This study examines whether the gender gap in long-term care use in the Netherlands has changed between 1995 and 2016. Previous research has shown that women use more formal care services than men, while men use more informal care. In the past decades, there have been changes in the individual determinants of care use, such as health and social resources, and care provision. This raises the question of whether gender differences in care use have also changed over time. The Longitudinal Aging Study Amsterdam (LASA) involved respondents aged 70–88 in seven waves: 1995/96, 1998/99, 2002/03, 2005/06, 2008/09, 2011/12 and 2015/16 (N = 6,527 observations). Generalised estimating equations (GEE) were used to analyse changes in the impact of gender on the use of informal and formal home care, residential care and private home care, and the non-use of care. Men used more informal care provided by a partner than women, but women used other sources of care more than men. Individual social resources explained the gender gap in informal and formal home care use, and health and social resources explained the gap in residential care. In the non-use of care and, to some extent, in residential care use, the gender gap widened over the years to the disadvantage of men and was not explained by health and social resources. The persistent and even increasing gender gap in the non-use of care over time warrants an exploration of the role of gender in seeking care and access to care, and a closer examination of the role of long-term care policies in maintaining this gap.

As a result of the rapid ageing of societies, meeting the demands for long-term care has become increasingly difficult. In the Netherlands, informal care is recognised as a key element to compensate for cut-backs in formal care provision. Formal, informal and privately paid long-term care services, however, are not used equally across socio-economic status (SES) groups and whether these inequalities have been reduced or exacerbated over time has not been researched. This study investigates to what extent educational and income inequalities in the use of formal, informal and privately paid care have changed over time. Data from the Longitudinal Aging Study Amsterdam (LASA) was used from three points in time: 1995 (N = 787), 2005 (N = 550) and 2015 (N = 473). Participants were between 75 and 85 years of age and living independently. The results indicate that lower SES groups are consistently more likely to use formal and informal care, and less likely to use privately paid care compared to higher SES groups. An increase in inequality was only found in the use of informal care; while informal care use is stable among lower SES groups, it decreases steeply among higher SES groups. These findings highlight the importance of education for explaining variation and changes over time in care use. Governmental efforts to mobilise informal care-givers might be outweighed by trends towards less long-term care.

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

Recent societal changes have increased the salience of non-kin relationships. It can be questioned whether network types that are more strongly non-kin-based give more informal care nowadays. We study how informal care use differs according to network type for three birth cohorts. Data from the Longitudinal Aging Study Amsterdam (LASA) on older adults aged 75–84 years, interviewed in 1992, 2002 and 2012, respectively (total sample size N = 2,151, analytical sample having functional limitations N = 926). We found four network types: restricted, family-focused with a partner, family-focused without a partner and wider community-focused diverse networks. Wider community-focused diverse networks are more common in the late birth cohort, whereas restricted networks and family-focused networks without a partner are less common. Logistic regression analyses reveal that those in a family-focused network with a partner use informal care more often than those in the other three network types, and insignificant interaction terms show that this does not differ by birth cohort. Irrespective of their network type, those in the late birth cohort use informal care less often. However, after controlling for need, predisposing and context factors, this cohort-difference is no longer significant. We conclude that despite large-scale societal changes, wider community-focused diverse networks do not provide more informal care than before and that among the functionally impaired, the odds of receiving informal care does not decline across birth cohorts.

This study investigates trends in, and the interdependence of, the use of informal and formal home care of community-dwelling older people over the last two decades in the context of governmental reform of long-term care services and modernisation of informal relationships. Seven observations of the Longitudinal Aging Study Amsterdam covering the time span between 1992 and 2012 were analysed using multi-level logistic regression analysis. The sample entailed 9,585 observations from 3,574 respondents, aged between 65 and 85 years and living independently at each time of measurement. Measures included formal and informal care use, health, physical and cognitive limitations, socio-demographics, partner status, social network, privately paid help and sense of mastery. Results showed that between 1992 and 2012, formal home-care use increased slightly while there was a large decrease in the use of informal care. Multivariate multi-level logistic regression analyses showed a substitution effect between formal and informal care use which decreased over time. Analyses also showed improved cognitive functioning, increased partner availability and social network size, as well as increased use of privately paid care over time. Nevertheless, these positive trends did not explain the large decrease in informal care use. The results regarding informal care use suggest a societal trend of weakened informal solidarity, reflecting increased individualisation and increased availability of formal home care. The decreased substitution effect suggests that, in agreement with current reforms of long-term care, complementary or supplementary forms of care use may be more common in the near future.

In ageing societies, policy makers aim for more contact between informal and formal care-givers as it may enhance the quality of care. So far, the linkage between formal and informal care-givers is generally studied from a one-sided or a single dyadic perspective, without taking into account that care networks of community-dwelling older adults often exist of multiple informal and formal care-givers. The current study examines discussion of care between all potential informal–formal care-giver dyads in a care network, and relates this to characteristics of the older care recipient, the care network and the care-givers. Seventy-four Dutch older care recipients provided information on all care-givers who helped with five different types of tasks; 410 care-givers reported on the contact between all care-givers identified. Multi-level logistic regression was conducted in 2,150 informal–formal care-giver dyads and revealed that in 26 per cent of all these dyads discussion on care occurred. This was more likely when both care-givers performed multiple types of tasks, the informal care-giver was residing with the care recipient, and contact within the formal and the informal sub-network was higher. To enhance discussion of care between informal and formal care-givers in care networks where no discussion occurs at all, home-care organisations may need to allocate formal care-givers who form a bridge with an extra-residential care-giver of care recipients living alone.

Cross-national comparisons employed welfare state classifications to explain differences in care use in the European older population. Yet these classifications do not cover all care-related societal characteristics and limit our understanding of which specific societal characteristics are most important. Using the Survey of Health, Ageing and Retirement (second wave, 2006–07), the effect of societal determinants relating to culture, welfare state context and socio-economic and demographic composition on informal and formal care use of older adults in 11 European countries was studied. Multinomial multi-level regression analyses showed that, in addition to individual determinants, societal determinants are salient for understanding care use. In countries with fewer home-based services, less residential care, more informal care support and women working full time, older adults are more likely to receive informal care only. Older adults are more likely to receive only formal home care or a combination of formal and informal care in countries with more extensive welfare state arrangements (i.e. more home-based services, higher pension generosity), whereas the odds of receiving a combination of informal and formal care are also larger in countries that specify a legal obligation to care for parents. We tentatively conclude that the incorporation of societal determinants rather than commonly used welfare state classifications results in more understanding of the societal conditions that determine older adults’ care use.

Previous research on the care-giver burden experienced by adult children has typically focused on the adult child and parent dyad. This study uses information on multiple informal care-givers and examines how characteristics of the informal care-giving network affect the adult child's care-giver burden. In 2007, 602 Dutch care-givers who were assisting their older parents reported on parental and personal characteristics, care activities, experienced burden and characteristics of other informal care-givers. A path model was applied to assess the relative impact of the informal care-giving network characteristics on the care-giver burden. An adult child experienced lower care-giver burden when the informal care-giving network size was larger, when more types of tasks were shared across the network, when care was shared for a longer period, and when the adult child had no disagreements with the other members of the network. Considering that the need for care of older parents is growing, being in an informal care-giving network will be of increasing benefit for adult children involved in long-term care. More care-givers will turn into managers of care, as they increasingly have to organise the sharing of care among informal helpers and cope with disagreements among the members of the network.

The study compares the formal and informal social participation of 60–69 year olds in The Netherlands in 1992 and 2002, and examines which attributes of the two cohorts favour social participation. Using data from the Longitudinal Aging Study Amsterdam, it was found that cohort differences in formal participation (as members of organisations, in volunteer work and in religious organisations) and in informal participation (having a large social network, and in cultural and recreational activities) associated with cohort differences in individual characteristics (level of education, health, employment status and marital status). Descriptive analyses showed an increase between 1992 and 2002 in all forms of participation except religious involvement. The 2002 cohort members were more educated and more engaged in employment, but in worse health and had a higher prevalence of divorce than the 1992 cohort members. Logistic regression analyses showed that the positive effect on social participation of the recent cohort's higher educational level was suppressed by the negative effect of their worse health. Being divorced had mixed effects on formal and informal participation, but the difference in the number of divorcees did not explain cohort differences in social participation. Interaction effects showed that the influence of sex and health on volunteer work and religious involvement changed over time. The paper concludes with a discussion of the prospects for higher levels of formal and informal social participation among future cohorts of young-older people.

Many current discussions of welfare state reforms focus on the ‘young old’, a group now generally perceived as healthy people past retirement age without a legal responsibility for dependent persons in need of care. For the welfare state, they constitute a resource whose activities are hard to steer. This article focuses on the influence of the welfare state on the number of ‘young old’ people. It describes different ways in which the welfare state influences the number of young old persons, and investigates whether variations in the regulations for the ages of normal, early and late retirement are the prime cause. The paper also estimates the share of the young old among those aged 50–90 years in 10 European countries in 2004 using comparable survey data. These shares ranged between 36 and 49 per cent for men and between 35 and 52 per cent for women. High shares were found in continental European countries, and low shares in Scandinavian countries and the United Kingdom. The shares in southern European countries varied among the countries and by gender. To explain the variations in the share, country differences in retirement regulations proved helpful but insufficient. When the overall influence of the welfare state on the share of young old persons in the population was analysed, a country-characteristic pattern emerged.

This study investigates the variations by older people's socio-economic status (SES) (i.e. educational level and social class) in the use of informal and formal help from outside the household in Great Britain, Italy, Belgium and The Netherlands. In all these countries, it was older people in low SES groups who mostly used such help. Multinomial logistic regression analyses showed that, in each country and for both types of help, there were SES gradients in the utilisation of both formal and informal care, and that differences in age, health and marital status largely accounted for the former but not the latter. Cross-national differences in the use of both informal and formal help remained when variations in sex, age, SES, health, marital status, home ownership and the use of privately-paid help were taken into account. Significant interaction effects were found, which indicated that older people in low SES groups in Great Britain and The Netherlands had higher odds of using informal help from outside the household than their counterparts in Italy, and similarly that those in The Netherlands were more likely to use formal help than their Italian peers. The results are discussed in relation to the cultural differences and variations in the availability of formal services among the countries.

This paper examines the impact of childhood and adulthood socio-economic status (SES) on personal network characteristics in later life. Data are derived from 2,285 married older adults (born between 1903 and 1937) who participated in face-to-face interviews for the Dutch survey on ‘Living arrangements and social networks of older adults’ conducted in 1992. Childhood and adulthood SES were indicated by the father's and own level of education and occupation. Multivariate analyses showed that SES in adulthood has more impact on network features in old age than father's SES. People with low lifetime SES or with downward SES mobility had small networks, low instrumental and emotional support from non-kin, but high instrumental support from kin, when compared with the upwardly mobile or those with high lifetime SES. The level of education was a better indicator of network differences than occupational prestige. It is concluded that obtaining a high SES during life pays off in terms of having more supportive non-kin relationships in old age. The small networks and less supportive non-kin relationships of low-status older adults make them more vulnerable to situations in which kin are unavailable or less willing to provide support. This study underscores the distinction between types of support and types of relationships in the SES–network association. Further research on the social pathways of socio-economic inequality in health and wellbeing should take these distinctions into account.