Let's Talk (Even Buurten)

Although neighbourhood approaches are increasingly advocated as means to support the growing number of community-dwelling older people, we lack thorough descriptions of such approaches, as well as insight into their effectiveness. A Dutch INA that aimed to improve older people’s health-related quality of life and well-being via strengthened integrated social support systems in the neighbourhood was evaluated. The INA was initiated in 2011 by diverse partners in Rotterdam, i.e. the municipality, local health and social care organisations, Erasmus University Rotterdam, the University of Applied Sciences, and Geriatric Network Rotterdam, with the ultimate aim of creating a supportive environment that would enhance older people’s well-being allowing them to age in place. In such partnerships, health and social care professionals and informal support-givers in the community become mutually responsible for the optimisation of current services and support of older people. The INA corresponds to broader policy in the Netherlands. The Social Support Act (WMO), which went into force in 2007, is a major Dutch reform enacted to address health and social care challenges. This act, which is currently being reformed, was designed to shift tasks and responsibilities concerning social care and support from central government to local governments. Based on the general principle that municipalities are best able to respond to the needs of citizens and support and enable them to participate in society, this act aims to promote individual responsibility and active participation among all groups in society (van Ewijk 2010).

The INA can be perceived as a real-life experiment that combines current policy aspirations and tests their ability to supporting community-dwelling older people in ageing in place by the enhancement of older people’s well-being. It thus serves as a perfect case for exploration of the complexity of today’s challenge to meet the increasing needs of older people with limited public resources. As the INA combines interacting components at several levels (i.e. personal, community, and professional levels), it is considered to be a complex social intervention (Campbell et al. 2007, Craig et al. 2008).

Our effectiveness study demonstrated that the INA had no effect on older people’s (health-related) quality of life or well-being within the 1-year timeframe. Our process evaluation highlighted the complexity of an INA development. An adapted version of Valentijn and colleagues’ (2013) integrated care model was used to identify barriers to, and facilitators of, integrated care andsupport. These findings indicated a lack of alignment between micro-level, bottom-up initiatives and top-down incentives in meso- and macro-level contexts, resulting in excessive reliance on professionals to achieve integration despite, rather than because of, the involvement of meso- and macro-level contexts. The findings also suggested that integration between levels was lacking. The lack of adequate material and immaterial support tools and structural incentives prevented the INA from integrating care and support, which made it more difficult for the project to reach its goals and improve the quality of life and well-being of participants (van Dijk 2015).

Evaluation of the INA approach in the Netherlands has demonstrated that the neighbourhood is of great significance for older people’s well-being and ability to age in place. Supportive neighbourhoods require an integrated social and physical environment, as well as strong interactions between formal and informal support-givers. INAs may integrate available neighbourhood resources and engage multiple community partners in health and social care delivery to (older) people. However, the INA examined in this research was not (yet) able to meet expectations. Micro-level initiatives are not aligned with top-down incentives, resulting in excessive reliance on professionals to achieve integration despite, rather than because of, the involvement of meso- and macro-level contexts. Local and national governments should seek to account for macro-level conditions that contribute to the micro- and meso-level complexities of integrated care and support provision. Lastly, policies should be sensitive to the importance of normative aspects of integrated care and support provision, appreciating delicate social processes that are crucial for the creation of an integrated mind-set (van Dijk 2015).

Publications

Van Dijk (2015). Neighbourhoods for ageing in place. Thesis Erasmus University Rotterdam.

Cramm, J.M., Nieboer, A.P. (2015). Social cohesion, belonging and changes therein predict the well-being of community-dwelling older people in the Netherlands over time. BMC Geriatrics. 15:30.  

Cramm, J.M. & Nieboer, A.P. (2015). Building social capital over one’s lifetime may protect loss of well-being among older people. Contribution to a Springer book: Social capital as a health resource in later life: the relevance of context (Part of the Springer book series International Perspectives on Aging). 

Cramm, J.M., Twisk, J & Nieboer, A.P. (2014). Self-management abilities and frailty are important for healthy aging among community-dwelling older people; a cross-sectional study. BMC Geriatrics, 14:28. doi: http://dx.doi.org/10.1186/1471-2318-14-28.

Dijk, H.M. van, Cramm, J.M., Exel, N.J.A. van & Nieboer, A.P. (2014). The ideal neighbourhood for ageing in place as perceived by frail and non-frail community-dwelling older people.Ageing & Society. doi: http://dx.doi.org/10.1017/S0144686X14000622.

Cramm, J.M. & Nieboer, A.P. (2014). ). Background characteristics, resources and volunteering among older adults (aged ≥ 70 years) in the community: A longitudinal study. Geriatrics & gerontology international. doi: DOI: 10.1111/ggi.12404.

Dijk, H.M. van, Cramm, J.M. & Nieboer, A.P. (2014). Social cohesion as perceived by community-dwelling older people: the role of individual and neighbourhood characteristics.International Journal of Ageing and Later Life (IJAL). doi: http://dx.doi.org/10.3384/ijal.1652-8670.13210.

Cramm, J.M. & Nieboer, A.P. (2013). Relationships between frailty, neighborhood security, social cohesion and sense of belonging among community-dwelling older people. Geriatrics & gerontology international, 13, 759-763. doi: http://dx.doi.org/10.1111/j.1447-0594.2012.00967.x.

Cramm, J.M., Nieboer, A.P. (2013). Neighborhood attributes security and solidarity promote the well-being of community-dwelling older people. Geriatrics and Gerontology International. doi: 10.1111/ggi.12133.

Dijk, H.M. van, Cramm, J.M., Lotters, F.J.B. & Nieboer, A.P. (2013). Even Buurten: Een wijkgerichte aanpak voor thuiswonende ouderen in Rotterdam. Rotterdam: Erasmus Universiteit Rotterdam ESHPM. Sociaal-Medische Wetenschappen (SMW).

Cramm, J.M., Dijk, H.M. van & Nieboer, A.P. (2013). Het belang van sociale cohesie en sociaal kapitaal in de buurt voor het welzijn van ouderen. Tijdschrift voor Gerontologie en Geriatrie, 44 (2), 50-58. doi: http://dx.doi.org/10.1007/s12439-013-0010-z.

Dijk, H.M. van, Cramm, J.M., Goumans, M., Brix, A., Bakker, S.M.H.A. & Nieboer, A.P. (2013). Belang van ondersteunende netwerken voor ouderen. Bijblijven. Cumulatief Geneeskundig Nascholingssysteem, 29 (4), 53-57.

Cramm, J.M., Dijk, H.M. van & Nieboer, A.P. (2013). The Importance of Neighborhood Social Cohesion and Social Capital for the Well-Being of Older Adults in the Community. The Gerontologist, 50 (1), 1-9. doi: http://dx.doi.org/10.1093/geront/gns052.

Cramm, J.M., Nieboer, A.P. (2013). Neighborhood attributes security and solidarity promote the well-being of community-dwelling older people. Geriatrics and Gerontology International. DOI: 10.1111/ggi.12133.

Dijk, H.M. van, Cramm, J.M. & Nieboer, A.P. (2013). The experiences of neighbour, volunteer and professional support-givers in supporting community dwelling older people. Health & Social Care in the Community, 21 (2), 150-158. doi: http://dx.doi.org/10.1111/hsc.12006.

Cramm, J.M., Dijk, H.M. van, Lotters, F.J.B., Exel, N.J.A. van & Nieboer, A.P. (2011). Evaluating an integrated neighbourhood approach to improve well-being of frail elderly in a Dutch Community: A study protocol. BMC Research Notes, 4 (1), 532. doi: http://dx.doi.org/10.1186/1756-0500-4-532.