Demographers measured old age by remaining life expectancy, halving the estimated burden of ageing in the European Union
Demographers measured old age by remaining life expectancy, halving the estimated burden of ageing in the European Union
On 16 September 2026, demographers from universities in Florence and Venice, Sweden’s Karolinska Institutet and other European centres published an article in the peer-reviewed Journal of Internal Medicine that changes how population ageing is measured. They replaced the fixed threshold of “65 years” with the number of years a person can statistically expect to live. By this measure, the estimated burden of ageing in the European Union was halved, while the gap between life expectancy and years lived in good health continues to widen.
The standard measure of the burden of ageing divides the number of people older than 65 by the working-age population. The threshold was introduced when a person aged 65 was nearing the end of life. Cohort data show how this has changed: in England and China, people born in 1950 had functional abilities at 62 comparable to those of people aged 52 in earlier generations. The threshold of 65 therefore overstates population ageing.
The authors proposed defining old age by remaining life expectancy: people are classified as “old” when they can statistically expect to live another 15 years. This threshold rises as each generation lives longer, whereas the fixed threshold stays at 65. Recalculating the measure across the 27 European Union countries from 1990 to 2024 gives a figure of about 20%, half the conventional estimate of ~40%. The measure itself comes from the work of Sanderson and Scherbov; the article’s contribution is its recalculation for the EU and its connection to demand for doctors.
The authors explain the discrepancy through a shift from a “pyramid” to a “boat” in the population’s age structure. Falling birth rates narrow the base of the population pyramid, producing ageing “from below”, while longer life expectancy widens the top, producing ageing “from above”. These processes have different causes and policy implications, yet the conventional measure of the older population’s share combines them into a single number.
The authors draw a practical conclusion: both boundaries of working age need to be recalculated. This applies to the upper boundary, retirement age, and the lower boundary, which is effectively fixed at 20 even though education has delayed entry into the labour market.
The same article also documents a less favourable trend: according to WHO data for 2000–2021, life expectancy at 60 in high-income countries grew twice as fast as healthy life expectancy. In Sweden, the proportion of people aged 75 with a disability fell from 13,9% to 5,6% over three decades, but the pattern across other countries is uneven.
Demand for doctors and nurses depends on how much illness accompanies each additional year of life among older people. The European Commission’s Joint Research Centre estimates that, if the burden of age-related disease remains unchanged, the European Union will need 30% more doctors and 33% more nurses by 2071. If the trend towards fewer years of illness before death continues (~0,9% per year since the 1990s), demand will instead fall by 18% and 16%. In April 2026, engineer and entrepreneur Casey Handmer proposed treating this same distinction as a separate demographic variable alongside fertility.
The authors argue that healthcare is organised around treating individual acute diseases, while growing numbers of older people live with several chronic conditions at once. Access to palliative care is uneven: cancer patients receive it substantially more often than people dying from organ failure or dementia.
“Population ageing should be understood as the context in which healthcare systems and policies must evolve, rather than as a problem to be solved,” the authors write in their conclusion.
The actual burden comes from the gap between how long people live and how many of those years they spend in good health. Recalculating the thresholds simply makes that gap visible; research on ageing has the potential to narrow it.