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Healthy ageing in Utrecht

Older people in Utrecht and in their neighbourhoods: their health, living environment and ability to participate in society.

Introduction

Utrecht is growing. Utrecht is expected to grow to 400,000 residents by 2024. Especially the group of Utrecht residents aged 65 and over will increase strongly in the coming years.

The Utrecht Health Profile1 was published in February 2018. This health profile provides an overview of the health of Utrecht’s population and the factors that affect this. A few key conclusions are that most Utrecht residents perceive their health as good and that on average Utrecht residents are getting older. Nevertheless, there are health inequalities between population groups; in some respects older people in Utrecht are not doing so well.

In this special report we focus on the health and wellbeing of Utrecht residents aged 65 and over who live independently. How do they perceive their health and physical living environment? Are they able to participate in society? How many older people in Utrecht are ageing healthily? And finally, what are they doing to make sure they are ageing as healthily as possible? This special report also shows for the first time how older people are doing in their neighbourhoods.

The information in this special report draws on various available data sources, such as large-scale, representative surveys, data registrations and numerous face-to-face interviews with professionals and residents. Unless otherwise stated, the information in this special report (both text and figures) relates to Utrecht residents aged 65 and over.

Older people in Utrecht: a growing and diverse population group

The population forecast of 2018 shows that the number of residents aged 65 and over in Utrecht will continue to grow in the coming years. In 2018, approximately 36,000 older people lived in Utrecht. The number of older people is expected to increase to approximately 60,000 in 20402. This is an absolute and relative increase . In 2018, 10% of all residents in Utrecht were aged 65 years and over. By 2040 this percentage is expected to be 13%3.

54% of the independent living residents in Utrecht aged 65 and over live alone. 37% of older people live together without children and 9% live together with their children. As Utrecht residents grow older, the percentage of them living alone will increase4.

On 1 January 2019, approximately 1,200 residents aged 65 and over were living in institutions, such as nursing homes. In recent years, the percentage of Utrecht residents aged 65 and over living in an institution has decreased5.

The majority of Utrecht residents aged 65 and over are younger than 80 years of age. 4% are older than 90 years. In particular, the percentage of residents aged 65-79 has increased in recent years6.

An increasing amount of older people in Utrecht have a migration background. The percentage of residents aged 65 and over with a migration background has increased from 19% in 2008 to 24% in 20196.


Health and healthy behaviour

We consider health as the ability to cope with the physical, emotional and social challenges of life. This is based on the model of ‘positive health’, in which health has different dimensions. The majority of older people perceive their health as good and feel they have sufficient control over their own lives. Nevertheless, there are (large) inequalities, according to the level of education and migration background.

57% of older people in Utrecht indicate that they perceive their health as good. 63% of residents aged 65-79 feel healthy. This percentage is 41% among Utrecht residents aged 80 and over.*

* The figures in this chapter have been taken from Utrecht Health Survey 2018. If different figures are used, this is indicated.

The sense that you are able to make decisions about your own life increases the quality of life and therefore improves your health. 86% of residents aged 65 and over feel they have sufficient control over their own lives.

At this age, you can’t help but check the obituaries every day. Getting older is great, but the downside is that you lose a lot of people around you. That certainly makes you face reality." Resident

More than three-quarters of residents aged 65 and over feel that their life has meaning and purpose. 64% of older people are confident about their future.

7% of Utrecht residents aged 80 and older have seen their GP in relation to some form of dementia and have been treated for this by their GP in the past year. 9% of residents aged 80 and over have seen their GP for memory, concentration or orientation problems8. The Public Health Foresight Study 2018 (Volksgezondheid Toekomst Verkenning 2018) shows that the number of older people with dementia in the Netherlands will increase in the coming years. By 2040, dementia will be the most common cause of death and the largest disease burden9.

As people get older, they are more likely to have a physical and/or mental illness or condition. 84% of residents aged 65 and over have at least one chronic physical and/or mental illness or condition. 64% of older people have at least two conditions. 17% feel severely hampered in their daily activities by their condition(s). The percentage of older people with at least one visual, hearing or mobility impairment (despite using aids) decreased from 39% in 2012 to 30% in 2018.

19% of older people in Utrecht have at least one chronic mental health condition. They report that they suffer from anxiety disorder, depression, prolonged emotional exhaustion, nervousness, stress or burn-out.

Healthy behaviour

11% of residents aged 65 and over consume alcohol in excess. 49% of residents aged 65 and over consume just one alcoholic drink a day or none at all. 13% of older people in Utrecht smoke. One-third of older people have never smoked.

38% of older people in Utrecht meet the exercise guidelines11 for moderate aerobic activity and bone and muscle-strengthening exercises. 10% of residents aged 65 and over do balance exercises weekly. 39% of residents aged 65 and over are overweight, 16% are obese.

Older people are more likely to be overweight and obese than adults in Utrecht. 25% of adults aged 19-64 are overweight and 8% are obese.

Health inequalities

We see major health inequalities in older people in the city, especially between older people with different levels of education and those with or without a migration background. An older person with a high level of education is almost twice as likely to perceive their health as good than an older person with a low level of education. Older people without a migration background are more likely to perceive their health as good than older people with a migration background.

Inequalities according to education and migration background can also be seen in other age groups in Utrecht, sometimes even at an early age1. Based on interviews with people in Utrecht and the literature, it also appears that older people with a migration background are more likely to have health problems at a younger age than older people without a migration background12.


Healthy living environment

A healthy living environment is an environment that people perceive to be pleasant, that invites healthy behaviour and where the impact on health is as low as possible13. For older people, their immediate living environment becomes increasingly important, as they often live independently at home until a very old age. Older people are generally very content with their home and living environment.

82% of residents aged 65 and over are very satisfied with their home. They give their home an average score of 8.410. 41% of residents aged 65 and over indicate that their home is suitable for older people or people with a physical disability. 11% of older people consider their home to be poorly maintained14.

One in four residents aged 55 and over is considering or planning to move house because of getting older. 14% have already made changes to their home or are planning to do so and 13% are considering it15. Interviews with older people in Utrecht show that if they are looking for accommodation that is suitable for older people, they are not always able to find it in their own neighbourhood. Older people are not always willing to move to another neighbourhood.

72% of residents aged 65 and over are very satisfied with their living environment. They give their living environment an average score of 8.010. We asked older people what they consider to be a healthy living environment. Their main response is that they would like a green and clean environment, with clean air and without noise nuisance. When asked about possible changes that could make their living environment healthier, older people mainly mention less traffic, noise nuisance and air pollution, more greenery and less litter.

31% of older people are satisfied with the services for older people in their neighbourhood. 22% are dissatisfied with the services for older people. Older people with higher levels of education are more likely to be dissatisfied14.

71% of older people are very satisfied with the green spaces in their neighbourhood. On average, they rate the green spaces in their neighbourhood with a score of 8.0. A large percentage of residents aged 65 and over indicate that the green spaces in their neighbourhood are safe, within walking distance and accessible10. However, interviews show that this is not the same for everyone:

Older people are for example too afraid to cross busy roads for getting to a park nearby." Resident

Two out of three older people visit a green space in their neighbourhood every week. 78% of older people visited a green space in the past 12 months10.

Public spaces

As older people continue to live in their own homes for longer, their immediate environment becomes increasingly important. Well-designed and properly maintained public spaces make it possible for them to stay mobile, maintain social contacts easily and continue carrying out day-to-day activities independently.

9% of residents aged 65 and over are bothered often by crossing places being inaccessible. A quarter of them are bothered by this sometimes14. This has been confirmed in interviews with older people in Utrecht and they consider this to be a point of concern. 30% often have problems with uneven pavements. This is a higher percentage than for adults under the age of 65(12%). Road safety is also a point of concern. 22% of older people reported that they are often bothered by dangerous traffic situations in their neighbourhood14.

Participating in society

The ability to participate in society is an important condition for a healthy and social lifestyle17. After reaching retirement age, fewer and fewer older people are in paid employment. Other forms of participation in social life therefore gain greater importance at this stage. Volunteering and social and cultural activities can give meaning and structure to everyday life and can provide more social contacts. This can help prevent loneliness and make older people feel that they are still part of the society.

76% of residents aged 65 and over feel that the things they do are meaningful10.

28% of residents aged 65 and over reported that they do volunteer work. Older people educated to HBO or WO level are more likely to report this (42%)10.

11% of Utrecht residents aged 65 and over are severely lonely. For older people with a migration background the percentage is 17%. Between 2003 and 2016, loneliness increased from 41% to 56%. This percentage was 54% in 2018. The percentage of severely lonely older people has been stable over the past 15 years10.

16% of residents aged 65 and over are currently informal caregivers, almost all of them quite intensively (for a period of at least three months and/or at least eight hours a week). Older people educated to HBO or WO level are more likely to be an informal caregiver, just like older people who live with a partner or others10.

17% of current informal caregivers feel heavily burdened. Nearly a quarter of current informal caregivers receive support in providing informal care10. In interviews, professionals and residents reported that providing care for someone with dementia is extremely difficult. Caregivers can feel lonely when caring for someone else. Their feelings of guilt often prevent them from reporting that caregiving is a burden or heavy burden on them.

Today's society demands a great deal of self-reliance from its citizens18. In order to cope, you need knowledge and skills. 43% of residents aged 65 or over have low health literacy. They have difficulty finding, understanding, assessing and implementing information regarding health10.

Not every older person is able to participate in the digital society. 27% of older people feel restricted because they cannot use the internet, either because they do not have access to the internet or because they lack the skills to use it. Older people with a lower level of education are more likely to feel restricted because they cannot use the internet (40%)14.

12% of residents aged 65 and over have an income around the threshold for obtaining income support (101% of the statutory minimum income)19. In Utrecht, approximately 1,700 older people receive a supplementary allowance (AIO supplement) on top of their AOW pension, for example because they do not have enough years of paid work20.

8% of older people in Utrecht reported that they have to go into debt or use their savings to make ends meet14. 5% have cancelled, postponed or declined appointments with a healthcare or care provider in the past year because of the financial costs10. This is more likely in residents aged 65 and over with a migration background.

Care and support

The extent to which a person can participate in society also depends on good care and support when necessary. It is not so much the illnesses themselves, but mainly the related limitations that can hinder participation in society21.

13% of residents aged 65 and over have contacted the community team(10) in the past year. Women (17%) and residents aged 80 and over (20%) are more likely to contact the community team. Community teams provide help and support to anyone who needs it, for example in the areas of care, welfare, assisted living, work and income.

92% of residents aged 65 and over have contacted their GP in the past year. Residents aged 80 and over are more like to contact their GP. Three-quarters of adults aged 80 and over contacted their GP in the last two months. 49% of the adults aged 80 and over received a home visit from their GP in the past year(8). Almost all older people are satisfied with their GP10.

In interviews, pharmacists reported that they have noticed older people live independently in their homes for longer. They often have (complex) multimorbidity**. They also reported that many older people have difficulty using medicines correctly. Research shows that medicines are often difficult to use for older patients22. Some problems when using medication can lead to a deterioration in the patient's health.

69% of residents aged 65 or over have been in contact with a medical specialist in the past year10.

*This help and support can be provided by both formal and informal care providers.
** The occurrence of two or more (chronic) illnesses or conditions in the same person.
 

Healthy ageing in Utrecht

In recent years, there has been more focus on healthy ageing. With rising life expectancy, an ageing population and increasing costs in care for older people, the importance of healthy ageing has grown. The focus is increasingly on promoting self-reliance, participation and quality of life, in addition to delaying the onset of and treating illnesses and conditions. This chapter shows how many Utrecht residents are ageing healthily and what they are doing to achieve this.

The Utrecht Healthy Ageing Index (Utrechtse Gezonde Verouderingsindex – UGVI) 2018* shows that 47% of residents aged 55 and over are ageing (very) healthily. They have a score of 9 or higher on a scale from 0 to 13. 32% of Utrecht residents aged 55 or over are not ageing healthily. They have a low score in several domains of the index.

What is the Utrecht Healthy Ageing Index?

The Utrecht Healthy Ageing Index has been developed by the Ministry of Health, Welfare and Sport23 based on scientific research24. The UGVI can be used to provide an overview of healthy ageing among Utrecht residents aged 55 and over. It was decided to look at residents aged 55 years and over because chronic illnesses become more prevalent at that age and possible health gains are still considerable. By combining seven domains, the UGVI explores healthy ageing from a wide angle. The UGVI corresponds to the model of positive health. The scores on the individual domains are combined into a total score. A score of 9 or higher on a scale of 0 to 13 indicates (very) healthy ageing. Utrecht residents with a score of 6 or lower are not considered to be ageing healthily.

* Based on the Utrecht Health Survey 2018, in which Utrecht residents were asked about their health and wellbeing status.

The Utrecht Healthy Ageing Index shows that men are more likely to age healthier than women. There are also large inequalities according to migration background and level of education. Older people in Noordoost, Oost and Vleuten-De Meern are more likely than average to age healthily.

We asked residents aged 65 and over in the Utrecht residents panel for their views on what is important when it comes to healthy ageing. They consider mental health and mental well-being (such being in control of one’s own life and outlook on life) to be the most important, followed by physical health15.

If you have a positive outlook on life, you forget all about your age. There is no need to avoid talking about your illnesses, but you shouldn’t focus too much on it. A big part of your health has to do with your mind." Resident

Older people on the residents panel most often report that they are staying active or exercise in order to age as healthily as possible. Healthy eating and drinking are also mentioned often, followed by being socially active15.

Older people also gave their suggestions in the residents panel about what could help them to grow old as healthily as possible. These suggestions include sports facilities nearby, better cycle paths and better air quality. They also propose lifestyle suggestions, such as reliable information on nutrition and healthy food options15.


Health status in the neighbourhoods of Utrecht

The health status of residents aged 65 and over varies between the neighbourhoods of Utrecht. This is due to differences in population composition between neighbourhoods and factors that influence health. It also depends on the type of health problems per district. Below we outline a number of important differences between the neighbourhoods.

The health and lifestyle of older people in Noordoost, Oost and Binnenstad are generally better than average. Relatively more older people with poorer health and lifestyle are living in Noordwest10.

The differences between Utrecht districts are less noticeable when it comes to participating in society. What is noticeable is that older people in Noordoost and Oost are more likely to do volunteer work.

Older people in Noordoost, Oost and Vleuten-De Meern are more likely to be satisfied with their home, living environment and the green spaces in their neighbourhood. Residents aged 65 and over in Noordwest and Zuidwest are less likely to be satisfied with this10.

More information

For more information about the health of older people in Utrecht, for example, about issues that have not been highlighted in this special report, or if you would like to know how we collected this data, please contact us. We can also share information about the health of young people and adults in Utrecht.
 

Sources

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