Ageing and health

Introduction

The ageing of societies essentially results from falling fertility rates and increased life expectancy. An additional impact stems from the so-called baby-boom, which has lead to large differences in the size of age groups. Migration movements can also affect the ageing process. While ageing will become more of a universal trend in the coming decades there is a wide diversity in terms of the timing and speed of demographic change, the social and economic contexts, and the perception of the challenges posed.

Among the developed countries, Europe and Japan will experience the most pronounced ageing trends up to 2050 - the share of the above 60 age group will be around 37% in Europe and even more in Japan, compared to only 27% in North America, where population growth will continue to be relatively strong. Within the 60+ age group, there will also be significant growth in the number of "very old", i.e. people aged 80 years and over. Whereas the very old constitute 3% of the European population today, 11 of the former EU-15 Member States will have at least 10% of their population aged 80 or over by 2050. Gender differences in ageing are considerable. In Europe women's life expectancy is currently more than 6 years higher than for men. In the age group of 60 years and over, there are 50% more women than men. Of people living alone at the age of 75+ more than 70% are women. The process of enlargement of the European Union is not expected to have a significant impact on the ageing process of the Union's population.

Within the overall framework of the EU approach to ageing some common key challenges for the European Union and its Member States have been identified: managing the economic implications of ageing in order to maintain growth and sound public finances; adjusting well to an ageing and shrinking workforce; ensuring adequate, sustainable and adaptable pensions; achieving access to high quality health care for all while ensuring the financial viability of health care systems.

Ageing form the social inclusion perspective

The Directorate-General for Employment and Social Affairs is responsible for EU policy on social inclusion for ageing populations.

The organisation and financing of social protection systems is a responsibility of the Member States. Nevertheless, the European Union has a particular role in ensuring, through EU legislation coordinating national social security systems, that people who move across borders and hence come within the remit of different social protection systems are adequately protected. Such legislation mainly concerns statutory social security schemes.

More recently, the European Union has also started promoting a closer cooperation among the Member States on the modernisation of social protection systems which face similar challenges across the EU. This cooperation takes place mainly within the Social Protection Committee (SPC) where the 'Open Method of Coordination' was developed and applied to the areas of social inclusion and pensions. A cooperation was also launched of health and long-term care and 'Making work pay', i.e. ensuring that social protection systems provide income security without discouraging employment.

Information on the organisation of the main social protection schemes in the Member States is compiled by MISSOC (Mutual Information System on Social Protection), a network of correspondents from national authorities. MISSOC produces regularly updated comparatives tables covering all areas of social protection and MISSOC Info Bulletins on specific topics and on the main changes in the social protection systems.

Ageing from the research quality of life perspective

The Fifth Framework Programme (FP5) sets out the priorities for the European Union's research, technological development and demonstration (RTD) activities for the period 1998-2002. These priorities have been selected on the basis of a set of common criteria reflecting the major concerns of increasing industrial competitiveness and the quality of life for European citizens. FP5 has a multi-theme structure, consisting of several Specific Programmes, of which: Quality of Life and management of living resources.

This Specific program is divided in several Key Actions. The Key Action 6: The Ageing Population and Disabilities is organised into five action lines, which in turn contained different sub-areas

Action line 6.1: Age-related illnesses and health problems

Action line 6.2: Basic Processes of Physiological Ageing

Action line 6.3: Demographic and social policy aspects of population ageing

Action line 6.4: Coping with functional limitations in old age

Action line 6.5: Health and social care services to older people

Some of these projects are meaningful for purposes of health information.

- Survey of Health, Ageing and Retirement in Europe (SHARE), a multidisciplinary and cross-national data base of micro data on health, socio-economic status and social and family networks of some 22 000 Continental European individuals over the age of 50. SHARE is co-ordinated centrally at the Mannheim Research Institute for the Economics of Aging. SHARE has been designed after the role models of the U.S. Health and Retirement Study (HRS) and the English Longitudinal Study of Ageing (ELSA). Compared to HRS and ELSA, SHARE has the advantage to encompass cross-national variation of public policies, cultures and histories in a variety of European countries. This advantage makes SHARE a unique and innovative data set. Data collected include health variables (e.g. self-reported health, physical functioning, cognitive functioning, health behaviour, use of health care facilities), psychological variables (e.g. psychological health, well-being, life satisfaction), economic variables (e.g. current work activity, job characteristics, opportunities to work past retirement age, sources and composition of current income, wealth and consumption, housing, education), and social support variables (e.g. assistance within families, transfers of income and assets, social networks, volunteer activities). µ

- Ageing, health an retirement in Europe (AGIR) coordinated by the Centre for European Policy. The objectives were: to document the improvement in the health of the elderly in Europe based on a systematic collection of existing national data. To provide projections for this process into the future (e.g. until 2050). To analyse retirement decisions and the demand for health care as a function of age and health (in addition to the usual economic variables). To combine these results with the projections for the health of the elderly into estimates of the future evolution of health care and pension costs. Recent bio-metric research, based mainly on US data suggests that people not only live longer, but also in better health. This project documents to what extent this trend exists in Europe and make projections for health of the elderly over the coming decades. These projections could be used to asses the sustainability of social security system based on a detailed analysis of the influence of better health on the demand for health care and retirement decisions.

- Future Elderly Living Conditions In Europe (FELICIE) coordinated by the Institut National d'Etudes Démographiques (France). The project is centred on a 2000-2030 forecast in a selection of nine European countries of the population aged 75+, classified by sex, age, marital status, together with health, family and socioeconomic conditions. It will result in a quantification of living arrangements and an estimate of the future needs of old-age populations. An assessment of the past and present position of the elderly (by sex and age) on various living conditions aspects. Marital status is first dealt with, together with sex and age. Health, family and socio-economic conditions are then considered. Statistical material is analysed through age-cohortperiod models. The data needed are extracted from vital statistics, censuses and population registers, large panels and repeated surveys. Most of them are national and an important attention will be devoted to comparability and reliability. All data will be organised in an interactive data base.

Ageing from the Community Public Health Programme perspective

Several Community Public Health Programme projects have been approved on 2003 and 2004:

- AgeingNutrition - Comparative analysis of existing data on nutrition and lifestyle of the ageing population in Europe, especially in the "new" Baltic, Central and Eastern regions of the Community. To collect existing data on nutrition and lifestyle of the elderly in the candidate countries representing the new Baltic, Central and Eastern regions of the European Community, to analyse data for comparability with existing data from Western Europe (Member States), to give recommendations for improvement of nutrition and lifestyle based on the comparable data, and to find out what data are missing and investigations have to be done in the applicant countries.

- Healthy work in an ageing Europe. Analysis and collection of data and indicators on public health impacts of ageing populations and workforces in Europe, analysis and collection of current practices, strategies and policies aimed at improving the health status and reducing health inequalities by tackling relevant health determinants among the elderly populations and workforces across Europe, and preparing a new working platform in the area of health information and work.

- HA - Healthy Ageing. The aim of this project is to promote healthy ageing in later life stages. The project will be looking at different aspects of health and promote healthy ageing by the development of an integrated holistic approach to health in later life. The main aims are; to review and analyse existing data on health and older people at EU and member state level and produce and disseminate a report, to make recommendations for policy at EU and member state level based on current evidence and practice for promoting the health of older people, taking into account cultural differences and disseminate the findings by developing a comprehensive strategy.

- EPIC - Elderly network on ageing and health. The source population is the EPIC-Elderly cohort consisting of 100,000 Europeans older than 60 years, recruited from 9 European countries. Environmental parameters, including socio-demographic factors, diet, physical activity, somatometry, smoking and alcohol consumption, as well as self-reported morbidity, namely cardiovascular diseases, diabetes, hypertension, hyperlipidaemia, and cancer, were recorded at enrolment. Longitudinal data on vital status and cause specific mortality have been collected for the whole cohort while environmental parameters and self-reported morbidity have been recorded in some countries through active follow up. The project will integrate all this information and create the EPIC-Elderly NAH databank with standardised baseline and follow up data on environmental determinants, self reported morbidity, and with updated data on cause specific mortality of European elders.

Ageing in the EU countries: impact on the long-term care

Long-term care services are crucial to the welfare of older people. As the numbers of older people rise throughout Europe, the importance of these services in terms of numbers of clients and expenditures can be expected to grow. The EU DG EMPL study Long-Term Care Expenditure in an Ageing Societypdf , coordinated by the London School of Economics, investigated the key factors that are likely to affect future expenditure on long-term care services in Germany, Spain, Italy and the United Kingdom. The aim was to investigate how sensitive long-term care projections are to assumptions about future trends in different factors, using comparable projection models. The main factors investigated include demographic changes, trends in functional dependency, future availability of informal care, the structure of formal care services and patterns of provision, and the future unit costs of services.

The debate on ageing populations focuses on the steps being taken to ensure the long term sustainability of public finances in EMU. While Eurostat carries out long term population projections (the latest up to 2050), the Economic and Financial Affairs DG of the European Commission actively works on the economic and budgetary consequences of ageing populations, among others on how to deal with the long-term sustainability of public finances within the existing EU framework for budgetary surveillance.

See The economic and budgetary consequences of ageing See workshop Understanding trends in disability among elderly populations and the implications of demographic and non- demographic factors for future health and long-term care costs

The ageing of OECD societies over coming decades will require comprehensive reform addressing the fiscal, financial and labour market implications of ageing, as well as the implications for pension, social benefits and systems of health and long-term care. The OECD analyses the challenges that ageing implies for Member countries in these policy domains.

See OECD Ageing Society