Elsevier

The Lancet

Volume 381, Issue 9874, 13–19 April 2013, Pages 1312-1322
The Lancet

Series
Ageing in the European Union

https://doi.org/10.1016/S0140-6736(12)62087-XGet rights and content

Summary

The ageing of European populations presents health, long-term care, and welfare systems with new challenges. Although reports of ageing as a fundamental threat to the welfare state seem exaggerated, societies have to embrace various policy options to improve the robustness of health, long-term care, and welfare systems in Europe and to help people to stay healthy and active in old age. These policy options include prevention and health promotion, better self-care, increased coordination of care, improved management of hospital admissions and discharges, improved systems of long-term care, and new work and pension arrangements. Ageing of the health workforce is another challenge, and policies will need to be pursued that meet the particular needs of older workers (ie, those aged 50 years or older) while recruiting young practitioners.

Introduction

At a time of austerity, concerns about the consequences of further population ageing for the economy and for health and welfare systems are now firmly on political agendas. Although societies need to respond to demographic realities, often concerns about the effect of ageing can be exaggerated, adding to the agendas of some governments to cut back welfare states. A discussion paper1 by the World Demographic and Ageing Forum, for example, was entitled A truly impossible equation: the future of welfare states in times of demographic ageing. In this Series paper, we ask whether the implications of population ageing for health, long-term care, and welfare systems in the European Union (EU) are really as substantial as often stated and how European societies can prepare to cope with ageing populations.

Key messages

  • Ageing will result in an increasing number of older people (ie, those aged 65 years or older) with various health problems that are more common in older than in younger people—eg, cancer, fractured hips, strokes, dementia; many of these people will have multimorbidities

  • However, alarmist perceptions of ageing as a fundamental threat to the European welfare state are greatly overblown, and projected increases in health expenditure because of ageing are slight

  • Countries of the European Union should not be complacent in their responses, and health care, long-term care, and welfare systems need to adapt to respond to population ageing

  • Health systems should become more age-friendly through active health promotion and disease prevention (for older people and across the life course), enabling better self-care, ensuring capacities of health services, improving coordination of care and management of hospital admissions and discharges, and addressing the ageing of the health workforce

  • Across the European Union, the scope for improvement of organisation and coordination of long-term care services is substantial

  • Small increases in pensionable age (in line with increases in healthy life expectancy) could offset the effects of ageing on public pension systems, but will need to account for socioeconomic disparities

Section snippets

Population trends

In all EU member states, the proportion of older people has increased in recent decades, because of a combination of low fertility and longer life expectancy. However, there are some variations between countries and time periods in the contributions of these factors. In many Scandinavian countries, for example, late 19th century declines in fertility led to large increases in the proportion of older people in the first half of the 20th century. In southern and eastern Europe, fertility declines

Implications for health and welfare systems

Increases in age-associated public expenditure in the EU are expected to be largest with respect to pensions (table). Public expenditure on pensions is expected to rise from 10·2% of gross domestic product (GDP) in 2007, to 12·6% by 2060, but with very large variations between member states.10

Although most long-term care for older people is still provided by family members and friends for free, public spending on long-term care is also expected to increase substantially and is projected to

Responsiveness to ageing

Even when per-person expenditure on health remains constant or decreases, the growing proportion of older people presents some challenges for the sustainability of health and welfare systems, because a declining share of the population might have to bear increasing costs of pensions and public health financing. However, these challenges are not insurmountable. Societies can take measures that increase the chance that additional years of life are spent in good health, improve system efficiency

Conclusion

The unprecedented ageing of European populations presents new challenges to health, long-term care, and welfare systems. Irrespective of a potential compression of morbidity, the numbers of older people with cancer, fractured hips, strokes, and dementia will increase, and many older people will have multimorbidities. However, projected increases in health expenditure as a result of ageing are slight and ageing does not present a fundamental threat to the European welfare state. However, many

Search strategy and selection criteria

We searched Medline, PubMed, and Google Scholar for papers published in English with the terms “ageing”, “compression of morbidity”, “policies”, and “health systems” We gave preference to articles published between Jan 1, 2005, and Aug 31, 2012, but also included older, important work. We also reviewed recent reports published by WHO, the Organisation for Economic Co-operation and Development, and the European Union.

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