**Author details**

Alexander Morales Erazo1,2,3,4,5\*


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98 Gerontology

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Alexander Morales Erazo1,2,3,4,5\*

\*Address all correspondence to: alexandermoraleserazo@gmail.com

2 CES University, Medellín, Antioquia, Colombia

5 COMETA Foundation, Pasto, Nariño, Colombia

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3 Cooperative University of Colombia, Pasto, Colombia

4 Nariño Departamental Hospital, Pasto, Nariño, Colombia

1 Internal Medicine and Geriatrics, Caldas University, Manizales, Caldas, Colombia

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**Chapter 6**

**Provisional chapter**

**Ageing Better in the Netherlands**

**Ageing Better in the Netherlands**

DOI: 10.5772/intechopen.74748

The Dutch National Care for the Elderly Programme was an initiative organized by the Netherlands Organisation for Health Research and Development (ZonMw) between 2008 and 2016. The aim of the programme was to collect knowledge about frail elderly, to assess their needs and to provide person-centred and integrated care better suited to their needs. The budget of EUR 88 million was provided by the Dutch Ministry of Health, Welfare and Sports. Putting the needs of elderly people at the heart of the programme and ensuring their active participation were key to the programme's success. The programme outcomes included the establishment of eight geriatric networks around the medical universities with 650 organisations and the completion of 218 projects. These projects, involving 43,000 elderly people and 8500 central caregivers, resulted in the completion of 45 PhD theses and the publication of more than 400 articles and the development of 300 practice toolkits, one database and a website, www.beteroud.nl. The Dutch National Care for the Elderly Programme has since developed into a movement and continues under the consortium Ageing Better, made up of eight organisations. Through the use of ambassadors, Ageing

Better promotes the message that ageing is not a disease but a new phase of life.

The European population is ageing as a result of lower birth rates and a higher life expectancy. The Netherlands is a relatively young country with 15% of the population aged 65 years and over (8% is aged 80 and over) compared to Germany, where 20% of the population is aged 65 years and over. Life expectancy in the Netherlands is still rising: average life expectancy is 79.9 years for men and 83.3 years for women. By 2050 the number of elderly people will

**Keywords:** ageing, elderly, healthy ageing, frailty, integrated care

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

distribution, and reproduction in any medium, provided the original work is properly cited.

Betty Meyboom-de Jong, Klaske Wynia and

Betty Meyboom-de Jong, Klaske Wynia and

Additional information is available at the end of the chapter

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.74748

Anjo Geluk-Bleumink

Anjo Geluk-Bleumink

**Abstract**

**1. Introduction**

#### **Chapter 6 Provisional chapter**

#### **Ageing Better in the Netherlands Ageing Better in the Netherlands**

Betty Meyboom-de Jong, Klaske Wynia and Anjo Geluk-Bleumink Betty Meyboom-de Jong, Klaske Wynia and Anjo Geluk-Bleumink

Additional information is available at the end of the chapter Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.74748

#### **Abstract**

The Dutch National Care for the Elderly Programme was an initiative organized by the Netherlands Organisation for Health Research and Development (ZonMw) between 2008 and 2016. The aim of the programme was to collect knowledge about frail elderly, to assess their needs and to provide person-centred and integrated care better suited to their needs. The budget of EUR 88 million was provided by the Dutch Ministry of Health, Welfare and Sports. Putting the needs of elderly people at the heart of the programme and ensuring their active participation were key to the programme's success. The programme outcomes included the establishment of eight geriatric networks around the medical universities with 650 organisations and the completion of 218 projects. These projects, involving 43,000 elderly people and 8500 central caregivers, resulted in the completion of 45 PhD theses and the publication of more than 400 articles and the development of 300 practice toolkits, one database and a website, www.beteroud.nl. The Dutch National Care for the Elderly Programme has since developed into a movement and continues under the consortium Ageing Better, made up of eight organisations. Through the use of ambassadors, Ageing Better promotes the message that ageing is not a disease but a new phase of life.

DOI: 10.5772/intechopen.74748

**Keywords:** ageing, elderly, healthy ageing, frailty, integrated care

#### **1. Introduction**

The European population is ageing as a result of lower birth rates and a higher life expectancy. The Netherlands is a relatively young country with 15% of the population aged 65 years and over (8% is aged 80 and over) compared to Germany, where 20% of the population is aged 65 years and over. Life expectancy in the Netherlands is still rising: average life expectancy is 79.9 years for men and 83.3 years for women. By 2050 the number of elderly people will

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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 disabilities and chronic diseases.

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

Ageing Better in the Netherlands

103

http://dx.doi.org/10.5772/intechopen.74748

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.

This project aimed to develop integrated support for vulnerable elderly people, using both

**3. Three exemplary projects on integrated care**

informal and formal networks [12–14].

**3.1. Integrated Neighbourhood Approach (***Even Buurten* **in Dutch)**

for the future and a proactive agenda were also established.

Fifty percent of elderly people suffer from one or more chronic diseases, but two-thirds experience no physical disabilities, and more than half report feeling healthy [1].

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

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) was well ahead of its time.
