목차
Title page 1
Contents 6
Foreword 4
Acknowledgements 5
Executive summary 9
1. Assessment and policy recommendations for healthy ageing and community care 11
Introduction 14
1.1. Populations are not ageing as healthily as they could 15
1.1.1. Gains in life expectancy do not fully translate into healthy life expectancy 15
1.1.2. Health and lifestyle indicators show room for further progress 16
1.1.3. Current living environments are not sufficiently age-friendly 20
1.1.4. Home and community care services remain limited 21
1.2. The economic benefits of healthy ageing 23
1.2.1. Better healthy ageing improves the sustainability of health and long-term care systems 23
1.2.2. More spending on prevention and health system adaptation can reduce health expenditures 24
1.2.3. Supporting ageing at home can reduce long-term care spending 26
1.3. Better prevention and health system adaptation 28
1.3.1. Implementing targeted interventions to better identify people at risk of health decline can be effective if properly designed 29
1.3.2. Bringing care closer to people's homes reduces inpatient expenditures 30
1.3.3. Some integrated care programmes have shown promising effects on functional outcomes and cost, but setting up effective programmes remains challenging 30
1.4. Promoting ageing close to people's homes 31
1.4.1. Adapting environments to older people reduce the risk of hospitalisation and institutionalisation, but such adaptations are not always sufficiently generous 31
1.4.2. Home care services that are comprehensive and affordable are available in a small number of countries 32
1.4.3. While adult day care is associated with positive health outcomes, there is a need for more widespread provision and a more systematic focus on quality 33
1.4.4. Affordable high-quality community housing options are only available in between one-quarter to two-fifths of countries 34
References 34
Notes 40
2. Are people ageing healthily? 41
2.1. Ageing is currently not as healthy as it could be 43
2.1.1. Improvements in life expectancy show limited progress across the OECD 43
2.1.2. Healthy life expectancy has also failed to keep up 44
2.1.3. Nonetheless, trends in the share of people having activity limitations show signs of improvement 47
2.1.4. Younger generation lags behind older generation in health gains 48
2.2. Ageing unequally is driving the lower gains in life expectancy 49
2.2.1. Women are consistently experiencing smaller gains than men 49
2.2.2. Health gaps tied to socio-economic status are widening 51
2.3. What is preventing healthy longevity? 53
2.3.1. Many people are not engaging in preventive health measures 53
2.3.2. Complex health needs in old age require people-centred and integrated approaches 54
2.3.3. Shifting disease patterns require a new approach to long-term care 56
2.3.4. Community environment does not always support independence and quality of life for older people 57
References 58
Notes 66
3. Promoting healthy ageing from the outset 67
3.1. Harnessing the potential of prevention and reablement at older age 69
3.1.1. Early intervention is desirable, but prevention can still be (cost-)effective in old age 69
3.1.2. Spending on prevention is low and programmes are insufficiently targeted to older people 70
3.1.3. Countries can make better use of prevention and reablement through action in four policy areas 72
3.2. Helping people live healthy lives 72
3.2.1. Health literacy equips people with the skills needed to make healthy choices 73
3.2.2. Platforms are a great first step, but might reach only those that are already somewhat literate 73
3.2.3. Health workers are key in improving health literacy, but require people to have good access 74
3.2.4. Partnering with other stakeholders can help diffuse health literacy across communities 74
3.2.5. Benefits of healthy lifestyles are well-established, but need targeted interventions to reach individuals 75
3.2.6. Promoting group exercises has benefits beyond physical activity alone 77
3.2.7. Financial incentives can further nudge healthy behaviours, but success is mixed 78
3.2.8. Social prescribing is gaining attention, but evidence is still missing 79
3.3. Promoting public health measures and preventive care 80
3.3.1. Improving access to public health services can increase their take-up 80
3.3.2. Financial incentives for prevention to providers cannot overcome broader staff shortages and time constraints 83
3.4. Identifying people at risk 84
3.4.1. Early detection allows for early intervention 84
3.4.2. Better targeting of screenings to people at risk can improve their efficiency and effectiveness 85
3.4.3. Screening for specific age-related conditions allows for early detection and intervention 86
3.4.4. Single interventions likely have a limited effect, but comprehensive interventions fare better 87
3.5. Supporting rehabilitation and reablement after health shocks 88
3.5.1. Evaluations suggest that rehabilitation is cost-effective, but access is limited 90
3.5.2. Rehabilitation at home can reduce costs while offering similar quality to hospital rehabilitation 91
3.5.3. Reablement is a relatively new concept with limited but promising evidence 92
References 93
4. Adapting health systems to an ageing population 105
4.1. Making health systems meet older people's needs 107
4.1.1. Health systems are insufficiently tailored to the needs of older people 107
4.1.2. Countries have recognised the need to better align their health systems with the needs of older people 108
4.2. Preparing the health workforce for an ageing population 109
4.2.1. The introduction of geriatricians is still in early stages 109
4.2.2. More OECD countries are closing in on expanding the roles of nurses 110
4.2.3. Equipping the health workforce with the right skills and tools 112
4.3. Increasing the supply of and access to healthcare services 112
4.4. Providing care where it is best 113
4.4.1. Avoiding hospitalisations through outreach teams 114
4.4.2. Replacing and shortening hospital stays through more intensified care at home 115
4.4.3. New provider types can improve access and efficiency of care delivery 120
4.5. Ensuring patient-centred care 122
4.5.1. Care pathways aim at streamlining care along the patient pathway 122
4.5.2. Integrated care programmes increasingly link health with social and long-term care 126
4.5.3. Integrated care programmes reform the way providers are paid to foster integration 128
4.5.4. Integrated care programmes are intuitive, but gains are difficult to materialise 128
References 131
5. How to ensure better ageing in place? 145
5.1. Introduction 147
5.2. Being able to afford a home is the first step towards ageing in place 147
5.2.1. Decreasing homeownership is likely to pose a challenge to older people in the coming decades 147
5.2.2. Incentivising supply is important to have sufficient affordable housing for older people in the face of demand changes 149
5.2.3. Providing financial support and social housing would help to make housing more affordable for older people 150
5.3. Adequate housing is crucial for age-friendly communities 152
5.3.1. Housing affects older people's ability to live independently and is not always accessible 152
5.3.2. Financial support for housing adaptations focusses on more basic equipment, while the application process and out-of-pocket costs limit user access 154
5.3.3. Public subsidies and tax credits for older people to adapt their housing remain limited 156
5.3.4. Developing guidance on public housing design is important for future housing 157
5.4. Building age-friendly communities calls for rethinking urban and rural planning 158
5.4.1. Urban planning can have an impact on the safety of older people 159
5.4.2. Accessibility of services is important for the autonomy of older people 161
5.4.3. Public transport and safe public spaces are needed for older people to age in place 163
5.4.4. A true participation of older people in the communities requires adequate cultural features 164
5.5. Enhancing access and affordability of home care services can facilitate ageing in place 165
5.5.1. Coverage of home care services is not always sufficient 165
5.5.2. Insufficient home care hours and funding for services hamper ageing in place 167
5.5.3. Improving the affordability of home care services would strengthen ageing in place 170
5.5.4. Public financial support for the provision of informal care can be further expanded 171
References 173
Notes 180
6. Promoting the continuum of care in the community 181
6.1. Adult day care can promote healthy ageing and ageing in place, but it is far from fulfilling its potential 183
6.2. Services and quality requirements for adult day care remain very heterogenous across the OECD 190
6.3. Innovative residential solutions are emerging as an option to make communities more age-friendly 198
6.3.1. There is renewed interest for people-centred settings with promising results in terms of health and quality of life 199
6.3.2. Assisted living for older adults is widely available, but it often requires out-of-pocket contributions 202
References 206
Notes 215
Tables 8
Table 1.1. This report's framework for healthy ageing close to people's home 15
Table 3.1. Several structured, evidence-based physical exercise programmes are now available 75
Table 3.2. Duration, referral pathways and services offered in rehabilitation and reablement programmes across selected OECD countries 89
Table 4.1. Overview of key characteristics of hospital-at-home programmes across OECD countries 115
Table 4.2. Overview of care pathways for older people across several OECD countries 123
Table 4.3. Integration of different health sectors in integrated care programmes 126
Table 6.1. Adult day care is fully or partially financed from public resources 188
Table 6.2. Services offered in adult day care are heterogeneous but tend to focus on basic needs 193
Table 6.3. Co-housing and intergenerational housing are available in one-third of countries 198
Figures 7
Figure 1.1. A consistent quarter of life expectancy at age 60 is spent living with disability 16
Figure 1.2. Health literacy is lower for older people 17
Figure 1.3. Only a quarter of older people met physical activity guidelines in 2019 (or nearest available year) 18
Figure 1.4. More people aged 65-74 are experiencing chronic conditions than a decade ago 19
Figure 1.5. Old-age disability is declining over cohorts, but midlife disability remains unchanged 20
Figure 1.6. Fewer than 1 in 5 older people reside in homes that support mobility and independence 21
Figure 1.7. Are there limitations in the maximum number of hours funded for personal care and care for household chores? 22
Figure 1.8. Less than 1% of the population aged over 65 years uses day-care in three-quarters of 16 countries surveyed 23
Figure 1.9. A 10% increase in prevention can reduce health spending on chronic diseases by 0.9% on average 25
Figure 1.10. Many congestive heart failure hospital admissions in adults can be avoided 26
Figure 1.11. A 1% increase in spending on long-term care at home can reduce overall long-term care spending by 0.5% on average 27
Figure 2.1. The growth in life expectancy has slowed in the mid-2010s, with a temporary drop during the pandemic 43
Figure 2.2. The gap between life expectancy and healthy life expectancy is growing 45
Figure 2.3. Improvement in activity limitations in old age varies across countries 47
Figure 2.4. Generational health gains have mainly benefited older people rather than midlife adults 49
Figure 2.5. The narrowing gender gap masks women's lesser gains in life expectancy 50
Figure 2.6. Despite the progress, women are still more likely to experience activity limitations 51
Figure 2.7. People with a lower socio-economic status are expected to have lower life expectancy 52
Figure 2.8. Most OECD countries do not meet the recommended vaccination rates for older people 54
Figure 2.9. One in two older people have experienced polypharmacy consistently over the past decade 55
Figure 2.10. Dementia has had a considerable negative impact on life expectancy 56
Figure 3.1. Spending on prevention remains low across OECD countries 71
Figure 3.2. Four policy areas of prevention and reablement to improve Healthy Ageing 72
Figure 3.3. Pharmacists can now perform seasonal flu vaccinations in 18 countries (by year of introduction) 82
Figure 3.4. Rehabilitation and reablement involves a multitude of different professions 90
Figure 4.1. Four areas of health system adaptation for an ageing population 108
Figure 4.2. Status of geriatrics as specialty across OECD countries 109
Figure 4.3. The Japanese Community-based Integrated Care System Model 130
Figure 5.1. Housing cost overburden rates have been rising for older people in latest years in EU countries 148
Figure 5.2. Most responding countries have programmes to make housing more affordable for older people 149
Figure 5.3. Over 80% of older people live in housing lacking mobility and independence support 153
Figure 5.4. The type of housing adaptations whose cost can be covered by public funds varies across countries 155
Figure 5.5. National funds are the most common source of funding for housing adaptations, but out-of-pocket contributions seem significant 156
Figure 5.6. Age-friendly features are available in the majority of countries 160
Figure 5.7. One in ten older people reside in a neighbourhood of low quality in Europe 161
Figure 5.8. Green spaces and hospitals are scarcely available within walking distance 162
Figure 5.9. 0.5 hospitals are accessible within a 15-minute walk across 30 OECD and EU countries 163
Figure 5.10. Formal care systems meet less than 30% of long-term care needs across the OECD 166
Figure 5.11. Most countries do not actively enforce policies to reduce or monitor a waiting list for services 167
Figure 5.12. Personal care and support with household activities are the most commonly funded services 169
Figure 5.13. The public share of costs covered tends to be higher at home 171
Figure 5.14. Public financial support for informal home care is limited 172
Figure 6.1. Day care represents a small fraction of overall long-term care expenditures 187
Figure 6.2. Many countries have few healthcare staff in adult day care centres 189
Figure 6.3. More than 40% of countries have no requirements or only registration for adult day care 194
Figure 6.4. Quality regulations focus on the environment and staff qualifications 196
Figure 6.5. Quality standards are the most prevalent mechanism while audits and public reporting exist less often 197
Figure 6.6. Evaluation of adult day care is often not very user-centric 198
Figure 6.7. Help with ADLs and IADLs are the most common services provided in assisted living facilities 203
Figure 6.8. Public funds are a common of funding for assisted living facilities, but out-of-pocket contributions are often needed 204
Boxes 28
Box 1.1. OECD estimations on the impact of healthy ageing 28
Box 2.1. Measuring healthy ageing: Diverging definitions and implications for international comparisons 46
Box 3.1. From an age-based to a risk-based approach: The Danish home visit scheme 86
Box 4.1. The Japanese Community-Based Integrated Care System 130
