In most Western SOCIeties, the number of elderly people is increasing, both in absolute terms and when expressed as a percentage of the total number of inhabitants. This 'greying' process will continue in the near future; in 1980, 11.5% of the residents in the Netherlands was aged 65 years or older; in 1993 this number had increased to 13.0%; in 2035 it is expected to rise to about 25% (CBS, 1994). Within this population the number of persons aged 85 and above will particularly increase, a phenomenon known as 'doublegreying'. Both the growing number of older adults, and improvements in health care which have reduced early death, have caused the number of elderly people with chronic disease and disability to steadily grow. Providing services for disabled elderly people has therefore been a major challenge for health care professionals over the last few decades. The elderly are disproportionate users of the health care system: they consume approximately 30% of the total expenditures on health care in the Netherlands (Groenenboom and Huijsman, 1995).

F.F.H. Rutten (Frans) , C.P.M. Knipscheer (Kees)
Erasmus University Rotterdam
Erasmus School of Health Policy & Management (ESHPM)