Across Europe, population ageing is no longer a forecast but a defining feature of societies. Ageing is often described as a challenge, yet it is also a remarkable opportunity. To seize this opportunity, policymakers should confront the contradictions at the heart of current systems: between health and social care, between prevention and treatment of diseases, and between the promises of innovation and the reality of unequal access to it. Drawing on insights from our research and from a closed-door expert dialogue among academic, policy, and civil society leaders, we present recommendations to bridge these divides and realise the full potential of longevity societies.
Ageing as a Systemic Transformation
Europe’s longevity transformation is occurring alongside profound shifts in family and household structures. The rising number of single-person households and childless couples, the diversification of family forms, and increasing geographic mobility are reshaping who gives and receives care. Even if funding were unlimited, demographic realities mean that there will not be enough people to provide the needed care, if nothing changes.
Yet, the systems that govern health and social support remain fragmented, divided between different institutional levels and policy logics, leaving many older people to fall into the gaps between them. These divisions are increasingly unfit for purpose. The sustainability of care systems will depend not only on increasing resources but also on making better use of them—by making health care more age-friendly and, particularly for long‑term care, strengthening coordination, supporting carers, and leverageing technology in inclusive and responsible ways.
Integration: Promise and Paradox
The idea of integrating health and social care has gained strong political traction, but experiences across Europe show that integration is not a panacea. When poorly designed, it can lead to considering mainly medical care needs while neglecting the social dimensions of care. For example, the Finnish experience shows the risk of merging systems without balance: after integrating health and home care, what remained was mainly home nursing, with social care largely absorbed into medical tasks. True integration requires shared governance, mutual respect between professional cultures, and the active participation of service users and carers.
Moreover, fragmentation is not limited to institutions. It is also spatial and social. Regional and municipal inequalities mean that access to services, trained professionals, and digital infrastructure varies widely across Europe. The challenge is therefore not only to connect systems but to ensure that everyone receives adequate support, regardless of where they live.
From Disease Management to Person-Centred Approaches
Health systems remain primarily oriented towards treating single acute diseases, even though most older people live with multiple chronic conditions, that is, multimorbidity. Managing multimorbidity requires multidisciplinary teams that combine medical, psychological, and social expertise, and that include geriatric competence as a central pillar. The main objectives of interventions should be also aligned with older people’s priorities: maintaining adequate functional autonomy and quality of life. Yet such approaches are still the exception rather than the rule.
Several initiatives within the Age-It programmeme demonstrate what can be achieved when care is reoriented around people rather than diseases. Multicomponent interventions that combine physical exercise, nutritional counselling, and digital monitoring have shown promise in maintaining mobility independence and delaying functional decline among frail multimorbid older adults. Importantly, these interventions rely on coordinated, multi‑actor networks that involve municipalities, universities, companies, and NGOs—illustrating the potential of collaborative, cross-sector innovation.
Supporting Those Who Care
Informal and family carers remain the backbone of long‑term care in Europe. However, their contribution is still undervalued and insufficiently supported. Many provide intensive care without access to training, respite, or financial assistance, often at the expense of their own physical and mental health. A sustainable care model should recognise and empower these carers through regular needs assessments, flexible support schemes and formal recognition of their role, and access to digital tools that facilitate both care delivery and self-care.
The concept of “carer medicine”, emerging from Age-It scholars, captures this shift in perspective. By caring for carers and providing them with digital educational and information platforms, besides improving the wellbeing of those who received care, policies can help prevent the deterioration of their wellbeing and reduce future dependency. Supporting carers, in other words, is not only an ethical imperative but also an investment in the resilience of the entire system.
Prevention, Environment, and the Life Course
Healthy ageing begins long before old age. Prevention of chronic diseases, promotion of physical activity, and mental wellbeing across the life course are essential pillars of a sustainable longevity society. Environmental factors such as air pollution and heat exposure also have profound negative effects on health in later life, yet older people remain underrepresented in climate and environmental research.
Research from the Age-It programme suggests that policies connecting environmental sustainability with health promotion should become a priority, yielding multiple benefits for present and future generations. Complementing these efforts, the daily use of advanced assistive and rehabilitation technologies in real-world environments would also allow the extraction of novel digital biomarkers to guide prevention, monitoring, and follow-up policies.
Technology for People, Not Just Efficiency
Technological innovation is often hailed as the solution to workforce shortages and rising costs in care. Yet technology must serve people, not replace them. The question is not whether to embrace digital tools, but how to deploy them responsibly and inclusively.
Digital tools—from wearable sensors to chatbots and online learning platforms—can help monitor health, share precise knowledge, and reduce isolation. Experience shows that older adults and carers are more willing to adopt such technology when it complements their existing routines and addresses real needs rather than adding complexity. Projects that are "sensor-agnostic," allowing users to integrate devices they already own, demonstrate how technology can adapt to people rather than forcing people to adapt to technology.
Looking ahead, advanced technologies promise even greater transformation. BioRobotics systems for assistance and rehabilitation, intelligent sensors for continuous monitoring, interactive and haptic interfaces for inclusion and accessibility, and sophisticated medical devices for accurate diagnosis are expected to revolutionize social and health care services. Critically, these innovations aim to address the complex care needs of older adults with multimorbidity and frailty not only in clinical settings but also in everyday living environments—bringing care closer to where people actually live.
However, technology alone cannot succeed. Successful adoption will depend on high user acceptability and ease of use, as well as integrated and interoperable care models with standardized procedures and data structures across primary care, specialists, nurses, therapists, carers, and other stakeholders.
Most urgently, digital exclusion remains a serious concern. Without adequate training, access, and trust, innovation risks deepening rather than bridging social inequalities, leaving behind the very populations it aims to serve.
Closing the Implementation Gap
A recurring frustration expressed by researchers and practitioners is the gap between scientific evidence already available and policy implementation. While European projects have produced strong evidence on effective interventions, few have been scaled up or embedded in national systems. Policymakers often operate on different time horizons and under different incentives. Supporting boundary activities where scientists, policymakers, and practitioners can discuss and co-design implementation pathways of solutions is essential to turn knowledge into sustainable policy change. Analogously, it is important to involve older people and their carers in the design of future solutions.
Action Points
- Redesign health care systems for an ageing population, taking into account the characteristics and needs of older patients and promoting the integration of geriatric expertise within health care services/teams. In addition, health care systems should become more age-friendly.
- Prioritise prevention and environmental health across the life course. Make early health promotion as well as climate change and pollution mitigation part of ageing policy, not separate from it.
- Ensure that health and social care systems work together without one subsuming the other, and that local governance structures reflect this balance.
- Use integrated data to target inequalities in care provision. Build on tools that combine demographic, service, and mobility data to identify territorial gaps, ensuring equitable access to care and support regardless of where people live.
- Recognise and support those who provide care. Establish regular assessments and support for informal carers, with training, respite, and digital resources that protect their wellbeing and prevent future dependency.
- Invest in technology that empowers users. Support solutions that adapt to people’s needs and capacities, coupled with digital literacy and ethical standards to avoid new divides.
- Foster research and innovation towards higher Technology Readiness Levels (TRL), enabling large-scale deployment in real-world settings, supported by a clear and structured evaluation framework based on both qualitative and quantitative key performance indicators.
- Bridge research and policy through transdisciplinary collaboration. Invest in schemes promoting partnerships among researchers, practitioners, older people, formal and informal carers and policymakers to scale evidence-based solutions beyond pilot projects.
Acknowledgment:
This publication is part of the Age-It project: Ageing Well in an Ageing Society, funded by Next Generation EU, in the context of the National Recovery and Resilience Plan, Investment PE8 – Project Age-It: “Ageing Well in an Ageing Society” [DM 1557 11.10.2022]. Age-It is an alliance of Italian universities, research centres, private firms, public institutions and civil society, covering, among others, demography, geriatrics and gerontology, neurology, cardiology, immunology, data science, education science, epidemiology, biology, genetic research, engineering, sociology, law, political science, and economics - https://ageit.eu