Longer lives are one of humanity's greatest achievements. However, we don't just want to add years to our lives. We also want to enjoy good health and well-being in later life.

This is healthy ageing.

Today, too many people around the world experience worse health than they should because of unsupportive environments that prevent them from maximising their later years.

The UN Decade of Healthy Ageing (2021–2030) aims to give everyone the opportunity to add life to years, wherever they live.

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The Thirteenth General Programme of Work (GPW 13) defines WHO’s strategy for the five-year period, 2019-2023. It focuses on triple billion targets to achieve measurable impacts on people’s health at the country level.

The triple billion targets are to ensure by 2023:

One billion more people are benefiting from universal health coverage

One billion more people are better protected from health emergencies

One billion more people are enjoying better health and well-being

Measurable impact is at the heart of WHO’s mission to transform the future of public health. See how progress is calculated towards achieving GPW 13.

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The level of unmet needs for health care reported in international surveys varies across countries and surveys - sometimes greatly. This brief explains these differences in the level of unmet needs, by comparing the methods and approaches used across three international surveys. It identifies at least five methodological differences that explain these inconsistencies. Despite differences in the level of unmet needs, the broard picture arising from these surveys is consistent: unmet needs are greater among the poor.

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Author: Keating, N.

Publication date: 2022/01

Abstract

The mission of UN Decade of Healthy Ageing (2020–2030) is to improve the lives of older people, their families and their communities. In this paper, we create a conceptual framework and research agenda for researchers to knowledge to address the Decade action items. The framework builds on the main components of healthy ageing: Environments (highlighting society and community) across life courses (of work and family) toward wellbeing (of individuals, family members and communities). Knowledge gaps are identified within each area as priority research actions. Within societal environments, interrogating beliefs about ageism and about familism are proposed as a way to illustrate how macro approaches to older people influence their experiences. We need to interrogate the extent to which communities are good places to grow old; and whether they have sufficient resources to be supportive to older residents. Further articulation of trajectories and turning points across the full span of work and of family life courses is proposed to better understand their diversities and the extent to which they lead to adequate financial and social resources in later life. Components of wellbeing are proposed to monitor improvement in the lives of older people, their families and communities. Researcher priorities can be informed by regional and national strategies reflecting Decade actions.

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The global indicator framework for Sustainable Development Goals was developed by the Inter-Agency and Expert Group on SDG Indicators (IAEG-SDGs) and agreed upon at the 48th session of the United Nations Statistical Commission held in March 2017.

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Authors: Rudnicka, E., Napierała, P., Podfigurna, A., Męczekalski, B., Smolarczyk, R., & Grymowicz, M.

Publication date: 2020/09

Abstract

The ageing of the global population is the most important medical and social demographic problem worldwide. The World Health Organization (WHO) has defined healthy ageing as a process of maintaining functional ability to enable wellbeing in older age. The WHO, Member States and Partners for Sustainable Development Goals have created a Global Strategy and Action Plan for Ageing and Health for 2016–2020 and its continuation with the WHO programme The Decade of Healthy Ageing 2020–2030. The WHO has established main priorities such as supporting country planning and action, collecting better global data and promoting research on healthy ageing, aligning health systems to the needs of older people, laying the foundations and ensuring the human resources necessary for long-term integrated care, undertaking a global campaign to combat ageism, and enhancing the global network for age-friendly cities and communities. There are several reports of coordinated preventive health and social health initiatives in well developed countries. However, there is little evidence on the application of the active ageing frameworks in developing countries. Greater national capacities and closer monitoring of the progress through age-disaggregated data is needed to effectively implement the intended programmes on healthy ageing.

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Reorienting health systems to primary health care as a resilient foundation for universal health coverage and preparations for a high-level meeting of the United Nations General Assembly on universal health coverage.

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Authors: Barbara Corso, Kanya Anindya, Nawi Ng, Nadia Minicuci, Megumi Rosenberg, Paul Kowal, Julie Byles

Publication date: 2022/12

Abstract

Providing good quality health care that meets the health needs of a population is a key objective of national and sub-national health systems, and consistent with 2030 United Nations Sustainable Development Goal 3.8 and the World Health Organization’s global impact framework1, 2.(UN 2015; WHO 2019) As populations age, health needs shift, where the predominant disease burden tends to be from chronic diseases. Many of these chronic diseases and their risks are modifiable and their outcomes can be improved through accessing quality health and social care services. But in many countries, not all health needs of older people are being met. The gap represented by unmet need raises issues of equity in service coverage and universality of health care. However, current measures of universal health coverage (UHC) do not assess unmet need.

Operationally, unmet health care need can be defined as the differences between services that are necessary to deal appropriately and optimally with a defined health problem (or need) and the services that are actually accessed and provided3. However, the measurement of unmet need is theoretically complex, as needs may be partially met, met with difficulty or delay, or met sometimes and not other times. There may also be a qualitative element in the meeting of needs, as health care may be available, accessed and provided, but not necessarily in a way that is appropriate to the health care problem, or to the satisfaction of the patient. There is no standard agreed definition or measure of unmet health need.

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The 2022 Revision of World Population Prospects is the twenty-seventh edition of official United Nations population estimates and projections that have been prepared by the Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat. It presents population estimates from 1950 to the present for 237 countries or areas, underpinned by analyses of historical demographic trends. This latest assessment considers the results of 1,758 national population censuses conducted between 1950 and 2022, as well as information from vital registration systems and from 2,890 nationally representative sample surveys The 2022 revision also presents population projections to the year 2100 that reflect a range of plausible outcomes at the global, regional and national levels.

The main results are presented in a series of Excel files displaying key demographic indicators for each UN development group, World Bank income group, geographic region, Sustainable Development Goals (SDGs) region, subregion and country or area for selected periods or dates within 1950-2100. An online database (Data Portal) provides access to a subset of key indicators and interactive data visualization, including an open API for programmatic access.

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Authors: Dominika Kalánková, Minna Stolt, Evridiki Papastavrou, Riitta Suhonen, and On behalf of the RANCARE COST Action CA15208

Publication date: 2021/10

Abstract

The aim was to synthesize the findings of empirical research about the unmet nursing care needs of older people, mainly from their point of view, from all settings, focusing on (1) methodological approaches, (2) relevant concepts and terminology and (3) type, nature and ethical issues raised in the investigations. A scoping review after Arksey and O’Malley. Two electronic databases, MEDLINE/PubMed and CINAHL (from earliest to December 2019) were used. Systematic search protocol was developed using several terms for unmet care needs and missed care. Using a three-step retrieval process, peer-reviewed, empirical studies concerning the unmet care needs of older people in care settings, published in English were included. An inductive content analysis was used to analyse the results of the included studies (n = 53). The most frequently used investigation method was the questionnaire survey seeking the opinions of older people, informal caregivers or healthcare professionals. The unmet care needs identified using the World Health Organization classification were categorized as physical, psychosocial and spiritual, and mostly described individuals’ experiences, though some discussed unmet care needs at an organizational level. The ethical issues raised related to the clinical prioritization of tasks associated with failing to carry out nursing care activities needed. The unmet care needs highlighted in this review are related to poor patient outcomes. The needs of institutionalized older patients remain under-diagnosed and thus, untreated. Negative care outcomes generate a range of serious practical issues for older people in care institutions, which, in turn, raises ethical issues that need to be addressed. Unmet care needs may lead to marginalization, discrimination and inequality in care and service delivery. Further studies are required about patients’ expectations when they are admitted to hospital settings, or training of nurses in terms of understanding the complex needs of older persons.

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Authors: Gemma Frances Spiers, Tafadzwa Patience Kunonga, Daniel Stow, Alex Hall, Andrew Kingston, Oleta Williams, Fiona Beyer, Peter Bower, Dawn Craig, Chris Todd, Barbara Hanratty

Publication date: 2022/10

Abstract

Populations are considered to have an ‘unmet need’ when they could benefit from, but do not get, the necessary support. Policy efforts to achieve equitable access to long-term care require an understanding of patterns of unmet need. A systematic review was conducted to identify factors associated with unmet need for support to maintain independence in later life.

Seven bibliographic databases and four non-bibliographic evidence sources were searched. Quantitative observational studies and qualitative systematic reviews were included if they reported factors associated with unmet need for support to maintain independence in populations aged 50+, in high-income countries. No limits to publication date were imposed. Studies were quality assessed and a narrative synthesis used, supported by forest plots to visualise data.

Forty-three quantitative studies and 10 qualitative systematic reviews were included. Evidence across multiple studies suggests that being male, younger age, living alone, having lower levels of income, poor self-rated health, more functional limitations and greater severity of depression were linked to unmet need. Other factors that were reported in single studies were also identified. In the qualitative reviews, care eligibility criteria, the quality, adequacy and absence of care, and cultural and language barriers were implicated in unmet need.

This review identifies which groups of older people may be most at risk of not accessing the support they need to maintain independence. Ongoing monitoring of unmet need is critical to support policy efforts to achieve equal ageing and equitable access to care.

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2020 review of

A new brief on measuring unmet health and care needs among older people using existing data

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Authors: Smith, S., & Connolly, S.

Publication date: 2020/10

Abstract

There is an increasing interest in assessing unmet need for health care services particularly in European countries. Despite this there has been relatively little analysis of unmet need in the European or wider international setting. It remains a challenge to pin down what types of unmet need can and should be addressed by health care policymakers, and how to go about identifying and quantifying those unmet needs. The objective of this paper is to propose a new way of thinking about unmet need for health care which can in turn guide analysis of unmet need in terms of potential data sources and analytic approaches. Unmet need is shown to be a complex multi-faceted concept that cannot be captured by a single indicator or measurement. To advance the literature in this field, this paper considers what happens to unmet need over time. By introducing a dynamic perspective, three alternative trajectories for health care needs are outlined: non-use of health care, delayed use of health care and sub-optimal use of health care. These trajectories are discussed with a view to improving the focus, and policy applicability, of empirical research in this field.

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Authors: Scherbov, S., & Sanderson, W. C.

Publication date: 2026/10

Abstract

Objective: Most studies of population aging focus on only one characteristic of people: their chronological age. Many important characteristics of people vary with age, but age-specific characteristics also vary over time and differ from place to place. We supplement traditional measures of aging with new ones that consider the changing characteristics of people.

Method: The characteristics approach to measuring of population aging is employed. We provide examples of new measures of population aging using characteristics, such as remaining life expectancy, health, normal public pension age, and hand-grip strength.

Results: Past and future population aging look less rapid using the characteristics approach, compared with traditional ones. For some regions, almost no aging occurred in the recent past.

Discussion: Supplementing chronological age with ages that take into account the changing characteristics of people allows us to analyze aging more comprehensively and more accurately.

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Authors: Md. Mizanur Rahman, Megumi Rosenberg, Gabriela Flores, Nadia Parsell, Shamima Akter, Md Ashraful Alam, Md. Mahfuzur Rahman & Tessa Edejer

Publication date: 2022/12

Abstract

The absolute number of older individuals needing medical care and long-term care (LTC) is increasing globally due to the growing ageing population. However, it is uncertain who and what proportion of the population has access to care. Therefore, a systematic review and meta-analysis of the prevalence and reasons for unmet needs for healthcare and long-term care among older people, 65 years old and above, across countries was conducted.

An information specialist performed a comprehensive search of four major databases (PubMed, EMBASE, Web of Science, and CINAHL) from inception to June 2020 without restrictions on language and date. We did random-effects meta-analysis to obtain pooled prevalence. We stratified the meta-analysis by reasons for unmet need categorized by barrier dimension (availability, accessibility, affordability, and acceptability), survey year, geographic location, and socio-demographic characteristics of the older individual.

After screening 3912 articles, we included 101 studies published between 1996 and 2020. Of the 101 studies, 87 studies reported unmet healthcare needs and 14 studies reported unmet LTC needs. Overall, 10.4% (95% CI, 7.3–13.9) of the older population had unmet needs for healthcare. The common reasons for unmet healthcare needs were cost of treatment, lack of health facilities, lack of/conflicting time, health problem not viewed as serious, and mistrust/fear of provider. A significant variation in pooled prevalence of unmet healthcare needs due to cost was found by gender (male [10.9, 95% CI, 8.9–13.1] vs female [14.4, 95% CI, 11.8–17.3]), educational level (primary or less [13.3, 95% CI, 9.6–17.6] vs higher [7.5, 95% CI, 5.9–9.3]), self-reported health (poor [23.2, 95% CI, 18.8–27.8] vs good [4.4, 95% CI, 3.4–5.5]), insurance status (insured [9.0, 95% CI, 7.5–10.6] vs uninsured [27.7, 95% CI, 24.0–31.5]), and economic status of population (poorest [28.2, 95% CI, 14.1–44.9] vs richest [7.1, 95% CI, 3.8–11.3]). One in four (25.1, 95% CI, 17.1–34.2) older people had unmet needs in LTC. Rural residents had a higher prevalence of unmet needs in LTC compared to their urban counterparts.

With the population ageing globally, it is necessary to improve access to health care and LTC for older people. Ensuring affordability of health services, reducing geographical barriers, and improving acceptability, will be critical in reducing unmet need. Unmet needs for healthcare were concentrated in population with no education, poor economic group, outpatient health facility user, and uninsured group. With education and economic-based inequalities at the forefront, all countries should focus on improving access to health services by reducing the burden related to healthcare costs.

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Authors: Jotheeswaran Amuthavalli Thiyagarajan, Christopher Mikton, Rowan H Harwood, Muthoni Gichu, Victor Gaigbe-Togbe, Tapiwa Jhamba, Daniela Pokorna, Valentina Stoevska, Rio Hada, Grace Sanico Steffan, Ana Liena, Eileen Rocard, Theresa Diaz

Publication date: 2022/07

Abstract

Over the past 100 years, life expectancy has increased dramatically in nearly all nations. Yet, these extra years of life gained have not all been healthy, particularly for older people aged 60 years and over. In 2020, the World Health Organisation (WHO) and United Nations (UN) member states embraced a sweeping 10-year global plan of action to ensure all older people can live long and healthy lives, formally known as the UN Decade of Healthy Ageing (2021–2030). With the adoption of the UN Decade of Healthy Ageing resolution, countries are committed to implementing collaborative actions to improve the lives of older people, their families and the communities in which they reside. The Decade addresses four interconnected areas of action. Adopting the UN's resolution on the Decade of Healthy Ageing has caused excitement, but a question that has weighed on everyone's mind is how governments will be held accountable? Besides, there have been no goals or targets set for the UN Decade of Healthy Ageing from a programmatic perspective for the action areas, and guidance on measures, data collection, analysis and reporting are urgently needed to support global, regional and national monitoring of the national strategies, programmes and policies. To this end, WHO in collaboration with UN agencies and international agencies established a Technical Advisory Group for Measurement of Healthy Ageing (TAG4MHA) to provide advice on the measurement, monitoring and evaluation of the UN Decade of Healthy Ageing at the global, regional and national levels.

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Author: Vlachantoni, A.

Publication date: 2017/07

Understanding the nature and extent of unmet need for social care among older people is a critical policy priority in the United Kingdom and beyond, as national governments juggle the provision of adequate social care for a growing older population with competing funding priorities. Several factors can heighten the experience of unmet need among older people, for instance, their family environment, and their health and socio-economic status. This paper contributes empirical evidence on the patterns of unmet need for social care among older people in England today, focusing on the individual characteristics associated with experiencing unmet need in relation to mobility tasks, activities of daily living (ADLs) and instrumental activities of daily living (IADLs). The results show that about 55 per cent of older individuals with an ADL difficulty had unmet need, compared to 24 per cent of those with an IADL difficulty and 80 per cent of those with a mobility difficulty. Characteristics reflecting greater vulnerability were more strongly associated with the risk of experiencing unmet need for ADLs, and such vulnerability was greater for particular ADLs (e.g. bathing), and for a higher number of ADLs. The findings reaffirm the complexity of conceptualising and empirically investigating unmet need in later life, and add to our understanding of the challenges of providing adequate and appropriate social care to older people.

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The 2022 Revision of World Population Prospects is the twenty-seventh edition of official United Nations population estimates and projections that have been prepared by the Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat. It presents population estimates from 1950 to the present for 237 countries or areas, underpinned by analyses of historical demographic trends. This latest assessment considers the results of 1,758 national population censuses conducted between 1950 and 2022, as well as information from vital registration systems and from 2,890 nationally representative sample surveys The 2022 revision also presents population projections to the year 2100 that reflect a range of plausible outcomes at the global, regional and national levels.

The main results are presented in a series of Excel files displaying key demographic indicators for each UN development group, World Bank income group, geographic region, Sustainable Development Goals (SDGs) region, subregion and country or area for selected periods or dates within 1950-2100. An online database (Data Portal) provides access to a subset of key indicators and interactive data visualization, including an open API for programmatic access.

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Authors: Angela Y Chang, Vegard F Skirbekk, Stefanos Tyrovolas, Nicholas J Kassebaum, Joseph L Dieleman

Publication Date: 2019

Summary

Traditional metrics for population health ageing tend not to differentiate between extending life expectancy and adding healthy years. A population ageing metric that reflects both longevity and health status, incorporates a comprehensive range of diseases, and allows for comparisons across countries and time is required to understand the progression of ageing and to inform policies.

Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2017, we developed a metric that reflects age-related morbidity and mortality at the population level. First, we identified a set of age-related diseases, defined as diseases with incidence rates among the adult population increasing quadratically with age, and measured their age-related burden, defined as the sum of disability-adjusted life-years (DALYs) of these diseases among adults. Second, we estimated age-standardised age-related health burden across 195 countries between 1990 and 2017. Using global average 65-year-olds as the reference population, we calculated the equivalent age in terms of age- related disease burden for all countries. Third, we analysed how the changes in age-related burden during the study period relate to different factors with a decomposition analysis. Finally, we describe how countries with similar levels of overall age-related burden experience different onsets of ageing. We represent the uncertainty of our estimates by calculating uncertainty intervals (UI) from 1000 draw-level estimates for each disease, country, year, and age.

92 diseases were identified as age related, accounting for 51·3% (95% UI 48·5–53·9) of all global burden among adults in 2017. Across the Socio-demographic Index (SDI), the rate of age-related burden ranged from 137·8 DALYs (128·9–148·3) per 1000 adults in high SDI countries to 265·9 DALYs (251·0–280·1) in low SDI countries. The equivalent age to average 65-year-olds globally spanned from 76·1 years (75·6–76·7) in Japan to 45·6 years (42·6–48·2) in Papua New Guinea. Age-standardised age-related disease rates have decreased over time across all SDI levels and regions between 1990 and 2017, mainly due to decreases in age-related case fatality and disease severity. Even among countries with similar age-standardised death rates, large differences in the onset and patterns of accumulating age-related burden exist.

The new metric facilitates the shift from thinking not just about chronological age but the health status and disease severity of ageing populations. Our findings could provide inputs into policymaking by identifying key drivers of variation in the ageing burden and resources required for addressing the burden.

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Authors: Mariana Calderón-Jaramillo & Pilar Zueras

Publication date: 2023/04

Abstract

Population care needs are dynamic. They change throughout individuals’ life courses and are related to the population structure. These needs are particularly demanding during population ageing and may vary depending on how societies cope with them. In this study, we explored the unmet social care needs of individuals in twelve European countries with different social care systems. We used data from the seventh wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) to conduct a cross-sectional study of individuals aged 65 and over with care needs (n = 7136). Unmet care needs were measured from an absolute approach. We fitted binomial regression models to explain the relative importance of individuals’ characteristics, health status and different social care systems on unmet needs. The absolute measure shows that 53.02% of the analytical sample faced unmet care needs as they reported limitations and did not receive help. The prevalence of unmet care needs is higher for men than women and for younger than older individuals. Furthermore, we found that individuals living in Mediterranean social care systems have the highest prevalence of these unmet needs. This analysis contributes to the ongoing debate about the challenges posed by ageing populations and their relationship with care.

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Authors: Jean-Frederic Levesque, Mark F Harris & Grant Russell

Publication date: 2013/03

Abstract

Access is central to the performance of health care systems around the world. However, access to health care remains a complex notion as exemplified in the variety of interpretations of the concept across authors. The aim of this paper is to suggest a conceptualisation of access to health care describing broad dimensions and determinants that integrate demand and supply-side-factors and enabling the operationalisation of access to health care all along the process of obtaining care and benefiting from the services.

A synthesis of the published literature on the conceptualisation of access has been performed. The most cited frameworks served as a basis to develop a revised conceptual framework.

Here, we view access as the opportunity to identify healthcare needs, to seek healthcare services, to reach, to obtain or use health care services, and to actually have a need for services fulfilled. We conceptualise five dimensions of accessibility: 1) Approachability; 2) Acceptability; 3) Availability and accommodation; 4) Affordability; 5) Appropriateness. In this framework, five corresponding abilities of populations interact with the dimensions of accessibility to generate access. Five corollary dimensions of abilities include: 1) Ability to perceive; 2) Ability to seek; 3) Ability to reach; 4) Ability to pay; and 5) Ability to engage.

This paper explains the comprehensiveness and dynamic nature of this conceptualisation of access to care and identifies relevant determinants that can have an impact on access from a multilevel perspective where factors related to health systems, institutions, organisations and providers are considered with factors at the individual, household, community, and population levels.

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