In recent decades, the share of the population aged 65 years and over has nearly doubled on average across OECD countries, increasing from less than 9% in 1960 to more than 17% in 2019. Declining fertility rates and longer life expectancy (see indicator “Life expectancy by sex and education level” in Chapter 3) have meant that older people make up an increasing proportion of the population in OECD countries. Across the 38 OECD member countries, more than 232 million people were aged 65 and over in 2019, including more than 62 million who were at least 80 years old. As ageing represents one of the key risk factors for serious illness or death from COVID‑19, the pandemic has driven home the need to ensure that health systems are prepared to adapt to the changing needs of an older population.

All OECD countries have experienced tremendous gains in life expectancy at age 65 for both men and women in recent decades. On average across OECD countries, life expectancy at age 65 increased by 5.7 years between 1970 and 2019 (). Seven countries (Australia, Finland, Ireland, Japan, Korea, Luxembourg and Spain) enjoyed gains of a least seven years over the period; two countries (Lithuania and Mexico) experienced an increase of less than three years between 1970 and 2019.

Even as life expectancy at age 65 has increased across OECD countries, many adults spend a high proportion of their older lives in poor or fair health (see indicator “Life expectancy and healthy life expectancy at age 65”). In 2019, more than half the population aged 65 and over in 36 OECD countries reported being in poor or fair health (). Older people in eastern European OECD countries reported some of the highest rates of poor or fair health: more than four‑fifths of people aged 65 and over reported their health to be fair, poor or very poor in Lithuania, Latvia, Portugal, Estonia and Hungary. Women are slightly more likely to report being in poor or fair health than men: 57% of women reported their health to be fair, poor or very poor on average across OECD countries in 2019, compared with 53% of men. Less than 40% of the total population aged 65 and over reported being in poor or fair health in Ireland, Switzerland, Norway, Sweden and the Netherlands. The lowest rate of poor or fair health for women was reported in Ireland (28.8%), while the lowest rate for men was reported in Switzerland (30.1%).

Dementia represents one of the greatest challenges associated with population ageing. The term “dementia” describes a variety of brain disorders, including Alzheimer’s disease, which progressively lead to brain damage and cause a gradual deterioration of a person’s functional capacity and social relations. Despite billions of dollars spent on research into dementia-related disorders, there is no cure, and substantially disease‑modifying treatments may only now be emerging.

As OECD populations are ageing rapidly, demand is increasing on the LTC sector to provide care for more, and older, people with complex conditions and heightened needs for expert care. This has put an enormous strain on LTC systems – a strain that is projected to increase in the coming years as OECD populations continue to age.

Across OECD countries, an average of 10.7% of people aged 65 and over received long-term care, either at home or in long-term care facilities, in 2019 (). More than one in five people aged 65 and over received LTC services in Israel (23.1%) and Switzerland (23.4%), compared with less than 5% in Canada (3.8%), the Slovak Republic (3.4%), Ireland (3.2%), Japan (2.6%), Portugal (1.9%) and Poland (0.8%).

Family and friends are the most important source of care for people with LTC needs in OECD countries. Because of the informal nature of the care they provide, it is not easy to get comparable data on the number of people caring for family and friends across countries, nor on the frequency of their caregiving. The data presented in this section come from national or international health surveys and refer to people aged 50 years and over who report providing care and assistance to family members and friends.

LTC is a labour-intensive service, and formal care is in many cases a necessary complement to informal, unpaid work in supporting people with LTC needs (see indicator “Informal carers”). Formal LTC workers are defined as paid staff – typically nurses and personal carers – who provide care and/or assistance to people limited in their daily activities at home or in institutions, excluding hospitals. There are on average five LTC workers per 100 people aged 65 and over across 32 OECD countries, ranging from 12 in Norway and Sweden to less than one in Greece, Poland and Portugal (). COVID‑19 has exacerbated the need for higher staffing levels to replace sick or isolating LTC workers and to take care of ill LTC recipients. While nearly all OECD countries with available data have introduced measures (such as funding) to recruit LTC workers directly or indirectly, more could be done (OECD, forthcoming[3]).

While countries have increasingly taken steps to ensure that people in need of LTC services who wish to live in their homes for as long as possible can do so, many people will at some point require LTC services that cannot be delivered at home. The number of beds in LTC facilities and in LTC departments in hospitals offers a measure of the resources available for delivering LTC services to individuals outside their home.

Compared to other areas of health care, spending on LTC has seen the highest growth in recent years (see indicator “Health expenditure by type of service” in Chapter 7). Population ageing leads to more people needing ongoing health and social care; rising incomes increase expectations of the quality of life in old age; the supply of informal care is potentially shrinking; and productivity gains are difficult to achieve in such a labour-intensive sector. All these factors create upward cost pressures, and substantial further increases in LTC spending in OECD countries are projected for the coming years.

Improving care at the end of life, which refers to the health and social care provided as an individual nears the end of life, is becoming a growing global public health priority and an important aspect of people‑centred policies. With ageing populations and changing epidemiology of disease, more people will require better care and support in their last phase of life. During the COVID‑19 pandemic, containment measures adopted to prevent the spread of the virus – including bans on visitors to LTC facilities and hospitals, even for dying patients – ran counter to key principles of high-quality, person-centred end-of-life care (EOLC). The difficult experience at the end of life for many patients and their families during the pandemic has underscored the importance of person-centred, accessible and high-quality EOLC services.