Population aging, demographic trends and consequences for long-term care

This chapter reviews recent projections related to the aging of populations, developments in health expectancy and disability, and associated trends in need for and provision of long-term care, focusing on the developments in Europe but mentioning worldwide trends where possible. First, I present demographic trends in changing age structure of populations, expected costs of those changes, and discuss how innovative measures such as the ‘real elderly dependency ratio’ could offer a more balanced view on those trends. Second, projections of healthy life expectancy and time spent with morbidity and disability are presented. Then possible limitations of those projections are discussed, especially regarding recent evidence on changing incidence of dementia, and the possible further reductions in incidence if unfavorable lifestyle and health behaviours were reduced. After that, I will delineate demographic trends in need for assistance with care, and their implications for both formal and informal long-term care provision and costs. Specifically, a ‘care gap’ both in the provision of formal and informal care has been foreseen for several countries. Lastly, I discuss some trends and phenomena in long-term care provision which may influence the trends in long-term care needs and provision. In particular, estimated care gaps could become less threatening if the trend of migration of trained and untrained caregivers to provide live-in and institutional care in understaffed countries will continue, and if technological innovations will reduce care needs by enabling persons with disabilities to carry out activities of daily living autonomously.