Small area variation in demographic aging: Informal and formal nursing care ratios inform health care planners
Background: The demographic change will increase the number of older individuals suffering from dementia and being in need of care. Nursing care is generated from two major sources, caring relatives (informal care) and professional caregivers (formal care). Demographic aging affects the number of older individuals potentially in need of care and those age groups of younger individuals potentially providing formal and informal care. Care ratios are calculated from the individuals potentially in need of care (80+ years) and those providing either formal (20 – 59 years) or informal care (children generation 40 – 59 years). Demographic aging varies according to countries, regions, in smaller geographic areas and over time.
Objective: This study examines the current and future demographic aging on a county level in Saxony.
Methods: To calculate formal (FISR) and informal intergenerational support ratios (IISR), population data from the Federal Institute for Research on Building, Urban Affairs and Spatial Development (BBSR) were used. Ratios were calculated for every county in Saxony from 2012 to 2035. Low ratios indicate critical constellations with high care needs and low care potential in the population.
Results: In 2012, the county with the lowest IISR was Chemnitz with 3.9. In comparison, North Saxony reached the highest IISR with 5.4 individuals. Regarding the formal care in 2012, Görlitz had the lowest FISR (6.8) and Dresden the highest FISR (10.2).
In 2035, Görlitz, Erzgebirge and Vogtland showed the lowest IISR (1.7); Leipzig showed the highest IISR (3.2). In 2035, Görlitz remained the county with the lowest FISR together with Erzgebirge and Vogtland (2.9). For Leipzig the highest FISR was estimated (6.2).
Discussion: In general, care ratios tend to decrease over time while substantial small area variation exists. The general trend for IISR and FISR is similar indicating that both may not naturally substitute for each other (e.g. less informal caregiving, more formal caregiving).
Implications: Caregiving in aging societies is one of the major future challenges. Upcoming care ratios may inform community health care planners and decision makers on critical constellations in advance. Strategies addressing informal and formal caregiving to ensure the future elderly care need to be developed and implemented.