Population ageing in LAC is bringing rapid growth in LTC needs, driven by rising chronic conditions, functional limitations and cognitive impairment at older ages. While age alone does not determine dependency, the accumulation of conditions greatly increases the likelihood of needing help with daily activities. Demographic change, morbidity patterns and health system performance together shape LTC demand, and without effective prevention and co‑ordinated care, longevity gains often translate into higher care needs rather than extended independence (Gianfredi et al., 2025[1]).
Older people with chronic conditions are much more likely to report needing help with activities of daily living than those without, underscoring how prevention and effective chronic disease management can delay dependency (Figure 9.5). Across LAC8, around 27% of older adults with at least one chronic condition report care needs, compared with 14% among those without. The gap is sizeable in many countries, reflecting how chronic disease contributes to functional limitations and the need for support.
Public spending on long-term care services is very limited in the LAC countries with available data (Figure 9.6). Reported spending represents less than 1% of current health expenditure in Paraguay and is close to zero in several other countries, compared with around 14% on average in the OECD. Some of this gap reflects genuine differences in coverage, but cross-country comparisons also require caution because long-term care may be recorded in either the health or social sector (e.g. Chile), and accounting practices differ. Low public spending is consistent with qualitative evidence that long-term care provision in LAC relies heavily on families and informal arrangements rather than organised services (PAHO/IDB, 2023[2]).
Dementia is becoming a growing driver of long-term care needs as populations age (Figure 9.7). Across LAC33, the mortality rate attributed to Alzheimer’s disease and other dementias increased modestly between 2014 and 2024 (from 17.8 to 18.6 deaths per 100 000 population), with substantial cross-country variation. Rates are highest in Paraguay and lowest in Haiti. Differences partly reflect population age structure, but also variation in diagnosis and cause‑of-death certification; in some countries, rising mortality may indicate better recognition and coding rather than faster underlying disease growth.
These indicators point to a widening gap between rising long-term care needs and the limited capacity of formal systems in LAC. With high burdens of chronic disease and dementia alongside very low public long-term care spending, much of the adjustment to population ageing is occurring within households rather than through organised services – reinforcing inequities, constraining women’s labour-market participation, and disproportionately affecting lower-income families. Without a gradual expansion of accessible, needs-based services, these pressures will intensify. Closing the gap requires a dual strategy: (1) strengthen prevention, person-centred primary care, care co‑ordination and rehabilitation/reablement to delay dependency, maintain function and reduce avoidable hospital use; and (2) progressively develop formal long-term care that complements family care – expanding home‑based and community services and providing support for informal carers. Regular monitoring of chronic conditions, long-term care spending and dementia trends is essential to assess whether systems are adapting quickly enough to the realities of population ageing in LAC.
