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.

This study investigates under what conditions older spouses receive personal care from their spouse. Whether spousal care is provided is determined by individual and societal factors related to informal and formal care provision. Individual factors concern the need for care (the care recipient's health status), the spouse's ability to provide care (the spouse's health status) and the quality of the marital bond. Societal factors reflect changing policies on long-term care (indicated by the year in which care started) and gender role socialisation (gender). From the Longitudinal Aging Study Amsterdam, which completed eight observations between 1996 and 2016, we selected 221 independently living married respondents, aged 59–93, who received personal care for the first time and had at least one previous measurement without care use. The results show that if an older adult received personal care, the likelihood of receiving that care from the spouse decreased over the years: from 80% in 1996 to 50% in 2016. A husband or wife was less likely to receive spousal care when the spouse was unable to provide care or the quality of the relationship was low. No gender differences were found in either the prevalence of spousal care use or in the factors associated with that use. Thus, individual factors and the societal context seem to determine whether one receives personal care from their spouse. The decline in the likelihood of personal care provision from a spouse over the years may indicate a crumbling of family solidarity, an unmeasured and growing inability of the older spouse to provide care or an increasing complexity of care needs that requires the use of formal care. As care-giving can be a chronic stressor and most spouses provide care without assistance from others, attention from policy makers is needed to sustain the well-being of older couples.

The Longitudinal Aging Study Amsterdam (LASA) is an ongoing prospective cohort study of older adults in the Netherlands, with data on multiple domains of functioning available over a period of more than 30 years of follow-up. The study started in 1992 with a nationally representative sample of older adults aged 55–84 years. Over the years, three refresher cohorts (two cohorts aged 55–64 years in 2002 and in 2012, and one cohort aged 60–86 years in 2024) were added. The main aim of LASA was to describe determinants, trajectories and consequences of (changes in) physical, cognitive, emotional and social functioning. LASA has multiple strengths, including its multidisciplinary character, the very long period of follow-up, and the cohort-sequential design which enables the study of longitudinal changes as well as historical time trends in functioning. So far, findings based on data from LASA have been reported in more than 800 scientific publications (see www.lasa-vu.nl). In this article, we provide an update of the design and methods of LASA, including a description of several ancillary studies such as the Loneliness study and the COVID-19 study.

ObjectivesOlder care recipients have different types of care networks, varying from spouse-only to large mixed care networks, that add to different levels of wellbeing. Applying Self-Determination Theory (SDT) to the care context, we argue that the care network composition may foster or hamper the three basic needs for wellbeing: relatedness, autonomy and competence.MethodData are from ten observations between 1992 and 2022 of the Longitudinal Aging Study Amsterdam (N = 18,434 observations from 4,837 older Dutch adults). Five care network types are used: no care, partner, informal, formal or privately paid care. Mixed-hybrid-multilevel regression analysis of depressive symptoms as measure of wellbeing is applied on care network type and loneliness, mastery and care sufficiency as indicators of the three basic needs for wellbeing.ResultsReceiving care from a partner care network is, compared to the formal care network, the most negatively associated with depressive symptoms, followed by informal care and privately paid care. Differences in care network types existed in loneliness and care sufficiency, but not in mastery, and in part explained the association between care network types and depressive symptoms. Results of between and within effects are comparable.ConclusionUsing a rich data set and advanced methodology support the hypotheses that formal care networks hamper wellbeing due to insufficient care and increased loneliness, in particular compared to partner and informal care. The role of mastery was less important, possibly because it does not measure care related level of control.

Informal care and spousal caregiver’s burden in old age The ageing of the population creates an increasing demand for public long-term care (LTC). In order to keep the LTC system sustainable, policies are aimed at ‘ageing in place’ and residential care is limited. In this context, informal care has become a key issue for welfare policy. Informal care giving can have negative consequences. The decision to take up the care of someone close to you may lead to emotional, physical and financial stress, resulting in overburden. In old age, in particular for spouses, caregiver’s burden may be related to the caregiver’s own health impairments and declining quality of the relationship with the care recipient. This thesis focuses on two issues: the use of informal care (part A) and the burden on the spouse who provides care (Part B). Part A We answered the question: under what circumstances is informal care used? Data from the Longitudinal Aging Study Amsterdam is used. The Andersen-Newman model views use of care as result of decisions made by an individual, which are constrained by their position in society and the availability of care. The Informal Care Model applies this model to the perspective of the caregiver. We examined whether informal care use changed over the years and, if an older adult started to use personal care, whether the likelihood of receiving that care from the spouse, changed over the years. In one study, we analysed 9,585 observations from 3,574 respondents between 1995 and 2012 for whether informal care was used. In another study, we analysed observations from 221 independently living married respondents between 1995 and 2016 who used personal care for the first time. Results showed that next to the care need and predisposing and enabling factors, changing societal circumstances as well as the caregiver’s physical functioning and the spousal relationship quality determine informal care use. The proportion of older people using informal care was lower in the late 2010s than in 1992, while the proportion of older people using formal care increased somewhat. These findings are only in part due to changing individual characteristics of the older adults included in our study. Part B We answered our second research question: what determines spousal caregiver’s burden? We used data from the Older Persons and Informal Caregivers Survey—Minimum Data Set. As the Caregiver Stress Process Model describes, caregiver’s burden depended on multiple conditions; the need for care, hours of caregiving, secondary stressors, and buffers as the help from others and fulfilment with the caregiving tasks. We examined whether the model works differently for husbands and wives by using mediation and moderation effects with structural equation modelling. We used cross-sectional data of 1,611 couples. Additionally, we applied multilevel regression analysis on burden, stratified by gender, to study the impact of one-year duration of the caregiving situation on burden; 1,444 observations from 722 couples were analysed. Results showed that care need factors, hours of caregiving, and secondary stressors explain spousal caregiver’s burden; however, the mechanisms differed for men and women. Longer caregiving leads to higher burden, especially for wives. Wives reported a higher burden, had spouses with a greater care need, provided more hours of care a week, and more fitted the wear-and tear model than husbands. Conclusion Variation in informal care use and caregiving burden is explained by three types of factors related to both the care user and caregiver, their mutual relationship, and the societal context. The thesis also provides evidence that informal care is a highly gendered phenomenon. Female caregivers were disadvantaged in all conditions.

The association between long-term care use and mental health is ambiguous: informal care is generally negatively related to depressive symptoms, while formal care use is positively associated. As both care use and mental health are highly gendered, this study explored gender differences in the association between care network types and depressive symptoms and examined two potential explanatory mechanisms based on Self-Determination Theory: loneliness (indicating relatedness) and care sufficiency (indicating autonomy). The data are from ten observations of the Longitudinal Aging Study Amsterdam (N = 18,954 observations from 4,925 older Dutch adults, between 1992 and 2022). Six types of care networks are considered (partner, informal, formal, institutionalised, privately paid and no care). A mixed-model hierarchical regression analysis was applied across care network types, stratified by gender, using hybrid models that disentangle between inter-individual differences (context related) and intra-individual changes. Results from between and within effects show that, for both men and women, users of partner, privately paid and no care reported fewer depressive symptoms than formal care users. This also applied to informal care for women, but not for men. These differences between care network types were (partly) explained by loneliness (both between- and within-person effects) and care sufficiency (only between-person effects), for both men and women. Changes in loneliness and care sufficiency impacted women’s depressive symptoms more than men’s. Results that formal care users have more depressive symptoms are very robust and imply that formal care must align more with the needs for emotional support.