The Health of Older People in Switzerland

As in all high-income countries, the population of Switzerland is ageing¹ Over the past century, the proportion of people under the age of 20 has decreased from 40.7% in 1900 to 20.2% in 2014². During the same period, the proportion of people aged over 65 rose from 5.8% to 17.8%, and those over 80 from 0.5% to 5.0%.

Demographic ageing results from rising life expectancy and declining fertility rates. In just over a century (from 1900 to 2015), life expectancy in Switzerland nearly doubled, from 46.2 to 80.7 years for men and from 48.8 to 84.9 years for women²,³,⁴. This impressive increase in life expectancy can be explained by declining rates of mortality in childhood and in old age: since 1900, infant mortality has dropped from approximately 140‰ to less than 4‰^{5, 6}. The age of death has also changed: in 1970, 50% of women died after age 76, and 50% of men after 70 years; in 2003, 50% of women died after age 84, and 50% of men after 78 years⁷,⁸. Since 1900, fertility rates have decreased from nearly 4 children per woman to less than 2⁹.

As a result, the Swiss population will continue to age. In absolute terms, the population over 65 is projected to rise from 1.3 million in 2008 to 2.1 million in 2030 and 2.7 million in 2045, an increase of 66% and 108%, respectively⁶.

The rising number of people over 65 will significantly affect the so-called old-age dependency ratio. By 2040, there will be 49 people over 65 per 100 people aged 20–64; in 2010, the figure was 27. The proportion of people aged over 80 among the population over 65 will increase from 28.4% in 2010 to 42.6% in 2050. In absolute terms, more than one million people will be over the age of 80 by 2050⁶,⁸.

Yet, in a country like Switzerland, the elderly population is highly diverse: it differs, in particular, by housing conditions, economic situation, level of education and migratory status, all of which can substantially affect health. The labor force participation rate also varies among those aged 65–69 (a mean of roughly 22%, but with a wide range across socioeconomic classes)¹⁰.

Although the natural ageing process is usually accompanied by an increasing prevalence of diseases and accidents, old age is not synonymous with ill health. In 2015, life expectancy at age 65 was 22.2 years for women and 19.2 years for men; life expectancy at age 65 in good health was 14.2 years for women and 13.6 years for men¹¹. In recent years, the number of healthy life years has increased faster than life expectancy. This positive trend is reflected in the perceptions of the elderly themselves. Among the elderly living at home in the 65–74 age group, 73% consider themselves to be in good health. After the age of 75, the proportion is 62%.

Almost half (49%) of people over 65 living at home report at least one chronic illness. Among the 65- to 79-year-olds living at home, 25.2% suffer from several chronic diseases; among people in the 80s, this figure reaches 41.3%. People aged over 80 are also particularly at risk for falls (30%). In addition, between 15% and 25% of the elderly suffer from at least one mental illness¹²,¹³.

In recent decades, healthcare costs have been rising in Switzerland due to various factors, such as a growing population, increasing labor costs, changes in consumer/patient behavior, new treatment standards, and ageing of the population. Overall, chronic NCDs account for 80% of healthcare costs, with cardiovascular disease, musculoskeletal disease and mental disorders at the top of the list.

Close to 30% of health care costs are attribuable to people over the age of 75. But according to the health authorities global health care costs could by drastically reduced if health and independence of the elderly can be improved¹⁴,¹⁵,¹⁶,¹⁷.

All this let the Health Authorities to support a national health promotion project, a quite unique endeavor in a federal state like Switzerland where health policies are defined at local and state levels, targeting the elderly throughout the country – the VIA Project - , a program based on successful local pilot programs. The overall goal of the VIA project is to promote the health of older people and to strengthen their self-determination and independence in order to maintain or improve their quality of life and overall well-being, allowing them to continue living at home for as long as possible. The project aims to help partners (cantons, communes, NGOs) to provide quality health promotion and prevention for the elderly. It offers the cantons a wide range of services (scientific foundations and aids to implementation, networking, advice and support, information and communication). Six priorities to be addressed were identified: (a) promotion of physical activity, (b) prevention of falls, (c) mental health, (d) targeting vulnerable groups, (e) integration of general practitioners, and (f) support of events, workshops and counseling sessions. This multi-year project is coordinated by Health Promotion Switzerland - a foundation supported by the cantons and the health insurance companies, and financed through a modest annual deduction from each insured person’s compulsory health insurance contributions¹⁸- and implemented in several steps by the cantonal and communal authorities.