Disability statistics - elderly needs for help or assistance - Statistics Explained

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Disability statistics - elderly needs for help or assistance


Data extracted in June 2019.

Planned article update: September 2021.

Highlights


Almost half of the elderly population of the EU-28 (people aged 65 and over), reported difficulties with at least one personal care or household activity.

Almost two fifths of the elderly population with a difficulty in personal care activities reported a lack of assistance with those activities.

More than one third of the EU-28 elderly population with a difficulty in household activities reported a lack of assistance with those activities.

Need-for-assistance 12.png



This article provides an overview of the assistance used or required by elderly people in the European Union (EU) to overcome personal care or household activity limitations (such as difficulty in showering, using toilets, doing housework or shopping). It is one of a set of statistical articles concerning disability statistics in the EU and accompanies a number of methodological articles which make up an online publication on disability statistics.

With rising life expectancy, more people now reach an age where declining physical and mental health make them dependent on help from others. This has an impact on long-term care expenditure, which is rising faster than expenditure on health and pensions.

The data presented in this article come from the second wave of the European Health Interview Survey (EHIS), conducted between 2013 and 2015. EHIS covers people aged 15 and over, while the data presented in this article refer to those aged 65 and above, in other words, the elderly population.


Full article


Difficulties in personal care or household activities

Almost half of the elderly population of the EU-28 (people aged 65 and over), reported difficulties with at least one personal care or household activity

Regarding personal care and household activities, Figure 1.1 shows that, on average, 47.9 % of the elderly EU-28 population reported having moderate or severe difficulties (represented by the category ‘Limited’), while 52.1 % reported not having any difficulties (‘Not limited’). In almost half of the EU Member States (13), a higher share of people reported moderate or severe difficulties with at least one personal care or household activity, while in a smaller group of countries (12), the trend was the opposite i.e. there was a higher share of people with no difficulties in those activities (see Figure 1.1). In Belgium, Italy and Croatia, the distribution between the elderly with and without difficulties in personal care or household activities was almost equal.

Among the EU-28 Member States, the highest rates for persons with difficulties in personal care or household activities were recorded in Slovakia (71.5 %) followed by Czechia (69.8 %), Latvia (67.1 %), Lithuania (67.0 %) and Bulgaria (62.9 %).

Figure 1.1: Persons limited in personal care activities or household activities, 2014
(% share of the population aged 65 and above)
Source: Eurostat (hlth_ehis_tae)

Women were more likely than men to report difficulties with personal care or household activities

An analysis by sex indicates that the proportion of women that reported limitations (moderate or severe) in personal or household activities was higher than that of men (55.8 % versus 37.6%, for EU-28); this was the case for all EU Member States (see Figure 1.2). The highest gender gaps were found in Portugal (38.8 percentage points (pp)), Greece (24.4 pp), Malta (23.3 pp), Cyprus (23.2 pp), Italy (22.9 pp), Spain (22.7 pp) and Hungary (20.5 pp).

Figure 1.2: Persons limited in personal care or household activities by sex, 2014
(% share of the population aged 65 and above)
Source: Eurostat (hlth_ehis_tae)

Difficulties with personal care or household activities more prevalent among those with lower educational attainment

Among the EU-28 Member States, difficulties with personal care or household activities for the elderly were more prevalent among those with less than primary, primary and lower secondary educations (55.5 %) compared to those with upper secondary and post-secondary non-tertiary educations (42.5 %) or tertiary educations (33.1 %) (see Figure 2).

Figure 2: Persons limited in personal care or household activities by educational attainment level, 2014
(% share of the population aged 65 and above)
Source: Eurostat (hlth_ehis_tae)

Across educational levels and EU Member States, there was a considerable educational gap between the elderly with upper secondary and post-secondary non-tertiary education and tertiary educational level who reported having difficulties with personal care or household activities. The highest differences were observed in Greece (13.7 pp) and Luxembourg (10.6 pp), while in the case of Malta, Estonia and Austria, the educational gap was considerably smaller (i.e. 1 pp or less).

In contrast, in Portugal, more persons with tertiary educations considered that they have difficulties (28.8 %) compared to those with upper secondary and post-secondary non-tertiary educations (26.9 %).

More than one quarter of the elderly population with less than primary, primary and lower secondary education reported difficulties with personal care activities

When looking only to the personal care activities (also known as activities of daily living), the trend was similar; at EU-28 level, 28.6 % of elderly persons with less than primary, primary and lower secondary educations reported difficulties in personal care activities compared with 20.0 % of people with an upper secondary and post-secondary non-tertiary education and 14.0 % with a higher educational level (see Figure 3).

Figure 3: Persons limited in personal care activities by educational attainment level, 2014
(% share of the population aged 65 and above)
Source: Eurostat (hlth_ehis_pc1e)

The largest gap was recorded in Slovakia, Lithuania and Hungary (31.5 pp, 31.0 pp and 28.0 pp difference, respectively) and concerned the first and third educational levels. In Estonia and Sweden, the gap between these educational levels was considerably smaller (close to 6.0 pp).

Almost a quarter of the EU-28 elderly population was limited in at least one daily life activity

In the EU-28, the share of people 65 aged and over limited in at least one of the five measured daily life activities (namely, feeding oneself, getting in and out of bed or chair, dressing and undressing, using toilets, bathing or showering) was 23.7 % in 2014. Among the EU Member States, 13 of them reported more than 25.0 % of elderly persons having difficulties with those activities, while in Denmark and Malta, that share was less than 15 % (see Figure 4).

Figure 4: Persons limited in personal care activities by activity where the limitation is encountered, 2014
(% share of the population aged 65 and above)
Source: Eurostat (hlth_ehis_pc1e)

The activities with which the elderly had the most difficulties were ‘Getting in and out of a bed or chair' (17.5 %) and ‘Bathing or showering’ (17.9 %). This trend holds for the majority (18) of the EU Member States with the exception of Croatia, Finland and Malta, where ‘Dressing and undressing’ was the second most common activity were difficulties were encountered among the elderly. The daily activity ‘’Feeding oneself’ was the least problematic, as less than 10 % of the elderly in almost all EU-28 countries encountered difficulties with it, except for Bulgaria, where the rate was slightly above 10 %.

Figure 5: Persons limited in household activities by educational attainment level, 2014
(% share of the population aged 65 and above)
Source: Eurostat (hlth_ehis_ha1e)

In all EU Member States, the share of elderly persons reporting difficulties with household activities (namely, preparing meals, using the telephone, shopping, managing medication, doing light housework, doing occasional heavy housework, taking care of finances and everyday administrative tasks) was also highest among those with less than primary, primary and lower secondary educational level (53.9 %), compared to those with upper secondary and post-secondary non-tertiary education (40.5 %) or tertiary education (31.0 %) (see Figure 5). An exception to this pattern was Portugal, where the share of persons with tertiary educations was slightly above the one for persons with upper secondary and post-secondary non-tertiary educations.

As observed in Figure 5, there was a considerable gap between the less than primary, primary and lower secondary education and tertiary educational level among the elderly persons reporting difficulties with household activities. The largest gaps, all in excess of 10.0 percentage points (pp), were recorded in Cyprus (36.3 pp), Greece (34.3pp), and Hungary (31.0 pp), while for Malta and Sweden, the educational gap was considerably smaller (8.8 pp and 9.7 pp, respectively).

Table 1: Persons limited in household activities by activity where the limitation is encountered, 2014
(% share of the population aged 65 and above)
Source: Eurostat (hlth_ehis_ha1e)

Table 1 provides information on the share of people having difficulties with different household activities. In total, 46.1 % of the elderly in the EU-28 encountered difficulties in at least one or more activity in 2014. Most difficulties were experienced with ‘Occasional heavy housework’ (43.7 %), ‘Shopping’ (23.5 %) and ‘Light housework’ (21.0 %). This trend holds for all the EU Member States with the exception of Spain, Latvia, Cyprus, Malta and Denmark, where the second most common activity, with which the elderly reported to have difficulties, was ‘Light housework’.

The activities “Using the telephone’’ and ‘’Managing medication” were reported the least problematic, in the (17) EU Member States less than 10 % of the elderly encountered difficulties with those two activities, while in the rest of the Member States the corresponding figure was up to 18 %.

Need for help with personal care or household activities

Almost two fifths of the elderly population with a difficulty in personal care activities reported a lack of assistance with those activities

In EU-28, 38.5 % of elderly persons with a difficulty in personal care activities reported a lack of assistance in 2014, while 26.9 % reported they ‘Get enough assistance’ and 34.6 % stated they had ‘No need for assistance’. Across EU Member States, the share of those lacking assistance ranged from 69.2 % in Malta, to 6.6 % in the Netherlands (Figure 6).

Figure 6: Persons limited in personal care activities by need for assistance, 2014
(% share of the population aged 65 and above)
Source: Eurostat (hlth_ehis_pchlpe)

The countries with the highest proportions of the elderly stating that they receive enough assistance were Estonia (62.7 %), Cyprus (52.8 %) and Latvia (39.3 %), while the countries with the lowest proportions were Luxembourg (3.7 %) Bulgaria (6.8 %) and Finland (7.5 %). Finally, the majority of the elderly in the Netherlands (71.5 %), Finland (66.1 %) and Luxembourg (55.8 %) answered that they had no need for assistance with personal care activities, while the corresponding group in Malta, Cyprus and Spain represented 8.9 %, 12.8 % and 16.1 %, respectively.

Figure 7: Persons limited in household activities by need for assistance, 2014
(% share of the population aged 65 and above)
Source: Eurostat (hlth_ehis_hahlpe)

More than one third of the EU-28 elderly population with a difficulty in household activities reported a lack of assistance with those activities

For the EU-28, 36.4 % of the elderly with a difficulty in household activities reported a lack of assistance in 2014, while 39.8 % stated that they ‘Get enough assistance’ and 23.8 % stated they had ‘No need for assistance’.

Nine EU Member States had a proportion higher than the EU-28 average; the highest share of lack of assistance was recorded in Bulgaria (59.5 %), followed by Romania (58.3 %) and Finland (53.3 %), while the lowest shares for lack of assistance, i.e. less than 24.0 %, were reported in the Netherlands, Latvia, Malta and the United Kingdom. Figure 7 shows that the countries that had the highest share of elderly persons getting enough assistance were Malta (66.5 %) followed by Estonia (64.9 %) and the United Kingdom (58.8 %), while those with the lowest were Czechia (10.4 %), Bulgaria (11.3 %) and Finland (16.2 %).

Finally, the highest shares of elderly with a difficulty in household activities that stated no need for assistance were reported in Czechia (65.3 %), Hungary (46.4 %) and Denmark (44.0 %) while the lowest, i.e. 10 % or less, were recorded in Estonia, Romania and Malta.

Self-reported use of home care services

One third of the EU-28 elderly with severe limitation in usual activities use home care services for personal needs

At the EU-28 level, in 2014, the share of elderly persons with severe limitation in usual activities and who self-reported the use of home care services for personal needs was 32.8 %, compared to 10.5 % of those having a moderate limitation and 2.9 % for those with no limitation. Across the EU Member States, there was a difference in the usage of the home care between the elderly with severe and moderate limitations; in most countries, this gap exceeded 10 pp, with the exception of Estonia, Belgium and Malta, where the difference was 10 pp or less.

Figure 8: Self-reported use of home care services by level of activity limitation, 2014
(% share of the population aged 65 and above)
Source: Eurostat (hlth_ehis_am7d)

Source data for tables and graphs

Data sources

The European Health Interview Survey (EHIS) is a population survey providing statistical data on health status (including activity limitations), health determinants — lifestyles and (use and limitations in access to) healthcare services, on a harmonized basis and with a high degree of comparability across EU Member States.

  • The first wave was conducted under a gentlemen’s agreement and implemented in 17 EU Member States, completed by Switzerland and Turkey,
  • The second wave was conducted as a mandatory survey in all EU Member States, Iceland and Norway as well as in Turkey between 2013 and 2015,
  • The third wave of EHIS is planned for 2019 in all EU Member States and some other European countries.

According to the current legal framework, EHIS is to be conducted every five years. EHIS wave 4 is planned to be conducted in 2025 under the new Regulation (EU) 2019/1700 of the European Parliament and of the Council establishing a common framework for European statistics relating to persons and households, based on data at individual level collected from samples (this regulation foresees the periodicity of EHIS to change to 6 years).

More details about EHIS are available in this background article which provides information on the scope of the data, its legal basis, the methodology employed, as well as related concepts and definitions.

Limitations in personal care activities show the level of difficulty in at least one personal care activity covering feeding, getting in and out of a bed or a chair, dressing and undressing, using a toilet, bathing or showering based on the self-reports of the population aged 65 and over. Respondents evaluated the extent of their difficulties on the following scale: no difficulty (in this article referred to as not limited), some difficulty, a lot of difficulty and cannot do at all (all of them composing the category limited).

Limitations in household activities show the level of difficulty in at least one household activity covering preparing meals, using the telephone, shopping, managing medication, carrying out light housework, carrying out occasional heavy housework, taking care of finances and everyday administrative tasks based on the self-reports of the population aged 65 and over. It should be noted that there may be other than health reasons behind difficulties doing household activities. Respondents evaluated the extent of their difficulties on the following scale: no difficulty (in this article referred to as not limited), some difficulty, a lot of difficulty and cannot do at all (all of them composing the category limited).

The indicator on home care services shows the use of any type of home (health and social) care services. It includes only formal care services provided by professional health or social workers (not by family members or friends) and refers to the past 12 months prior to the interview.

Limitations of the data

All of the indicators presented in this article are derived from self-reported data so they are, to a certain extent, affected by respondents’ subjective perception as well as by their social and cultural background.

EHIS does not cover the institutionalised population, for example, people living in health and social care institutions who are more likely to face limitations than the population living in private households. It is therefore likely that, to some degree, EHIS under-estimates the share of the population facing limitations. Finally, despite substantial and continuous efforts for harmonisation, the implementation of EHIS is organised nationally, which may impact on the results presented, for example, due to differences in the formulation of questions or their precise coverage.

Context

In November 2010, the European Commission adopted a European disability strategy for the period 2010–20. For people with disabilities, this aims at improving their social inclusion, their well-being and enabling them to fully exercise their rights. The strategy is based on the United Nations Convention on the Rights of Persons with Disabilities. In order to foster the inclusion of people with disabilities, the European Commission identified eight areas for joint action between the EU and Member States.

  • Accessibility: make goods and services accessible to people with disabilities and promote the market of assistive devices.
  • Participation: ensure that people with disabilities enjoy all benefits of EU citizenship; remove barriers to equal participation in public life and leisure activities; promote the provision of quality community-based services.
  • Equality: combat discrimination based on disability and promote equal opportunities.
  • Employment: raise significantly the share of persons with disabilities working in the labour market.
  • Education and training: promote inclusive education and lifelong learning for students and pupils with disabilities; equal access to quality education and lifelong learning enable disabled people to participate fully in society and improve their quality of life.
  • Social protection: promote decent living conditions, combat poverty and social exclusion.
  • Health: promote equal access to health services and related facilities.
  • External action: promote the rights of people with disabilities in the EU enlargement and international development programmes.

Indicators on activity limitations and use of home care services are used for monitoring long-term care systems.


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Functional and activity limitations (hlth_fal)
Difficulties in personal care activities or household activities by sex, age and educational attainment level (hlth_ehis_tae)
Difficulties in personal care activities by sex, age and educational attainment level (hlth_ehis_pc1e)
Difficulties in household activities by sex, age and educational attainment level (hlth_ehis_ha1e)
Need for help with personal care activities by sex, age and educational attainment level (hlth_ehis_pchlpe)
Need for help with household activities by sex, age and educational attainment level (hlth_ehis_hahlpe)
Home care and help (hlth_home)
Self-reported use of home care services by sex, age and level of activity limitation (hlth_ehis_am7d)

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