: 

22%
19%
15%.

We  have  chosen  ‘grocery  shopping’  as  a  wide  definition  rather  than  those  close  to  severe  disability.
Taking  into  account  the  results  of  other  countries,  this  indicator  is  representative  of  instrumental
activities, a relatively wide definition of dependency.

For comparison, in 1999, roughly 8% of people aged 65 and over were entitled to home help services
in ordinary housing. The corresponding figure for those aged 80 and over was 20%. In 1980, almost
16% of persons aged 65 and over were entitled to home help services in ordinary housing (S2). This
change indicates that social security statistics are very sensitive to restrictive policies concerning help
and  may  not  be  used  as  an  indicator  of  actual  needs.  Home  help  services  include  service  tasks  (e.g.
cleaning  and  doing  laundry,  help  with  shopping,  post  office  and  bank  errands  and  preparation  of
meals)  and  personal  care  (e.g.  eating  and  drinking,  getting  dressed,  personal  hygiene  and  moving
about).

United Kingdom

The  data  comes  from  the  Health  Survey  for  England.  They  use  the  WHO  (World  Health
Organisation)-ICIDH protocol.

The wide definition 'Persons with a personal care disability' (2001) is based on the activities of daily
living such as washing, dressing, feeding, using the toilet, and requiring help getting in and out of a
bed or a chair.

The  narrow  definition  'Persons  with  a  severe  personal  care  disability'  (2000)  comes  from  the  Health
Survey  for  England.  In  accordance  with  the  WHO  (World  Health  Organisation)-ICIDH  protocol,
disability  was  measured  across  five  domains:  locomotor,  personal  care,  sight,  hearing  and
communication.  For  each  domain,  the  level  of  severity  was  scored  into  none  (0),  moderate  (1)  and
severe (2).

The  criteria  was  given  by  the  activities  of  daily  living  such  as  washing,  dressing,  feeding,  using  the
toilet,  and  requiring  help  getting  in  and  out  of  a  bed  or  a  chair.  The  persons  who  needed  assistance
with any of these tasks were classified as severely disabled on the personal care disability dimension.

It  is  important  to  notice  that  the  2000  Health  Survey  for  England  includes  two  samples:  one
concerning private households and one covering care homes.

16

PEOPLE WITH SEVERE LIMITATIONS

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COMPARABLE STATISTICS IN THE AREA OF CARE OF DEPENDENT ADULTS IN THE EUROPEAN UNION

Table 1: People severely hampered in daily activities by age group; Percentage of the same age group, 1999 

B

DK

D

EL

E

F

IRL

L
% (Percentage, same age group)

I

NL

Age
All (16+)

65 +

8
16
21
75 +
Source: Eurostat (ECHP 1999) and S1. The data covers private households. The Irish data might underestimate the true value.
Note: For comparison the Survey of Income and Program Participation in the US gives: all (0+): 10%, 65+: 34%. 2

6
18
21

6
14
20

7
19
24

6
14
19

3
8
10

5
16
24

6
14
19

11
28
34

11
26
38

A

5
17
25

P

FIN

S

UK

EU

10
25
32

9
25
36

22
33

7
19
29

8
21
29

Chart 1: People severely hampered in daily activities by age group, 1999.

All (16+)

65+

75 +

%

40
35
30
25
20
15
10
5
0

B

DK

D

EL

E

F

IRL

I

L

NL

A

P

FIN

S

UK

EU

Source: Eurostat (ECHP 1999) and S1. Data covers private households.

2   John M. McNeil, ‘Americans with Disabilities: 1991-92; Data from the Survey of Income and Program Participation’, Current Population Reports, Household Economic Studies, Bureau of

the Census. 1994.

17

 
 
 
                                                
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COMPARABLE STATISTICS IN THE AREA OF CARE OF DEPENDENT ADULTS IN THE EUROPEAN UNION

Chart 2: Persons aged 16 or more severely hampered in daily activities by gender, 1999

Males

Females

%

35
30
25
20
15
10

5
0

EU

B

DK

D

EL

E

F

IRL

I

L

NL

A

P

FIN

UK

Source: Eurostat (ECHP 1999). Data for Luxembourg: 1996. Private households.

Chart 3: Persons aged 65 or more severely hampered in daily activities by gender, 1999

Males

Females

%

35

30

25

20

15

10

5

0

EU

B

DK

D

EL

E

F

IRL

I

L

NL

A

P

FIN

UK

Source: Eurostat (ECHP 1999). Data for Luxembourg: 1996. Private households.

18

DEPENDENT PERSONS

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COMPARABLE STATISTICS IN THE AREA OF CARE OF DEPENDENT ADULTS IN THE EUROPEAN UNION

Table 2: Prevalence of dependency  as a percentage of the population covered of the same age group (Wide definition)
F
Persons
dependent
for at least
one ADL

P
Persons
with severe
mobility
disabilities

L
Dependent
persons
receiving
help

NL
Persons
with ADL
limitations

B
Persons
with ADL
limitations

EL
Persons
with ADL
limitations

Definition

IRL
Persons
having
major
difficulties
with ADL

I
Persons
with
serious
ADL
limitations

D
Persons
needing
regular care
and help for
housework

E
Persons
with
performing
housework
limitations

A
Persons
requiring
help
(large
sense)

DK
Persons
with very
restricting
long-
standing
illness

S
Persons
needing
help
(shopping)

UK

Persons
needing
help
(mobility)

Persons
with a
personal
care
disability

FIN
Persons
unable to
fulfil
demands
of
everyday
life

Year
Type of
residence
Source

Adults
Age group

Men 
Women 
Total

65+
Age group

Men 
Women 
Total

75+
Age group

Men 
Women 
Total

1997

All

B2

2000

All

DK1

1991/92

1999

1999

1998/99

2000

1999/00

1992

2000

1996

1995

2001

1996/97

1998

2001

Priv house

D2

All

EL1

Priv house

E1

All

F1

Priv house

Priv house

Priv house Priv house

IRL1

I1

L1

NL1

All

A2

All

Priv house Priv house Priv house Priv house

P2

FIN1

S1

UK3

UK1

15+

4

60+

17

30

16+
10 
13 
12 

67+
25 
27 
26

80+
29 
34 
32

20+

4 

60+
9
12
11

80+
23 
34 
31

65+
8
18
14

75+

20*

25+
2 
4 
3 

65+
9
15
12

75+
17 
27 
23

65+

65+

19

14*

75+

75+

30

23*

65+
9
20
15

75+

19

32
27

20+

5* 

All

4 

60+
10 
14 
12

65+

65+

65+

18

26

14

80+

75+

75+

75+

25

27

37

20

65-84
13 
12 
12

75-84
17 
16 
16

65-84

15

75-84

22

65+
9
19
15

75+
14
29
23

65+
15
17
16

75+
18
21
19

19

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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COMPARABLE STATISTICS IN THE AREA OF CARE OF DEPENDENT ADULTS IN THE EUROPEAN UNION

Notes
For a description of the different concepts used in this table, see the discussion in the text.
*: Estimation.

DK
B
E
NL

S
FIN

For comparison, the 1994 survey provided for 16+: 12,2%.
For comparison B1 gives for persons with a severe limitation in at least one of 10 ADL functions, in 2001: 15+: 7%; 65+: 23% and for 75+: 33%.
Data refers to disabilities.
For the estimation see NL1. The observed prevalence for the age group 55+ is 13% (men: 8%, women: 17%).
For comparison the proportion of people with severe limitations is 12,5% (16+) and 31,6% (65+), in 2000.
Total '65+' covers the age group 65-84 and '75+' covers 75-84.
Persons who feel unable to fulfil the demands of everyday life. Total '65+' covers the age group 65-84 and '75+' covers 75-84.

Note: For comparison the Survey of Income and Program Participation in the US gives for persons needing assistance for one or more IADL: all (15+): 4,5%, 65+: 17%. (John M. McNeil, 1994)

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COMPARABLE STATISTICS IN THE AREA OF CARE OF DEPENDENT ADULTS IN THE EUROPEAN UNION

Table 3: Prevalence of dependency as a percentage of the population covered of the same age group (Narrow definition)
A
Persons
requiring
regular help
(ADL)
1996

B
Highly care
dependent
persons (ADL) or
plus
1997

I
Persons
confined in bed,
in a chair or at
home
1999/00

E
Persons with
caring for
oneself
limitations
1999

IRL
Persons having
severe difficulties
with ADL

D
Persons needing
regular
(personal) care

F
Persons
needing
significant
help
1991

L
Care dependent
insurance
beneficiaries

NL
Persons
needing help
for ADL

Definition

2000/2001

1991/92

2000

2002

All

B2

Priv house

Priv house

Priv house

Priv house

Priv house

D2

E1

F2

IRL1

I1

All

L2

Priv house

NL1

All

A2

Year
Type of
residence
Source

Adults
Age group

Men 
Women 
Total

65+
Age group

Men 
Women 
Total

75+
Age group

Men 
Women 
Total

15+

40+

2

3 

60+

65+

8

75+

12

7

75+

12

20+

2 

65+

8

75+

12 

65+
7 
10 
9

75+
14 
18 
17

65+
4
11
8

6+

2 

65+
6 
11 
9

75+
12 
19 
16

P
Persons with
severe ADL
limitations

UK
Persons with a
severe personal
care disability

1995

All

P2

2000

All

UK1

16+

1 

60+

65+

65+

65+

5

7

6

4

80+

75+

75+

75+

11

12

10

7

65+
5
5
5

80+
10
12
11

Notes
For a description of the different concepts used in this table, see the discussion in the text.
B
E
F
UK

For comparison the proportion of persons permanently bedridden, or from time to time and hampered at least from time to time in daily activities is: 15+: 3%; 65+: 8% and 75+: 9%.
Data refers to disabilities.
Persons with serious restricted activities, not autonomous at home, and bedridden.
Persons with a serious personal care disability: Age groups: 65-79 and 80+. Data refers to England.

For comparison, the Survey of Income and Program Participation in the US gives for persons needing assistance for one or more ADL: 2%, (15+), and 8% (65+) (John M. McNeil, 1994).

21

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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COMPARABLE STATISTICS IN THE AREA OF CARE OF DEPENDENT ADULTS IN THE EUROPEAN UNION

Chart 4: Dependent persons aged 65 and over, % of the same age group

%

40

35

30

25

20

15

10

5

0

B

D

EL

E

F

IRL

I

L

NL

A

P

FIN

S

UK

Note:  See Table 2 for the definitions, the population covered, the sources and the explanatory notes.

The survey for Austria has adopted a relatively wider definition.

Chart 5: Dependent persons aged 75 and over, % of the same age group

%

40

35

30

25

20

15

10

5

0

B

D

EL

E

F

IRL

I

L

NL

A

P

FIN

S

UK

Note:  See Table 2 for the definitions, the population covered, the sources and the explanatory notes.

The survey for Austria has adopted a relatively wider definition.

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COMPARABLE STATISTICS IN THE AREA OF CARE OF DEPENDENT ADULTS IN THE EUROPEAN UNION

Chapter 2

Distribution by age group

The previous chapter presented two indicators of dependency for the total population and for elderly
people.  On  several  occasions  we  noted  that  the  proportion  of  people  who  are  dependent  increases
strongly with age. The present chapter presents this relation in more details.

Age is important since the needs and expectations of individuals are influenced by age. A person of a
working age might have work expectations, which are absent for persons aged 65 and over. Of course
both might expect some form of assistance, which might enable them to do the essential activities of
daily living and if possible participate actively in social life.

First we present in Chart 6 the prevalence of moderate and severe limitations in the EU by age group.
The  chart  reports  the  percentage  of  people  hampered  in  their  daily  activities  (moderate  or  severe
limitation) and the percentage of people who are severely hampered by age group. This serves only as
a reference to the following, which presents the proportion of dependent people by age group. As we
have noted above, the percentage of persons with a severe limitation might serve as an indication of
the upper limit of the prevalence of dependency.

Tables 4 and 5 present the prevalence of dependency by age group. Again we distinguish between a
wide and a narrow definition of dependency.

The tables reveal that a first problem relates to the use of different age groups. However, this does not
hide the general trend across ages.

A  second  problem  concerns  the  nature  of  data.  Disability  and  health-related  surveys  (notably  DK)
report  higher  rates.  These  rates  measure  severe  disability  rather  than  dependency.  In  fact,  as  it  was
noted in the previous chapter, these statistics refer to severe disabilities, and a severe limitation might
not  necessarily  generate  a  dependency.  In  terms  of  Chart  6,  this  means  that  these  large  concepts  are
close to severe limitations.

An  important  distinction  concerns  the  frequency  of  needs  and  the  degree  of  dependency.  Surveys
which  use  a  wide  definition  of  dependency  e.g.  Austria  (Table  4)  report  rates  which  are  close  to  the
prevalence of severe disability.

On the contrary a narrow definition (Table 5) gives a much lower dependency rate.

To summarise, we can say that differences in dependency prevalence by age group may stem notably
from:

- 
- 
- 
- 

differences in methodology (only a few surveys cover institutions),
differences in the reference year,
differences in the definition of dependency (nature of activities covered),
differences in the definition of the degree of dependency (regular needs, daily needs, etc.).

Available  data  indicates  that  the  dependency  rates  for  women  are  higher.  However,  this  is  partly  or
totally due to the longer life expectancy of women.

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Chart 6: Persons hampered in their daily activities by age, EU 1999
Percent of the same age group

All

Severe

%

70

60

50

40

30

20

10

0

0

10

20

30

40

50

Age

60

70

80

90

100

Source: Eurostat (ECHP, 1999). Private households.

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COMPARABLE STATISTICS IN THE AREA OF CARE OF DEPENDENT ADULTS IN THE EUROPEAN UNION

Table 4: Prevalence of dependency by age group, as a percentage of the population covered of the same age group (Wide definition)

B
Persons
with severe
ADL
limitations

DK
Persons
with very
restricting
long-
standing
illness

D
Persons
needing
regular care
and help for
housework

Definition

E
Persons with
performing
housework
limitations

F
Persons
dependent
for at least
one ADL

I
Persons
with serious
ADL
limitations

L
Dependent
persons
receiving
help

NL
Persons
with ADL
limitations

A
Persons
requiring
help (large
sense)

P
Persons
with severe
mobility
disabilities

Year
Population
Source

2001
All
B1

2000
All
DK1

1991/92
Priv house
D2

1999
Priv house
E1

1998/1999
All
F1

1999/00
Priv house
I1

1992
Priv house
L1

2000/2001
Priv house
NL1

1996
All
A2

1995
All
P2

FIN
Persons
unable to
fulfil
demands
of
everyday
life
2001
Priv house
FIN1

S
Persons
needing
help
(shopping)

UK
Persons
with a
personal
care
disability

1996/97
Priv house
S1

2001
Priv house
UK1

20-24
25-29
30-34
35-39
40-44
45-49
50-54
55- 59
60-64
65-69
70-74
75-79
80-84
85-89
90 +

Total (65+)

Total (75+)

3

6

14

24

32

26
32

3

2

4

7

15

33

23
33

1

1

2

4

5

9

26

53
11
31

1

1

2

5

12

35

12
23

8
12
19
30

55

19
30

6
10
16
26

45

15
27

1

1

3

7

10

20

14
20

9
8
16
20

12
16

5

9

22

15
22

5
6
8
16
23

35

19
28

14
15
22
29
40

45

26
37

8

12

25

12
25

1

2

4

6

11

13

17

31

16
19

25

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Notes
For a description of the different concepts used in this table, see the discussion in Chapter 1 and 2.

Feasibility Study
COMPARABLE STATISTICS IN THE AREA OF CARE OF DEPENDENT ADULTS IN THE EUROPEAN UNION

Persons with at least one severe limitation among the ten physical daily activities and sensory functions. Last age group: 75+.

B: 
DK:  Persons with very restricting long-standing illness; the age groups are: 16-24, 25-44, 45-66, 67-79 and 80+. Totals refer to 67+, 67-79 and 80+.
E: 
F: 

Data concerns disabilities. For comparison the percentage of people (65+) with a severe limitation concerning the activities of daily living is 15%. Last age group: 85+.
Persons dependent for at least one ADL: Age groups: 20-29, etc. and 90+. Totals refer to 60+ and 80+. 
For comparison the number of persons in private households who received help was: 20% (65-69), 22% (70-74), 35% (75-79), 55% (80-84), 70% (85-89) and 85% (90+.
provisional data by age group. Age groups: 25-44, 45-54, 55-64, 65-74, 75-79, 80+.
Age groups: 60-69; 70-79; 80+. Totals: 60+, 60-79 and 80+.

I: 
L: 
NL:  The last age group refers to 80+. These are pooled data combining 2000 and 2001.
A: 
FIN:  Persons who feel unable to fulfil the demands of everyday life. The Age groups are: 65-69, 70-74, 75-79 and 80-84.Total 65+ cover 65-84 and 75+ covers 75-84.
S: 
UK:  Persons with a personal care disability. For comparison the survey in 2000 concerning the elderly gives a rate of 16% for all people aged 65+ but does not provide information on younger

The percentage by age group of persons needing care follows a similar path as the one for persons requiring regular help. Last age group: 85+.

Total '65+' covers 65-84 and '75+' covers 75-84.

adults. Age groups: 16-24, 25-34, etc. and 85+. Data refers to England.

26

   
Table 5: Prevalence of dependency by age group, as a percentage of the population covered of the same age group (Narrow definition)

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COMPARABLE STATISTICS IN THE AREA OF CARE OF DEPENDENT ADULTS IN THE EUROPEAN UNION

Definition

Year
Population
Source

20-24
25-29
30-34
35-39
40-44
45-49
50-54
55- 59
60-64
65-69
70-74
75-79
80-84
85-89
90 +
Total (65+)

Total (75+)

B
Persons
bedridden
(from time to
time)

D
Persons
needing
regular
(personal) care
1991/92
All Priv house
B1

D2

2001

E
Persons with
caring for
oneself
limitations
1999
Priv house
E1

F
Persons
needing
significant
help
1991
Priv house
F2

I
Persons confined
in bed, in a chair
or at home

L
Care dependent
insurance
beneficiaries

NL
Persons needing
help for ADL

1999/00
Priv house
I1

2002
All
L2

2000/2001
Priv house
NL1

A
Persons
requiring
regular help
(ADL)
1996
All
A2

P
Persons with
severe ADL
limitations

UK
Persons with a
serious personal
care disability

1995
All
P2

2000
All
UK1

2

3

5

5

7

9

8

9

1

2
3
6
11

26

7

12

3
5
8
15

33

9

17

1
1
0
1
1
0
2
2
4
4
6
8
10

23

8

12

0

0

1

1

2
4
8

25

9

16

0

0

1

5

11

5

11

0

0

1

1

2

3

7

4

7

1
1
2
5
9

16

7

12

1
2
4
6
10

16

6

10

3

11

5

11

27

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Feasibility Study
COMPARABLE STATISTICS IN THE AREA OF CARE OF DEPENDENT ADULTS IN THE EUROPEAN UNION

Notes

For a description of the different concepts used in this table, see the discussion in Chapter 1 and 2.

Permanently bedridden or from time to time and hampered at least from time to time in daily activities.
Data concerns disabilities.
Persons needing help: persons with serious restricted activities, not autonomous at home and bedridden.
Age groups: 19-39; 40-59; 60-69; 70-79; 80+.
Age groups: 16-24, 25-34, etc. and 75+. 

B: 
E: 
F: 
L: 
P: 
UK:  Persons with a serious personal care disability: Age groups: 65-79 and 80+. Data refers to England.

28

Feasibility Study
COMPARABLE STATISTICS IN THE AREA OF CARE OF DEPENDENT ADULTS IN THE EUROPEAN UNION

Chart 7a: Dependent persons by age group, % of the same age group

4
4
-
5
3

4
5
-
5
4

4
6

-
5
5

+
5
7

4
7
-
5
6

4
4
-
5
2

4
6
-
5
4

9
7
-
5
6

+
0
8

9
6
-
5
6

4
7
-
0
7

B

DK

9
7
-
5
7

D

+
5
8

4
8
-
0
8

9
6
-
5
6

4
7
-
0
7

9
7
-
5
7

4
8
-
0
8

+
5
8

9
2
-
0
2

9
3
-
0
3

9
4
-
0
4

9
5
-
0
5

9
6
-
0
6

9
7
-
0
7

9
8
-
0
8

+
0
9

4
4
-
5
2

4
5
-
5
4

4
6

-
5
5

4
7
-
5
6

9
7
-
5
7

+
0
8

9
6
-
0
6

E

F

I

+
0
8

9
7
-
0
7

L

Chart 7b: Dependent persons by age group, % of the same age group

60

50

40

30

20

10

0

60

50

40

30

20

10

0

9
5

-
5
5

4
6
-
0
6

9
6
-
5
6

4
7
-
0
7

9
7
-
5
7

+
0
8

4
6
-
0
6

9
6
-
5
6

4
7
-
0
7

9
7
-
5
7

4
8
-
0
8

+
5
8

4
3
-
5
2

4
4
-
5
3

4
5
-
5
4

4
6

-
5
5

4
7
-
5
6

+
5
7

9
6
-
5
6

4
7
-
0
7

9
7
-
5
7

4
8
-
0
8

4
6

-
5
5

NL

A

P

FIN

4
7
-
5
6

S

4
8
-
5
7

4
2
-
0
2

4
3
-
5
2

4
4
-
5
3

4
5
-
5
4

4
6

-
5
5

4
7
-
5
6

4
8
-
5
7

+
5
8

UK

See Table 4 for the sources, the population covered, the definitions and the explanatory notes.

29

 
 
 
 
 
 
 
Feasibility Study
COMPARABLE STATISTICS IN THE AREA OF CARE OF DEPENDENT ADULTS IN THE EUROPEAN UNION

Chapter 3

Nature of dependency

Previous chapters presented a summary description of a certain number of global indicators chosen for
each country. This chapter presents and discusses the nature of dependency used by the Member States
in the different surveys.

In the following, we present a summary of the relevant parts of the questionnaires. This will enable the
reader to better understand and assess the data reported in the next table 6 and 7.

Tables 6 and 7 are a simplified version of the International Classification of Functioning (WHO).

Belgium

Within  the  disabilities  concerning  the  most  elementary  activities  of  daily  life  such  as  getting  up,
washing  oneself,  dressing,  etc.,  the  survey  makes  the  distinction  between  those  who  can  do  it  'with
difficulty' and those 'who necessitate the help of someone else' (B1).

The respondents were asked to value (on a 100 points scale) the physical functions they are still able to
perform such as walk (the score100 = no limitation), go up and down stairs, carry a shopping bag, etc.
In general, the survey estimates severe limitation, moderate limitation and no limitation. In this case,
we have retained persons with severe limitations.

Main questions include:

-  mobility; to get up, to lie down; to sit, to get up; go to the toilet.
-  to dress, to undress; to wash hands and face; eat and cut food; bite and chew hard food;

continence

-  hearing
-  seeing.

In certain cases, in the following tables, we have completed the survey data with estimations on care
dependency  based  on  ADL  limitations  (B2).  The  authors  distinguish:  self-dependent  persons,
moderately care dependent, highly care dependent, and very highly care dependent.

They use the Katz index (for persons less than 75 years, they use an approximate Katz index):

-  Fully independent person: Katz index = 0.
-  Moderately care dependent: Katz index = 1 or 2.
-  Highly care dependent: Katz index = 3 or 4.
-  Very highly care dependent: Katz index = 5 or 6.

Denmark

Data includes persons who have difficulties in doing the different activities, notably:

-  follow a normal conversation
-  speak (judgement of the interviewer)
-  walk 400 m without resting
-  walk up and down the stairs from one floor to another without resting
-  carry without difficulties 5 kg (e.g. shopping bag)

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Germany

The autonomous performance of activities distinguishes doing the activity ‘with difficulties / need of
help' and ‘impossible’. The data reported here includes both levels. This means that the data might be
broader  compared  to  other  countries.  The  definition  of  dependency  covers  chronic  diseases,
complaints  or  handicaps,  certified  severe  disability,  use  of  medical-technical  aids,  long-term
dependency on care or help, confined to bed.

The different types of limitations concern:

-  Personal Care and Hygiene: Take a bath; take a shower/to wash oneself; take a bath; get

dressed/undressed; brush the hair; continence; use the toilet; organise medication.

-  Food: Cook; organise medication; cut the food; eat.

-  Household performance: Clean the home; go shopping; organise finances; heat the place.

-  Mobility  at  home:  Climb  stairs;  walking  in  the  home;  go  to  bed/get  out  of  bed;  sit

down/get up.

-  Communication/Mobility  outside  home:  Use  public  transport;  visit  people;  orientate

outside home; use telephone.

-  Other: be alone for hours.

This  last  question  has  also  been  used  in  French  surveys  in  order  to  measure  mental/psychological
dependency.

The  German  National  Health  Examination  and  Interview  Survey  has  a  bloc  of  questions  with  some
ADL  activities.  However,  the  statistics  are  not  comparable  with  those  of  other  countries,  since  they
distinguish: a) limited a lot, b) limited a little, and c) not limited at all.

Spain

The severity grade of a disability relates to the difficulty (no, moderate, severe and total difficulty) in
performing daily activities. Disability is defined as limiting the human capacity to the point of making
a  person’s  normal  activity  impossible  or  extremely  difficult.  The  survey  uses  the  International
Classification of Impairments, Disabilities and Handicaps (WHO).

Unlike  previous  data,  present  data  refers  to  disabilities  and  not  to  persons.  A  person  may  declare
several disabilities.

People (65+) with a severe or total disability by limitations of activities of daily living include:

-  seeing:  disability  in  receiving  any  image;  disability  in  overall  visual  tasks;  disability  in

detailed visual tasks; other visual disabilities.

-  hearing: disability in receiving any sound; disability in hearing loud sounds; disability in

hearing speech.

-  communicating:  communicating  through  speech;  communicating  through  alternative
through

through  non-signing  gestures;  communicating 

languages;  communicating 
conventional reading and writing.

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-  learning,  applying  knowledge  and  performing  tasks;  recognising  people,  objects  and
orienting  oneself  in  space  and  time;  remembering  information  and  recent  and/or  past
events; understanding and carrying out simple commands and/or performing simple tasks;
understanding and carrying out complex commands and/or performing complex tasks.

-  getting  around:  changing  and  maintaining  different  body  positions;  getting  up,  lying

down, standing or sitting; getting around inside the home.

-  using  arms  and  hands:  moving-carrying  light  objects;  using  utensils  and  tools;

manipulating small objects with hands and fingers.

-  getting around outside the home: getting around without a means of transportation; getting

around using public transport; driving one's own vehicle.

-  caring  for  oneself:  caring  for  personal  hygiene  without  assistance:  washing  oneself  and
taking care of one's appearance; controlling bodily functions and using the toilet without
assistance; dressing, undressing, grooming; eating, drinking.

-  performing housework; shopping and supervising supplies and services; preparing meals;
washing  and  ironing  clothes;  cleaning  and  maintaining  the  house;  looking  after  the
welfare of other family members.

-  relations  with  other  people:  maintaining  affectionate  relationships  with  close  family
members;  making  and  keeping  friends;  dealing  with  co-workers,  superiors  and
subordinates.

France

The data covers individuals who responded that they did need help for doing the activity in question:

-  Self-care: Washing (body hygiene); dressing and undressing; cut food; eating and drinking

processed food.

-  Elimination: ensure hygiene as well as faecal and urine elimination: use the toilet; control

stools and urines.

-  Mobility: confined in bed, in the room, inside the home.

-  Changing position: get in and out of bed; get seated and get up from a chair.

-  Moving inside the home: move about in all the rooms on the same floor; go up and down

one flight of stairs; use the lift.

-  Moving outside: go out of the home; longest distance one can cover on his own without

stopping and being seriously bothered.

-  Shopping  (direct  or  mail  order  buying):  do  shopping;  carry  a  five-kilo  object  on  a  ten-

meter distance (for example a shopping bag or a school bag).

-  House  chores  and  management;  cook;  common  house  chores  (dishwashing,  laundry,
ironing,  cleaning);  fill  in  plain  forms;  manage  to  order/take  a  taxi,  or  use  public
transportation; take the medicines prescribed by the doctor.

-  Distance communication (using means of communication, phone, bell, alarm).

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COMPARABLE STATISTICS IN THE AREA OF CARE OF DEPENDENT ADULTS IN THE EUROPEAN UNION

Coherence (conversing and/or behaving sensibly): communicate with relatives.
Orientating  (finding  one’s  bearings  in  time,  moments  of  the  day  and  places):  forget  the
time of a day; find his/her way when going out.

-  Sight  (see  well  close  to,  recognise  the  face  of  someone  4  meters  away),  hearing  (hear  a

conversation), speech.

-  Being supple and handling objects: cut toenails, use hands and fingers; open/close a door,

turn taps on and off; bend over and pick up an object on the floor (such as a shoe).

Published statistics present grouped data in certain cases.

Ireland

Functional  ability  was  measured  using  the  Stanford  health  assessment  Questionnaire  (HAQ).
Respondents  were  asked  to  rate  their  ability  to  perform  seventeen  daily  tasks  within  eight  activity
categories  in  the  past  week  on  a  four  point-scale  –  ‘without  difficulty’,  ‘with  some  difficulty’,  ‘with
much difficulty’ or ‘unable to do so’. An overall measure of independence (ranging from 0-3) can be
calculated  from  the  eight  categories,  yielding  four  levels  of  ability  to  maintain  independence  in
activities of daily living (ADL):

-  0 - 0,5:
-  0,51-1,25:

-  1,26-2,00:

-  2,10-3,00:

the person is completely self-sufficient;
the person is reasonable self-sufficient and experiences some minor and even
major difficulties in performing ADL;
the person is still self sufficient but has many major difficulties in performing
ADL;
the person may be called ‘severely disabled’.

The eight categories included:

-  Personal care (wash and dry entire body, take a bath, get on/off the toilet, dress, shampoo

hair, care of feet and toenails).

-  Arising ability (stand up from an armless chair, get in and out of bed).

-  Eating and drinking (prepare meals, make a cup of tea, cut meat, lift a full cup of glass to

mouth, open a new milk cartoon).

-  Walking ability (walk outdoors on flat ground, climb up 5 stairs).

-  Reach ability (reach up and get down a five pound object, bend down and pick up clothing

from the floor).

-  Grip ability (open car doors, open jars previously opened, turn taps on/off).

-  Activity ability (do messages, shopping, etc; get into/out of car; do housework).

-  Cognitive ability (manage own affairs-pay bills; remember daily tasks).

We  retain  only  persons  who  are  unable  to  do  the  activity.  Data  concerning  big  categories  refers  to
persons who usually need help for one or more tasks in the category.

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Italy

The survey focuses on:

-  Confinement: Forced to always remain in bed even if someone is available to help him/her
get  up;  Forced  to  always  sit  in  a  chair  or  armchair  even  if  someone  is  available  to  help
him/her walk; Forced to always stay at home without being able to go out for physical or
psychological reasons.

-  Mobility:  Can  walk  200  metres  or  more  by  him/herself  without  stopping  and  without
getting too tired, climbing stairs, ability to bend down to pick up a shoe from the floor, go
to bed and get out of bed without help, sit down in and get up from a chair without help,
and get dressed and undressed without help.

-  Self care: Take a bath or a shower, wash his/her hands and face without help, eat without
help  (even  cutting  the  food  without  help),  manage  to  chew  without  difficulty,  prepare
meals, take medicine by him/herself, and incontinence.

-  Communication  /  Sensory:  Watch  a  television  program  at  a  high  volume;  recognise  a

friend 1 meter away; Speak without difficulty.

-  Instrumental  activities:  Use  the  telephone,  do  shopping,  take  care  of  his/her  home,  wash

his/her clothes, use means of public transport, and manage his/her own finances.

In the following table we report cases where he/she can do the activity only with the help of someone.
In  certain  cases  we  add  the  two  situations:  ‘with  big  difficulties’  and  ‘total  inability’.    This  aims  to
increase  comparability  with  other  countries  (for  example  concerning  the  capacity  to  speak,  ability  to
bend down to pick up a shoe from the floor and climbing stairs).

Luxembourg

The survey distinguishes five levels: complete autonomy, light loss of autonomy, loss of autonomy but
not  problematic,  serious  dependency  and  severe  dependency.    Data  includes  the  last  two  levels
(persons with a serious or severe dependency). It is important to note that the data covers only persons
who receive help. Consequently, needs might be higher.

Netherlands

The  Dutch  data  distinguishes:  No  difficulty,  with  some  difficulty,  with  big  difficulties  and  only  wit
help.  We  report  the  last  two  dimensions.  In  presenting  the  degree  of  dependency,  we  make  the
distinction between the two dimensions. The data might be higher compared to other more restrictive
definitions  but  the  numbers  concerning  only  those  who  need  help  are  small  and  consequently  the
reported estimators less efficient.

We do not report information on incontinence since this statistic reports the number of persons who in
the latest 12 months suffered from involuntary urine losses and consequently is not comparable with
other data.

The  ADL  (Activities  of  Daily  Living)  indicator  refers  to  limitations  in  carrying  out  general  daily
activities.  Since 1989 respondents are asked if they can: 'eat and drink', 'sit down in and get up from a
chair', 'get into and out a bed', 'dress and undress', 'move to another room on the same floor', 'walk up

34

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COMPARABLE STATISTICS IN THE AREA OF CARE OF DEPENDENT ADULTS IN THE EUROPEAN UNION

and  down  stairs',  'go  out  and  let  themselves  in  again',  'move  around  outside',  'wash  their  face  and
hands' and 'wash themselves completely'.

The  figures  present  people  who  are  not  able  to  do  one  or  more  of  these  activities,  only  with  great
difficulty, and with some difficulty. We report data only for the first two categories.

The Netherlands is the only Member State to report the OECD indicator. For people aged 65 and over,
the indicator gives 31,6% (2000). The figure refers to people who reported not being able to do one or
more of these activities, or only with great difficulty. For comparison the ADL indicator gives 19%.

The OECD indicator refers to limitations in the ability to communicate and move around; Respondents

are asked if they can do the following:

-  follow a conversation in a group of 3 or more persons (if necessary with a hearing aid),
-  read small print in a newspaper (if necessary with glasses or contact lenses),
-  recognise a face at a distance of 4 meters (if necessary with glasses or contact lenses),
-  carry an object weighing five kilos (e.g. a bag of shopping) a distance of 10 meters,
-  from upright position, bend down and pick something up from the ground, walk for 400

meters without stopping (if necessary with a stick).

The Longitudinal Ageing Study Amsterdam (LASA) (NL2) measures the time needed to:

-  Take off a cardigan,
-  Walk three meters back and forth,
-  Get up from a kitchen chair five times without arms folded.

Data concerning the number of respondents who were not able to perform the test are similar to the
ones reported in table 6.

Austria

Interviewed persons responded to the following questions:

Which of the following activities can you do without the help of a third party, only with the help of a
third party, not at all:

-  getting up and down,
-  washing and getting dressed,
-  walking in the house,
-  eating and drinking,
-  easy household tasks – clearing up, doing the dishes, preparing meals,
-  difficult  household  tasks  –  vacuum  cleaning,  doing  the  laundry,  hanging  up  laundry,

cleaning the windows,

-   going shopping,
-   going out and making visits.

Reported statistics in the table include 'only with the help of a third party' and ' not at all'.

Portugal

The health survey reports persons with a long term disability concerning:

-  Confinement: always in bed; always bound to a chair; confined to the house

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-  Mobility:  lie  down  and  get  up  from  bed;  sit  down  and  get  up  from  a  chair;  go  and  use
toilet; pick up something from the ground; can walk on a flat terrain without discomfort;
climb and go down 12 steps.

-  Personal  care:  get  dressed  and  undressed;  wash  face  and  hands;  eat  (cut  food  and  bring

food and drinks to mouth) and incontinence.

-  Sensory / communication: listen to TV or radio; distinguish forms and recognise friends;

difficulties to speak.

Concerning personal care the answer is: alone, without difficulty; alone with difficulty; with help. We
have retained persons who answer ‘with help’.
Concerning sensory functions and certain mobility questions the answers are different. In this case, we
have retained ‘cannot / not at all’. Concerning incontinence we have chosen the stricter definition: at
least once per week.

Finland

The survey covers ability to:

-  read a newspaper
-  hear a conversation
-  manage tasks which require good memory and mental effort
-  use stairs
-  handle matters outside home
-  walk outside
-  carry heavy things
-  cook
-  do housework.

The  answer  distinguishes,  in  general,  ability  to  do  the  activity:  without  difficulties;  alone,  but  it  is
difficult; yes, if somebody helps; and no, not even with help. Statistics in the following table include
the last two degrees.

Sensorial  abilities  distinguish:  No;  Yes,  but  it  is  difficult;  Without  difficulties.  The  data  retained
includes only those who answer ‘No’.

Sweden

The Swedish survey presents data on the following aspects/activities:

-  Difficulties to carry heavy objects
-  Difficulties to grip, e.g. turn on tap
-  Difficulties to climb stairs
-  Difficulties to get onto a bus
-  Can not take a short walk at a fairly quick pace
-  Can not get up from a chair

-  Physical disability
-  Impaired hearing
-  Impaired eyesight
-  Seriously impaired working capacity

-  Need of care: Need of personal assistance indoors; Need of personal assistance outdoors;

Has/in need of taxi services for disabled

36

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COMPARABLE STATISTICS IN THE AREA OF CARE OF DEPENDENT ADULTS IN THE EUROPEAN UNION

-  Needs help with: cleaning; grocery shopping; cooking; laundry; bath or shower; getting up

or getting to bed.

United Kingdom

The indicator 'Persons with a severe personal care disability' (2000) comes from the Health Survey for
England.  In  accordance  with  the  WHO  (World  Health  Organisation)-ICIDH  protocol,  disability  was
measured across five domains: locomotor, personal care, sight, hearing and communication.  For each
domain, the level of severity was scored into none (0), moderate (1) and severe (2).

-  Locomotor  disability  includes:  Difficulty  walking  200  meters;  Difficulty  climbing  12

stairs; Difficulty picking up shoes.

-  Personal care disability includes: Difficulty getting in / out of bed; Difficulty getting in /
out of chair; Difficulty dressing / undressing; Difficulty washing; Difficulty feeding self;
Difficulty getting to / using toilet.

In general, a person may answer: No difficulty; Moderate difficulty; Severe difficulty.

The indicator 'Persons needing help' (1998) covers private households in Great Britain.

The survey reports persons usually unable to manage on their own, for the following activities:

-  Mobility: Going out of doors and walking down the road; Getting up and down stairs and

steps; Getting around the house; Going to the toilet; Getting in and out of bed.

-  Self-care:  Bathing,  showering,  washing  all  over;  Dressing  and  undressing;  Washing  face

and hands; Feeding; Cutting toenails.

-  Domestic  tasks:  Household  shopping;  Wash  and  dry  dishes;  Clean  windows  inside;  Jobs
involving climbing; Use a vacuum cleaner to clean floors; Wash clothing by hand; Open
screw tops; Deal with personal affairs; Cook a main meal; Prepare a snack; Make a cup of
tea

Comments

Most surveys focus on mobility, self-care and domestic life.

Activities  of  daily  living  (ADL)  include  self-care  activities,  such  as  bathing,  dressing  and  feeding
oneself. Most Member States focus on the following items:

-  washing,
- 
dressing,
- 
transfer,
- 
going to the toilet,
- 
continence and
- 
eating.

However,  the  same  denomination  often  hides  different  measures.  For  example  washing  may  refer  to
wash  face  and  hands,  or  showering  or  bathing.  It  is  clear  that  there  is  a  big  difference  between  the
three questions. The last one is the most restrictive and might present the lowest percentage.

37

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COMPARABLE STATISTICS IN THE AREA OF CARE OF DEPENDENT ADULTS IN THE EUROPEAN UNION

Transfer may refer notably to:

- 
- 

transfer from a bed to a chair, or
sitting down, standing up.

Walking may refer to:

-  walking 100 meters without resting; or
-  walking 400 meters without resting;

Going to the toilet refers in many surveys to a mobility problem and notably the capacity to maintain a
body position, while use the toilet refers often to a continence problem. In the latter case, the reported
rates  may  vary  sharply  according  to  the  question.  The  question  “Did  you  have  a  problem  during  the
last month” will give a very high rate in comparison to the question “Do you have every day …”.

Eating sometimes is combined with problems related to the use of hands (for example cut food) while
in other cases it has a very restrictive sense.

Watching,  listening  and  speaking  are  included  in  most  surveys.  It  is  important  to  note  that  all  report
difficulties concerning these functions.  As one could expect the reported rates are relatively high. On
the other hand some surveys report total inability.

Recent  EU  policies  on  improving  the  quality  of  life  of  the  elderly  people  and  improving  equal
opportunities in social and leisure activities has put emphasis on social and cultural participation.

There  is  an  increasing  tendency  to  include  Instrumental  Activities  of  Daily  Living  (IADL).  They
include domestic activities such as cooking, shopping and house keeping.

Communication  and  relations  with  others  are  items,  which  are  more  difficult  to  measure,  and  only  a
few  surveys  have  included  them.  They  are  called  to  take  a  higher  importance  in  the  future  for  the
following reasons:

- 
- 

they are important determinants of social participation, and
they might be important factors for certain persons in their decision to enter into an institution.

Communication  is  taken  into  account,  but  big  differences  exist  across  countries  (Germany:  use  the
telephone, visit people; DK: follow a normal conversation; E: maintaining relations with other people;
F: coherence, communicate with relatives; A: making visits; etc.).

38

Table 6:  Nature of dependency. Number of elderly persons with a specific dependency as a percentage of the population covered of the same age group.

Feasibility Study
COMPARABLE STATISTICS IN THE AREA OF CARE OF DEPENDENT ADULTS IN THE EUROPEAN UNION

Definition

Age group

Year

Population covered

Source

Mobility

Changing body positions (sitting down, standing 
up, getting into/out of a seat)

Maintaining a body position

Go to/use the toilet

-Inside the home

-Outside the home

Lifting and carrying objects

Hand and arm use

Walking

Climbing stairs

Moving around

Self-care

Washing

Caring for body parts

Toileting (incl. continence)

Dressing

Eating

Drinking

Looking after one's health

I

a

b

c

d

e

f

g

h

II

a

b

c

d

e

f

g

III

Domestic life

a

b

c

Preparing meals

Doing housework

Shopping

IV

Communication

a

b

V

a

b

c

VI
a

b

c

VII

Speaking

Conversation

Sensory experiences & solving problems

Watching

Listening

Solving problems / making decisions

General tasks and demands

Understanding tasks

Handling stress

Memory / orientation

Community and social life

B

DK

D

E

F

IRL

Persons with 
severe limitations

Persons who 
have difficulties

Dependent 
persons

Persons with a 
severe disability

Persons needing 
help

Persons unable 
to do the activity

65+

2001

All

B1

60+

1994

All

DK1

65+

1991/92

65+

1999

Pr. House.

Pr. House

D2

E1

60+

1998/99

All

F1

65+

2000

I
Persons with 
serious 
difficulties
65+

1999/00

L

NL

A

P

FIN

S

UK

Persons 
receiving help

Persons with 
severe limitations

Persons needing 
help

Persons needing 
help

Persons needing 
help

Persons needing 
help

Persons needing 
help

60+

1992

65+

2000/2001

60+

1998

65+

1998/99

65-84

2001

65-84

1996/97

65+

1998

Pr. House.

Pr. House.

Priv house

Priv house

Priv house

Priv house

Priv house

Priv house

Priv Hous

IRL1

I1

L1

NL1

A1

P1

FIN1

S1

UK3

11

4

2

11

14

5

13

6

3

1

2

32

33

30

5

26

6

5

5

18

6

17

10

5

5

10

3

6

11

20

19

11

10

14

6

4

3

7

7

5

14

6

5

5

} 1,9

8

12

9

2

6

4

7

3

5

17

7

17

10

18

5

13

4

7

4

2

4

2

3

3

3

5

2

7

3

17

8

3

6

1

3

3

6

13

21

1

0

3

2

13

2

10

4

3

8

8

4

5

16

5

10

3

7

11

10

7

5

6

3

4

7

4

3

11

2

16

4

9

5

3

0

20

1

9

3

} 2,6

4

12

3

7

13

22

16

4

4

9

2

7

6

5

13

5

3

4

2

2

16

6

6

9

12

9

23

2

4

7

8

4

10

19

24

2

6

4

8

17

15

6

29

2

1

2

9

1

12

7

30

3

1

7

10

14

1

3

2

6

VIII

Total reference population 1.000s

1,730

1,040

12,795

6,435

12,072

426

10,049

75

2,164

1,547

1,627

707

1,353

9,282

39

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COMPARABLE STATISTICS IN THE AREA OF CARE OF DEPENDENT ADULTS IN THE EUROPEAN UNION

Notes
The table indicates that in Belgium 4% of persons aged 65 and over are dependent for mobility activities.
Numbers in Italics refer to difficulties.
‘Total reference population’ presents the total number of persons (private households and establishments). The reader has to use with caution these numbers as a certain number of estimates
cover only people living in private households.

B
DK
D
E
F

IRL
I

L
NL

A
P

FIN

S

UK

II: Activities of daily living; IIe: includes arms use limitations.
If: Walk 400 m without resting; Id: Carry 5 kg without difficulties.
If: to organise medication; IIb: Brush the hair; VII: Visit people.
Ib: Changing and maintaining a body position; If: Getting around; Vc: looking after the welfare of other family members; VIa: Learning and applying knowledge.
Ia: Lying down /getting up from a bed. For comparison getting into/out of a seat: 2,4%; Ie: for comparison cut food: 4%. Id: Pending and taking an object.
We did not report, 'cut toenails': 22,0%. Vic: Refers to memory, for comparison orientation: 1%.
I: Walking ability; Ie: grip ability; II: Personal grooming; IIa: Take a bath: 8%; IIb: Care of feet and toenails; Vc: manage own affairs (pay bills)
I: includes walking, climbing stairs, bending and Ia; Ia: getting into and out of bed; Id: Pending and taking shoes; If: Can walk only a few steps; Iha: Confined at home; II: Includes
activities of daily living;
IIa: Needs the assistance to wash hands and face. For comparison 12,5% need assistance for shower or bath; IIe: Needs help to eat and cut food; V includes sight, hearing and speech;
Va: See and recognise at 4 meters.
The data include both ‘with big difficulties’ and ‘total inability’ in the following cases: capacity to speak, ability to bend down to pick up a shoe from the floor and ability to climb
stairs.
The nature refers to the type of assistance. Data refers to persons with a serious or severe dependency receiving often or daily help. VIa: Administrative procedures.
Ia: getting in and out of bed. The corresponding rate for getting in and out of a chair is 3,6%. If: move to another room on the same floor; for comparison, walk for 400 meters without
stopping: 13,9%.
IIa: Wash oneself completely. For comparison the prevalence for washing face and hands is 0,6%. Va: Recognise a face at a distance of 4 meters. For comparison read small print in a
newspaper: 7%.
IIIc: Carry an object weighting 5 kilos a distance of 10 meters.
IIa: Washing includes dressing; VII: To go out to visit
Persons needing help; for comparability reasons, we have added persons confined in bed to all mobility (except 'constrained in house',
where it was included),  washing and dressing items.
Ia: Lie down and get up from bed; Id: Pick up something from the ground; Ih: Constrained to the house; IIc: At least once per week; IIe: Includes arms use.
Persons with a serious disability; Id: Intolerance, resistance; III: Open doors, use of telephone, use of arms, coordination, etc.
II: Demands of everyday life. V: Difficulties (including inability) are: to read a newspaper: 23,6% (M: 20,9 and W: 25,4); to hear a conversation: 35% (M: 41% and W: 31%).
VIa: Ability to handle tasks outside home.
Ia: Cannot get up from a chair. The percentage of getting up / going to bed is 2,2%; Laundry: 13,3% (M: 14,1 and W: 12,7)
Ih: Has/is in need of taxi service for disabled: 18,1%.
Persons needing help (General Household Survey).
It covers Great Britain. Eyesight and hearing refer to difficulties, while the remaining refers to inability to manage on their own.
IIa: Refers to bathing, showering, washing all over. Washing face and hands: insignificant percentage. IIb: Cutting toenails; If: Wash and dry dishes
IIIa: Cook a main meal: 5% and prepare a snack: 2%; The table does not include: clean windows inside: 19% (M: 12% and W: 24%),
Jobs involving climbing: 28% (M: 19% and W: 35%), Wash clothing by hand: 8% (M and W: 8%)
A certain number of data comes from the Health Survey for England (2000) covering all persons (including institutions). The survey defines 'Persons with a severe disability'.
These numbers are: IV, Va and Vb. The remaining data is similar to the one presented here.

40

Table 7:  Nature of dependency by gender. Number of elderly men/women with a specific dependency as a percentage of the population covered of the same sex and age group.

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COMPARABLE STATISTICS IN THE AREA OF CARE OF DEPENDENT ADULTS IN THE EUROPEAN UNION

B
Persons with severe 
limitations
65+

2001

All

B1

DK

Persons who have difficulties

60+

1994

All

DK1

E
Persons with a severe 
disability
65+

1999

Priv Hous

E1

F

Persons needing help

60+

1998/99

All

F1

I
Persons with a serious 
disability
65+

1999/2000

Priv Hous

I1

A

P

FIN

S

UK

Persons needing help

Persons needing help

Persons needing help

Persons needing help

Persons needing help

60+

1998

Priv Hous

A1

65+

1998/99

Priv Hous

P1

65-84

2001

Priv Hous

FIN1

65-84

1996/97

Priv Hous

S1

65+

1998

Priv Hous

UK3

Persons with severe 
disabilities
65+

2000

All

UK1

M

W

M

W

M

W

M

W

M

W

M

W

M

W

M

W

M

W

M

W

M

W

Definition

Age group

Year

Population covered

Source

Sex

I Mobility

a

Changing body positions (sitting down, 
standing up, getting into/out of a seat)

b Maintaining a body position
c

Go to/use the toilet

d

e

Lifting and carrying objects

Hand and arm use

f Walking
g

Climbing stairs
h Moving around

-Inside the home
-Outside the home

II
Self-care
a Washing
b

Caring for body parts

c

d

e

f

g

Toileting (incl. continence)

Dressing

Eating

Drinking

Looking after one's health

III Domestic life
a

Preparing meals

b

c

Doing housework

Shopping

IV Communication
a

Speaking

b

Conversation

7

4

2

3

10

4

2

13

4

3

6

14

7

4

V Sensory experiences & solving problems
a Watching
b
Listening

c

Solving problems / decisons

1

2

1

3

VI General tasks and demands
a
Understanding tasks

b

Handling stress
c Memory / orientation

VII Community and social life

18

26

24

43

39

36

6

29

5

23

4

3

2

5

5

4
11

5

4

4

7

5

4

8

8

6
17

7

6

5

} 1,5

} 2,1

5

6

6

2

5

4

5

2

9

14

12

2

6

4

9

4

2

2

3

1

4

2
17

6

2

5

1

2

3

8

12

21

1

0

3

2

10

1

4

4

3

2

9

4
22

9

3

7

1

3

4

6

13

26

2

1

4

2

15

3

12

5

13

7

13

3

9

3

6

3

2

3

1

3

4

4

10

3

13

4

7

7

} 2,5

} 2,6

12

18

13

25

21

8

21

12

22

6

15

4

8

4

2

5

2

3

4

4

9

2

6

5

5

9

6

4

5

2

2

4

4

10

2

8

7

5

16

5

3

3

3

2

3

4

5

16

19

1
3

4

10

15

10

15

21

28

2
8

4

7

19

18

6

37

7

24

1

1

1

6

1
6

5

22

3

0

6

5

8

24

27

4

3

1

2

12

1
16

9

36

3

1

7

13

18

30

20

7

10

2

2

6

8

5

1

4

1

1

3

2

14

3

3

8

12

5

2

4

1

2

3

2

11

4

5

13

20

8

7

12

13

20

6

25

2

5

8

8

2

4

5

9

13

18

41

Notes

The table indicates that in Belgium 7% of men aged 65 and over are dependent for mobility activities.
Numbers in italics refer to difficulties.

Feasibility Study
COMPARABLE STATISTICS IN THE AREA OF CARE OF DEPENDENT ADULTS IN THE EUROPEAN UNION

B
DK
D
E
F
I

A
P

FIN

UK

IIe: Includes arms use limitations.
If: Walk 400 m without resting; Id: Carry 5 kg without difficulties.
If: To organise medication; IIb: Brush the hair; VII: Visit people.
Ib: Changing and maintaining a body position; If: Getting around; Vc: Looking after the welfare of other family members; VIa: Learning and applying knowledge.

I: Includes walking, climbing stairs, bending and Ia; Ia: Getting into and out of bed; Id: Pending and taking shoes; If: Can walk only a few steps; Iha: Confined at home; II: Includes
activities of daily living;
IIa: Needs the assistance to wash hands and face; IIe: Needs help to eat and cut food; V: Includes sight, hearing and speech; Va: See and recognise at 4 meters.
IIa: Washing includes dressing; VII: To go out to visit
Persons needing help; For comparability reasons, we have added persons confined in bed to all mobility (except 'constrained in house', where it was included), washing and dressing
items.
Ia: Lie down and get up from bed; Id: Pick up something from the ground; Ih: Constrained to the house; IIc: At least once per week; IIe: Includes arms use.
II: Demands of everyday life. V: Difficulties (including inability) are: to read a newspaper: 23,6% (M: 20,9 and W: 25,4); to hear a conversation: 35% (M: 41% and W: 31%).
VIa: ability to handle tasks outside home.
Persons needing help (General Household Survey).
It covers Great Britain. ‘Eyesight’ and ‘ Hearing’ refer to difficulties, while the remaining refers to inability to manage on their own.
IIa: Refers to bathing, showering, washing all over. Washing face and hands: insignificant percentage. IIb: Cutting toenails; If: Wash and dry dishes
IIIa: Cook a main meal: 5% and prepare a snack: 2%; The table does not include: clean windows inside: 19% (M: 12% and W: 24%),
Jobs involving climbing: 28% (M: 19% and W: 35%), Wash clothing by hand: 8% (M and W: 8%)
Persons with a severe disability (Health Survey for England)
The survey covered only England. The reference population is the total UK.

42

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COMPARABLE STATISTICS IN THE AREA OF CARE OF DEPENDENT ADULTS IN THE EUROPEAN UNION

Chart 8: Nature of dependency. Number of elderly people with a specific dependency as a

percentage of the population covered of the same age group.

Mobility (Ia)

%

%

%

%

%

25

20

15

10

5

0

25

20

15

10

5

0

25

20

15

10

5

0

25

20

15

10

5

0

25

20

15

10

5

0

B

D

E

F

IRL

I

NL

A

P

S

UK

Climbing stairs

D

F

IRL

I

NL

A

P

FIN

UK

Washing

B

D

E

F

IRL

I

L

NL

A

P

S

UK

Dressing

B

D

E

F

IRL

I

NL

P

UK

Preparing meals

D

E

F

IRL

L

FIN

S

UK

43

Feasibility Study
COMPARABLE STATISTICS IN THE AREA OF CARE OF DEPENDENT ADULTS IN THE EUROPEAN UNION

Housework

%

%

25

20

15

10

5

0

25

20

15

10

5

0

%

%

25

20

15

10

5

0

25

20

15

10

5

0

D

E

F

IRL

L

A

FIN

S

UK

Shopping

D

E

F

IRL

NL

A

S

UK

Watching

B

F

I

NL

P

FIN

UK

Listening

B

E

F

I

P

FIN

S

Note: See Table 6 for definitions, population covered, explanatory notes and sources.

44

Feasibility Study
COMPARABLE STATISTICS IN THE AREA OF CARE OF DEPENDENT ADULTS IN THE EUROPEAN UNION

Chapter 4

Nature of dependency by age group

In  Chapter  2  we  presented  the  evolution  of  dependency  with  age.  The  present  chapter  describes  the
evolution of each specific dependency by age group.

In general, all types of dependency follow a similar path of increase with age.

In  general,  the  number  of  self-care  dependencies  is  lower  at  all  ages  compared  to  mobility  and
domestic life activities (see Table 8)

Table 8 presents the same surveys as those presented in previous chapters. A small difference concerns
Italy. Previous table was reporting cases where he/she can do the activity with the help of someone. In
certain cases we reported cases ‘with big difficulties’ and ‘total inability’ (for example concerning the
capacity to speak). The prevalence by age group in the present table presents persons with limitations
and includes ‘people with a little difficulty’ in certain cases.

45

Table 8:  Nature of dependency by age group. Number of elderly persons with a specific dependency as a percentage of the population covered of the same age group.

Feasibility Study
COMPARABLE STATISTICS IN THE AREA OF CARE OF DEPENDENT ADULTS IN THE EUROPEAN UNION

B

DK

D

E

F

I

NL

A

P

FIN

S

UK

Persons with severe limitations

Persons who have difficulties

Dependent persons

Persons with a disability

Persons needing help

Persons with a disability

Persons with severe limitations

Persons needing help

Persons needing help

Persons needing help

Persons needing help

Persons needing help

65-74

75+

60-79

80+

65-79

80+

65-74

75+

60-79

80+

65-74

75+

65-74

75+

65-74

75+

65-74

75+

65-74

75-84

65-74

75-84

65-74

75+

2001 (1997)

All

B1, B2

1994

All

DK1

1991/92

Priv Hous

D2

1999

Priv Hous

E1

1998/99

All

F1

Definition

Age group

Year

Population covered

Source

Mobility

I

a

b

c

d

e

f

g

h

Changing body positions (sitting down, 
standing up, getting into/out of a seat)

Maintaining a body position

Go to/use the toilet

3

11

Lifting and carrying objects

Hand and arm use

Walking

Climbing stairs

Moving around

19

28

25

47

62

58

-Inside the home

-Outside the home

7

13

17

15

II

Self-care
a Washing
b

Caring for body parts

2

3

8

19

3

21

14

50

c

d

e

f

g

Toileting (incl. continence)

Dressing

Eating

Drinking

Looking after one's health

III Domestic life

a

b

c

Preparing meals

Doing housework

Shopping

IV Communication

a

b

V

Speaking

Conversation

Sensory experiences & solving problems

a Watching
b

Listening

c

Solving problems / decisons

VI General tasks and demands

a

b

c

Understanding tasks (simple)

Handling stress

Memory / orientation

VII Community and social life

4

2

3

13

4

11

6

3

3

6

1

3

6

13
12

6

5

8

12

11

13

34

14

37

22

12

12

20

7

15

25

39
38

28

24

32

7

4

6

3

5

14

4

3

1

3

1

4

7
7

2

1

7

6

2

1

2

3

16

11

12

15

15

32

17

15

8

13

5

18

24
23

8

3

17

17

8

4

8

9

1

1

3

1

3

1

10

4

1

3

0

1

2

4

9
13

1

0

2

1

9

1

12

11

15

5

25

12

49

25

10

20

4

10

11

19

33
57

5

1

4

2

34

7

1999/00

Priv Hous

I1

9

3

34

17

5

23

2

7

2000/2001

Priv Hous

NL1

1998

Priv Hous

A1

1998/99

Priv Hous

P1

2001

Priv Hous

FIN1

1996/97

Priv Hous

S1

1998

Priv Hous

UK3

2

2

6

1

4

3

2

10

3

2

3

1

1

6

7

15

4

13

11

10

19

10

6

5

5

3

3

5

9

12

18

1

2

2

5

11
9

3

25

13

29

32

3

10

7

13

26
22

10

34

9

3

3

9

5

13

1

3

4

4

29

12

11

16

16

40

4

7

11

14

2

5

3

7

7

1

10

2

5

2

2

0

12

1

6

1

17

4

24

7

14

8

5

1

29

2

13

5

8

2

5

20

6

13

2

4

9
16

23
37

11

29

2

1

3

15

1

19

11

43

4

1

11

16
22

4

7

6

10

2

1

1

5

1

6

4

21

2

1

4

5
7

0

2

1

3

46

Notes

The table indicates that in Belgium 3% of persons aged 65 to 74 years old are dependent for mobility activities.
Numbers in italics refer to difficulties.

Feasibility Study
COMPARABLE STATISTICS IN THE AREA OF CARE OF DEPENDENT ADULTS IN THE EUROPEAN UNION

B
DK
D
E

F
I

NL

A
P

Ia: Limited to a chair; Ih: Limited to house/garden; II: Activities of daily living;  III: Refer to the Flemish region, 1997.
If: Walk 400 m without resting; Id: Carry 5 kg without difficulties.
Ih:  Outside the home: use public transport; IIb: Brush the hair; VII: Visit people.
II: Caring for oneself; VIc: Refers to remembering information and recent events; Recognising people and orientation: 0,9% and 5%. Washing and ironing: 5,2% and 20,7%.

The data here refers to disabilities. Previous tables present persons with a severe disability.
Ie: For comparison cut food: 1,9% and 14,1%. II: Demands of everyday life.
I: Includes walking, climbing stairs, bending and Ia; Ia: Confined in bed, in a chair or at home; II: Includes activities of daily living; Due to a filter question on confinement in bed or a
chair, this percent might be underestimated.
V: Includes sight, hearing and speech.
Ia: Getting in and out of bed. If: Move to another room on the same floor; For comparison, walk for 400 meters without stopping: 7,9% and 21,4%.
IIa: Wash oneself completely. For comparison the prevalence for washing face and hands is 0,3% and 1%. Va: Recognise a face at a distance of 4 meters. For comparison read small print
in a newspaper: 5,3% and 9,1%.
IIIc: Carry an object weighting 5 kilos a distance of 10 meters.
IIa: Washing includes dressing; VII: To go out to visit …
Persons needing help; For comparability reasons, we have added persons confined  in  bed  to  all  mobility  (except  'constrained  in  house',  where  it  was  included),  washing  and  dressing
items.
Ia: Lie down and get up from bed; Id: Pick up something from the ground; Ih: Constrained to the house; IIc: At least once per week; IIe: Includes arms use. 
Persons with a serious disability; Id: intolerance, resistance; III: open doors, use of telephone, use of arms, coordination, etc.

FIN VIa: Ability to handle tasks outside home.
S
UK

Ih: Has/is in need of taxi service for disabled: 9,2% and 30,2%.
Persons needing help (General Household Survey). 
It covers Great Britain. Eyesight and hearing refer to difficulties, while the remaining refers to inability to manage on their own.
Eyesight and hearing refer to difficulties, while the remaining refers to inability to manage on their own.
IIa: Refers to bathing, showering, washing all over. Washing face and hands: insignificant percentage. IIb: Cutting toenails; If: Wash and dry dishes
IIIa: Cook a main meal: 5% and prepare a snack: 2%; The table does not include: clean windows inside: 19% (M: 12% and W: 24%), 
Jobs involving climbing: 28% (M: 19% and W: 35%), Wash clothing by hand: 8% (M and W: 8%)
Data concerning 'Communication', 'Watching' and 'Listening' comes from the Health Survey for England. They refer to persons with a severe disability (UK1)
The latter survey covered only England.

47

Table 9: Dependent persons aged 65 to 74, by gender. Number of men/women with a specific dependency as a percentage of the population covered of the same sex and age group.

Feasibility Study
COMPARABLE STATISTICS IN THE AREA OF CARE OF DEPENDENT ADULTS IN THE EUROPEAN UNION

Definition

Age group

Year

Population covered

Source

Sex

Mobility

Changing body positions (sitting down, 
standing up, getting into/out of a seat)

Maintaining a body position

Go/use to the toilet

Lifting and carrying objects

Hand and arm use

Walking

Climbing stairs

Moving around

-Inside the home

-Outside the home

Self-care

Washing

Caring for body parts

Toileting (incl. continence)

Dressing

Eating

Drinking

Looking after one's health

I

a

b

c

d

e

f

g

h

II

a

b

c

d

e

f

g

III Domestic life

a

b

c

Preparing meals

Doing housework

Shopping

IV Communication
a

Speaking

b

V

a

b

c

Conversation

Sensory experiences & solving problems

Watching

Listening

Solving problems / decisons

VI General tasks and demands

a

b

c

Understanding tasks (simple)

Handling stress

Memory / orientation

VII Community and social life

DK

E

F

I

A

P

FIN

S

UK

Persons having difficulties

Persons with a disability

Persons needing help

Persons with a disability

Persons needing help

Persons needing help

Persons needing help

Persons needing help

Persons needing help

Persons with severe disabilities

60-79

1994

All

DK1

65-74

1999

Priv Households

E1

60-79

1998/99

All

F1

65-74

1999/00

65-74

1998

65-74

1998/99

65-74

2001

65-74

1996/97

65-74

1998

Priv Households

Priv Households

Priv Households

Priv Households

Priv Households

Priv Households

I1

A1

P1

FIN1

S1

UK3

65-79

2000

All

UK1

M

W

M

W

M

W

M

W

M

W

M

W

M

W

M

W

M

W

M

W

23

33

30

19

28

25

3

25

3

18

5

3

4

3

3

11

4

3

1

3

1

3

4

4

2

1

6

6

2

1

2

2

8

5

7

3

6

16

4

3

1

3

1

4

10

8

2

1

8

6

1

2

3

1

1

1

2

1

12

5

1

4

0

1

2

6

10

15

1

0

2

1

8

1

2

1

1

4

2

12

4

1

3

0

1

2

3

8

16

1

0

2

1

9

1

7

3

10

4

4

5

1

2

3

8

2

6

2

8

2

4

2

2

10

14

9

17

11

11

2

2

6

1

3

2

2

6

4

2

4

1

1

2

1

6

1

3

3

2

13

2

1

2

1

0

7

3

2

10

3

4

10

8

7

11

2

15

2

3

6

4

1

3

3

3

2

3

4

11

17

1

2

3

6

9

7

3

34

13

13

20

0

3

2

4

12

11

3

18

1

1

1

3

1

4

3

14

2

0

4

3

5

2

1

1

7

0

9

5

27

3

1

4

7

9

3

3

8

2

1

5

7

3

0

2

0

0

2

0

8

2

1

4

6

3

1

2

1

0

2

1

48

Feasibility Study
COMPARABLE STATISTICS IN THE AREA OF CARE OF DEPENDENT ADULTS IN THE EUROPEAN UNION

Notes

The table indicates that in Spain 5% of men in the 65 to 74 age group are dependent for changing a body position.
Numbers in italics refer to difficulties.

DK
D
E

F
I

A
P

If: Walk 400 m without resting; Id: Carry 5 kg without difficulties.
Ih:  Outside the home: use public transport; IIb: Brush the hair; VII: Visit people.
II: Caring for oneself; VIc: Refers to remembering information and recent events.
The data here refers to disabilities. Previous tables present persons with a severe disability.
Ie: Cut food.
I: Includes walking, climbing stairs, bending and Ia; Ia: Confined in bed, in a chair or at home; II: Includes activities of daily living; Due to a filter question on confinement in bed or a
chair, this percent might be underestimated.
V: Includes sight, hearing and speech.
IIa: Washing includes dressing; VII: to go out to visit
Persons needing help; For comparability reasons, we have added persons confined in bed to all mobility (except  'constrained  in  house',  where  it  was  included),  washing  and  dressing
items.
Ia: Lie down and get up from bed; Id: Pick up something from the ground; Ih: Constrained to the house; IIc: At least once per week; IIe: Includes arms use. 

FIN II: Demands of everyday life. VIa: Ability to handle tasks outside home.
S
UK

Ia: Getting up / going to bed is 1,4% and 0,9%; Ih: Has/is in need of taxi service for disabled: 8,2% and 10,1%.
Persons needing help (General Household Survey). 
It covers Great Britain. Eyesight and hearing refer to difficulties, while the remaining refers to inability to manage on their own.
Eyesight and hearing refer to difficulties, while the remaining refers to inability to manage on their own.
IIa: Refers to bathing, showering, washing all over. Washing face and hands: insignificant percentage. IIb: Cutting toenails; If: Wash and dry dishes
IIIa: Cook a main meal: 5% and prepare a snack: 2%; The table does not include: clean windows inside: 19% (M: 12% and W: 24%), 
Jobs involving climbing: 28% (M: 19% and W: 35%), Wash clothing by hand: 8% (M and W: 8%)
Persons with a severe disability (Health Survey for England)
The survey covered only England. The reference population is the total UK.

49

Table 10: Dependent persons aged 75 and over by gender. Number of men/women with a specific dependency as a percentage of the population covered of the same sex and age
group.

Feasibility Study
COMPARABLE STATISTICS IN THE AREA OF CARE OF DEPENDENT ADULTS IN THE EUROPEAN UNION

Definition

Age group

Year

Population covered

Source

Sex

I Mobility

a

Changing body positions (sitting down, standing 
up, getting into/out of a seat)
b Maintaining a body position
c

Go to/use to the toilet

d

Lifting and carrying objects

Hand and arm use

e
f Walking
g

Climbing stairs

h Moving around

-Inside the home

-Outside the home

II

Self-care
a Washing
b

Caring for body parts

c

d

e

f

g

Toileting (incl. continence)

Dressing

Eating

Drinking
Looking after one's health

III Domestic life

a

b

c

Preparing meals

Doing housework

Shopping

IV Communication

a

b

Speaking

Conversation

V Sensory experiences & solving problems
a Watching
b

Listening

c

Solving problems / decisons

VI General tasks and demands
a

Understanding tasks (simple)

b

c

Handling stress

Memory / orientation

VII Community and social life

DK

E

F

I

A

P

FIN

S

UK

Persons having difficulties

Persons with a disability

Persons needing help

Persons with a disability

Persons needing help

Persons needing help

Persons needing help

Persons needing help

Persons needing help

Persons with severe disabilities

80+

1994

All

DK1

75+

1999

Priv. House

E1

80+

1998/99

All

F1

75+

1999/00

Priv. House

I1

75+

1998

Priv. House

A1

75+

1998/99

Priv. House

P1

75-84

2001

Priv. House

FIN1

75-84

1996/97

Priv. House

S1

75+

1998

Priv. House

UK3

80+

2000

All

UK1

M

W

M

W

M

W

M

W

M

W

M

W

M

W

M

W

M

W

M

W

47

58

52

47

64

61

21

55

11

47

13

8

10

12

12

25

14

13

7

11

4

14

17

7

3

16

17

3

6

7

18

12

14

17

17

36

18

17

9

13

5

20

23

27

8

3

18

16

8

4

9

11

8

7

3

15

7

51

18

7

14

2

7
9

19

27

60

4

0

3

2

26

4

14

13

6

29

15

57

27

12

23

4

11
12

20

37

66

6

1

5

2

38

10

24

12

40

19

8

7

17

5

21

6

17

27

14

13

4

4

22

31

23

41

7

8

23

32

7

7

15

4

12

9

10

15

10

7

6

4

3

7

7

15

4

14

12

9

21

9

6

4

5

4

20

9

9

34

13

13

17

16

25

39

4

9

13

15

11

41

4

6

9

14

4

6

15

7

24

22

1

5

5

16

23

15

9

40

42

17

32

39

4

14

8

11

28

26

11

30

2

1

2

10

0

10

9

36

3

0

11

10

14

3

2

4

19

2

25

13

48

4

1

11

19

27

7

11

20

5

3

13

16

10

3

9

2

2

9

5

29

8

8

18

25

12

5

9

4

5

6

7

50

Feasibility Study
COMPARABLE STATISTICS IN THE AREA OF CARE OF DEPENDENT ADULTS IN THE EUROPEAN UNION

Notes

The table indicates that in Spain 13% of men aged 75 and over are dependent for changing a body position.
Numbers in italics refer to difficulties.

DK
D
E

F
I

A
P

If: Walk 400 m without resting; Id: Carry 5 kg without difficulties.
Ih: Outside the home: use public transport; IIb: Brush the hair; VII: Visit people.
II: Caring for oneself; VIc: Refers to remembering information and recent events.
The data here refers to disabilities. Previous tables present people with a severe disability.
Ie: Cut food
I: Includes walking, climbing stairs, bending and Ia; Ia: Confined in bed, in a chair or at home; II: Includes activities of daily living; Due to a filter question on confinement in bed or a
chair, this percent might be underestimated.
V: Includes sight, hearing and speech.
IIa: Washing includes dressing; VII: To go out to visit somebody.
Persons  needing  help;  For  comparability  reasons,  we  have  added  persons  confined  in  bed  to  all  mobility  (except  'constrained  in  house',  where  it  was  included),  washing  and  dressing
items.
Ia: Lie down and get up from bed; Id: Pick up something from the ground; Ih: Constrained to the house; IIc: At least once per week; IIe: Includes arms use.

FIN II: Demands of everyday life. VIa: Ability to handle tasks outside home.
S
UK

Ia: Getting up / going to bed is 2,4% and 4,5%; Ih: Has/is in need of taxi service for disabled: 18,3% and 38,3%.
Persons needing help (General Household Survey).
It covers Great Britain. Eyesight and hearing refer to difficulties, while the remaining refers to inability to manage on their own.
IIa: Refers to bathing, showering, washing all over. Washing face and hands: insignificant percentage. IIb: Cutting toenails; If: Wash and dry dishes
IIIa: Cook a main meal: 5% and prepare a snack: 2%; The table does not include: clean windows inside: 19% (M: 12% and W: 24%),
Jobs involving climbing: 28% (M: 19% and W: 35%), Wash clothing by hand: 8% (M and W: 8%)
Persons with a severe disability (Health Survey for England)
The survey covered only England. The reference population was the total UK.

51

Feasibility Study
COMPARABLE STATISTICS IN THE AREA OF CARE OF DEPENDENT ADULTS IN THE EUROPEAN UNION

Chart 9: Nature of dependency by age group. Number of people with a specific dependency as a

percentage of the population covered of the same age group.

Mobility (Ia)

65-74

75+

B

D

E

F

I

NL

A

P

S

UK

Climbing stairs

65-74

75+

D

E

F

NL

A

P

FIN

S

UK

Washing

65-74

75+

D

E

F

NL

A

P

S

UK

Dressing

65-74

75+

40

30

%

20

10

0

40

30

%

20

10

0

40

30

%

20

10

0

40

30

%

20

10

0

D

E

F

NL

P

UK

52

Feasibility Study
COMPARABLE STATISTICS IN THE AREA OF CARE OF DEPENDENT ADULTS IN THE EUROPEAN UNION

Preparing meals

65-74

75+

B

D

E

F

FIN

S

UK

Housework

65-74

75+

B

D

E

F

A

FIN

S

UK

Shopping

65-74

75+

D

E

F

NL

A

S

UK

40

30

%

20

10

0

40

30

%

20

10

0

40

30

%

20

10

0

Note: See Table 8 for definitions, population covered, explanatory notes and sources.

53

Feasibility Study
COMPARABLE STATISTICS IN THE AREA OF CARE OF DEPENDENT ADULTS IN THE EUROPEAN UNION

Chapter 5

Nature and degree of dependency

As  noted  above,  the  Katz  index  has  six  items:  washing,  dressing,  transfer,  going  to  the  toilet,
continence and eating. For each item, we distinguish four cases. Let’s take washing. A person able to
wash without assistance receives a score of zero points. A person needing assistance in washing lower
part of body receives one (1) point, etc. A fully self-dependent person has a total score of zero (0), etc.

-  Full self-dependent person: Katz index = 0,
-  Moderately care dependent: Katz index = 1 or 2,
-  Highly care dependent: Katz index = 3 or 4,
-  Very highly care dependent: Katz index = 5 or 6.

The  simplicity  of  the  Katz  index  explains  its  widespread  use.  But  the  use  is  often  restricted  to  the
nature of items retained. The rating is rarely used.

Most surveys focus on the ability to do these activities with or without help. In this case the surveyed
person has to answer whether he/she needs help or not. In other cases, we distinguish:

-  No help,
-  Some help,
-  Significant help, and
-  Rely totally to another person.

In  the  following  table  we  retain  only  the  last  two  possibilities  and  the  distinction  ‘need  help’  or
‘impossible to realise the activities’.

The Dutch data distinguishes: No difficulty, with some difficulty, with big difficulties and only with
help. We report the last two dimensions.

Including  occasional  need  for  help  raises  the  rates  significantly  and  gives  estimates  close  to  persons
with severe limitations and in certain cases even higher rates.

There is some argument to advance that a high number of elderly people experiences light or moderate
care needs and a small number faces a severe dependency.

The time spent per week or month to assist the dependent person is another indicator of the degree of
dependency. Another one, which is used, is the frequency of help. Some data will be presented in the
next Section.

54

Feasibility Study
COMPARABLE STATISTICS IN THE AREA OF CARE OF DEPENDENT ADULTS IN THE EUROPEAN UNION

Table 11: Nature of dependency by degree (Need help/Impossible) (Percent of the same age group)

Definition

Age group

Year

Population covered

Source

B

D

E

F

IRL

NL

A

FIN

UK

Persons with a limitation

Dependent persons

Persons with a disability

Dependent persons

Persons with ADL difficulties

Persons with severe limitations

Persons needing help

Persons needing help

Persons with a severe disability

65+

2001

All

B1

65+

1991/92

Private house.

D2

65+

1999

Private house.

E1

60+

1990

Private house.

F3

65+

2000

Private house.

IRL1

65+

2000/2001

Private house.

NL1

60+

1998

Private house.

A1

65-84

2001

Private House.

FIN1

65+

1985

Private House.

UK1

Degree of dependency

Moderate

Severe

Need help

Imp.

Need help

Imp.

Need help

Imp.

Much
diff.

Imp.

Big diff.

Need help

Need help

Imp.

Need help

Imp.

Need help

Imp.

16

15

7

27

6

4

14

6

11

4

2

14

5

13

6

3

9

19

1

2

I

a

b

c

d

e

f

g

h

II

a

b

c

d

e

f

g

Mobility

Changing body positions (sitting down, standing 
up, getting into/out of a seat)
Maintaining a body position

Go to/use the toilet

-Inside the home

-Outside the home

Lifting and carrying objects

Hand and arm use

Walking

Climbing stairs

Moving around

Self-care

Washing

Caring for body parts

Toileting (incl. continence)

Dressing

Eating

Drinking

Looking after one's health

III

Domestic life

a

b

c

Preparing meals

Doing housework

Shopping

IV

Communication

a

b

V

a

b

c

VI

a

b

c

Speaking

Conversation

Sensory experiences & solving problems

Watching

Listening

Solving problems / decisions

General tasks and demands

Understanding tasks (simple)

Handling stress

Memory / orientation

VII Community and social life

5

3

3

14

5

7

6

3

4

7

2

3

5

9

8

5

4

7

1

2

2

4

2

10

4

2

1

2

1

3

6

10

11

7

6

7

4

2

8

12

17

10

6

3

10

5

13

4

17

27

2

7

4

5

1

2

2

1

3

8

3

8

2

11

3

5

2

2

0

6

1

7

1

2

2

4

1

2

4

2

3

2

2

5

1

2

2

4

3

8

4

4

5

5

10

3

7

11

10

7

5

1

3

1

5

2

4

3

1

0

14

0

2

1

3

8

3

7

1

4

1

1

2

0

6

11

7

11

9

8

6

4

4

8

4

10

5

6

11

3

2

5

5

13

2

3

4

3

3

1

0

1

2

2

1

0

1

2

2

2

1

0

1

1

1

1

0

1

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COMPARABLE STATISTICS IN THE AREA OF CARE OF DEPENDENT ADULTS IN THE EUROPEAN UNION

Notes

The table indicates that in Germany 5% of persons aged 65 and over  need the assistance of a third party to change a body position, and 1% cannot do it at all (exactly 1,4%).
Degree of dependency. The categories are: 'Need help' or 'Impossible'. In certain cases we have 'Big difficulty' instead of 'Need help'.
Data in italics refers to difficulties and are not comparable with other countries

F

B
D
E

Ia: To get up, to lie down; IIe: Eat and cut food.
The distinction is ‘Difficult’ and ‘Impossible’. Ih:  Outside the home: use public transport; IIb: Brush the hair; VII: Visit people.
The distinction is ‘Severe’ and ‘Impossible’. Contrary to previous tables, data here refers to disabilities and not to persons. If: Getting around;
Vc: Learning, applying knowledge.
The  data  refers  to  dependent  and  very  dependent  persons.  I:  Refers  to  physical  dependency  (mobility  and  self-care).  III:  Refers  to  dependency  for  domestic  life  activities  (including
administrative tasks).
Domestic tasks include: shopping, cooking, housework, heavy housework and administrative tasks. Each activity has a specific weight.
Ie: Open car doors. 'Much diffic' means much difficulty.
Ia: Getting in and out of bed. If: Move to another room on the same floor; for comparison, walk for 400 meters without stopping: 4,7% and 9,3%.
IIa: Wash oneself completely. Va: To recognise a face at a distance of 4 meters. For comparison read small print in a newspaper: 2,9% and 4,1%.
IIIc: Carry an object weighting 5 kilos a distance of 10 meters.
'Big dif/ty' means big difficulty.
A
IIa: Washing includes dressing; VII: To go out to visit somebody.
FIN II: Demands of everyday life. VIa: Ability to handle tasks outside home.
UK

Need help: Persons with a disability degree of 7-8. Impossible: Persons with a disability degree of 9-10.
Ie: Dexterity. For comparison 'reaching and stretching' gives 1,8% and 1,2%. VIc: Consciousness. VII: Behaviour.

IRL
NL

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Chapter 6

Nature of dependency, degree and age

As noted earlier the number of severe limitations relative to light limitations increases with age.

Table 12 presents the nature of dependency by degree and age group for each type of long-term care
needs.

57

Table 12: Nature of dependency by degree and age group (Need help/Impossible) (Percent of the same age group)

Feasibility Study
COMPARABLE STATISTICS IN THE AREA OF CARE OF DEPENDENT ADULTS IN THE EUROPEAN UNION

Definition

Age group

Year

Population covered

Source

Degree of dependency

I Mobility

a

Changing body positions (sitting down, standing up, 
getting into/out of a seat)

b Maintaining a body position
c

d

e

Lifting and carrying objects

Hand and arm use

f Walking
g

Climbing stairs
h Moving around

Go to/use the toilet

-Inside the home

-Outside the home

II

Self-care
a Washing
b

Caring for body parts

c

d

e

f

g

Toileting (incl. continence)

Dressing

Eating

Drinking

Looking after one's health

III Domestic life

a

b

c

Preparing meals

Doing housework

Shopping

IV Communication
a

Speaking

b

V

Conversation

Sensory experiences & solving problems

a Watching
b

Listening

c

Solving problems / decisions

VI General tasks and demands
a

Understanding tasks (simple)

b

Handling stress
c Memory / orientation

VII Community and social life

D

Dependent persons

E

Persons with a disability

NL

Persons with severe limitations

A

Persons needing help

FIN

Persons needing help

UK

Persons with a severe disability

65-79

80+

65-74

75+

65-74

75+

65-74

75+

65-74

75-84

65-74

75+

1991/92

Priv. Households

D2

1999

Priv. Households

E1

2000/2001

Priv. Households

NL1

1998

Priv. Households

A1

2001

Priv. Households

FIN1

1985

Priv. Households

UK1

Need help

Imp.

Need help

Imp.

Need help

Imp.

Need help

Imp.

Big difficulty

Need help

Big difficulty

Need help

Need help

Imp.

Need help

Imp.

Need help

Imp.

Need help

Imp.

Need help

Imp.

Need help

Imp.

3

2

2

11

3

6

4

2

2

5

1

1

3

7

7

3

2

5

1

1

1

2

1

5

2

1

1

1

0

1

3

6

6

3

3

4

9

7

8

22

10

12

12

7

9

14

5

6

10

14

12

3

4

6

12

4

25

10

5

3

5

1

9

15

25

27

10

18

10

13

14

19

2

0

6

1

6

2

5

2

4

9

3

1

0

0

5

7

14

4

12

4

10

17

6

2

1

1

13

21

2

6

1

8

2

3

1

1

0

4

1

5

0

0

2

0

2

1

2

1

1

0

8

0

1

1

4

11

3

15

4

8

3

3

0

8

1

9

3

1

5

1

9

3

6

6

2

0

22

0

4

2

5

7

11

4

9

1

4

2

2

3

1

9

2

11

1

1

1

1

12

19

26

19

29

3

11

6

9

11

7

11

10

43

6

3

2

6

1

3

4

13

6

5

15

13

4

2

2

6

2

7

3

2

5

2

2

3

3

6

1

2

9

8

8

10

20

4

4

7

7

15

9

25

7

9

4

6

3

2

3

1

0

1

1

1

1

0

1

1

1

1

1

0

1

1

1

1

0

1

5

3

5

2

0

2

3

3

2

0

1

3

2

3

2

0

2

2

2

2

0

2

58

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Notes

The table indicates that in Germany 3% of people aged 65 to 79 need the assistance of a third party to change a body position, and almost 1% cannot do it at all.
Degree of dependency. The categories are: 'Need help' or 'Impossible'. In certain cases we have 'Big difficulty' instead of 'Need help'.

D
F
E
NL

A
FIN
UK

Difficult/Impossible. Ih: Outside the home: use public transport; IIb: Brush the hair; VII: Visit people.
Domestic tasks: Age 70-74: dependent 9% and very dependent 1%; Age 80+: dependent 32% and very dependent 12%..
Severe/Impossible. The data refers to disabilities, not persons. If: Getting around; Vc: Learning, applying knowledge.
Ia: Getting in and out of bed. If: Move to another room on the same floor; For comparison, walk for 400 meters without stopping gives for 65-74: 2,6% and 5,3%; for 75+: 7,2% and
14,2%.  IIa: Wash oneself completely. Va: Recognise a face at a distance of 4 meters. IIIc: Carry an object weighting 5 kilos on a distance of 10 meters.
IIa: Washing includes dressing; VII: To go out to visit.
II: Demands of everyday life. VIa: Ability to handle tasks outside home.
Need help: Persons with a disability degree of 7-8. Impossible: Persons with a disability degree of 9-10.
Ie: Dexterity. For comparison 'reaching and stretching' gives 1,4% and 0,9% for the age group 65-74,
and 2,4% and 1,7% for the age group 75+. VIc: Consciousness; VII: Behaviour.

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Chapter 7

Place of residence

The  distribution  of  elderly  people  living  at  home  or  in  an  institution  depends  notably  from  the
following factors:

-  Nature and degree of dependency,
-  Available help,
-  Policy concerning institutionalisation, and
-  Socio-cultural elements.

Table  13  “Share  of  population  aged  65  and  over  in  institutions  (Mid  90s)”  presents  the  number  of
elderly people in formal long-term care institutions, as a percentage of the total elderly population.

Statistics are estimates made by the Organisation for Economic Co-operation and Development using
different  sources,  including  a  questionnaire  to  the  Member  Countries  (Source:  OECD1).  The  author
notes that the statistic includes formal long term care institutions as the increased diversity in lodging
makes it difficult to isolate nursing homes. “Estimates may vary according to the concept chosen for
institutions (sheltered housing, hotels for the elderly, medical homes). Normally, the concept described
should include only staffed homes”.

The  author  notes  that  the  data  needs  to  be  interpreted  with  caution.  “Between  residences  which  are
almost like hotels, with medical care available only in case of emergency, and nursing homes offering
the  full  range  of  medical  care,  there  are  establishments  offering  varying  degrees  of  medical  care”.
“The  types  of  accommodation  arrangements  are  extremely  diverse.  Mostly  public  in  the  Nordic
countries, they are mixed in continental Europe”.

In the Nordic countries, during the 60s and 70s, a place in an institution was considered as a right of
the  elderly  persons.  The  result  was  an  active  policy  of  developing  places  in  institutions.  This  policy
was later challenged and reversed. Living at home with the necessary help became the priority. This
partly explains the relatively higher rate in the Nordic countries (see Table 13).

In  Mediterranean  countries,  where  infrastructures  (staffed  homes)  are  not  developed,  the  number  of
dependent people living in institutions seems to be lower.

In Great Britain, the General Household Survey 1998 (UK3) gives for people aged 65 and over:

- 
- 

90% live in private households, and
10%  in  sheltered  accommodation.  Sheltered  housing  is  defined  as  having  a  warden  on
premises  or  a  central  alarm  system.  This  excludes  communal  establishments  such  as  nursing
homes and hospitals. Half of these sheltered housing have a resident warden.

Comparison across countries has to take into account that certain institutions may include persons who
are not dependent. This is notably true when the definition includes rest homes.

The  previous  data  covers  all  people.  The  focus  of  our  study  is  the  number  of  dependent  persons  at
home and in institutions. Table 14 presents some data.

Available statistics are poor and are not comparable.

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Statistics available for Portugal are not presented in the table. They cover all persons with a disability
in  private  housing  (99%)  and  in  collective  housing  (1%).  Collective  institutions  include  educational,
hospitals, other providing assistance, religious, military and others (P2).

Table  15  presents  the  distribution  of  dependent  persons  by  age  and  type  of  residence.  Data  for
Germany  and  Luxembourg  cover  beneficiaries  of  long  term  insurance.  The  table  indicates  that  the
share of institutions increases sharply with age. But even for persons aged 90 and over, the majority of
people live at home.

Table 13 : Share of population aged 65 and over in institutions (Mid 90s)
A

DK D EL

L NL

  B

IRL

E

F

I

P

FIN

S

UK

Share of pop aged 65 and
over in institutions
 (mid 90s)
Source: OECD1 and FIN2
Note: Includes formal long-term care institutions. The authors note that “Estimates may vary according to the concept

6,8

6,4

7,0

6,5

6,9

8,8

2,9

5,0

6,8

4,9

3,9

8,7

-

-

5,1

chosen for institutions (sheltered housing, hotels for the elderly, medical homes). Normally, the concept described
should include only staffed homes”.

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Table 14: Dependent persons by type of residence 

D

F

NL

L

UK

Definition

Persons with a need for
long-term care (law on
long-term care
insurance)

Elderly dependent
persons (grille Colvez)

Dependent persons
(sensory and ADL)

Recipients of care
dependency
insurance

Persons with a
locomotion disability

Age
Year
Source

%

N

60+
1999
D1

68

60+
1998/99
F1

65+
1999
NL3

Persons living at home (Private households)

60+
2002
L2

55

3.135

60+
1985/86
UK2

91

3.000.030

1.158.608

1.053.000

74

75

355.025

Persons living in institutions

Institution Institutions for elderly

Institutions for elderly
and other institutions

Institutions for
elderly and nursing
homes

Institutions for
elderly

Communal
establishments

%
N

32
543.191

26
364.000

25
115.804

45
2.515

9
292.000

Numbers in italics are not comparable with data from other countries (L and UK).

Institutions
D
L
F

NL

UK

Home-care, full-time and part-time institutional services 
Residential and day care homes. They include a minority of persons aged 40 to 60 years old.
Residential homes for elderly, services for long term care in hospitals, institutions for disabled 
and psychiatric units. For comparison the total number of elderly persons in institutions is about 498.000. 
About 115.000 are not dependent and for 19.000 persons the information is missing.
The Katz index gives: 447.000 dependent persons for at least two activities living at home 
and 250.000 in institutions.
Homes for the elderly (recognised), Nursing homes, Homes for mentally disabled persons, Mental hospitals, and
Family replacement homes (notably for persons with sensorial disabilities).
Great Britain. Communal establishments.

Chart 10: Distribution of elderly dependent persons by type of residence

Private home

Institution

100%

80%

60%

40%

20%

0%

D (60+)

F (60+)

NL (65+)

Sources: see Table 14.

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Table 15: Persons by type of residence and age group 

F

D

L

NL

A

S

UK

Total population

Persons needing long
term care

Beneficiaries of long
term care insurance

Total population

Total population

Total population

Total population

1998

F1

1999

D1

2002

L2

1999

NL1

2000

A2

2000

S2

2000

UK1

Private

Institution

Private

Institution

Private

Institution

Private

Institution

Private

Institution

Private

Institution

Private

Institution

All

99

99,3

97,9

87,8

69,3

15+

40+

65+

All

All

65+

1

72

28

55

45

95

5

98

2

92

8

96

4

0,7

2,1

12,2

30,7

78,0
79,1
77,8
72,8
68,4
63,4
56,7

22,0
20,9
22,2
27,2
31,6
36,6
43,3

73,4

65,4

47,6

35,9

26,6

34,6

52,4

64,1

99,8
99,1
97,0
90,6
77,8
61,7
49,1

0,2
0,9
3,0
9,4
22,2
38,3
50,9

98,8
98,1
96,1
92,5
87,0
79,0
70,8

1,2
1,9
3,9
7,5
13,0
21,0
29,2

98,6

95,3
89,1
75,9
53,7

1,4

4,7
10,9
24,1
46,3

99,6
99,0
97,4
93,4
84,0
69,0

0,4
1,0
2,6
6,6
16,0
31,0

Year

Source

Age
All

60-65
65-70
70-75
75-80
80-85
85-90
90 +

Notes
Numbers in italics are not comparable with data from other countries (D and L).

D
L
F
NL
A
S
UK

Home-care, full-time and part-time institutional services 
Residential and day care homes.
Homes for elderly and other institutions (healthcare and welfare institutions) 
Homes for elderly
Public housing (institutions for elderly and care dependent)
Special housing
England. Care homes (residential and nursing)

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Chart 11: Distribution of persons in establishments by gender and age

Men

Women

100

80

60

40

20

0

F

NL

S

UK

F

NL

S

UK

Age group 65-70

Age group 90+

Sources: see Table 15.

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Chapter 8

Dependency by type of residence

Belgium

The UFSIA-DSSB survey of the elderly people (B2) indicates that some 38% of the elderly residing in
rest homes had no ADL-limitations. Only 7% of these elderly people without ADL-limitations had no
IADL-limitations either.

A  survey  done  by  Vanden  Boer  L.  (B2)  in  Flanders,  in  1993,  finds  out  that  16%  of  the  service-flat
residents were self-sufficient. About 67% of service-flat residents had some need for assistance, 13%
had considerable need for assistance and 4% a serious need for assistance.

France

The  indicator  'Persons  dependent  for  at  least  one  Activity  of  Daily  Living'  covers  individuals  who
responded that they did need help for at least one of the activities of daily living. The survey uses the
Katz-index  that  includes  the  activities  washing,  dressing,  going  to  toilet  and  using  it,  lying  /  sitting
down and getting up, continence, eat already prepared meals (F1).

The survey of homes for the elderly provides that 37% of residents have ‘no or a small dependency’.
The proportion of clients with ‘no or small dependency’ is 42% in residential homes and 2% in long-
term nursing homes (F5). Furthermore, 65% of residents in care homes have ‘no or small psychical’
dependency. This proportion is 20% in long-term nursing homes.

Ireland

The  statistic  concerning  persons  in  private  households  gives  the  number  of  older  people  who  have  a
difficulty with ADL (IRL1).

The estimate of persons in long-stay institutions (IRL3) covers Health boards (geriatric home, Welfare
home,  and  private  nursing  home).  Dependent  persons  exclude  the  'Low  Dependency'  category.  This
category  refers  to  people  who  need  some  support  in  the  community  and  the  more  independent
residents  in  residential  accommodation  who  require  little  nursing  care.  They  are  usually  mobility
independent but may use a walking stick and have difficulty climbing stairs.

The  distribution  of  residents  indicates  that  about  39%  of  ‘Welfare  Homes’  patients  are  characterised
by a low dependency and thus might not be considered as dependent in a strict sense.

From  the  medico/social  status  criterion  (i.e.  the  main  reason  for  residence)  about  13%  of  resident
patients  report  social  reasons.  Other  reported  statuses  are:  chronic  illness,  rehabilitation  and
disability/handicap. The group reporting 'social reasons' is concentrated in Welfare homes. However,
this category might include drug-addicted persons, etc.

NL

For private households, we take 18% of persons 65+ (see Table 2). Van Herten et al (NL3) present the
prevalence  of  dependency  by  age  group  and  type  of  institution  (Nursing  homes  and  Homes  for  the
elderly).

The dependency rate of persons aged 75-79 years is:
-  Nursing homes: men 66,4%, women 75,2%.
-  Homes for the elderly: men: 55,0%, women: 60,8%.

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De  Klerk  (NL3)  reports  that  almost  100%  of  nursing  homes’  residents  and  71%  of  ‘Homes  for  the
elderly’  residents  make  use  of  professional  help.    However,  this  might  overestimate  dependency  as
some persons might use these services, which are defined in a broad way, once in a while.

The distribution of residents in homes for the elderly is:
Always in bed
Totally dependent on help
Partially dependent on help
No physical assistance
Total

    5,3%
  26,2%
  45,7%
  22,7%
100 %

This gives a dependency rate of about 77%, which is significantly higher than the two rates presented
above.  However,  we  may  note  that  a  certain  number  of  partially  dependent  persons  might  not  very
often use help. Consequently, this rate might be considered as an upper limit.

UK

The United Kingdom data refers to England. It relates to persons with a severe disability.

The  survey  distinguishes  severe  disability  by  type  of  care  home:  Residential  homes  (70%),  nursing
homes  (91%),  dual  registered  homes  (85%).  55%  in  care  homes  needed  assistance  with  one  or  more
self-care tasks but only 3% in private households.
Prevalence of severe disability for 65+: 16%. Care homes: men 69%, women: 79%.

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Table 16: Prevalence of dependency by type of residence
IRL
B
Dependent
Persons with
persons
severe ADL
limitations

F
Dependent for at
least one ADL
activity (Katz)

Definition

NL
Dependent
persons (mainly
ADL)

UK
Persons with a
severe disability
(England)

Source

Age

Year

Private households

B2

60+

F1

60+

1999/01

1998/99

IRL1, IRL3

NL1, NL3

65+

2000

65+

1999/2000

% of persons living at home who are dependent
14

15

9

Institutions

78

63

89

%  of persons living in institutions who are dependent

Notes

*: Estimation.

18

68*

UK1

65+

2000

13

77

B

F

IRL

NL

UK

Flemish region. Rest homes and nursing homes
Private households: All persons with severe ADL limitations in 2001.
Institutions: Dependency according to the health insurance criteria (personal care and dementia) in 1999.

Dependent for at least one ADL activity (Katz): 
Washing, dressing, go to and use the toilet, get in/out of bed and get in/out of a chair, 
incontinence, and eat prepared food.
The survey of homes for the elderly provides that 37% of residents have ‘no or a small dependency’. 
The proportion of clients with ‘no or small dependency’ is 42% in residential homes and 2% in long-term nursing
homes (F5).

Institutions include Health boards (geriatric home, Welfare home, and private nursing home)
About 5% of long-stay patients are less than 65 years age.
About 13% of patients residents report social reasons as a medico/social status. 
The remaining people report a chronic illness, rehabilitation or disability/handicap.

For private households, we take 18% of persons 65+ (see Table 2) 
Institutions: persons with a severe sensory or ADL limitation (NL3). Van Herten et al. give the dependency rate of
persons aged 75-79 years:
-
-
De Klerk (NL3) reports that almost 100% of nursing homes' residents and 71% of 'Homes for the elderly' residents
make use of professional help. 

Nursing homes: men 66,4%, women 75,2%.
Homes for the elderly: men: 55,0%, women: 60,8%.

Residential homes, nursing homes, dual registered homes.
Severe disability by type of care home: 
Residential homes (70%), nursing homes (91%), dual registered homes (85%).
55% in care homes needed assistance with one or more self-care tasks but only 3% in private households.
Prevalence of severe disability for 65+: 16%. Care homes: men 69%, women: 79%.

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Discussion and recommendations

a. Comparability of existing surveys

Identified data reveals that comparability presents the following problems:

-  The definition of dependency varies across countries,
-  The methods and classifications used to measure dependency are different;
-  The same term may contain different concepts.

Despite  these  differences,  many  Member  States  use  classifications,  which  are  close  to  WHO
classifications and Activities of Daily Living. Most Member States focus on the following items:

-  washing,
- 
dressing,
- 
transfer (getting in/out of bed/chair),
- 
going to the toilet,
- 
continence and
- 
eating.

Watching  and  listening  is  included  in  most  surveys.  It  is  important  to  note  that  all  report  difficulties
concerning these functions.  The notion of help here is difficult to apply. The important point here is
the availability of different degrees of limitations, which enables us to identify the extent of assistance
required.

Recent policies on improving the quality of life of disabled and elderly people have put emphasis on
social  and  cultural  participation.  Furthermore,  improving  equal  opportunities  in  social  and  leisure
activities has led many countries to take into account both the provision of services and the elimination
of barriers.

There is thus an increasing tendency to include in the surveys questions concerning:

activities related to domestic life (cooking, shopping and house keeping), and

- 
-  mobility in a larger extent (moving outside the home, etc).

They are called to take a higher importance in the future for the following reasons:

- 
- 

they are important determinants of social participation, and
they might be important factors for certain persons in their decision to enter into an institution.

Mobility  poses  the  problem  of  barriers  and  environmental  accommodation.  The  rate  of  dependency
might  be  very  sensitive  to  public  policies.  In  fact,  the  provision  for  example  of  an  accessible  public
transport  might  reduce  significantly  the  number  of  people  who  declare  that  they  need  help  to  use
public transport.

Communication,  general  tasks  and  demands,  and  social  life  are  considered  important  but  are  more
difficult to measure. Consequently, only a few surveys have included them.

Number of dependent persons

Following  previous  comments  it  is  interesting  to  see  the  implications  of  the  Indicator  EO  c10
concerning: 'dependent elderly men and women (unable to look after themselves on a daily basis) over
75'.

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If we interpret the indicator in a strict sense to mean only personal self-care dependency, we have to
notice that there are a significant number of dependent people below the age of 75 years.

As discussed above, available statistics are not comparable. However, they deliver a certain number of
lessons,  which  may  characterise  current  tendencies.  Concerning  the  number  of  dependent  persons,
identified  data  indicates  that  an  approximate  estimation  for  the  different  age  groups  might  be  (see
Table 53):

- 
- 
- 

age group 20-59: 
age group 60-75: 
age group 75+: 

 1%,
 3%
12%

This data uses the narrow definition and ought to be considered as minima. They give the following
approximations:

- 
- 
- 

2,1 million persons aged 20 to 59 years,
1,6 million persons aged 60 to 75 years, and
3,2 million persons aged 75 and over.

These  numbers  indicate  that  the  majority  of  highly  dependent  people  are  less  than  75  years  old.
Consequently, a relevant estimator ought to take all age groups into account.

As noted above, the number of persons with a severe disability might be considered as an upper limit
for the number of dependent people. Chart 12 presents both the proportion of people who are severely
hampered in their daily activities and the proportion that are dependent (narrow definition).

Furthermore  Table  17  indicates  that  the  number  of  elderly  people  is  going  to  increase  in  the  coming
years. This means that the number of persons aged 65 and over with a severe disability is expected to
increase significantly.

The definition of the EU indicator

If  we  interpret  the  indicator  in  a  strict  sense,  it  means  that  we  have  to  include  mainly  self-care  and
basic  transfer  activities  (washing,  dressing,  transfer  (getting  in/out  of  bed/chair),  going  to  the  toilet,
continence and eating).

This  means  that  a  person  who  needs  help  to  accomplish  at  least  one  of  these  activities  may  be
considered as dependent. This strict interpretation leads to the Katz index.

The Katz index (ADL) has six items: washing (bathing), dressing, transfer (to or from a bed or chair),
going  to  the  toilet,  continence  and  eating.  The  index  covers  tasks,  which  people  need  to  be  able  to
perform to survive without help. They were initially used for clinical purposes and may be sufficient
in  certain  institutional  settings.  They  are  considered  too  restrictive  for  a  person  living  in  the
community.

In order to take into account these critics, the Lawton and Brody index (IADL) includes 8 Instrumental
Activities  of  Daily  Living:  using  the  telephone,  shopping,  food  preparation,  housekeeping,  laundry,
travel, responsibility for own medicine and ability to handle finances. These activities are considered
to be necessary for living a more or less normal life without help.

Communication, general tasks and demands, and social life are considered important by most but pose
a methodological problem of measurement.

3 Different definitions of average for the age group 65-74 range from 3% to about 3,5%. The different definitions
of average for the age group 75+ are close to 12%.

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The  EU  indicator  requires  inability  to  look  after  oneself  on  a  daily  basis.  If  we  consider  that  for
example shopping or the ability to take his/her medication are prerequisites for the ability to look after
oneself, then we must take into account these activities. In fact, instrumental activities enter indirectly
in the definition as they make possible the implementation of the basic daily activities (eating, etc).

Social  security  definitions  in  the  Member  States  take  into  account  IADL  activities,  considering  that
they  are  essential  for  an  independent  living.  However,  the  nature  of  these  activities  as  well  as
conditions  imposed  upon  them  (minimum  number  or  hours  needed)  differs  greatly  across  countries
and inside a country between different services.

In  deciding  the  granting  of  certain  services  promoting  independent  living,  the  Member  States  use
notably the following criteria:

-  B
-  DK 

-  D
-  E 

-  F
- 
I
-  NL

-  A
-  S
-  UK

Use of ADL-related scales (bathing, dressing, transfer and/or toileting).
Activities  of  daily  life  including  eating,  dressing,  bathing,  toileting,  continence,
walking, cooking, shopping, cleaning and transportation.
Assistance in special life situations (participation, integration, care).
Most  essential  acts  of  life  including  personal  care,  domestic  activities,  shopping,
communication and coherence, etc.
Lack of autonomy in ordinary daily activities including dressing, toileting, etc.
Basic daily tasks.
ADL  and  IADL  activities,  including  limitations  concerning  living  or  moving  in  and
outside the dwelling.
Daily activities, mobility, etc.
Daily activities include both ADL and IADL activities.
Need care notably for bathing and washing.

It  is  clear  that  many  Member  States  include  instrumental  activities  in  their  assessments  of  needs.  Of
course,  a  person  who  cannot  make  his/her  shopping  in  a  big  city  may  not  be  considered  as  fully
dependent. In fact, most of the national social security schemes impose a minimum number of hours.

The  frequency  of  the  activity  is  an  important  element.  The  indicator  use  the  term  'on  a  daily  basis’.
The  question  then  is  how  to  take  into  account  these  activities  in  the  definition  of  dependency.  One
possibility might be to assign a weight to each of these activities.

A  person  receives  ‘1’  or  ‘0’  depending  whether  he/she  is  not  able  to  do  or  is  able  to  do  each  of  the
basic activities (washing, dressing, transfer-getting in/out of bed/chair, going to the toilet, continence
and eating). A person unable to do at least one of these activities is considered dependent and receives
at least one point.

For the remaining activities we may assign a weight to each activity. The weight may depend on the
frequency  of  each  activity.  Time-use  surveys  might  for  example  provide  information  for  the
calculation  of  these  weights.  In  a  simplified  version,  if  we  assign  the  weight  ‘0,33’  to  each  activity,
then  a  person  might  be  considered  dependent  if  he/she  is  unable  to  do  three  of  the  instrumental
activities.

Concerning self-care, we assumed that the person is able/unable to do the activity. The situation might
be more complicated if we assume that he/she needs help every day, every week, once in a while, etc.
Again we may assign a specific weight to each answer.

A  certain  number  of  methodological  problems  might  arise  in  the  definition  of  questions  concerning
communication general tasks and demands, and social life.

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Dependent persons in institutions

Data  ought  to  include  both  dependent  persons  in  private  households  and  in  institutions.  As  noted
above, not all persons in residential homes for the elderly may be considered as dependent persons.

In  designing  the  sample  of  a  survey,  a  special  attention  ought  to  be  given  to  include  all  dependent
persons.  Furthermore,  given  the  high  diversity  of  institutions  (protected  homes,  care  homes,  nursing
homes, etc.) a fair representation ought to be guaranteed.

On the other hand, restricting the sample on private households might be undesirable as a big number
of people aged 80+ live in institutions. The choice of a residence is not independent from the nature
and degree of dependency.

The  inclusion  of  people  in  institutions  might  imply  the  elaboration  of  two  questionnaires  one  for
people living in private households and one for those living in institutions. In fact, a certain number of
questions might have no relevance for people in establishments, notably those concerning Instrumental
Activities of Daily Living (shopping, etc.).

The collection of reliable data for people aged 80+ would require a special attention on methodologies
and samples. The non-response rate might be a function of dependency.

Elements of a European survey

Previous  discussion  indicates  that  a  future  survey  at  a  European  level  might  include  the  following
activities of the WHO classification (ICF):

1.  Mobility

a.  Changing basic body position (getting in/out of a seat/bed, bending)
b.  Maintaining body positions (use the toilet)
c.  Transferring oneself (transferring oneself while sitting or lying: from a chair to a toilet

seat)

d.  Carrying,  moving  and  handling  objects  (lifting  and  carrying  objects,  hand  and  arm

use)

e.  Walking and moving around (walking short and long distances, climbing steps)
f.  Moving around using transportation (moving around within the home, moving around

outside the home, use public transport)

g.  Other

2.  Self-care

a.  Washing oneself
b.  Caring for body parts
c.  Toileting
d.  Dressing
e.  Eating
f.  Drinking
g.  Looking after one’s health
h.  Other

3.  Domestic life – Household tasks
a.  Preparing meals
b.  Doing housework (light housework)
c.  Other

4.  Communication

a.  Speaking
b.  Conversation / Discussion

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5.  Sensory experiences

a.  Watching (recognise a face or read a newspaper or watch a television programme)
b.  Listening (listen to radio, etc.)

6.  General tasks and demands

a.  Undertaking single (manage his/her own finance, etc.)
b.  Memory

7.  Community and social life

The  classification  ought  to  include  questions  enabling  us  to  identify  contextual  factors,  which
constitute barriers to participation. For example, the need of assistance in going out might result from
the absence of accessible transport services. In this case either we say that the person needs assistance
or  we  propose  to  adapt  the  existing  transport  services.  The  latter  case  might  simply  require  the
presence of a bus with low stairs or an easy entry.

Concerning the degree of dependency, ICF proposes the following scale:

-  No difficulty
-  Mild difficulty
-  Moderate difficulty
-  Severe
-  Complete difficulty
-  Other / Not specified

An alternative scale based on the need of assistance could be:

I can do it without any assistance and with no difficulty
I can do it without any assistance but with some difficulty
I can do it without any assistance but with much difficulty
I need some assistance
I need much assistance
I can not do it at all

- 
- 
- 
- 
- 
- 
-  Other.

However, this might create practical problems and might be difficult to incorporate in certain national
questionnaires. As many surveys have a first filter question on the presence or not of any difficulty, it
might be more interesting to keep this question and add a follow up question determining the nature of
help. Consequently, if the interviewee answers positively in the filter question, the next question could
focus on the needs for each activity:

I can do it without any assistance but with difficulty
I need some assistance
I need much assistance
I can not do it at all

- 
- 
- 
- 
-  Other.

One possible alternative could be to follow the following path:

-  Question on the presence of a difficulty or a limitation. If the answer is positive,
-  Question whether the limitation is moderate or severe. If the answer is positive,
-  Question  on  the  nature  of  need  by  type  of  activity.  Questions  on  sensory  experiences

might have a different structure, as the formulation of needs could be different.

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Member  States  express  the  view  that  new  questions  ought  to  preserve  continuity  with  existing
instruments and hence guarantee longitudinal comparability of national data. From this point of view,
one ought to take into account the path of the different filters used in national surveys.

An  important  dimension  is  the  amount  of  time  required  per  week  and  the  periodicity.  This  could
provide a more objective indicator for the degree of care dependence. The periodicity might indicate
whether assistance is needed:

-  Once a week,
-  Several times a week,
-  Once/twice per day,
-  Several times a day.

Periodicity  will  enable  us  to  retain  only  persons  with  a  significant  dependency  and  exclude  the
occasional need for help.

Finally,  as  it  was  noted  in  the  general  introduction,  the  survey  ought  to  retain  only  long-term
(permanent) dependencies. A criterion might be an expected duration of six months or more.

A survey at a European level might be organised in two ways. A specific survey covering all aspects
might  be  organised  at  a  European  level.  This  might  be  the  more  costly  solution.  Another  possibility
might be the extension of existing national surveys.

The  second  solution  might  be  preferable  since  all  Member  States  organise  surveys  with  similar
questions.  The  preparatory  work  here  will  consist  in  harmonising  existing  surveys  at  least  for  a
common bloc of questions.

The different surveys, which might support a common module on care dependency, are the European
Community Household Panel survey and the National Health Interview surveys.

The  survey  “Statistics  on  Income  and  Living  Conditions”  (SILK),  previously  European  Community
Household Panel survey, could include a simplified module on the characteristics of dependent people.
This is the less costly solution but the information might be very general. The module could focus on
ADL activities.

A  more  elaborated  module  on  the  characteristics  of  dependent  people  and  the  nature  of  care/needs
provided could be included in the national Health Interview Surveys. For many countries this would
require only the harmonisation of existing questions and the adoption of a common classification. This
seems to be the best solution and probably the less expensive if we take into account the final product.
Furthermore, a certain number of Member States are exchanging information on the implementation of
the  WHO  classifications  (notably  ICF)4.  In  fact,  the  EUROHIS  project  aims  to  promote  the  use  of
common instruments in health interview surveys in Europe. The project is coordinated by WHO. The
project has focussed on health indicators but is expected to begin work on the use of ICF.

As  a  conclusion,  we  can  say  that  a  certain  policy  of  harmonisation  of  existing  surveys  might  be  the
most efficient solution.

4 It is interesting to note the Survey of Health, Ageing and Retirement in Europe project (SHARE). It aims notably to study
the  link  between  health  status  and  socio-economic  status,  the  dependency  risk  and  retirement  decisions.  The  study  is
coordinated by OECD. It focuses on cross-national differences of ageing-related diseases and the way to improve health
care systems.

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Chart 12: Persons hampered in their daily activities by age, EU 1999
Percent of the same age group

20

All

40

Severe

60

80

100

Age

Dependent (Narrow definition)

%

70

60

50

40

30

20

10

0

0

Source: 
Note: 

Eurostat (ECHP 1999) and Table 5.
Table 5 gives approximately (narrow definition): 1%; 3%, and 12%. The remaining points on the chart are extrapolations based on an exponential fit.

Table 17: Severely hampered people by age group (ECHP); Absolute number and percentage change
E

IRL

DK

NL

EL

A

D

B

F

P

FIN

S

UK

EU

65+ (1999)

65+ (2020)
% change

75+ (1999)

75+ (2020)
% change

244
293
20

135
171
26

139
191
37

79
97
24

3.434
4.520
32

2.176
3.248
49

339
432
27

169
272
61

923
1.092
18

519
687
32

2.599
3.339
28

1.426
1.764
24

1.666
2.222
33

L
I
Absolute numbers, 1000
9
12
41
Absolute numbers, 1000
5
8
59

1.041
1.650
58

33
52
55

19
26
37

343
515
50

201
279
39

210
279
33

144
205
43

400
467
17

211
267
27

191
294
54

116
166
43

336
449
34

258
323
25

1.795 12.662
2.323 16.480
30

29

7.771
1.272
1.585 10.748
38

25

Source:  The estimation uses ECHP (1999) and Eurostat projections for the total population (see Eurostat,  "Statistiques sociales européennes: Démographie"; Thème 3, Population et conditions

Note: 

sociales, 2001). % change: percentage increase between 2020 and 1999.
The Irish data might underestimate the true number

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SECTION II

INFORMAL CARE

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Introduction

Care  may  be  provided  by  professionals  or  by  informal  sources.  The  informal  sector  includes  mainly
the  family,  relatives,  friends  and  neighbours.  The  next  chapter  will  discuss  the  meaning  of  the  term
‘informal’.

A  question  concerns  the  frontier  between  help  considered  to  be  convenience  assistance  and  help
considered  to  be  dependency  care.  The  frequency  and  the  time  spent  by  the  carer  might  be  relevant
criteria.  But  someone  has  still  to  fix  these  values.  Comparison  of  the  criteria  used  by  national  social
security  systems  could  provide  an  indication  here.  The  problem  is  that  these  criteria  differ  across
countries and inside a country across services.

Another possibility might be to measure the time and frequency of care provided among members of
households  without  dependent  persons  and  to  take  this  quantity  as  a  critical  level.  Help  over  this
amount could be considered as help related to dependency.

The family may provide the bulk of care in certain countries. It is consequently interesting to identify
the characteristics of both the persons receiving informal care and the characteristics of the carers.

Another question concerns care allowances. In certain countries elderly persons have a right to:

- 

- 

the funding of personal assistance provided by a professional (contribution to cost, partial
payment, credit, reimbursement, etc.) or
an amount of money which he can use to pay a relative or any other informal carer.

It often concerns home nursing, e.g. assistance in activities such as personal hygiene, dressing, etc. In
such cases, we might have a nominal shift of informal care towards formal care.

Also, a family carer may receive different types of support (for example: social security contributions
of  the  carer  are  paid  by  public  authorities,  if  the  amount  of  assistance  is  over  14  hours  per  week,  in
Germany; the carer receives an allowance if he/she lodges a dependent person in Spain; an allowance
or a set of services is provided to the carer, in Sweden and the United Kingdom). These measures may
affect the amount of help provided by the family.

The goal here is not to present an analysis of such measures but to keep in mind that different factors
might influence the amount of help provided by the family apart from socio-cultural elements.

We consider that operations, which generate an official transaction and are registered (directly or by
estimation) in the national accounts, ought to be characterised as a formal activity. All other operations
ought to be included in the informal sector. Consequently, a free help supplied by a charity employing
a staff ought to be included in the formal sector. In fact, the freely available service gives rise to a paid
work, which is included in the national accounts.

From this perspective a family member providing help ought to be considered as informal help. On the
contrary, the same person if public authorities support him/her financially, ought to be considered as
formal carer, at least for this part of care, which corresponds to the financial counterpart.

Given this precision, we have to acknowledge that it is not possible to identify correctly the distinction
between formal and informal. The best proxy which can be used in a questionnaire is whether help is
paid  or  not  (directly  or  indirectly).  What  is  important  here  is  to  have  a  clear  classification  of  carers,
which  has  a  meaning  for  the  interviewed  person.  Existing  classifications  do  not  seem  to  pose  any
serious  problem  in  the  comparability  of  collected  data.  The  use  of  paid/free  service  seems  to  be  a
workable instrument.

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Chapter 1

Characteristics of people receiving informal care

a. Analysis by country

This chapter aims to present data concerning informal care to dependent persons. This means that data
related  to  temporary  limitations  and  acute  sickness  ought  to  be  excluded.  However,  this  was  not
always possible.

France

The survey distinguishes between professional and non-professional help.

Informal care includes any care not directly provided by a professional sector – i.e., a medical, social
service,  or  institutional  sector.  Informal  care  thus  excludes  services  provided  by  professionals  and
volunteers  working  for  non-profit  organisations.  Professional  care  includes  notably,  medical  and
paramedical professionals, cleaning personnel, educators and non-lucrative associations.

Non-professional  carers  include  the  family  (partner,  child,  grand  child,  brother/sister,  other),  friends
and neighbours, person sharing the residence, and servant or salaried living with the beneficiary.

The nature of help retained includes activities such as self-care, mobility, cleaning, ironing, shopping,
administrative procedures, taking care and defending the interests of the beneficiary, etc. This means
that  the  frequency  might  be  at  least  once  a  week  and  even  less  in  certain  cases.  Consequently,  the
definition is very broad and one might expect high rates.

In fact, data in Table 18 indicates that the number of elderly persons (60+) receiving care from a non-
professional  is  higher  compared  to  the  number  of  persons  needing  help  for  at  least  one  ADL  (Katz)
activity.

Netherlands

In 1999, about 9% of private households received informal help (NL4). This rate was stable during the
last ten years. For comparison, about 8% received individual help (from an employee or a nurse) and
7% benefited from Home care (including personal care, housework, etc.). This data covers all persons
and all types of informal care. It is important to note that this data includes persons who receive help
but may not be considered as dependent.

Among  persons  aged  65  years  and  over  receiving  at  least  one  type  of  help  (informal,  individual  or
home care):

- 
- 

25% received only informal help, and
11% received informal care and Home care.

Austria

Concerning informal care, interviewed persons responded to several questions (A3):

a. 

Your household provides care for whom – chief of household (COH), husband / wife of COH,
mother-in-law  of  COH,  father-in-law  of  COH,  children-in-law  of  COH,  sister  or  brother-in-
law of COH, grandparents of COH, other relatives or friends?

b. 

Which household member provides care for persons aged 60 and more?

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c. 

d. 

e. 

How many hours per week (travel included) of help are given by your household for a person
aged  60  or  more:  until  1  hour,  2-3  hours,  4-5  hours,  6-10  hours,  11-19  hours,  more  than  20
hours?

For  which  activity  do  members  of  your  household  help  persons  aged  60+:  personal  care,
medical  care,  going  shopping,  preparation  of  meals,  cleaning  up,  washing  and  ironing,  other
household tasks, making provisions, going out?

How often do you provide care / help: every day, several times per week, once a week, less
often, never?

The data reports persons with physical limitations who receive help by family, friends, home help and
others.  They  distinguish  daily  help,  once  a  week,  regularly,  not  often,  never,  not  known.  In  the
following  table  we  present  help  provided  by  the  family,  relatives  and  friends.  We  distinguish  help
provided daily and help provided at least once a week.

Furthermore, we have added help provided by the family and the friends. This might involve double
counting if a person receives help both from the family and the friends. However, this overestimation
might be low as the number of friends providing help is very small.

The survey makes the distinction between help provided by household members and social services. It
does not refer explicitly to formal and informal.

Sweden

For Sweden, we dispose only of an estimation done by Johansson et al. (S4). It includes family help
with  ADL-functions.  The  authors  advance  that  increased  inputs  from  families  match  the  decline  of
public services, that is, a ‘reverse’ substitution has recently been taking place.

UK: Family Resource Survey (UK5)

An individual is recorded as receiving care if he receives care from another person in the household
and/or from someone outside the household. They are counted only once no matter how many people
provide care to them.

Informal care is defined as giving and receiving help on an informal basis, that is, not as part of a paid
job. The authors note that what should be counted as care is not prescriptively defined.

The data gives the frequency of help: continuously, several times a day, once or twice a day, several
times a week and once a week. In the following table we distinguish daily help (at least once a day)
and at least once a week.

Concerning  persons  receiving  care  available  data  does  not  distinguish  between  formal  and  informal
help.

The data for England (General Household Survey, 1994; source: UK3) indicates that 46% of elderly
persons without dependency receive an informal help.

Consequently,  it  is  important  to  have  a  filtering  question  before  to  put  the  question:  Do  you  receive
any help?  This might involve a question on “Do you have any limitations …”. If the person answers
“Yes”, then the question on help might be relevant.

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Dependent persons

Only the Austrian data presents the rate of dependent persons receiving informal help. Data for other
countries refers to the total population.

French data indicates that more than three-quarters of all dependent seniors receive informal help (F4).

Concerning United Kingdom, if we assume that all daily care (11% in Table 18) is provided to persons
with long standing limiting illness, then the proportion of persons with a long standing limiting illness
who receives care amounts to 25%. This could be compared with the Austrian data, but we know that
our  hypothesis  is  not  correct.  As  a  certain  number  of  persons  without  dependency  receive  help  from
the family, the rate ought to be lower.

The General Household Survey for England (UK1) indicates that the percentage of persons unable to
perform  one  or  more  domestic  tasks  that  receives  informal  help  is  85%.  The  percentage  of  elderly
persons  unable  to  perform  one  or  more  personal  care  tasks  that  receives  informal  help  is  76%.  The
percentages are high because there is no constraint on the frequency.

Table 18: Persons receiving informal care, as a percentage of the population of the same age group.
A

UK

F
Persons
receiving care
from a non-
professional
(private
households)

IRL
Persons
receiving a
high level of
informal help
(age: 65+)

Definition of
 beneficiaries
and care

Persons with
physical
limitations
receiving daily
help from
family and
relatives

Persons with
physical
limitations
receiving help
at least once a
week from
family and
relatives

S
Persons
receiving
help with
ADL
functions

Persons
receiving
daily care

Persons
receiving
help at least
once a week

Source
Year

F1
1999

IRL1
2000

A3
1995

S4
2000

UK5
2000/01

Source
Year

20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-65
65-69
70-74
75-79
80-84
85-89
90+

65+
75+

2

2

4

7

13

21

48

70

22
51

21
-

3

4

6

8

16

42

18
42

5

6

8

12

25

59

27
59

-
37

1

2

3

4
6

7

14

28

11
17

4

2

2

  20-24
25-29
30-34
35-39
40-44
45-49
50-54
5 55-59
7 60-65
65-69
70-74
75-79
80-84
49 85-89
90+

24

10

18
29

65+
75+

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Notes
In France, 22% of persons living at home, aged 65+ receive care from a non-professional.

F:  Age-groups: 20-29; …; 80-89; 90+. Totals refer to 60+ and 80+.
A:  Age groups: 30-39; …; 70-79, 80+. Totals refer to 60+ and 80+.
      The percentage of persons receiving daily help from friends is less than one percentage point except for persons aged

70-79: 1,2% and 80+: 3,5%.

S:   The survey covers only persons 75+.
UK: The % of persons  aged  65+  unable  to  perform  one  or  more  domestic  tasks  receiving  informal  help  is  85%.  The  %  of
elderly persons unable to perform one or more personal care tasks receiving informal help is 76% (General Household
Survey, England, 1994).

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b. Informal / Formal help

Another important aspect is that many persons may receive help from different sources (see Tables 19
and 20).  In fact, many persons cumulate informal help with formal home services.

In France, the data indicates that a significant proportion of people without dependency receive some
kind of regular help. Furthermore, among those who receive help an important number combines help
from  different  sources.  Table  19  presents  the  sources  of  care  by  degree  of  dependency.  We  have
retained the two most used indicators in France: the ‘Colvez’ and the ‘Isoressources group’ index.

An isoressources group is a group of people requiring a comparable volume of assistance, measured in
man-hours. The groups are numbered from 1 to 6 by decreasing level of dependency. Group 1 mainly
comprises  individuals  who  have  lost  their  mental,  bodily,  motor,  and  social  independence,  and  thus
require a continuous presence of caregivers. On the other extreme, the individuals in group '5' need ad-
hoc care (usually home help) and those in group 6 are persons who remain independent in all daily-
living activities. On the other hand, the ‘Colvez’ classification distinguishes four levels.

In  Sweden,  a  fifth  of  the  older  people  who  are  helped  by  their  families  also  use  home  help  services
(see table 20).

In the Netherlands, among persons 65 years old and over receiving at least one type of help (informal,
individual  paid  or  home  care):  25%  received  only  informal  help,  11%  combined  informal  care  and
Home care, and about 6% received another combination of different types of help (NL4).

An  important  discussion  concerns  the  substitutability  or  complementarity  between  formal  and
informal help.

Analysis of different surveys provides mixed results. In certain cases formal and informal seem to be
substitutes and in other cases they seem to be complementary. The Swedish study noted above finds
that increased inputs from families match the decline of public services, that is, a ‘reverse’ substitution
has recently been taking place in Sweden.

Complementarity might arise in situations where the formal sector provides personal care services and
leaves to the family the provision of instrumental activities (shopping, etc.).

Following a study, in France, the lower the average hourly price of formal care, the longer the hours
received.  However,  formal  and  informal  care  volumes  vary  too  much  from  one  dependent  person  to
another  to  be  able  to  determine  the  extent  to  which  these  two  types  of  care  are  substitutes  (F4).
Furthermore, it seems that total hours of care increase with dependency and isolation.

Research in the US indicates that "as long as a person has faculties of comprehension, spousal care is a
viable  and  often  used  substitute.  For  all  individuals,  male  and  female,  without  comprehension
limitations,  marriage  cuts  the  probability  of  nursing  home  entrance  by  more  than  half.  Only  for  the
most severely disabled people, who suffer from an inability to understand or communicate, is spousal
care not an important substitute"5.

5 Lakdalla, D., and Philipson, T., “Aging and the Growth of Long-Term Care”, NBER Working Paper Series, N° 6980, 1999.

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Table 19: Source of care received by dependency level (France),

France, 1999; Persons aged 60 and over.
Type of care/Degree of dependency

Severe
(GIR 1, 2 and 3)

Moderate
(GIR 4)

Little or no
(GIR 5 and 6)

30
63
7
100

100

53
40
7
100

99

51
25
24
100

25

For the definition of ‘GIR’ see ‘AGGIR’ in the Glossary. '6' means self-sufficient.
The data includes only private households.

Informal care alone
Formal and informal care
Professional care alone
TOTAL
Percent of elderly persons receiving
help
Note: 

Source:  F1.

France, 1996; Persons aged 65 and over.

Type of care

Informal care alone
Formal and informal care

Formal care alone

Total
Note: 
Source:  F4

Extreme
dependency
(Adjusted Colvez 1 & 2)
53
30

Moderate
dependency
(Adjusted Colvez 3)
54
29

16

100

17

100

Little dependency

(Adjusted Colvez 4)

For the definition of the type of care see ‘Colvez’ in the glossary. Private households.

Table 20: Source of care received by persons 75+ in need of help (Sweden), 2000.

Type of support
Informal care only
Both informal care and Home Help
Home Help services only
Total
Note: 
Source:  S4.

Persons residing in the Community.

All

Live alone

Co-resident

66
16
18
100

47
24
28
100

41
24

35

100

88
7
5
100

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c. Classifications of informal care

The  different  surveys  distinguish  between  different  types  of  carers.  In  general  they  avoid  the  terms
formal and informal, contrary to academic works. The relationship to the person being cared for can
be:

D
Wife/ husband
/partner
Daughter / son
Sister / brother
Daughter-in-law
Other relatives
Friends, neighbours
Others

E
Partner
Daughter/Son
Sister/Brother
Mother/Father
Other relative
Employee
Friends and
neighbours
Guests
Social services

(volunteer)

Other relations
Not known

F
Partner
Child
Grandchild
Other ascendant
Brother/sister
Other relative
Friend, neighbour
Other person (no
relative)

Employee

A
Spouse/partner
Daughter (in-law)
Son (in-law)
Other female relative
Other male relatives
Female friends
Male friends
Social services
including volunteer
Other persons ( paid
domestic aid)

Not  known

UK(1)
Spouse
Parents
Children
Other relatives
Others

UK(2)
Parent
Partner/spouse/
        cohabitee
Son / Daughter
Brother / Sister
Other relative
Non relative

Statistics on informal care by type of relationship between the carer and the beneficiary are presented
below.

d. Co-resident / Other household

Table 20 makes an interesting differentiation: whether the beneficiary of informal care is living alone
or resides with the carer.

A  British  survey  (UK5)  distinguishes  between  whether  the  informal  carer  lives  in  or  outside  the
household.

Also, the General Household Survey (UK3) asks who gave the help: Spouse or partner;  Other
household member; Non-household relative; Friend/neighbour;  NHS or personal social services; Paid
help; and Other.

If  the  person  usually  gets  help  from  someone  outside  the  household,  he  is  asked  who  is  the  person:
Son;  Daughter;  Brother;  Sister;  Other  relation;  Friend/Neighbour;  Social  services;  District  nurse/
Health visitor; Paid Help; Other.

Finally, the German data makes a distinction between help received at home and help received in an
institution. They don’t present informal and formal help.

It  is  important  to  note  that  help  may  be  provided  to  another  household,  without  being  able  to
distinguish  the  beneficiary  inside  the  household  (e.g.  cleaning  the  house),  while  in  other  cases,  the
member of the household can be identified (e.g. washing a person).

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Chapter 2

Type of informal care

The  previous  chapter  presented  the  number  of  (dependent)  persons  receiving  informal  help.  This
chapter will analyse the nature of this help.

It is important to note that ideally the data ought to exclude care for temporary and acute sickness. For
example, available Dutch data (NL4) indicates that among the informal carers, 9% of carers provide
help to persons with chronic sickness, 15% provide care to persons temporarily sick, 6% provide care
to persons at a terminal stage, etc. Data ought to eliminate informal care provided to temporarily sick
persons. However, available information does not always makes this distinction.

Type of informal care provided

Table  21  indicates  that  in  the  majority  of  cases,  informal  help  concern  instrumental  activities  like
shopping and household tasks.

Both constitute important activities of independent living at home and maintenance in the community.

Statistics are not comparable since they adopt different points of view (dependent person or carer).

Frequency

Table 22 presents the frequency of informal care. The data is only indicative since the definitions and
the frequencies used are not strictly comparable.

Hours are important in surveys aiming to study the link between needs and social security benefits.
For example, modelling Social Security benefit entitlement is central to the “Family resources survey”
(UK5), notably for policy evaluation and costing of policy options.

The time spent for caring varies sharply across countries. The high importance of permanent care need
in Germany might be the result of the population covered. In fact reported statistics cover beneficiaries
of  the  long  term  insurance  scheme,  and  thus  more  dependent  persons  compared  to  people  in  general
surveys.

Provider

We  have  very  little  information  on  the  preferences  of  older  people  concerning  the  nature  of  the  care
provider.  A  recent  study  in  Ireland  (HeSSOP,  IRL1)  asked  older  people  about  their  preferences  for
long-term care. In the case of housekeeping care (cleaning, cooking, shopping and so on), 54% of the
respondents  said  that  they  preferred  to  receive  this  type  of  care  from  family,  friends  or  neighbours.
The percentage of respondents preferring professional care providers was slightly higher (23%) in the
case of personal care services (bathing, dressing and so on), with 50% preferring their family, friends
or neighbours. The most popular living at home situation was the current home with involvement of
the health board through the provision of respite care services. This data has only an indicative value
and may not be extrapolated to other countries. In fact, preferences might depend upon the availability
of market services, the quality of such services, the cost of these services, traditions, etc.

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A  survey  among  Danish  elderly  people6  revealed  that  there  is  an  agreement  among  older  people,
relatives  and  parties  involved  with  older  people  that  in  cases  regarding  couples  the  non-dependent
spouse  is  responsible  for  assisting  with  both  practical  tasks  and  personal  care.    Furthermore,  neither
older  people  nor  relatives  think  that  family,  friends  and  neighbours  should  be  burdened  with  the
responsibility of assisting older people with practical tasks or personal care.

In  the  Netherlands,  a  study  concerning  the  reasons  for  entering  a  nursing  home,  a  care  home  or  a
protected form of housing indicates that the inability to receive the necessary help from the family and
the friends was a main reason to enter a nursing home and an important reason to enter a care home for
the  elderly.  On  the  contrary,  this  was  not  an  important  reason  to  enter  a  protected  form  of  housing
(NL4).

Table 21: Type of care provided / received in %

A

S

UK

Households with
help for elderly

Distribution of type
of care

Carers with main
person cared for

F

Type of non-
professional care
given

F1
1999

25
36
52

42
28
67
39

Definition

Source
Year

personal care
medical help
going shopping
preparing meals
household tasks
going out
financial matters
others

NL
Distribution of
private households
receiving informal
help by type of help
NL4
1999

A1
1998

Type of care given / received (in %)

27

73

28
28
59
30
95
18
45

S1

37
19
39

UK4
2000

26
22

71
52
39

Note:
Percentages might not add up to 100, because one carer might provide several types of care. Also, the dependent
person may receive different types of help. Statistics are not comparable since they adopt different points of view (dependent
person or carer).

F
NL
A
S
UK

F: 
NL: 
S: 

25% of non-professional help supplied by non-professionals concern personal care.
27% of private households receiving informal help benefit from services concerning personal care.
28% of households with help for elderly people receive services concerning personal care.
37% of care provided concerns personal care;
26% of carers provided help concerning personal care.

Financial matters: defense of rights / administrative help; Others: keeping company
The categories of help are very large.
Data comes from different studies exploiting the same survey.

6 “An Old Person Needs Assistance. Who should provide it?”, Colmorten, E. et al., Institute of Local Government Studies,

2003.

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Table 22: Frequency of informal help received

E
Disabled
persons aged
65+
receiving
informal care
E1
1999

A1
1998
(in %) both sexes

Time spent
on informal
caring

A
Informal care
provided to
persons aged
60+

S
Elderly being
cared for by
relatives

UK
Households
members aged
60+ receiving
care

A1
1998

S1
1980-1998

UK5
 2000-2001

12
19
19

25

26

6
10

22

49
13

24

5

55
15

13
22

20

23
23

100

100

100

100

(in %) men

Definition

Source
Year

once a week
several times/week
once a day
twice a day
several times/day
permanent
never
not often
not known

once a week
several times/week
once a day
twice a day
several times/day
permanent
never
not often
not known

once a week
several times/week
once a day
twice a day
several times/day
permanent
never
not often
not known

D
Dependent persons (all
ages) cared for at home
(dependency level I)

D3
1999

8
10
15
13
25
22
4

3
100

8
9
10
12
27
27
5

3
100

8
11
17
14
24
19
4

3
100

15
17
16
9
42

2
100

11
17
15
10
45

1
100

(in %) women

16
17
16
9
41

2
100

11
18

20

23
28

100

17
25

20

20
19

100

Notes
D
Once a week (housework)
Several times/week
Once a day
Twice a day
3 times a day/more
Permanent
Not known

A

E
Several times /week: < 7 hours Once a week: -1 hour
Once a day: 7-14
Twice per day: 15-30
Several times /day: 31-40
Permanently: 40+
Not known

Several times/week: 2-5 hours
Once a day: 6-10 hours
Several times/day: 11-19 hours Daily
Permanent: 20+ hours

A

No help

UK
Continuously
Several times a day

Once a week
Several times/week Once/twice a day

D:  The data includes formal and informal help. 
UK: The data includes formal and informal help. 

Several times a week
Once a week

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Chapter 3

Distribution by sex and age of informal carers

Previous  chapters  presented  the  characteristics  of  dependent  persons.  The  following  chapters  will
present the characteristics of carers.

As noted above, this chapter aims to present data concerning carers of dependent persons. This means
that  care  related  to  temporary  limitations  and  acute  sickness  ought  to  be  excluded.  Furthermore,  we
exclude data concerning childcare, maternity care, and related forms, as they are not part of this study.

It is important to note that we identified data only for Austria and Sweden. The data for the remaining
countries covers all carers. Consequently, they are not comparable with Austria and Sweden.

The gender breakdown indicates that the majority of carers are women.

Data  in  Great  Britain  indicates  that  women  were  more  likely  to  be  carers  than  men  were  but  the
difference was not marked, 14% compared with 11%. However, since there are more women than men
in  the  total  adult  population  of  Great  Britain,  it  is  true  that  the  number  of  women  caring  is
considerably greater than that of men, 3,3 million compared with 2,4 million (UK3). This gives 42%
men and 58% women.

Authors note (UK3):

-  Women looking after someone outside the household 10%, men 7%;
- 
-  The peak age for caring was 45-64. 20% of adults in this age group were providing informal

5% of adults looked after parents and 3% cared for friends and neighbours

care.

Additional data for Germany indicates that, more than 1.7 million people were using nursing services
offered  by  the  Long  Term  care  insurance.  74%  lived  in  their  own  homes  and,  the  rest  in  nursing
homes. 83% of those giving care at home are women7.

In Ireland, 30% of carers are aged over 65 years (IRL1) and the majority of carers are in the age group
45-68.  The  survey  reports  that  8%  of  older  people  are  the  main  person  providing  care  for  someone
else.

In the Netherlands, 10% of persons 18 years old and over provide informal help (NL4). This statistic is
relatively large as it includes help to non-dependent persons. About 17% of persons 45 to 54 years old
and 19% of 65-74 provide informal help.

7 Federal Statistical Office, “Health Report for Germany: Abridged Version”, Statistisches Bundesamt, 1998.

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Table 23: Distribution of informal carers by sex in %

D

E

F

IRL

Definition

Carers

Carers

Carers

Carers of older
people

A
Carers for
elderly with a
long-term
need for care
A1
2000

S
Carers of older people
(75+) who live alone
and have needs with
ADL functions
S4
2000

UK

Adult
carers
(16-64)

Carers

UK2 UK3
1989 1995

Source
Year

Men
Women
Total

D4
2002

20
80
100

E1
1999

F1
1999

IRL1
2000

Distribution of carers by sex in %

26
74
100

36
64
100

33
67
100

20
80
100

27
72
100

35
65
100

42
58
100

Table 24: Informal carers by age group
E
D
Carers providing care to
a person needing special
attention
E1
2000

Carers for persons
depending on care

Source
Year

D2
1996

Definition

NL

Informal carers
(aged 18+)

NL4
1999

A
Carers for
persons aged
60+
A1
1999

2
17

49

21
10
100

Age-distribution of carers in %

10
15
20
23
15
17
100

16
16
20
22
19
7
100

31

38

30

100

18-29
30-44
45-50
50-64
65-74
75+
Total

Notes

UK

Informal adult
carers

UK2
1989

23

37
24
16
100

Carers

UK3
1995

32

48

20

100

E:  The age groups are: 18-24, 25-34, 35-44, 45-54, 55-64 and 65+.
NL:  Age groups: 18-34, 35-44, 45-54, 55-64, 65-74, and 75+.
A:  Age-groups: -39, 40-59, 60+
UK: Age-groups: -50, 50-64, 65-74, 75+
UK: The General Household Survey 1995 (UK3) gives: carers aged 16-44: 32%, 45-64: 48% and 65+: 20%.

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Chapter 4
Relationship of informal carers to persons cared for

As indicated in the first chapter of this section, the family is the main provider of informal care.

Spouse/partner and daughters appear to be the most important groups of informal care providers.

We present below certain key aspects of the British General Household Survey (UK3).

Concerning all carers, we may note the following:

-  Carers looking after someone in their own household: 52% were caring for a spouse; 22%

was caring for parents and parents in law.

-  Carers looking after someone in other household: over a half (55%) were looking after

parents or parents in law; just over a fifth (22%) were looking after friends and neighbours.

Co-resident carers constitute about 25% of carers. Certain advance that co-resident care involves often
a heavier involvement for the carer. Also, this indicates that there might be differences between spouse
carers and daughters/sons carers.

About 13% of all persons aged 65 and over were carers.

From the point of view of dependent persons:

-  Persons being cared for by someone in the same household: 54% were aged 65 or over;
-  Persons being cared for by someone in a different household: 85% were aged 65 or over.

The  general  Household  Survey  (UK3),  1998,  notes  that  the  most  common  source  of  help  with
mobility, self-care and domestic tasks was the respondent’s husband, wife or partner, providing help in
about half of cases. Other common sources of help were other household members and non-household
relatives.  Apart  from  getting  in  and  out  of  bed,  for  which  20%  of  respondents  used  personal  social
services,  only  a  small  proportion  used  help  from  anyone  other  than  a  household  member  or  relative
outside the household.

In Spain (E1), there is a significant difference concerning the origin of help between elderly men and
women  with  disabilities.  About  45%  of  men  receive  assistance  from  a  partner  and  21%  from  a
daughter. In comparison, the rates for women are 15% and 37% respectively. This might be partly due
to the longer life expectancy of women.

Concerning the number of hours provided to persons with disabilities:

-  Help provided by social services and the market concentrates relatively more in assistance,

which last less than 7 hours per week.

-  Help provided by partners and daughters concern in the majority of cases help, which lasts

more than 30 hours per week.

However, this information does not indicate whether the two forms are substitutes or complements.

About 21% of adult population provides care to elderly persons requiring special attention. The rate is
25% for women and 17% for men. About 31% of persons 45 to 54 years old are carers.

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Table 25: Relationship of carer to person cared for in %

D

E

F

IRL

A

Definition

Carer for persons
aged 65-79

Principal carer of
persons 65+ with
disabilities

Non-professional
carers

Carers for older
people

Personal care for
people aged 60+

Source
Year
spouse / partner
son (in-law)
daughter (in-law)
sister / brother
other relatives
friends /
neighbours
volunteers /
employees
others
not known
Total

D2
1996
61
2
30

6

2

100

E1
1999
23
6
32
3
15

2

12

7

100

IRL1
1994/2000
25

34

12

F1
1999
29

35

4
25

7

0

0

100

100

A1
1998
36
10
26

6

9

2

4
7
100

Note
Similar results are found in the Netherlands (NL4).
Classifications
used

D
Wife
Husband
Partner

E
Partner
Daughter
Son

Daughter
Son

Sister/brother

Sister/brother
Other relatives
Friends,
neighbours

Daughter-in-law Employees

Other relatives

Social services

Friends,
neighbours
Others

Others

F
Partner
Child
Grandchild

Other ascendant
Brother/sister

Other relative
Friend,
neighbour
Other person
(no relative)

Employee

IRL
Different sources Spouse/partner

A

Daughter (in-law)
Son (in-law)
Other female
relatives
Other male relatives

Female friends

Male friends
Social services
including volunteer
Other persons e.g.
paid domestic aid
not known

S
Carers of older
people (75+)
who live alone
and have needs
with ADL
functions
S4
2000
-
13
33

53

UK

Carers for persons
aged 65+ (GB)

UK3
1995
19

43

37

100

100

SW
Daughter(s)
Son(s)
Female relative Child (any age)

UK
Spouse
Parent/parent in-law

Male relative Other relative or friend

Dependent's
relationship to carer

The study
focuss on older
people (75+)
who live alone
and have needs
with ADL
functions

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Chapter 5

Employment status of informal carers

From an equal opportunities perspective it is important to know whether the carer participates in the
labour market or is unable to work due to care constraints.

German and Austrian statistics indicates that providing care might have an adverse impact on labour
participation. Caregivers are over-represented among the 'not working' (Germany) and 'part-time work
/ work per hour' (Austria).

However, a certain number of authors consider that the relationship between employment and care is
not straightforward (UK3). Caring responsibilities can impact upon employment, but the employment
status may also influence an individual’s propensity to care.

The Austrian data indicates that the higher the time spent for providing care, the lower the proportion
that works. But this correlation does not reveal the direction of causality.

Different  econometric  studies  have  analysed  the  relation  between  caring  and  part-time  work8.
However,  most  of  them  do  not  distinguish  caring  for  children  and  caring  for  adults  and  elderly
persons.

As we saw before (see Table 24), there is a concentration of carers for dependent persons in the age
group  50  to  64.  The  European  Community  Household  Panel  (Eurostat,  2001)  provides  a  certain
number  of  statistics,  which  makes  the  distinction  between  'looking  after  a  child'  and  'looking  after
someone other than a child'.

The following charts present a comparison between the employment rate of persons 50 to 64 years old
looking  after  someone  other  than  a  child  and  persons  not  doing  so.  The  charts  distinguish  between
men and women. The data relates to 1998. It is important to note that data relates to the employment
rate and not to the labour participation.

The  results  indicate  that  caring  might  have  an  important  adverse  effect  on  the  employment  of  older
workers. However, this ought to be interpreted with caution as many econometric studies indicate that
several factors may intervene in which case it is difficult to discriminate among correlated variables.
From another point of view, 'looking after someone' might act as a proxy for other characteristics. In
any case, the results indicate that further research into this direction is desirable.

Several  Member  States  have  established  allowances  in  favour  of  caregivers.  J.  Jenson  and  S.
Jacobzone  undertook  a  qualitative  review  of  the  impact  of  various  types  of  care  benefits  on  women
caregivers9. They note that "instituting such allowances does not seem to have the effect, which some
feared, of lowering women’s labour participation. However, nor does it mean that they represent a way
to promote gender equality, as they do not change the gender distribution of caring work".

The Labour Force Survey includes a group of questions of interest:

- 
- 

reason for working part time, and
reasons for not participating in the labour market

8  “Le travail à temps partiel féminin et ses déterminants”, Bourreau-Dubois, C., Guillot, O., et Jankeliowitch-Laval, E.,

Economie et statistique, N° 349-350, 2001 – 9/10.

9 Jenson, J. and Jacobzone, S.,  “Care allowances for the frail elderly and their impact on women care-givers”, Labour

Market and Social Policy – Occasional Papers N° 41, OECD, 2000.

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The  respondent  has  a  set  of  choices.  However,  the  grouping  of  reasons  does  not  enable  us  to
distinguish 'care for an adult'.

Only  the  United  Kingdom  has  introduced  a  question  concerning  reasons  for  not  looking  for  work
where they distinguish:

- 
- 
- 

caring for children,
caring for dependent adult relative, and
other.

The result of the UK experience might be interesting for the definition of a EU approach.

Table 26: Informal carers by employment status in %

D

A

UK

Carer for a
person with a
constant need
for care

Main Carer
(working)

Adults who
were carers

Definition

Age

Source

Year

18-64

D2

1996

%

18-64

A3

1997

not working
work per hour
part-time work
full-time work
Total
Note: The data is only indicative and not comparable.

-
22
64
14
100

77
5
7
10
100

16-64

UK4

2000

27

18
54
100

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Chart 13a: How much lower is the employment rate of women caring for 
someone other than a child over those non-caring?  (age group: 50-64) 

EL

% 

75

50

25

B

DK

0

-25

-50

-75

IRL

I

F

E

D

A

FIN

NL

P

UK

EU

%:  (Employment rate of carers - Employment rate of non-carers)/(Employment rate of non-carers) in percent.
Source: Eurostat (ECHP 1998)

Chart 13b: How much lower is the employment rate of men caring for 
someone other than a child over those non-caring?  (age group: 50-64) 

% 

75

50

25

0

-25

-50

-75

DK

EL

s

B

D

F

E

NL

A

UK

EU

IRL

I

FIN

P

%:  (Employment rate of carers - Employment rate of non-carers)/(Employment rate of non-carers) in percent.
Source: Eurostat (ECHP 1998)

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Discussion and recommendations

The review of available data indicates that Household tasks are the main type of care provided by the
informal  carers.  Going  shopping  is  the  second  largest  need.  Both  constitute  important  activities  of
independent living at home and maintenance in the community.

The EU indicator might be interpreted to favour a rather narrow definition of dependency. However,
taking  into  account  instrumental  activities  and  moderate  dependencies  might  have  very  important
implications  for  the  carers.  In  fact,  persons  with  the  most  severe  personal  care  dependencies  tend  to
die fairly soon. They do not seem to be the heaviest nursing homes users10. On the other hand, persons
with  moderate  needs  seem  to  be  the  heaviest  users  of  nursing  home  care.  As  moderately  dependent
persons constitute an important share of nursing home residents, they are likely to be cared for at home
by  an  informal  carer.  In  fact,  they  are  more  numerous  and  live  longer.  This  means  that  moderate
dependencies  might  have  a  significant  impact  on  informal  carers  and  this  ought  to  be  taken  into
account.  Restricting  ourselves  into  a  very  restrictive  definition  of  dependency  might  exclude  an
important number of informal carers.

Concerning  carers,  data  in  Great  Britain  indicates  that  carers  looking  after  someone  in  their  own
household and carers looking after someone in another household might have different characteristics
and thus different needs.

German  and  Austrian  statistics  indicate  that  providing  care  might  have  an  adverse  impact  on  labour
participation. Caregivers are over-represented among the 'not working' (Germany) and 'part-time work
/  work  per  hour'  (Austria).  However,  a  certain  number  of  authors  consider  that  the  relationship
between employment and care is not straightforward. Caring responsibilities can have an impact upon
employment, but the employment status may also influence an individual’s propensity to care.

Some results indicate that caring might have an important adverse effect on the employment of older
workers. However, this ought to be interpreted with caution as many econometric studies indicate that
several factors may intervene in which case it is difficult to discriminate among correlated variables.

Furthermore,  concerning  allowances  to  care,  social  security  and  welfare  measures  indicate  that
"instituting  such  allowances  does  not  seem  to  have  the  effect,  which  some  feared,  of  lowering
women’s labour participation. However, nor does it mean that they represent a way to promote gender
equality,  as  they  do  not  change  the  gender  distribution  of  caring  work".  These  results  need  to  be
studied further.

Informal care is defined as giving and receiving help on an informal basis, that is, not as part of a paid
job. This appears to be a workable criterion.

Guidelines concerning the questions of surveys

Certain surveys report that the number of persons receiving care is higher compared to the number of
persons  needing  help.  Consequently,  it  is  important  to  have  a  filtering  question  before  to  put  the
question: Do you receive any help?  This might involve a question on “Do you have any limitations
…”.  If  the  person  answers  “Yes”,  then  the  question  on  help  might  follow.  By  the  same  way,  we
exclude some forms of convenience help.

Concerning the carers a bloc of questions ought to collect information on their characteristics and the
implication on equal opportunities. This bloc of questions ought to collect information on:

10 Lakdalla, D., and Philipson, T., “Aging and the Growth of Long-Term Care”, NBER Working Paper Series, N° 6980,
1999.

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- 
- 
- 
- 
- 

- 
- 

gender and age distribution;
type of care provided;
the relationship of the informal carer to the person cared for;
the employment status of the carer (full time, part time)
periodicity of care provision (continuously, several times a day, once or twice a day, several
times a week and once a week);
desired working time in the absence of any constraint concerning the dependent person;
etc.

An  individual  ought  to  be  recorded  as  receiving  care  if  he  receives  care  from  another  person  in  the
household and/or from someone outside the household. They ought to be counted only once no matter
how many people provide care to them.

The survey ought to precise whether the beneficiary of informal care is living alone or resides with the
carer.

The  survey  might  ask  in  a  first  step  who  gave  the  help.  For  example:  Spouse  or  partner;  Other
household member; Non-household relative; Friend/neighbour;  NHS or personal social services; Paid
help; etc.

If the person usually gets help from someone outside the household, he ought to be asked who is the
person:  for  example:  Son;  Daughter;  Brother;  Sister;  Other  relation;  Friend/Neighbour;  Social
services; District nurse / Health visitor; Paid Help; etc.

Questions concerning the carers fit well in the Labour Force Survey but they pose some problems in a
health  interview  survey.  In  the  latter,  this  kind  of  information  ought  to  be  collected  only  indirectly,
which  is  questionable.  The  person  receiving  the  informal  care  or  another  person  in  the  household
ought to provide information concerning the informal care provider.

Concerning  the  Labour  Force  Survey,  this  might  require  only  marginal  adaptations  of  existing
questionnaires. The proposed modifications are already introduced in the United Kingdom and the first
lessons might be interesting for other countries.

Labour Force Survey includes a group of questions of interest:

- 
- 

reason for working part time, and
reasons for not participating in the labour market

The respondent has a set of choices. It is thus important to distinguish the following:

- 
- 
- 

caring for children, and/or
caring for dependent adult, and/or
other.

This  will  provide  some  information  at  a  marginal  cost.  Full  modules  on  carers  could  follow  the
analysis of the first results.

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SECTION III

FORMAL CARE

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Introduction

In general, formal care corresponds to professional care. It is a 'paid' service. However, this does not
hold  for  all  surveys.  In  each  case,  we  will  indicate  how  these  services  are  treated  in  the  different
surveys.

As formal is often associated with ‘professional’ or ‘paid’ service, this implies that a significant part of
these  services  are  related  to  the  social  protection  system.  Consequently,  many  studies  report
administrative statistics, which are based on the number of beneficiaries of different services paid by
the  public  sector.  For  example,  home  help  is  an  important  service  paid  by  local  authorities.  In
Denmark,  Finland  and  Sweden  this  is  a  municipal  matter.  A  financial  support  is  provided  towards
payment of personal assistance and help to manage the household.

In  France,  the  formal  sector  includes  any  service  provided  directly  by  a  professional  sector  –  i.e.,  a
medical,  social  service,  or  institutional  sector  (F1).  In  the  United  Kingdom,  most  surveys  favour  the
‘paid’ or not criterion.

The nature of services paid or provided by public authorities has an important impact on certain data.
For  example,  a  ‘cleaning  lady’  might  be  considered  as  professional  care  if  it  is  provided  by  a  local
authority  service.  On  the  contrary,  the  same  service  might  be  included  in  the  informal  sector  if  the
dependent person pays it. Normally a cleaning person ought to be included in the formal sector, if it
generates a transaction, which is officially registered or declared.

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Chapter 1

Formal care and place of residence

Table 27 presents persons aged 65 and over living outside the institutions and receiving home help. In
general,  home  help  includes  personal  care,  and  housekeeping.  However,  in  several  cases  other  types
are included. This makes the comparability across countries very difficult.

We present a selection of statistics aiming to be as close as possible to a set of common criteria. At
this end, each time it was possible we retained:

- 
- 

long term care, and
a minimum amount of time in order to exclude persons receiving for example for only one or
two hours of help per week.

We  have  completed  our  data  with  estimations  provided  by  the  OECD.  The  OECD  notes  that  home
help  might  include  notably  day  care,  respite  care,  visiting  nurses  and  home  helps  (OECD3).  The
OECD estimations use different sources, including a questionnaire to the Member countries.

OECD  has  also  estimated  the  “Share  of  population  aged  65  and  over  receiving  formal  help  at  home
(Mid  90s)”  (OECD2).  It  includes  population  aged  65  and  over  receiving  formal  help  at  home,
including  district  nursing,  and  help  with  Activities  of  Daily  Living.  The  authors  note  that  home  care
should  include  all  home  care  services,  including  district  nurses  services,  excluding  medical  visits.
This data presents the total number of beneficiaries and might include persons who are not dependent
or  are  only  temporary  beneficiaries.  Estimations  did  by  OECD  use  different  sources,  including  a
questionnaire to the Member countries. The author notes that existing estimates for long term care in
OECD  Health  Data  are  somewhat  lower  but  do  exclude  a  considerable  share  of  long-term  care
programmes.

The  Nordic  Social-Statistical  Committee  (NOSOSCO)  notes  that  statistics  concerning  home  help  in
the  Nordic  countries  are  not  easily  comparable  (DK2).  It  indicates  that  the  extent  of  assistance  is
determined on the basis of individual needs and may vary from a few hours per month to several hours
per day. The assistance is a municipal matter and is provided by municipal or privately employed staff.
In  all  Nordic  countries,  people  with  severe  disabilities  may  be  granted  financial  support  towards
payment of personal assistance and help to manage the household (personal care and housekeeping).

In  order  to  improve  comparability  across  countries,  we  have  retained  only  people  receiving  a
minimum amount of help. For example,

- 

- 

10 hours or more per month in Sweden. In fact, of all elderly persons (65+) receiving home
help, about 39% receive help of 1 to 9 hours per month.
4 hours or more per week in Denmark. The number of recipients aged 67+ receiving 3 hours
or less of help per week is about 63% of all the beneficiaries.

-  At least once per week in Austria.

It is important to note that data might overestimate the number in the following cases:

- 

some questionnaires ask about the use of services in the last month. This means that persons
with  a  temporary  dependency  might  be  included.  Also,  some  persons  use  home  help  but  do
not consider themselves as dependent persons.

-  Administrative  statistics  report  the  number  of  beneficiaries.  Similarly,  persons  with  a

temporary dependency or very low need frequency might be included.

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Previous  tables  cover  all  persons.  Statistics  focusing  on  dependent  persons  are  rare  and  not
comparable.

In  Belgium  (Flanders),  about  40%  of  persons  aged  60+  with  ADL-limitations  receive  personal  care,
cleaning services and meals on wheels (B2).

In Germany, the long term care insurance scheme reports 2,02 million care dependent persons (of all
ages).  573.000  dependent  persons  receive  care  in  8.900  nursing  homes.  1,44  million  dependent
persons  receive  care  in  private  households.  1,03  million  of  them  get  only  informal  care.  The  others
(415.000) get additional or exclusive care by the 10.800 care services (D1).

In  France,  half  of  the  dependent  elderly  receive  care  from  professionals.  Two-thirds  of  dependent
seniors living alone receive professional care as opposed to half of those living with a partner and 40%
of those sharing accommodation with other family members (F4).

In the United Kingdom (GB) 45% of persons aged 65+ needing help to go outdoors and walk down
the road use home help (from Local Authorities and private services).

The  French  HID  survey  finds  that  the  number  of  all  elderly  persons  (60+)  receiving  care  from  a
professional  is  14%.  This  rate  is  higher  than  the  rate  of  persons  needing  help  for  at  least  one  ADL
(Katz)  activity  (11%).  This  indicates  that  some  persons  use  professional  services  but  are  not
considering themselves as dependent.

Finally, Table 28 presents the rate of persons receiving formal help by age group. The data covers all
persons except for Germany.

The  Danish  data  reports  the  number  of  people  who  received  help  from  municipal  or  privately
employed staff during a year. For comparability reasons, in certain tables we have excluded the short-
term beneficiaries e.g. persons who received help ranging from 1 to 3 hours per week. For comparison,
Sweden reports the number of people who per 31 December (1 November for 1999) had been granted
home help. Help may stem from municipal or privately employed staff.

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Table 27: Share of population aged 65 and over receiving home help (includes only significant long term help)

Source

Share of pop aged 65 and over
receiving home help

B
1997

B2

DK
1998

DK2

D
1995

O1

EL

E
2001

E2

F
1998/99

IRL
1996

I
1995

L
1992

F1

IRL2 OECD2

L1

NL
1996

O1

A
1995

P
1992

A1

OECD3

FIN
2001

FIN3

S
2001

S2

UK
1998

UK3

5

9

5

-

2

7

4

3

7

10

5

1

8

8

5

Notes:
The data excludes occasional non-regular help and help to persons who may not be considered as dependent persons
OECD includes notably day care, respite care, visiting nurses and home helps. Other countries include mainly housekeeping and personal care.
B:
Home help use by all elderly persons (60+) in the Flemish area is about 4% (B2). OECD estimates that 5% of the elderly (65+) receive formal help at home (OECD2).
DK:  Persons aged 67+. Persons in ordinary housing with home-help services: 25%. Help may stem from municipal or privately employed staff (DK2). The number of recipients aged 67+ with

D:

E:

3 hours or less of help per week is about 63% of the beneficiaries.
Professional home care 3% and help with domestic work from the domestic service agencies 2%. OECD estimates that 10% of elderly (65+) receive formal help at home, but this
includes all persons whatever the amount of help received (OECD2).
About 1% of the same age group benefit from the public tele-assistence service. OECD reports also a rate of 2% (OECD3). It includes public, private non-profit and private home care
services.
Persons aged 60+. Domiciliary care amounts to 6% in 1992 (O1). OECD estimates that 6% of elderly receive formal help at home, for mid 90s (OECD2).

F:
IRL: Home helps by the health boards and voluntary agencies subsidised by the health boards (IRL2). For 2000, the number is estimated at 20.000 persons: 4,7%. It includes home helps and

home care attendants.

Persons aged 60+ receiving regular help. It includes housework and personal care. The total might involve double counting and informal help (L1).
Persons 60+ receiving daily or weekly help from social services (A1). An additional 0,8%receives help less than once per week.

NL: Housekeeping and personal care. Includes specialised care and domestic care. Age group: 60+.
L:
A:
FIN:  Persons having regular home care services (Home help service or home nursing)  (FIN3).  Persons 65+ in ordinary housing with home-help services: 11% (FIN2).
S: 
UK: Covers Great Britain. The % includes only persons receiving and needing help. If we take into account all persons who report use of home help in the previous month, we obtain: Home

Persons in ordinary housing with home help services (from municipal or privately employed staff) (S2). Persons who receive home help (in relation to ADL) in 2000: 8% (S4).

help from local authorities: 4%. Use of private domestic help amounts to 9%. In 1991, the rates were respectively 9%  (LA) and 4%. (Private).

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Chart 14: Persons receiving Home help,  as a percentage of the same age group

%

12
10
8
6
4
2
0

B

DK

D

E

F

IRL

I

L

NL

A

P

FIN

S

UK

Source: see Table 27 for the definitions, the explanatory notes and the sources.

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Table 28: Persons receiving formal help

DK
Persons
receiving formal
help

1999
All
DK2

D

F

Beneficiaries of long-
term care insurance

Persons receiving help
from a professional

FIN
Persons
receiving formal
help

S
Persons
receiving formal
help

1999
All
D1

1999
Pr. House.
F1

1999
All
FIN2

1999
All
S3

0

1

2

3

4

14

41

62
13
4
23

5

14

44

16
5
30

3

10
22
41
68
14
3
24

7

36

64

28
7
52

2
3
5
11
21
38
60
12
4
23

Definition

Year
Population
Source

20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85-89
90 +
Total (65+)
Total (65-74)
Total (75+)

Notes

DK:  Persons receiving formal help. Data includes persons receiving 1+ hour of help. Age groups: 67-74, 75-79 and 80+.
        Certain statistics regroup 67-74 and 75-79 age groups. For these we have assumed a split similar to other Nordic

D: 
F:    

countries.
Beneficiaries of long-term care insurance, including households chores at least several times a week (D1).
Persons receiving help from a professional living in private households. 'Total 65+' refers to 60+; '65-74' to 60-70;
and '75+'refers to 70+.
Persons receiving formal help. The age groups are: 65-74; 75-79; and 80+. Total: 65+.

FIN:
        Certain statistics regroup 75-79 and 80-84 age groups. For these we have assumed a split similar to other Nordic

countries.
Persons receiving formal help: Age groups: 65-74; 75-79; 80-84; 85-89 and 90+.

S: 

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Chapter 2

Type of formal care

The data in the next table indicates that the classifications used are different and put serious problems
of comparability.

Germany

Care  facilities  include  home-care  and  full-time  and  part-time  institutional  services  that  are  certified
within the framework of the law on long-term care insurance (D1).

Austria

The  data  are  the  result  of  a  written  interview  with  beneficiaries  of  dependency  allowances  and  a
certain number of direct interviews.

Sweden

The importance of the different sources of formal help for persons aged 65 and over in 1999 was as
follows (S2):

- 8%  Municipal Home Help;
- 1%  Private home help (approximation),
- 3%  Home nursing care,
- 3%  Daytime activities,
- 3%  Short-term help.

A person may benefit from several forms of formal help at the same time.

UK

The  General  Household  Survey  asks  a  question  on  who  is  providing  care.  If  the  person  gets  usually
help from someone outside the household, he is asked who is the person:

Son
Daughter
Brother
Sister
Other relation
Friend/Neighbour
Social services
District nurse/ Health visitor
Paid Help
Other

Personal social services include:

District nurse / health visitor
Home help (LA)
Home help (private)
Meals-on-wheels
Day centre

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Table 29: Number of persons using formal help by type of help, in percentage of the same age group.

B
All persons Persons with

ADL-
limitations

A
Beneficiaries of dependency
allowances (services at home)

FIN
All persons

S
All persons

UK
All persons (GB) Dependent persons
(Need help to go
outdoors and walk
down the road) (GB)

B2
60+
1997

4

8

0
4
5

13

13

2
15
12

A3
60+
1995

FIN1
65-84
2001

O1
65+
1996

Care-use in % of the same age group
10
8
17

6
14
23

14

5

4

17

23

1

UK3
65+
1998

5

13

5
3

19

45

11
11

Definition

Source
Age
Year

Nursing / Personal care
Medical services
Housework / Domestic
Transport / Mobility
Administrative services
Visiting service / company
Food / Meals on wheels
Others

Notes

Data are not fully comparable.
In Belgium: 4% of all persons aged 60+ , and 13% of persons with ADL limitations receive nursing/personal care.

Covers services at home.
Includes only social services. The percentage for Home help is: 17%.

A: 
S: 
        We present below additional data concerning older persons (65+), in 1989 (Source: O1). They result from the following question: Who provides help with ... in %;

- Cleaning: Local authority 51%, Spouse: 26%, Children: 12%.
- Shopping: Local authority 38%, Spouse: 28%, Children: 30%.
- Visit toilet: Local authority 57%, Spouse: 36%, Children: 0%.

UK:  Data on voluntary organisations is not included.

Dependent persons are defined as persons needing help to go outdoors and walk down the road.
Housework / domestic services include Local authority home help (4% all, and 23% dependent persons) and private home help (9% and 22%). The addition (4+9%, and 23+22 %) might
involve double counts.

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Classifications used

B
Home help
Cleaning service
Meals-on-wheels
Informal care
Day centre
Help from local employment agencies
Other

F
Personal care
Mobility within house
Leaving house
Defence of rights/interests
Medical services
Administrative help
Shopping
Housework
Keeping company

A
Nursing services
Home help services
Meals on wheels / Food services
Visiting service
Medical service
others

FIN
Basic Service
Meals on wheels
Transport service
Help with bathing

UK3
District nurse/health visitor
Local auth.  home help and home care
Private home help
Meals-on-wheals
Lunch club
Day centre
Voluntary organisation (not reported)

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Discussion and recommendations

Statistics concerning formal help are not comparable across countries. Available statistics often rely on
administrative  registers.  Consequently  they  include  persons  who  receive  help  from  public  services
directly or indirectly.

This data includes all beneficiaries, even those who benefit a few hours per month or for a short period
of  time.  Furthermore,  these  statistics  might  include  activities  like  gardening,  small  repair  works,  etc.
which may not be included in the definition of dependency.

As these statistics are collected for the follow up of certain welfare schemes, they follow national legal
definitions. Consequently, it is difficult to achieve comparability.

Different  attempts  to  elaborate  comparable  statistics  notably  by  the  Organisation  for  Economic
Cooperation and Development (OECD) or the Nordic Social-Statistical Committee (NOSOSCO) note
the difficulties to elaborate comparable data.

Collection of comparable statistics through a survey ought to include a minimum set of questions on
the type of services used. This might include paid help concerning:

-  Personal care (ADL activities)
-  Nursing services
-  Mobility within house
-  Mobility outside the house
-  Housework
-  Shopping
-  Meals on wheels
-  Visiting service
-  Administrative help
-  Etc.

The survey ought to focus on dependent persons. Consequently, a filtering question ought to precede
the questions on the type of formal care.

An elaborated questionnaire might focus on the type of services:

- 
- 
- 

used ,
not used and not needed, and
not used but needed.

The type of provider (notably public) can be generated through administrative statistics. Furthermore,
many persons might not be able to answer whether the provider is public or private. Consequently, the
nature of the provider does not seem to be a relevant question.

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ANNEX TO SECTION III

FIN
Clients having home help services and home nursing by type of
service and age

Total

both

home help

home nursing

6.313
10.054
25.119
16.822
60.869

1.411
2.760
7.396
5.653
17.378

3.610
4.709
11.555
8.158
30.155

1.292
2.585
6.168
3.011
13.336

Total
  45-64
  65-74
  75-84
  85+
  Total
in % of clients
  45-64
  65-74
  75-84
  85+
  Total
  Mean age
Source: FIN3
Note
Statistics are based on discharge reports (reports to be made for each discharged client) and on client census reports (to be
filled in for all clients in care on the census day). Reports and censuses concern persons that receive

10
17
41
28
100
76,2

8
16
43
33
100
79,0

12
16
38
27
100
74,4

10
19
46
23
100
76,6

Institutional care and housing services with 24-hour assistance;

- 
-  Housing services with part-time assistance; and
-  Home care

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Sweden
Persons (65-84) who get help from... in % of those who need help

All

Men

Women

Living alone

Cohabitants

Daily

Every week

More seldom
Receives no help

Daily
Every week
More seldom
Receives no help

Daily
Every week
More seldom
Receives no help

Daily
Every week
More seldom
Receives no help

Daily
Every week
More seldom
Receives no help
Personal assistant
Total population in 1000*
Number of interviews
Source: S1

Other member of the household

50

5

2
44

32

10

1
57

Relative outside the household

5
19
11
65

0
1
4
95

5
28
18
49

Other private help

0
2
8
89

Municipal help including medical care

14
10
4
72

12
13
8
67

Other help (except personal assistant)

0
0
0
100
0
102
172

1
1
1
97
0
165
265

3

2

2
93

9
35
21
35

0
3
9
89

21
16
10
53

1
1
1
97
0
134
213

39

8

1
52

5
24
15
55

0
2
7
92

13
12
6
69

1
1
1
98
0
269
441

75

13

0
11

1
13
9
76

0
0
5
95

5
7
3
86

0
0
1
99
0
134
224

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UK
Proportion of disabled adults who received different services in the last year by severity category and age: adults
living in private households (1989)

Type of service received

65-74

LA home help
Meals on wheels
Laundry service
Incontinence service
Night sitting service
Mobility/technical officer for
the blind
Social worker
Voluntary services
Visiting service
Private domestic help
Private nursing help
Other services
Any of the above
Base

75+

LA home help
Meals on wheels
Laundry service
Incontinence service
Night sitting service
Mobility/technical officer for
the blind
Social worker
Voluntary services
Visiting service
Private domestic help
Private nursing help
Other services
Any of the above
Base
Source: UK2

1-2

6
0
0
0

2
1
0
3
0
1
12
1017

17
5

2
1
0
6
0
0
27
864

Severity category
5-6

3-4
Proportion of disabled adults who received each service

9-10

7-8

All Adults

8
2
1
0

0
3
1
0
3

1
15
622

28
6
1

1
4
2
0
7

1
38
719

20
2
0
1

0
8
1
1
3
0
1
29
462

41
11
2
0
0

7
2
0
7
1
1
51
715

20
5
1
1

1
12
2
1
4

2
36
288

43
17
2
2
1

10
2
1
7
2
2
58
566

28
2
4
4
1

1
22
2
1
4
2
3
55
144

30
11
5
5
1

12

4
3
2
50
317

12
2
1
1
0

0
6
1
0
3
0
1
21
2533

31
9
1
1
0

6
1
0
7
1
1
42
3181

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General conclusions

The  review  of  national  surveys  reveals  that  current  data  presents  a  certain  number  of  comparability
problems.  However,  despite  these  differences,  available  statistics  reveal  a  certain  number  of
tendencies across the Member States.

The  results  of  the  different  surveys  enable  us  to  give  a  gross  approximation  of  persons  considered
dependent  according  to  the  European  indicator  EO  c10  concerning:    'dependent  elderly  men  and
women (unable to look after themselves on a daily basis) over 75'.

If we interpret the indicator in a narrow sense to mean only personal with a self-care dependency, an
indicative approximation of the proportion of dependent people by age group might be:

- 
- 
- 

age group 20-59: 
age group 60-75: 
age group 75+: 

 1%,
 3%
12%

These percentages constitute minima levels. Still, we have to notice that there are a significant number
of dependent people below the age of 75 years.

In fact, in absolute terms, the indicative estimations are:

- 
- 
- 

2,1 million persons aged 20 to 59 years,
1,6 million persons aged 60 to 75 years, and
3,2 million persons aged 75 and over.

From the point of view of carers, this means that providing help to dependent people less than 75 years
old  might  be  as  important  as  it  is  for  persons  aged  75  and  over.  Previous  statistics  do  not  cover
dependent children as our study covers only adults and elderly people.

If we interpret the indicator in a narrow sense, it means that we have to include mainly self-care and
basic  transfer  activities  (washing,  dressing,  transfer  -  getting  in/out  of  bed/chair,  going  to  the  toilet,
continence  and  eating).  This  strict  interpretation  leads  to  the  Katz  index,  but  this  index  is  generally
considered too restrictive for a person living in the community.

In order to take into account these critics, Instrumental Activities of Daily Living have been included
in several surveys. These activities are considered to be necessary for living a more or less normal life
without  help.  In  fact,  many  Member  States  take  into  account  these  activities  in  deciding  upon  the
granting of assistance to dependent persons.

Communication, general tasks and demands, and social life are considered important by most national
social services but these activities pose a methodological problem of measurement.

Data  ought  to  include  both  dependent  persons  in  private  households  and  in  institutions.  As  noted
above,  not  all  persons  in  residential  homes  for  the  elderly  may  be  considered  as  dependent  persons.
And the choice of a residence is not independent from the nature and degree of dependency.

The discussion indicated that a future survey at a European level might include the following activities
of  the  WHO  classification  (ICF):  1)  Mobility,  2)  Self-care,  3)  Domestic  life  –  Household  tasks,  4)
Communication, 5) Sensory experiences, 6) General tasks and demands and 7) Community and social
life.

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Member  States  express  the  view  that  new  questions  ought  to  preserve  the  continuity  with  existing
instruments  and  hence  guarantee  longitudinal  comparability  of  national  data.  Furthermore,  this
harmonisation  strategy  ought  to  promote  comparability  of  data  concerning  the  socio-economic
situation of dependent persons.

A survey at a European level might be organised in two ways. A special survey covering all aspects
might  be  organised  at  a  European  level.  This  might  be  the  more  costly  solution.  Another  possibility
might be the extension and harmonisation of existing national surveys.

The  second  solution  might  be  preferable  since  all  Member  States  organise  surveys  with  similar
questions  on  activity  limitations.  The  preparatory  work  here  will  consist  mainly  in  harmonising
existing surveys, at least for a common bloc of questions.

A short simplified module could be included in the European survey “Statistics on Income and Living
Conditions” (SILC). This simplified version could be organised in regular intervals.

The review of available data indicates that household tasks are the main type of care provided by the
informal carers and women constitute the big majority of informal carers. It is important to note that
restricting ourselves into a very narrow definition of dependency might exclude an important number
of informal carers.

Some results indicate that caring might have an important adverse effect notably on the employment
of  older  workers.  However,  this  ought  to  be  interpreted  with  caution  and  needs  to  be  investigated
further in relation with the impact of allowances granted to carers.

Concerning carers, a bloc of questions could be designed to collect information on their characteristics
and the implication of caring on equal opportunities.

Questions concerning the carers fit well in the Labour Force Survey but they pose some problems in a
health interview survey. In the latter, this kind of information could be collected only indirectly, which
is questionable.

Available  statistics  on  formal  help  often  rely  on  administrative  registers.  Surveys  in  this  field  are
scarce. Further research here needs to improve our understanding of what are the desires of dependent
people and what are the best ways to meet these demands.

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PART B

STATISTICAL METHODS AND SOURCES

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Introduction

This part presents in the form of record sheets, the statistical methods and sources for the data given in
Part A.

The statistics were obtained from:

-  National sources: mainly statistical offices and ministries; and
- 

International institutions: mainly from Eurostat.

Each record sheet is made up of the following elements:

- Definition:

The  definition  of  dependency  and  other  concepts  analysed  in  this  study,  as
presented in the statistical series;

- Source:

The institution which collected the quantitative data;

- Years:

It  presents  the  reference  period  e.g.  the  year  during  which  the  data  is  collected
and the frequency of collection.
We  report  only  the  years  for  which  we  have  exploited  the  statistical  data  (and
previous years). Consequently, this is not an exhaustive list of years. Our goal is
not to present a history of these surveys. Furthermore, we do not report recent
years for which we do not possess data or the results are not of interest to our
study.
The  term  'annual  data'  means,  for  instance,  that  in  theory,  we  expect  to  have
data for each year. However, owing to delays in publication, the last few years
may be missing.

- Population:

It indicates whether the survey covers private households or institutions.

- Method:

It presents the methodology utilised for the collection and the exploitation of the
statistical series.

- Publication:

The  original  publication  from  which  the  statistics  are  taken  or,  where  non-
published information is concerned, the institution responsible.

- Commentary:

Provides comments and additional information for the interpretation of statistics.

- Tables:

Lists the tables in Part A of the report, which present the statistics for the record
sheet in question.

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BELGIUM

B1.

Health Interview Survey

Definition

Activity limitation
The survey considers different indicators.
The  first  determines  if  the  person  suffers  from  a  long-term  illness  or  handicap.    The
survey  distinguishes  permanent  and  temporary  limitations.  Then,  the  respondents
were asked to value (on a 100 points scale) the physical functions they are still able to
perform  such  as  walk  (the  score100  =  no  limitation),  go  up  and  down  stairs,  carry  a
shopping bag, etc.

Within  the  disabilities  concerning  the  most  elementary  activities  of  daily  life  such  as
getting  up,  washing  oneself,  dressing,  etc.,  the  survey  makes  the  distinction  between
those  who  can  do  it  'with  difficulty'  and  those  'who  necessitate  the  need  of  someone
else'.

Persons with a severe disability
Persons with at least one severe limitation among the following ten functions: getting
in  and  out  of  bed,  getting  up  sitting  down,  dressing/undressing,  washing  hands  and
face, eating and cutting food, going to the toilet, urinary continence, walking, hearing
and seeing.

Social participation restriction
The survey uses here the notion of 'mobility handicap' expressed by confinement, e.g.
'stay at home', 'stay sitting in a chair', or 'stay in bed'.

Source

Institut Scientifique de la Santé Publique – Institut National de Statistique

Years

1997, 2001.

Population

All

Methodology The  sample  of  12.111  persons  was  chosen  randomly  on  the  base  of  the  National
Register Book of the population.  No exclusion was made as to the nationality or as to
the group of age.  Certain questions however were just asked to persons aged 15 years
or more.  The sample includes isolated persons.

The  first  part  is  dedicated  to  the  state  of  health  in  general.  Follows  questions  on
physical troubles, the impact of problems of mental health, emotional troubles on well
being and on the quality of life.  These topics are treated in the survey through the use
of  two  questionnaires:  The  “General  Health  Questionnaire”  and  the  “Symptom
Checklist-90-Revised”.

The  survey  also  studies  the  consequences  of  the  physical  or  psychological  problems
on  daily  life.    Respondents  also  have  been  questioned  about  recent  disabilities  i.e.
which have occurred within the last 2 weeks.

Publication

“Enquête  de  Santé  par  Interview      Belgique  2001”,  Institut  Scientifique  de  la  Santé
Publique, IPH/EPI Reports nr 2002 – 22 & 25.

Comments

The exploitation of the results distinguishes physical disability and mental health.

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Tables :

4, 5, 6, 7, 8, 11.

B2.

Dependent persons in care homes

Definition

Care dependent persons in rest homes and nursing homes.
The study distinguishes:
-  Category 0: Independent persons, not suffering from dementia
-  Category A: Assistance in washing and dressing + persons suffering from dementia

with no functional limitations

-  Category  B:  Assistance  in  washing  and  dressing  and  assistance  in  getting  to  the
toilet  and/or  assistance  in  transfer  +  persons  suffering  from  dementia  needing
assistance in washing and dressing

-  Category C: Assistance in washing, dressing, getting to the toilet, moving about and
assistance in eating and/or incontinence + persons suffering from dementia meeting
criteria of category B.

Care dependency
The  authors  distinguish:  self-dependent  persons,  moderately  care  dependent,  highly
care dependent, and very highly care dependent.
Persons 75+: Use of Katz index.
- 
Fully independent person: Katz index = 0.
- 
Moderately care dependent: Katz index = 1 or 2.
- 
Highly care dependent: Katz index = 3 or 4.
- 
Very highly care dependent: Katz index = 5 or 6.
Persons less than 75 years: Use of an approximate Katz index.

National Sickness and Invalidity Insurance Institute (RIZIV)
Health Interview Survey (see B1)
Department of Sociology and Social Policy, University of Antwerp (UFSIA)

1999 (RIZIV)
1997 (see B1)
1994 (UFSIA-DSSB)

Source

Years

Population

All Flemish population.

Methodology Estimation  by  the  authors  using  the  number  of  persons  in  rest  homes  and  nursing

homes provided by the National Sickness and Invalidity Insurance Institute.

For persons aged less than 75 years, they use the Health Interview Survey, 1997. For
persons aged 75 or over, they use the UFSIA-DSSB-1994 survey.

In order to calculate the totals for persons aged 60 and over, we have used as weights
for the different age groups, the distribution of the total population by age group.

Publication

Breda,  J.  and  Geerts,  J.,  “Care  dependency  and  non-medical  care  use  in  Flanders”,
Archives of Public Health, 2001, 59, p. 329-346.

Comments

By  exploiting  the  results  of  the  Health  Interview  Survey  (1997)  and  other  special
surveys,  the  authors  estimate  the  percentage  of  care  dependent  individuals  in  the
Flemish  Region  to  be  11,6%  for  persons  aged  60-74  and  30,1%  for  75+,  in  1997.
These estimates include moderately, highly and very highly care dependent persons.

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The authors note that the UFSIA-DSSB survey of the aged reports that some 38% of
the elderly residing in rest homes had no ADL-limitations. Only 7% of these elderly
people without ADL-limitations had no IADL-limitations either.

A survey done by Vanden Boer L. (Vanden Boer L., “Functional status and the care
network  among  elderly  residents  of  sheltered  housing”,  Archives  of  Public  Health,
1997, 55, p. 63-85) of 620 residents of service flats and serviced housing complexes
in Flanders, in 1993, finds that 16% of the service-flat residents turns out to be self-
sufficient. About 67% of service-flat residents had some need for assistance, 13% had
considerable need for assistance and 4% a serious need for assistance.

Tables

2, 3, 8, 16, 27.

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DENMARK

DK1.     Danish Health and Morbidity Survey

Definition

Persons  with  very  restricting  long-standing  illness.  However,  detailed  data  refers  to
difficulties.

Physical mobility includes notably:
-  Walking up and down a stair case from one floor to another without resting;
-  Walking 400 meters without resting and carrying 5 kg.

Communication skills include:
-  Difficulty in reading a newspaper,
-  Ability to hear a conversation between several individuals, and
-  Ability to talk without difficulty.

Source

National Institute of Public Health

Years

1987, 1991, 1994, 2000

Population

All

Methodology The  Danish  Health  and  Morbidity  Surveys  (SUSY)  are  established  by  interviewing
randomly  selected  Danes  extracted  from  the  Danish  Civil  Registration  System.  Each
interview  is  carried  out  in  the  residence  of  the  interviewee.  After  completing  an
interview,  a  postal  questionnaire  is  handed  out  in  order  to  be  completed  at
convenience. It covers Danes adults aged 16 years or older.

All  in  all  22.486  adult  persons  were  invited,  16.690  (74,2%)  were  interviewed  and
14.278  (63,5%)  returned  a  postal  questionnaire,  in  2000.  The  overall  sampling
fraction was 0,54% ranging between 0,36% and 2,35% in the 15 counties.

The data for 1994 was collected in three waves. Every wave was containing a random
sample of about 2000 individuals. 4668 individuals completed the interview equalling
78% of the random sample.

Estimations  of  prevalence  in  the  entire  population  use  stratified  (weighted)
computations.

Publication

“Sundhed & Sygelighed I Danmark 2000 & udviklingen siden 1987”, Statens Institut
for Folkesundhed, København, 2002.

“Danish Health and Morbidity Survey 1994”, http://www.susy.si-folkesundhed.dk/

Comments

The  years  of  healthy  life  lost  at  60  years  old  measures  the  life  expectancy  of  a  60-
year-old  man  minus  the  number  of  years  in  states  of  reduced  functioning.  The
expected  number  of  years  of  healthy  life  lost  for  a  60-year-old  man  decreased  from
5,3 in 1987 to 4,1 in 2000. The decrease among women was slightly less – from 8,4 to
7,7 years.

Tables

2, 4, 6, 7, 8, 9, 10.

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DK2.     Persons receiving help

Definition

Persons  (Households)  receiving  help  in  ordinary  housing,  and  in  institutions  and
service housing. Home help includes personal and practical help.

Institutions  include  nursing  homes,  homes  for  the  long-term  ill  and  old  people’s
homes.  Service  housing  includes  sheltered  homes,  service  flats,  collective  housing,
housing where special care is provided, etc. Elderly people may also, be offered long-
term  medical  treatment  in  hospital  wards  –  often  in  the  so-called  geriatric  wards.
There are special wards in some nursing homes.

Source

Nordic Social-Statistical Committee (NOSOSCO)
Statistics Denmark

Years

Annual data

Population

All

Methodology Home help

Number of people who received help from municipal or privately employed staff.

Until 1998, recipients were calculated as households, from 1999 as persons.

In  1998,  there  were  201.500  recipients.  The  number  of  beneficiaries  in  2001  was
203.000 persons. The average number of hours allocated for permanent home help is
about  5  hours  per  week  in  2001.  The  number  of  recipients  aged  67+  who  received
permanent  home  help  in  1998  was  172.463  (25%  of  the  same  age  group).  The
distribution of beneficiaries by hours of help was:

- 
- 
- 
- 

63% received 
13%
13%
11%.

1-3 hours per week;
4-6 hours per week;
7-12 hours per week;
13+ hours per week:

For comparability purposes, when we refer to dependent beneficiaries, we exclude the
first group (1-3 hours per week).

Dependent people in institutions or service housing
Number of people living in institutions or service housing.

In order to take into account only persons requiring assistance we have taken 50% of
the age group 67-74, 60% for 75-89, 70% for 80+. These are non-weighted averages
of dependent persons in institutions in Belgium, France and the United Kingdom.

For home help, the age groups are: 67-79 and 80+. For institutions the age groups are:
67-74, 75-79 and 80+. We had to split the home help component into 67-74 and 75-
79. We took into account comparable rates in other Nordic countries and the weights
of the respective age groups.

Publication

“Social  Protection  in  the  Nordic  Countries”,  Nordic  Social-Statistical  Committee
(NOSOSCO), Copenhagen, 2001.

“The social Sector in Figures 2002”, Ministry of Social Affairs, Copenhagen.

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Comments

The Nordic Social-Statistical Committee (NOSOSCO) notes that statistics concerning
home  help  in  the  Nordic  countries  are  not  easily  comparable.  It  indicates  that  the
extent of assistance is determined on the basis of individual needs and may vary from
a few hours per month to several hours per day.

The  assistance  is  a  municipal  matter  and  is  provided  by  municipal  or  privately
employed staff.

In  all  Nordic  countries,  people  with  severe  disabilities  may  be  granted  financial
support towards payment of personal assistance and help to manage the household.

Tables

27, 28.

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GERMANY

D1. 

Beneficiaries of long-term care insurance

Definition

Activities of daily living

Personal  hygiene:  washing,  showering,  bathing,  dental  hygiene,  combing  your  hair,
shaving, going to the bathroom
Eating: eating, and preparing food so that it is bite-sized and ready to eat
Mobility:  getting  out  of  and  going  to  bed,  getting  dressed  and  undressed,  walking,
standing, climbing stairs, leaving and getting back to your home without assistance
Housekeeping:  grocery  shopping,  cooking,  cleaning,  dishwashing,  changing  and
washing linen and clothing, heating the home

Care dependency

Level 1: considerable need of care, requiring help at least
-  Once  a  day  with  personal  hygiene,  eating,  or  with  a  minimum  of  two  activities

from one or more types of activity, and

-  Several times a week help with household chores

Level 2: severe need of care, requiring help at least
-  Three times a day with personal hygiene, eating or getting around, and
-  Several times per week with household chores

Level 3: extreme need of care, requiring
-  Round-the-clock  help  every  day  with  personal  hygiene,  eating  or  getting  around,

and

-  Help several times a week with household chores

Care facilities

Care facilities include home-care and full-time and part-time institutional services that
are  certified  within  the  framework  of  the  law  on  long-term  care  insurance
(Pflegeversicherungsgesetz SGB XI)

Source

Statistisches Bundesamt

Years

Data was collected for the first time in December 1999; is collected twice a year.

Population

All

Methodology The  aim  of  the  data  collection  is  to  obtain  information  concerning  offer  and  demand
of care provision. Data collection includes therefore on the one-hand persons who are
care-dependent  and  on  the  other  hand  institutions  and  home  help  services  including
their staff.

on 

are 

based 

Definitions 
insurance,
Pflegeversicherungsgesetz  SGB  XI  (§  109.1  in  relation  with  BGBI.  I.  S.  2282  of
24.11.1999).  Statistics  must  be  provided  by  private  and  public  health  insurance
companies  and  by  the  concerned  care  facilities  (legal  obligation  under  BGBI.  I.  S.
2282).

long-term 

care 

law 

the 

on 

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Statistics include 2,02 million care dependent persons. 10.800 care services and 1,03
million  informal  carers  care  for  1,44  million  dependent  persons.  573.000  dependent
persons receive care in 8.900 nursing homes.

Publication

Statistisches  Bundesamt,  Kurzbericht  :  Pflegestatistik  1999.  Deutschlandergebnisse,
Bonn, 2000

Comments

-

Tables  

14, 15, 28.

D2.

 Help and care dependent persons in private households

Definition

Restrictions of activities
Persons were asked if the following indicators of restrictions were relevant to them
-  Continuous diseases, complaints or handicaps
-  Certified severe disability
-  Use of medical-technical aids
-  Long-term dependency on care or help
-  Confined to bed

If one of these categories applied, persons were asked on restrictions of activities and
instrumental activities of daily living.

Dependency on care and help
The  autonomous  performance  of  activities  is  impossible  or  the  person  depends  on
help.  Generally,  care-dependency  is  due  to  several  restrictions  that  concern  whole
blocks of activities.
1.  Continuous dependency

Persons need help for all areas of body-care (leave the bed, use the toilet etc.) and
are  generally  immobile.  Continence,  eating  and  drinking  are  the  most  common
factors. Housework is entirely done by a third party.

2.  Daily need for care

Persons  need  help  for  daily  hygiene  (bath,  shower,  washing).  Mobility  and
movements of body-parts are restricted (getting dressed etc.). Persons need help in
order to do their housework.

3.  Need for care several times a week

Persons need help for some household-tasks, but are in general still able to cook.

Informal carers
The  informal  carer  is  the  main  carer  in  private  households.  One  carer  might  give
several types of care or help.

Employment situation
Principal carers aged 18-64 in private households.

Source

Statistisches Bundesamt

Years

1991/92

Population

Private households.

Methodology The survey is based on two samples of the population of East and West Germany: a
household sample (B) for the whole population and a sample of elderly persons aged

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70 and more (A) living in private households. The sample excludes persons living in
institutions.

The  sample  ‘A’  follows  a  survey  of  1986  in  West  Germany.  In  order  to  add  East
German  data,  supplementary  addresses  were  drawn  out  of  the  population  register.
Sample ‘B’ was formed along the Random-Route-Procedure.

Sample  ‘B’  is  based  on  22.644,  sample  ‘A’  on  3.092  households.  Both  samples
include  60.938  persons.  The  survey  was  done  from  November  1991  until  February
1992. Data projections were made in relation to the population structure of 1989.

Publication

“Hilfe-  und  Pflegebedürftige  in  privaten  Haushalten”,  Schneekloth  U.  et  al,  Bonn,
1996.

Comments

-

Tables

2, 3, 4, 5, 6, 8, 11, 12, 24, 25, 26.

D3.  Microcensus: care dependency in the framework of the long-term care insurance

Definition

Care dependency
Persons answered the following questions:
-  Do you need help for body-care, nutrition, movements, mobility, housework?
-  How often do you receive help? Once a day; Twice a day; Three times a day and

more; All the time; Not known; No help

-  Do you receive allocations of the long-term care insurance?
-  For which level of dependency do you receive benefits? Level 1; Level 2; Level 3;

Not known; No benefits

Disability
Disability is the consequence of a restricted functionality with a minimum duration of
six months, based on a physical, mental or emotional health status that deviates from
the typical health-status of the specific age group. Normal characteristics of ageing are
hence not considered as a disability.

Persons,  whose  degree  of  disability  amounts  to  at  least  50,  are  considered  to  be
severely  disabled.  Persons  with  a  degree  of  less  than  50  are  considered  as  moderate
disabled. The degree of disability reflects the extent of the restriction of functionality.
The scale rises in grades of ten from 20 until 100.

Persons answered the following questions:
-  Was a handicap testified or did you apply for such an official recognition?
-  What is the degree of the officially recognised handicap? Under 25 %; 25-29 %;

30-39 %; … 90-99 %; 100 %

Source

Statistisches Bundesamt

Years

Annual data – the questions about care and disability every four years.

Methodology The microcensus covers 370.000 households with 820.000 persons. All households in
certain districts are questioned. A quarter of chosen districts are replaced every year.
Households participate hence during 4 years in the census.

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The  microcensus  consists  of  a  basic  module  with  yearly  periodicity  and  additional
modules  that  appear  every  four  years.  The  module  on  care  dependency  is  such  an
additional module and will be included the next time in April 2003.

Results of the care-module are based on the sample of the Microcensus of April 1999.
The  framework  for  extrapolations  was  the  Pflegestatistik.  Definitions  are,  as  in  the
Pflegestatistik, 
insurance,
law 
Pflegeversicherungsgesetz SGB XI.

long-term 

based 

care 

the 

on 

on 

Results  of  the  module  on  disability  are  based  on  the  sample  of  the  Microcensus  of
April  1999.  The  framework  for  extrapolations  was  the  Schwerbehindertenstatistik
(Statistics of severely disabled). Definitions are based on the law on severe disability,
Schwerbehindertengesetz.

Publication

Heiko  Pfaff,  Sonderbericht:  Lebenslagen  der  Pflegebedürftigen  –  Pflege  im  Rahmen
der Pflegeversicherung – Deutschlandergebnisse des Mikrozensus 1999

Heiko  Pfaff,  “Lebenslagen  der  Behinderten  –  Ergebnis  des  Mikrozensus  1999”,  in
Wirtschaft und Statistik 10 / 2002, S.869 – 876.

Comments

-

Tables

22.

D4

4th Report on the situation of elderly

Definition

The report covers very old persons, defined as elderly aged 80 and more.

Source

Federal Ministry of Family, Elderly, Women and Youth.

Years

2002

Population

-

Methodology The  estimation  was  done  by  the  Federal  Ministry  of  Family,  Elderly,  Women  and
Youth. The Ministry installed an expert commission for the topic: “Risks in high age
under consideration of dementia – challenges for politics”.

Publication

Bundesministerium  für  Familie,  Senioren,  Frauen  und  Jugend,  Vierter  Bericht  zur
Lage  der  älteren  Generation 
in  der  Bundesrepublik  Deutschland.  Risiken,
Lebensqualität  und  Versorgung  Hochaltriger  –  unter  besonderer  Berücksichtigung
Dementieller Erkrankungen, Berlin 2002.

Comments

-

Tables

23.

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ELLAS

Definition

Persons with limitations of Activities of Daily Living.

Source

Estimations by the author.

Years

1999

Population

All

Methodology The European Community Household Panel (ECHP) generally gives an estimation of
the  total  number  of  people  hampered  in  daily  activities  by  any  physical  or  mental
health  problem,  illness  or  disability  lower  compared  to  other  European  countries.
Similar results are found for Ireland and Italy. This estimation for Greece is close to
the  number  of  persons  receiving  a  disability  related  benefit.  In  fact,  the  following
chart  indicates  that  the  number  of  beneficiaries  of  a  disability  related  benefit  (EL:
Beneficiaries)  is  close  to  the  number  of  people  who  are  severely  or  moderately
hampered (EL: Total). Similar results are found for Italy.

Concerning  severe  disabilities,  the  ECHP  estimation  for  Greece  is  close  to  the  EU
average (see chart), but slightly lower. The situation in Greece appears thus very close
to  the  EU  average.  Consequently,  in  order  to  estimate  the  number  of  persons  with
ADL  limitations,  we  have  taken  the  average  (geometric  mean)  of  the  national
estimates  presented  in  Table  2.  Furthermore,  in  order  to  take  into  account  the  slight
difference between Greece and the EU average, we have taken 90% of this average.

Finally, we obtain approximately 14% (age group: 65+) and 23% (age group: 75+).

Greece: Persons with limitations by age

%

80

70

60

50

40

30

20

10

0

EL: Beneficiaries

EL: Severe

EL: Total

EU: Severe

0

20

40

60

80

100

Publication

-

Comments

Concerning the estimation of beneficiaries of disability related benefits, we have used
the data presented in “Disabled People: Statistical Data”, S. Grammenos, Eurostat, 2nd
Edition, 1995. 

Table

2.

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SPAIN

E1.

 Impairment, Disabilities and Handicaps

Definition

Number of dependent persons
The  survey’s  definition  of  disability  is  based  on  the  International  Classification  of
Impairments,  Disabilities  and  Handicaps  (ICIDH).  Disability  is  defined  as  limiting
the  human  capacity  to  the  point  of  making  a  person’s  normal  activity  impossible  or
extremely  difficult.  For  example,  a  difficulty  to  speak,  understand,  communicate,
move, take care of oneself etc.

Distribution by nature of needs
The  survey’s  definition  of  disability  is  based  on  the  International  Classification  of
Impairments, Disabilities and Handicaps (ICIDH).

Distribution by degree of dependency
The  severity  grade  of  a  disability  relates  to  the  difficulty  (no,  moderate,  severe  and
total  difficulty)  in  performing  activities  of  daily  living:  changing  the  position  of  the
body;  getting  up  and  lying  down;  getting  around  inside  the  home;  getting  around
without  a  means  of  transportation;  washing  oneself;  controlling  bodily  functions;
dressing oneself; eating and drinking; shopping, preparing meals, washing and ironing
clothes,  cleaning  and  maintaining  the  home  and  looking  after  the  welfare  of  other
family members.

Informal carers
The  study  includes  the  following  classification  of  the  carers:  husband  or  wife/son  or
daughter/brother 
or
neighbours/host/other relation It also mentions if the carer lives in the same household
or if he or she lives outside, as well as the number of hours devoted to help.

or  mother/other 

sister/father 

relative/ 

friends 

or 

Formal help
The study distinguishes the help coming from 'employees' and from 'social services'.

Source

Instituto Nacional de Estadistica (INE)

Years

1986, 1999

Population

Private households

Methodology The survey addresses the population living in households. The sample includes 80.000
households, that is 220.000 people. Information was collected in the second quarter of
1999. The survey established three age groups, 0-5 years, 6-64 years and 65+ years.

Only  disabilities  taking  their  origin  in  a  well-defined  impairment  were  taken  into
account.  Exception was made for the ones due to a process of natural degeneration.
A  disability  is  considered  as  'long-term  disability'  if  it  is  implicit  in  the  impairment
(e.g..  in  case  of  mental  retardation),  or  if  it  has  been  lasting  for  at  least  1  year.    A
disability entirely compensated by a technical relief, will not be retained.  Let us note
moreover that with regard to the group 'less than 6 years of age', certain impairments
are not yet translated into disabilities.

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The  variables  used  for  the  group  'more  than  64  years'  are  the  same  as  for  the  group
'between  6  and  64  years  '.    However,  the  exploitation  of  these  variables  was  made
independently.

We can point out that in a first stage of the survey, questions were addressed to all the
members  of  the  household.  The  aim  was  to  define  the  type  and  composition  of  the
household.  Information  was  requested  about 
the
professional  situation,  the  type  of  relationship  between  the  persons  living  in  the
household,  also  about  the  internment  in  a  public  establishment  within  the  last  12
months, etc.

the  education 

level,  about 

Publication

INE  (2001)  :  Encuesta  sobre  Discapacidades,  Deficiencias  y  Estado  de  Salud  1999:
Avance de resultados, Madrid

Comments

The characteristics of carers providing help was provided by CIS.

Tables

2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 22, 23, 24, 25.

E2.

Beneficiaries of home help

Definition

Number of beneficiaries of home help provided by public services. Help includes care
and domestic tasks.

Source

Instituto Nacional de Estadistica (INE)

Years

Annual

Population

-

Methodology Administrative data. Number of beneficiaries.

Publication

INEbase.

Comments

About  76.000  persons  aged  65  and  over  are  beneficiaries  of  public  tele-assistence
services. It represents about 1% of the same age group.

The  Survey  on  Disabilities  (E1)  reports  that  about  138.000  persons  with  disabilities
receive help from social services and the market. This represents 2% of the population
aged 65+.

OECD  reports  the  rate  of  elderly  people  receiving  home  help.  It  amounts  to  2%
(OECD3). It includes public, private non-profit and private home care services.

Tables

27.

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FRANCE

F1. 

Handicaps-Disabilities-Dependencies

Definition

Impairments, Disabilities and Handicaps
The  study  uses  the  International  classification  of  Impairments,  Disabilities  and
Handicaps  (WHO).  The  relationship  of  diseases  and  handicaps  is  described  in  terms
of the Wood-Sequence.

Disabilities are a restricted ability, or a lack, of ability, to perform normal activities or
more complex ones. Normal activities include physical activities such as standing up,
getting  up,  or  walking  up  a  staircase,  and  mental  activities  such  as  memorising.
Complex activities include dressing, using the telephone, and conversing with several
persons. Disabilities are generally due to one or more impairments.

Disadvantages denote a restricted ability, or a lack of ability, to fulfil a social role that
the  person  may  seek  to  perform  or  that  society  expects  of  the  person.  Such  roles
include  attending  school,  doing  work,  communicating  with  other  people,  and
parenting.

Persons living in institutions
Institutions consist of healthcare and welfare institutions accommodating handicapped
persons  and  seniors  suffering  from  functional  impairments.  This  category  primarily
includes  homes  for  seniors  and  handicapped  adults,  teenagers,  and  pre-teenage
children. Psychiatric institutions were added.

Degree of dependency
Data covers individuals who responded that they did not or that they did need aid for
each of the activities of daily living. The study uses the Katz-index that includes the
activities  washing,  dressing,  going  to  toilet  and  using  it,  lying  /  sitting  down  and
getting up, continence, eat already prepared meals.

Informal care
Any  care  not  directly  provided  by  a  professional  sector  –  i.e.,  a  medical,  social
service,  or  institutional  sector.  Informal  care  thus  excludes  services  provided  by
professionals and volunteers working for non-profit organisations.

Colvez-indicator / Formal help
The Colvez-indicator classes persons in four groups:
1. 
2. 
3. 

Limited to bed or chair
Not limited to bed or chair but needing help for toilet or dressing
Persons  needing  help  to  leave  their  home  or  institution,  but  who  don’t
belong to level 1 or 2
Other persons who are considered to be not dependent

4. 

Data  covers  persons  who  belong  to  the  first  three  levels.  Types  of  residence  include
establishments for elderly, other establishments and private households.

Source

Institut  national  de  la  statistique  et  des  études  économiques  (INSEE  :  National
Institute of Statistics and Economic Studies).

Years

1998/99 and 2000/01.

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Population

All

Methodology The  Handicaps-Disabilities-Dependency  (HDD)  project  has  four  main  goals:  (1)  to
provide framework data, (2) to establish forecasts and estimate flows, (3) to make the
most  of  existing  sources,  and  (4)  to  meet  local  players’  information  needs.  The  first
objective  required  a  survey  of  both  the  institutional  population  and  private
households.  The  second  required  tracking  the  survey  respondents  over  time.  This
called  for  two  surveys—each  with  its  tracking  procedure—and  even  three  surveys,
since  the  definition  of  the  HDD  survey  sample  of  private  households  demanded  a
prior  large-scale  filtering  of  the  total  population  using  the  criteria  of  the  Daily  Life
and Health survey (hereafter DLH; in French, Vie Quotidienne et Santé: VQS).

Persons living in institutions
16.000  individuals  in  2000  pension  homes,  homes  for  disabled  and  psychiatric
institutions  were  questioned  in  two  waves  in  1998  and  in  2000;  the  questionnaire
covers the three dimensions of a handicap: deficiency, incapacity and disadvantage.

Persons living in private households
Persons  living  in  private  households  required  a  two-stage  survey.  The  first  filtering
stage  serves  merely  to  count  the  people  concerned  and  select  those  for  subsequent
interview. The second stage serves to describe respondents’ disabilities, the origins or
causes  of  these  disabilities,  and  any  limiting  consequences  on  participation  in  the
main areas of social activity.

A filtering survey requires a sample eight to ten times larger than the population to be
interviewed and described. The sample for the HDD survey’s household section was
set at 20.000 people. The preliminary filtering operation – i.e., the DLH – thus had to
cover at least 160.000 people representative of the French population living in private
dwellings.

The sample for the preliminary filtering did finally amount to 400.000 persons. These
persons  received  a  written  questionnaire  in  1999.  359.000  answers  were  exploited.
20.000 persons were finally interviewed in two waves in 1999 and 2001.

Formal help
C. Aliaga and N. Dutheil (F1) report that 3.230.000 persons aged 60+ living at home
received a regular help. This represents 28% of the same age group.

About  50%  of  these  beneficiaries  receive  a  professional  help  or  a  combination  of
professional  and  informal  help.  Consequently,  14%  of  persons  aged  60+  receives
formal care. Among those receiving formal help, about one third receives at least care
from a paramedical worker (nurse, kinesitherapist, etc.). This means that about 5% of
persons  aged  60+  receives  at  least  a  paramedical  service.  We  consider  this  as  an
important indicator for self-care dependency.

Furthermore,  the  average  duration  of  help  is  almost  7  hours,  but  50%  of  the
beneficiaries receive help, which lasts less than 3 hours per week. This means that 7%
of the population aged 60+ receives a regular and significant formal help. In fact, we
consider that we have to exclude those receiving care of less than 3 hours per week.
This  help  might  be  convenience  help  or  include  help  that  is  dominated  by  cultural
patterns (e.g. cleaning services). This is further sustained by the fact that among those
who receive professional help 86% use a cleaning man/woman or an auxiliary help.

Finally, we consider that the rate of 7% is the best indicator.

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Publications

“Enquête  Handicaps  -  Incapacités  -  Dépendance  en  Institution  en  1998:  Résultats
détaillés”, Goillot, C., and Mormiche P., 2001.

Comments

“Enquête  Handicaps  –  Incapacités  -  Dépendance  auprès  des  personnes  vivant  en
domicile ordinaire en 1999: Résultats détaillés”, Goillot, C., and Mormiche P., 2002.

“Aider les personnes âgées à vivre à domicile: nature des aides et conséquences pour
l’entourage”,  Aliaga,  C.,  and  Dutheil,  N.,  Protection  sociale  9,  Données  Sociales
2002-2003, INSEE, p. 635-640.

“Le  nombre  de  personnes  dépendantes  d’après  l’enquête  Handicaps-incapacités-
dépendance”,    C.  Colin  and  V.  Coutton,  Etudes  et  résultats  N°  94,  décembre  2000,
drees.

The  survey  retains  the  relationship  of  diseases  and  handicaps  as  described  in  the
Wood-Sequence.  Diseases  (in  the  broad  sense,  i.e.  including  accidents  and  other
mental  and  physical  traumas)  are  the  first  link  in  the  chain.  They  are  susceptible  to
diagnosis and medical treatment. Impairments denote any loss (such as amputation or
sclerosis) or dysfunction of a body part (limb, muscle or organ) or of the brain. They
generally result from a disease or trauma. A similar and more commonly used notion
is 'invalidity'.

For information, we present below the distribution according to the Colvez index:

Elderly dependent persons (Colvez  indicator)

Level1 (confined in bed or chair)
Level 2 (need for washing and dressing)
Total severe dependency
Level  3 (need to go out)
Total dependency
Level 4 (non dependent)
Unknown dependence level
Total 60+

Level1 (confined in bed or chair)
Level 2 (need for washing and dressing)
Total severe dependency
Level 3 (need  to go out)
Total dependency
Level 4 (non dependent)
Unknown dependence level
Total 60+

Home

Institutions
for elderly

Homes for
disabled and
psychiatric

Total

105.000
300.000
405.000
648.000
1.053.000
10.509.000
34.000
11.586.000

118.000
99.000
217.000
135.000
352.000
111.000
17.000
480.000

225.000
2.000
403.000
4.000
628.000
6.000
789.000
6.000
12.000
1.417.000
4.000 10.624.000
53.000
2.000
18.000 12.084.000

47
74
64
82
74
99
64
96

52
25
35
17
25
1
32
4

1
1
1
1
1
0
4
0

100
100
100
100
100
100
100
100

Tables

2, 4, 6, 7, 8, 9, 10, 14, 15, 16, 18, 19, 21, 23, 25, 27, 28.

 F2.

Survey on Health and Medical Care (ESSM)

Definition

Handicap
Persons who are handicapped or have some troubles or difficulties in every day life.

Degree of impairment

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No  trouble  (discomfort),  very  small  trouble,  trouble  but  has  a  normal  life,  has  to
restrict his activities, restricted or slow activity, no autonomy at home, permanently in
bed.

Degree of dependency
For  daily  activities  the  interviewee  could  answer:  can  do  the  activity  a)  with  no
difficulty; b) with many difficulties.

Mobility disability
Persons who declare having trouble (discomfort) to stand up, to go out. The statistic is
large as it includes all levels of discomfort.

Confined at home
Persons who may not stand up or may do it sometimes.

Source

National Institute of Statistics and Economic Studies (Institut national de la statistique
et des études économiques: INSEE).

Years

1980, 1991.

Population

Private households

Methodology Representative sample of ordinary households in Metropolitan France. The sample is
drawn from the census. Every interviewee received five visits, one every three weeks.

Publication

“Enquêtes  décennales  sur  la  Santé  et  les  Soins  Médicaux  1980-1991”,  Centre  de
Recherche en Economie de la Santé (CREDES).

Comments

-

Tables

3, 5.

F3.

Living conditions

Definition

Physical dependency
Need  for  assistance  for  the  following  activities:  eat,  washing  oneself,  dressing,
mobility (getting out of bed, of the room, of the house), climb stairs. Weighting of the
different  activities  takes  into  account  the  frequency  of  help  required  (occasional,
regular, permanent).

Dependent for domestic life activities
Need for assistance for the following activities: shopping, preparing  meals,  cleaning,
and  administrative  tasks.  Weighting  of  the  different  activities  takes  into  account  the
frequency of help required (occasional, regular, permanent).

Source

National Institute of Statistics and Economic Studies (Institut national de la statistique
et des études économiques: INSEE).

Years

1990

Population

Private households. Age: 60 and over.

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Methodology The  survey  centred  on  income  and  living  conditions.  It  took  place  during  1989  and
1990. The representative sample included 8.071 private households with at least one
person aged 60 or more.

Publication

“Aisance à 60 ans, dépendance et isolement à 80 ans”, M. G. David and C. Starzec,
INSEE PREMIERE, N° 447 – Avril 1996, INSEE.

Comments

We did not retain data concerning people ‘moderately autonomous’.
The survey gives for persons 60 years and over: 3,7%, 3,6% and 1,1% persons of the
same  age  group  needing  respectively  help  for  standing  up,  climbing  a  stair  and
washing oneself.

Tables

11.

F4.

Household Living Conditions

Definition

Dependency
Adjusted Colvez classification  (See Glossary: ‘Colvez’).

Source

National Institute of Statistics and Economic Studies (Institut national de la statistique
et des études économiques: INSEE).

Years

1996

Population

Private households.

Methodology The  national  ‘Household  Living  Conditions’  panel  survey  collected  information  on
14.845  individuals  (2.211  of  whom  were  elderly)  living  at  home.  Two  extensions
were  added  to  this  survey.  The  Paris  area  extension  used  the  same  methodology  to
collect  information  on  2.479  individuals  (251  of  whom  were  elderly).  The  Eure-et-
Loir  extension  was  designed  to  study  care  received  by  seniors  and  was  based  on  an
abridged questionnaire. This second extension collected information from 1.058 aged
individuals.  The  national  survey  and  the  two  extensions  were  combined  to  form  a
preliminary sample of 3.520 seniors, 1.509 of whom answered the Kish questionnaire
on dependency care.

Households are asked among other questions about the informal and formal care they
receive  (excluding  dependency  care).  Dependency  care  data  is  collected  by  a  Kish
questionnaire.

Dependency care focuses on essential daily activities (by excluding activities assumed
to  be  characteristic  of  convenience  care).  The  methodology  prevents  a  reduced
volume of care from having an influence on the receipt of formal and informal care.

Publication

“Caring  for  the  dependent  elderly:  More  Informal  than  Formal”,  Breuil-Genier,  P.,
INSEE Studies, no 39, September 1999.

Comments

The author estimates that one in ten people aged 65 and over cannot get out without
help.

Total  hours  of  care  increase  with  dependency  and  isolation.  The  lower  the  average
hourly price of formal care, the longer the hours received. Formal and informal care

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volumes vary too much from one dependent person to another to be able to determine
the extent to which these two types of care are substitutes.

Tables

19.

F5

Survey of residential institutions for elderly people (EHPA)

Definition

Residents of care homes for the elderly people.

Source

Ministry of Employment and Solidarity.

Years

1992, 1994, 1996

Population

Residents of homes for elderly persons

Methodology The  survey  takes  place  every  two  years.  It  aims  to  identify  the  activities,  structures
and  the  personnel  of  the  residential  homes  for  elderly  people.  Every  four  years  a
specific module collects information on the characteristics of clients.
A  specific  survey  on  health  institutions  collects  information  on  long-term  nursing
homes.

Publication

“Annuaire  des  statistiques  sanitaires  et  sociales:  2000”,  Collection  Etudes  et
statistiques  ;  Direction  de  la  recherche,  des  études,  de  l’évaluation  et  des  statistiques
(DREES) ; La Documentation Française, 2001.

Comments

In 1996, there were about 600.600 persons aged 65+ in care homes for the elderly and
long-term nursing homes. They represented about 6,6% of the total population.

There is a big difference between the clients of residential homes for the elderly
(542.026 persons) and long-term nursing homes (77.195 persons). Physical
dependency is as follows:

Physical dependency

Confined in bed/chair
Help for washing and dressing
Help to go out of the institution
No or small dependency
Total

Psychical dependency

Psychical dependency
No or small dependency
Total

Residential homes
for elderly

31 December 1994
Total

Long-term
nursing

12
31
15
42
100

52
41
5
2
100

17
32
14
37
100

Residential homes
for elderly

31 December 1994
Total

Long-term
nursing

35
65
100

80
20
100

40
60
100

Psychical  dependency  includes  problems  related  to  behavioural  troubles  and
orientation in space and time.

Tables

-

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IRL1. Persons needing help

IRELAND

Definition

Older people living in the community who have a difficulty with ADL.

Available data reports persons having:
-  Mostly minor difficulties with ADL
-  Major difficulties with ADL, and
-  Severely impaired.

The authors report also, the number of persons usually needing help with one or more
daily tasks.

Different  sources  (notably  Health  and  Social  Services  for  Older  people  in  Ireland  -
HeSSOP)

-

-

Source

Years

Population

Methodology Analysis of different sources. 

Most  data  comes  from  the  analysis  of  a  sample  of  937  people  aged  over  75  years
living  in  the  community  (HeSSOP).  Functional  ability  was  measured  using  the
Stanford  health  assessment  Questionnaire  (HAQ).  Respondents  were  asked  to  rate
their  ability  to  perform  seventeen  daily  tasks  within  eight  activity  categories  in  the
past  week  on  a  four  point-scale  –  ‘without  difficulty’,  ‘with  some  difficulty’,  ‘with
much  difficulty’  or  ‘unable  to  do  so’.  An  overall  measure  of  independence  (ranging
from 0-3) can be calculated from the eight categories, yielding four levels of ability to
maintain independence in activities of daily living (ADL):

- 
- 

- 

- 

0-0,5:
0,51-1,25:

1,26-2,0:

2,1-3,0:

the person is completely self-sufficient
the  person  is  reasonable  self-sufficient  and  experiences  some  minor
and even major difficulties in performing ADL
the  person  is  still  self  sufficient  but  has  many  major  difficulties  in
performing ADL
the person may be called ‘severely disabled’.

The eight categories included are:

1. 
2. 
3. 
4. 
5. 
6. 
7. 
8. 

Personal care
Arising ability
Eating and drinking
Walking ability
Reach ability
Grip ability
Activity ability
Cognitive ability

Different  European  surveys  (Eurobarometer  and  ECHP)  report  generally  relatively
low  prevalence  disability  rates  for  Ireland.  Given  these  statistics  and  the  estimate
reported  by  HeSSOP,  we  consider  that  a  good  estimate  for  the  prevalence  of
dependency for people aged 75 and over might be around 20%.

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Publications

“Carers”,  Ageing  in  Ireland  Fact  File  No.  9,  2002,  National  Council  on  Ageing  and
Older People.

“Supporting Carers: A Social Policy Report”, COMHAIRLE, July 2002.

Comments

The Department of Health (1997) estimates that the number of persons aged 65 years
and over in long term institutional care is 5%.

Tables

2, 3, 6, 11, 16, 18, 23, 25.

IRL2. Home help service

Definition

Recipients of Community Welfare Services. It includes home helps employed by the
health boards and by voluntary agencies subsidised by the health boards and provided
to the older persons.

Source

Department of Health and Children

Years

Annual

Population

Administrative data

Methodology Administrative data, number of recipients for year ended 31 December.

Publication

“Health  Statistics  1999”,  Prepared  by  Information  Management  Unit,  Department  of
Health and Children.

Comments

The  number  of  physically  handicapped  who  used  home  help  services  was  1.401
persons in 1996.

The National Physical and Sensory Disability Database (NPSDD) covers only people
less than 66 years old.

Tables

27.

IRL3. Long-Stay Units

Definition

Dependency
Low  Dependency:  This  category  refers  to  people  who  need  some  support  in  the
community  and  the  more  independent  residents  in  residential  accommodation  who
require  little  nursing  care.  They  are  usually  mobility  independent  but  may  use  a
walking stick and have difficulty to manage stairs.

Medium Dependency: Person whose independence is impaired to the extent that he or
she requires residential care because the community does not provide the appropriate
support  and  nursing  care  required  by  the  person.  Mobility  is  impaired  to  the  extent
that the person requires supervision or a walking aid.

High  Dependency:  Independence  is  impaired  to  the  extent  that  the  person  requires
residential care but is not bed bound. The person may have a combination of physical
and  mental  disabilities,  may  be  confused  at  times  and  be  incontinent.  He/she  may
require a walking aid and physical assistance to walk.

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Maximum  Dependency:  People  whose  independence  is  impaired  to  the  extent  that
he/she  requires  nursing  care.  The  person  is  likely  to  be  bed  bound,  to  require
assistance  with  all  aspects  of  physical  care  and  may  be  ambulant  but  confused,
disturbed and incontinent.

Nursing homes:
A  private  nursing  home  is  run  as  a  private  business  for  the  care  and  maintenance  of
dependent persons, running on a profit-making basis.

A  voluntary  nursing  home  is  run  by  a  charitable  non-profit  making  organisation  in
which patients are not maintained for the personal profit of the proprietors.

Number of beds: Total bed complement at 31.12.2000 excluding respite beds.
Number of respite beds: Allocated for the planned admission of dependent persons for
short periods of time in order to assist carers in their task of caring.

Source

Department of Health and Children

Years

1996-1998

Population

Institutions (Long stay units)

Method

Survey of long-stay units/nursing homes. In 2000, 384 questionnaires out of 562 were
returned.
Number of patients in residence at 31.12.2000, including occupants of respite beds.

Publication

“Long-Stay Activity Statistics 2000”, The Information management Unit, Department
of Health and Children.

Commentary The majority of patients in long-stay units were female (66,5%).

- 
- 
- 
- 

11,0% 
20,5%: 
29,8%: 
38,6%: 

have been categorised as low dependency

medium dependency,
high dependency,
maximum dependency.

Tables

16.

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I1.

Health conditions of the population and recourse to health services

ITALY

Definition

Disability
The index measuring the lack of self-sufficiency is privileged over that measuring the
presence  of  handicaps.  Use  of  the  International  Classification  of  Impairments,
Disabilities and Handicaps (ICDH, 1980).

Activity of Daily Living (ADL)
Use  of  the  OECD  list  of  domains  concerning  the  ability  to  implement  in  an
autonomous  way  the  essential  activities  of  daily  living.  They  take  into  account  three
dimensions:
-  Activities of daily living: go to bed and get out of bed, sit down in and get up from

a chair, washing, dressing, take a shower or a bath and eating.

-  Mobility:  walk,  climbing  stairs,  take  an  object  from  the  ground;  Confinement

refers to permanently confined to bed, chair or at home.

-  Communication: speaking, sight and hearing.

Degree
It ranges from absolute incapacity to implementation without problems.
Persons with a sight, hearing and speech disability refer to difficulties.

Source

Istituto Nazionale di Statistica (ISTAT)

Years

1986-1987, 1999-2000

Population

Private households. Age: 6+.

Methodology The  survey  1999-00  on  health  conditions  of  the  population  and  access  to  health
services covers about 140.000 individuals living in 52.300 households, representative
of  the  Italian  resident  population.  Persons  currently  living  in  hospitals  or  institutions
are not interviewed. The information was supplied by a member of the family and in
72%  of  the  cases  it  is  the  individual  itself  that  answered  the  questions.  Disability
statistics were collected only for population aged 6 years and over.

Statistics concerning prevalence by age group are provisional.

Publication

“Le  condizioni  di  salute  della  popolazione:  Indagine  Multiscopo  sulle  famiglie
‘Condizioni  di  salute  e  ricorso  ai  servizi  sanitari’  Anni  1999  –  2000’”,  Istituto
Nazionale di Statistica, 2002.

“Indagine Multiscopo sulle Famiglie – Anni 1987-91 – La condizione degli anziani”,
Istituto Nazionale di Statistica, 1994.

“Indagine Multiscopo sulle Famiglie – Anni 1987-91 – I disabili”, Istituto Nazionale
di Statistica, 1995.

“Relazione sullo stato sanitario del Paese 2000”, Ministerio della Salute, 2001.

“Relazione  sulla  condizione  dell’anziano,  1989/90”,  Presidenza  del  Consiglio  dei
Ministri: Dipartimento per gli Affari Sociali, Roma, 1992.

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Comments

The  “Report  on  the  State  of  Health  in  the  Country  2000”  presents  non-standardised
data.

The Multipurpose Survey on Family gives the number of persons needing:
a)  Help from time to time,
b)  Continuous help.

Tables

2, 3, 4, 5, 6, 7, 8, 9, 10.

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LUXEMBOURG

L1.

Socio-economic panel

Definition

Dependency
The survey distinguishes five levels: complete autonomy (O), light loss of autonomy
(1),  loss  of  autonomy  but  not  problematic  (2),  serious  dependency  (3)  and  severe
dependency (4).

Source

Centre  d’Etudes  de  Populations,  de  Pauvreté,  et  des  Politiques  Socio-économiques
(CEPS).

Years

Annual

Population

All private households.

Method

Available  data  refers  to  1992.  In  1992,  the  Socio-Economic  Panel  (PSEL)  covered
5.191  persons,  of  which  1.081  were  aged  60  years  and  over.  Questions  concerning
dependency and care focus on persons aged 60 years and over (1.039 answers).

In  2000  the  survey  included  a  module  on  care  and  services  rendered  between
generations.

Publication

“Les personnes âgées dépendantes en ménage privé: contribution au groupe de travail
sur la dépendance”, A. Kerger, Document de recherché n° 9439, CEPS, 1994.

Commentary The questions focussed on activities such as: prepare a hot meal, shopping, climbing
stairs, walk inside home and outside home, carry an object, take the bus or the train,
washing oneself and does not forget to take his medicine

Tables

2, 4, 6, 27.

L2.

Long term care insurance

Definition

Dependent persons
Need of regular help for the essential activities of daily life.

Source

Ministère de la Sécurité Sociale

Years

Annual

Population

All

Methodology Number of beneficiaries of the law 19.06.1998 concerning the dependence insurance.

Statistics refer to 30 June 2002.

Publication

Unpublished data.

Commentary -

Tables

3, 5, 14, 15.

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NETHERLANDS

NL1.  Permanent Survey on Life Conditions

Definition

Physical disabilities
Physical  disabilities  are  surveyed  with  the  aid  of  two  instruments:  the  OECD
(Organisation  for  Economic  Cooperation  and  Development)  indicator  for  persons
aged  16  years  and  older  and  the  ADL  (Activities  of  Daily  Living)  indicator  for
persons aged 55 years or more.

OECD indicator
The  OECD  indicator  refers  to  limitations  in  the  ability  to  communicate  and  move
around; Respondents are asked if they can do the following:
-  Follow a conversation in a group of 3 or more persons (if necessary with a hearing

aid),

-  Read small print in a newspaper (if necessary with glasses or contact lenses),
-  Recognise  a  face  at  a  distance  of  4  meters  (if  necessary  with  glasses  or  contact

lenses),

-  Carry  an  object  weighing  five  kilos  (e.g.  a  bag  of  shopping)  a  distance  of  10

meters,

-  From upright position, bend down and pick something up from the ground, walk

for 400 meters without stopping (if necessary with a stick).

The  figures  refer  to  people  who  reported  not  being  able  to  do  one  or  more  of  these
activities, or only with great difficulty.

ADL indicator
The  ADL  (Activities  of  Daily  Living)  indicator  refers  to  limitations  in  carrying  out
general daily activities.  Since 1989 respondents are asked if they can: 'eat and drink',
'sit down in and get up from a chair', 'get into and out a bed', 'dress and undress', 'move
to  another  room  on  the  same  floor',  'walk  up  and  down  stairs',  'go  out  and  let
themselves  in  again',  'move  around  outside',  'wash  their  face  and  hands'  and  'wash
themselves completely'.
The  figures  present  persons  who  are  not  able  to  do  one  or  more  of  these  activities,
only with great difficulty, and with some difficulty. We report data only for the first
two categories.

Mobility
Percentage of persons who have problems moving around.

Incontinence
Percentage  of  persons  who  in  the  latest  12  months  suffered  from  involuntary  urine
losses (incontinence).

Source

Centraal Bureau voor de Statistiek

Years

Annual

Population

Private households

Methodology The  POLS  (Permanent  Onderzoek  Leefsituatie)  aims  at  providing  permanent
information about different life topics for the Netherlands population taken in private

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households. The survey covers the total population. The sample was taken in the local
administration register and included 9.323 respondents in 1999 and 9.877 in 2000.

The questions are divided in different modules each one focusing on a certain subject.
The different modules are subjected only to one part of the respondents, in exception
of  the  base  module.  This  latter  provides  ground  information  i.e.  about  age,  sex,
education, etc. as well as some general information about health.

Data  about  long-term  impairments  is  based  on  written  report  by  the  persons
themselves. Interviewees are asked if they suffer from or have suffered during the last
12 months from long-term impairments taken of a list of 24.

The  table  concerning  physical  limitations  stems  from  questions  on  the  base  of  the
OECD-indicator.

The question on ADL limitations covers only persons aged 55+. In order to estimate
the  prevalence  for  all  adults  (20+),  we  have  first  run  a  logistic  regression  on  the
observed rates. The good results in terms of R² (0,9), DW (2,1) and heteroscedasticity
test  (nR²=0,6)  must  not  make  us  forget  that  the  number  of  observations  is  very
limited.  The  estimated  rates  applied  to  the  number  of  persons  living  in  private
households gives a global rate for persons aged 20+ equal to 4,5%. This has only an
indicative value. For comparison the estimation for the age group 65+ is 18, 5 and the
observed 18,6%.

Publication

Vademecum  gezondheidsstatistiek  Nederland  2001,  Centraal  Bureau  voor  de
Statistiek, Voorburg/Heerlen, 2001.

Http://statline.cbs.nl

Comments

In certain tables we present pooled data combining 2000 and 2001. This increases the
efficiency  of  the  reported  estimators.  In  calculating  the  prevalence  for  grouped  ages,
use was made of the 2000 population distribution.

Tables

2, 3, 4, 5, 6, 8, 11, 12, 15, 16.

NL2. Longitudinal Ageing Study Amsterdam (LASA)

Definition

Functional limitations
It is based on:
-  Ability to walk up and down 15 steps of a staircase without stopping,
-  Use public or private transport, and
-  Cut one’s own toenails.
We retain as dependency the case where all three activities are done with difficulty.

Performance tests measure the time needed to:
-  Take off a cardigan,
-  Walk three meters back and forth,
-  Get up from a kitchen chair five times without arms folded.
We report only the number of respondents who were not able to perform the test.

Source

Ministry of Health, Welfare and Sports.

Years

1992/93, 1995/96 and 1998/99.

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Population

All persons aged 55-85.

Methodology The  Longitudinal  Ageing  Study  Amsterdam  (LASA)  covers  a  representative  sample

of institutionalised and non-institutionalised population of individuals aged 55-85.

No  refreshment  samples  are  drawn  at  wave  II  and  wave  III.  Wave  I  covered  2.925
individuals,  wave  II:  2.204  individuals,  and  wave  III:  1.717  individuals.  Short
interviews were organised as well as interviews by telephone.

Publication

“An  Econometric  Analysis  of  the  Mental-Health  Effects  of  Major  Events  in  Life  of
Elderly  Individuals”,  Lindeboom,  M.,  Portrait,  F.,  and  van  den  Berg,  G.,  Discussion
Paper No. 398, IZA, Bonn, 2001.

Comments

The authors argue that institutionalisation has negative effects on both emotional well-
being and cognitive abilities.

For  information,  dependency  defined  as  difficulty  to  perform  all  three  functional
limitations (walk up and down 15 steps of a staircase without stopping, use public or
private transport, and cut one’s own toenails) gives 11% for persons aged 55-85.

Tables

-

NL3.

Institutional care

Definition

Persons in:
-  Homes for the elderly (recognised),
-  Nursing homes,
-  Homes for mentally disabled persons,
-  Mental hospitals
-  Family replacement homes (notably for persons with sensorial disabilities), etc.

Available  statistics  often  do  not  distinguish  between  different  institutions.  For
comparability  purposes,  each  time  it  was  possible,  we  have  retained  only  persons  in
homes  for  the  elderly.  In  all  cases,  we  have  excluded  other  institutions  such  as
religious, prisons and boarding schools.

Dependency
Persons in institutions with very serious limitations in hearing, seeing, mobility and/or
ADL activities.

Source

Centraal Bureau voor de Statistiek

Years

Annual data

Population

-

Methodology Number  of  residents,  1  January.  The  population  consists  of  persons  whose
accommodation and daily needs are provided by for by a third party on a professional
basis.

Estimation of the number of dependent persons (65+).

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Private households: we take 18% of persons 65+ (POLS, source: NL1.)
Institutions: In 1999, there were about 230.000 persons in institutions. About 170.000
persons were aged 65 and over (excluding religious institutions, prisons and boarding
schools). They represent 8% of the same age group. Van Herten et al (cited in rivm,
2003)  present  the  prevalence  of  dependency  by  age  group  and  type  of  institution
(Nursing  homes  and  Homes  for  the  elderly).  We  suppose  a  prevalence  rate  for  all
elderly  persons  outside  nursing  homes  similar  to  the  one  of  residents  of  ‘Homes  for
the elderly’.

De Klerk (cited in rivm, 2002) reports that almost 100% of nursing homes’ residents
and  71%  of  ‘Homes  for  the  elderly’  residents  make  use  of  professional  help.  This
might  overestimate  dependency  as  some  persons  might  use  once  in  a  while  these
services.

De Klerk defines dependency as persons using:
-  Personal  care  services  (eat  and  drink,  get  out/in  the  bed,  washing  oneself,

dressing, etc.),

-  Nursing services (medicine, caring wounds, etc),
-  Light housework (shopping, ranging, dust, etc.),
-  Mobility (going up/down stairs, mobility outside the home, etc.).

Publication “Vademecum  gezondheidsstatistiek  Nederland  2001”,  Centraal  Bureau  voor  de

Statistiek, Voorburg/Heerlen, 2002.

“Lichamelijk 
Volksgezondheid, rivm, Bilthoven, 2003.

functioneren:  Omvang  van  het  probleem”,  Nationaal  Kompas

“Verpleeghuis-  en  verzorgingshuiszorg:  Vraag  en  gebruik”,  Nationaal  Kompas
Volksgezondheid, rivm, Bilthoven, 2002.

“Statistical Yearbook 2002”, Statistics Netherlands, Voorburg/Heerlen, 2003.

Comments

Persons in 1999:
-  Homes for the elderly (recognised):
-  Nursing homes:
-  Homes for mentally disabled persons:
-  Mental hospitals:
-  Family replacement homes, etc.:
-  Other institutions

(Religious, prisons and boarding schools):

108.207
  33.145
  28.653
  11.607
  36.000

  12.895
230.507.

-  TOTAL
In 2001, there were 218.784 persons (79.209 men and 139.838 women).

Tables

14, 16.

NL4.

Informal help

Definition

Informal help includes non-paid help provided by the family, friends and neighbours.

Individual help includes help from an employee or a nurse.

Home care includes personal care, housework, alphahelp, maternity, nutrition and diet,
advice, provision of technical aids, etc.

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Source

Analysis of different sources.

Years

Population

-

-

Methodology Analysis of different sources.

Publication

“Informele  hulp:  Aanbod”,  Nationaal  Kompas  Volksgezondheid,  rivm,  Bilthoven,
2003.

“Informele  hulp:  Vraag  en  gebruik”,  Nationaal  Kompas  Volksgezondheid,  rivm,
Bilthoven, 2003.

“Thuiszorg:  Vraag  en  gebruik”,  Nationaal  Kompas  Volksgezondheid,  rivm,
Bilthoven, 2003.

Commentary -

Tables

21, 24.

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AUSTRIA

A1.

Microcensus

Definition

Activities of daily living
Interviewed persons responded to the following questions:
a.  Which  of  the  following  activities  (getting  up  and  down,  washing  and  getting
dressed,  walking  in  the  house,  eating  and  drinking,  easy  household  tasks  –
clearing  up,  doing  the  dishes,  preparing  meals  –  difficult  household  tasks  –
vacuum cleaning, doing the laundry, hanging up laundry, cleaning the windows
– going shopping, going out and making visits) can you do without the help of a
third party, only with the help of a third party, not at all.

b.  Are  you  not  able  to  perform  body  care  due  to  impairment  of  vision,  hearing,
mobility  or  of  a  chronic  disease  and  do  you  receive  help  of  a  family  member,
parents,  friends,  social  services  or  other  persons?  Do  also  indicate  how  often
you are helped – once a week, less often, never.

Informal care
Interviewed persons responded to several questions:
a. 

Your household provides care for whom – chef of household (COH), husband /
wife of COH, mother-in-law of COH, father-in-law of COH, children-in-law of
COH, sister or brother-in-law of COH, grandparents of COH, other relatives or
friends?

b.  Which household member provides care for persons aged 60 and more?
c. 

How  many  hours  per  week  (travel  included)  of  help  are  given  by  your
household for a person aged 60 or more: until 1 hour, 2-3 hours, 4-5 hours, 6-10
hours, 11-19 hours, more than 20 hours?
For  which  activity  do  members  of  your  household  help  persons  aged  60+:
personal care, medical care, going shopping, preparation of meals, cleaning up,
washing and ironing, other household tasks, making provisions, going out?
How often do you provide care / help: every day, several times per week, once a
week, less often, never?

d. 

e. 

Informal care
It refers to persons aged 60+ with a long-term need for care.

Source

Österreichisches Statistisches Zentralamt

Years

Irregular periods

Population

Private households

Methodology Participation  is  obligatory,  except  for  supplementary  programs.  The  sample  includes
33.600  private  households  in  800  municipalities  (60.000  persons).  One  eighth  of  the
sample  is  replaced  every  three  months.  Projection  on  the  total  population  takes  into
account the evolution of the population by region, sex, age and nationality.

Whenever it was possible, we have corrected the estimates for non-response, notably
in cases where the non-response rate was known and relatively high.

Publication

Bundesministerium für Soziale Sicherheit und Generationen: Ältere Menschen – Neue
Perspektiven :  Seniorenbericht  2000:  Zur  Lebenssituation  älterer  Menschen  in
Österreich, Wien.

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Österreichisches 
körperlichen
Zentralamt, 
Beeinträchtigungen.  Ergebnisse  des  Mikrozensus  Juni  1995.  Beiträge  zur
österreichischen Statistik Heft 1.276, Wien 1998

Personen  mit 

Statistisches 

Pomezny,  W.,  Häufigkeit  bezahlter  Hilfe  in  Privathaushalten.  Ergebnisse  des
Mikrozensus März und September 1992, in: Statistische Nachrichten 4/1994, pp.336

Statistik  Österreich:  Lebenssituation  älterer  Menschen.  Ergebnisse  des  Mikrozensus
Juni 1998, Beiträge zur österreichischen Statistik, Heft 1.340, Wien, 2000

Vötsch  W.,  Personen  mit  körperlichen  Beeinträchtigungen:  Wobei  benötigen  sie
Unterstützung.  Ergebnisse  des  Mikrozensus  Juni  1995,  in:  Statistische  Nachrichten
8/1997

Vötsch W., Personen mit körperlichen Beeinträchtigungen: Wer hilft? Ergebnisse des
Mikrozensus Juni 1995, in: Statistische Nachrichten 9/1997, 743-748

Vötsch,  W.,  Haushalte:  Unterstützung  für  Senioren.  Ergebnisse  des  Mikrozensus-
Sonderprogramms Juni 1998, in: Statistische Nachrichten 11/1999, pp.959

Wiedenhofer  B.,  Gesundheitliches  Befinden  von  Senioren.  Ergebnisse  des
Mikrozensus-Sonderprogramms  Juni  1998,  in:  Statistische  Nachrichten  2/2000,
pp.112

Wiedenhofer  B.,  Unentgeltliche  Hilfeleistung  bei  der  Betreuung  von  Erwachsenen.
Ergebnisse  des  Mikrozensus  März  und  September  1992,  in:  Statistische  Nachrichten
6/1994, pp.509

Comments

-

Tables

6, 7, 8, 9, 10, 11, 12, 21, 22, 23, 24, 25, 27.

A2.

Report for the Austrian Chapter des Club of Rome

Definition

Care dependent persons:
Limitations in the autonomous performance of daily body-care that lead to a need for
regular  or  irregular  care.  A  person  that  needs  help  for  body-care  activities  at  least
several  times  a  week  is  in  need  of  regular  care.  People  that  are  in  need  of  irregular
care are limited for some body-care activities and housework chores and need help at
least once a week.

Persons dependent on help (large sense)
The  need  for  help  is  defined  in  a  very  wide  sense  including  those  persons  that  e.g.
can’t iron anymore or that can’t bend down. Help is provided from time to time or in
case of a need.

Persons dependent on help (restricted sense)
The  degree  of  need  of  help  is  higher  and  includes  persons  who  can’t  climb  stairs
anymore,  who  can  no  longer  dress  themselves  etc.  Support  and  help  is  needed
regularly.

Source  

Österreichisches Bundesinstitut für Gesundheitswesen (ÖBIG)

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Years

Population

-

-

Methodology  This publication is not a survey, but a report that is based on several sources.

Publication

ÖBIG  (Österreichisches  Bundesinstitut  für  Gesundheitswesen):  Alte  Menschen  in
Österreich:  Lebensverhältnisse,  Probleme,  Zukunftsperspektiven  –  Bericht  an  das
Austrian Chapter des Club of Rome, Wien, 1998

Comments

-

Tables

2, 3, 4, 5.

A3. 

Consequences of the long-term care provision system

Definition

Activities of daily living
Number  of  persons  who  consider  that  they  could  not  do  the  enumerated  activities
without the help of a third person.

Informal care
Percentage of carers who provide care for a certain number of hours per week with a
remunerated activity

Source

Badelt Ch. et al., Analyse der Auswirkungen des Pflegevorsorgesystems, Wien 1997

Years

1995

Population

All

Methodology Written  interviews  with  3.120  beneficiaries  of  dependency  allowances.  1.498
dependent  persons  and  1.396  carers  were  interviewed.  6,6%  of  dependent  persons
were less than 40 years old.

Publication

Badelt Ch. et al., Analyse der Auswirkungen des Pflegevorsorgesystems, Wien 1997

Comments

-

Tables

18, 26.

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PORTUGAL

P1.

National Survey on Health

Definition 

Persons declaring suffering a long-term disability.

The health survey reports persons with a long term disability concerning:

-  Confinement: always in bed; always bound to a chair; confined to the house
-  Mobility: lie down and get up from bed; sit down and get up from a chair; go and
use  toilet;  pick  up  something  from  the  ground;  can  walk  on  a  flat  terrain  without
discomfort; climb and go down 12 steps.

-  Personal  care:  get  dressed  and  undressed;  wash  face  and  hands;  eat  (cut  food  and

bring food and drinks to mouth); incontinence.

-  Sensory  /  communication:  listen  to  TV  or  radio;  distinguish  forms  and  recognise

friends; difficulties to speak.

Degree
Concerning  personal  care  the  answer  is:  alone,  without  difficulty;  alone  with
difficulty; with help. We have retained persons who answer ‘with help’.
Concerning sensory functions and certain mobility questions the answers are different.
In this case, we have retained ‘cannot / not at all’.
Concerning  incontinence  we  have  chosen  the  stricter  definition:  at  least  once  per
week.

Source

Department of Health – National Health Institute

Years

1998-99

Population

Private households.

Methodology The national health survey covered private households and excluded institutions. The
survey  took  place  during  October  1998  and  September  1999.  The  representative
sample covered 21.808 households.

Questions concerning long-term disability covered persons aged 10 and over.

The  survey  presents  first  people  who  are  confined  and  then  (excluding  confined
individuals) persons with long-term disabilities (for example: persons not confined in
bed/chair  but  needing  help  to  walk  on  a  flat  terrain).  In  these  cases,  we  have  added
both in order to arrive at the total estimate.

Publication

“Inquérito  Nacional  de  Saúde:  Dados  gerais;  Continente  1998-1999”,  Ministerio  da
Saúde: Instituto Nacional de Saúde, 2001.

Comments

The  rate  of  persons  65+  who  have  difficulties  to  ‘wash  hands  and  face’  amounts  to
9%. The rate of those needing help amounts to 5%. Concerning ‘climbing and going
down 12 stairs’ the rates are respectively: 42% and 7%.

If we add those confined in bed/chair we obtain the total of persons with difficulties in
‘climbing and going down 12 stairs’. It is about 45%. This could be a good proxy for
the proportion of persons with a disability.

Tables

6, 7, 8, 9, 10.

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P2.

National Survey on Impairments, Disabilities and Handicaps

Definition

Persons with severe mobility disabilities
Persons with a severe reduction or limitations concerning personal mobility or moving
objects.

Persons with severe ADL limitations
Persons  with  a  severe  reduction  or  limitations  concerning  activities  of  daily  living
such as open/close doors, switch on/off light, telephone, manipulate objects, etc.

Collective housing
Collective  institutions  include  educational,  hospitals,  other  providing  assistance,
religious, military and others.

Source

National Rehabilitation Secretariat

Years

1995

Population

All households.

Methodology The sample covered 47.020 families representing 142.112 persons.

Publication

“Inquérito Nacional ás Incapacidades, Deficiências e Desvantagens : Resultados
Globais”, Secretariado Nacional de Reabilitação, Lisboa, 1996.

Comments

This  survey  yields  disability  prevalence  rates,  which  are  slightly  lower  to  the  ECHP
(1996)  estimates.  For  comparison,  concerning  persons  aged  ’65-74’,  the  present
survey gives a prevalence of disability of 37%, while the ECHP gives 48%.

Tables

2, 3, 4, 5.

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FINLAND

FIN1. Health survey

Definition

The  indicator  refers  to  “Persons  who  feel  unable  to  fulfil  the  demands  of  everyday
life”. The answer distinguishes never, seldom, every now and then, often and most of
the time. The data presented here includes ‘often’ and ‘most of the time’.

Source

National Public Health Institute

Years

2001; Health Behaviour among elderly has been monitored since 1985

Population

Private households. Age: 65-84.

Methodology The  purpose  of  the  survey  was  to  obtain  information  about  living  conditions,  health
status and lifestyle and coping with daily activities among 65-84 year old citizens of
Finland. Random  samples  of  300  persons  from  each  five-year  age  group  of  men  and
women  were  drawn  from  the  National  Population  Register.  Out  of  2.400  persons
2.388 were contacted by mail. 83% of men and 80% of women responded.

Publication

“Health Behaviour and Health among Finnish Elderly, Spring 2001, with trends 1993-
2001”, National Public Health Institute.

Comments

-

Tables

2, 4, 6, 7, 8, 9, 10, 11, 12.

FIN2:  Persons receiving help

Definition

Households receiving help in ordinary housing and in institutions and service housing.

Institutions  include  nursing  homes,  homes  for  the  long-term  ill  and  old  people’s
homes.  Service  housing  includes  sheltered  homes,  service  flats,  collective  housing,
housing where special care is provided, etc. Elderly people may also, be offered long-
term  medical  treatment  in  hospital  wards  –  often  in  the  so-called  geriatric  wards.
There are special wards in some nursing homes.

Source

Nordic Social-Statistical Committee (NOSOSCO)

Years

Annual data

Population

All

Methodology Home help

Number  of  people  (head  of  household)  who  received  help  during  a  year.  Help  may
stem from municipal or privately employed staff.

Dependent people in institutions or service housing
Number of people (head of household) aged 65 years and older living in institutions or
service housing.

In order to take into account only persons requiring assistance we have taken 50% of
the  age  group  65-74,  60%  for  75-89  and  70%  for  80+.  These  are  non-weighted

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averages  of  dependent  persons  in  institutions  in  Belgium,  France  and  the  United
Kingdom.

For  home  help,  the  age  groups  are:  65-74,  75-84  and  85+.  For  institutions  the  age
groups are: 65-74, 75-79 and 80+. We had to split the home help component into 75-
79  and  80-84.  We  took  into  account  comparable  rates  in  other  Nordic  countries  and
the weights of the respective age groups.

Publication

“Social  Protection  in  the  Nordic  Countries”,  Nordic  Social-Statistical  Committee
(NOSOSCO), Copenhagen, 2001.

Comments

The Nordic Social-Statistical Committee (NOSOSCO) notes that statistics concerning
home  help  in  the  Nordic  countries  are  not  easily  comparable.  It  indicates  that  the
extent of assistance is determined on the basis of individual needs and may vary from
a few hours per month to several hours per day.

The  assistance  is  a  municipal  matter  and  is  provided  by  municipal  or  privately
employed staff.

In  all  Nordic  countries,  people  with  severe  disabilities  may  be  granted  financial
support towards payment of personal assistance and help to manage the household.

Tables

13, 28.

FIN3. Beneficiaries of help/care

Definition

Number of beneficiaries of different dependency provisions

Source

Research and Development Centre of Health and Social Affairs (STAKES)

Years

2001

Population

All

Methodology Statistics  are  based  on  discharge  reports  (reports  to  be  made  for  each  discharged
client) and on client census reports (to be filled in for all clients in care on the census
day). Reports and censuses concern persons that receive

Institutional care and housing services with 24-hour assistance;

- 
-  Housing services with part-time assistance; and
-  Home care

The total number of social welfare clients on 31 December 2001 was 135.000 persons.
88.000 persons of this group were aged 75 years and more.

Publication

“Institutional  Care  and  Housing  Services  on  Social  Welfare”,  Research  and
Development Centre of Health and Social Affairs (STAKES), 2002.

Comments

-

Tables

27.

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SWEDEN

S1.

 Survey on living conditions

Definition

The survey produces different indicators for persons aged 65-84, notably:

- 
- 
- 
- 

Persons with physical disability
Needs help with different activities of daily living
Difficulties with certain instrumental activities of daily living, and
Impairments for sensory activities.

Source

Official Statistics of Sweden (Socialstyrelsen)

Years

1996/97

Population

Private households. Module: 65-84.

Methodology The questionnaire is a module of the Survey on living conditions. The first Survey on
living  conditions  was  done  in  1974.  Different  modules  have  been  added  throughout
the years and are repeated with a periodicity of 5 to 8 years.

Data  is  collected  throughout  the  year.  Results  are  an  average  of  two  years.  112.404
people aged 20-84 were interviewed. 40.829 of those interviewed were aged 55-84.

Publication

“Äldres  levnadsförhållanden  1980-1998”,  Rapport  nr  93,  Statistiska  centralbyrån  –
Socialdepartementet – Socialstyrelsen, 2000.

Comments

The prevalence of physical disability provided by the present survey is 22% (age: 65-
84). The estimations provided by the ECHP and the present survey give similar results
for 65+ and 75+.

Tables

1, 2, 4, 6, 7, 8, 9, 10, 21, 22.

S2. 

Care for the elderly

Definition

Statistics focus on persons aged 65 and over living in ordinary housing, persons living
in  retirement  homes  or  hospitals,  people  with  home-help  services  and  home  medical
care, persons with attendance allowance, with personal assistance, companion service,
relief service in the home, short stay away from home and persons in residences with
special services and daily activities.

Source

Official Statistics of Sweden (Socialstyrelsen)

Years

2001

Population

Persons aged 65 and over.

Methodology Statistics  were  collected  by  the  municipalities  who  are  obliged  to  respond.  The

collection took place in October 2001.

Beneficiaries  of  permanent  and  short-term  care  in  retirement  homes  or  other  living
arrangements  risk  to  be  counted  twice.  Some  municipalities  may  also  interpret
retirement  homes or  service  homes as  ordinary  living  arrangements  and  might

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therefore class people in the wrong category. One municipality (Göteborg) could not
distinguish persons with home sick care from those with ordinary home care services
and did hence only report the former category.

Publication

“Äldre – vard och omsorg år 2001”, Socialtjänst 2002:3, Socialstyrelsen.

“Policy for the elderly”, Ministry of Health and Social Affairs, Sweden, Fact sheet N°
4, Mars 2001.

Comments

The  publication  notes  that  all  the  municipalities  have  responded  to  the  request,  but
have not always been able to answer all the questions. The authors note that there is
also a risk of different interpretations of terminology by the different municipalities.

Tables

15, 27.

S3. 

Persons receiving help

Definition

Persons receiving help in ordinary housing and in institutions and service housing.

Institutions  include  nursing  homes,  homes  for  the  long-term  ill  and  old  people’s
homes.  Service  housing  includes  sheltered  homes,  service  flats,  collective  housing,
housing where special care is provided, etc. Elderly people may also, be offered long-
term  medical  treatment  in  hospital  wards  –  often  in  the  so-called  geriatric  wards.
There are special wards in some nursing homes.

Source

Nordic Social-Statistical Committee (NOSOSCO)

Years

Annual data

Population

All

Methodology Home help

Number  of  people  who  per  31  December  (1  November  for  1999)  had  been  granted
home help and who live in their own house or flat. Help may stem from municipal or
privately employed staff.

Dependent people in institutions or service housing
Number of people aged 65 years and over living in institutions or service housing, as
per  1  November  1999.  People  staying  on  a  short-term  basis  are  included  in  the  age
group 65+.

In order to take into account only persons requiring assistance we have taken 50% of
the  age  group  65-74,  60%  for  75-89  and  70%  for  80+.  These  are  non-weighted
averages  of  dependent  persons  in  institutions  in  Belgium,  France  and  the  United
Kingdom.

The age groups are: 65-74, 75-79 and 80+.

Publication

“Social  Protection  in  the  Nordic  Countries”,  Nordic  Social-Statistical  Committee
(NOSOSCO), Copenhagen, 2001.

Comments

The Nordic Social-Statistical Committee (NOSOSCO) notes that statistics concerning
home  help  in  the  Nordic  countries  are  not  easily  comparable.  It  indicates  that  the

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extent of assistance is determined on the basis of individual needs and may vary from
a few hours per month to several hours per day.

The  assistance  is  a  municipal  matter  and  is  provided  by  municipal  or  privately
employed  staff.    In  all  Nordic  countries,  people  with  severe  disabilities  may  be
granted financial support towards payment of personal assistance and help to manage
the household.

Home  help  in  Sweden  provides  help  with  household  tasks  (shopping,  cooking,
cleaning,  etc)  and  personal  care  tasks  (getting  in  and  out  of  bed,  bathing,  toileting,
eating, (un)dressing, and outdoor walks).

Tables

28.

S4.

Old-age care

Definition

Family care (informal care)
Persons  who  receive  at  least  weekly  help  or  monitoring  by  household  member,
neighbour, close friends or acquaintance (year 1975).
Persons who receive help with ADL-functions (years 1994 and 2000).

Home help
Estimates are restricted to help concerning activities of daily living (ADL).

Source

Statens Offentliga Utredningar (SOU).

Years

1994, 2000.

Population

Community-residing population aged 75 and over.

Methodology Two surveys were commissioned by the National Board of Health and Welfare (1994,
2000) to assess the situation of older people. These nationally representative surveys
over-sampled men and the oldest age groups, so all the reported pooled estimates are
corrected by weighting by the authors. Number of interviews: 1.379 (1994) and 1.466
(2000). The first survey had a drop out rate of 27%, the second 30%.

Publication

“State provision down, offspring’s up: the reverse substitution of old age care in
Sweden”, Johansson, L., Sundström, G., and Hassing, L. B., “Ageing & Society”, 22,
2003, p. 1-13, Cambridge University Press.

“The Shifting Balance of Long Term Care in Sweden”, Sundström, G., Johansson, L.,
and Hassing, L. B., The Gerontologist, Vol. 42, No 3, p. 350-355.

Comments

The  authors  advance  that  increased  inputs  from  families  match  the  decline  of  public
services, that is, a ‘reverse’ substitution has recently been taking place. The 
authors
challenge also the so-called substitution thesis.

Tables

18, 20, 23, 25.

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UNITED KINGDOM

UK1. Health Survey for England.

Definition

Disability
In  accordance  with  the  WHO-ICIDH  protocol,  disability  was  measured  across  five
domains:  locomotor,  personal  care,  sight,  hearing  and  communication.  For  each
domain, the level of severity was scored into none (0), moderate (1) and severe (2). A
summary disability score was then calculated which took the highest value of 0, 1 or 2
in  order  to  assess  overall  physical  disability  levels  across  care  homes.    (The  WHO
developed a series of questions designed to estimate the percentage of the population
experiencing different levels of severity: a lower and a higher level).

Dependency
The  criteria  was  given  by  the  activities  of  daily  living  such  as  washing,  dressing,
feeding, using the toilet, and requiring help getting in and out of a bed or a chair. The
persons  who  needed  assistance  with  any  of  these  tasks  were  classed  as  severely
disabled on the personal care disability dimension of the WHO protocol.

Care Homes
Five  categories  of  care  homes  were  chosen  to  be  eligible  for  the  sample,  on  the
grounds  that  these  types  of  home  were  most  likely  to  contain  older  residents.    The
categories were public (local authority) residential homes, private nursing homes, dual
registered homes, private residential homes and private small residential homes.

Source

Great Britain Department of Health

Years

Annual.

Population

Private households (England), except 2000.

Methodology The  main  focus  of  the  Health  Survey  for  England  2000  was  on  the  health  of  older
people, defined for this purpose as persons aged 65 and over, although the survey also
included interviews with children and with adults below the age of 65.  It included the
private  household  population  as  well  as  residents  (aged  65  and  over)  in  residential
care and nursing homes.

Thus, the population surveyed is the population aged two and over living in England.
There was no over-sampling of adults aged 65 and over. Older people living in care
homes  were  included  in  a  special  sample  in  the  2000  survey,  but  residents  in  other
types  of  institutions  were  not  included.    A  random  sample  of  6840  addresses  was
selected from the Postcode Address File, interviews with 7988 adults were obtained.
1677  were  aged  65  and  over.    Where  there  were  more  than  two  children  aged  2-15,
only two (selected at random) were interviewed.

The  sample  concerning  care  homes  was  selected  from  Laing  and  Buisson’s  Care
Home  and  Hospital  Information  database  (CHIC).    In  homes  with  six  or  fewer
residents  aged  65  and  over,  all  residents  were  interviewed;  otherwise,  six  were
randomly  selected  for  interview.    544  homes  co-operated  in  the  survey.    Interviews
were made with 2493 residents.  Of the 2493 interviews, 1273 were carried out via a
proxy informant.

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Concerning  private  households,  data  was  collected  at  two  levels:  household  and
individual.    The  interview  with  informants  from  the  private  household  sample
included  the  question  modules,  which  are  asked  in  most  years  in  the  Health  Survey
such  as  general  health  and  longstanding  illnesses,  use  of  health  services,  cigarette
smoking,  psychosocial  health  and  accidents.    Questions  on  disability  were  also
included.  In the private household sample, all adults aged 65 and over were eligible
for the second stage of the survey, a nurse visit.

Information  about  longstanding  illnesses  was  also  collected  during  the  survey.
Concerning care homes, data was collected at two levels: care home and individual. In
care homes around half of those selected could not be interviewed in person. In these
cases the interview was carried out with a proxy (nurse). In addition to the interviews
with private household and care home residents, a short interview was carried out with
care home managers.

As to the sampling of the different types of care homes, local authorities homes were
chosen  as  the  primary  sampling  units.    Within  these,  677  care  homes  were  selected
systematically  with  probability  proportional  to  the  number  of  beds  in  the  home.    A
pre-decided total of care homes were selected in each category.  In each care home, up
to  six  residents  aged  65  and  over  were  selected  at  random.  A  resident  had  to  be
resident  in  the  home  for  at  least  three  months  or  to  be  expected  to  be  resident  for  at
least three months.

In  2001,  the  Health  Survey  for  England  dedicates  a  section  to  deal  about  the  latest
estimates  of  the  prevalence  of  disability  among  those  living  in  private  households  in
England.

Interviews  were  obtained  with  15.647  adults  (aged  16  and  over)  and  3.993  children
(aged  under  16),  residents  in  9.373  households.  In  this  report,  the  2001  sample  has
been  combined  with  the  equivalent  sample  of  the  population  resident  in  private
households in HSE 2000 to improve the precision of estimates.

Publication

Health Survey for England 2000.
Health Survey for England 2001.
www.official-documents.co.uk

Commentary -

Tables

2, 3, 4, 5, 6, 7, 9, 10, 11, 12, 15, 16.

UK2. Survey on disability and care

Definition

Disabled adults
Persons  aged  16  and  over  who,  owing  to  the  impairment  of  any  mental  or  physical
structure or function, experience significant restrictions in their ability (or a total lack
of  ability)  to  carry  out  the  normal  activities  of  life,  taking  age  into  account.  The
minimum  threshold  for  this  definition  was  fixed  relatively  low  to  enable  data  to  be
collected on a wide range of cases.

In  general,  the  definitions  of  the  International  Classification  of  Impairments,
Disabilities and Handicaps were used.

Source

Office of Population Censuses and Surveys (O.P.C.S.)

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Years

1985/1986

Population

All (Great Britain)

Methodology The  survey  covered  people  aged  16  or  more,  living  at  home  or  in  community
establishments in Great Britain. It took place in 1985 for the former and in 1986 for
the latter.

Adults living at home

The  first  stage  was  to  ask  the  occupants  of  100.000  private  addresses  to  fill  in  a
questionnaire to identify persons who had a) difficulty carrying out everyday activities
and b) health problems.

Approximately  80.000  questionnaires  were  sent  out  by  mail  and  20.000  distributed
personally by the enumerators. In the first group (of 80.000 addresses), the response
rate from permanent residents was 82 % and in the second group 86%.
Of  those  households  that  did  not  return  the  questionnaire,  approximately  1.500  was
chosen  for  an  additional  investigation.  81%  of  the  households  in  this  latter  group
subsequently provided the information requested by the enumerators.

The  second  stage  was  for  the  enumerators  to  visit  those  persons  restricted  in  their
everyday  activities  who  had  been  identified  during  the  first  stage  (by  the
questionnaire). Thus approximately 18.000 were contacted for an interview.

80%  of  those  persons  were  interviewed,  whilst  9%  of  the  adults  identified  were  not
interviewed  because  of  changes,  which  occurred  between  the  mailing  of  the
questionnaire and the date scheduled for the visit.

Adults living in establishments

A  questionnaire  was  sent  to  all  (community)  establishments  where  disabled  adults
were  likely  to  be  living  permanently.  Establishments  that  accepted  people  for  short
stays were eliminated. Such people were included with those living at home.

A  total  of  1.408  institutions  were  contacted  by  post.  Approximately  63&%  of  these
(892) had four or more permanent residents prepared to cooperate. Finally, 3.533 full
interviews were carried out in 570 establishments.

Total estimate

The  survey  estimated  the  number  of  disabled  adults  at  6.202.000.  The  confidence
interval, with a 95% probability threshold, was 6.202.000 +/- 169.000.

Publication

The  prevalence  of  disability  among  adults,  J.  Martin,  H.  Meltzer  and  D.  Elliot,
O.P.C.S.  surveys  of  disability  in  Great  Britain:  Report  1:  Office  of  Population
Censuses and Surveys / Social Survey Division, HMSO, London, 1988

Disabled  adults:  Services,  transport  and  employment,  J.  Martin,  A.  White  and  H.
Meltzer,  O.P.C.S.  surveys  of  disability  in  Great  Britain:  Report  4:  Office  of
Population Censuses and Surveys / Social Survey Division, HMSO, London, 1989

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The financial circumstances of disabled adults living in private households, J. Martin
and  A.  White,  O.P.C.S.  surveys  of  disability  in  Great  Britain:  Report  2:  Office  of
Population Censuses and Surveys / Social Survey Division, HMSO, London, 1988

Comments

The  survey  defined  disability  in  relation  to  a  certain  number  of  activities,  which  the
disabled person is not able to do. This does not correspond with the definition used in
the Disabled Persons (Employment) Act.

Tables

14, 23, 24.

UK3.

General Household Survey

Definition

Persons usually unable to do tasks by themselves (Module on elderly: 65+)

Sheltered accommodation
Sheltered housing is defined as those having a warden on premises or a central alarm
system. Sheltered housing excludes communal establishments such as nursing homes
and hospitals.

Source

Office for National Statistics – Social Survey Division

Years

The module was included in the GHS in 1980, 1985, 1991, 1994 and 1998

Population

Private households (Great Britain). Age: 65+ for the module.

Methodology The Study was carried out as part of the 1998 General Household Survey.

3.082  people  aged  65  and  over  were  interviewed  about  their  living  circumstances,
their health, their ability to perform a range of domestic and other tasks, and the use
they make of health and social services.

57%  (1.745  persons)  were  women  and  43%  (1337  persons)  were  men.  As  the  GHS
only  covers  private  households,  the  sample  of  elderly  people  is  not  representative  of
the  elderly  population  as  a  whole.  Households  with  at  least  one  person  aged  65  and
over are referred to as 'elderly households'.

The  proportion  of  GHS  respondents  in  each  five-year  age  group  declined  with
increasing age, from 31% in the 65-69 age group to 8% aged 85 and over.

Since  no  suitable  list  of  private  households  exists,  the  GHS  selects  a  sample  of
addresses while households are identified at the interviewing stage. For the 1998 GHS
13.248 addresses were selected from the Postcode Address File, of which 1575 were
ineligible. The remaining addresses yielded a sample of 11.831 households. Personal
or  proxy  interviews  were  conducted  with  all  adult  members  at  72%  of  these
households, 23% did not wish to take part and 4% could not be contacted.

Information  is  collected  throughout  the  year  by  personal  interview  with  all  adult
members (aged 16 or over) in the sample of private households.

Publication

“People  aged  65  and  over:  Results  of  an  independent  study  carried  out  on  behalf  of
the  Department  of  Health  as  part  of  the  1998  General  Household  Survey”,  Ann
Bridgewood, Office for National Statistics – Social Service Division

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“Informal  Carers:  results  of  an  independent  study  carried  out  on  behalf  of  the
Department of Health as part of the 1995 General Household Survey”, The Stationary
Office, 1998

Comments

Just  over  three-fifths  (61%)  of  elderly  people  said  they  had  a  longstanding  illness;
42% said this limited their activities in some way. This proportion remained relatively
stable between 1980 and 1998.

Concerning  dependency,  with  the  exception  of  jobs  involving  climbing,  there  has
been  little  change  over  the  years  in  the  proportion  unable  to  perform  domestic  tasks
unaided.

Use  of  home  help  in  the  month  before  the  interview:  Home  help  from  local
authorities:  4%.  The  use  of  private  domestic  help  amounts  to  9%.  In  1991,  the  rates
were  respectively  9%    (LA)  and  4%.  (Private).  These  estimates  might  include  short-
term beneficiaries and persons not considered dependent.
For  comparison,  in  2000,  the  number  of  persons  receiving  an  attendance  allowance
was a 1.250.000 beneficiary. This represents about 14% of the population aged 65 and
over. The attendance allowance is a non-contributory, non-income related benefit paid
to people over the age of 65 who need help with personal care or need a lot of looking
after.  It  aims  to  compensate  the  extra  cost  of  care.  Consequently,  it  might  include
people who rate not dependent on a long-term base.

Tables

2, 6, 7, 8, 9, 10, 23, 24, 25, 27.

UK4.

Carers 2000

Definition

The  definition  of  care  in  the  report  is  based  on  respondents’  answers.  Carers  are
defined  as  people  who  were  looking  after,  or  providing  some  regular  service  for  a
sick, disabled or elderly person living in their own or another household. All types of
caring tasks for any number of hours were included.

Certain  types  of  caring  have  been  excluded:  volunteer  for  a  charity  or  other
organisation;  those  caring  for  someone  receiving  care  in  an  institution;  those
providing  financial  support  only;  and  those  caring  for  someone  with  a  temporary
illness or disability (as defined by the respondent).

Source

Office for National Statistics – Social Service Division

Years

2000, five-yearly intervals since 1985.

Population

Private households (Great Britain)

Methodology The survey on the extent and nature of care giving is a part of the General Household
Survey  (GHS).  Fieldwork  for  the  GHS  is  conducted  on  a  financial  year  basis,  with
interviewing taking place continuously throughout the year. The results are based on a
nationally  representative  sample  of  adults  living  in  private  households  in  Great
Britain.  A  sample  of  13,248  addresses  is  selected  each  year  from  the  Postcode
Address File.

In  2000/01,  this  produced  a  sample  of  12393  eligible  addresses.  Interviews  were
achieved  at  8221  households,  representing  a  response  rate  of  67%.  Since  the  1994
survey, 
interviews  have  been  conducted  using  computer-assisted  personal
interviewing  (CAPI)  on  laptop  computers,  with  the  addition  from  2000  of  telephone

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interviews  (CATI)  with  those  people  for  whom  proxy  data  had  been  collected.  The
software is BLAISE.

Publication

“Carers 2000”, National Statistics, London: The Stationery Office.

Comments

-

Tables

21, 26.

UK5. Family resources survey

Definition

Persons receiving care
An individual is recorded as receiving care if they receive care from another person in
the  household  and/or  from  someone  outside  the  household.  They  are  counted  only
once no matter how many people provide care to them.

Informal care
Giving and receiving help on an informal basis, that is, not as part of a paid job.

Source

Department for Work and Pensions

Years

Periodic survey. Last: 2000/2001

Population

Private households in Great Britain.

Methodology The survey uses a stratified clustered probability sample drawn from the Royal Mail’s
small users Post Code Address File. The sample covered about 24.000 households and
included 55.801 individuals. The overall response rate was 65%.

The survey took place between April 2000 and March 2001. Respondents are asked if
anyone in the household provides care to any one in the household and/or to anyone
living outside the household. Questions are then asked about who is receiving the help
or being looked after. There are then follow-up questions for each person named about
that provides the help and the frequency. The follow up questions are only asked for
those receiving help at least once a week.

The publication reports household members receiving care by frequency of help. The
publication reports the prevalence of long-standing illness.

Publication

“Family  Resources  Survey:  Great  Britain  2000-2001”,  edited  by  N.  Butt  et  al.,
National Statistics, Department for Work and Pensions.

Comments

The authors note that what should be counted as care is not prescriptively defined.
Carers are counted only once, even if they look after more than one individual.
Modelling  Social  Security  benefit  entitlement  is  central  to  the  survey,  notably  for
policy evaluation and costing of policy options.

Tables

18, 22.

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OECD

OECD1:

Elderly people in institutions

Definition

Population aged 65+ in institutions.
Includes formal long-term care institutions.

Source

Organisation for Economic Co-operation and Development (OECD).

Years

Different years according to country. In general, mid 90s.

Population

Population aged 65+ in residential care.

Methodology Estimations  done  by  the  OECD  using  different  sources,  including  a  questionnaire  to
the  member  Countries.  The  author  notes  that  data  includes  formal  long  term  care
institutions  as  the  increased  diversity  in  lodging  makes  it  difficult  to  isolate  nursing
homes.  “Estimates  may  vary  according  to  the  concept  chosen  for  institutions
(sheltered  housing,  hotels  for  the  elderly,  medical  homes).  Normally,  the  concept
described  should  include  only  staffed  homes”.  For  Denmark  the  concept  of  older
persons  refers  mostly  to  over  67.  In  the  Netherlands,  some  of  the  residential
accommodation is provided within hospitals.

Publication

“Ageing and care for frail elderly persons: An overview of international perspective”,
S.  Jacobzone,  Labour  Market  and  Social  Policy  –  Occasional  papers  N°  38,  OECD,
1999.

Comments

The  author  notes  that  the  data  needs  to  be  interpreted  with  caution.  “Between
residences  which  are  almost  like  hotels,  with  medical  care  available  only  in  case  of
emergency,  and  nursing  homes  offering  the  full  range  of  medical  care,  there  are
establishments  offering  varying  degrees  of  medical  care”.  “The 
types  of
accommodation  arrangements  are  extremely  diverse.  Mostly  public  in  the  Nordic
countries, they are mixed in continental Europe”.

Tables

-

OECD2:

Elderly people receiving formal help at home

Definition

Population aged 65 and over receiving formal help at home, including district nursing,
and help with Activities of Daily Living.

Home  care  should  include  all  home  care  services,  including  district  nurses  services,
excluding medical visits.

Source

Organisation for Economic Co-operation and Development (OECD).

Years

Different years according to country. In general, mid 90s.

Population

Population aged 65+ living at home.

Methodology Estimations  done  by  the  OECD  using  different  sources,  including  a  questionnaire  to

the Member countries.

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Publication

“Ageing and care for frail elderly persons: An overview of international perspective”,
S.  Jacobzone,  Labour  Market  and  Social  Policy  –  Occasional  papers  N°  38,  OECD,
1999.

Comments

The author notes that existing estimates for long term care in OECD Health Data are
somewhat lower but do exclude a considerable share of long-term care programmes.

Tables

27.

OECD3. Elderly people receiving home help

Definition

Persons aged 65 and over remaining outside the institutions and receiving home help.
Home  help  might  include  notably  day  care,  respite  care,  visiting  nurses  and  home
helps.

Source

Organisation for Economic Co-operation and Development (OECD).

Years

Different years according to country. In general, beginning 90s.

Population

Population aged 65+ living at home.

Methodology Estimations  done  by  the  OECD  using  different  sources,  including  a  questionnaire  to

the Member countries.

Denmark refers to persons aged 67+ receiving home help.
Spain includes public, private non-profit and private home care services.
Netherlands refers to administrative statistics.

Publication

“Social protection for dependent elderly people: Perspective from a review of OECD
countries”, Labour Market and Social Policy Occasional Paper, N° 16, OECD, 1995.

Comments

The  publication  does  not  provide  further  information  on  the  questionnaire  and  the
replies of the different countries.

Tables

27.

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O1.

Caring for people

Definition

Home help
France:
Germany
Netherlands

OTHER SOURCES

Housework. Home nurses provide personal care.
Personal care and domiciliary care.
Housekeeping and personal care. Includes specialised care and
domestic care.

Source

Different sources according to country and type of information.

Years

Different years.

Population

-

Methodology Administrative data, surveys and personal communications to authors.

Home  help  for  France  is  an  estimation  done  by  Lebeaupin.  Administrative  statistics
are used for Germany and for the Netherlands.

Publication

“Caring  for  Children  and  Older  People:  A  comparison  of  European  Policies  and
Practices”,  Rostgaard,  T.  and  Fridberg,  T.,  Social  Security  in  Europe  6,  The  Danish
National Institute of Social Research 98:20, Copenhagen, 1998.

Comments

The authors present data concerning institutional accommodation for people aged 65
and  over.  Denmark:  4,5%;  England:  5%;  Finland:  3%;  France:  4,5%;  Germany:  5%,
Netherlands: 9% and Sweden: 5%.

We  do  not  report  data  on  'sheltered  housing'  as  they  might  not  concern  significant
numbers of dependent people. Sheltered accommodation aim to promote independent
living for older people who are mainly able to perform basic tasks, but who may still
need some regular help or security, e.g. by being linked to an alarm system.

Tables

27.

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Summary of main sources

Country
Belgium

Denmark

Germany

Survey
Health Interview Survey

Health and Morbidity
Survey
Administrative data

Greece
Spain

France

Ireland

Help and care dependency
survey
Microcensus

-

Survey on Impairments,
Disabilities and Handicaps
Survey on Handicaps-
Disabilities-Dependencies

Survey on Health and
Medical Care
Household Living
Conditions Panel survey
Functional ability of older
people

Survey of Long-stay units

Italy

Health conditions and
access to health services

Luxembourg Socio-economic panel

Netherlands

Austria

Permanent Survey on Life
Conditions
Microcensus

Source
Institut Scientifique
de la Santé Publique
National Institute of
Public Health
Statistisches
Bundesamt
Idem

Idem

-
Instituto Nacional de
Estadistica
Institut national de la
statistique et des
études économiques
Idem

Idem

Health and Social
Services for Older
people in Ireland
Department of
Health and Children
Istituto Nazionale di
Statistica
CEPS

Centraal Bureau
voor de Statistiek
Österreichisches
Statistisches
Zentralamt

Portugal

National Survey on Health Department of

Finland

Sweden

United
Kingdom

Survey on Impairments,
Disabilities and Handicaps
Health survey

Health
Nat. Rehabilitation
Secretariat
National Public
Health Institute
Statistics Sweden

Survey on living
conditions
Care to the elderly
(Administrative data)
Health Survey for England GB Department of

Idem

General Household Survey
(GHS)
Survey on carers
Module of the GHS
Family Resources Survey

Health

Office for National
Statistics
Idem

Department for
Work and pensions

Year

2001

2000

1999

Sample
All
12.111 persons
All
22.486 adults
Beneficiaries of
care insurance

1991/92 Private households

1999

-
1999

60.938 persons
All
820.000 persons

-
Private households
220.000 persons

1999/01 All

1991

1996

2000

20.000 and 16.000
in Institutions
Private households

Private households
14.845 persons
Private households
837 persons 65+

Ref.
B1

DK1

D1

D2

D3

-
E1

F1

F2

F4

IRL1

1998

Institutions

IRL2

1999/00 Private households

1992

2000

1996

140.000 persons
Private households
5.191 persons
Private households
9.877
Private households
60.000 persons

1995

1998/99 Private households
21.808 households
All
142.112 persons
Private households
2.400 persons

2001

1996/97 Private households

2001

2001

1998

2000

112.404 persons
All (Persons 65+)
Beneficiaries / care
Private households
Except 2000: 7.988
and 2493 in instit.
Private households
3.082 persons 65+
Private households
12.393 addresses

I1

L1

NL1

A1

P1

P2

FIN1

S1

S2

UK1

UK3

UK4

2000/01 Private households

UK5

55.801 persons

Notes
Source:
persons in institutions.

It  presents  the  main  partner.  Sample:  The  numbers  refer  generally  to  persons  and  not  households.  All:  Includes

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ANNEX A

GLOSSARY

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Activities of daily living

Activities of daily living (ADL)

They  include  self-care  activities,  such  as  bathing,  dressing  and  feeding  oneself.  The  Katz
index is the most often used index.

Instrumental activities of daily living (IADL)

They include domestic activities such as cooking, shopping and house keeping.

Katz index (ADL):

This  index  has  six  items:  washing  (bathing),  dressing,  transfer  (to  or  from  a  bed  or  chair),
going to the toilet, continence and eating. For each item, we distinguish four cases. Let’s take
washing. A person able to wash without assistance receives a score of zero points. A person
needing  assistance  in  washing  lower  part  of  body  receives  one  (1)  point,  etc.  A  fully  self-
dependent person has a total score of zero (0), etc..
-  Full self-dependent person: Katz index = 0,
-  Moderately care dependent: Katz index = 1 or 2,
-  Highly care dependent: Katz index = 3 or 4,
-  Very highly care dependent: Katz index = 5 or 6.

Lawton and Brody index (IADL):

This  index  includes  using  the  telephone,  shopping,  food  preparation,  housekeeping,  laundry,
travel, responsibility for own medicine and ability to handle finances.

AGGIR

The French “Isoressources Group Gerontological Independence grid” (AGGIR or GIR) is designed to
evaluate  the  workload  associated  with  the  dependency  of  seniors  (over  60  years  old)  living  at  home
and in institutions. It is based on ten discriminating elements concerning coherence, bearings, washing
the  top  and  bottom  half  of  the  body,  dressing,  (top,  middle  and  bottom),  eating,  urinary  and  faecal
elimination, transfers, getting around indoors and outdoors, and communicating over distances.

 An ‘isoressources’ group is a group of people requiring a comparable volume of assistance, measured
in man-hours. The groups are numbered from 1 to 6 by decreasing level of dependency.

Group  1  mainly  comprises  individuals  who  have  lost  their  mental,  bodily,  motor,  and  social
independence,  and  thus  require  a  continuous  presence  of  caregivers.  On  the  other  extreme,  the
individuals in group '5' need ad-hoc care (usually home help) and those in group '6' are persons who
remain independent in all daily-living activities (cited above).

A multi-disciplinary team of doctors and social services professionals does the assessment. Depending
on what the senior does, does not do or partially does in these ten areas, he/she is classed in one of the
six  isoressources  groups.  The  team  fills  in  an  evaluation  grid,  which  is  processed  by  a  software
program that determines the respondent’s isoressources group.

Care

Carer

A  person  who  supports  a  dependent  person.  Often  used  to  designate  the  non-professional,
benevolent provider of care and assistance.

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Community-based care

Any  type  of  care,  supervision  and  rehabilitation  outside  the  hospital  by  health  and  social
workers based in the community (Atlas, 2001). Community care is associated with provision
of services and care at home rather than in an institution.

Institutional care

Care in institutional settings (notably, rest and nursing homes), also called residential care.
Currently, priority is given in a certain number of countries (e.g. Nordic countries) to favour
the return to the community / ‘disinstitutionalisation’.

Colvez classification

This classification distinguishes four levels11:

Level 1: Bedridden and chairridden
Level 2: Not bed or chairriden but helped to wash and dress
Level 3: Neither bed/chairriden nor helped to wash and dress but helped to get out of the house
Level 4: Independent.

Three  additional  categories  (bearings  in  time  and  space,  behaviour,  and  help  with  bearings  and
behaviour)  are  used  to  refine  this  classification  by  dividing  each  of  the  first  four  categories  into  two
sub-categories according to level of psychological dependency.

In order to take into account care received by slightly dependent individuals, the adjusted Colvez
classification adds a new level (4): the individual is assisted in activities of daily living (shopping,
housework, etc.).

Disability adjusted life years (DALYs)

Quality  adjusted  life  years  (QALYs)  is  a  summary  measure  of  health  gain  that  combines  life
expectancy  and  quality  of  life.  A  year  in  full  health  is  assigned  a  weight  of  one  and  a  state  that  is
considered  equivalent  to  death  is  assigned  a  value  of  zero.  Health  states  that  lie  between  these  two
limits will be given a weight that lies between zero and one. For example, a given status of health (e.g.
living  with  a  chronic  disease)  may  be  assigned  a  weight  of  0,75.  Living  for  20  years  with  a  chronic
disease would then be considered equivalent to 15 QALYs (20x0,75=15). A policy preventing chronic
disease would lead to a health gain of five QALYs (A. Shiell et al., 2002). Disability is one candidate
health state and the measure is called DALY.

Disability free life expectancy (DFLE)

Number of years of projected life expectancy that will be spent free of disability. Disability free life
expectancy is important because it indicates not only the increase in the number of years but also the
quality of life during these additional years.

International Classification of Diseases (Tenth Revision)

ICD-10 is a classification of health conditions (diseases, disorders, injuries, etc.). Functioning and
disability associated with health conditions are classified in ICF. Consequently, ICD-10 and ICF are
complementary.

11   “Caring for the Dependent Elderly : More Informal than Formal” , P. Breuil-Genier, INSEE Studies, n° 39, September

1999.

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International Classification of Functioning, Disability and Health (ICF)

ICF  constitutes  a  revision  of  the  International  Classification  of  Impairments,  Disabilities  and
Handicaps  (ICIDH).  ICF  was  endorsed  by  the  Fifty-fourth  World  Health  Assembly  for  international
use  on  22  May  2002  (WHO,  2001).  It  defines  components  of  health  and  some  health-related
components of well being (such as education and labour). It presents two basic lists:

Part 1.  Functioning and Disability

a)  Body Functions and Structures, and
b)  Activities and participation

Part 2. Contextual factors

a)  Environmental factors
b)  Personal factors.

Part  1.  terms  replace  the  formerly  used  terms  'impairment',  'disability'  and  'handicap'.  ICF  also  lists
environmental factors that interact with all other constructs.

Body functions
Body  functions  are  the  physiological  functions  of  body
systems (including psychological functions),

Body structures
Body  structures  are  anatomical  parts  of  the  body  such  as
organs, limbs and their components.

1. Mental functions
2. Sensory functions and pain
3. Voice and speech functions
4. Functions  of 

the  cardiovascular,  haematological,

immunological and respiratory systems

5. Functions  of  the  digestive,  metabolic  and  endocrine

systems

6. Genitourinary and reproductive functions
7. Functions of the skin and related structures

1.  Structures of the nervous system
2.  The eye, ear and related structures
3.  Structures involved in voice and speech
4.  Structures  of  the  cardiovascular,  immunological

5.  Structures 

and respiratory systems
to 

related 
reproductive systems

the  genitourinary  and

6.  Structures related to movement
7.  Skin and related structures

Activities and participation
Activity is the execution of a task or action by an individual.
Participation is involvement in a life situation.

Environmental factors
Environmental  factors  make  up  the  physical,  social  and
attitudinal  environment  in  which  people  live  and  conduct
their lives

9.  Learning and applying knowledge
10.  General tasks and demands
11.  Communication
12.  Mobility
13.  Self-care
14.  Domestic life
15.  Interpersonal interactions and relationships
16.  Major life areas
17.  Community, social and civic life

1.  Products and technology
2.  Natural  environment  and  human-made  changes  to

environment

3.  Support and relationships
4.  Attitudes
5.  Services, systems and policies

Impairments are problems in body functions or structure such as significant deviation or loss.
Activity limitations are difficulties an individual may experience in involvement in life situations.

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International Classification of Impairments, Disabilities and Handicaps (ICIDH)

ICIDH published by the World Health Organisation (WHO) distinguishes: impairment, disability and
handicap (WHO, 1980).

Impairment

Disability

Any  loss  or  abnormality  of  psychological,  physiological  or
anatomical structure or functions.

Any  restriction  or  lack  (resulting  from  an  impairment)  of
ability  to  perform  an  activity  in  the  manner  of  or  within  the
range considered normal for a human being.

Intellectual impairments

1. 
2.  Other psychological impairments
3.  Language impairments
4.  Aural impairments
5.  Ocular impairments
6.  Visceral impairments
7.  Skeletal impairments
8.  Disfiguring impairments
9.  Generalised, sensory, and other impairments

1.  Behaviour disabilities
2.  Communication disabilities
3.  Personal care disabilities
4.  Locomotor disabilities
5.  Body disposition disabilities
6.  Dexterity disabilities
7.  Situational disabilities
8.  Particular skill disabilities
9.  Other activity restrictions

Handicap

A disadvantage, for a given individual, resulting from an impairment or a disability, that limits
or  prevents  the  fulfilment  of  a  role  that  is  normal  (depending  on  age,  sex  and  social  and
cultural factors) for the individual.
The term handicap refers to the relation between a person with his environment. It involves a
limitation of scope to participate in community life on an equal footing with others.

Kuntzmann’s score

This measure is used to assess the dependency of a person.
Nine indicators describe five fields (human resources requirements, getting around, continence,
psychological state and care needs). These are used to ascribe a dependency score of 0 to 10.

Prevalence

Proportion of cases of a given social/medical condition at any one time in the population studied.
Incidence is the proportion of people contracting/acceding the condition in question over a specified
period of time. The first refer to a stock and the second to a flow.

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ANNEX B

NOTE ON METHODOLOGY

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Calculations of % by age group (65+ and 75+)

We have always used rates given in the original publications. In exceptional cases, where we
have only absolute numbers (number of answers), we have estimated first the rate for each age
group and then for 65+ and 75+.

For weighting purposes, we have used the population data included in the publications;
otherwise we have used the average population by five-year age groups provided by Eurostat.

Estimations

*: Means that the estimation is done by the author.

Charts

In general, charts present non-rounded data.

Rounding

Excel rounds 0,5 at the upper unit.
If the original publication rounds up 1,45 to 1,5; then the introduction of 1,5 into Excel will
give 2.

Sources

Sources of the data are described in record sheets (fiches). They are presented in Part B by
country. The first letter identifies the country and the second the N° of the fiche.

Zero

Due to rounding up, ‘0’ means less than 0,5.

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