In recent decades, the share of the population aged 65 and over has doubled on average across OECD countries, increasing from less than 9% in 1960 to 18% in 2021. Declining fertility rates and longer life expectancy (see section on “Life expectancy at birth” 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 242 million people were aged 65 and over in 2021, including more than 64 million who were at least 80 years old. These demographic developments highlight the importance of ensuring that health systems are equipped to meet 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, although these gains have been diminished by the impact of COVID‑19. On average across OECD countries, life expectancy at age 65 increased by 6 years between 1970 and 2021, and by 2.1 years between 2000 and 2021. Five countries (Korea, Ireland, Chile, Australia and Portugal) enjoyed gains of a least 3 years between 2000 and 2021; five countries (United States, Poland, Latvia, Hungary and the Slovak Republic) experienced an increase of less than 1 year over the period, and one country (Mexico) experienced a slight decrease of 0.3 years (Figure 10.3). In Lithuania, life expectancy at age 65 remained unchanged between 2000 and 2021.

Even as life expectancy at age 65 has increased across OECD countries, not all older adults spend their remaining years in good health (see section on “Life expectancy and healthy life expectancy at age 65”). In 2021, less than half the population aged 65 and over in 36 OECD countries reported being in good or very good health (Figure 10.5). Excluding countries whose data are not directly comparable (see the “Definition and comparability” box), more than three‑fifths of older respondents reported being in good or very good health in only five countries (Costa Rica, Ireland, Norway, Sweden and Switzerland). On average, fewer than half of older adults (45.9%) reported being in good or very good health across 36 OECD countries. Fewer than 30% of older adults reported being in good health in 11 OECD countries, including six – Croatia, Estonia, Korea, Latvia, Lithuania and Portugal – in which fewer than 25% reported being in good or very good health. Men are slightly more likely to report being in good health than women: 48% of men reported their health to be good or very good on average across OECD countries in 2021, compared to 45% of women. Excluding New Zealand, Canada and the United States (whose results are biased upward, see Definition and Comparability box), the highest rates of good health were reported in Switzerland for both men (72%) and women (67%).

One of the greatest challenges of population ageing across the world, dementia describes a variety of brain disorders, including Alzheimer’s disease, which progressively lead to brain cells and cause a gradual deterioration of a person’s functional capacity and social relations. Years of research and billions of dollars invested in dementia-related disorders have only recently begun to pay off, with the first treatment for Alzheimer’s disease in decades approved in the United States in July 2023. Even with these promising medical advances, there is no cure, and even disease‑modifying treatments are only likely to slow the progression of the condition, with the possibility of concerning side‑effects.

OECD populations are ageing rapidly. The demand on the LTC sector to provide care for more, and older, people with complex conditions and heightened needs for expert care is increasing as a result. This puts an enormous strain on LTC systems – a strain that is projected to increase in the coming years as OECD populations continue to age (see section on “Demographic trends”).

Across OECD countries, an average of 11.5% of people aged 65 and over received LTC, either at home or in LTC facilities, in 2021 (Figure 10.12). More than 20% of people aged 65 and over received LTC services in four OECD countries (Lithuania, Israel, Switzerland and Germany), while fewer than 4% received LTC services in eight countries (Canada, the Slovak Republic, Ireland, Japan, Portugal, the United States, Poland and Latvia). Cultural norms around the degree to which families look after older people may also be an important driver of the use of formal services (see section on “Informal carers”).

Informal carers are a major – and often the only – source of care for people with LTC needs across OECD countries. Among analysed 19 OECD countries, about 60% of older people reported receiving only informal care (Rocard and Llena-Nozal, 2022[1]). Informal care is provided by family members, friends and people in social networks to individuals who need support with everyday tasks. Due to the informal nature of care, comparable data are difficult to obtain. The data discussed in this section stem from international and national surveys. There are differences in the definition of informal care across these surveys, which affects the comparability of the data (see the “Definition and comparability” box).

All OECD countries offer some degree of formal LTC to assist people in need of care in their daily activities. Care is provided by LTC workers, who are defined as paid staff – typically nurses and personal carers – providing care and/or assistance to people limited in their daily activities at home or in institutions, excluding hospitals.

Many people receiving LTC wish to remain at home for as long as possible, and most countries have increasingly taken steps in recent years to support this preference and promote community and home‑based care. However, depending on individual circumstances, a move to LTC facilities may – at least eventually – be the most appropriate option. For example, people living alone and requiring round-the‑clock care and supervision, or people living in remote areas with limited home care support, may find it difficult to manage at home as their needs increase, and will at some point require LTC services that cannot be delivered at home. It is therefore important that countries retain an appropriate level of residential LTC capacity. 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.

While LTC spending has been growing at a slower pace than overall health spending in most OECD countries since the pandemic, LTC was the healthcare activity with the highest growth rate leading up to this health emergency. It is probable that LTC spending growth will outpace health spending growth again in the years to come, driven by a number of factors. Population ageing will lead to more people needing ongoing health and social care, rising incomes increase expectations of quality of life in old age, the supply of informal care is likely to shrink, 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.

End-of-life care refers to the care provided to people who are near the end of life. It involves all the services providing physical, emotional, social and spiritual support to the dying person, including management of pain and mental distress. Emotional support and bereavement care for the dying person’s family are also part of end-of-life care. Because of population ageing and an associated increase in prevalence of chronic conditions across OECD countries, the number of people in need of end-of-life care is growing and expected to reach 10 million people by 2050, up from 7 million in 2019. However, fewer than half of those who need end-of-life care are currently receiving it, meaning that many people die without adequate care (OECD, 2023[1]). Measuring the quality of end-of-life care is not straightforward, but exploring where people die and what type of care they receive in their last months of life are considered good proxies.