**2. Dutch National Care for the Elderly Programme**

The Dutch National Care for the Elderly Programme began in 2008 and was run by the Netherlands Organisation for Health Research and Development (ZonMw) until 2016 [2, 3].

The aim of the programme was to collect knowledge about frail elderly people, to examine their needs and wants and to provide models for person-centred and integrated care better suited to their needs. The programme had a budget of EUR 88 million provided by the Dutch Ministry of Health, Welfare and Sports and was supported by a committee and 15 staff members. The programme was organized into three steps: the formation of regional geriatric networks with executive commitment, the delivery of innovative and transition projects and nationwide dissemination and implementation of the effective projects.

The responsible ZonMw committee worked to ensure that elderly people were not only the object of inquiry and research in the programme but were also included as subjects and participants. The principle for this approach and the slogan used by the elderly themselves was 'nothing about us without us'. As a result, the focus of empirical research on care innovation shifted over time from medical care to care and welfare, based on what elderly people themselves considered being important. This in turn led to an increasing emphasis on welfare and support of the elderly in the continuum of well-being and care. In addition, funding was provided for the design and use of a database and for the improvement of education. A vision for the future and a proactive agenda were also established.

have increased to 4.6 million, a quarter of the Dutch population [1]. Due to improved education and better lifestyles, the increase in the number of frail elderly people will be relatively smaller. However, large health differences do still exist. Poverty causes illness, and illness causes poverty. The life expectancy of people at the lower end of the social economic scale is 7 years lower than it is for those at the higher end of the scale, as measured by education and income. The difference in healthy life expectancy between people with a low and a high socioeconomic status (SES) is 16 years. People with a lower SES experience more and earlier

Fifty percent of elderly people suffer from one or more chronic diseases, but two-thirds expe-

Elderly people prefer to live at home as long as possible. Currently, six out of seven people aged 80 and older live at home, and the remainder (14%) lives in a nursing home. Of the total 80+ population, about one-third suffers from frailty through loss of function and reduced self-reliance. Frailty results from a combination of advanced age, chronic diseases, welfare problems, poor living situations, weak social networks and low income. The desire of most people to live at home as long as possible is supported by government policy. Cost containment plays an important role in this policy. Care, support and welfare for (elderly) people in

Care for the elderly is facing its greatest ever period of change. This is not only because of concerns about the quality, accessibility and affordability of care but also because our view of ageing is gradually changing. That view ultimately determines what we expect of care and support for the elderly. In this respect, the National Care for the Elderly Programme (NPO)

The Dutch National Care for the Elderly Programme began in 2008 and was run by the Netherlands Organisation for Health Research and Development (ZonMw) until 2016 [2, 3]. The aim of the programme was to collect knowledge about frail elderly people, to examine their needs and wants and to provide models for person-centred and integrated care better suited to their needs. The programme had a budget of EUR 88 million provided by the Dutch Ministry of Health, Welfare and Sports and was supported by a committee and 15 staff members. The programme was organized into three steps: the formation of regional geriatric networks with executive commitment, the delivery of innovative and transition projects and

The responsible ZonMw committee worked to ensure that elderly people were not only the object of inquiry and research in the programme but were also included as subjects and participants. The principle for this approach and the slogan used by the elderly themselves was 'nothing about us without us'. As a result, the focus of empirical research on care innovation shifted over time from medical care to care and welfare, based on what elderly people

rience no physical disabilities, and more than half report feeling healthy [1].

the Netherlands are financed according to three Acts (Appendix A).

**2. Dutch National Care for the Elderly Programme**

nationwide dissemination and implementation of the effective projects.

disabilities and chronic diseases.

102 Gerontology

was well ahead of its time.

For the programme, 8 geriatric networks were developed with a panel of elderly at 8 medical universities. These networks were open to organisations and professionals in the care of the elderly, for example, hospitals, nursing homes, GPs, municipalities and healthcare insurance companies. A total of 650 organisations joined these geriatric networks. The networks allowed innovative experiments and research projects for improving care and support to be developed with the participation of the target groups. The programme led to many important outcomes. A total of 218 projects were developed and financed, involving 43,000 elderly and 8500 caregivers. Forty-five PhD theses were completed, and more than four hundred Dutch and English articles were published. A unique database (TOPICS-MDs) and 300 practice tools were developed, and a website was launched, www.beteroud.nl. The website acts as a central resource for information, tips and tools [3]. The TOPICS-MDS database contains information on the wellbeing of the frail elderly, covering health experiences, quality of life, illness and ailments, daily functioning, mental well-being, social functioning, use of care and caregiver burden [4–9].

The 218 projects carried out as part of the National Care for the Elderly Programme were focused on themes such as early signalling, care plans, recovery care, ICT and eHealth, district-oriented work, welfare and education. Some projects specifically focused on care for elderly immigrants with different ethnic backgrounds [10, 11]. The group of older migrants is growing fast. They are among the frailest people in the society. They have often done a lot of heavy work and have language problems and little education, and they live in deprived neighbourhoods of minimal income. All these factors have an unfavourable effect on their health. Key figures from their own community with the same background play a central role in the project 'voice of the older migrant' (*De stem van de oudere migrant* in Dutch). Through their relationship based on mutual trust, the key figures are able to provide the elderly with information and advice. Besides they form the bridge between the elderly on one hand and care and welfare professionals and organisations on the other hand. After the project, the older migrants experienced improved quality of life and self-reliance; less social isolation; better access to and familiarity with care, welfare and housing; better communication with healthcare professionals; and more knowledge about health. The professionals experienced better coordination of care and welfare tailored to the wishes and needs of the older migrant and knowledge about caring for this group. For society, the result was that older migrants are healthier and more self-reliant and caused less burden on informal caregivers.
