gms | German Medical Science

Background: The demographic change will increase the number of older individuals suffering from chronic conditions (e.g. from dementia and other conditions) and being in need of care. Nursing care is generated from two major sources, caring relatives (informal care) and professional caregivers working in mobile community services or in nursing homes (formal care). Demographic aging as one of the component of demographic changes, on the one hand, affects the number of old age individuals potentially in need of care (those 80+ years) and, on the other hand, those age groups of younger individuals potentially providing formal (20-59 years) and informal care (mainly from the children generation 40-59 years). Intergenerational support ratios are calculated from the individuals potentially in need of care (those 80+ years) and those potentially providing either formal (20-59 years) or informal care (children generation 40-59 years). Formal intergenerational support ratios (FISR) and informal intergenerational support ratios (IISR) inform decision makers and futures health care planner. Demographic aging varies according to countries, regions, and even in smaller geographic areas and over time. Small area variations may be of utmost importance for community health care planners.

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 small areas (every county in Saxony) and every year 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, the Erzgebirge as well as the Vogtland showed the lowest IISR (1.7) and Leipzig showed the highest IISR (3.2). In 2035, Görlitz remained the county with the lowest FISR together with the Erzgebirge and Vogtland (2.9). Leipzig was estimated to be the city with the highest FISR (6.2).

Discussion: In general, care ratios tend to decrease over time while substantial small area variation does exist. The general trend for IISR and FISR is similar. This indicates 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 well in advance. Strategies to ensure the future elderly care need to be developed and implemented. They should address both, informal and formal caregiving.