Title page 1

Contents 2

1. Introduction 3

2. Demographic and health scenarios 5

2.1. Demographic scenarios 6

2.2. Demographic projections 7

3. Health scenarios 12

3.1. Defining functional impairment 13

3.2. Projecting functional impairment 14

3.3. Healthy ageing as a lever for reducing future long-term care demand 16

3.4. Physical activity, frailty and fall prevention 17

3.4.1. Physical activity 17

3.4.2. Preventing chronic disease and multimorbidity 18

3.4.3. Reducing the translation of impairment into dependency 19

3.5. Prevention expenditure and targeting 20

3.6. Socioeconomic inequalities and future care needs 22

4. Policy implication and concluding remarks 23

References 25

Appendix 29

Table 1. Demographic scenarios 7

Table 2. Definition of the different levels of functional impairment 13

Figure 1. Population growth by country and demographic scenario, relative to 2023 8

Figure 2. Growth of the population aged 65 and above by country and demographic scenario, relative to 2023 9

Figure 3. Growth of the population aged 85 and above by country and demographic scenario, relative to 2023 9

Figure 4. Old-age to working-age ratio by country and demographic scenario, relative to 2023 10

Figure 5. Very-old-age to working-age ratio by country and demographic scenario, relative to 2023 11

Figure 6. Life expectancy at age 65 12

Figure 7. Distribution of functional impairment levels by age group 13

Figure 8. Share of the population with moderate-to-severe care needs, relative to the working-age population 15

Figure 9. Functional impairment by age group and activity 17

Figure 10. Preventive care expenditure and composition across selected OECD countries (2024) 20

Figure 11. Functional impairment by age group and education level 22

Figure 12. Functional impairment by income quintile 22

Table A1. Population growth by country and demographic scenario, relative to 2023 29

Table A2. Growth of population aged 65 and above, by country and demographic scenario, relative to 2023 29

Table A3. Growth of population aged 85 and above, by country and demographic scenario, relative to 2023 30

Figure A1. Age-impairment profiles, for each country and health scenario 30