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Trends in Severe Disability Among Elderly People: Assessing the Evidence in 12 OECD Countries and the Future Implications


  • Gaetan Lafortune
  • Gaëlle Balestat


As the number and share of the population aged 65 and over will continue to grow steadily in OECD countries over the next decades, improvements in the functional status of elderly people could help mitigate the rise in the demand for, and hence expenditure on, long-term care. This paper assesses the most recent evidence on trends in disability among the population aged 65 and over in 12 OECD countries: Australia, Belgium, Canada, Denmark, Finland, France, Italy, Japan, the Netherlands, Sweden, the United Kingdom and the United States. The focus is on reviewing trends in severe disability (or dependency), defined where possible as one or more limitations in basic activities of daily living (ADLs, such as eating, washing/bathing, dressing, and getting in and out of bed), given that such severe limitations tend to be closely related to demands for long-term care. One of the principal findings from this review is that there is clear evidence of a decline in disability among elderly people in only five of the twelve countries studied (Denmark, Finland, Italy, the Netherlands and the United States). Three countries (Belgium, Japan and Sweden) report an increasing rate of severe disability among people aged 65 and over during the past five to ten years, and two countries (Australia, Canada) report a stable rate. In France and the United Kingdom, data from different surveys show different trends in ADL disability rates among elderly people, making it impossible to reach any definitive conclusion on the direction of the trend. One of the main policy implications that can be drawn from the findings of this study is that it would not be prudent for policymakers to count on future reductions in the prevalence of severe disability among elderly people to offset completely the rising demand for long-term care that will result from population ageing. Even though disability prevalence rates have declined to some extent in some countries, the ageing of the population and the greater longevity of individuals can be expected to lead to increasing numbers of people at older ages with a severe disability and in need of long-term care. The results of the projection exercise to 2030 for all countries, regardless of different trends in disability prevalence, confirm this important finding. Alors que le nombre et la proportion de personnes âgées de 65 ans et plus vont continuer de s'accroître dans les pays de l'OCDE au cours des prochaines décennies, une amélioration de l'état fonctionnel des personnes âgées pourrait contribuer à ralentir l'augmentation de la demande et des dépenses pour les soins de longue durée. Cette étude examine les tendances les plus récentes concernant l'évolution de l'incapacité parmi la population âgée de 65 ans et plus dans 12 pays de l'OCDE : Australie, Belgique, Canada, Danemark, Finlande, France, Italie, Japon, Pays-Bas, Suède, Royaume-Uni et États- Unis. L'étude se concentre sur l'incapacité sévère (ou la dépendance), définie dans la mesure du possible comme une ou plusieurs limitations dans les activités de la vie quotidienne (AVQ, comme la capacité de se nourrir, de faire sa toilette, de s'habiller et de sortir du lit), étant donné que ce sont de telles limitations qui tendent à être associées à des demandes pour des soins de longue durée. Un des principaux résultats de cette revue est qu'il y a eu une diminution claire de la prévalence de l'incapacité sévère parmi la population âgée dans seulement cinq des douze pays étudiés (Danemark, Finlande, Italie, Pays-Bas et États-Unis). Par ailleurs, dans trois pays (Belgique, Japon, Suède), on observe une augmentation de la prévalence de l'incapacité sévère parmi les personnes âgées au cours des cinq ou dix dernières années, alors que les taux ont été stables dans deux pays (Australie, Canada). Enfin, en France et au Royaume- Uni, il n'est pas possible pour l'instant de tirer des conclusions définitives, parce que les résultats des analyses de tendance divergent selon les sources (enquêtes) utilisées. Une des principales implications politiques de ces résultats est qu'il ne serait pas prudent de la part des décideurs politiques de compter sur une réduction à venir de la prévalence de l'incapacité sévère chez les personnes âgées pour compenser l'augmentation de la demande de soins de longue durée qui résultera du vieillissement de la population. Même si la prévalence de l'incapacité sévère a diminué dans une certaine mesure dans certains pays, il est à prévoir que le vieillissement de la population et l'allongement de l'espérance de vie vont contribuer à l'augmentation du nombre de personnes âgées dépendantes. Les résultats de l'exercice de projections jusqu'en 2030 pour tous les pays, quelles que soient les tendances passées de la prévalence de l'incapacité, viennent appuyer cette conclusion.

Suggested Citation

  • Gaetan Lafortune & Gaëlle Balestat, 2007. "Trends in Severe Disability Among Elderly People: Assessing the Evidence in 12 OECD Countries and the Future Implications," OECD Health Working Papers 26, OECD Publishing.
  • Handle: RePEc:oec:elsaad:26-en

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    Cited by:

    1. Flavia Coda Moscarola, 2010. "Informal Caregiving and Women's Work Choices: Lessons from the Netherlands," LABOUR, CEIS, vol. 24(1), pages 93-105, March.
    2. van Kippersluis, Hans & Van Ourti, Tom & O'Donnell, Owen & van Doorslaer, Eddy, 2009. "Health and income across the life cycle and generations in Europe," Journal of Health Economics, Elsevier, vol. 28(4), pages 818-830, July.
    3. Luz Peña-Longobardo & Juan Oliva-Moreno, 2015. "Economic valuation and determinants of informal care to people with Alzheimer’s disease," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(5), pages 507-515, June.
    4. Freedman, Vicki A. & Martin, Linda G. & Schoeni, Robert F. & Cornman, Jennifer C., 2008. "Declines in late-life disability: The role of early- and mid-life factors," Social Science & Medicine, Elsevier, vol. 66(7), pages 1588-1602, April.
    5. Mäki, Netta & Martikainen, Pekka & Eikemo, Terje & Menvielle, Gwenn & Lundberg, Olle & Östergren, Olof & Jasilionis, Domantas & Mackenbach, Johan P., 2013. "Educational differences in disability-free life expectancy: a comparative study of long-standing activity limitation in eight European countries," Social Science & Medicine, Elsevier, vol. 94(C), pages 1-8.
    6. Levantesi, Susanna & Menzietti, Massimiliano, 2012. "Managing longevity and disability risks in life annuities with long term care," Insurance: Mathematics and Economics, Elsevier, vol. 50(3), pages 391-401.
    7. García-Gómez, Pilar & Hernández-Quevedo, Cristina & Jiménez-Rubio, Dolores & Oliva-Moreno, Juan, 2015. "Inequity in long-term care use and unmet need: Two sides of the same coin," Journal of Health Economics, Elsevier, vol. 39(C), pages 147-158.
    8. de Meijer, Claudine & O’Donnell, Owen & Koopmanschap, Marc & van Doorslaer, Eddy, 2013. "Health expenditure growth: Looking beyond the average through decomposition of the full distribution," Journal of Health Economics, Elsevier, vol. 32(1), pages 88-105.
    9. Schulz, Erika & Geyer, Johannes, 2013. "Societal Change, Care Need and Long-Term Care Workforce in Selected European Countries," EconStor Preprints 128602, ZBW - German National Library of Economics.
    10. Mizunoya, Suguru & Mitra, Sophie, 2013. "Is There a Disability Gap in Employment Rates in Developing Countries?," World Development, Elsevier, vol. 42(C), pages 28-43.
    11. Heger, Dörte & Kolodziej, Ingo W.K., 2016. "Changes in morbidity over time: Evidence from Europe," Ruhr Economic Papers 640, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    12. Plisson, Manuel, 2009. "Assurabilité et développement de l'assurance dépendance," Economics Thesis from University Paris Dauphine, Paris Dauphine University, number 123456789/5064 edited by Lorenzi, Jean-Hervé, January.
    13. Denis Kessler, 2010. "Confronting the Challenge of Long-term Care in Europe," ifo DICE Report, ifo Institute - Leibniz Institute for Economic Research at the University of Munich, vol. 8(2), pages 18-23, 07.
    14. Katharina Herlofson & Gunhild Hagestad, 2011. "Challenges in moving from macro to micro: Population and family structures in ageing societies," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 25(10), pages 337-370, August.
    15. Juan Oliva-Moreno & Luz Peña-Longobardo & Cristina Vilaplana-Prieto, 2015. "An Estimation of the Value of Informal Care Provided to Dependent People in Spain," Applied Health Economics and Health Policy, Springer, vol. 13(2), pages 223-231, April.
    16. Gargett, Susan, 2010. "Public policy and the dependency of nursing home residents in Australia: 1968-69 to 2006-07," Health Policy, Elsevier, vol. 96(2), pages 143-153, July.
    17. Schulz, Erika, 2013. "Ageing, Care Need and Long-Term Care Workforce in Germany," EconStor Preprints 128597, ZBW - German National Library of Economics.

    More about this item


    disability; OECD countries;

    JEL classification:

    • J11 - Labor and Demographic Economics - - Demographic Economics - - - Demographic Trends, Macroeconomic Effects, and Forecasts
    • J14 - Labor and Demographic Economics - - Demographic Economics - - - Economics of the Elderly; Economics of the Handicapped; Non-Labor Market Discrimination

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