Promoting good physical and mental health across the life course is key to allow people to live active and fulfilling lives for as long as possible and to reduce the demand on health and long-term care systems in the context of population ageing. The available evidence shows that about two‑thirds of the gains in life expectancy at birth and at age 65 over the past 20 years in the EU have been years lived in good health, while the other one‑third have been years lived with some health issues and disabilities. Despite these gains in healthy life years, less than half of the life expectancy of people at age 65 in 2022 in the EU could be expected to be lived free of disability. The proportion of life lived without disability is significantly lower among women, as they live longer but with more health issues than men. There are also large inequalities in health status according to socio-economic status, highlighting the need to step up health promotion and disease prevention policies to promote healthy longevity for all. One of the main priorities to support further gains in life expectancy in good health is to prevent the main burden of diseases and disabilities among older people in the EU, including dementia, falls, diabetes, arthritis, mental health issues and cardiovascular diseases. Not all diseases and injuries can be prevented, and health systems also need to be prepared to provide more people‑centred and integrated care for the growing number of older people who will require chronic care.
Health at a Glance: Europe 2024
Abstract
Healthy longevity can be defined as living a long life in good physical and mental health and social well-being. It allows people to live active and fulfilling lives across the life course, remaining engaged in work, leisure and social activities well beyond traditional retirement age. The benefits of healthy longevity are clear. If people live longer and healthier lives, this may enable them to work longer and to reduce the demands on health and long-term care systems. Conversely, if people live longer but spend a greater part of their lives with health issues and disabilities, this will reduce their ability to remain active on the labour market and will put additional pressures on health and long-term care systems and the related demand for health and long-term care workers.
This chapter reviews the most recent trends in life expectancy, healthy life expectancy, morbidity and disability in the EU, focussing in particular on the growing number of people aged over 65. It uses data from Eurostat and WHO to assess to what extent people live not only longer but also healthier lives. Indicators of “healthy life expectancy” are arguably the most important indicators to monitor gains in health status, as they combine both the quantity and the health-related quality of life. However, as noted in this chapter, they are also much more difficult to measure than life expectancy alone as there are many dimensions to health (e.g. physical, mental, functioning) that can be measured in many different ways. The available data used to measure trends over time in healthy life expectancy at the European or global level are not yet as robust as they would ideally be. There are many breaks in the time series in the Eurostat’s indicator of healthy life years, which hamper robust analysis of trends over time, and there are many data gaps and uncertainties around the WHO estimates underlying the calculations of healthy life expectancy.
Bearing these limitations in mind, one of the main findings of this chapter is that the data available from both Eurostat and WHO suggest that about two‑thirds of the additional years of life at age 60 or 65 gained over the past 20 years in the EU are lived in good health, while the other one‑third is lived with some health issues and disabilities. Looking at more specific indicators of morbidity, data from the EU statistics on income and living conditions (EU-SILC) show that in most EU countries, fewer people aged over 65 reported to be in poor health in 2023 than in 2010, while the proportion reporting some chronic diseases and activity limitations (disabilities) have remained relatively stable. Nonetheless, less than half of the life expectancy of people at age 65 in the EU can be expected to be lived free of disability, calling for further health promotion and disease prevention efforts.
This chapter also reviews the overall burden of diseases and injuries among older people in the EU to assess the relative importance of some of the main health issues in old age and help identify priorities for action. The most recent results from the 2021 Global Burden of Disease (GBD) study show that chronic diseases such as Alzheimer’s disease and other dementias, arthritis, diabetes, cardiovascular diseases, as well as mental health issues such as depression and anxiety, represent the bulk of the burden of diseases in old age in the EU. Falls and fall-related injuries also account for a large burden of health issues and disabilities in old age.
Policies to promote healthy longevity must address important risk factors to ill-health among people at all ages, including physical inactivity, malnutrition, overweight and obesity, preventing falls and other injuries among older people, and social isolation. However, not all health issues can be prevented, and health systems must also be prepared to meet the healthcare needs of a growing number of older people. While this chapter reviews mainly a range of prevention policies to support healthy longevity, it also identifies some of the main challenges and emerging best practices in the management of chronic conditions through more integrated and people‑centred care.
2.2.1. The share of people aged over 65 in the EU is expected to reach 29% by 2050, driven by gains in life expectancy and declining fertility rates
The demographic profile of EU countries is undergoing a profound transformation due to rising life expectancy and declining fertility rates.1 The post-World War II baby boom observed in many European countries has also contributed to an increasing proportion of people over age 65 during the past decade and will continue to increase the proportion in the coming years as this cohort reaches that age group. The proportion of people aged over 65 in the EU has risen from 16% in 2000 to 21% in 2023 and is projected to reach 29% by 2050 (Figure 2.1).
The share of people aged over 65 in 2023 was particularly high in Italy and Portugal with nearly 25% of the population in that age group, while Ireland and Luxembourg had the lowest proportion with 15%. However, population ageing will accelerate greatly in some countries in the coming decades. For example, while Ireland currently has a relatively young population, the share of its population aged over 65 is projected to increase by more than two‑thirds between 2023 and 2050.
By 2050, the share of people aged over 65 is expected to be the highest in Italy and Portugal but also in Greece and Spain with at least one‑third of the population in that age group. It is expected to be the lowest in Luxembourg, Malta and Sweden, but nonetheless rising to reach at least 23% by 2050 in these three countries.
Note: The EU average is weighted.
Source: Eurostat (proj_23np, demo_pjangroup).
2.2.2. Life expectancy in the EU has increased by over four years since 2000
As already noted, populations are ageing because of declining fertility rates and rising life expectancy. Life expectancy at birth in the EU has increased by over four years between 2000 and 2023, from 77.3 years in 2000 to 81.5 years in 2023 (Figure 2.2). While there was a sharp reduction in life expectancy during the COVID‑19 pandemic (with a reduction in life expectancy by more than a year between 2019 and 2021), it started to bounce back in 2022. In 2023, it was at about the same level as before the pandemic in most EU countries or even reaching a slightly higher level than before the pandemic in some countries, although typically still below the pre‑pandemic trajectory.2
Women live longer than men in all EU countries, on average over 5 years longer (84.2 years for women in 2023 compared to 78.9 years for men). However, this gender gap has narrowed by 1.5 years since 2000 as the life expectancy of men has increased more rapidly than that of women in most EU countries.
Note: The EU average is weighted.
Source: Eurostat (demo_mlexpec), and OECD calculations for 2000 and 2001.
The gains in life expectancy over the past two decades have been particularly strong in Central and Eastern European countries, converging towards the EU average. By contrast, the gains in life expectancy slowed down in many Western European countries (e.g. in France and Germany) in the years before the pandemic (2010‑19) compared to the previous decade (2000‑09). This slowdown was partly due to slower reductions in death rates from circulatory diseases, which was previously one of main drivers of increased life expectancy in these countries. Death rates from respiratory diseases such as influenza and pneumonia among older people were also higher in several Western European countries in some years in the decade before the pandemic.
Focussing on the population aged 65 and over, the trends in life expectancy were similar to that of life expectancy at birth. It increased by 2.5 years between 2000 and 2023, rising from 17.7 years in 2000 to 20.2 years in 2023. However, the COVID‑19 pandemic led to a temporary reduction in life expectancy at age 65 in all EU countries (Box 2.1).
The COVID‑19 pandemic led to a substantial increase in the number of deaths in the EU in 2020, 2021 and 2022, and therefore a reduction in life expectancy. The overall number of deaths in the EU increased from 4.65 million in 2019 to 5.18 million during the first year of the pandemic in 2020 and reached a peak of 5.29 million in 2021, before falling slightly to 5.15 million deaths in 2022 (Eurostat, 2024[1]). The vast majority of these additional deaths during the pandemic were among older people. In 2020 and 2021, over 85% of COVID‑19 deaths were among those aged over 65 on average across EU countries.
Despite the reduction in COVID‑19 deaths in 2022 due to widespread vaccination efforts, increasing population immunity through prior infections and the virus mutating into less severe variants, excess mortality in many European countries remained relatively high. This was due at least partly to the resurgence of the flu and other infections as well as heatwaves during the summer of 2022 (Morgan et al., 2023[2]). Based on some estimations, more than 60 000 heat-related deaths occurred in Europe in the summer 2022, with about 85% of these deaths occurring among people aged over 65 (Ballester et al., 2023[3])
In the EU, life expectancy at age 65 temporarily fell by one year between 2019 and 2021, from 20.2 years in 2019 to 19.2 years in 2021, and only recovered slightly to 19.5 years in 2022. It then bounced back in 2023, going at least back to its 2019 level in most countries. The reduction in life expectancy at age 65 during the pandemic affected men and women to the same extent on average in the EU (Figure 2.3).
Note: The EU average is weighted.
Source: Eurostat (demo_mlexpec).
2.3.1. Some additional years of life are lived in good health, but not all
While life expectancy at birth has increased by over four years on average across the EU between 2000 and 2023, many years of life in old age are lived with chronic diseases and disabilities. How many of the additional years of life are spent in good health is a crucial question to assess the growing demand for health and long-term care, but also to guide decision-making on employment and retirement policies.
Both the EU and WHO have developed some indicators of healthy life expectancy that combine data on mortality and morbidity (or disability) to measure how many years of life people can expect to live in good health (or free of activity limitations). Since 2004, Eurostat has reported an indicator of “healthy life years” (HLY) that provides an estimate of the number of years that people at different ages can expect to live free of activity limitations. This indicator is also known as “disability-free life expectancy” (DFLE). The calculation of this indicator is based on self-reported responses to a two‑question item on general activity limitations due to health problems from the EU-SILC survey. At the global level, WHO periodically reports an indicator of “health-adjusted life expectancy” (HALE), which is defined as life expectancy in full health, based on different data sources and statistical models to calculate the “health adjustment”. A comparison of the most recent WHO’s HALE estimates with those from Eurostat’s HLY shows large variations in national estimates and country rankings (Box 2.2).
Indicators of healthy life expectancy, which combines both the “quantity” of life and the health-related “quality” of life, are arguably among the most important indicators to monitor population health. However, it is challenging to get reliable and comparable data because of the complexity in measuring health (or ill-health). The measurement of health often relies on population-based surveys that may not be harmonised across countries and are based on self-reported information that may be affected by cultural biases and different expectations.
Eurostat calculates and reports two indicators of healthy life expectancy, based on a simple approach that relies on responses to questions from the EU-SILC survey for each indicator. The first and main indicator is referred to as “healthy life years” (HLY) and relies on the two‑question item on activity limitations due to health problems. The recommended survey questions are as follows: “Are you limited because of a health problem in activities people usually do?” with response categories including “severely limited”, “limited but not severely” or “not limited at all”; and “Have you been limited for at least the past six months? with “yes” and “no” answer categories. People who report having been limited for at least six months are considered to be “unhealthy” in the calculation of the HLY indicator. The second indicator of healthy life expectancy (less frequently used) is based on the question on self-reported health in EU-SILC, with the recommended formulation being: “How is your health in general?” with response categories including “very good, good, fair, bad, very bad”. People responding to be in very good, good or fair health are considered to be healthy, while those responding to be in bad or very bad health are considered unhealthy.
The main advantages of the approach used by Eurostat are its simplicity and the availability of annual data from EU-SILC to update these two indicators annually. However, the main downside is that these indicators depend entirely on the reliability of responses to a few questions from EU-SILC and the comparability of the survey instrument used across countries. Another downside is that these indicators are based on a simple binary valuation of the reported health status. For the main indicator of HLY, a value of zero is assigned to people reporting severe or at least some limitations, or one if they report no activity limitation (for the secondary indicator, a value of zero is assigned for people reporting to be in bad or very bad health and one for those reporting to be in fair, good or very good health). Any changes in the formulation and translation of the survey item in EU-SILC can result in large variations in the reported number of HLY. For example, when Germany revised the EU-SILC question on activity limitations in 2015, it included a first “screening” question that forced people with some but not severe limitations to choose between “Yes” or “No”. This resulted in an immediate increase of 10 healthy life years because of the large reduction in the percentage of people reporting some activity limitations. In 2022, Germany revised again this EU-SILC question and dropped this first “screening” question. This resulted in a loss of 4.5 healthy life years due to the large increase in the percentage of people reporting some or severe activity limitations.
The calculation of the WHO’s indicator of health-adjusted life expectancy (HALE), defined as years of life lived in “full health”, is based on a much more complex approach that requires a large volume of data to describe the health status of the population, taking into account the overall burden of diseases and injuries, as well as some valuation (weighting) of the severity of disability related to all these diseases and injuries. The indicator draws on morbidity data, namely years lived with disability (YLD), based on statistical modelling from the Global Burden of Disease (GBD) study, given that the wide range of required data are not readily available across countries. These estimates may not be consistent with national data.
These two very different approaches between Eurostat and WHO in calculating indicators of healthy life expectancy based on different data sources and methodologies explain why the two indicators of HLY and HALE vary widely in terms of national estimates and country ranking (Figure 2.4). Among EU countries, the WHO’s HALE indicator provides higher values in all countries except Bulgaria. Except for Sweden, the complete country ranking changes between the two indicators and often quite widely (with an average shift of six positions). These discrepancies between HLY and HALE and the complex methodological issues underlying the calculation of any measure of healthy life expectancy highlight the need to be cautious in interpreting these indicators and using them in policy development.
Note: Data refer to 2021 (the latest year available for both indicators) and include both men and women.
Source: Eurostat (tps00150) and WHO.
It is very difficult to analyse trends in healthy life years (HLY) based on the Eurostat data because of breaks in the time series in most EU countries, meaning that the data after a break should not usually be compared with the data before the break. Bearing in mind this important limitation, the available data suggest that life expectancy at age 65 increased by 1.2 years in the EU between 2005 and 2022. Of this increase, two‑thirds were gains in healthy life years (0.8 years) and the other third were years with disability (0.4 years) (Figure 2.5). As a result, the share of life expectancy at age 65 lived with some disability decreased slightly, from 55% in 2005 to 53% in 2022.
WHO data on HALE at age 60 show similar trends between 2000 and 2021. On average across EU countries, about 60% of the gains in life expectancy at age 60 since 2000 were in good health (1 year) while about 40% (0.7 year) was in less than full health (Figure 2.6).
Note: Healthy life years is defined as years free of disability. The EU average is weighted. Caution is needed when interpreting these data because of breaks in time series in most EU countries during that period.
Source: Eurostat (lth_hlye).
Note: The EU average is unweighted.
Bearing in mind the breaks in time series in most countries based on the Eurostat data, the number of healthy life years at age 65 has increased between 2005 and 2022 in nearly all EU countries (Figure 2.7). At the same time, the number of years lived with disability also increased at least marginally in most countries. National estimates based on the WHO’s HALE indicator at age 60 are available in Annex 2.A.
Note: There is at least one break in the time series for most EU countries during that period, thereby limiting the interpretation of these trends. The time trend is restricted to 2010 to 2022 for Romania, Denmark and Bulgaria to avoid a major break in series between 2005 and 2010, and for Croatia because of missing data before 2010.
Source: Eurostat (lth_hlye).
When looking at gender differences, women continue to have a higher life expectancy at age 65 than men in all countries, but a lower share of their life expectancy can be expected to be lived in good health and without activity limitation. According to the Eurostat data, in 2022 there was almost no gender gap in the number of healthy life years at age 65 (9.2 years of healthy life years for women compared to 8.9 years for men). Women not only spend more time with diseases and disabilities in old age, but they are also less likely to have the financial resources to meet their health and long-term care needs (Box 2.3).
Older women can expect to live many more years than men, yet they report more chronic diseases and disabilities than men, thereby reducing the gender gap in the number of healthy life years. Older women are more likely than men to have chronic conditions such as arthritis, osteoporosis, depression and dementia, and they are also more likely to have multiple health problems. One of the consequences of these health issues is that older women are also more likely to have difficulties carrying out activities of daily living such as dressing, walking or bathing according to data from the Survey of Health, Ageing and Retirement in Europe (SHARE) survey, which may require long-term care support.
At the same time, older women have fewer financial resources to pay for health or long-term care. In the EU, women received on average 26% less in retirement benefits than men in 2022, reflecting persistent disparities in employment rate and unequal pay during their working years (European Commission, 2024[4]). Over one in five women over age 75 in the EU was living below the poverty line in 2023, according to EU-SILC data.
The combination of higher health and long-term care needs with lower incomes impacts the ability of older women to afford health and long-term care services. According to the EU-SILC survey, unmet medical care needs were higher among women aged over 65 than men in 2023 (4.1% compared to 3.0% in the EU), and it was particularly high among older women in the lowest income group (6.0% among women in the lowest income quintile compared to 1.9% among women in the highest income group), mainly because the care was unaffordable. Going without such medical care may aggravate the health problems of older women.
2.3.2. Since 2010, fewer older people report being in bad health, while chronic conditions and activity limitations have remained stable on average in the EU
The share of older people reporting to be in bad or very bad health has fallen in nearly all EU countries since 20103 (Figure 2.8). In the EU as a whole, the share of people aged over 65 reporting to be in bad or very bad health decreased from 25% in 2010 to 19% in 2023. This reduction was particularly noticeable in Central and Eastern European countries. It was also particularly marked among women, although the proportion of older women reporting to be in bad or very bad health remains higher than men (20% compared to 17%).
Note: The EU average is weighted. There are breaks in times series in Germany and Luxembourg.
Source: Eurostat based on EU-SILC (hlth_silc_10).
The share of older people reporting to have at least one chronic disease has remained stable at around 60% between 2010 and 2023 in the EU, meaning that the absolute number has increased given the growing number of people aged over 65 (Figure 2.9). While the share of people aged over 65 reporting at least one chronic disease increased in some countries (e.g. Czechia, Denmark, Lithuania and Sweden), it decreased at least slightly in others (e.g. Austria, Estonia, Italy, Poland and Slovenia). The proportion of women aged over 65 reporting at least one chronic disease was only marginally higher than men in 2023.
Note: The EU average is weighted. There are breaks in time series in Croatia, France, Germany, Ireland and Norway.
Source: Eurostat (hlth_silc_05).
The share of people aged over 65 reporting some or severe activity limitations due to health problems has decreased slightly in the EU from 55% in 2010 to 52% in 2023, although breaks in time series in most countries during that period limit the interpretation of these trends (Figure 2.10). The proportion of women aged over 65 reporting such activity limitations is higher than men (54% compared to 49% in 2023). This measure of activity limitations is the “health” indicator used by Eurostat to calculate the healthy life years indicator (see section 2.3 above).
Note: There is at least one break in the data series for most EU countries during that period, reducing the interpretability of these trends.
Source: Eurostat (hlth_silc_07).
Figure 2.11 presents data from the 2021 Global Burden of Disease (GBD) study to identify the most common causes of ill-health and disability among older people aged over 70 in the EU to help identify priority for actions (IHME, 2024[5]). These data provide an indication of the estimated incidence and severity of different conditions and the length of time that people on average will be affected by them.4
Based on these data, the greatest burden of disability among older people in the EU in 2021 was related to dementias (including Alzheimer’s disease) and Parkinson’s disease, and falls. Diabetes, arthritis, depression and anxiety, and cerebrovascular and ischaemic heart diseases were also among the most important causes of healthy life years lost due to disability among older people in the EU.
Note: Dementias include Alzheimer’s disease. Arthritis includes rheumatoid arthritis and osteoarthritis. Cancer covers all cancer sites except non-melanoma skin cancer. COPD = chronic obstructive pulmonary diseases.
Source: IHME (2024), GBD Results (estimates refer to 2021), https://vizhub.healthdata.org/gbd-results/.
2.4.1. Alzheimer’s disease and other dementias are among the greatest challenges of population ageing
As in other parts of the world, Alzheimer’s disease and other dementias are one of the greatest challenges as the population ages in EU countries. Despite years of research and large amounts of money invested in dementia-related research, there is no cure yet and even disease‑modifying treatments are only likely to slow the progression of the condition, with the possibility of negative side‑effects affecting quality of life. This emphasises the need to focus on prevention as recently highlighted in the 2024 report of the Lancet Commission on dementia (Livingston et al., 2024[6]) (see also section on Preventing Alzheimer’s disease and other dementias below).
Across EU countries, nearly 8 million people were estimated to have Alzheimer’s disease or another dementia in 2021, according to GBD estimates. Focusing on people aged over 70, over 9% of people in that age group were estimated to have Alzheimer’s disease or another dementia (Figure 2.12). The prevalence increases sharply with age, rising from 3% among people aged 70‑74 to 18% among those aged over 80 across EU countries.
Source: IHME (2024), GBD Results (estimates refer to 2021), https://vizhub.healthdata.org/gbd-results/.
Data from some European countries (e.g. France, Sweden, the United Kingdom) suggest that age‑specific dementia incidence rates have decreased over the past two decades. This positive trend indicates that prevention is possible (Wolters et al., 2020[7]).
In many cases, dementia in old age is accompanied by other chronic diseases (Box 2.4).
As people age, they are also more likely to have multiple chronic conditions (multimorbidity), often requiring careful management and care co‑ordination because of possible interactions between different treatments and prescriptions. Based on the Survey of Health, Ageing and Retirement (SHARE), 44% of people aged 65 and over reported having at least two chronic diseases on average across EU countries in 2021‑22. Older women reported having multiple chronic diseases more often than men (46% versus 40% on average), partly because they live longer. This gender gap is more pronounced in many Central and Eastern European countries such as Romania, the Slovak Republic, Latvia and Croatia.
Note: The EU average is unweighted and based on 26 EU countries (Ireland does not participate in the SHARE survey). Chronic diseases include Alzheimer’s disease, cancer, chronic kidney diseases, chronic lung diseases, diabetes, heart attack, hip fracture, hypertension, Parkinson’s disease, stroke, rheumatoid arthritis and osteoarthritis.
Source: SHARE wave 9 (data refer to 2021‑22).
2.4.2. Falls increase markedly with age, especially among women
Older people are at higher risk of falling for many reasons, including a loss of muscle and balance, physical inactivity, declining vision, the consumption of multiple medications, and malnutrition. Poor living conditions and not having enough light at home also add to the risk of falling. Such falls frequently lead to emergency department visits and hospital admissions due to fractures and can cause lasting damage to mobility and quality of life.
Data from the SHARE survey show that the proportion of people affected by falls increases markedly with age, and the gender gap becomes more pronounced in older age groups (Figure 2.14). Nearly one in six (16%) people aged over 75 reported that they have been affected by falls over the past 6 months on average across EU countries in 2021‑22, and the rate was particularly high among women (18%).
Note: The EU average is unweighted. People considered affected by falls are those who answered “falling down” to the question: “For the past six months at least, have you been bothered by any of the health conditions [including falls]?”
Source: SHARE wave 9 (data refer to 2021‑22).
Taking several medications at the same time is an important risk factor for falls among older people as this can impair balance and reaction time. Nearly half of people aged over 75 were taking at least five medications at the same time in 2021 on average in 11 EU countries with available data (OECD, 2023[8]). There is a consistent association in particular between the use of most psychotropic medications and falls.
2.4.3. Depression and suicide increase in old age
Good mental health plays a critical role in enabling people to stay active and physically healthy as they age. Depression is a common mental health issue among all age groups, but particularly among older people. Older people are more exposed to some key risk factors for depression than the working-age population, including lower rates of social interactions in everyday life, death of a partner, and the lack of family contact, which all play a more pronounced role in late‑life depression (Vasile et al., 2023[9]). Depression among older people also often coexists with chronic physical illnesses, particularly when these chronic diseases are painful.
Results from the European health interview survey (EHIS) show that 8.5% of people aged over 65 in the EU reported depression in 2019, compared to 6.8% among people aged 15 to 64. Older women are much more likely to report depression than men (10.8% compared to 5.5%). Some of this gender gap may be due to women being more likely to report depression.
Data from the 2021‑22 SHARE survey also show that depression symptoms tend to increase with age among both women and men (Figure 2.15). The rates increase slightly from age 50‑64 to age 65‑74, and then rise strongly in older ages. Among people aged over 75, 45% of women and 27% of men reported at least four depression symptoms on average across EU countries in 2021‑22.
Note: Data refer to 2021‑22. The EU average is unweighted and based on 26 EU countries. The shares are based on the EURO-D score, with a cut-off point of at least 4 out of the 12 symptoms.
Source: SHARE wave 9 (data refer to 2021‑22).
Suicide rates among people aged over 75 are much higher than those in younger age groups, particularly among men. Among people aged 65‑74, the suicide rate is approximately 15 per 100 000 population on average in the EU, with the rate about three times higher among men than among women. Among people aged over 75, the rate goes up to 21 per 100 000 population, with the rate among men soaring to nearly 40 per 100 000, almost five times the rate for women. However, the gender gap in suicide attempts is much smaller or even reversed in some countries, as women often use less fatal methods. For example, in France, suicide attempts among women of all ages were about 40% higher than among men in 2020 (DREES, 2022[10]).
Note: Data refer to 2021. The EU average is weighted.
Source: Eurostat (hlth_cd_acdr2 and tps00202).
2.4.4. Socio-economic inequalities in health status are large among older people
Large inequalities in health status exist among older people not only by gender, but also by socio-economic status, be it measured by education level, income or occupational group. These inequalities stem from many different factors, including greater exposure to various risk factors during the whole life course, more difficult living and working conditions during the working life, and lesser access to and use of health services.
Inequalities in life expectancy by education level are generally larger among men than among women, and they are particularly large in Central and Eastern Europe. Based on the latest data from Eurostat which date back to 2017, the life expectancy of 30‑year‑old men with less than secondary education was about 7 years less than those with a tertiary education (a university degree or the equivalent) on average across 15 EU countries. The education gap in longevity among women was smaller, about 3 years (OECD/European Union, 2020[11]). Previous OECD analysis has shown that the significant gap in mortality rates by education level among both older men and women is driven mainly by higher death rates from the two leading causes of death, circulatory diseases and cancer (Murtin et al., 2017[12]).
A study of 11 EU countries based on data from 2010 to 2014 found significant disparities in disability-free life expectancy (healthy life years) by education level. Disability-free life expectancy was 9 years shorter among men aged 35 to 80 with the lowest level of education (less than secondary education) compared to the most educated (with a tertiary education). The gap among the least educated and most educated women was slightly narrower at about 8 years. The risk factor contributing most to these educational inequalities in disability-free life expectancy was low income. Other important risk factors included being overweight or obese, and smoking (Valverde et al., 2021[13]).
All indicators of health status show that older people with a lower level of education are on average in poorer health compared to those with the highest level of education (Table 2.1).
Note: Low education is defined as people who have not completed secondary education, while high education refers to people who have completed tertiary education (a university degree or the equivalent).
Source: Eurostat based on EU-SILC (hlth_silc_02, hlth_silc_05, hlth_silc_07) and SHARE wave 9 (2021‑22 data, weighted observations).
2.5.1. Some behavioural and environmental risk factors are more important among older people
A wide range of behavioural and environmental risk factors can increase the likelihood of illness or injury amongst people in old age. Some behavioural risk factors increase with age, while others decrease. Physical inactivity is a particularly important issue among older adults. Over three‑quarters (78%) of people aged over 65 in the EU do not meet the WHO recommendation regarding the minimum level of physical activity per week, compared to 65% among younger adults. Obesity rates are also higher among people aged over 65 (18%) than among younger adults (15% among people aged 25‑64). On the other hand, nutritional habits, as measured by the consumption of fruit and vegetables, are generally better among older people. While other risk factors such as tobacco smoking and heavy alcohol consumption also tend to be less frequent among older people than younger adults, this is mostly due to both behavioural changes and a selection effect. As people age, they are more likely to stop smoking and reduce alcohol consumption, especially if they have chronic diseases that require healthier lifestyles. However, the lower smoking and drinking rates among older people is also partially due to survivorship. Adults who smoke more and consume more alcohol at younger ages are more likely to be ill and die before reaching age 65. When it comes to environmental factors, exposure to air pollution and extreme temperatures have a more pronounced impact on older people than younger adults (Table 2.2).
Note: Data refer to 2019 for physical activity (duration), nutrition, smoking, alcohol consumption; 2021 for air pollution and extreme temperature;2022 for obesity and physical inactivity (frequency).
Source: Eurostat (hlth_ehis_pe2e, ilc_hch07b, ilc_hch10, hlth_ehis_al3e, hlth_ehis_sk3e, hlth_ehis_fv3e) and IHME GBD for environmental risks.
2.5.2. Physical activity decreases sharply with age, despite being crucial for mitigating the negative effects of ageing
Physical activity is one of the most important activities that people can do to avoid or slowdown the negative consequences of ageing. It reduces the risks of many chronic conditions and falls, promotes mental health, and reduces cognitive functioning decline. WHO released in 2020 new guidelines on physical activity and sedentary behaviour for different age groups, including people aged over 65. These guidelines recommend at least 150‑300 minutes of moderate intensity physical activity or 75‑150 minutes of vigorous intensity physical activity per week for older adults. As part of their weekly physical activity, it is also recommended that older adults do varied physical activity that emphasises functional balance at least three days per week. Older adults should also limit the amount of time spent being sedentary (WHO, 2020[14]).
The share of people meeting the WHO recommendation on physical activity declines with age in all EU countries (Figure 2.17). On average across the EU, it drops from 35% among those aged 18 to 64 years to 22% among those aged over 65. In 11 EU countries, less than 10% of people aged over 65 meet these guidelines. Only in Norway, the Netherlands and Sweden did at least half of the older population meet the WHO recommendations. This highlights the need for policies to promote appropriate physical activity among older adults, but also among young adults, as the shares of people reporting sufficient physical activity are low across all age groups.
Note: The EU average is weighted.
Source: Eurostat (hlth_ehis_pe2e) (the data refer to 2019).
Physical activity decreases with age equally among both men and women, and less women report physical activity than men in all age groups. About 27% of men aged over 65 reported doing physical activity that met the WHO guidelines in 2019 compared to 19% of women only.
Not only does the time spent doing physical activity reduce with age, but its frequency also decreases. Based on the EU-SILC survey, over half (52%) of people aged over 65 reported doing physical activity less often than once a week or never in 2022. This proportion was highest in Central and Eastern European countries, and lowest in Nordic countries and the Netherlands.
The highest burden of new disease cases due to insufficient physical activity are among people aged 60 to 79 (Figure 2.18). Cardiovascular diseases account for 40% of all new disease cases due to lack of physical activity among people aged 60 to 79, and nearly 75% of the burden for people aged 80 to 89. People over 80 are at high risk of developing diseases due to physical inactivity, but there are fewer cases of new diseases because there are fewer people in this older age group (OECD/WHO, 2023[15]).
Note: CVDs = cardiovascular diseases.
Source: OECD/WHO (2023[15]), Step Up! Tackling the Burden of Insufficient Physical Activity in Europe, OECD Publishing, Paris, https://doi.org/10.1787/500a9601-en.
2.5.3. Obesity rates increase gradually with age to peak at age 65‑74
Obesity rates increase gradually as people age to reach a peak of about 20% at age 65‑74 on average across EU countries in 2022, according to data from EU-SILC (Figure 2.19). Obesity rates then start to fall after age 75.
While obesity rates are higher among younger men than younger women, the gender gap diminishes and even inverts after age 75, with a slightly higher obesity rate among women than men in that age group on average across EU countries.
A much smaller proportion of people aged 65‑74 and over 75 are considered to be underweight (about 1% according to data from EU-SILC in 2022) than overweight or obese. While physiological changes such as muscle atrophy and bone density loss often lead to a reduction in body weight in old age, this reduction does not necessarily mean that people become underweight.
Note: The data refer to the EU average. The EU average is weighted. Obesity and underweight are based on the body mass index (BMI) that divides weight by height in metres, squared. Obesity is defined as a BMI over 30, while underweight is defined as a BMI under 18.5.
Source: Eurostat based on EU-SILC 2022 (ilc_hch10).
2.5.4. Malnutrition is the main contributor to weight issues and deficiencies in specific nutrients
Malnutrition is the main contributor of overweight and obesity at all ages. Eating five fruit and vegetables a day is recommended by WHO for all adults (including older adults) to stay healthy. However, only one in seven people (14%) aged over 65 in the EU reported eating at least five fruit and vegetables a day in 2019, according to the EHIS. Nonetheless, this rate was slightly higher than among younger adults aged 15‑64 (12%). The consumption of fruit and vegetables is strongly influenced by socio-economic status. Older people in the highest income quintile are over twice as likely to eat five fruit and vegetables a day compared with those in the lowest income quintile (19% compared to 10% in 2019 on average in the EU). More highly educated older people were also 40% more likely to eat five fruit and vegetables a day than the least educated (18% compared to 14% in 2019).
More recent data from the EU-SILC survey 2022 only asked people if they were eating fruit and vegetable each day or week, hence the percentage of the population is much higher than for those who reported eating five fruit and vegetables per day in 2019. These data confirm that retired (older) people were more likely to eat at least one fruit and vegetable per day than employed (younger) adults, but nonetheless about one‑third of retired people reported not eating one fruit and vegetable each day.
Deficiencies in specific nutrients are another significant health issue among older adults. They can manifest as involuntary weight loss and a very low body mass index, although this does not necessarily lead to weight loss. It is estimated that almost a quarter (23%) of European adults over the age of 65 are at high risk of malnutrition based on a meta‑analysis of nearly 200 studies published between 2000 and 2016 (Crichton et al., 2018[16]; Leij-Halfwerk et al., 2019[17]).5 People aged over 80 years, women and those with comorbidities have a higher risk of malnutrition. The risk is also higher in long-term care settings (e.g. nursing homes). These increased risks can be due to difficulties in eating because of dental issues, difficulties in preparing meals, and chronic diseases that lead to decreased appetite.
2.5.5. People aged over 65 are more vulnerable to extreme temperatures and air pollution
The health of older people can also be affected by a number of environmental factors that may have a detrimental effect on their health. This includes extreme temperature (hot or cold) and air pollution.
According to the GBD study, about 4% of all deaths among people aged over 65 in the EU in 2021 (or 188 000 deaths) could be attributed to air pollution. Air pollution in the form of fine particulate matter (often referred to as PM2.5) can lead to strokes and ischaemic heart diseases by affecting blood vessels and increasing the risk of clot formation. Prolonged exposure also contributes to lung cancer, while respiratory diseases can be triggered or worsened by the inhalation of these particles.
About 165 000 deaths of people aged over 65 in the EU in 2021 could be attributed to extreme temperature (too cold or too hot), according also to GBD estimates. The percentage of deaths due to extreme temperature rises from 2% among those aged 65‑69 to 4% among those aged over 80. A combination of physiological and behavioural factors makes older adults particularly vulnerable to hypothermia and heat. Certain chronic illnesses affecting physiological responses, such as diabetes, and the use of various medications can impair heat regulation. Older people are also more vulnerable to heat because they don’t sweat or cool down as efficiently as younger people, making them more susceptible to heat stress, which can worsen underlying conditions like heart, lung and kidney diseases. Poor air quality can also make it harder for older people to breathe, especially among those with existing respiratory issues.
Note: These estimates relate to the EU as a whole and refer to 2021.
Source: IHME GBD Results, available from https://vizhub.healthdata.org/gbd-results/.
Promoting healthy longevity is more important than ever as the proportion of people aged over 65 will continue to grow in the coming years and can be expected to increase pressure on health spending unless they are able to live in good health for longer. Both the OECD’s and EC’s most recent projection results indicate that the growth in health spending over the coming decades would be reduced significantly under a “healthy ageing” scenario. According to a baseline scenario assuming that there would be no progress in the health status of the population, the results from the most recent OECD projections show that public spending on health as a share of GDP could grow by 1.2 percentage points between 2019 and 2040 on average across the 23 EU countries included in these projections, because public spending on health would grow faster than GDP. However, this increase could be reduced by 0.4 percentage point of GDP on average under a “healthy ageing” scenario (OECD, 2024[18]).
The most recent projections from the 2024 EC’s Ageing Report show a more modest growth in public spending on health as a share of GDP between 2022 and 2070 under the baseline scenario, but this would be accompanied by a stronger increase in public spending on long-term care due to population ageing. Under the baseline scenario, the projected increase in public spending on health on average across EU countries would go up from 6.9% of GDP in 2022 to 7.3% in 2070, while public spending on long-term care would rise from 1.7% of GDP in 2022 to 2.6% in 2070. However, under a “healthy ageing” scenario where all future gains in life expectancy would be spent in good health (and not only half of these gains as under the baseline scenario), the projection results from the 2024 Ageing Report suggest that it may be possible to stabilise public expenditure on health at 6.9% of GDP by 2070 and to contain the growth of public expenditure on long-term care to 2.4% of GDP (European Commission, 2024[19]).6
Achieving healthy longevity requires fostering environments and promoting lifestyles that help people to avoid becoming ill in the first place, and that provide access to people‑centred and integrated care to people when they do get sick to restore their health and reduce the risk of complications. Another important element of healthy longevity strategies is to mitigate the inequalities that develop and often widen over the life course by addressing the social determinants of health and ensuring universal access to care when people get sick.
This section identifies a range of policy actions and good practices in health promotion and disease prevention, as well as in providing more integrated care for people with chronic conditions with a particular focus on older people, drawing on recent OECD evaluations of best practices (OECD, 2022[20]; 2023[21]).
2.6.1. Preventing diseases and injuries as people age
A significant proportion of health issues in old age can be prevented or delayed by supporting healthier lifestyles and health-promoting environments to reduce exposure to risk factors to various diseases and injuries.
Making physical activity a daily habit
Being physically active is one of the most important activities people at all ages can do to maintain and improve their physical and mental health. Physical activity helps prevent a range of non-communicable diseases, such as cardiovascular diseases and cancers, and improves mental health and cognitive functioning. Nevertheless, as already noted (see Figure 2.17 above), too many Europeans are not doing enough physical activity, and the proportion of people not sufficiently active increases with age. Recent joint OECD/WHO work has estimated that increasing physical activity levels to the WHO recommendation could prevent more than 10 000 premature deaths of people aged 30 to 70 years in the EU each year and increase the life expectancy of people who are not sufficiently active by 7.5 months (OECD/WHO, 2023[15]).
Most EU countries report that they have some programmes in place to promote physical activity among older adults (OECD/WHO, 2023[15]). Programmes such as the Multimodal Training Intervention, initially developed in Iceland and since then transferred in certain regions in Spain and Lithuania, provide good examples of effective ways to promote physical activity as well as healthy eating among older people (Box 2.5).
The Multimodal Training Intervention (MTI) is an exercise‑based intervention first developed in Iceland targeting people aged 65 years and over who live independently at home. The intervention involves endurance and resistance training under the guidance of a personal training over a period of 24 months. Participants also have access to lectures on topics such as nutrition, physical activity training and sleep.
The MTI includes several digital features. First, participants can track their performance by logging their workouts and diet in a dedicated mobile app. Second, municipalities have access to an online dashboard displaying the results from each round of participants’ measurements. Third, MTI administrators have created a website and Facebook group to provide participants with important information as well as direct contact with professional trainers and nutrition counsellors.
The OECD assessment of the MTI showed that it is effective in preventing chronic diseases and has the potential to lead to significant gains in life expectancy and disability-adjusted life years among older population over the long term. However, the MTI is a relatively expensive intervention as it offers participants supervised exercise classes and tailored healthy living lectures for a relatively small number of people. Hence, affordability may be an issue if participants are required to pay out-of-pocket for the programme.
The MTI has been successfully transferred to some regions in Spain and Lithuania.
Source: OECD (2022[20]), Healthy Eating and Active Lifestyles: Best Practices in Public Health, https://doi.org/10.1787/40f65568-en.
Reducing falls through prevention campaigns
Falls are among the most common health issues among older people as highlighted in Figure 2.14 above, and in many cases result in serious injuries and fractures, requiring hospitalisations and long periods of immobilisation.
Many EU countries have put in place a series of measures to reduce falls among older people. These measures often focus first on raising awareness among older people about the risks of falls and the steps that can be taken to lessen these risks. This is done, for example, by disseminating preventive checklists. A second common measure of fall prevention strategies is to identify people at higher risk of falling and to target efforts to reduce potential environmental hazards for these people. This identification process can be implemented, for example, through regular fall risk assessments conducted by primary care providers. A third measure is to encourage discussions on fall prevention between all older people and their primary care providers and facilitate referrals to specialists (e.g. orthopaedic doctors) or physiotherapists who may be able to intervene to reduce risks.
Research on the effectiveness of fall prevention strategies is limited in Europe, and the results across OECD countries are mixed. Promoting physical exercise has been identified as a potential effective measure to reduce the risk of falls among older people. A systematic review of evaluations of more than 50 interventions carried out mainly in non-EU OECD countries (e.g. Australia, Japan, the United States and the United Kingdom) found that exercise may reduce the rate of falls by up to 23% (Sherrington et al., 2019[22]). However, another systematic review of about 40 trials carried out mainly in the United States and the United Kingdom as well as in some EU countries (e.g. the Netherlands, Spain and Sweden) found that multifaceted interventions, often including exercise prescription along with other interventions, may only reduce slightly the risk of falls among older people (Hopewell et al., 2019[23]).
Interventions to reduce fall hazards at home may significantly diminish the number of falls, particularly if they are targeted to people at greater risk. A review of 22 evaluations from 10 countries found a reduction of 38% in the number of falls when programmes target those at higher risk. This review did not find any evidence of a reduction in falls when people were not selected based on risk (Clemson et al., 2023[24]).
Preventing Alzheimer’s disease and other dementias
Much can be done to prevent Alzheimer’s disease and other dementias through a comprehensive approach to dementia risk reduction, The 2024 Lancet Commission on dementia reported that 14 modifiable risk factors account for up to 45% of dementia cases around the world (Livingston et al., 2024[6]). It recommended a series of actions to address these risk factors to prevent or delay dementia (Box 2.6).
One of the key messages from the 2024 Lancet Commission on dementia is that modifying 14 risk factors might prevent or delay up to 45% of dementia cases worldwide. The Commission recommended a series of specific actions to address these modifiable risk factors, including:
Ensuring good quality education is available for all and encouraging cognitively stimulating activities in midlife to protect cognition
Making hearing aids accessible for people with hearing loss and decreasing harmful noise exposure to reduce hearing loss
Making screening and treatment for vision loss accessible for all
Treating depression effectively
Encouraging exercise as people who participate in sport and exercise are less likely to develop dementia
Reducing cigarette smoking through education, price control, preventing smoking in public places, and making smoking cessation advice accessible
Preventing or reducing hypertension
Detecting and treating high LDL cholesterol from midlife
Maintaining a healthy weight and treating obesity as early as possible, which also helps to prevent diabetes
Reducing high alcohol consumption through price control and increased awareness of levels and risks of overconsumption
Prioritising age‑friendly and supportive community environments and housing and reducing social isolation by facilitating participation in activities and living with others.
Source: Livingston, G. et al. (2024[6]), “Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission”, https://doi.org/10.1016/s0140-6736(24)01296-0.
Policy efforts are underway across EU countries to tackle dementia more effectively. For instance, the EU4Health programme includes a Joint Action with funding of EUR 4.5 million to support collaborative work between EU countries to address challenges related to neurological disorders and dementia. This Joint Action is expected to focus on early detection and improved access to care and management, and on awareness raising and fighting stigma.
Protecting older people against infectious diseases
While it is crucial to step up efforts to prevent chronic diseases among older people, it is also important to protect them against infectious diseases, notably by boosting vaccination rates. Vaccination is a cornerstone of public health and disease prevention programmes. It is particularly critical for older adults who are more vulnerable to severe complications from infections. Ensuring high vaccination coverage among older populations can minimise illness and death rates, as well as alleviate pressure on healthcare systems.
The COVID‑19 pandemic served as a stark demonstration of the life‑saving efficacy of vaccines, with countries that achieved higher vaccination rates experiencing markedly lower excess mortality (OECD, 2023[25]). COVID‑19 vaccination was especially crucial for people aged over 60 who accounted for 93% of all COVID‑19 deaths in the EU in 2020 and 2021. By the end of 2021, nearly 90% of people aged over 60 in the EU had completed their primary vaccination course, with all countries except three reaching at least 75% coverage (see indicator “Public health measures: Vaccination to protect older people” in Chapter 8).
Similar to COVID‑19, all EU countries have national recommendations to promote influenza vaccination among older people. Before the pandemic, 44% of people aged over 65 on average across EU countries received the flu vaccine during the 2019/20 influenza season. The start of the pandemic prompted efforts to prevent a simultaneous outbreak of influenza and COVID‑19, which led to a marked increase in flu vaccination rates in the EU to 51% during the 2020/21 season. In 2021/22, average vaccination uptake decreased to 48% despite the fact that influenza virus activity resumed following the relaxation of measures to reduce COVID‑19 transmission. The vaccine take‑up nevertheless remained 4 percentage points above the pre‑pandemic level (Figure 2.21). Denmark, Portugal and Ireland attained over 75% coverage in 2021/22, while Latvia, Estonia and Ireland maintained significant increases from their pre‑pandemic rates. Conversely, nine EU countries experienced declines below pre‑pandemic levels, with Croatia, Malta, Slovenia and the Slovak Republic seeing particularly sharp reductions.
Note: The data for 2019/20 refer to the flu vaccination campaign that started in fall 2019 and ended in winter 2020, as do the data for the 2021/22 vaccination campaign. No recent data is available for Austria.
Source: OECD Health Statistics 2024; Eurostat (hlth_ps_immu).
Maintaining high vaccination coverage rates can be challenging due to various factors, including vaccine hesitancy and other barriers. The project “Overcoming Obstacles to Vaccination” aims to identify and pilot exemplary practices to address practical and administrative obstacles to vaccination in participating EU countries (https://overcomingobstaclestovaccination.eu/).
2.6.2. Promoting more people‑centred and integrated care for older people with chronic conditions
Even with enhanced prevention efforts, not all health issues in old age can be prevented, and it is essential to ensure that all older people receive the necessary care when they are ill.
As the first point of contact, general practitioners (GPs) and other primary care providers are key to boost prevention, early diagnosis and to provide treatments for older people with multiple diseases. During the pandemic, only about 2% of people aged over 65 reported having had to forgo some GP visits due to cost or accessibility issues, according to the SHARE survey in 2021/22 (Figure 2.22). This share was higher in Finland and Hungary (over 6%), and in Portugal, Italy, the Slovak Republic and Romania (over 4%).
Forgone care tends to be higher among older people with a lower socio-economic status. About 3.5% of older people with a low level of education (less than secondary education) reported forgoing care in 2021‑22, compared to 1.8% among the most highly educated on average across EU countries.7
Note: Forgone care due to cost, distance or waiting times. The EU average is unweighted and based on 26 EU countries (Ireland does not participate in the SHARE survey).
Source: SHARE wave 9 (data refer to 2021‑22).
The proper management of people living with multiple chronic conditions (multimorbidity) requires the involvement of multidisciplinary care teams and co‑ordination between various health services and providers (generalists and specialists). Many EU countries have developed different types of integrated care models to better respond to the needs of people with multimorbidity. One good example is in the Spanish Basque country (Box 2.7).
In 2010, the Spanish Basque country started to implement an integrated care model for patients with multiple chronic conditions to improve chronic care for this population group. This model incorporates several key components to enhance care quality for these patients:
A comprehensive baseline assessment conducted by a multidisciplinary care team.
An individualised therapeutic plan tailored to each patient’s needs.
The support from multidisciplinary care teams, including a general practitioner, specialists, social workers, a care manager (usually a primary care nurse), and a hospital liaison nurse.
Co‑ordinated hospital discharge, with a collaboration between the hospital liaison nurse and the primary care nurse to ensure smooth transitions from hospital to home, with follow-up calls to detect any early signs of deterioration.
Patient empowerment programmes to provide education sessions to help patients understand and manage their conditions.
The Basque Country model also leverages technology to enhance patient accessibility and ensure continuous care. The health information system provides unified electronic health records, ePrescriptions and a Personal Health Folder. A Health Service Centre offers a 24x7 eHealth Call Centre, patient tele‑monitoring, online consultations, and a mobile app. This integrated care model increases patient contacts with primary care providers and reduces hospitalisations. The evaluation of the model showed that the average healthcare costs were 5% lower for patients who received the integrated care model compared to the control group.
Source: OECD (2023[21]), Integrating Care to Prevent and Manage Chronic Diseases: Best Practices in Public Health, https://doi.org/10.1787/9acc1b1d-en.
2.6.3. Supporting older people in the management of chronic conditions
While health professionals will remain important actors in regularly monitoring older people with chronic conditions and providing required care, much of the day-to-day management of chronic conditions can be undertaken by people themselves. Successful self-management hinges on a range of factors, including people’s health status, the complexity of their healthcare needs, their personal capabilities, and the effectiveness of the information and support that they receive from healthcare providers.
As people get older, their level of health literacy (defined as the ability to obtain, understand, and use health information) generally diminishes while their healthcare needs often become more complex. Across EU countries, the shares of people needing help to read medical instructions are larger for older age groups. At age 65‑74, 16% of people need help to read medical instructions and this share nearly doubles to 29% among people aged over 75. The share of women needing help to read medical instructions is much higher than that of men in older age groups (Figure 2.23).
Older people with a lower level of education are more likely to have difficulties with health literacy. Over one‑third (35%) of people aged over 65 who have not completed secondary education need help to read medical instructions, compared with 9% among those with a tertiary education.
Note: The EU average is unweighted and based on 26 EU countries. The survey question is: “How often do you need to have someone help you when you read instructions, pamphlets, or other written material from your doctor or pharmacy?”, with possible answers being: always, often, sometimes, rarely, never. The figure shows the percentage of people responding “always”, “often” and “sometimes”.
Source: SHARE wave 9 (data refer to 2021‑22).
Preliminary results from the 2023 OECD Patient Reported Indicator Surveys (PaRIS) also show that people’s confidence in managing their own health and well-being tends to decrease as the number of chronic conditions increases, and is lower among people with lower levels of education (OECD, 2024[26]).
Informal carers (typically family members or friends) play an important role in supporting older people to manage their chronic conditions. These carers often assist them with medications (e.g. helping with medication schedules, refills and administration), care co‑ordination (e.g. helping with managing multiple healthcare providers and treatments) and lifestyle support (e.g. helping with maintaining healthy diets and encouraging physical activity). While this support can significantly improve the quality of life for older adults, this caregiving can also have a negative impact on carers’ labour market participation and well-being. Policies aimed at achieving healthy longevity should support these informal carers through respite care, care leave and short trainings to foster appropriate care.
2.6.4. Promoting good mental health among older people and appropriate access to mental health services
Mental health must be a key part of healthy longevity policies alongside physical health. Promoting good mental health and preventing mental health issues across all ages has gained greater attention since the COVID‑19 pandemic. Almost all EU countries that responded to an OECD survey conducted in 2023 reported that they had expanded existing efforts or introduced new measures to promote mental health, with two‑thirds of countries reporting that they included some interventions for key population groups, notably children, young people and older people.
In 2023, the European Commission released a comprehensive approach to mental health with 20 flagship initiatives supported by EUR 1.23 billion funding. While the approach focusses to a large extent on promoting mental health among children and young people, it also recognises that older people should be empowered to manage their own mental health and to increase their social interactions and reduce loneliness (European Commission, 2023[27]). Risk factors for loneliness often stem from major life events that particularly affect older people, such as the loss of a partner or health issues affecting oneself or close family members. These events underscore the importance of providing support to maintain social ties in older age. In 2022, a mapping of interventions to reduce loneliness in EU countries found that most interventions were targeting older people (53% of all interventions). These interventions, primarily led by NGOs and local governments, typically involve different ways of connecting people and offering group and social activities. However, these interventions are rarely evaluated, making it difficult to determine what kind of interventions work to reduce loneliness, for whom and under what conditions (Nurminen, 2023[28]).
Alongside tackling risk factors for mental health issues, older adults should also have access to effective mental health care services when they need it. Despite having a higher prevalence of common mental health issues such as depression, older people tend to access mental health services less often than younger adults. Out of five EU countries, only in Slovenia did people aged over 65 have as many mental health consultations with specialists as younger adults aged 18 to 64, although the number of consultations in both age groups is relatively small (Figure 2.24).
Digital health services can offer a potential solution to bridge some of the gap in access to both physical and mental care services among older people. This is especially beneficial for those who have mobility issues or are living in rural and remote areas. Since the pandemic, teleconsultations for mental health issues have increased among older people, as has also been the case for younger adults. However, teleconsultation rates for mental health issues among older people still account for a relatively small share of consultations compared to in-person consultations, as is the case also among younger age groups. The only country where older people had more teleconsultations than in-person consultations in 2022 was Denmark.
Note: Data refer to 2022 and only include the appointments/contacts in outpatient mental health clinics.
Source: OECD calculations based on responses to OECD Mental Health Questionnaire 2023.
Despite a temporary setback during the COVID‑19 pandemic, life expectancy at birth in the EU has increased by more than four years since 2000 to reach 81.5 years in 2023, and life expectancy when people reach age 65 has never been higher, now exceeding 20 years. Combined with low fertility rates, this increase in longevity has led to a growing share of people aged over 65 in the EU, rising from 16% in 2000 to 21% in 2023, with this share projected to increase further to reach 29% by 2050.
Whether people are ageing in good physical and mental health will have substantial consequences for health and long-term care systems. The available data from Eurostat and WHO to assess to what extent the gains in life expectancy over the past two decades have been lived in good health and free of disabilities are not as robust as they would ideally be. There are breaks in the time series of many countries for the Eurostat’s indicator of healthy life years and many data gaps and uncertainties around the estimates used in WHO’s calculations of healthy life expectancy. Bearing these important limitations in mind, both the data available from Eurostat and WHO generally show some positive trends: about two‑thirds of the additional years of life at age 60 or 65 gained over the past 20 years in the EU are lived in good health and free of activity limitations, while the remaining one‑third of gains in life expectancy is lived with some health issues and disabilities.
Despite these positive trends, over half of life expectancy at age 65 in 2023 is lived with some disabilities, based on the Eurostat data. While women continue to live many years longer than men in all EU countries, they also tend to spend a greater proportion of their lives with some health issues and disabilities, so the gender gap in healthy life years is almost nil.
As people age, the prevalence of various chronic diseases and disabilities tends to increase, although a substantial share of these chronic diseases can be prevented or delayed through effective health promotion and disease prevention. Over 60% of people aged over 65 in the EU reported having at least one chronic disease in 2023, and this share has remained stable since 2010. Data from the SHARE survey show that over 40% of people aged over 65 had at least two chronic conditions (multimorbidity) in 2021/22, often requiring strong care co‑ordination from multiple providers.
Dementia (including Alzheimer’s disease) is the most important cause of healthy life years lost due to disability among older people in the EU, but other chronic diseases such as diabetes, arthritis, depression and cardiovascular diseases, are also important causes of ill-health and disabilities. In addition, accidental falls account for a large number of years of life lost due to disability among older people.
Many of the risk factors contributing to the burden of these diseases and injuries are preventable through individual actions and health promotion and prevention policies. Promoting physical activity, healthy eating and healthy weight, and better management of conditions such as hypertension and hearing loss can substantially prevent or delay many chronic diseases and injuries. However, not all health issues can be prevented in old age and health systems must be prepared to meet the healthcare needs of a growing number of older people. Early diagnosis of health conditions, along with equal access to people‑centred and integrated care, will be instrumental to help older people manage their health conditions and avoid or delay any further deterioration in their health and functional status.
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← 1. The 2024 edition of Society at a Glance provided a detailed analysis of the long-term decline in fertility rates in OECD and EU countries, as well as policy options to halt this decline (OECD, 2024[29]). The fertility rates have fallen over the past few decades to reach just 1.5 children per woman in 2022 on average across the OECD and EU, well below the “replacement level” of 2.1 children per woman. Among EU countries in 2022, the fertility rate was highest in France with 1.8 children per woman, and lowest in Malta, Italy and Spain with 1.2 children per woman.
← 2. See indicator on trends in life expectancy in Chapter 3 for more information by country.
← 3. The main reason why 2010 was selected as the baseline year rather than 2005 is that Eurostat does not report any EU average before 2010.
← 4. The data from the IHME GBD study are model-based estimates that may not always be consistent with national data.
← 5. People at risk of malnutrition are identified based on one of the 22 validated malnutrition screening tools for older adults. These tools assess various parameters such as nutritional intake, weight loss, body mass index and physical health.
← 6. See indicator on public expenditure projections for health and long-term care in Chapter 8 for more specific information.
← 7. Unmet medical care needs among older people are also low based on the EU-SILC survey: 3.6% of people aged 65 and over reported unmet medical care needs in 2023 in the EU. However, there is also large inequality across income groups: while only 1.6% of older people in the highest income quintile reported going without medical care, this proportion reached 5.5% in the lowest quintile.