Living longer, but in better or worse health? - WHO policy brief
People in Europe tend to live much longer than they used to, but in what state of health are these additional years spent? Are the aims of policies promoting healthy and active ageing being achieved or is an increasing share of life years being spent in poor health? These questions matter not only to the older people concerned, but have wider implications for health systems and expenditure. This policy brief explores available information on the health and disability of older people in Europe and how it relates to increases in life expectancy. It considers the main theories on health and ageing, explores the latest evidence on health and disability measures, and considers policy options to support healthy and active ageing.
The publication is part by the World Health Organization (WHO) European Observatory on Health Systems and Policies are part of a serie on active and healthy ageing.
- Longer lifespans can be due to additional years of life being spent in good or poor health, or some combination of the two.
- The ‘health’ of older people can be measured in many ways, including using data on disease prevalence or self reported health status, but it is perhaps best captured by measures of disability or functional impairment.
- Assessments of whether people in Europe are living longer in better or worse health depend to a large degree on the measure used.
- Most surveys on ageing measure functional independence in activities of daily living (ADLs) and instrumental activities of daily living (IADLs), which are then used to quantify health states and measure changes over time.
- Studies using comparative data from the Survey of Health, Ageing, and Retirement in Europe (SHARE) generally find increases in functional limitations in some countries and decreases in others.
- One overarching finding is that later cohorts of older people have much better cognitive functioning than earlier cohorts.
- There are major health inequities at older age across and within countries.
- While a definitive answer of whether older people in Europe are in better or worse health is impossible to obtain, what is clear is that health systems are important contributors to increases in life expectancies, decreases in severe disability, and better coping and functioning with chronic disease.