Working Paper No. 142

The Rise in Life Expectancy, Health Trends among the Elderly, and the Demand for Health and Social Care

The objective of this report is to review the evidence on (a) ageing and health and (b) the demand for health and social care among the elderly. The issues discussed are: does health status of the elderly improve over time, and how do the trends in health status of the elderly affect the demand for health and social care? The review is based on some 100 published scientific papers. While it is not a complete review, it covers most recent empirical studies of health trends and the changing pattern of demand for health and social care.

Health is a multidimensional concept. It includes self-assessed health, presence of disease, functional status, and disability, usually expressed as capacity to perform activities of daily living (ADL). There are certainly elderly who have no problems in any of these dimensions. But health among elderly varies, and to a much larger extent than among younger people. Many elderly have one or more chronic diseases; if the disease is well controlled, there may be no problems in other dimensions of health. If not, other health problems may follow, lowering self-assessed health, creating ADL limitations etc.

When analyzing health trends, it is important to cover all four dimensions of health, since the impact on health care and social care differ, depending on which dimension shows improved health.

The reviewed literature provides strong evidence that the prevalence of chronic disease among the elderly has increased over time. There is also fairly strong evidence that the consequences of disease have become less problematic due to medical progress: decreased mortality risk, milder and slower development over time, making the time with disease (and health care treatment) longer but less troublesome than before.

Evidence also suggests the postponement of functional limitations and disability. Some of the reduction in disability may certainly be attributed to improvements in treatments of chronic diseases. But they are apparently also due to the increased use of assistive technology, public transport, accessibility of buildings, etc.

The results, hence, indicate that the ageing individual is expected to need health care for a longer (and not necessarily postponed) period of time than previous generations but elderly care for a shorter (and certainly postponed) period of time. Thus, one might say that the development overall has been in accordance with the “dynamic equilibrium” scenario.

A general conclusion of the empirical literature seems to be that expenditures will not be lower over remaining life years but they will be distributed over a longer period of time.

Several authors warn against the potential negative impact of an increasing prevalence of obesity on life expectancy, health, and health and social care. The role of technological advances within medicine is highlighted by many authors and its consequences for the elderly analyzed