Well-being and care for the elderly in Rotterdam according to the Integrated Community Approach (GENERO-IWA)

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The aim of the care programme called ‘Well-being and care for the elderly in Rotterdam according to the Integrated Community Approach’ is to enable frail elderly people (75+) living independently to lead the life they would like to lead, thereby increasing their quality of life and self-reliance. The main focus is on what the elderly person wants and is still capable of, and participation is encouraged (empowerment).

The programme’s secondary goals are to improve the quality of life of carers and reduce their burden, utilise the talents of vital elderly people (social participation/participation in society) and create more cohesion in the neighbourhood or community.

Lastly, the project seeks to promote cohesion and harmony between residents and well-being and care at the neighbourhood level, and to share and roll out best practices throughout the city.

The core of the programme is to strengthen the well-being and care for the elderly in Rotterdam by means of an ‘Integrated Community Approach’. The goal is to promote and strengthen the social network of vulnerable elderly people so that problems are detected early and concrete assistance can be provided. To this end, an intervention is being developed in a systematic manner, with strategies aimed at informing, motivating and mobilising key figures, vital elderly residents and all other community residents, from next-door neighbours to local cafe owners.

The GENERO - IWA care programme is part of the GENERO National Elderly Care Programme.


  • S. Bakker, Municipality of Rotterdam, Social Affairs and Employment Department (SOZAWE)

GENERO website

Assessment project leader

Prof. Anna P. Nieboer, PhD

Assessment study

An assessment study is very important to determine how the Integrated Community Approach contributes to the well-being of the elderly. The assessment study focuses specifically on the outcomes, processes, costs and how they relate to each other.

The success of this project depends greatly on good cooperation between the partners from initial detection of a problem to provision of care. Little is known about such partnerships work and their effects on outcomes.

The assessment offers insight into the underlying mechanisms of the Integrated Community Approach and thereby contributes to knowledge about the feasibility and cost-effectiveness of community-oriented programmes, the improved well-being of vulnerable elderly people and the strengthening of their network and engagement in their community.

The study is based on data collected from:

  • impact assessment based on primary outcome benchmarks for the elderly, carers and those directly involved (volunteers, key figures, professional welfare workers and care providers)
  • process assessment and analysis of cost-effectiveness
  • qualitative methods (interviews and document analysis)
  • quantitative methods (questionnaires and recordings of a limited number of directly involved care providers, particularly key figures in the social networks)

This information is used to produce a ‘community picture’. The information is gathered from a random sample of 1,440 independently living elderly people above the age of 70 (in both intervention and control communities) by means of written questionnaires and telephone interviews (at the start, and after 1 and 2 years).

For the impact assessment, 370 vulnerable elderly people aged 75 and above with a score of >5 on the Tilburg Frailty Indicator will be included in an intervention or control group. These elderly people will be interviewed at home at three separate times (at the start and after 3 and 12 months). Their carers will also be interviewed twice by phone.




  • Municipality of Rotterdam: Social Affairs and Employment Department (SOZAWE) and the Rotterdam-Rijnmond Municipal Health Service
  • Elderly: General Dutch Association for the Elderly (ANBO), Rotterdam District
  • Well-being: Community Services Centre Foundation (SMDC), Alexander Community Services (MDA), IJsselwijs Foundation, Centre for Service Provision (CVD)
  • Primary care: Sprong Foundation, Zorg Op Noord Foundation, Zorgimpuls Regional Support Structure
  • Nursing and Care Sector: Laurens, Stromen Opmaat Group
  • Education/research: Erasmus School of Health Policy & Management (Erasmus University), Rotterdam University of Applied Sciences - Institute for Health, Erasmus MC


1. Cramm, J.M., van Dijk, H., Nieboer, A.P. The importance of perceived neighborhood social cohesion and social capital for the well-being of older adults in the community. The Gerontologist. 53(1):142-52.

2. Cramm, J.M., van Dijk, H., Lotters, F., van Exel. J., Nieboer, A.P. (2011). Evaluation of an integrated neighbourhood approach to improve well-being of frail elderly in a Dutch community: a study protocol, BMC Research Notes. 4, 532.

3. van Dijk, H., Cramm, J.M., Nieboer, A.P. Neighbor support for older people in the Netherlands. Health and Social Care in the Community. 21(2):150-158.

4. Cramm, J.M., Nieboer, A.P. Relationships between frailty, neighbourhood security, social cohesion, and sense of belonging among community-dwelling older people. Geriatrics and Gerontology International. doi: 10.1111/j.1447-0594.2012.00967.x

5. Cramm, J.M., Nieboer, A.P. Relationships between Background Characteristics, Resources and Productive Aging Activities among Older Adults (Aged 70+ Years) in the Community, submitted to Journal of Gerontology B.

6. van Dijk, H., Cramm, J.M., Nieboer, A.P. Social cohesion perceived by community dwelling older people: the role of individual and neighborhood characteristics, submitted to Aging and Society.