Europe’s long-term care gap: longevity risk and health uncertainty

This paper examines how uncertainty in demographic and health trajectories shapes the assessment of future long‑term care (LTC) needs in the European Union. While populations continue to age and life expectancy rises, recent evidence suggests that long‑term improvements in health may be slowing, increasing the likelihood that individuals spend more years living with functional impairments. This paper discusses the three demographic and three health scenarios detailed in Börsch-Supan and Rausch (2024), constructed using Eurostat data, SHARE data and Rausch’s MEA-SOCSIM simulation model. In all scenarios, the population aged 85 and over expands markedly, with roughly 42 percent of that population projected to experience mild‑to‑severe functional limitations. The findings show that future health trajectories exert a stronger influence on LTC demand than demographic ageing alone. Under more optimistic health assumptions, it should be possible to reduce the negative impact in case the most-pessimistic demographic scenario materialises, thus mitigating the increase in the share of individuals requiring care. The paper highlights several modifiable determinants of impairment, including chronic disease, multimorbidity, frailty and physical inactivity, and concludes that prevention and healthy‑ageing policies could substantially mitigate future LTC pressures on the overall healthcare system. 

This paper has been prepared within the scope of the BB-Future project (https://www.bb-future.eu/), which has received funding from the European Union’s Horizon 2020 research and innovation programme under project ID 101093849. We gratefully acknowledge comments received at the BB-Future Consortium meeting, Paris, 24-25 June 2026, from participants in the Bruegel Research Meeting, Brussels, 13 April 2026, and at the European Commission’s Mutual Learning Workshop on ‘Enhancing the Monitoring and Evaluation of Evidence‑Based Practices in Long‑Term Care’, Brussels, 17–18 March 2026. We are particularly grateful to Roel Dom, Hans Gerooms and Lucio Pench for their valuable comments and feedback, as well as the other members of the BB-Future consortium.