In recent decades, the share of the population aged 65 years or older has nearly doubled on average across OECD countries. The proportion of the population aged 65 years or over increased from less than 9% in 1960 to more than 17% in 2017. Declining fertility rates and longer life expectancies (see indicator on “Life expectancy” in Chapter 3) have meant that older people make up an increasing proportion of the population in OECD countries.

All OECD countries have experienced tremendous gains in life expectancy at age 65 for both men and women in recent decades. On average across OECD countries, life expectancy at age 65 increased by 5.5 years between 1970 and 2017 (). Four countries (Australia, Finland, Korea, and Japan) enjoyed gains of more than seven years over the period; only one country (Lithuania) experienced an increase in life expectancy at age 65 of less than two years between 1970 and 2017.

Even as life expectancy at age 65 has increased across OECD countries, many adults spend a high proportion of their older lives in poor or fair health (see indicator on “Life expectancy and healthy life expectancy”). In 2017, more than half the population aged 65 and over in 35 OECD countries reported being in poor or fair health (). Older people in eastern European OECD countries report some of the highest rates of poor or fair health, with more than three-quarters of people aged 65 and over reporting their health to be fair, bad or very bad in Lithuania, Latvia, Estonia, Hungary, Poland, and the Slovak Republic. High rates of poor health are also reported in Portugal and Korea. Women are slightly more likely to report being in poor or fair health than men: 59% of women report their health to be fair, bad or very bad on average across OECD countries, compared with 54% of men. Less than 40% of the total population aged 65 and over reported being in poor or fair health in five European countries (Norway, Ireland, Switzerland, Sweden and the Netherlands). The lowest rate of poor or fair health for women was reported in Ireland (31%), while men reported the lowest rate of poor or fair health in Norway (also 31%).

Dementia represents one of the greatest challenges associated with population ageing. Dementia describes a variety of brain disorders, including Alzheimer’s disease, which progressively lead to brain damage and cause a gradual deterioration of a person’s functional capacity and social relations. Despite billions of dollars spent on research into dementia-related disorders, there is still no cure or even substantially disease-modifying treatment for dementia.

Prescribing is a critical component of care for older people. Ageing and multimorbidity often require older patients to take multiple medicines (polypharmacy) for long periods of their lives. While polypharmacy is in many cases justified for the management of multiple conditions, inappropriate polypharmacy increases the risk of adverse drug events (ADEs), medication error and harm, resulting in falls, episodes of confusion and delirium. Various initiatives to improve medication safety and prevent harm involve regular medicine reviews and increased coordination between prescribing networks of doctors and pharmacists along the patient care pathway. ADEs cause 8.6 million unplanned hospitalisations in Europe every year (Mair et al., 2017[1]). Polypharmacy is one of the three key action areas of the third WHO Global Patient Safety Challenge (WHO, 2019[2]).

As populations across OECD countries continue to age, an increasing number of people will require support from long-term care (LTC) services, including nursing homes and LTC living facilities (see indicator on “Recipients of long-term care”). Providing safe care for these patients is a key challenge for OECD health systems, as residents of LTC facilities are more frail and sicker, and present a number of other risk factors for the development of patient safety events, including healthcare-associated infections (HAIs) and pressure ulcers (OECD/European Commission, 2013[1]).

Across OECD countries, an average of 10.8% of people aged 65 and over received long-term care (LTC) in 2017. This represents a 5% increase compared with 2007 (). More than one in five people aged 65 and over received LTC services in Switzerland (22%) and Israel (20%), compared with less than 5% in the Slovak Republic (4%), Canada (4%), Ireland (3%), Portugal (2%), and Poland (1%).

Family and friends are the most important source of care for people with long-term care (LTC) needs in OECD countries. Because of the informal nature of the care they provide, it is not easy to get comparable data on the number of people caring for family and friends across countries, nor on the frequency of their caregiving. The data presented in this section come from national or international health surveys and refer to people aged 50 years and over who report providing care and assistance to family members and friends.

Long-term care (LTC) is a labour-intensive service, and formal care is in many cases a necessary complement to informal, unpaid work in supporting people with LTC needs (see indicators on “Informal carers”). Formal LTC workers are defined as paid staff – typically nurses and personal carers – who provide care and/or assistance to people limited in their daily activities at home or in institutions, excluding hospitals. There are on average five LTC workers per 100 people aged 65 and over across 28 OECD countries, ranging from 13 in Norway to less than one in Greece, Poland, and Portugal ().

While countries have increasingly taken steps to ensure that people in need of long-term care (LTC) services who wish to live at home for as long as possible can do so, many people will at some point require LTC services that cannot be delivered at home. The number of beds in LTC facilities and in LTC departments in hospitals offers a measure of the resources available for delivering LTC services to individuals outside their home.

Compared to other areas of health care, spending on long-term care (LTC) has seen the highest growth in recent years (see indicator on “Health expenditure by function” in Chapter 7). Population ageing leads to more people needing ongoing health and social care; rising incomes increase expectations on the quality of life in old age; the supply of informal care is potentially shrinking; and productivity gains are difficult to achieve in such a labour-intensive sector. All these factors create upward cost pressures, and substantial further increases in LTC spending in OECD countries are projected for the coming years.