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Project: ANCIEN [concluded]

Assessing Needs for Care in European Nations

The objectives of ANCIEN are to review the long-term care (LTC) systems in European Union member states, to assess the actual and future numbers of elderly care-dependent people in selected countries and to develop a methodology for comprehensive analysis of actual and future LTC needs and provisions across European countries. ANCIEN is financed under the 7th EU Research Framework Programme. The project is coordinated by the Centre for European Policy Studies (CEPS), includes 20 partners from EU member states, started in January 2009 and will last until 31 October 2012. NIDI is responsible for the development of a methodology to improve forecasts of long-term care needs and the application of the model to a limited number of countries with different long-term care settings and data availability.

The future number of disabled elderly can be estimated using a multistate model. The use of a multistate model for making scenarios requires assumptions about future changes in disability incidence rather than prevalence. Data on disability incidence however are expensive to acquire and often missing. Therefore we developed a generic estimation procedure for calculating incidence into disability rates estimated from prevalence rates. To apply the model, we selected four countries that are representative of different European epidemiology and systems for provision of long-term care: Spain, Poland, Germany and the Netherlands. As point of departure for the projections of the number of future disabled elderly we used the mortality forecasts of the EUROPOP 2008 population scenarios. We calculated scenarios according to several assumptions about how disability and mortality are related and added scenarios on the effect of smoking and obesity (BMI). Data were derived from Eurostat (forecasts of mortality and populations), ANCIEN WP 1 (the elderly living in institutions), the SHARE project (the elderly living in the community) and the Dutch Rotterdam Study (on ageing). 
The main determinant of the future numbers of the disabled elderly turned out to be the demographic ageing of the large baby boom cohorts. This is projected to cause increases of 44 per cent (Germany), 65 per cent (Spain), 82 per cent (the Netherlands) and 57 per cent (Poland). The impact of longevity depends on the correlation of disability in old age and mortality, and is moderate under reasonably conservative assumptions: +11 per cent for Germany, +7 per cent for Spain, +9 per cent for the Netherlands and +22 per cent for Poland. For Poland, convergence with Germany on the onset of disability in terms of timing would limit this increase. Obesity and (quitting) smoking have little effect, increasing levels of disability by around 2 percentage points per absolute increase in the prevalence of obesity of 5 per cent, while quitting smoking has even less effect. 
We conclude that the future numbers of long-term care recipients can be robustly predicted and will be mainly determined by demographic ageing.

Change in BADLs among the disabled elderly in 2040 compared with 2008

Change in BADLs among the disabled elderly in 2040 compared with 2008

Notes: BADL: having at least one limitation in Basic Activities of Daily Living 'Demo' is the expected change assuming constant mortality and incidence. Life extension adds the numbers of the intermediate 'Delay' scenario. 'Chron' adds the numbers if the incidence of disability remained constant.

More information on the project is available on the project website


Bonneux, L., N. van der Gaag, G. Bijwaard, E. Mot & P. Willemé (2012),
Demographic epidemiologic projections of long-term care needs in selected European countries Germany, Spain, the Netherlands and Poland. Enepri Policy Brief, No. 8.
Bonneux, L., N. van der Gaag, G. Bijwaard, E. Mot, P. Willemé, J. Geerts & J. de Beer (2011),
Forecasting disability in the European Union. Paper presented at the Reves conference 2011 (REVES23), Paris, 25-27 May 2011.
Bijwaard, G., N. van der Gaag, J. de Beer & L. Bonneux (2010),
Forecasting long-term care need in Europe. Paper presented at the European Population Conference 2010, Vienna, 1-4 September, 2010.


Research team

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