While healthy ageing holds the potential to lower projected health and long-term care expenses, countries are not fully reaping its potential. Life expectancy increased between 2001 and 2011 across the OECD, but improvements have slowed down over the past decade: Over the period of 2012 to 2023, life expectancy at age 60 increased by 1.0 year compared to 1.7 years between 2001 and 2011. Not all of these additional years gained are lived in good health. The gap between life expectancy and healthy life expectancy has widened slightly from 5.2 years in 2000 to 5.7 years in 2021. Trends in limitations in (instrumental) activities of daily living for older people confirm that people are not necessarily living in better health in more recent years: younger cohorts show stable trends in activity limitations compared with older cohorts where the share of people with limitations was declining.
More emphasis on prevention and community care improves economic returns to healthy behaviours. Unhealthy behaviours can increase the likelihood of poor health in older adults. Physical inactivity has a strong impact on obesity, falls and cognitive decline which can be detrimental in older ages. Just under three‑quarters (74%) of people aged 65 and above across the OECD do not meet the recommended minimum level of physical activity per week. Strategic investment in health and long-term care spending can help reverse these trends. Investment in prevention helps people to age more healthily, for example by delaying, reducing, or outright preventing chronic diseases. OECD estimates show that a 10%-increase in spending on prevention is associated with a decrease in the share of people with chronic conditions by 0.9% after a period of five years. Similarly, countries could spend more on helping people to age independently at home and delay a transfer to long-term care facility, for example through housing adaptation and a greater supply of home‑based services. Home‑based care is generally less expensive for people with low and moderate needs than care in facilities and supporting them to age at home not only meets the preferences of older people but is also cost-effective. OECD calculations show that an increase in the ratio of spending on long-term care at home over long-term care in facilities by 10% can lead to a decrease in the overall long-term care spending by 4.9%.
A lack of adapted homes, easy access and affordable home and community care services limits the ability for older people to age in the community. Housing adaptation can support people’s autonomy at home by reducing the probability of falls and of needing help with activities of daily living and by delaying admissions to nursing homes. Yet only 20% of older people have introduced adaptations to their homes and bigger modifications such as ramps and solutions for stairs are even less common, with only 5% having them. Across OECD countries, 60% of countries reported that public transportation is easy to access for people with mobility limitations and affordable for older people. Older people do not always benefit from sufficient hours of home care services for independent living: more than 40% of countries have limitations in the number of hours provided for home care and one‑third of countries do not provide public funding for help with some important instrumental activities of daily living such as support for grocery shopping and attending appointments. In addition, there are gaps in the generosity of care especially for people with severe needs: in 16 countries, out-of-pocket costs exceed 50% of median income while they are above median income itself in seven countries. While community care options have shown a range of benefits in terms of health, quality of life and loneliness, their supply is limited. The number of adult day-care users is below 1% of the older population and less than one‑fourth of countries make health screening and rehabilitation mandatory components of day care. Shared living arrangements such as co-housing or co‑operatives are not common and were reported in about one‑third of OECD countries, a similar proportion to intergenerational housing options.
Such shortcomings call for greater policy priority and measures to incentivise healthy ageing close to older people’s homes.
First, a stronger focus on improving prevention and reablement and identifying older people at risk of health deterioration is key to promoting healthy ageing. While early intervention at younger ages is key to building healthy lives throughout the life course, prevention and improvements in healthy lifestyles in older ages can still materialise in significant health gains. Health literacy campaigns equip people with the skills to make healthy choices. Physical activity is key to healthy ageing, but because adherence remains challenging, group exercise programmes offer the benefit of improving it while helping to fight isolation. Early identification of people is key to allow for early and targeted interventions. An important number of countries (16), such as Australia, Denmark, Mexico, Norway and Switzerland, have introduced dedicated home visit schemes which have demonstrated effectiveness in reducing hospital admissions and delaying entrance to a long-term care facility. More specific screening for conditions such as dehydration, inappropriate medication, and the risk of falls seems to be beneficial, as undertaken in Finland, Hungary, the Netherlands, Portugal and Sweden. Finally, reablement as offered in Australia, Denmark, Japan, New Zealand and the United States helps people maintain or recover their functions, with some evidence that it is cost-effective and linked to a reduction in the use of home care services in Denmark.
Providing care closer to people’s homes by a workforce with greater expertise on older people’s needs and in a more integrated manner will be paramount to further promote healthier ageing. Addressing shortages of geriatricians and enhancing primary care centres with different professionals can help better address complex needs, as in Canada or France. Promoting nurse‑led outreach teams, especially with advanced nurse practitioners to offer assessments and simple interventions can reduce the risk of emergency admissions, as seen in Australia, Canada, Denmark and Finland. Similarly, hospitals at home have proved effective in replacing or shortening inpatient stays and are in place in at least 22 OECD countries, such as in Chile, England, France and Spain. The introduction of specific care pathways for older people or integrated care programmes, such as in Canada (Québec), and in Japan with multidisciplinary teams, and changing payment structures appear to have good results in terms of quality of life of older people.
There is room to expand the range of services and affordability of long-term care services at home and in the community, while also ensuring adapted homes and age‑friendly environments. To ensure that older people can remain at home, changes in long-term care systems could be considered, including lifting or loosening restrictions on hours of home care, considering a more comprehensive view on the type of limitations people need help with in order to live independently, and looking into 24‑hours care options, as in Finland, especially for people without informal care support. The generosity of home care system currently leaves a high share of people in many OECD countries at risk of poverty and aligning benefits and services to enhance the affordability of home care for people with severe needs would be important as done in Nordic countries, Luxembourg and Japan. More funding and support to adapt the housing environment to make age‑friendly modifications which reduce the risk of falls, such as is Norway, can significantly impact autonomy of older people and impact long-term care needs. A broader variety of long-term care models are also essential for healthy ageing, including promoting high-quality adult day care as in Japan and shared-living or intergenerational options, as in the Netherlands.