Disability statistics - elderly needs for help or assistance

Data extracted in August 2022.

Planned article update: November 2027.

Highlights

In 2019, almost half of the EU elderly population (people aged 65 and over) reported difficulties with at least one personal care or household activity.

In 2019, 46.6 % of the EU elderly population with a severe difficulty in personal care or household activities reported a lack of assistance with those activities.

Almost 30 % of the EU elderly population with a difficulty in personal care or household activities used home care services for personal needs.

This article provides an overview of the assistance used or required by elderly people in the European Union (EU) to overcome personal care or household activity limitations (such as difficulty in showering, using toilets, doing housework or shopping). It is one of a set of statistical articles concerning disability statistics in the EU and accompanies a number of methodological articles which make up an online publication on disability statistics.

With rising life expectancy, more people now reach an age where declining physical and mental health make them dependent on help from others. This has an impact on long-term care expenditure, which is rising faster than expenditure on health and pensions.

The data presented in this article come from the third wave of the European Health Interview Survey (EHIS), conducted in 2019. EHIS covers people aged 15 and over, while the data presented in this article refer to those aged 65 and above, in other words, the elderly population.

Full article

Difficulties in personal care or household activities

Almost half of the EU elderly population (people aged 65 and over), reported difficulties with at least one personal care or household activity

Regarding personal care and household activities, Figure 1.1 shows that, on average, 49.7 % of the EU elderly population reported having moderate or severe difficulties (represented by the category ‘Limited’), while 50.3 % reported not having any difficulties (‘Not limited’). In almost half of the EU Member States (13), as well as in Serbia and Turkey, a higher share of people reported moderate or severe difficulties with at least one personal care or household activity, while in 14 countries, the trend was the opposite i.e. there was a higher share of people with no difficulties in those activities (see Figure 1.1). This was also the case in Iceland and Norway.

Among the EU Member States, the highest rates for persons with difficulties in personal care or household activities were recorded in Romania (80.1 %) followed by Lithuania (67.4 %), Slovakia (66.2 %) and Latvia (65.5 %).

Figure 1.1: Persons limited in personal care or household activities, 2019
(% share of the population aged 65 and above)
Source: Eurostat (hlth_ehis_tae)

Women were more likely than men to report difficulties with personal care or household activities

An analysis by sex indicates that the proportion of women that reported limitations (moderate or severe) in personal or household activities was higher than that of men (57.1 % versus 39.9 %, for EU); this was the case for all EU Member States (see Figure 1.2). The highest gender gaps were found in Portugal (30.8 percentage points (pp)), Cyprus (27.2 pp) and Spain (23.0 pp). A higher difference was found in Turkey (31.0 pp).

Figure 1.2: Persons limited in personal care or household activities by sex, 2019
(% share of the population aged 65 and above)
Source: Eurostat (hlth_ehis_tae)

Difficulties with personal care or household activities more prevalent among those with lower educational attainment

Among the EU Member States, difficulties with personal care or household activities for the elderly were more prevalent among those with less than primary, primary and lower secondary educations (56.2 %) compared to those with upper secondary and post-secondary non-tertiary educations (46.4 %) or tertiary educations (35.3 %) (see Figure 2).

Figure 2: Persons limited in personal care or household activities by educational attainment level, 2019
(% share of the population aged 65 and above)
Source: Eurostat (hlth_ehis_tae)

Across educational levels and EU Member States, there was a considerable educational gap between the elderly with upper secondary and post-secondary non-tertiary education and tertiary educational level who reported having difficulties with personal care or household activities. The highest differences were observed in Slovakia (17.1 pp) and Belgium (15.8 pp), while in the case of Spain and Finland, the educational gap was considerably smaller (i.e. 1 pp or less).

In contrast, in Portugal, more persons with tertiary educations considered that they have difficulties (33.7 %) compared to those with upper secondary and post-secondary non-tertiary educations (28.7 %).

More than one quarter of the elderly population with less than primary, primary and lower secondary education reported difficulties with personal care activities

When looking only to the personal care activities (also known as activities of daily living), the trend was similar; at EU level, 28.4 % of elderly persons with less than primary, primary and lower secondary educations reported difficulties in personal care activities compared with 20.5 % of people with an upper secondary and post-secondary non-tertiary education and 14.5 % with a higher educational level (see Figure 3).

Figure 3: Persons limited in personal care activities by educational attainment level, 2019
(% share of the population aged 65 and above)
Source: Eurostat (hlth_ehis_pc1e)

The same pattern is observed across all Member States, except in Greece, Spain and Portugal where the lowest share of elderly persons reporting difficulties with the daily activities was found among those having completed upper secondary or post-secondary non-tertiary education (see Figure 3).

Almost a quarter of the EU elderly population was limited in at least one daily life activity

In the EU, the share of people aged 65 and over limited in at least one of the five measured daily life activities (namely, feeding oneself, getting in and out of bed or chair, dressing and undressing, using toilets, bathing or showering) was 23.6 % in 2019. Among the EU Member States, eight of them reported more than 25.0 % of elderly persons having difficulties with those activities, while in Ireland, Denmark and Malta, that share was less than 12 % (see Figure 4).

Figure 4: Persons limited in personal care activities by activity where the limitation is encountered, 2019
(% share of the population aged 65 and above)
Source: Eurostat (hlth_ehis_pc1e)

The activities with which the elderly had the most difficulties were ‘Getting in and out of a bed or chair' (17.2 %) and ‘Bathing or showering’ (16.5 %). This pattern holds for the majority (18) of the EU Member States with the exception of Belgium, Estonia, Greece, Spain, Croatia, Cyrus, Italy, Lithuania and Hungary, where ‘Bathing or showering’ was the most common activity where difficulties were encountered among the elderly. The daily activity ‘’Feeding oneself’ was the least problematic, as less than 10 % of the elderly in almost all EU countries encountered difficulties with it, except for Romania, Poland and Lithuania, where the rate was slightly above 10 %.

Figure 5: Persons limited in household activities by educational attainment level, 2019
(% share of the population aged 65 and above)
Source: Eurostat (hlth_ehis_ha1e)

In all EU Member States, the share of elderly persons reporting difficulties with household activities (namely, preparing meals, using the telephone, shopping, managing medication, doing light housework, doing occasional heavy housework, taking care of finances and everyday administrative tasks) was also highest among those with less than primary, primary and lower secondary educational level (54.0 %), compared to those with upper secondary and post-secondary non-tertiary education (44.2 %) or tertiary education (32.9 %) (see Figure 5). An exception to this pattern was Portugal, where the share of persons with tertiary educations was above the one for persons with upper secondary and post-secondary non-tertiary educations.

As observed in Figure 5, there was a considerable gap between the less than primary, primary and lower secondary education and tertiary educational level among the elderly persons reporting difficulties with household activities. The largest gaps were recorded in Slovakia (35.8 pp), Austria (34.7 pp) and Croatia (33.1 pp), while for Malta and Sweden, the educational gap was considerably smaller (10.6 pp and 11.5 pp, respectively).

Table 1: Persons limited in household activities by activity where the limitation is encountered, 2019
(% share of the population aged 65 and above)
Source: Eurostat (hlth_ehis_ha1e)

Table 1 provides information on the share of people having difficulties with different household activities. In total, 47.4 % of the elderly in the EU encountered difficulties in at least one or more activity in 2019. Most difficulties were experienced with ‘Occasional heavy housework’ (44.9 %), ‘Shopping’ (22.6 %) and ‘Light housework’ (20.6 %). This pattern holds for most EU Member States with the exception of Belgium, Denmark, Spain, Cyprus, Latvia, Malta, Romania and Slovenia, where the second most common activity, with which the elderly reported to have difficulties, was ‘Light housework’. This was also the case in Iceland, Serbia and Turkey.

The activities “Using the telephone’’ and ‘’Managing medication” were reported the least problematic by the elderly population (about 9 %). The only exception was found in Malta where the share of the elderly having difficulties "Preparing meals" was slightly lower than the share for "Managing medication" (8.7 % and 9.0 %, respectively).

Need for help with personal care or household activities

People having difficulties with personal care or household activities (in particular, those having a severe difficulty) are likely to seek for help or assistance with those problematic activities. Whether the elderly persons who struggle with everyday activities (that is, those with severe difficulties) receive or need (more) help is next presented.

Almost half of the elderly population with a severe difficulty in personal care or household activities reported a lack of assistance with those activities

In EU, 46.6 % of elderly persons with a difficulty in personal care or household activities reported a lack of assistance in 2019, while 40.1 % reported they ‘Get enough assistance’ and 13.3 % stated they had ‘No need for assistance’. The latter category might indicate people who do not want any help, wishing to remain entirely independent. Across EU Member States, the share of those lacking assistance ranged from 74.6 % in Luxembourg, to 23.4 % in Malta (Figure 6).

Figure 6: Persons severely limited in personal care or household activities by need for assistance, 2019
(% share of the population aged 65 and above)
Source: Eurostat (hlth_ehis_tadlh)

The countries with the highest proportions of the elderly with severe difficulties stating that they receive enough assistance were Latvia (60.9 %) and Austria (60.4 %), while the countries with the lowest proportions were Finland (16.0 %) and Malta (16.9 %).

Self-reported use of home care services

Almost 30 % of the EU elderly with severe difficulties in personal care or household activities used home care services for personal needs

At the EU level, in 2019, the share of elderly persons with severe difficulties in activities and who self-reported the use of home care services for personal needs was 28.6 %, compared to 6.9 % of those having a moderate difficulty and 2.6 % for those with no difficulty. Across the EU Member States, there was a difference in the usage of the home care by the elderly with severe difficulties. The share ranged from more than 50 % in Belgium, Denmark and the Netherlands to less than 5% in Romania.

Figure 7: Self-reported use of home care services by level of difficulty with personal care or household activities, 2019
(% share of the population aged 65 and above)
Source: Eurostat (hlth_ehis_am7ta)

Source data for tables and graphs

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Data sources

The third wave of the European health interview survey (EHIS) is the source of information for the data presented in this article. The general coverage of the EHIS is the population aged 15 years and over living in private households residing in the national territory. This source is documented in more detail in this background article which provides information on the scope of the data, its legal basis, the methodology employed, as well as related concepts and definitions.

The third wave of the EHIS was conducted in all 27 EU Member States, as well as in Iceland, Norway, Serbia and Turkey. The data collection period was generally 2019. However, it was 2018 for Belgium, 2018–2019 for Austria, and 2019–2020 for Germany and Malta.

According to the current legal framework, EHIS is to be conducted every five years. EHIS wave 4 is planned to be conducted in 2025 under the new Regulation (EU) 2019/1700 of the European Parliament and of the Council establishing a common framework for European statistics relating to persons and households, based on data at individual level collected from samples (this regulation foresees the periodicity of EHIS to change to 6 years).

More details about EHIS are available in this background article which provides information on the scope of the data, its legal basis, the methodology employed, as well as related concepts and definitions.

Limitations in personal care activities show the level of difficulty in at least one personal care activity covering feeding, getting in and out of a bed or a chair, dressing and undressing, using a toilet, bathing or showering based on the self-reports of the population aged 65 and over. Respondents evaluated the extent of their difficulties on the following scale: no difficulty (in this article referred to as not limited), some difficulty, a lot of difficulty and cannot do at all (all of them composing the category limited).

Limitations in household activities show the level of difficulty in at least one household activity covering preparing meals, using the telephone, shopping, managing medication, carrying out light housework, carrying out occasional heavy housework, taking care of finances and everyday administrative tasks based on the self-reports of the population aged 65 and over. It should be noted that there may be other than health reasons behind difficulties doing household activities. Respondents evaluated the extent of their difficulties on the following scale: no difficulty (in this article referred to as not limited), some difficulty, a lot of difficulty and cannot do at all (all of them composing the category limited).

The indicator on home care services shows the use of any type of home (health and social) care services. It includes only formal care services provided by professional health or social workers (not by family members or friends) and refers to the past 12 months prior to the interview.

Limitations of the data

All of the indicators presented in this article are derived from self-reported data so they are, to a certain extent, affected by respondents’ subjective perception as well as by their social and cultural background.

EHIS does not cover the institutionalised population, for example, people living in health and social care institutions who are more likely to face limitations than the population living in private households. It is therefore likely that, to some degree, EHIS under-estimates the share of the population facing limitations. Finally, despite substantial and continuous efforts for harmonisation, the implementation of EHIS is organised nationally, which may impact on the results presented, for example, due to differences in the formulation of questions or their precise coverage.

Context

In March 2021, the European Commission presented a new Strategy for the Rights of Persons with Disabilities 2021-2030 aiming to tackle the diverse challenges that persons with disabilities face. The Strategy aims to progress on all areas of the United Nations Convention on the Rights of Persons with Disabilities, both at EU and Member State level.

The goal is to ensure that persons with disabilities in Europe, regardless of their sex, racial or ethnic origin, religion or belief, age or sexual orientation:

enjoy their human rights,
have equal opportunities,
have equal access to participate in society and economy,
are able to decide where, how and with whom they live,
can move freely in the EU regardless of their support needs,
no longer experience discrimination.

This new and strengthened Strategy takes account of the diversity of disability comprising long-term physical, mental, intellectual or sensory impairments (in line with Article 1 of the United Nations Convention on the Rights of Persons with Disabilities). It contains an ambitious set of actions and flagship initiatives in various domains.

Persons with disabilities are still at a higher risk of poverty and social exclusion than persons without disabilities. Access to healthcare, lifelong learning, employment, and leisure remains difficult, participation in political life is limited, and persons with disabilities are still discriminated against. Furthermore, the COVID-19 pandemic has exacerbated existing inequalities. One of the major inequalities is about labour market: "only 50 % of persons with disabilities has a job, compared to 75% of persons without disabilities. The Commission calls on Member States to unlock the potential of persons with disabilities and improve their position on the labour market"^[1]. Already in 2023, the European Commission will issue guidance on the participation of persons with disabilities in the electoral process. It will also support inclusive democratic participation, including for persons with a disability, through the new Citizenship, Equalities, Rights and Values program.

Indicators on activity limitations and use of home care services are used for monitoring long-term care systems.

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Notes

↑ Questions and Answers: Strategy for the Rights of Persons with Disabilities 2021 - 2030

[1] Questions and Answers: Strategy for the Rights of Persons with Disabilities 2021 - 2030

[1]