This chapter presents policy options countries have to outright prevent health complications for older people and to help them recover their functional ability after a sudden deterioration of their health. It discusses means to improve health literacy to empower people to make healthy lifestyle choices and to manage complex care needs as well as policies to support people in taking up healthier behaviours. It zooms in on strategies to identify people at risk to allow for targeted and timely interventions, such as fall interventions, and closes with an overview of policies to support the reablement of people to help them recover the capacity to perform (instrumental) activities of daily living.
The Economic Benefit of Promoting Healthy Ageing and Community Care
Abstract
Large parts of the population display unhealthy lifestyles. Sedentary behaviours and unhealthy diets limit the potential of healthy ageing and translate into higher healthcare costs at a later stage. Low levels of health literacy further limit the potential of older people to make healthy choices. Unhealthy behaviours come at a cost: Obesity and related diseases were estimated to reduce life expectancy by 2.7 years, and healthy life expectancy by 3.2 years on average across the OECD from 2020 to 2050.
Policies are insufficiently targeted. Policies work most effectively when they target people at risk. For example, fall prevention only has a significant benefit when it targets people who are at risk of falling, such as frail older people. This requires a good identification of people at risk who benefit from such interventions to ensure effective and efficient delivery of care amid workforce shortages and financial constraints.
Investment in prevention remains low across the OECD. In 2023, OECD countries spent about 0.3% of their GDP on prevention, equating around 3.3% of their total spending on health. This limits the scale and scope of programmes and the impact they have in leading to tangible effects.
Policy options
Building health literacy. Health literacy builds the knowledge to make healthy lifestyle choices and manage complex care needs. Health workers are key in building health literacy but often operate under time constraints and only reach people who already interact with them. Hungary has introduced Health Promotion Officers across the country, and Austria and Switzerland have introduced a foundation that supports health literacy programmes across the country in communities.
Promoting a healthy lifestyle adapted to the needs of older people. The benefits of healthy lifestyles, such as good diet and high levels of physical activity, are clear and well-established. For example, regular physical activity can reduce the rate of falls among older people by 38%. Group physical activity programmes might be more motivating for older people to follow, improve physical activity, and can also be beneficial to help fighting social isolation. For example, Japan facilitates a community-led sports course that helps older people increase their physical activity while also building social networks.
Identifying people at risk. Public health measures that target broad populations offer few gains, but targeted measures, for example towards frail people, yield positive effects. This makes an effective and successful identification of people at risk a key building block for healthy ageing. Ideally, these screenings are not based on chronological age but on specific risk parameters. In Denmark, municipalities offer preventive home visits to people who have experienced an event that could lead to a deterioration in their health, such as a hospitalisation or the death of their partner. Preventive home visits were also positively evaluated in Norway and reduce the use of healthcare resources, such as emergency hospitalisations.
Integrating and expanding reablement across the healthcare system. Reablement aims at supporting independence, relearn (instrumental) activities of daily living and reduce the need for long-term care. It is typically provided to people in their home‑based setting after a health event, such as a fall and a hospitalisation, or upon the deterioration of their health. The concept is new, and evidence is scarce, but where available, points at promising results. Reablement remains in its infancy and access is heterogeneous within OECD countries.
Many older people do not live a lifestyle that puts them on a trajectory towards healthy ageing. Healthy behaviours, such as regular physical activity, a balanced diet, low alcohol consumption and non-smoking are key predictors of healthy ageing, slow down the process of ageing and can prevent health conditions and limitations or reduce their severity (Sowa et al., 2016[1]). For example, physical activity has consistently been identified as a successful strategy to reduce cognitive decline and falls. It can lower the number of people aged 65 and above who experience at least one fall by 15%, and the incidence of falls by 38% (Sherrington et al., 2019[2]). Once people have developed limitations and chronic diseases, interventions require substantial, concerted effort to prevent a worsening of their health. While the evidence on the benefits of prevention is clear, policies that target populations that have already developed certain conditions, such as frailty, yield more mixed results (Yao et al., 2020[3]; Sherrington et al., 2019[2]; El-Khoury et al., 2015[4])
Across the OECD, public health indicators, such as physical activity rates, alcohol consumption, smoking and vaccination coverage against vaccine‑preventable diseases indicate further room for improvement (OECD, 2023[5]; 2019[6]). In most countries, the majority of people lives a lifestyle that does not meet the recommendations by the World Health Organization (WHO) and national institutes (OECD, 2023[5]; OECD, 2019[6]). This puts them at risk for adverse events, such as falls, which occur frequently among older people. For example, in Australia, Canada, France and the United States, around one fourth to one‑third of those aged 65 and above, and about half of those aged 80 and above report at least one fall per year (AIWH, 2023[7]; CDC, 2023[8]; Santé Publique, 2020[9]; Public Health Agency of Canada, 2022[10]). Falls increase healthcare consumption, such as visits to emergency departments following fractures and hospital readmissions, increase health expenditures, reduce quality of life and are a major cause of mortality (Florence et al., 2018[11]; Dykes et al., 2023[12]; Hoffman et al., 2019[13]). A share of these falls and costs associated with them could be reduced by healthier lifestyles.
Healthier lifestyles and prevention have a clear economic benefit. OECD calculations using the OECD’s Strategic Public Health Planning for NCDs (SPHeP-NCDs) model show that meeting the WHO recommendations of 150 minutes of physical exercise could increase life expectancy by 7.5 months and healthy life expectancy by 7.9 months on average for those who are currently insufficiently active across the 27 countries of the European Union over the period between 2022 and 2050 (OECD/WHO, 2023[14]). Obesity and related diseases were estimated to reduce life expectancy by 2.7 years, and healthy life expectancy by 3.2 years on average across the OECD over the time span from 2020 to 2050. While these calculations estimate gains that are accumulated across the lifespan, prevention and promoting healthy behaviours at an older age can still generate positive returns and improve healthy ageing.
3.1.1. Early intervention is desirable, but prevention can still be (cost-)effective in old age
Early prevention is desirable and can yield better returns than prevention at a later age. Firstly, behaviours are easier to influence when people are still in the process of forming them (Heckman, Pinto and Savelyev, 2013[15]). Patterns are shaped by socio‑economic and environmental characteristics and are difficult to break. They are handed over from parents and grandparents to children and are often exacerbated by time and money constraints. Earlier intervention at a point where behaviours are still in the process of being formed require less intense policies than those that target people who have already spent several decades with unhealthy lifestyles and who might already experience negative consequences of these behaviours, such as chronic diseases. Secondly, earlier interventions can extend the duration to which people live healthily. This increases the cost-effectiveness of programmes that target people at a younger age. Thirdly, younger people are often easier to target. In most OECD countries, compulsory education ranges from 6 years or below to 16 years, allowing for at least a decade of policy interventions, and contain a share of instruction time dedicated to physical education (OECD, 2023[16]). Working-aged people can be targeted through workplace interventions, such as incentivising cycling to work (OECD/WHO, 2023[14]). Thirdly, the contribution to the gross domestic product (GDP) is greater from increased labour market supply and productivity through healthier lifestyles.
Nevertheless, prevention and promoting healthy behaviours at an older age can still generate positive returns and improve healthy ageing. Across the OECD, almost one in five people is aged 65 and above, thus representing a considerable share of the population, and countries might want to offer support to live healthier lives and participate in prevention measures for already existing populations. Secondly, not every public health measure has a long trajectory. For example, vaccinations against seasonal influenza are strongly recommended for everyone aged 65 and above, and for younger people only when certain risk factors, such as diabetes, are present, and influenza vaccinations are only valid for one year. Thirdly, support for healthier behaviours and prevention measures that target older people have shown to lead to improved health and lower expenditures even if only picked up at a later age. For example, people who increase their physical activity at the age of 60 or 65 can still significantly benefit and delay the onset of physical impairments (Hamer, Lavoie and Bacon, 2013[17]). Physical activity in older age reduces falls, supports cognitive and emotional functioning and improves well-being and quality of life (Pinheiro et al., 2022[18])
3.1.2. Spending on prevention is low and programmes are insufficiently targeted to older people
Despite the clear and manifold evidence of the positive effects of healthy lifestyles and prevention on healthy ageing, adherence to and compliance with recommendations is difficult to realise. Older people who make unhealthy lifestyle choices have usually already spent many years with these habits, making these patterns difficult to break, or experienced recent lifestyle changes that make it hard for them to keep up with healthy behaviours. Older people tend to be in a disadvantaged situation over their younger peers. Health literacy – especially using health information online – is lower in older and less educated people than in younger and better educated ones, limiting their potential to make healthy lifestyle choices and to manage complex health conditions, such as several chronic conditions concurrently (OECD, 2025[19]; Kwon and Kwon, 2025[20]). Older people can already face limitations that present additional barriers to healthy lifestyles. For example, they avoid physical activity because they lack of strength, discomfort and pain as some obstacles that prevent them from doing sports (Hida et al., 2023[21]). In addition, financial barriers of access, and competing tasks, such as caregiving responsibilities, can further deter people from physical activity. A share of older people also experiences cognitive decline and dementia which can negatively affect the extent to which they can consume and apply health-related information (Rostamzadeh et al., 2020[22]).
Countries currently invest limited resources into prevention, which restricts the scale and scope of measures to support healthy lifestyles and prevention. In 2023, OECD countries spent around 0.3% of their GDP on prevention, representing 3.3% of their total spending on health (See Figure 3.1). Only in 6 out of 22 countries where a more granular breakdown of spending on prevention was available, spending on information, education and counselling amounted to 1% or more out of total health expenditures.
Spending on prevention by health function as part of total health spending, 2023 (or latest available year)
1. Data refers to 2022.
Source: OECD (2025[23]), “Health expenditure and financing”, https://data-explorer.oecd.org/s/2wd.
3.1.3. Countries can make better use of prevention and reablement through action in four policy areas
Four policy areas prevail for OECC countries to better harness the potential of prevention and reablement to advance on healthy ageing. Firstly, they can help people to make healthier lifestyle choices. For example, countries can improve health literacy through information, education and training that inform older people about the benefits of living a healthy lifestyle and use financial incentives to nudge them. Secondly, countries can promote the participation of older people in public health measures, such as regular screening to reduce the rate of preventable diseases. Thirdly, countries can work with different tools to identify people at risk, for example people that are frail and at the risk of falling and might require additional support to avoid falls to improve the effectiveness of healthcare interventions. Finally, countries can help citizens to regain their health after a health shock, such as trauma-related injury. This section first describes policies countries have in place before it synthesises and reflects on the evidence of each of these policy areas and formulates policy recommendations on which policies to advance further.
OECD countries have well-recognised the importance of supporting their populations in leading healthy lifestyles. All 29 OECD countries that responded to the OECD Questionnaire on Healthy Ageing and Community Care have introduced some type of policy in this field. These aim at improving the health literacy of people to empower them to make healthy choices, and to further support them in adopting healthier behaviours by improving access and nudging them towards living more healthily.
3.2.1. Health literacy equips people with the skills needed to make healthy choices
High levels of health literacy are related to better health outcomes, as people more often live healthy lifestyles, follow screening and vaccination guidelines and adhere to the treatments they need (Chesser et al., 2016[24]). Health literacy refers to the ability to access, understand, evaluate and act upon health information and are a key contributor to good health outcomes. Vice versa, insufficient levels of health literacy of older adults drive up healthcare utilisation and expenditures and hamper the effectiveness of education and training for people to self-manage their health, such as education to reduce falls, and increase mortality (Park et al., 2024[25]; Bostock and Steptoe, 2012[26]). Effective interventions to support health literacy can save significant resources by equipping people with the skills to make healthy lifestyle choices and to self-manage their health conditions, which can reduce healthcare needs, delay the worsening of health conditions, reduce their severity and help avoid adverse events, such as avoidable hospitalisations (MacLeod et al., 2017[27]; Moreira, 2018[28]).
While promoting health literacy ideally starts in school, specific interventions targeting older people can still be effective and are essential in supporting this population in confidently managing their own health. Older people display lower average levels of health literacy while having more complex needs (Lee and Oh, 2020[29]). At the same time, they face additional challenges in maintaining and improving health literacy. Some of them already suffer from cognitive impairment and difficulties to read and to hear, which affects their ability to process information. This collides with their need to manage more complex conditions, such as several chronic diseases and the intake of multiple pharmaceuticals concurrently, raising the need for health literacy. Health literacy is strongly associated with socio‑economic status and particularly educational attainment, and risks exacerbating differences in healthy ageing by socio‑economic status and education (Stormacq, Van den Broucke and Wosinski, 2019[30]; Cutilli et al., 2018[31]).
3.2.2. Platforms are a great first step, but might reach only those that are already somewhat literate
The majority of OECD countries (23 out of 29 countries that responded to the OECD Questionnaire on Healthy Ageing and Community Care have advertisements and information campaigns in place to improve health literacy of their population and to help older people make informed choices. Countries have built information platforms that offer advice to their population on how to live and age healthily and where to find additional support. For example, in Australia, Canada and Spain, national and subnational levels offer information including free phone and online coaching, such as Active and Healthy by the Government of New South Wales, or En buena edad by the region of Andalucía. France has set up the webpage Pourbienvieillir, which offers information on preparing for the retirement, maintaining good physical and mental health, remaining socially active and ageing better at home. Germany offers the platform Gesund und aktiv älter werden as well a national health portal (gesund.bund.de) and the government works together with leading associations of the healthcare system in the alliance for health literacy, while Japan operates the Online Kayoinoba App alongside dedicated websites with good practices for older people. New Zealand offers the digital balance app Nymbl to people aged 50 and above in addition to the website Live Stronger For Longer. Dietary and physical activity guidelines (Eating and Activity Guidelines for New Zealand Adults) offer further directions to older people. Luxembourg offers a similar website that offers advice on nutrition and physical activity (Gesond iessen, Méi beweegen). In the Slovak Republic, the Public Health Authority offers information leaflets alongside health literacy and awareness-raising activities by regional public health authorities and in Türkiye, public institutions and organisations offer posters, brochures and electronic messages to inform and support older people in living healthily.
Evaluations of mass media and information campaigns suggest a positive effect on selected healthy behaviours, such as a reduction in sedentary behaviour (den Braver et al., 2022[32]; Stead et al., 2019[33]). Interventions to increase older people’s health literacy can achieve a lot, but they cannot reach everyone or eradicate socio-economic disparities, making it is crucial to ensure that healthcare is more accessible to those with low health literacy. This can include introducing less complex service structures, simplifying health-related documents, training doctors to give plain language explanations and sending out regular reminders for screenings and vaccinations to facilitate adherence (OECD, 2025[19]). Adapting communication and intervention strategies to the health literacy level of the target population and to the specific needs of older people is key to ensure that messages are well received and clearly understood (Michel and Goldberg, 2021[34]).
3.2.3. Health workers are key in improving health literacy, but require people to have good access
Health workers, particularly primary care physicians and nurses, play a key role in improving health literacy, as they are generally primary point of contact for patients and are well-equipped to assess their knowledge and provide targeted guidance. Health workers enjoy high levels of trust and are often already involved in the treatment pathway of older people. As digital health literacy is lower among older people than among younger people, older people have limited means to turn to alternative sources to health workers and to educate themselves, which reinforces the role of health workers in building health literacy among older people (OECD, 2025[19]).
While measures delivered by health workers are essential, it is also crucial to note that since not everyone has a general practitioner or access to dental care or other healthcare professionals, they may fail to reach some of the people who would need it most (Batterham et al., 2016[35]). Training non-health workers who frequently interact with older people, such as meals-on-wheels volunteers (Rubin et al., 2014[36]) or religious and community leaders (Rivera-Hernandez, 2015[37]; Cook, 2021[38]) as health literacy coaches can thus be an important supplement to general practitioner-based interventions.
3.2.4. Partnering with other stakeholders can help diffuse health literacy across communities
OECD countries often partner with local stakeholders, such as civil societies, to reach individuals at the local level, and some countries have set up contact points across the country. For example, Hungary has introduced Health Promotion Offices that aim at helping individuals to develop health-related skills and promote healthy lifestyles, such as physical exercise and nutrition, help communicate guidelines, such as on nutrition, strengthen community action and support, and support the uptake of public health measures, such as screening. Austria and Switzerland have both launched funds, the Fonds Gesundheit Österreich and Gesundheitsförderung Schweiz/Promotion Santé Suisse/Promozione Salute Svizzera, which co‑ordinate and financially support health promotion programmes. Both countries now offer a broad set of activities on the community-level to inform people of strategies to live healthier. For example, the Cantons Zurich and Bern (Zwäg ins Alter) offer advice on health and prevention for older people, and the programme HEKS AltuM Zürich/Schaffhausen in Zurich and Schaffhausen offers support for migrants aged 55 and above and refugees aged 50 and above and their families that offers information and counselling on ageing and living in Switzerland as well as sports courses, tandems and meetings with that are offered in a variety of languages. The project Tavolata brings together older people in a private or semi-private setting to cook and eat together and helps supporting a balanced diet while fighting social isolation. In addition, Austria is currently testing model regions (Modellregion für Gesundheitskompetenz und -förderung), for example in the region Liezen in the Steiermark. Regions offer approved and easily understandable information, health workers are trained in patient-centred communication, physical and activity programmes, information offers guidance on how to navigate the health system, and counselling on nutrition and health checkups aims at preventing health limitations. In Canada, the province of New Brunswick has launched the Healthy Aging Champion programme, where people aged 60 and above promote healthy ageing, work with community organisations that support and promote healthy ageing and share their own experiences on healthy ageing.
Health literacy campaigns have to balance outreach, costs, effectiveness and targeting. Broad awareness campaigns, for example via posters, newspapers or television, yield smaller results but may reach more people. Educational interventions for health literacy among older adults are most effective when they include active and interactive learning components, e.g. if participants apply their learnings within the scope of the programme and collaboratively design plans for healthy lifestyle changes. For example, a 24‑week active learning programme for community-dwelling older adults with low health literacy in Japan yielded significantly improved health literacy, lifestyle behaviours, physical function, and mental health compared to a didactic learning course (Uemura, Yamada and Okamoto, 2021[39]).
Health literacy campaigns often reach those best that are already receptive to information. People who respond better to these campaigns are generally higher educated, which risks increasing differences in healthy ageing by socio‑economic status (Moreira, 2018[28]). Countries can counter this through an active outreach to people at risk. Places where older adults often gather, such as churches, community centres or adult day care facilities can also be pivotal in distributing health literacy messages and conducting campaigns (de Wit et al., 2018[40]).
3.2.5. Benefits of healthy lifestyles are well-established, but need targeted interventions to reach individuals
The benefits of physical activity on healthy ageing are well-established and manifold. Physical activity reduces the risk of chronic diseases and cognitive decline, prevents falls, fights sarcopenia, has a positive effect on mental health and reduces loneliness if performed in a group. This translates into lower healthcare costs and a lower burden on healthcare systems. To date, there is a wide range of activity programmes across countries with demonstrated success in improving physical strength and stability, reducing the number of falls, delaying the onset of limitations of daily living and mild cognitive impairment (Table 3.1). Broadly speaking, most types of physical activity programmes improve people’s health, reduce adverse events and are often cost-effective. Structured programmes of 12 to 24 weeks were found to be able to reduce the number of falls by around 30‑40% (See Table 3.1).
Source: AFFINTY: (HSE, 2024[43]); ATP: (BIÖG, n.d.[44]; BIÖG, n.d.[45]); FINGER: (Ngandu et al., 2015[46]); Fujisawa +10: (Komatsu et al., 2017[47]); GLA: D: (Thalund Grønne et al., 2021[48]); HAPPIER: (Senik, Milcent and Gerves, 2015[49]); LiFE: (Clemson et al., 2012[50]); MoB: (aging, 2023[51]); SAIL: (Stay Active and Independent for Life (SAIL), 2025[52]; York et al., 2011[53]); STEADI: (CDC, 2024[54]; Neser, 2020[55]); Stepping On: (Carande-Kulis et al., 2015[56]; Clemson, Swann and Webb, 2025[57]): Tai Ji: (Tai Ji Quan: Moving for Better Balance, 2024[58]; Fuzhong, 2022[59])
All OECD countries recommend some form of physical activity and have some policies in place that improve access to physical activity programmes by informing people of these programmes, offering them free of charge or at low cost and increasing their offer across communities. In addition, several countries have helped develop programmes, and finance or directly offer sports courses. For example, in Germany, the Federal Institute of Public Health (formerly Bundeszentrale für gesundheitliche Aufklärung) has developed a 12‑weeks prevention course and a continuous sports prevention programme with sports associations and the German Sport University of Cologne and courses are now offered across the country. In Switzerland, a number of Cantons offer programmes to improve physical activity, moving physical activity closer to people’s homes, and improving social interaction, for example through joint group walks (e.g. Café Bâlance, DomiGym, Hopp-la, Pas de retraite pour ma santé, Zämegolaufe). Greece has set up community centres that offer a variety of activites including physical and cultural services (Κέντρα Ανοιχτής Προστασίας Ηλικιωμένων, KAPI) to people aged 60 and above for free, and Mexico offers four cultural centres run by the National Institute for Older Adults (Instituto Nacional de las Personas Adultas Mayores, INAPAM) that offer free educational, physical and cultural services to people of the same age group and in Korea, senior welfare centres offer a variety of physical exercise classes, such as dancing and gymnastics, to older people. In England, Public Health England recommends the Falls Exercise Management (FaME) programme and the Otago Exercise Program, both offered free of charge or against a small user fee of GBP 3‑8 per session and in the United States, Medicare, Medicare Advantage and private insurers also cover the Otago Exercise Program under certain conditions.
3.2.6. Promoting group exercises has benefits beyond physical activity alone
While the benefits of healthy lifestyles are well-established, participation and adherence of older people is challenging to achieve. The individual benefits of healthy lifestyles, such as physical activity, are not clear to all individuals, who might also lack of motivation, and there is a gap between the stated intention to live healthily, for example to engage in physical activity, and to actually realise it (Mandigout et al., 2025[60]). In addition, adherence to physical activity programmes is often higher by people who enjoy better physical and mental health to begin with and that have a higher socio‑economic status (Picorelli et al., 2014[61]).
Generally, team-based or combined (group and individual components) incentives seem to be most effective, and ambitious but realistic goals and regular feedback are also key (Patel et al., 2016[62]; Kullgren et al., 2014[63]). Programmes that offer social interaction offer short-term gains through building social ties and increase the perceived value of being physically active. These short-term effects are more effective than informing of the long-term benefit of physical activity, and can offset concerns about one’s capability about the need to engage in physical activities (Devereux-Fitzgerald et al., 2016[64]). Participants of the programme Fujisawa 10+ (+10: Be active for 10 more minutes than now) in Japan, for example, strongly value the social interaction with people of their same age, and reported to feel as an integral part of the community (Komatsu et al., 2017[47]). This programme combines the promotion of physical activity through information, such as the media, leaflets and T-shirts with the logo, and supports older people to voluntarily gather in their community and to perform simple exercises in the community. Since 2014, it also includes activities to prevent dementia. An evaluation over a period of five years showed that physical activity increased from 108 min per day to 134 min per day, increased for groups of a high and low socio‑economic status, and improved more steeply for those of a low socio‑economic status than for those of a high one (Saito et al., 2021[65]).
Supervised programmes that are available to older people tend to show better outcomes. Unsupervised programmes offer greater flexibility and can be performed at home at a time that is most convenient to the individual, but they lack the social element of performing physical activity in a group. Supervised programmes are led by an instructor in a group. They require some form of transportation to the place where the exercise is performed and have to be integrated into a person’s schedule but offer social interaction in a group and having an instructor can offer additional security to people who are afraid of falling or that fear negative side‑effects of sports. The participation in both supervised and unsupervised programmes largely yields positive results (Gómez-Redondo et al., 2024[66]), as physical exercise generally has a positive effect on an older person’s health. Comparisons of health outcomes of and adherence to supervised versus unsupervised programmes suggests a slight advantage of supervised over unsupervised programmes (Gómez-Redondo et al., 2024[66]).
3.2.7. Financial incentives can further nudge healthy behaviours, but success is mixed
Around a third of countries operates with financial incentives and financial support for certain physical activities to reduce barriers of access and to incentivise the uptake and maintenance of healthy lifestyles. For example, in Austria, Germany and Switzerland, health insurance funds co-pay the participation in physical exercise programmes. In New Zealand, the SuperGold programme offers discounts of in most cases around 10% to a set of health-related services, such as dentists, pharmacies, and healthy food and supplements.
While financial support for certain activities, such as physical activity, can reduce barriers of access, which are prominent among certain population groups of old age, the empirical evidence of dedicated financial incentives on the behaviour of individuals is mixed and points at some short-term gains while their sustainability is unclear (Salmani et al., 2025[67]). While financial incentives targeting occasional behaviours like screenings or vaccinations quickly become cost-effective, evidence on the cost-effectiveness of measures to promote regular behaviours like walking and better nutrition remains mixed, especially because effects often do not last beyond the intervention period (Barte and Wendel-Vos, 2017[68]; Finkelstein et al., 2008[69]; Luong et al., 2021[70]; Mitchell et al., 2020[71]). For smoking cessation, financial incentives to providers are effective in improving the recording of patients’ smoking status, smoking cessation advice, and referrals to further cessation services, but it is unclear whether this actually lowered smoking rates (Hamilton et al., 2013[72]). Incentives for smoking cessation might need to be higher to show results and a significant share of participants relapses post-intervention, but due to the very large healthcare costs associated with smoking, they are still often cost-effective, though probably more so at a younger age (Halpern et al., 2015[73]). For larger and most persistent effects, incentives should always be paired with information campaigns to build intrinsic motivation that can last beyond the initial intervention. Consistent monitoring and evaluation of any intervention is also essential to adjust policies and strengthen the existing evidence base.
Some design choices could improve the effect of financial incentives. Financially incentivising healthy behaviours such as physical activity, improved nutrition, or weight loss and smoking cessation aims at further supporting people in overcoming motivational barriers to build better habits that prevent or delay age‑related health issues. Firstly, incentives should be specifically tied to certain outcomes rather than unconditional or attendance‑based to maximise their motivating effects (Barte and Wendel-Vos, 2017[68]). Secondly, older people may be more motivated by donations to charity, possibly because they mitigate skepticisms about the morality of financial incentives (Harkins et al., 2017[74]). Other incentive designs that target older people’s emotional and social needs, such as vouchers for family entertainment nights, may also increase engagement (Klein and Karlawish, 2010[75]). Although not specifically about older people, Patel et al. (2016[76]) suggest that loss-based incentives (for example, allocating a certain sum at the start and deducting money for days that a goal is not met) may be more effective than rewards as they utilise people’s loss aversion. However, deposits are the least popular incentives while non-cash rewards like vouchers are most accepted, despite opposite trends regarding effectiveness. This highlights potential disparities between the methods that people may feel most comfortable with and those that are the strongest motivators in practice (McGill et al., 2018[77]; Halpern et al., 2015[73]). Thirdly, for the largest and most persistent effects, incentives should best be paired with other policies, such as information campaigns, to build intrinsic motivation that can last beyond the initial intervention, and efforts to strengthen social interaction (Yamashita et al., 2021[78]).
Other type of incentives can also be beneficial. In many experiments on financial incentives, the control group also received regular feedback on their performance and showed significant improvements compared to baseline levels, often larger than those between the control and incentive group. This suggests that just consistently measuring results (such as step count or calorie intake) and discussing them may already induce behaviour changes, especially when paired with social effects (Kullgren et al., 2014[63]). Gamification and nudges can also be powerful and cost-effective motivators that can be combined with financial incentives or used on their own. For example, just giving sedentary older adults in the United Kingdom a booklet with tips around forming activity habits and a tick-sheet for self-monitoring decreased mean sitting time and led to more light and moderate activity (Matei et al., 2015[79]).
Inadequately designed incentives are not only inefficient but also risk unintended consequences such as crowding-out intrinsic motivation, where people may start expecting incentives and be even less willing to continue a habit once they are withdrawn (Vlaev et al., 2019[80]). Paying for behaviours that someone would have done either way can exacerbate this, and too small or too large incentives or poor framing may also be counterproductive, so it is essential to carefully consider these aspects and build policies based on a combination of theory and existing empirical findings (Kamenica, 2012[81]).
These findings are limited by the fact that most of the research on the effectiveness of financial incentives is not specifically about older people or even largely excludes them by being workplace‑based. Although prevention ideally starts early and studies on young and middle‑aged people are therefore important, the lack of research on older people creates issues as they often show distinct decision making patterns from younger age groups, and the same interventions may therefore not always be effective on them (Klein and Karlawish, 2010[75]). Additionally, it can be harder to reach older people who are retired but not in institutional care settings, and they are often wary of explicit financial incentives and of technologies used for tracking, such as smartphone apps (Tambor et al., 2016[82]; McGill et al., 2018[77]).
3.2.8. Social prescribing is gaining attention, but evidence is still missing
Several OECD countries, including Austria, Canada, Germany, Ireland, Portugal, Spain and the United Kingdom (OECD, 2024[83]), have been introducing “social prescribing” into their healthcare systems. Social prescribing refers to health workers prescribing initiatives that aim at prevention, helping to reduce loneliness and social isolation, delaying the development of care needs, reducing the care needs of those who require assistance and enabling people to live as independently as possible. Furthermore, the concept of social prescribing has emerged as a person-centred approach to link people to non-clinical and community-based support to improve their health and well-being (The King's Fund, 2020[84]).
Social prescribing initiatives might vary in terms of activities and services prescribed, target populations, as well as professionals involved in the referrals. The activities and services prescribed span from services that address basic material and legal needs (e.g. food, shelter, transportation), to lifestyle interventions to improve health behaviours (e.g. exercise, diet, smoking), to programmes to develop vocational skills (e.g. education, vocational training) or social activities (e.g. volunteering, arts and crafts, nature activities, community engagement). Recipients of social prescriptions might be people with chronic conditions, people who are socially isolated, those at high risk of mental illness, people with a vulnerable housing situation, as well as older people.
Social prescribing is currently gaining momentum across the OECD. In a first pilot phase, Austria supported 24 institutions and has just launched a new funding period for the period from 2026-2028 (Gesundheit Österreich GmbH, 2025[85]). In Ireland, social prescription is now available in 30 sites across the country. Older people are one target group that is thought to benefit particularly from social prescribing, and countries have launched several programmes that specifically target older individuals. For instance, in Canada (Ontario), almost half the participants of social prescribing initiatives were between 61 and 80, mostly female and with low income. The professionals authorised to prescribe services as part of social prescribing practices may vary across countries, spanning from primary care physicians in Spain and Portugal, to non-clinical “link workers” in Canada (Alberta) and in the United Kingdom (England and Wales) (OECD, 2024[83]).
Social prescribing is intuitive and intriguing, but evidence is scarce, although pointing to positive results (Husk et al., 2018[86]; Bickerdike et al., 2017[87]). Evidence on the impact of social prescribing practices is scarce due to the heterogeneity of such practices and their local nature. Trials often include a low number of people and suffer from high drop-out rates. A review of seven evaluations of social prescription programmes to older people reported an average competition rate of 66% (Percival et al., 2022[88]). Where available, evidence points to some improvements in quality of life, physical and mental health (Aggar et al., 2020[89]), while some evidence also suggests that social prescribing contributes to improved well-being and the ability to self-manage for people receiving socially prescribed services. Social prescribing has also been found to be useful to improve individuals’ well-being and reduce repeat visits, as well as improve care integration (Hamilton-West, Milne and Hotham, 2020[90]; Drinkwater, Wildman and Moffatt, 2019[91]).
3.3.1. Improving access to public health services can increase their take‑up
OECD countries can improve the uptake of public health services, such as vaccination rates and screenings, by informing people about their benefits, by reminding people of participating in, and providers of performing public health measures, and by lowering access barriers, for example by improving their financial coverage and by moving the provision of certain measures to communities and people’s homes.
According to the OECD Questionnaire on Healthy Ageing and Community Care, 22 OECD countries recommend certain vaccinations for everyone beyond the age of 60 or 65, and earlier for people at risk, for example those with chronic diseases. These vaccinations aim at protecting them from vaccine‑preventable diseases, such as the seasonal influenza and pneumococci. Vaccinations against seasonal influenza have proven to be effective in reducing hospitalisations and mortality among older people. However, success rates are lagging behind. The take‑up of vaccinations against seasonal influenza among people aged 65 and above is below target across all but six out of 36 OECD countries, them being Mexico, the United Kingdom, Korea, Denmark, Portugal and Ireland.
Countries use a set of strategies to improve vaccination rates that target both health workers who perform vaccinations and individuals for whom the vaccinations have been recommended. Education about the benefits of vaccinations, reminders to get vaccinated, and interventions to improve access, such as vaccinations at home and free vaccines, were largely found to be effective (Jacobson Vann et al., 2018[92])
Reminders have been successful in reminding older people to get vaccinated (Jacobson Vann et al., 2018[93]; Buttenheim et al., 2022[94]). For example, England sent out invitations to people aged 65 and above and other people at risk (National Call and Recall Service) for the first time in 2020 in addition to already existing efforts undertaken by general practitioners and in Latvia, text messages were sent to older people about COVID‑19 and flu vaccinations during the pandemic emergency. The effect might be modest, but the intervention is also largely low-cost, for example if executed via SMS. While interactive and targeted interventions that include healthcare providers are generally more impactful than education-only policies or generic measures like posters and reminder or recall letters, those interventions reach a greater audience at a smaller cost (Eiden, Barratt and Nyaku, 2023[95]). Hurley et al. (2018[96]) showed that generic reminders for influenza, tetanus, diphtheria, acellular pertussis, and pneumococcal vaccines for adults aged 65 and above in the United States led to one additional vaccination per 29.4 contacts, but at a cost of USD 0.86 per person, this may still be a cost-effective policy.
National vaccination programmes that are free of charge to older people can help streamline the delivery of vaccinations. In 2014, for example, Japan introduced he pneumococcal vaccination for people aged 65 and above into their five‑year routine vaccination programme. An evaluation found a pronounced increase in the annual vaccination rate from 2‑5% prior to the integration to 10‑11% afterwards, which helped increase the cumulative vaccination rate (Naito, Yokokawa and Watanabe, 2018[97]). The use of digital records can help identify individuals who have an incomplete vaccination status and to tailor strategies to people who are particularly at risk. Japan introduced a checkbox in the electronic medical records that indicates whether a patient is vaccinated or not as part of the introduction of pneumococcal vaccinations into the regular vaccination schedule and contributed to better vaccination rates (Fukushima et al., 2019[98]).
Year of authorisation of pharmacists to perform seasonal flu vaccinations
Note: In several OECD countries, the authorisation of pharmacists to perform vaccinations is decided on a subnational level. For these countries, the year of the subnational region that first introduced it was chosen (Australia: Western Australia; Canada: Yukon; Switzerland: Canton Zurich, the United States: Washington State). In Norway, France and Germany, vaccination performed in pharmacies was first piloted (Norway: 2017, France: 2019, Germany: 2020). The dates displayed refer to the national roll-out.
Several countries have broadened access to vaccinations by allowing other professional groups, such as pharmacists and nurses, to perform vaccinations, as well. In 18 OECD countries, pharmacists have been performing seasonal influenza vaccinations for several years. For example, in Portugal, pharmacists have been allowed to perform vaccinations since 2007, in New Zealand since 2011, and several Canadian provinces expanded their pharmacists’ competencies over the past decade. Germany introduced seasonal flu vaccinations in pharmacies in 2022 following pilots in several states in the two previous years and Italy had rolled out the mandate one year earlier to pharmacists with respective training (Buchan et al., 2016[99]). Pharmacists are allowed to perform vaccinations after additional training. Similarly, Belgium and France authorised pharmacists to perform vaccinations against seasonal flu after additional training from 2023 onwards. In Switzerland, all cantons are now allowing pharmacists to perform vaccinations who have performed the respective training, and training on vaccinations has been added as an integral part of the education of pharmacists. Some countries have also expanded influenza vaccinations beyond medical doctors and pharmacists. For example, in 2021, Poland has expanded the mandate to perform seasonal influenza vaccinations to dentists, physiotherapists and laboratory diagnosticians alongside medical doctors and pharmacists. Since 2025, community pharmacies contracted with the National Health Fund (Narodowy Fundusz Zdrowia, NFZ) can provide seasonal influenza vaccinations and a broad range of other vaccinations, such as against pneumococcal disease, human papillomavirus, herpes zoster, COVID‑19. Vaccinations are partially or fully reimbursed by the National Health Fund, with particular exemptions for priority groups such as adults aged 65 and above and pregnant women.
Expanding the mandate of performing vaccinations to professions beyond medical doctors can help improve access to vaccinations. Patients might pass by a pharmacy more frequently than a doctor’s office, and the roll-out to other professions can maintain access in areas where access to general practitioners is hampered, for example in rural areas and in countries with long waiting times for medical practitioners. In addition, it can reduce the workload of medical doctors. While vaccinations in pharmacies are also of particular interest to the working-age population at risk, such as people aged 55‑65 with chronic diseases and health workers, for convenience and longer opening hours, they are also taken up by people and help reduce the workload to general practitioners.
However, it can take some time to familiarise patients with this additional means to get vaccinated. In Canada, the roll-out of vaccinations in pharmacies for seasonal influenza was associated with a limited increase in coverage by 2.2% (Buchan et al., 2016[99]). In 2023‑2024, pharmacies have become the most frequently reported place of vaccinations in Canada, with 57% of individuals who were vaccinated against seasonal influenza reporting to have received it in a pharmacy against, e.g. 28% in 2016‑2017 (Public Health Agency of Canada, 2025[100]). Those who decide to get vaccinated in a pharmacy report high satisfaction rates, which stood at 99% among surveyed individuals in Australia, New Zealand and Switzerland (Stämpfli et al., 2020[101]; Burt, Hattingh and Czarniak, 2018[102]; Dalgado et al., 2023[103]) and report easy access as their main reason (Stämpfli et al., 2020[101]).
3.3.2. Financial incentives for prevention to providers cannot overcome broader staff shortages and time constraints
A number of OECD countries have introduced financial incentives to improve the performance of providers to meet public health objectives for older people. A total of 16 countries reported in the OECD’s 2023 Health System Characteristics Survey that part of the income of general practitioners is subject to pay-for-performance criteria. The pay-for-performance part can be considerable and reach up to a quarter of a physician’s total income. For example, in Estonia, it represents a bit more than 3% of a physician’s total income, around 10% in the Netherlands and can reach up to 30% in Portugal (Levévre, Levy and Van de Voorde, 2023[104]). This is a contrast to hospital pay-for-performance programmes, where only a minor fraction of a few percentage points (p.p.) is conditional on quality, which is deemed insufficient to really alter provider behaviour (Milstein and Schreyoegg, 2016[105]).
A few countries operate a pay-for-performance programme with indicators that directly relate to older people. They either directly apply to an older population, for example a share of people aged 65 and above that are vaccinated against seasonal influenza or have been screened for cancer, or to a population with chronic conditions that are generally more prevalent among older people, such as congestive heart failure and diabetes. England offers the probably most comprehensive pay-for-performance programme in the OECD. The Quality and Outcomes Framework (QOF) was introduced in 2004. In this scheme, physicians can collect points for meeting predefined objectives and can obtain up to 127 points for public health-related items that cover four categories, them being blood pressure, smoking, vaccination and immunisation as well as cervical screening. Twelve clinical domains, which are very present among older people, such as cholesterol control and lipid management, heart failure, diabetes mellitus, and dementia complement the public health domain and represents a total of 437 points. France joined in 2012 with the Remuneration sur Objectifs de Santé Publique (ROSP), which built upon the Contrat d’Amélioration des Practiques Individuelles (CAPI) and covers 12 prevention-related indicators alongside 8 indicators on managing chronic diseases (diabetes, hypertension, and cardiovascular risks) and 9 efficiency-related indicators (CNAM, 2023[106]). Medical practitioners can obtain a total of 940 points, with one point equating EUR 7. It is being replaced by the Forfait Médecin Traitant (FMT) from 1 January 2026 onwards. Portugal offers pay-for-performance to Family Health Units to the team and individual practitioners for access, care performance, user satisfaction and efficiency.
Evidence from pay-for-performance programmes points to modest improvements that are likely not sustainable and cost-effective. Pay-for-performance pays physicians more for meeting certain health objectives, and sufficiently higher payments generally translate into higher service provision. For example, the French scheme ROSP was found to increase screening for chronic kidney disease among people with diabetes and hypertension, albeit remaining low, and diabetic retinopathy screening and HbA1c measurement improved steadily, as well (Atramont et al., 2019[107]), but the link to improvements in health outcomes is modest and patients do not necessarily perceive any changes (Saint-Lary et al., 2015[108]). Its predecessor, CAPI, did not lead to any significant changes in cancer screening rates (Sicsic and Franc, 2016[109]). Also in the English QOF and the Estonian Quality Bonus System, where physicians quickly adhered to meeting targets, the effect on mortality was modestly significant to insignificant (Ryan et al., 2016[110]). In addition, gains were short-lived and not sustainable after the withdrawal of financial incentives (Ho et al., 2025[111]).
Pay-for-performance can help direct the focus of general practitioners to the provision of care that aligns with public health goals and generally comes with the benefit of better data collection. Pay-for-performance can lead to an increase in the number of people with chronic diseases (Merilind et al., 2016[112]), but it is unclear to what extent this closes diagnostic gaps, as suggested for dementia, and to what extent this leads to upcoding. However, pay-for-performance does not fix broader health system constraints, such as an overall shortage in health workers (Merilind et al., 2016[112]), and after several decades of experience, it still remains difficult to design programmes that set a sufficiently high incentive to alter provider behaviour while remaining cost-effective, that do not increase health disparities by rewarding physicians while penalising providers that provide care to disadvantaged populations, and choosing indicators that translate into better health outcomes.
3.4.1. Early detection allows for early intervention
OECD countries work with two sets of programmes that either offer comprehensive screening of all people beyond a certain age, or specific screening for certain diseases or conditions, such as cancer, frailty, and polypharmacy. In addition, they employ means to identify unmet and suboptimal care that requires interventions, such as polypharmacy and dehydration. Besides general preventive screenings, counties employ screening campaigns for specific disease groups, such as dementia and mental health, oncological and musculoskeletal screenings, as well as setting-specific screenings, for example screenings of the health status of residents in long-term care facilities. A total of 23 out of 29 OECD countries offers either home visits (17 countries), preventive consultations (15 countries), or a combination thereof. The schemes vary in how systematic and structured they are. Eligibility for screenings can be conditional on reaching a certain minimum age or having certain risk factors.
Some OECD countries have integrated preventive screening procedures into their healthcare system to detect diseases as early as possible and to identify unmet needs. These take place at a doctor’s office or at home. Several countries offer preventive check-ups beyond a certain age, mostly from 65 or 75 years onwards. In Australia, people are entitled to an annual health check-up free of charge from the age of 75 onwards (75+ Assessment). Besides clinical questions, it covers items related to the individual’s social history, such as their housing situation and participation in social events, their risk of falling, nutrition, cognitive status, personal well-being and safety and suggests a list of referrals to health, social and long-term care services. Chile offers annual exams to people aged 65 and above (Examen de Medicina Preventiva en el Adulto Mayor), which assesses the person’s ability to live independently, potential abuse in the home, and their mental health besides a list of health-related and other items. France offers preventive screening (Mon bilan prévention) free of charge to everyone aged 60 to 65 and 70 to 75 (Ministère du Travail, 2023[113]). In Spain, the region of Andalucía has launched the medical exam for people aged 65 and above in 2006 (Examen de Salud para mayores de 65 años) (Consejería de Salud, 2017[114]).
Evidence on general screening programmes is mixed. A Cochrane review of 17 randomised control trials found little to no effect on overall mortality or heart disease, which was linked to already existing awareness of physicians of their patients’ conditions and a lack of follow-up to findings in general health checks (Krogsbøll, Jørgensen and Gøtzsche, 2019[115]). However, while preventive screenings might not reduce overall mortality and diseases, they can lead to the better identification and management of chronic diseases, increase participation in preventive services, and were associated with better patient-reported outcomes (Liss et al., 2021[116]). Some screenings have succeeded in achieving an improvement in both processes and outcomes. For example, the NHS Health Check was found to reduce cardiovascular diseases and help prevent other conditions thanks to earlier detection and timely intervention (McCracken et al., 2024[117]). In addition, they offer an opportunity to refer individuals to services that offer support in adopting healthier lifestyles, but are met by funding constraints and compete with other tasks of providers (Duddy et al., 2022[118]).
3.4.2. Better targeting of screenings to people at risk can improve their efficiency and effectiveness
While the effect of general screenings on health outcomes might be very limited and could consume already limited time resources of health workers, countries have several means to improve the effectiveness of screenings by moving towards more targeted approaches, such as preventive home visits, that allow for a comprehensive assessment of the health and living conditions of older people in their home setting.
Preventive home visits are widely available and have been found to be cost-effective. A total of 16 OECD countries report offering preventive visits at home. Some countries, such as Australia, Denmark, Germany (Berlin), Finland, Norway and Switzerland have introduced dedicated home visits schemes for individuals aged 75 and above, and Norway for people aged 75 or 80 and above. Australia and Denmark introduced them in 1998. Some municipalities in Norway experimented with preventive home visits in the early 1990s already, before it took off on a large scale in the early to mid‑2000s (Bannenberg et al., 2021[119]). Mexico offers periodic visits to people aged 65 and above and people with disabilities irrespective of their insurance status to assess the person’s health, well-being and living conditions in their home and to refer them to refer them to other services if necessary (Salud casa por casa). In Switzerland, at least eight Cantons (E.g., Bern, Jura, Wallis and Zürich) offer preventive home visits to people 65 and above, which are sometimes part of a broader preventive programme. For example, the health promotion and prevention programme Zwäg ins Alter includes preventive home visits to older people and an assessment of their home setting for fall-inducing risks. In Germany, Hamburg introduced preventive home visits (Hamburger Hausbesuche) in 2018, and Berlin launched a pilot of preventive home visits to people aged 70 and above in 2021. In the Netherlands, municipalities also offer preventive home visits. For example, Hof van Trente introduced them in 2012 for everyone aged 78 and above and they are performed by volunteers. Home visits in Denmark, Finland, Norway and Sweden were found to be cost-effective (Kronborg et al., 2006[120]; Liimatta et al., 2019[121]; Sahlen et al., 2008[122]). The introduction of preventive home visits in Norway was led to a 7%-reduction in hospital admissions among those aged 80 and above and in admissions to long-term care facilities, 11% in the average number of hospital days, and 4% lower mortality of those aged 80 and above (Bannenberg et al., 2021[119]).
Preventive home visit programmes require good co‑operation of practitioners and collaboration between health workers and other stakeholders. Evaluations of the first phase of Zwäg ins Alter highlighted low support by general practitioners who were sceptical of the programme, felt that their time commitment was too demanding and that the additional work was not sufficiently reimbursed (Egger, Künzi and Oesch, 2010[123]). The outright integration of general practitioners in the design and implementation of preventive care programmes can support the acceptance of such programmes, but questions around the reimbursement of their activities might likely require a more fundamental rethinking of the way providers are paid.
Denmark uses its generous data infrastructure and additional information to identify people at risk
Denmark has been offering preventive home visits to older people (forebyggende hjemmebesøg till ældre) since 1996 (LBK no. 868 of 10 September 2009, see also law no. 1 117 of 20 December 1995 and law no. 469 of 14 May 2025). Municipalities can offer their citizens preventive home visits unless they already receive services from the municipality. Home visits are offered to people aged 70 and above if they live alone, to anyone aged 75 to 80, and annually to everyone aged 82 and above as well as everyone aged 65 to 81 based on their needs and particular risk of reduced social, mental or physical functional capacity. People at particular risk include those who have, for example, lost a spouse, been discharged from a hospital, or display an overconsumption of alcohol.
Denmark uses its comprehensive data environment and co‑operates with partners to identify people at risk. It uses a range of data sources, such as the register of residents, death statistics, medical data and pension data to changes in places of living, the loss of a spouse, discharge from hospital, and a change in benefits, which could indicate a deterioration in health. The co‑operation with a range of actors, such as general practitioners, hospitals, social, community and long-term care workers, care co‑ordinators, funeral homes, librarians, self-help groups and NGOs as well as family members, neighbours can suggest a preventive home visit to the community. People can also refer themselves for a visit.
During the visit, a prevention consultant of the municipality assesses the physical, mental and social status and well-being of the individual. This includes, for example, the nutrition status, physical ability but also loneliness, cognitive impairment, grief reaction after loss, depression and suicide risk. The person’s housing condition and financial situation are also assessed as well as their IT literacy and need to use additional technologies. Following the visit, the person is informed about and referred to services in the municipality, such as health and long-term care services, dementia co‑ordinators, as well as offers by the civil society, among them networks of older people, visiting services, and cultural events. The visit is documented and a follow-up visit can be arranged.
Municipalities have adopted their own approaches, with some, such as the Odense Municipality and the City of Copenhagen, having adopted a more structured approach, and Copenhagen and Høje Taastrup Municipality have developed their own conversation guide as a scoring tool.
Source: Højgaard et al. (2019[124]), “Forebyggende hjemmebesøg til ældre – tidlig opsporing. Litteraturgennemgang og ti kommuners erfaringer. Vive.”; Sundhedsstyrelsen (2020[125]), “Forebyggende hjemmebesøg til ældre. Vejledning”.
3.4.3. Screening for specific age‑related conditions allows for early detection and intervention
Countries use targeted strategies to identify people at risk of a certain condition or people who have already developed it and are particularly prevalent among older people, such as dehydration and weight loss, a risk of falling, and inappropriate prescriptions. Unintended, sudden weight loss is associated with an increase in mortality (Hussain et al., 2023[126]; McMinn, Steel and Bowman, 2011[127])
A total of 17 countries reported having measures in place to allow for an early prevention of people at risk of falling in the OECD Questionnaire on Healthy Ageing and Community Care, and all countries employ some strategies to identify inappropriate medication or polypharmacy. Several countries offer tools to healthcare professionals to equip them with the necessary information to improve prescribing patterns, either through digital prescription tools (mandatory in Hungary, Iceland, Latvia, New Zealand, Portugal, Sweden, the United States, voluntary in Japan offering health workers to identify and potentially deprescribe fall-inducing drugs. In Portugal, for example, the single computer system, (Prescrição Eletrónica Médica, PEM) allows different health professions to access a person’s medication plan and pharmacists are involved in monitoring person’s medication including those in long-term care facilities. Similarly, in Hungary, the use of a digital prescription tool in mandatory, and pharmacists are involved in reviewing the patient’s medication and assess potential medication problems.
Several lists are now available to health professionals that help detect inappropriate medication (Anrys et al., 2021[128]). For example, the Swedish National Board of Welfare has developed a list of Fall-Inducing Drugs (FRIDs), the American Geriatrics Society Beers Criteria include a list of potentially inappropriate medication that should be avoided for older adults, and the European Geriatric Medicine Society (EuGMS) Task and the Finnish Group on Fall-Risk-Increasing Drugs have developed the “Screening Tool of Older Persons Prescriptions in older adults with high fall risk” (STOPPFall) (Seppala et al., 2020[129]) and Norway has the nursing-home specific list “NORGEP-NH” (Nyborg et al., 2015[130]).
Guidelines on reducing inappropriate prescriptions, that are used in 12 OECD countries, further help health workers in detecting inappropriate medication and take necessary steps to reduce it, and are supplemented by training of the health workforce on polypharmacy, which is mandatory in Iceland and voluntary in another nine countries (Austria, Chile, Czechia, Denmark, the Netherlands, New Zealand, Portugal, Sweden and the United States). Guidelines also support health workers in detecting other risks and health concerns among older people. At least 16 OECD countries now have guidelines on diagnosing dementia in place, and have a treatment plan in place to reduce the worsening of cognitive impairment, to delay the onset of dementia, to ensure high quality of care and well-being to people with dementia and to direct them to dementia-related activities (OECD, 2018[131]). These cover, for example, cognitive training in group activities (12 countries), individual activities for cognitive stimulation (11 countries), talks (11 countries), cognitive rehabilitation (9 countries) or other means. For example, in Luxembourg, the Programme Démence Prevention has been introduced for people with mild cognitive impairment and offers personalised activities.
OECD countries also use a set of policies to identify people at risk of falling, with at least 17 countries having such means in place. An early identification allows them to launch mechanisms to reduce or avoid the risk of falling, to then provide people at risk with a safety checklist to identify potential hazards for calls (in 14 countries), to have primary care teams discuss fall prevention (in 13 countries), and to refer them to specialists if needed (8 countries).
3.4.4. Single interventions likely have a limited effect, but comprehensive interventions fare better
The evidence of individual interventions on adverse events, such as the rate of falls, often shows a limited effect. While the negative effects of polypharmacy and fall-inducing drugs on falls are well-established, the effect of deprescribing certain drugs alone is modest at best (Lee et al., 2021[132]; Colón-Emeric et al., 2024[133]). The effect of certain nutritious supplements alone on falls is mixed, as well. A total of 15 OECD countries reported to offer dietary advice and follow-up, 10 OECD countries also prescribe supplements, such as Vitamin D and Calcium, and another 9 countries offer prescriptions of proteins to prevent muscle loss. First evaluations of checklists to identify potential fall hazards suggest a positive effect on reducing falls at a low cost, but the evidence remains unclear (Ziebart et al., 2020[134]; Clemson et al., 2019[135]).
This suggests that individuals require more comprehensive interventions to reduce the rate of falls than individual interventions, such as deprescribing, alone, but rather a combination of a set of interventions, such as physical activity, deprescribing of certain drugs and the removal of fall-inducing hazards (the Task Force on Global Guidelines for Falls in Older Adults, 2022[136]; Colón-Emeric et al., 2024[133]). Several countries offer such comprehensive packages. For example, the Netherlands have just integrated fall prevention measures in their basic insurance package in 2024. It consists of the identification of people who are at risk of falling, an assessment to identify modifiable risk factors, and a referral to tailored interventions and treatments that reduce the individual’s risk of falling. In Austria, a medication review is part of the 12‑week-long programme Trittsicher & Aktiv, which covers a self-assessment of the risk of falling, recommendations to build strength, a checklist of potential fall-inducing risks, and suggestions for housing adaptation. Such interventions include a strong component of physical activity, which is instrumental in reducing the rate of falls and is a key ingredient for these more complex interventions to be successful.
Reablement and rehabilitation services aim at supporting older people to maintain their functional capacities, or to regain them after injuries and illness to allow them to live independently, to participate in social and physical and social activities and to enjoy high quality of life. It generally includes a set of targeted interventions for individuals to maintain and/or regain these functions. From an economic perspective, reablement and rehabilitation can also translate into a lower consumption of high-cost care, such as frequent hospital admissions, and home‑based care instead of long-term care facilities.
Most OECD countries that responded to the OECD Questionnaire on Healthy Ageing and Community Care reported that they have measures for rehabilitation and reablement in place, with 24 OECD countries having responded positively to this question, one country (Latvia) considering it, and one country (Slovenia) having just introduced it. Reablement and rehabilitation follow different objectives and use different interventions to achieve their objectives. Reablement refers to care that aims at helping people relearn (instrumental) activities of daily living, such as cooking meals and doing the laundry, is time‑limited, for example to up to 12 weeks, and occurs after a hospital stay or other health event, such as a fall, or upon any other deterioration of health (Cochrane et al., 2016[137]; Metzelthin et al., 2022[138]). In contrast to that, rehabilitation often takes place after an acute event, such as a heart attack, stroke, trauma, hip or knee replacement, and tends to have a medical orientation and often takes place in a hospital or in outpatient care amid moves to strengthen community-based rehabilitation.
OECD countries offer a diverse set of services. Physical activity is the most commonly offered type, with 23 countries offering some type of physical activity during rehabilitation and recovery. The next three most prevalent types of services are occupational therapy, speech and language therapy, and skills training for daily living, such as cooking and shopping to allow people to live as independently as possible, with a total of 19 countries each having these services included. Cognitive therapy and mental health therapy were slightly less common, with 16 countries offering these services. Only 7 countries also accompany patients in their home setting, for example in public transport.
Note: – = depends. No clear limit. NB: New Brunswick.
Source: OECD Questionnaire on Healthy Ageing.
The duration of reablement and rehabilitation differs across countries. Fourteen countries do not set clear time limits but make the duration conditional on the patient’s need. In the remaining countries, the maximum duration individuals have access to ranges from 2 weeks in Switzerland to 16 weeks in Poland and Portugal.
Rehabilitation and reablement services are offered by a broad set of professions (See Figure 3.4). Nurses, physiotherapists and doctors are the most common professions and are involved in providing services in 20, 19 and 18 countries, respectively. Speech therapists are another prominent profession and provide services in 16 countries, followed by nurse assistants (14 countries) and psychotherapists and psychologists (13 countries). 15 countries also reported the involvement of other professions, such as occupational therapists (e.g. Canada, Chile, Denmark, Germany and Sweden) as well as care workers (e.g. Slovenia, Türkiye), social workers (e.g. New Zealand) and home health aides (the United States).
Type of professions involved in rehabilitation and reablement across 29 OECD countries
Note: The data for Canada refer to New Brunswick.
Source: 2023‑2024 OECD Questionnaire on Healthy Ageing.
While all countries offer physical therapy, and the majority of countries offers, occupational therapy, speech and language therapy as well as skills training, only few countries offer all types of rehabilitation and reablement. New Zealand and Portugal also offer comprehensive rehabilitation services across all types listed in Table 3.2. In New Zealand, the Non-Acute Rehabilitation Pathway service includes rehabilitation in four different settings (inpatient, community, transitional care rehabilitation as well as rehabilitation admission avoidance) depending on a person’s need. Following the assessment of a health professional and the development of a rehabilitation plan, care is provided in the most appropriate setting by a multidisciplinary team. Services are funded by a case‑mix model depending on the person’s complexity and the services needed. In Portugal, the integrated continued care programme includes dedicated units for intensive rehabilitation for short-term and medium-term rehabilitation (short and medium-term units). In 2022, Portugal had 4 397 of such places.
3.5.1. Evaluations suggest that rehabilitation is cost-effective, but access is limited
Rehabilitation can help people regain part of their functions after an adverse health event, such as a stroke, a heart attack, chronic obstructive pulmonary disease, or a surgery. Cardiac rehabilitation and rehabilitation after stroke was can reduce mortality in the longer term, improve functioning and reduce hospitalisations (Yagi et al., 2017[139]; Taylor, Dalal and McDonagh, 2021[140]; Song et al., 2023[141]; Long et al., 2019[142]; Shields et al., 2018[143]). It can support a faster discharge from hospitals to a dedicated rehabilitation centre or home and through that reduce hospital expenditures (Anderson et al., 2002[144]; Peiris et al., 2018[145]). In addition, tailored interventions that help older people to regain their abilities after a health shock can reduce expenditures in the longer term (Shields et al., 2023[146]). A number of rehabilitations were also found to be cost-effective, among them pulmonary rehabilitation for chronic obstructive pulmonary disease (Mosher et al., 2022[147]). Rehabilitation displayed a cost-effectiveness ratio of USD 1 065 to USD 71 755 per quality-adjusted life‑year gained (Shields et al., 2018[143]).
While rehabilitation has been found to have positive effects on health outcomes and to be cost-effective, their effect depends on the overall constitution of the patient. The effect of physical activity on activities of daily living among people in long-term care facilities, for example, and enhanced medical rehabilitation performed by physical and occupational therapists in long-term care facilities is modest (Crocker et al., 2013[148]; Lenze et al., 2019[149]).
Rehabilitation and reablement have been successful in helping people regain their functional ability, but the offer remains limited across OECD countries. Internationally comparable data on the number of people who used rehabilitation and reablement services is lacking. Where available, it shows high heterogeneity across OECD countries. For example, reablement and rehabilitation services are very limited in Latvia, where 20 people per 100 000 received reablement and rehabilitation services in 2022 compared to New Zealand, where 157 people per 100 000 received rehabilitation services provided by the Non-Acute Rehabilitation services, whereas in Germany and France, 646 and 789 people per 100 000 inhabitants received rehabilitation and reablement services in 2022. Some countries are responding in increasing the availability and access to rehabilitation. For example, the Netherlands have increased access to geriatric rehabilitation from 2025, which can also now be initiated directly at home following the assessment of a geriatric specialist who determines the optimal geriatric rehabilitation. Slovenia has been introducing rehabilitation services since 2025.
In 18 countries, reablement and rehabilitation are generally covered by the health insurance or the national health service, except for two countries, Japan and Slovenia, where it is covered by the long-term care insurance. In 11 countries, people co-pay for rehabilitation and reablement services.
3.5.2. Rehabilitation at home can reduce costs while offering similar quality to hospital rehabilitation
Rehabilitation services are offered at the place of residence of a person or a dedicated facility. In 18 countries, rehabilitation and reablement are offered at home, and in 17 countries in a nursing home. Another 18 countries reported offering long-term care in a dedicated rehabilitation facility, in 15 countries it takes place in a hospital and a total of 14 countries reported offering rehabilitation and reablement in day-care facilities.
Rehabilitation services in outpatient and home‑based care often constitute the minority of all rehabilitation services. For example, in Germany, rehabilitation in outpatient care represented 12% of all cases, and 9.5% of all days provided, with the remainder being provided in an inpatient setting. In Japan, 15% of rehabilitation was provided through home visits whereas the remainder took place in an outpatient setting, and in New Zealand, close to 60% of people who received Non-Acute Rehabilitation Services did so in an inpatient facility while the remainder received non-acute rehabilitation in a community setting. In the Slovak Republic, in 2022, around a fifth of social rehabilitation was provided at home and the remainder of in other settings, lice facilities for older people, like social service homes, and specialised facilities.
While the provision of some more complex services might be more cost-effective, home‑based rehabilitation often performs well against rehabilitation in other settings (Dalal et al., 2010[150]). It can either entirely replace inpatient rehabilitation or shorten and complement inpatient rehabilitation and offer continued support after inpatient rehabilitation and support the transition to living at home.
For cardiac rehabilitation, home‑based rehabilitation was found to be cost-effective compared to centre‑based options (Shields et al., 2022[151]) and studies also suggest cost-effectiveness of home‑based over centre‑based rehabilitation for stroke (Candio et al., 2022[152]). Studies evaluating inpatient rehabilitation versus home‑based rehabilitation did not find a significantly better improvement of outcomes in inpatient rehabilitation over home‑based rehabilitation (Buhagiar et al., 2017[153]; Buhagiar et al., 2019[154]; Lee and Lee, 2022[155]).
3.5.3. Reablement is a relatively new concept with limited but promising evidence
Reablement aims to delay and ideally reverse the more gradual decline that comes with ageing and can thus be applied in a preventive manner in contrast to rehabilitation, which is usually offered as part of the recovery process after an acute event (Metzelthin et al., 2022[138]) and is a new and intriguing concept, but in very early stages, the concept is not clearly defined yet and evidence is scarce.
Some OECD countries are in process of introducing and expanding reablement in their health systems. Australia, for example, has introduced the Short-Term Restorative Care (STRC) Programme, which provided support for up to eight weeks to help maintain functional capacities and delay or avoid the need for long-term care services. Services include, among others, occupational and physiotherapy, nursing support and personal care, as well as minor home modifications and technologies that help with daily activities. Patients undergo an assessment by an Aged Care Assessment Team and can be referred to the assessment by an outpatient provider, hospital, long-term care provider, or can refer themselves. Services are provided at home or in residential care, or a combination of both. In England, for example, people can receive reablement services (intermediate/aftercare) for up to six weeks that can be provided by a set of different professions, such as doctors, nurse, occupational, speech and language therapist, physiotherapist, social workers and carers. Several countries have launched pilots to test reablement models in their country. For example, the Netherlands have introduced several pilots, such as the training programme “I-MANAGE” in the region of Limburg (Mouchaers et al., 2023[156]), which covers five phases totaling eight weeks on average. During this time, the patient receives a comprehensive assessment of their needs in collaboration with their informal caregiver if applicable, a tailored care plan that is enacted with the support of a reablement team and continuously evaluated during the programme and adjusted if necessary. The programme also offers additional support to informal caregivers if necessary. After the end of the programme, the patient can be referred to usual care or receive a two‑week extension (Mouchaers et al., 2023[157]).
Reablement is a new and promising intervention. Countries have just started to integrate it into their health systems. As a result, reablement programmes so far also often lack a strong evidence base regarding their efficacy and cost-effectiveness, and systematic research on the topic is still in its infancy, but where available, evidence suggests a promising approach. Some countries have already gained positive experience with reablement services with programmes generating positive results (Aspinal et al., 2016[158]). For example, in Australia, people who underwent a home‑based reablement programme were less likely to have an unplanned emergency admission or unplanned hospital admission, required 40% fewer hours of home‑based care and had 35% lower total home‑based costs and 20% lower total health and home‑care‑related costs than those receiving standard care in a follow-up period of two years (Lewin, Alfonso and Alan, 2013[159]; Lewin et al., 2014[160]). In Norway, reablement was also found to lead better performance of and satisfaction with daily activities while requiring 25% fewer home visits, and costs being 17% lower than standard care (Kjerstad and Tuntland, 2016[161]).
First evidence from pilots indicate that the interdisciplinary development and collaboration and organisational support are important enablers for the successful implementation of reablement programmes (Mouchaers et al., 2023[157]). In contrast to that, the success of reablement programmes was hampered by a lack of motivation and engagement among participants, financial and time constraints among providers (Mouchaers et al., 2023[157]). This stresses the need to introduce clear coal-setting and a clear and well-communicated care plan.
References
[89] Aggar, C. et al. (2020), “Social Prescribing for Individuals Living with Mental Illness in an Australian Community Setting: A Pilot Study”, Community Mental Health Journal, Vol. 57/1, pp. 189-195, https://doi.org/10.1007/s10597-020-00631-6.
[51] aging, N. (2023), Evidence-Based Program: A Matter of Balance, https://www.ncoa.org/article/evidence-based-program-a-matter-of-balance/.
[7] AIWH (2023), Falls, Australian Institute of Health and Welfare.
[144] Anderson, C. et al. (2002), “Stroke Rehabilitation Services to Accelerate Hospital Discharge and Provide Home-Based Care”, PharmacoEconomics, Vol. 20/8, pp. 537-552, https://doi.org/10.2165/00019053-200220080-00004.
[128] Anrys, P. et al. (2021), “An International Consensus List of Potentially Clinically Significant Drug-Drug Interactions in Older People”, Journal of the American Medical Directors Association, Vol. 22/10, pp. 2121-2133.e24, https://doi.org/10.1016/j.jamda.2021.03.019.
[158] Aspinal, F. et al. (2016), “New horizons: Reablement - supporting older people towards independence”, Age and Ageing, Vol. 45/5, pp. 574-578, https://doi.org/10.1093/ageing/afw094.
[107] Atramont, A. et al. (2019), “Pay for performance scheme for general practitioners in France: results in 2018”, European Journal of Public Health, Vol. 29/Supplement_4, https://doi.org/10.1093/eurpub/ckz187.147.
[119] Bannenberg, N. et al. (2021), “Preventive Home Visits”, American Journal of Health Economics, Vol. 7/4, pp. 457-496, https://doi.org/10.1086/714988.
[68] Barte, J. and G. Wendel-Vos (2017), “A Systematic Review of Financial Incentives for Physical Activity: The Effects on Physical Activity and Related Outcomes”, Behavioral Medicine, Vol. 43/2, pp. 79-90, https://doi.org/10.1080/08964289.2015.1074880.
[35] Batterham, R. et al. (2016), “Health literacy: applying current concepts to improve health services and reduce health inequalities”, Public Health, Vol. 132, pp. 3-12, https://doi.org/10.1016/j.puhe.2016.01.001.
[87] Bickerdike, L. et al. (2017), “Social prescribing: less rhetoric and more reality. A systematic review of the evidence”, BMJ Open, Vol. 7/4, p. e013384, https://doi.org/10.1136/bmjopen-2016-013384.
[44] BIÖG (n.d.), AlltagsTrainingsProgramm (ATP), https://www.gesund-aktiv-aelter-werden.de/bewegung/alltagstrainingsprogramm-atp/ (accessed on 1 July 2025).
[45] BIÖG (n.d.), “Evaluation des AlltagsTraingsProgramms (ATP)”, https://www.gesund-aktiv-aelter-werden.de/fachinformationen/bewegungsprogramme/alltagstrainingsprogramm-atp/atp-evaluation/ (accessed on 1 July 2025).
[26] Bostock, S. and A. Steptoe (2012), “Association between low functional health literacy and mortality in older adults: longitudinal cohort study”, BMJ, Vol. 344/mar15 3, pp. e1602-e1602, https://doi.org/10.1136/bmj.e1602.
[99] Buchan, S. et al. (2016), “Impact of pharmacist administration of influenza vaccines on uptake in Canada”, Canadian Medical Association Journal, Vol. 189/4, pp. E146-E152, https://doi.org/10.1503/cmaj.151027.
[154] Buhagiar, M. et al. (2019), “Assessment of Outcomes of Inpatient or Clinic-Based vs Home-Based Rehabilitation After Total Knee Arthroplasty”, JAMA Network Open, Vol. 2/4, p. e192810, https://doi.org/10.1001/jamanetworkopen.2019.2810.
[153] Buhagiar, M. et al. (2017), “Effect of Inpatient Rehabilitation vs a Monitored Home-Based Program on Mobility in Patients With Total Knee Arthroplasty”, JAMA, Vol. 317/10, p. 1037, https://doi.org/10.1001/jama.2017.1224.
[102] Burt, S., L. Hattingh and P. Czarniak (2018), “Evaluation of patient satisfaction and experience towards pharmacist-administered vaccination services in Western Australia”, International Journal of Clinical Pharmacy, Vol. 40/6, pp. 1519-1527, https://doi.org/10.1007/s11096-018-0738-1.
[94] Buttenheim, A. et al. (2022), “Effects of Ownership Text Message Wording and Reminders on Receipt of an Influenza Vaccination”, JAMA Network Open, Vol. 5/2, p. e2143388, https://doi.org/10.1001/jamanetworkopen.2021.43388.
[152] Candio, P. et al. (2022), “Cost-effectiveness of home-based stroke rehabilitation across Europe: A modelling study”, Health Policy, Vol. 126/3, pp. 183-189, https://doi.org/10.1016/j.healthpol.2022.01.007.
[56] Carande-Kulis, V. et al. (2015), “A cost–benefit analysis of three older adult fall prevention interventions”, Journal of Safety Research, Vol. 52, pp. 65-70, https://doi.org/10.1016/j.jsr.2014.12.007.
[54] CDC (2024), STEADI - Older Adult Fall Prevention, https://www.cdc.gov/steadi/about/index.html (accessed on 1 July 2025).
[8] CDC (2023), Older Adults Falls Data, Centers for Disease Control and Prevention.
[24] Chesser, A. et al. (2016), “Health Literacy and Older Adults”, Gerontology and Geriatric Medicine, Vol. 2, https://doi.org/10.1177/2333721416630492.
[50] Clemson, L. et al. (2012), “Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study): randomised parallel trial”, BMJ, Vol. 345/aug07 1, pp. e4547-e4547, https://doi.org/10.1136/bmj.e4547.
[135] Clemson, L. et al. (2019), “Environmental interventions for preventing falls in older people living in the community”, Cochrane Database of Systematic Reviews, https://doi.org/10.1002/14651858.cd013258.
[57] Clemson, L., M. Swann and Webb (2025), Stepping On, https://www.steppingon.com/ (accessed on 1 July 2025).
[106] CNAM (2023), Guide methodologique. Rémunération fur Objectifs de Santé Publique (ROSP) 2023. Medecin traitant de l’adulte, CNAM.
[137] Cochrane, A. et al. (2016), “Time-limited home-care reablement services for maintaining and improving the functional independence of older adults”, Cochrane Database of Systematic Reviews, Vol. 2016/10, https://doi.org/10.1002/14651858.cd010825.pub2.
[133] Colón-Emeric, C. et al. (2024), “Risk Assessment and Prevention of Falls in Older Community-Dwelling Adults”, JAMA, Vol. 331/16, p. 1397, https://doi.org/10.1001/jama.2024.1416.
[114] Consejería de Salud (2017), Examen de Salud para Mayores de 65 años, Junta de Andalucía,.
[38] Cook, L. (2021), “HIV stigma reduction and health literacy education program with a cross-generational populaton in an African American faith-based church”, Journal of Public Health, Vol. 29/5, pp. 1089-1106, https://doi.org/10.1007/s10389-020-01203-4.
[148] Crocker, T. et al. (2013), “The effect of physical rehabilitation on activities of daily living in older residents of long-term care facilities: systematic review with meta-analysis”, Age and Ageing, Vol. 42/6, pp. 682-688, https://doi.org/10.1093/ageing/aft133.
[31] Cutilli, C. et al. (2018), “Health Literacy, Health Disparities, and Sources of Health Information in U.S. Older Adults”, Orthopaedic Nursing, Vol. 37/1, pp. 54-65, https://doi.org/10.1097/NOR.0000000000000418.
[150] Dalal, H. et al. (2010), “Home based versus centre based cardiac rehabilitation: Cochrane systematic review and meta-analysis”, BMJ, Vol. 340/jan19 4, pp. b5631-b5631, https://doi.org/10.1136/bmj.b5631.
[103] Dalgado, A. et al. (2023), “Need a flu jab? Let’s try pharmacy: patient characteristics and experiences with pharmacy immunisation services”, International Journal of Pharmacy Practice, Vol. 31/4, pp. 380-386, https://doi.org/10.1093/ijpp/riad026.
[40] de Wit, L. et al. (2018), “Community-based initiatives improving critical health literacy: a systematic review and meta-synthesis of qualitative evidence”, BMC Public Health, Vol. 18/1, p. 40, https://doi.org/10.1186/s12889-017-4570-7.
[32] den Braver, N. et al. (2022), “The impact of mass-media campaigns on physical activity: a review of reviews through a policy lens”, European Journal of Public Health, Vol. 32/Supplement_4, pp. iv71-iv83, https://doi.org/10.1093/eurpub/ckac085.
[64] Devereux-Fitzgerald, A. et al. (2016), “The acceptability of physical activity interventions to older adults: A systematic review and meta-synthesis”, Social Science & Medicine, Vol. 158, pp. 14-23, https://doi.org/10.1016/j.socscimed.2016.04.006.
[91] Drinkwater, C., J. Wildman and S. Moffatt (2019), “Social prescribing”, BMJ, p. l1285, https://doi.org/10.1136/bmj.l1285.
[118] Duddy, C. et al. (2022), “Understanding what happens to attendees after an NHS Health Check: a realist review”, BMJ Open, Vol. 12/11, p. e064237, https://doi.org/10.1136/bmjopen-2022-064237.
[12] Dykes, P. et al. (2023), “Cost of Inpatient Falls and Cost-Benefit Analysis of Implementation of an Evidence-Based Fall Prevention Program”, JAMA Health Forum, Vol. 4/1, p. e225125, https://doi.org/10.1001/jamahealthforum.2022.5125.
[123] Egger, T., K. Künzi and T. Oesch (2010), Gesundheitsförderungs- und Präventionsprojekt «Zwäg ins Alter» (ZIA) – Evaluation der Umsetzungsphase 2008-2010.
[95] Eiden, A., J. Barratt and M. Nyaku (2023), “A review of factors influencing vaccination policies and programs for older adults globally”, Human Vaccines & Immunotherapeutics, Vol. 19/1, https://doi.org/10.1080/21645515.2022.2157164.
[4] El-Khoury, F. et al. (2015), “The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults:”, British Journal of Sports Medicine, Vol. 49/20, pp. 1348-1348, https://doi.org/10.1136/bmj.f6234.
[69] Finkelstein, E. et al. (2008), “A randomized study of financial incentives to increase physical activity among sedentary older adults”, Preventive Medicine, Vol. 47/2, pp. 182-187, https://doi.org/10.1016/j.ypmed.2008.05.002.
[11] Florence, C. et al. (2018), “Medical Costs of Fatal and Nonfatal Falls in Older Adults”, Journal of the American Geriatrics Society, Vol. 66/4, pp. 693-698, https://doi.org/10.1111/jgs.15304.
[98] Fukushima, S. et al. (2019), “Impact of the Introduction of a Vaccination Status Checkbox in Electronic Medical Records on Pneumococcal Vaccination Rates”, Juntendo Medical Journal, Vol. 65/1, pp. 92-94, https://doi.org/10.14789/jmj.2019.65.jmj18-re01.
[59] Fuzhong, L. (2022), “Tai Ji Quan - Moving for Better Balance - Program Information”.
[85] Gesundheit Österreich GmbH (2025), Fördercall für Social Prescribing, https://goeg.at/foerdercall_social_prescribing.
[66] Gómez-Redondo, P. et al. (2024), “Supervised Versus Unsupervised Exercise for the Improvement of Physical Function and Well-Being Outcomes in Older Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials”, Sports Medicine, Vol. 54/7, pp. 1877-1906, https://doi.org/10.1007/s40279-024-02024-1.
[73] Halpern, S. et al. (2015), “Randomized Trial of Four Financial-Incentive Programs for Smoking Cessation”, New England Journal of Medicine, Vol. 372/22, pp. 2108-2117, https://doi.org/10.1056/NEJMoa1414293.
[17] Hamer, M., K. Lavoie and S. Bacon (2013), “Taking up physical activity in later life and healthy ageing: the English longitudinal study of ageing”, British Journal of Sports Medicine, Vol. 48/3, pp. 239-243, https://doi.org/10.1136/bjsports-2013-092993.
[72] Hamilton, F. et al. (2013), “Effectiveness of providing financial incentives to healthcare professionals for smoking cessation activities: systematic review”, Tobacco Control, Vol. 22/1, pp. 3-8, https://doi.org/10.1136/tobaccocontrol-2011-050048.
[90] Hamilton-West, K., A. Milne and S. Hotham (2020), “New horizons in supporting older people’s health and wellbeing: is social prescribing a way forward?”, Age and Ageing, Vol. 49/3, pp. 319-326, https://doi.org/10.1093/ageing/afaa016.
[74] Harkins, K. et al. (2017), “A Trial of Financial and Social Incentives to Increase Older Adults’ Walking”, American Journal of Preventive Medicine, Vol. 52/5, pp. e123-e130, https://doi.org/10.1016/j.amepre.2016.11.011.
[15] Heckman, J., R. Pinto and P. Savelyev (2013), “Understanding the Mechanisms Through Which an Influential Early Childhood Program Boosted Adult Outcomes”, American Economic Review, Vol. 103/6, pp. 2052-2086, https://doi.org/10.1257/aer.103.6.2052.
[21] Hida, M. et al. (2023), “Investigation of factors influencing low physical activity levels in community-dwelling older adults with chronic pain: a cross-sectional study”, Scientific Reports, Vol. 13/1, https://doi.org/10.1038/s41598-023-41319-7.
[13] Hoffman, G. et al. (2019), “Posthospital Fall Injuries and 30-Day Readmissions in Adults 65 Years and Older”, JAMA Network Open, Vol. 2/5, p. e194276, https://doi.org/10.1001/jamanetworkopen.2019.4276.
[124] Højgaard, B. et al. (2019), Forebyggende hjemmebesøg til ældre - tidlig opsporing - Litteraturgennemgang og ti kommuners erfaringer.
[111] Ho, L. et al. (2025), “Effect of UK Quality and Outcomes Framework pay-for-performance programme on quality of primary care: systematic review with quantitative synthesis”, BMJ, Vol. 389, p. e083424, https://doi.org/10.1136/bmj-2024-083424.
[43] HSE (2024), About AFFINITY National Falls and bone health project 2018-2023, https://www.hse.ie/eng/services/list/4/olderpeople/falls-prevention-and-bone-health/ (accessed on 30 June 2025).
[96] Hurley, L. et al. (2018), “RCT of Centralized Vaccine Reminder/Recall for Adults”, American Journal of Preventive Medicine, Vol. 55/2, pp. 231-239, https://doi.org/10.1016/j.amepre.2018.04.022.
[86] Husk, K. et al. (2018), “Social prescribing: where is the evidence?”, British Journal of General Practice, Vol. 69/678, pp. 6-7, https://doi.org/10.3399/bjgp19x700325.
[126] Hussain, S. et al. (2023), “Associations of Change in Body Size With All-Cause and Cause-Specific Mortality Among Healthy Older Adults”, JAMA Network Open, Vol. 6/4, p. e237482, https://doi.org/10.1001/jamanetworkopen.2023.7482.
[92] Jacobson Vann, J. et al. (2018), “Patient reminder and recall interventions to improve immunization rates”, Cochrane Database of Systematic Reviews, Vol. 2018/1, https://doi.org/10.1002/14651858.cd003941.pub3.
[93] Jacobson Vann, J. et al. (2018), “Patient reminder and recall interventions to improve immunization rates”, Cochrane Database of Systematic Reviews, Vol. 2018/1, https://doi.org/10.1002/14651858.cd003941.pub3.
[81] Kamenica, E. (2012), “Behavioral Economics and Psychology of Incentives”, Annual Review of Economics, Vol. 4/1, pp. 427-452, https://doi.org/10.1146/annurev-economics-080511-110909.
[161] Kjerstad, E. and H. Tuntland (2016), “Reablement in community-dwelling older adults: a cost-effectiveness analysis alongside a randomized controlled trial”, Health Economics Review, Vol. 6/1, https://doi.org/10.1186/s13561-016-0092-8.
[75] Klein, E. and J. Karlawish (2010), “Challenges and Opportunities for Developing and Implementing Incentives to Improve Health‐Related Behaviors in Older Adults”, Journal of the American Geriatrics Society, Vol. 58/9, pp. 1758-1763, https://doi.org/10.1111/j.1532-5415.2010.03030.x.
[47] Komatsu, H. et al. (2017), “Regular group exercise contributes to balanced health in older adults in Japan: a qualitative study”, BMC Geriatrics, Vol. 17/1, p. 190, https://doi.org/10.1186/s12877-017-0584-3.
[115] Krogsbøll, L., K. Jørgensen and P. Gøtzsche (2019), “General health checks in adults for reducing morbidity and mortality from disease”, Cochrane Database of Systematic Reviews, Vol. 2019/1, https://doi.org/10.1002/14651858.cd009009.pub3.
[120] Kronborg, C. et al. (2006), “Cost effectiveness of preventive home visits to the elderly”, The European Journal of Health Economics, Vol. 7/4, pp. 238-246, https://doi.org/10.1007/s10198-006-0361-2.
[63] Kullgren, J. et al. (2014), “A Mixed-Methods Randomized Controlled Trial of Financial Incentives and Peer Networks to Promote Walking Among Older Adults”, Health Education & Behavior, Vol. 41/1_suppl, pp. 43S-50S, https://doi.org/10.1177/1090198114540464.
[20] Kwon, D. and Y. Kwon (2025), “Patterns of health literacy and influencing factors differ by age: a cross-sectional study”, BMC Public Health, Vol. 25/1, https://doi.org/10.1186/s12889-025-22838-6.
[155] Lee, H. and S. Lee (2022), “Effectiveness of multicomponent home‐based rehabilitation in older patients after hip fracture surgery: A systematic review and meta‐analysis”, Journal of Clinical Nursing, Vol. 32/1-2, pp. 31-48, https://doi.org/10.1111/jocn.16256.
[132] Lee, J. et al. (2021), “Deprescribing fall-risk increasing drugs (FRIDs) for the prevention of falls and fall-related complications: a systematic review and meta-analysis”, BMJ Open, Vol. 11/2, p. e035978, https://doi.org/10.1136/bmjopen-2019-035978.
[29] Lee, M. and J. Oh (2020), “Health-Related Quality of Life in Older Adults: Its Association with Health Literacy, Self-Efficacy, Social Support, and Health-Promoting Behavior”, Healthcare, Vol. 8/4, p. 407, https://doi.org/10.3390/healthcare8040407.
[149] Lenze, E. et al. (2019), “Effect of Enhanced Medical Rehabilitation on Functional Recovery in Older Adults Receiving Skilled Nursing Care After Acute Rehabilitation”, JAMA Network Open, Vol. 2/7, p. e198199, https://doi.org/10.1001/jamanetworkopen.2019.8199.
[104] Levévre, M., M. Levy and C. Van de Voorde (2023), General practitioner remuneration: overview of selected countries with a mixed system of fee-for-service and lump-sum payments, Belgian Health Care Knowledge Centre.
[159] Lewin, G., Alfonso and J. Alan (2013), “Evidence for the long term cost effectiveness of home care reablement programs”, Clinical Interventions in Aging, p. 1273, https://doi.org/10.2147/cia.s49164.
[160] Lewin, G. et al. (2014), “A comparison of the home‐care and healthcare service use and costs of older Australians randomised to receive a restorative or a conventional home‐care service”, Health & Social Care in the Community, Vol. 22/3, pp. 328-336, https://doi.org/10.1111/hsc.12092.
[116] Liss, D. et al. (2021), “General Health Checks in Adult Primary Care”, JAMA, Vol. 325/22, p. 2294, https://doi.org/10.1001/jama.2021.6524.
[142] Long, L. et al. (2019), “Exercise-based cardiac rehabilitation for adults with heart failure”, Cochrane Database of Systematic Reviews, Vol. 2019/1, https://doi.org/10.1002/14651858.cd003331.pub5.
[70] Luong, M. et al. (2021), “The Impact of Financial Incentives on Physical Activity: A Systematic Review and Meta-Analysis”, American Journal of Health Promotion, Vol. 35/2, pp. 236-249, https://doi.org/10.1177/0890117120940133.
[27] MacLeod, S. et al. (2017), “The impact of inadequate health literacy on patient satisfaction, healthcare utilization, and expenditures among older adults”, Geriatric Nursing, Vol. 38/4, pp. 334-341, https://doi.org/10.1016/j.gerinurse.2016.12.003.
[60] Mandigout, S. et al. (2025), Does the offer of a supervised program improve community-dwelling older adults’ engagement in physical activity? A restrospective study, Society for Transparency, Openness, and Replication in Kinesiology, https://doi.org/10.51224/srxiv.550.
[79] Matei, R. et al. (2015), “Acceptability of a theory-based sedentary behaviour reduction intervention for older adults (‘On Your Feet to Earn Your Seat’)”, BMC Public Health, Vol. 15/1, p. 606, https://doi.org/10.1186/s12889-015-1921-0.
[117] McCracken, C. et al. (2024), “NHS Health Check attendance is associated with reduced multiorgan disease risk: a matched cohort study in the UK Biobank”, BMC Medicine, Vol. 22/1, https://doi.org/10.1186/s12916-023-03187-w.
[77] McGill, B. et al. (2018), “Acceptability of financial incentives for maintenance of weight loss in mid-older adults: a mixed methods study”, BMC Public Health, Vol. 18/1, p. 244, https://doi.org/10.1186/s12889-018-5136-z.
[127] McMinn, J., C. Steel and A. Bowman (2011), “Investigation and management of unintentional weight loss in older adults”, BMJ, Vol. 342/mar29 1, pp. d1732-d1732, https://doi.org/10.1136/bmj.d1732.
[112] Merilind, E. et al. (2016), “Pay for performance of Estonian family doctors and impact of different practice- and patient-related characteristics on a good outcome: A quantitative assessment”, Medicina, Vol. 52/3, pp. 192-198, https://doi.org/10.1016/j.medici.2016.04.003.
[138] Metzelthin, S. et al. (2022), “Development of an internationally accepted definition of reablement: a Delphi study”, Ageing and Society, Vol. 42/3, pp. 703-718, https://doi.org/10.1017/S0144686X20000999.
[42] Mgbeojedo, U. et al. (2023), “Effects of Otago Exercise Program on Physical and Psychosocial Functions Among Community-Dwelling and Institutionalized Older Adults: A Scoping Review”, INQUIRY: The Journal of Health Care Organization, Provision, and Financing, Vol. 60, https://doi.org/10.1177/00469580231165858.
[34] Michel, J. and J. Goldberg (2021), “Education, Healthy Ageing and Vaccine Literacy”, The Journal of nutrition, health and aging, Vol. 25/5, pp. 698-701, https://doi.org/10.1007/s12603-021-1627-1.
[105] Milstein, R. and J. Schreyoegg (2016), “Pay for performance in the inpatient sector: A review of 34 P4P programs in 14 OECD countries”, Health Policy, Vol. 120/10, pp. 1125-1140, https://doi.org/10.1016/j.healthpol.2016.08.009.
[113] Ministère du Travail, D. (2023), Mon bilan prévention : en quoi ça consiste ?, https://sante.gouv.fr/prevention-en-sante/preserver-sa-sante/mon-bilan-prevention-les-rendez-vous-sante-aux-ages-cles-de-la-vie/article/mon-bilan-prevention-en-quoi-ca-consiste.
[71] Mitchell, M. et al. (2020), “Financial incentives for physical activity in adults: systematic review and meta-analysis”, British Journal of Sports Medicine, Vol. 54/21, pp. 1259-1268, https://doi.org/10.1136/bjsports-2019-100633.
[28] Moreira, L. (2018), “Health literacy for people-centred care: Where do OECD countries stand?”, OECD Health Working Papers, No. 107, OECD Publishing, Paris, https://doi.org/10.1787/d8494d3a-en.
[147] Mosher, C. et al. (2022), “Cost-effectiveness of Pulmonary Rehabilitation Among US Adults With Chronic Obstructive Pulmonary Disease”, JAMA Network Open, Vol. 5/6, p. e2218189, https://doi.org/10.1001/jamanetworkopen.2022.18189.
[157] Mouchaers, I. et al. (2023), “Implementing reablement in community care: How do we succeed?”, Innovation in Aging, Vol. 7/Supplement_1, pp. 693-693, https://doi.org/10.1093/geroni/igad104.2249.
[156] Mouchaers, I. et al. (2023), “Development and content of a community-based reablement programme (I-MANAGE): a co-creation study”, BMJ Open, Vol. 13/8, p. e070890, https://doi.org/10.1136/bmjopen-2022-070890.
[97] Naito, T., H. Yokokawa and A. Watanabe (2018), “Impact of the national routine vaccination program on 23-valent pneumococcal polysaccharide vaccine vaccination rates in elderly persons in Japan”, Journal of Infection and Chemotherapy, Vol. 24/6, pp. 496-498, https://doi.org/10.1016/j.jiac.2018.01.004.
[55] Neser, S. (2020), Stopping Elderly Accidents, Deaths and Injuries: Fall Prevention for Community-Dwelling Older Adults, University of Maryland, Maryland.
[121] Newman, A. (ed.) (2019), “The Effects of Preventive Home Visits on Older People’s Use of Health Care and Social Services and Related Costs”, The Journals of Gerontology: Series A, Vol. 75/8, pp. 1586-1593, https://doi.org/10.1093/gerona/glz139.
[46] Ngandu, T. et al. (2015), “A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial”, The Lancet, Vol. 385/9984, pp. 2255-2263, https://doi.org/10.1016/S0140-6736(15)60461-5.
[130] Nyborg, G. et al. (2015), “The Norwegian General Practice – Nursing Home criteria (NORGEP-NH) for potentially inappropriate medication use: A web-based Delphi study”, Scandinavian Journal of Primary Health Care, Vol. 33/2, pp. 134-141, https://doi.org/10.3109/02813432.2015.1041833.
[19] OECD (2025), Does Healthcare Deliver?: Results from the Patient-Reported Indicator Surveys (PaRIS), OECD Publishing, Paris, https://doi.org/10.1787/c8af05a5-en.
[23] OECD (2025), Health expenditure and financing, https://data-explorer.oecd.org/s/2wd.
[83] OECD (2024), An analysis of the state of integration of home-based integrated health and social care services (Output 3), OECD, Paris, https://www.oecd.org/en/about/programmes/dg-reform/towards-person-centered-integrated-care-in-italy.html.
[16] OECD (2023), Education at a Glance 2023: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/e13bef63-en.
[5] OECD (2023), Health at a Glance 2023: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/7a7afb35-en.
[6] OECD (2019), The Heavy Burden of Obesity: The Economics of Prevention, OECD Health Policy Studies, OECD Publishing, Paris, https://doi.org/10.1787/67450d67-en.
[131] OECD (2018), Care Needed: Improving the Lives of People with Dementia, OECD Health Policy Studies, OECD Publishing, Paris, https://doi.org/10.1787/9789264085107-en.
[14] OECD/WHO (2023), Step Up! Tackling the Burden of Insufficient Physical Activity in Europe, OECD Publishing, Paris, https://doi.org/10.1787/500a9601-en.
[25] Park, Y. et al. (2024), “Health Literacy in Fall-Prevention Strategy: A Scoping Review”, Asian Nursing Research, Vol. 18/5, pp. 532-544, https://doi.org/10.1016/j.anr.2024.10.011.
[76] Patel, M. et al. (2016), “Framing Financial Incentives to Increase Physical Activity Among Overweight and Obese Adults”, Annals of Internal Medicine, Vol. 164/6, p. 385, https://doi.org/10.7326/M15-1635.
[62] Patel, M. et al. (2016), “Individual Versus Team-Based Financial Incentives to Increase Physical Activity: A Randomized, Controlled Trial”, Journal of General Internal Medicine, Vol. 31/7, pp. 746-754, https://doi.org/10.1007/s11606-016-3627-0.
[145] Peiris, C. et al. (2018), “Additional Physical Therapy Services Reduce Length of Stay and Improve Health Outcomes in People With Acute and Subacute Conditions: An Updated Systematic Review and Meta-Analysis”, Archives of Physical Medicine and Rehabilitation, Vol. 99/11, pp. 2299-2312, https://doi.org/10.1016/j.apmr.2018.03.005.
[88] Percival, A. et al. (2022), “Systematic review of social prescribing and older adults: where to from here?”, Family Medicine and Community Health, Vol. 10/Suppl 1, p. e001829, https://doi.org/10.1136/fmch-2022-001829.
[61] Picorelli, A. et al. (2014), “Adherence to exercise programs for older people is influenced by program characteristics and personal factors: a systematic review”, Journal of Physiotherapy, Vol. 60/3, pp. 151-156, https://doi.org/10.1016/j.jphys.2014.06.012.
[18] Pinheiro, M. et al. (2022), “Impact of physical activity programs and services for older adults: a rapid review”, International Journal of Behavioral Nutrition and Physical Activity, Vol. 19/1, https://doi.org/10.1186/s12966-022-01318-9.
[100] Public Health Agency of Canada (2025), Seasonal influenza vaccination coverage, Public Health Agency of Canada.
[10] Public Health Agency of Canada (2022), Surveillance report on falls among older adults in Canada, Public Health Agency of Canada.
[37] Rivera-Hernandez, M. (2015), “The Role of Religious Leaders in Health Promotion for Older Mexicans with Diabetes”, Journal of Religion and Health, Vol. 54/1, pp. 303-315, https://doi.org/10.1007/s10943-014-9829-z.
[22] Rostamzadeh, A. et al. (2020), “Health Literacy in Individuals at Risk for Alzheimer’s Dementia: A Systematic Review”, The Journal of Prevention of Alzheimer’s Disease, Vol. 7/1, pp. 47-55, https://doi.org/10.14283/jpad.2019.34.
[36] Rubin, D. et al. (2014), “Training Meals on Wheels Volunteers as Health Literacy Coaches for Older Adults”, Health Promotion Practice, Vol. 15/3, pp. 448-454, https://doi.org/10.1177/1524839913494786.
[110] Ryan, A. et al. (2016), “Long-term evidence for the effect of pay-for-performance in primary care on mortality in the UK: a population study”, The Lancet, Vol. 388/10041, pp. 268-274, https://doi.org/10.1016/s0140-6736(16)00276-2.
[122] Sahlen, K. et al. (2008), “Preventive home visits to older people are cost-effective”, Scandinavian Journal of Public Health, Vol. 36/3, pp. 265-271, https://doi.org/10.1177/1403494807086983.
[108] Saint-Lary, O. et al. (2015), “Patients’ views on pay for performance in France: a qualitative study in primary care”, British Journal of General Practice, Vol. 65/637, pp. e552-e559, https://doi.org/10.3399/bjgp15x686149.
[65] Saito, Y. et al. (2021), “A community-wide intervention to promote physical activity: A five-year quasi-experimental study”, Preventive Medicine, Vol. 150, p. 106708, https://doi.org/10.1016/j.ypmed.2021.106708.
[67] Salmani, B. et al. (2025), “Financial incentives for physical activity in adults: Systematic review and meta-analysis update”, Preventive Medicine, Vol. 192, p. 108237, https://doi.org/10.1016/j.ypmed.2025.108237.
[9] Santé Publique (2020), Chute, Santé Publique, https://www.santepubliquefrance.fr/maladies-et-traumatismes/traumatismes/chute.
[49] Senik, C., C. Milcent and C. Gerves (2015), An evaluation of a physical activity programme designed for elderly people, http://www.parisschoolofeconomics.eu.
[129] Seppala, L. et al. (2020), “STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk): a Delphi study by the EuGMS Task and Finish Group on Fall-Risk-Increasing Drugs”, Age and Ageing, Vol. 50/4, pp. 1189-1199, https://doi.org/10.1093/ageing/afaa249.
[2] Sherrington, C. et al. (2019), “Exercise for preventing falls in older people living in the community”, Cochrane Database of Systematic Reviews, Vol. 2019/1, https://doi.org/10.1002/14651858.cd012424.pub2.
[151] Shields, G. et al. (2022), “EE431 The Cost-Effectiveness of Home-Based Cardiac Rehabilitation Interventions: A Systematic Review”, Value in Health, Vol. 25/12, p. S140, https://doi.org/10.1016/j.jval.2022.09.677.
[146] Shields, G. et al. (2023), “Cost-effectiveness of home-based cardiac rehabilitation: a systematic review”, Heart, Vol. 109/12, pp. 913-920, https://doi.org/10.1136/heartjnl-2021-320459.
[143] Shields, G. et al. (2018), “Cost-effectiveness of cardiac rehabilitation: a systematic review”, Heart, Vol. 104/17, pp. 1403-1410, https://doi.org/10.1136/heartjnl-2017-312809.
[109] Sicsic, J. and C. Franc (2016), “Impact assessment of a pay-for-performance program on breast cancer screening in France using micro data”, The European Journal of Health Economics, Vol. 18/5, pp. 609-621, https://doi.org/10.1007/s10198-016-0813-2.
[141] Song, I. et al. (2023), “Impact of cardiac rehabilitation on cardiovascular event in Korea”, Scientific Reports, Vol. 13/1, https://doi.org/10.1038/s41598-023-46503-3.
[1] Sowa, A. et al. (2016), “Predictors of healthy ageing: public health policy targets”, BMC Health Services Research, Vol. 16/S5, https://doi.org/10.1186/s12913-016-1520-5.
[101] Stämpfli, D. et al. (2020), “Community pharmacist-administered seasonal influenza vaccination: a national customer survey”, Journal of Pharmaceutical Policy and Practice, Vol. 13/1, https://doi.org/10.1186/s40545-020-00259-7.
[52] Stay Active and Independent for Life (SAIL) (2025), Stay Active and Independent for Life, https://www.sailfitness.org/ (accessed on 1 July 2025).
[33] Stead, M. et al. (2019), “Mass media to communicate public health messages in six health topic areas: a systematic review and other reviews of the evidence”, Public Health Research, Vol. 7/8, pp. 1-206, https://doi.org/10.3310/phr07080.
[30] Stormacq, C., S. Van den Broucke and J. Wosinski (2019), “Does health literacy mediate the relationship between socioeconomic status and health disparities? Integrative review”, Health Promotion International, Vol. 34/5, pp. e1-e17, https://doi.org/10.1093/heapro/day062.
[125] Sundhedsstyrelsen (2020), Forebyggende hjemmebesøg til ældre. Vejledning.
[58] Tai Ji Quan: Moving for Better Balance (2024), About The Program, https://tjqmbb.org/ (accessed on 1 July 2025).
[82] Tambor, M. et al. (2016), “Financial incentives for a healthy life style and disease prevention among older people: a systematic literature review”, BMC Health Services Research, Vol. 16/S5, p. 426, https://doi.org/10.1186/s12913-016-1517-0.
[41] Tan, M. (ed.) (2021), “The effects of the Otago Exercise Programme on actual and perceived balance in older adults: A meta-analysis”, PLOS ONE, Vol. 16/8, p. e0255780, https://doi.org/10.1371/journal.pone.0255780.
[140] Taylor, R., H. Dalal and S. McDonagh (2021), “The role of cardiac rehabilitation in improving cardiovascular outcomes”, Nature Reviews Cardiology, Vol. 19/3, pp. 180-194, https://doi.org/10.1038/s41569-021-00611-7.
[48] Thalund Grønne, D. et al. (2021), GLA:D ® Annual report 2020, http://www.gladdanmark.dk.
[84] The King’s Fund (2020), What is social prescribing?, https://www.kingsfund.org.uk/insight-and-analysis/long-reads/social-prescribing.
[136] the Task Force on Global Guidelines for Falls in Older Adults (2022), “Medication reviews and deprescribing as a single intervention in falls prevention: a systematic review and meta-analysis”, Age and Ageing, Vol. 51/9, https://doi.org/10.1093/ageing/afac191.
[39] Uemura, K., M. Yamada and H. Okamoto (2021), “The Effectiveness of an Active Learning Program in Promoting a Healthy Lifestyle among Older Adults with Low Health Literacy: A Randomized Controlled Trial”, Gerontology, Vol. 67/1, pp. 25-35, https://doi.org/10.1159/000511357.
[80] Vlaev, I. et al. (2019), “Changing health behaviors using financial incentives: a review from behavioral economics”, BMC Public Health, Vol. 19/1, p. 1059, https://doi.org/10.1186/s12889-019-7407-8.
[139] Yagi, M. et al. (2017), “Impact of Rehabilitation on Outcomes in Patients With Ischemic Stroke”, Stroke, Vol. 48/3, pp. 740-746, https://doi.org/10.1161/strokeaha.116.015147.
[78] Yamashita, R. et al. (2021), “Effects of social network incentives and financial incentives on physical activity and social capital among older women: a randomized controlled trial”, BMC Public Health, Vol. 21/1, https://doi.org/10.1186/s12889-021-10175-3.
[3] Yao, S. et al. (2020), “Do nonpharmacological interventions prevent cognitive decline? a systematic review and meta-analysis”, Translational Psychiatry, Vol. 10/1, https://doi.org/10.1038/s41398-020-0690-4.
[53] York, S. et al. (2011), “A Translational Research Evaluation of the Stay Active and Independent for Life (SAIL) Community-Based Fall Prevention Exercise and Education Program”, Health Promotion Practice, Vol. 12/6, pp. 832-839, https://doi.org/10.1177/1524839910375026.
[134] Ziebart, C. et al. (2020), “The Efficacy of Fall Hazards Identification on Fall Outcomes: A Systematic Review With Meta-analysis”, Archives of Rehabilitation Research and Clinical Translation, Vol. 2/3, p. 100065, https://doi.org/10.1016/j.arrct.2020.100065.