The LTC sector faces growing demand for expert care due to ageing populations with complex conditions and functional needs. Ensuring safety is not only about preventing harm but also about promoting trust, quality of life and effective delivery of care.
A major concern for LTC safety is healthcare‑associated infections (HAIs) caused among other things by antibiotic-resistant bacteria. HAIs are generally considered to be preventable with standard infection prevention and control measures, but can still adversely affect older adults living in LTC facilities (OECD/WHO, 2022[1]). Across 16 OECD countries, 3.2% of LTC facility residents had at least one HAI in 2023‑2024 (Figure 10.9). The reported prevalence was high in Portugal, Spain and the Netherlands (over 5%).
The use of benzodiazepines also comes with safety risks. For older people, most guidelines advise complete avoidance of benzodiazepines because of the associated risks of dizziness, confusion and falls. Even so, benzodiazepines continue to be prescribed for older adults for anxiety and sleep disorders. Long-term use of benzodiazepines can lead to adverse events (overdoses), tolerance, dependence and dose escalation. Long-acting (as opposed to short-acting) benzodiazepines are further discouraged for older adults because they take longer for the body to eliminate (OECD, 2017[2]).
Benzodiazepine use declined across 18 OECD countries, with chronic use dropping from 33 to 27 per 1 000 people aged 65 and over in 2013‑2023, on average (Figure 10.10, left panel). In 2023, figures ranged from below 1 in Italy to 92.8 in Iceland. Iceland saw the largest decline (34 fewer patients per 1 000 population) but remained the top user. Luxembourg and Estonia showed slight increases. For long-acting benzodiazepines, the OECD average fell from 64 to almost 42 per 1 000 in 2023 (Figure 10.10, right panel). Italy and Finland had relatively low rates, at less than 5 per 1 000 population, while the rates exceeded 90 in Spain, Korea and Estonia. Korea, Estonia and Iceland recorded the largest declines in long-acting benzodiazepine use. Spain had the highest use and was the only country to increase by 7 per 1 000 between 2013 and 2023. The variation is partly due to different reimbursement and prescribing policies, disease prevalence and treatment guidelines.
Owing to multimorbidity and complex care needs, older patients often take multiple medications for extended periods. Although there are justifiable cases of polypharmacy, inappropriate use increases the risk of adverse drug events, medication errors and harm – leading to falls and episodes of confusion and delirium. Across 16 OECD countries, the share of adults aged 75 and over taking at least five medications has increased by 2.6 percentage points (p.p.) from 2014 to 2024. Türkiye, Denmark and Austria reported the lowest rates in 2024, at less than 30%, while Australia reported the highest rates at 77%, followed by Portugal, Korea, Italy and Ireland at more than 63% (Figure 10.11). These large variations are explained in part by the establishment of targeted polypharmacy initiatives in some countries, including related reimbursement and prescribing policies. Over time, the Netherlands experienced the largest decline of 6.3 p.p in polypharmacy, followed by Australia and Denmark. In contrast, Türkiye and Slovenia both experienced an increase of 8 p.p.
