World Health Systems Facts currently has sections on the US and sixteen other OECD nations. The links below lead directly to national sections on Long-Term Services & Supports:

“The LTC [Long Term Care] sector suffers from shortages of workers, and this is likely to get worse in the future. In three-quarters of OECD countries, growth in the number of LTC workers has been outpaced by the growth in numbers of elderly people between 2011 and 2016. Demand for care will likely keep going up and put more pressure on the LTC sector. The number of people aged over 80 years will climb from over 57 million in 2016 to over 1.2 billion in 2050 in 37 OECD countries. Keeping the current ratio of five LTC workers for every 100 people aged 65 and older across OECD countries would imply that the number of workers in the sector will need to increase by 13.5 million by 2040.”

Source: OECD (2020), Who Cares? Attracting and Retaining Care Workers for the Elderly, OECD Health Policy Studies, OECD Publishing, Paris. doi.org/10.1787/92c0ef68-en.

“LTC [Long Term Care] workers are often dissatisfied with pay, working conditions and career prospects, adding to the physical and mental stress of the job. That, in turn, leads to low recruitment and retention and an overall shortage of workers in elderly care.

“LTC workers earn much less than those working at hospitals in similar occupations. The median wage for LTC workers across European countries was EUR 9 per hour, compared to EUR 14 per hour for hospital workers in broadly similar occupations. There are also more career promotion prospects in hospitals than in the LTC sector.

“Non-standard employment, including part-time and temporary work, is common in the sector. Almost half (45%) of LTC workers in OECD countries work part-time, over twice the share in the economy as a whole. Temporary employment is frequent: almost one in five LTC workers have a temporary contract, compared to just over one in ten in hospitals. Furthermore, jobs are physically and mentally very demanding. For example, half of LTC workers do shift work, which is associated with health risks such as anxiety, burnout and depression.”

Source: OECD (2020), Who Cares? Attracting and Retaining Care Workers for the Elderly, OECD Health Policy Studies, OECD Publishing, Paris. doi.org/10.1787/92c0ef68-en.

“In recent decades, the share of the population aged 65 years and over has nearly doubled on average across OECD countries, increasing from less than 9% in 1960 to more than 17% in 2019. Declining fertility rates and longer life expectancy (see indicator “Life expectancy by sex and education level” in Chapter 3) have meant that older people make up an increasing proportion of the population in OECD countries. Across the 38 OECD member countries, more than 232 million people were aged 65 and over in 2019, including more than 62 million who were at least 80 years old. As ageing represents one of the key risk factors for serious illness or death from COVID‑19, the pandemic has driven home the need to ensure that health systems are prepared to adapt to the changing needs of an older population.

“Across OECD member countries on average, the share of the population aged 65 and over is projected to continue increasing in the coming decades, rising from 17.3% in 2019 to 26.7% by 2050 (Figure 10.1). In five countries (Italy, Portugal, Greece, Japan and Korea), the share of the population aged 65 and over will exceed one‑third by 2050. At the other end of the spectrum, the population aged 65 and over in Israel, Mexico, Australia and Colombia will represent less than 20% of the population in 2050, owing to higher fertility and migration rates.

“While the rise in the population aged 65 and over has been striking across OECD countries, the increase has been particularly rapid among the oldest group – people aged 80 and over. Between 2019 and 2050, the share of the population aged 80 and over will more than double on average across OECD member countries, from 4.6% to 9.8%. At least one in ten people will be 80 and over in nearly half (18) of these countries by 2050, while in five (Portugal, Greece, Italy, Korea and Japan), more than one in eight people will be 80 and over.

“While most OECD partner countries have a younger age structure than many member countries, population ageing will nonetheless occur rapidly in the coming years – sometimes at a faster pace than among member countries. In the People’s Republic of China (China), the share of the population aged 65 and over will increase much more rapidly than in OECD member countries – more than doubling from 11.5% in 2019 to 26.1% in 2050.”

Source: OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, doi.org/10.1787/ae3016b9-en.

“Over half of the harm that occurs in LTC is preventable, and over 40% of admissions to hospitals from LTC are avoidable. Reducing and preventing harm in LTC is an end in itself, but there is also an economic case to be made. The total cost of avoidable admissions to hospital due to safety lapses in LTC facilities was almost USD 18 billion in 2016 across OECD countries. This figure is equivalent to 2.5% of all spending on hospital inpatient care or 4.4% of all spending on LTC (de Bienassis, Llena-Nozal and Klazinga, 2020[5]).

“For older people, most guidelines advise complete avoidance (that is, an ideal rate of 0%) of benzodiazepines because of the risk of dizziness, confusion and falls. Even so, benzodiazepines are prescribed for older adults for anxiety and sleep disorders, despite these risks. Long-term use of benzodiazepines can lead to adverse events (overdoses), tolerance, dependence and dose escalation. Long-acting (as opposed to short-acting) benzodiazepines are furthermore discouraged for use in older adults because they take longer for the body to eliminate (OECD, 2017[6]).

“Use of benzodiazepines varies greatly, but – on average – has declined between 2009 and 2019 in OECD countries (Figure 10.10). The largest declines in chronic use have occurred in Iceland, Portugal and Denmark. Korea, Iceland and Denmark experienced the largest decline in use of long-acting benzodiazepines. The wide variation is explained in part by different reimbursement and prescribing policies for benzodiazepines, as well as by differences in disease prevalence and treatment guidelines.”

Source: OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, doi.org/10.1787/ae3016b9-en.

“Based on 2010 population estimates – 6.9 billion with 5.04 billion 15 years and over and 1.86 billion under 15 years – and 2004 disability prevalence estimates (World Health Survey and Global Burden of Disease) there were around 785 (15.6%) to 975 (19.4%) million persons 15 years and older living with disability. Of these, around 110 (2.2%) to 190 (3.8%) million experienced significant difficulties in functioning. Including children, over a billion people (or about 15% of the world’s population) were estimated to be living with disability.”

Source: World Report on Disability 2011. Geneva: World Health Organization; 2011.

“Based on the broad measure of disability used in the SSA Supplement, 27.2 percent, or 85.3 million, of people living in the United States had a disability in 2014 (Table 1). About 17.6 percent, or 55.2 million people, had a severe disability. The survey also collected information on individuals that needed assistance performing certain tasks, such as getting in or out of bed or a chair, due to a long-lasting condition. In 2014, 10.1 percent of people aged 18 and older (24.2 million people) indicated they needed such assistance.”

Source: Taylor, Danielle M., “Americans With Disabilities: 2014,” Current Population Reports, P70-152, U.S. Census Bureau, Washington, DC, 2018.

“All OECD countries have experienced tremendous gains in life expectancy at age 65 for both men and women in recent decades. On average across OECD countries, life expectancy at age 65 increased by 5.5 years between 1970 and 2017 (Figure 11.3). Four countries (Australia, Finland, Korea, and Japan) enjoyed gains of more than seven years over the period; only one country (Lithuania) experienced an increase in life expectancy at age 65 of less than two years between 1970 and 2017.

“On average across OECD countries, people at age 65 could expect to live a further 19.7 years. Life expectancy at age 65 is more than 2.5 years higher for women than for men of the same age. This gender gap has not changed substantially since 1970, when life expectancy at age 65 was 2.9 years longer for women than men. Life expectancy at age 65 was highest for women in Japan (24.4 years) and for men in Switzerland (20 years). Among OECD countries, life expectancy at age 65 in 2017 was lowest for women in Hungary (18.4 years), and for men in Latvia (14.1 years).

“While all OECD countries experienced gains in life expectancy at age 65 between 1970 and 2017, not all additional years are lived in good health. The number of healthy life years at age 65 varies substantially across OECD countries (Figure 11.4). In Europe, an indicator of disability-free life expectancy known as “healthy life years” is calculated regularly, based on a general question about disability in the European Union Statistics on Income and Living Conditions (EU-SILC) survey. On average across OECD countries participating in the survey, the number of healthy life years at age 65 was 9.6 for women and 9.4 for men – a markedly smaller difference than that of general life expectancy at age 65 between men and women. Healthy life expectancy at age 65 was above 15 years for both men and women in Norway, Sweden and Iceland; for men, this was nearly three years above the next-best performing countries (Ireland and Spain). Healthy life expectancy at 65 was less than five years for both men and women in the Slovak Republic and Latvia. In the Slovak Republic and Latvia, women spend nearly 80% of additional life years in poor health, compared with less than 30% in Norway, Sweden and Iceland.”

Source: OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, doi.org/10.1787/4dd50c09-en.

“Dementia describes a variety of brain disorders, including Alzheimer’s disease, which progressively lead to brain damage and cause a gradual deterioration of a person’s functional capacity and social relations. Despite billions of dollars spent on research into dementia-related disorders, there is still no cure or even substantially disease-modifying treatment for dementia.

“Nearly 20 million people in OECD countries are estimated to have dementia in 2019. If current trends continue, this number will more than double by 2050, reaching nearly 41 million people across OECD countries. Age remains the greatest risk factor for dementia: across the 36 OECD countries, average dementia prevalence rises from 2.3% among people aged 65-69 to nearly 42% among people aged 90 or older. This means that as countries age, the number of people living with dementia will also increase – particularly as the proportion of the population over 80 rises. Already, countries with some of the oldest populations in the OECD – including Japan, Italy, and Germany – also have the highest prevalence of dementia. Across OECD countries on average, 15 people per 1,000 population are estimated to have dementia (Figure 11.9). In seven countries, more than 20 people per 1,000 population are living with a dementia disorder. By 2050, all but three OECD countries (Slovak Republic, Israel and Hungary) will have a dementia prevalence of more than 20 people per 1,000 population, while in four countries (Japan, Italy, Portugal and Spain), more than one in 25 people will be living with dementia.”

Source: OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, doi.org/10.1787/4dd50c09-en.

“As populations across OECD countries continue to age, an increasing number of people will require support from longterm care (LTC) services, including nursing homes and LTC living facilities (see indicator on ‘Recipients of long-term care’). Providing safe care for these patients is a key challenge for OECD health systems, as residents of LTC facilities are more frail and sicker, and present a number of other risk factors for the development of patient safety events, including healthcare-associated infections (HAIs) and pressure ulcers (OECD/European Commission, 2013[1]).

“HAIs can lead to significant increases in patient morbidity, mortality and cost for the health system. In the acute care sector, HAIs alone are estimated to make up 3-6% of hospital budgets (Slawomirski et al., 2017[2]). These infections are also generally considered to be preventable through standard prevention and hygiene measures. The most commonly occurring HAIs in LTC facilities include urinary tract infections, lower respiratory tract infections, skin and soft tissue infections (Suetens et al., 2018[3]).

“In 2016-17, the average prevalence of HAIs among LTC facility residents in OECD countries was 3.8% (Figure 11.14). This proportion was lowest in Lithuania, Hungary, Sweden, Germany, and Luxembourg (less than 2%), and highest in Denmark, Portugal, Greece and Spain (over 5%).

“The impact of HAIs is increased by the rise of antibioticresistant bacteria, which can lead to infections that are difficult or even impossible to treat. Figure 11.15 shows the proportions of bacteria isolated from LTC residents that are resistant to antibiotics. On average, over one quarter of isolates were resistant to antibiotics. This is nearly equivalent to levels seen in acute care hospitals, where antibiotic resistance is considered a major threat.”

Source: OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/4dd50c09-en.

“For any given country, there is also substantial variation across the specific domains, which highlights areas for improvement. For instance, while the United States and The Netherlands both scored 60 in the composite index, they varied in their performance across individual domains. The United States scores high on productivity and engagement and cohesion, average on well-being, and low on equity and security. Having the highest productivity and engagement domain score of 83 reflects that older Americans retire later and volunteer more than people in many European countries. On the other hand, The Netherlands scores high on equity, security, and well-being but low on productivity and engagement and cohesion.

“Japan is the highest ranked in well-being and is the world leader in healthy life expectancy, with men and women expected to live another 16.7 y of relatively good health, on average, at the age of 65 y. In comparison, the United States ranks ninth in well-being. The United States ranks 16th out of 18 countries in the equity domain, and this finding is consistent with current research on gaps in health that are related to large socioeconomic differences across individuals in the United States. The Nordic countries rank the highest in the equity domain.

“Social cohesion, neighborhood support, and financial transfers and housing support between generations of family members are resources that may act as a buffer against adverse shocks. The United States ranks fourth among all countries in the cohesion domain. Ireland, the United Kingdom, Finland, and Spain also rank in the top five of all countries.

“The United States (ranked 12th) is in the bottom half of all countries in the security domain, with Spain, The Netherlands, and Italy at the top. Income, pension wealth, public expenditure on long-term care, government debt, and physical safety were measured. In Western Europe, people aged 65 y and older are physically and financially more secure than in the United States.”

Source: Cynthia Chen, Dana P. Goldman, Julie Zissimopoulos, John W. Rowe, and Research Network on an Aging Society. Multidimensional comparison of countries’ adaptation to societal aging. Proceedings of the National Academy of Sciences Sep 2018, 115 (37) 9169-9174; DOI: 10.1073/pnas.1806260115.

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World Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and sixteen other nations.

Page last updated July 16, 2023 by Doug McVay, Editor.