Even as life expectancy at age 65 has increased across OECD countries, not all older adults (or those aged 65 and over) spend their remaining years in good health (see section on “Life expectancy and healthy life expectancy at older ages”). In all OECD countries with available data, more older people in the lowest income quintile rate their health as poor than those in the highest quintile (Figure 10.4). Across 24 OECD countries on average, one in four (22.8%) people in the lowest income quintile reported their health to be poor or very poor in 2024, compared to one in ten (9.7%) among those in the highest income quintile.
In ten countries, people in the lowest income quintile were at least two and a half times as likely as those in the highest quintile to report having poor or very poor health, while in five countries – Slovenia, Czechia, Estonia, the Netherlands and Lithuania – people in the poorest quintile were more than three times as likely to report living in poor health. In Switzerland, however, the lowest shares of older people reported being in poor health across OECD countries for both the lowest (7.1%) and highest (2.8%) income quintiles. In five countries (Finland, Italy, Luxembourg, Poland, Spain and the Slovak Republic), older adults in the poorest income quintile were less than twice as likely to report being in poor health.
Across 27 OECD countries in 2022, slightly more than one in five people aged 65 and over reported having at least some limitations in their activities of daily living (ADL) and instrumental activities of daily living (IADL): 19% reported some limitations and a further 3% reported severe limitations (Figure 10.5). Many of the countries reporting the highest rates of self-rated poor or very poor health also reported some of the highest rates of limitations in ADL/IADL. In Hungary, Portugal, Belgium and England (United Kingdom), more than 24% of adults aged 65 and over reported at least some limitations in ADL/IADL. In Korea, Ireland, and Luxembourg, less than 13% of adults in the same age group reported such limitations. In four countries – Japan, Spain, Lithuania and Portugal – more than 7% of adults aged 65 and over reported experiencing severe limitations in ADL/IADL. Overall, Japan, Portugal, Lithuania and Spain account for the highest levels of self-reported limitations in ADL/IADL, approaching or surpassing 30% in total.
In 2024, 83% of primary care users aged 65 and over with at least one chronic condition across 17 OECD countries reported their social functioning as good, very good, or excellent (Figure 10.6). The highest share was observed in Switzerland (92%), with seven other countries also reporting shares above 85% – France, Canada, the United States, Slovenia, Belgium, Luxembourg and Czechia. In contrast, fewer than 80% of older primary care users reported at least good social functioning in Spain, Wales (United Kingdom) and Italy, with the lowest share observed in Portugal (70%) and in accession country Romania (70.9%).
