Chronic diseases and disabilities among older people
While the current generation of older people can expect to live much longer than previous generations, many years of life in old age are lived with some chronic diseases and disabilities. Based on the Survey on Health, Ageing and Retirement in Europe (SHARE), 36% of people aged 65 and over reported having at least two chronic diseases on average across EU countries in 2020 (Figure 3.17).
Older women report having multiple chronic diseases more often than men (40% versus 32% on average), partly because they live longer. Disparities also exist by income group. On average across EU countries, 29% of people aged 65 and over in the highest income quintile reported at least two chronic diseases, compared with 44% for those in the lowest income quintile. This reflects the cumulative effect of more difficult living and working conditions and greater exposure to various risk factors for chronic conditions earlier in life.
Long COVID (also known as “post COVID-19 condition”) will likely increase the prevalence of chronic diseases among both younger and older people in the coming years. While there is not yet one commonly accepted definition of long COVID, preliminary estimates indicate that at least 10% of people infected with COVID-19 experience some long COVID symptoms that last for more than one month (Expert Panel on effective ways of investing in health, 2022[1]).
Living with chronic diseases does not necessarily hinder older people from carrying on their usual activities. Nonetheless, on average across EU countries 26% of people aged over 65 reported in 2020 having at least one limitation in activities of daily living (ADL), such as eating or dressing, or instrumental activities of daily living (IADL), such as cooking or doing the laundry (Figure 3.18).
Women more often report at least one ADL or IADL limitation in all EU countries (30% of women and 22% of men on average). This is mainly due to the fact that women report more chronic diseases with disabling effects, such as arthritis. There are also large disparities in disability by income quintile: on average across EU countries, 19% of people aged over 65 in the highest income quintile reported at least one ADL or IADL limitation compared with 35% among those in the lowest income quintile.
Many older people with activity limitations require some long-term care at home or in institutions. The pandemic led to disruptions in the provision of long-term care, especially at the beginning. About 30% of long-term care recipients at home reported forgone or postponed care in June-August 2020 on average across 14 European countries (Rocard, Sillitti and Llena-Nozal, 2021[2]).
The question in SHARE to measure the prevalence of any chronic disease asks whether people have ever been told by a doctor that they have some chronic conditions. The data include people reporting Alzheimer’s disease, cancer, chronic kidney diseases, chronic lung diseases, diabetes, heart attack, stroke, hip fracture, Parkinson’s disease, stroke, rheumatoid arthritis and osteoarthritis.
The question on activity limitations relate to ADL and IADL limitations such as dressing, walking, bathing/showering, eating, getting in/out of bed, using the toilet, preparing meals, doing groceries, taking medications and doing the laundry.
The survey excludes the population living in long-term care facilities, thereby resulting in an under-estimation of the true prevalence of chronic diseases and activity limitations.
References
[1] EXPH (2022), Expert Panel on effective ways of investing in health, draft opinion: Facing the impact of post-COVID-19 condition on health systems.
[2] Rocard, E., P. Sillitti and A. Llena-Nozal (2021), “COVID-19 in long-term care: Impact, policy responses and challenges”, OECD Health Working Papers, No. 131, OECD Publishing, Paris, https://doi.org/10.1787/b966f837-en.
Note: The EU average is unweighted. The prevalence does not include people living in LTC facilities. Chronic diseases include Alzheimer’s disease, cancer, chronic kidney diseases, chronic lung diseases, diabetes, heart attack, hip fracture, Parkinson’s disease, stroke, rheumatoid arthritis and osteoarthritis.
Source: Survey of Health, Ageing and Retirement in Europe (wave 8).
