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Healthy Ageing Network Northern Netherlands. Netwerk voor oplossingen die bijdragen aan gezonde samenleving. Doel: Meer Gezonde Jaren. Doe mee!

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Healthy Ageing Network Northern Netherlands - HANNN

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Healthy Ageing Network Northern Netherlands - HANNN, Groningen. 831 likes. Het Healthy Ageing Network Noord-Nederland (HANNN) is het kennis- en ontwikkelingscluster op het gebied van levenslang...

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places in the world where people live longer

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Ze heten blauwe zones, de plaatsen in de wereld waar mensen langer en gezonder leven dan ergens anders op de wereld. Mensen die in één van deze plaatsen wonen worden gemiddeld 90 of zelfs 100 jaar, in goede gezondheid, zonder medicijnen of invaliditeit. Willen we dat niet allemaal?
De vijf blauwe zones zijn:
Het Italiaanse eiland Sardinië
Okinawa in Japan
Loma Linda in Californië
geïsoleerde Nicoya in Costa Rica Peninsula
Ikaria, een geïsoleerd Grieks eiland

Geen mysterie
Het lijkt mysterieus maar het is goed te begrijpen. Het is een keuze die mensen in deze zones maken: men leeft zonder enige vorm van stress, deelt het geluk met familie, heeft het gevoel een doel te hebben in het bestaan met een gezonde dosis aan spiritualiteit en zorgt voor voldoende slaap. Mensen in deze zones gebruiken in hun dagelijks voedingspatroon o.a. veel gezonde oliën en honing.
Nooit te oud
Veel kunnen wij uiteraard zelf toepassen in onze eigen levens- en voedingswijze. Het is nooit te laat om te beginnen. Verschillende studies tonen aan dat een drastische verbetering van de levensverwachting en gezondheid kunnen terugkeren, zeer snel na het corrigeren van een slechte levensstijl.
Uit het onderzoek en interviews met 263 honderdjarigen in de Blue Zones werden negen gemeenschappelijke kenmerken gevonden. Het geheim hoe je langer kunt leven ligt niet in diëten of oefenprogramma's, maar in het creëren van de juiste omgeving voor jezelf.

1. Beweeg natuurlijk
De mensen uit De Blauwe zones gebruiken geen vitaminepreparaten of bezoeken sportscholen. In plaats daarvan leven ze in een omgeving die hen voortdurend stimuleert om te bewegen zonder er bij na te denken. Ze tuinieren en hebben weinig mechanische hulpmiddelen voor het werk in huis en tuin.
2. Ken je doel
In Japan noemt men het "Ikigai" en in Costa Rica "plan de vida," Vrij vertaald betekent het datgene waar je in de ochtend voor wakker wilt worden. Het hebben van een doel kan zelfs zeven jaar extra levensverwachting opleveren
3. Zo min mogelijk stress
Ook in de Blauwe Zones ervaart men stress, want dat hoort bij het leven. Erg veel stress leidt echter tot chronische ontsteking en andere ernstige leeftijdgebonden ziekten. Mensen uit de Blue Zones hebben dagelijkse routines om die stress af te schudden. In Okinawa neemt men een paar momenten per dag om aan hun voorouders te denken, In Ikaria doet men overdag een dutje en in Sardinie kent men een happy hour.
4. de 80%-regel
Verlaag je calorie-inname met 20%. De Okinawaanse 2500-jaar oude confucianistische mantra die altijd voor de maaltijd wordt opgezegd herinnert hen eraan om te stoppen met eten als hun maag voor 80 procent vol is. De 20% tussen het niet hongerig meer zijn en een vol gevoel kan het verschil zijn tussen het verliezen van gewicht of juist dikker worden. Mensen in de blauwe zones eten hun kleinste maaltijd in de late namiddag of in de vroege avond en eten de rest van de avond niet meer.
5. Bonen en plantaardig voedsel
Het zelf verbouwen en eten van alle soorten bonen, zoals tuinbonen, zwarte bonen, sojabonen en linzen, zijn de hoeksteen van de meeste honderdjarige diëten. Vlees (meestal varkensvlees) wordt slechts in kleine porties gemiddeld vijf keer per maand gegeten.
6. Wijn
In alle Blauwe zones (behalve Adventisten) drinkt men regelmatig, vaak dagelijks, met mate alcohol. 1-2 glazen per dag en dan tijdens het eten of het gezellig samenzijn met vrienden.
7. Gelijkgestemden
Maar vijf van de 263 honderdjarigen die werden geïnterviewd behoorden niet tot een geloofsgemeenschap. Hieruit mag worden opgemaakt dat het behoren tot een groep waarmee regelmatig wordt samengekomen een positieve invloed heeft op de gezondheid.
8. Familie
Alle geïnterviewde honderdjarigen in de Blue Zones stellen hun familie en geliefden op de eerste plaats. Ouders en grootouders worden in huis genomen of wonen in de buurt van de woning. Ze zijn trouw aan een levenspartner en zetten zich in voor de relatie en ze investeren tijd en liefde in hun kinderen. Ook gaan mensen niet met pensioen, maar blijven naar vermogen actief tot het einde van hun leven.
9. Vriendenkring
Een goede vriendenkring en voldoende sociale contacten dragen bij aan een extra lange levensverwachting. Okinawanen creëren "moais", groepen van vijf vrienden die zich voor het leven aan elkaar verbinden en elkaar levenslang ondersteunen.

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De Blauwe Zone voedingsadvies en - coaching

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Ze heten blauwe zones, de plaatsen in de wereld waar mensen langer en gezonder leven dan ergens anders op de wereld. Mensen die in één van deze plaatsen wonen worden gemiddeld 90 of zelfs 100 jaar, in goede gezondheid, zonder medicijnen of invaliditeit. Willen we dat niet allemaal?

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longer life and healthy ageing

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People are living longer and most countries are experiencing unprecedented increases in the number and proportion of their elderly populations, resulting from declines in mortality, lower fertility, and the baby boom cohorts entering old age.

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Longstanding tradition in human ageing research

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The LUMC has a longstanding tradition in human ageing research and is leading national and international consortia with the mission to make people live healthier for longer. We envision disease in elderly patients as a holistic problem affecting many tissues simultaneously.

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Risk factors of ill health among older people

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As people age, they become more susceptible to disease and disability. However, much of the burden of ill health among older people can be reduced or prevented by adequately addressing specific risk factors, including:

injury

development of noncommunicable diseases

poverty

social isolation and exclusion, mental health disorders

elder maltreatment.

Injury

Falls and the injuries to which they often lead cause a large share of the burden of disease and disability on older people. The risk of falls increases steeply with age. Injuries from falls (such as femur fracture) usually require hospitalization and costly interventions, including rehabilitation, and cause much of the functional limitations that lead to the need for long-term care, including admissions to nursing homes.

Frailty in itself can considerably increase the risk of falls, which can happen in all settings. About 30-50% of people living in long-term care institutions fall each year. Convincing evidence, however, shows that most falls are predictable and preventable. Some injury-prevention measures (such as hip protectors) have been shown to be cost effective or even cost saving, and there are examples of successful implementations of strategies to prevent falls, supported by public policies.

Risk factors of noncommunicable diseases

Healthy ageing is a lifelong process. Patterns of harmful behaviour, often established early in life, can reduce the quality of life and even result in premature death. Poor nutrition, physical inactivity, tobacco use and harmful use of alcohol contribute to the development of chronic conditions: 5 of these (diabetes, cardiovascular diseases, cancer, chronic respiratory diseases and mental disorders) account for an estimated 77% of the disease burden and 86% of the deaths in the European Region. The most disadvantaged groups carry the greatest part of this burden.

Although smoking or lack of exercise, for example, can have long-term effects, changing course is beneficial at any age. The risk of premature death actually decreases by 50% when people stop smoking at age 60-75 years. Also, according to WHO's "Global recommendations for physical activity and health":

"the overall evidence for adults aged 65 years and above demonstrates that, compared to less active individuals, men and women who are more active have lower rates of all-cause mortality, coronary heart disease, high blood pressure, stroke, type 2 diabetes, colon cancer, breast cancer, a higher level of cardiorespiratory and muscular fitness, healthier body mass and composition, and a biomarker profile that is more favourable for the prevention of cardiovascular disease, type 2 diabetes and the enhancement of bone health. These benefits are observed in adults in the older age range, with or without existing noncommunicable diseases."

In addition, a healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use can delay or prevent the onset of type 2 diabetes.

Poverty

The risk of poverty grows with older age and is much higher among women than men. The prevalence of poverty (defined as having less than 60% of the national median income) among people older than 65 years varies widely across Europe. For European Union countries, for example, the prevalence is 4% in Hungary, 5% in Luxembourg and 7% in the Czech Republic, but 51% in Latvia, 49% in Cyprus and 39% in Estonia.

Moreover, many older people cannot afford to pay health costs, including prescription drugs, from their own pockets. WHO/Europe works closely with Member States to support them in developing policies that reduce this financial risk and ensure a more equitable distribution of the burden of health system funding.

Social isolation and exclusion, mental health disorders

Loneliness, social isolation and social exclusion are important social determinants and risk factors of ill health among older people. They affect all aspects of health and well-being, including mental health, the risk of maltreatment and the risk of emergency admission to hospital for avoidable conditions, such as severe dehydration or malnutrition. In all countries, older women have a higher risk of social isolation than older men.

Depression among older people is frequently undiagnosed. Its prevalence in those over 65 in the European Region is estimated at 2-15%. Mental health support, including preventive action, is a vital, often neglected, aspect of medical and social attention to older people.

Elder maltreatment

Elder maltreatment is defined as physical, sexual, mental and/or financial abuse and/or neglect of people aged 60 years and older. The scale of the problem has not been fully investigated, but estimates indicate that at least 4 million older people in the WHO European Region experience it in any one year. Maltreatment affects both the mental and physical well-being of older people and, if unchecked, reduces the quality of life and survival.

Until recently, elder maltreatment was considered a private matter. Only in the last two decades has the scope of the problem been recognized and systematically studied and addressed in various settings where older people live. WHO/Europe's "European report on preventing elder maltreatment" reviews the findings of recent surveys and programmes to address the problem in the Region.

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Risk factors of ill health among older people

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As people age, they become more susceptible to disease and disability. However, much of the burden of ill health among older people can be reduced or prevented by adequately addressing specific risk factors, including: injury development of noncommunicable diseases poverty social isolation and exclusion, mental health disorders elder maltreatment.

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Life expectancy still rising, but less swiftly than in the past decade

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Demographic developments are among the most powerful forces driving public health trends. The population age structure, in particular, is set to alter substantially. The percentage of people aged 65 or older grew from 14% in 2000 to 16% in 2012, and it will further increase to 24% in 2030, after which it should more or less stabilise at around 26%.

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research and development

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facts and figures of healthy ageing and long term care

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Statistical yearbook of the Netherlands 

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Statistical yearbook of the Netherlands 

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SER (sociaal economisch raad)
possibe solutions for the system of care for the eldery and funding

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Healthy ageing in the Netherlands - RIVM

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Older people who are ill do not necessarily experience limitations in their daily functioning. One-half of the Dutch elderly who live independently suffer from one or more chronic diseases; however, two thirds of this group are not limited physically, and more than half of these feel healthy.

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Welkom bij de gezondste coalitie van Nederland: Healthy Ageing Network Northern Netherlands (HANNN). Wij mobiliseren alle ondernemers, denkers en beslissers die bij kunnen dragen aan een gezondere regio. Samen bouwen we aan een omgeving die gezondheid stimuleert. Van bewegen en voeding tot een gezonde omgeving, zingeving en sociale samenhang.

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Abstract

The 16.7 million Dutch inhabit a country that was once rated as number one in the world in taking care of its older adults (Edwards, 2004). Whether that is still the case today will be examined in this article describing the current state of the art in aging and science in the Netherlands. Our discussion covers key demographics, aging public policy issues, research and education, and some emerging social issues. We conclude that the Netherlands is transitioning from a welfare state toward a participation society, leading to major challenges for individuals and organizations in policy making, services, education, and research. Researchers have added to the public debate on aging by providing state-of-the-art information.

Demographics of Aging

The Netherlands is a small, densely populated country in one of the most economically important European deltas. As in many other European countries, the population is aging. At 16%, the proportion of people aged 65 and older in the Netherlands is lower than the European average (17%) and the German and Italian average (both 21%) ( Eurostat, 2013), but higher than proportions in Australia (14%), the United States (13%), and India (5%) ( Population Reference Bureau, 2013). The percentage of people aged 65+ in the Netherlands is expected to increase to 26% in 2035 ( Statistics Netherlands [CBS], 2010) ( Figure 1). Further, the proportion of adults over the age of 80 in the Netherlands is expected to increase from 3.9% of the total population in 2010 ( Statistics Netherlands [CBS], 2012a) to 10.2% in 2050 ( Statistics Netherlands [CBS], 2011). Life expectancy at birth was 78.8 years for men and 82.7 years for women in 2010 ( Statistics Netherlands [CBS], 2012b), although the figures for people with low socioeconomic status (SES) are 6-7 years less than for those of high SES. In addition, people with low SES live, on average, 14 more years in poor health than those with high SES ( Busch & Schrijvers, 2010) ( Figure 1).

Although Dutch society is culturally diverse, the proportion of people aged 65+ among non-Western immigrants was still only 4% in 2010. This figure is expected to increase to 6% in 2020 and 22% in 2060 (Garssen, 2011). As various elderly migrant groups tend to be of low SES, their life expectancy is expected to be shorter than for Dutch society overall.

Key Public Policy and Aging Issues

A Society in Transition

The Netherlands is the fourth happiest country in the world ( Helliwel & Wang, 2012), a rating that some attribute to the welfare state developed after World War II ( Jager-Vreugdenhil, 2012). The Dutch welfare state assists residents in the domains of labor, income, education, unemployment, and disability, engendering solidarity between healthy and capable people and those who are not, and resulting in general protection against extreme poverty and lack of care ( Jager-Vreugdenhil, 2012). In the 1980s, political emphasis shifted to more individual responsibility, fueled by the rising costs of the welfare state. The Social Support Act (Wet Maatschappelijke Ondersteuning) that went into effect in 2007 reflects a change in the relationship between government and citizens, calling for increased autonomy at local levels and more responsibility for nongovernmental organizations and individual citizens in "civil society" ( Jager-Vreugdenhil, 2012). Nevertheless, Dutch citizens are still largely protected from extreme poverty and unmet needs for care by the welfare state provisions described earlier.

Labor Market and Income Security

The Dutch pension system is built on three pillars ( Ministry of Social Affairs and Employment [SZW], 2008). The first is a flat rate state pension (National Old Age Pension Act) financed via payroll taxes and paid to residents aged 65 and older, although the official retirement age will gradually increase from 65 to 67 years by 2021 ( Ministry of Social Affairs and Employment [SZW], 2012). In 2013, the net state pension is €816 (US$1,069) per month per person in single households and €565 (US$741) per person for couples. The second pillar consists of supplementary occupational pensions accrued during employment, which cover 95% of all employees ( Ministry of Social Affairs and Employment [SZW], 2008). Due to the recent recession and increased longevity, pension benefits are currently under pressure, however. The third pillar consists of voluntary private pension provisions, either through annuity insurance or endowment insurance (providing a lump sum), incentivized by tax relief ( Ministry of Social Affairs and Employment [SZW], 2008). The Dutch pension system has been classified as a B+ system, defined as a system that has a sound structure and many good features, but with some areas in need of improvement ( Mercer, 2012). Denmark, by comparison, is the only country with an A-rating (a first class and robust retirement income system that delivers good benefits, is sustainable, and has a high level of integrity). Australia is the only other country in the B+ category, and the U.S. system is rated a C, which is defined as a system that has some good features but also has major risks and/or shortcomings that should be addressed. The Netherlands' high ranking may cause fiscal challenges, though. Public pension expenditures in the Netherlands are part of the Dutch gross domestic product's "long-term sustainability gap" of 5.9%, which is significantly above the EU average of 2.6% ( European Commission, 2012). According to the Organisation for Economic Co-operation and Development (OECD), the Dutch government should focus its attention on curbing aging-related increases in expenditures, including pensions ( OECD, 2012).

The net standardized income for people aged 65 and older has increased over the past few decades ( Knoef, Alessie & Kalwij, 2012). Their households have the most assets of all households ( Statistics Netherlands [CBS], 2012c), usually including a home without a mortgage. The proportion of poor elderly people aged 65+ was 3.5% in 2011, with little variation among different elderly age groups ( The Netherlands Institute for Social Research [SCP], 2012), whereas the average income of elderly non-Western older immigrants is low ( Statistics Netherlands [CBS], 2012d).

Housing

Informal Care and Community Services

Three fourths of all elder care in the Netherlands is provided by partners, relatives, friends, and neighbors ( Broese van Groenou, 2012). Significant support is also provided by volunteers affiliated with care and welfare organizations, charity foundations, and churches ( Suanet, Broese van Groenou, & Braam, 2009). Because many volunteers are aged 65 and older, in practice many elders take care of other older adults.

Formal Care and Residential Facilities

Health Care System and Expenditures

All Dutch residents are required by law (Health Insurance Act) to have a private health insurance policy, at a cost of approximately €100-150 (US$130-190) per month per person; insurers are obliged to accept every applicant. In addition, a national insurance system for long-term care (e.g., nursing homes) and exceptional medical expenses (e.g., vaccinations and extended hospital stays) is in place. This insurance is mandatory and is paid for through public insurance contributions by all. Total expenditures for health care and welfare (including child, youth, and senior care) were almost €90 billion in 2012 (US$117 billion) or 14.9% of the gross national product ( CBS, 2012e). As in some other western countries, for example, Canada ( Sheets & Gallagher 2012), concerns are being raised about increasing health care costs. According to OECD data, the Netherlands has the second highest health care spending as a proportion of gross domestic product (12.0% in 2009) in the world, after the United States (17.4% in 2009), which is attributed to high long-term care expenditures and low out-of-pocket expenses ( Rijksinstituut voor Volksgezondheid en Milieu [RIVM], 2012). The cost of care for senior citizens comprises approximately 18% of total health care expenditures in the Netherlands ( The National Institute for Public Health and the Environment [RIVM], 2012).

Aging Research

In the Netherlands, research in gerontology and geriatrics is a growing and lively enterprise, concen- trated among several interdisciplinary research groups and funded mostly by government entities and some private foundations. Many funding organizations nowadays stress the importance of involvement of older adults and care professionals in research and implementation of findings. Research involving an increasing number of international studies, funded by the European Union, highlights the difficulties and benefits of international collaboration. Large-scale studies and research centers with ongoing or recently completed data collections in gerontology and geriatrics are described subsequently.

Major Studies and Research Centers

The Longitudinal Aging Study Amsterdam (LASA; www.lasa-vu.nl) was specifically designed to study determinants of the autonomy and well-being of older persons. These longitudinal data have helped to facilitate the development of new policies. The first round of data collection took place in 1992 ( N = 3,107; age range 55-85) and subsequent data collection has occurred every 3 years. In 2002 and 2012, new cohorts of approximately 1,000 adults aged 55-65 were included, allowing for cohort comparisons. In 2013, a new sample of older Turkish and Moroccan men and women will be added. (Turkish and Moroccan people are the two largest groups of non-Western immigrants in the Netherlands and most have experienced relatively high levels of socioeconomic deprivation, hard manual labor, and low levels of social integration.) LASA is conducted by the Faculty of Medicine of VU Medical Center and the Faculty of Social Sciences of VU University Amsterdam, in collaboration with other faculties. Study results have provided details about intra- and interindividual changes in four domains of functioning, that is, cognitive, social, emotional, and physical; common risk factors; and relationships among autonomy, well-being, and need for care (see Huisman et al., 2011, for a summary of major outcomes).

The Rotterdam Study ( http://www.epib.nl/research/ergo.htm) is a prospective cohort study initiated in 1990 with follow-up examinations every 2-3 years; it includes 10,994 men and women aged 55 and older. The main objective of the study, conducted at the University Medical Center Rotterdam, is to investigate the prevalence and incidence of risk factors for chronic diseases in the elderly people, in hopes of enabling better prevention and treatment. Among the important findings is that having diabetes increases the risk of incidence of dementia by almost 9% ( Ott et al., 1999).

The ongoing Amsterdam Longitudinal Study of Autobiographical Memory, conducted by the ERGO Foundation/Amsterdam, uses the Life-line Interview Method (LIM) to study the dynamics of memories and expectations over the life span. This method entails respondents being asked to draw their lifeline and tell their own life story, both past and future. Since 1995, the LIM has been administered four times to 98 men and women aged 18-85. Life-event data are reported in terms of number, affect, and content in relation to age, gender, and time perspectives ( Assink & Schroots, 2010). The focus of the study is on the reminiscence "bump" in older adults, that is, the disproportionately high number of life events recalled from late adolescence and early adulthood. The use of the LIM | Life-line Interview Method has fueled many insights into psychological theories of aging ( Schroots, 1996, 2012/2013) and has provided new perspectives on the dynamics of both retrospective and prospective memory. One of the major findings has been that the sum of past and future autobiographical events is constant over the life span, whereas their relation changes systematically with age ( Schroots, 2003).

Elderly in Institutes, the OII ( http://www.scp.nl), is a repeated cross-sectional study of the living situation, social networks, health, and financial situation of residents aged 65+ in nursing homes, residential homes, and mental health care institutes. Conducted by the Netherlands Institute for Social Research, the first wave of data collection was completed in 1996 with 1,108 residents. One of the main findings was that only 4% of all people aged 55 and older spend any length of time in a care home or institution, debunking the persistent myth that elderly persons primarily live in institutions ( de Klerk, 2004).

In 2006, a large cohort study on healthy aging started at the University Medical Centre Groningen. In the LifeLines study, 165,000 children, parents, and grandparents will be interviewed and tested for 30 years, with a focus on environmental exposures, (epi)genetics, psychological and social factors, and health care use ( https://www.lifelines.nl/lifelines-research/general). The first round of data collection will be completed by the end of 2013.

Also noteworthy is the National Program of Elderly Care ( http://www.nationaalprogrammaouderenzorg.nl/english/the-national-care-for-the-elderly-programme/) initiated by the Ministry of Health, Welfare, and Sports, which aims to develop a coherent long-term program tailored to the individual needs of older adults. In this program, more than 650 organizations in health, welfare, and housing work together in eight regional networks led by academic medical centers.

The Netherlands Institute of Mental Health and Addiction ( www.trimbos.org) conducts evaluation studies and implementation programs. One recent study was the Monitor Mental Health Care of the Elderly. Similar monitoring of the living arrangements of people with dementia is currently underway.

An increasing number of studies are being conducted at universities of applied sciences. These research groups are closely linked to professional education curricula (nursing, social work, and applied gerontology) and several focus on professional care issues. A noteworthy study conducted at Windesheim University addresses shared decision making in personal care networks of people with dementia, development of a theoretical model, and professional competencies. After finding that persons with dementia rarely participate meaningfully in the development of supportive information technology (IT) tools (Span, Hettinga, Vernooij-Dassen, Eefsting, & Smits, 2013), the researchers decided to facilitate the full participation of people with dementia in the design of a shared decision-making IT tool.

In summary, the tradition of longitudinal research on aging in the Netherlands, with the earliest large-scale data collection both from community-dwelling and institutionalized people dating back to 1991, has enabled researchers to provide detailed pictures of changes in social, psychological, and biological domains of functioning. Currently, a large number of studies at academic and applied universities are being conducted in close collaboration with professional organizations and with older adults themselves, facilitating the process of validating and translating the findings into practice. The scientific insights gained from these studies inform international and national colleagues, policymakers, and professionals and contribute to a better understanding of human aging.

Education on Aging

Education on aging in the Netherlands also has a long, although somewhat sporadic, history. The VU University Amsterdam and the Radboud University in Nijmegen offered undergraduate and graduate programs in gerontology and psychogerontology in the last century, but failing to attract sufficient numbers of students, and both programs ended in 2000. The VU University continued gerontology education with a European Master in Gerontology (EuMaG) in collaboration with universities from the United Kingdom (Keele), France (Paris), and Germany (Heidelberg). EuMaG started with support from the European Commission. When this support was discontinued, however, the program was no longer cost-effective (Aartsen, 2011), so it closed in 2010. Shorter courses or minors are currently offered at bachelor's and master's levels at the Radboud University Nijmegen, VU University Amsterdam, and Maastricht University. A complete English scientific master's course of study, Vitality and Aging, is offered by the Leyden Academy.

Despite the discontinuation of some master's programs, there are currently more than 60 scientific chairs with a focus on human aging in various scientific disciplines, such as social sciences, economics, health and medical sciences, epidemiology, dentistry, and mechanical engineering. Professors holding these chairs have doctoral students and research team members, who produce more than 30 dissertations annually ( www.narcis.info).

At the same time, new initiatives in universities of applied sciences include a wide range of courses in geriatric and gerontological nursing in cities such as Rotterdam, Utrecht, Arnhem, Nijmegen, The Hague, and Leeuwarden. Full bachelor's degree programs in applied gerontology are currently offered at Windesheim University in Zwolle and Fontys University in Eindhoven.

Emerging Issues in Aging

Dementia

Population aging has led to an increase in the number of Dutch people with dementia. Most elderly persons with dementia live at home and are cared for by relatives, and at a later stage, by home care helpers and case managers. Whereas nursing home care has traditionally been offered in relatively large buildings with little privacy, more than a quarter of residents now live in small-scale residences offering person-centered care (Willemse, Smit, de Lange, Pot, 2012). Health care technology applications are increasingly being used, particularly to increase safety and comfort and to reduce staff demands. As some nursing staff are reluctant to use "high-tech" tools, staff involvement and training in the development and implementation of these applications deserve more attention.

As in the United States, dementia has become a national concern. Currently, a nationwide consortium is developing a Deltaplan Dementia to increase research in this area and improve the lives of people with dementia and of their caregivers ( http://deltaplandementie.nl).

Health Promotion

Increasing numbers of older adults have unhealthy lifestyles, including alcohol abuse and lack of physical activity (Zantinge et al., 2011). These problems are particularly urgent among elderly persons with low SES and chronic diseases. Health promotion focusing on individual responsibility is offered by lifestyle professionals such as dieticians, but also by care and welfare professionals who may detect problems at an early stage and discuss them with their clients during day-to-day care activities.

Health promotion efforts should not be restricted to the second half of life, however, because earlier development of habits may have later-life consequences. Computer simulation with the Janus model, which focuses on the dynamics of the human life course in terms of synchronic growth and decline over the life span, shows the dynamic limits of human nature. It may thus stimulate effective policies for promoting active aging in the first half of life, as well as reveal the growth potential of older people in the second half of life ( Schroots, 2012/2013).

Social Life and Self-Management

Although families have become smaller, the social lives of Dutch elders have not deteriorated. For example, they have more friends in 2012 than in 1992 (Stevens & van Tilburg, 2011). Social media are increasingly popular, and e-communities for adults aged 55 and older are thriving, as older adults may wish to remain autonomous and often do not want to (over)burden their relatives. These are new venues for public debate about whether family caregivers should become more involved in caregiving or whether the elderly people should take more care of themselves (i.e., self-management), as well as discussion of the costs of care, the recession, and the financial well-being of the elderly people.

Euthanasia and "Completed Lives"

Conclusion

Dutch society is currently in transition from a demographically young welfare state to an aging society with increasing individual responsibility. The welfare state has resulted in an affluent society with high levels of individual well-being. New generations of older adults are well educated, financially well off, and accustomed to personal choice in matters of life, care, and death. Those elderly persons with lower income, however, may have fewer options and have to rely more on relatives and the government.

Gerontological and geriatric research and education have grown rapidly and show more interdisciplinary variety than earlier, whereas researchers increasingly involve older adults in the design of their studies. Excellent research is expected to lead to further improvements in the health, autonomy, and well-being of Dutch elders. Research has also contributed to public debate on aging by providing insight into the state of the art regarding physical, mental, social, and financial issues. Thanks to these insights, discussion focuses not only on the costs of health care and pensions but also on older generations' autonomy and contributions to society.

References

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Aging in The Netherlands: State of the Art and Science | The Gerontologist | Oxford Academic

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The 16.7 million Dutch inhabit a country that was once rated as number one in the world in taking care of its older adults (Edwards, 2004). Whether that is still the case today will be examined in this article describing the current state of the art in aging and science in the Netherlands.

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De rol van het HANNN is het bij elkaar brengen van alle ingrediënten en partijen op het gebied van Healthy Ageing. Dit met als doel nieuwe producten, diensten en concepten tot stand te brengen die een bijdrage leveren aan preventie, genezing, betere zorg en zelfmanagement.

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Bijdrage aan Alles is gezondheid...Healthy Ageing Network Northern Netherlands (HANNN) brengt alle partijen en ingrediënten op het gebied van 'Healthy ageing' bij elkaar. De innovaties komen van de leden van dit platform. HANNN geeft vervolgens ondersteuning bij business development, het vinden van financieringsbronnen en het zoeken naar internationale partners.