Report Summary

The promise of healthy ageing in Europe is clouded by the rising incidence of chronic disease. These diseases, whose hallmark is a gradual and long-term deterioration of function rather than a sudden acute event, increasingly threaten both the quality of life of older Europeans and the ability of healthcare systems to cope with their demands. In the absence of reforms in both the care of individual patients and the overall design of healthcare systems themselves, the rising tide of chronic illness threatens to overwhelm the resources of healthcare by mid-century, ensuring that ageing is a burden and not an opportunity for Europe.

Most of the work on healthy ageing, including the European Union’s Innovation Partnership on Active and Healthy Ageing, focuses on how to improve care for the aged. This study refocuses attention on getting people to old age in a healthier condition by looking at what can be done throughout people’s lives to increase the odds for healthy longevity. 

Key Findings 

• Chronic diseases threaten to overwhelm Europe’s healthcare system. Between 70% and 80% of European healthcare costs are spent on chronic
  care, amounting to €700bn in the EU. Chronic diseases account for over 86% of deaths in the EU.

• This scourge is largely preventable. Scientists believe that much of the disease burden can be prevented, or at least substantially delayed, through a combination of primary prevention measures, screening and early intervention.

• An ounce of prevention is worth a pound of cure. The “four basics” of primary prevention are already well known: a healthy diet, regular exercise, avoiding tobacco and eschewing excessive alcohol intake.

• Prevention also includes early diagnosis and intervention. While primary prevention focuses on healthy living, secondary prevention (early screening and diagnosis) and tertiary prevention (early intervention to slow the progress of diseases identified) also play important roles in reducing the burden of chronic disease.

• It is never too early to tackle chronic diseases such as cardiovascular and respiratory illnesses, Type 2 diabetes, cancer, dementia, kidney and liver diseases, obesity and being overweight. Indeed, healthy practices begun in infancy—and perhaps even earlier, in vitro—can help to forestall the onset of disease.

• Care of chronic conditions has distinct needs compared to acute care, and must be refashioned accordingly. To ensure appropriate care for chronic disease sufferers as well as free up medical resources for acute-care patients, communities and healthcare systems should direct more resources to wellness, prevention and disease management programmes for chronic patients.

• Healthcare should be integrated and patient-centred to the greatest extent possible. Integration of medical services and other services such
  as mental health, in-home sanitary care, and instruction in self-monitoring and self-care methods are crucial components of creating an integrated, patient-centred chronic care system. This is particularly important for patients suffering from more than one chronic disease, who often must co-ordinate their own care among silo-like specialised care providers under the current system.

• Healthcare should be devolved as far as possible down the provider chain. As part of patient-centred healthcare, patients should be encouraged to do as much as possible for themselves, with appropriate support from a variety of providers—not all of them necessarily specialised doctors. Pharmacists, nurses, community workers, home care workers and others can all play a part, and are often in a better position than doctors and hospitals to provide time-intensive coaching and personal attention to patients.

• Employers and health insurers have major contributions to make in fighting chronic disease. Health and wellness programmes are
  increasingly being offered by progressive employers as a way to ensure that older workers are able to remain on the job longer. Health insurers are also increasingly sponsoring health and wellness programmes as incentives to encourage healthy lifestyles and practices.

• Mental healthcare is an important part of the mix in the prevention and treatment of chronic illnesses. Researchers have found that isolation and loneliness among those whose function is impaired owing to chronic disease aggravates their condition. Several promising initiatives aim at reducing that loneliness through individual case management and personal health coaching. In general, healthcare providers are increasingly incorporating mental health services as part of treatment for chronic-care patients.