Time trends and projections in functional limitations in ageing population in Finland in 2013-2040

Abstract Background Promoting functional ability and targeting support to those in need are an essential part of social policy for healthy aging. Limitations in activities of daily living (ADL) and instrumental ADL (IADL) increase older adults’ need for care and reduce their quality of life. To evaluate the change in these limitations as the aging population grows, this study examines recent trends and future projections of ADL and IADL limitations in older adults. Methods Population-based data on persons aged 75+ were collected in six cross-sectional surveys in 2013, 2015, 2018, 2020, 2022, and 2024 (n = 60,197). ADL (preparing/heating meals, bathing, dressing/undressing, toilet use) and IADL (performing light household chores, grocery shopping, managing medication, handling daily finances) limitations were self-reported. Multiple imputation was used to project future prevalence of these limitations, taking population aging into account. Results The prevalence of functional limitations in older adults has declined since 2013, and the projection indicated a slight decline also in the future. In 2013, 14.1% (95% CI 13.4-14.9) had ADL limitations, while by 2024, this fell to 8.4% (95% CI 7.8-9.0) and was projected to be 4.7% (95% CI 3.8-5.7) in 2040, corresponding to 41,500 persons. The prevalence of IADL limitations was 23.9% (95% CI 23.0-24.7) in 2013, 18.2% (95% CI 17.3-19.1) in 2024, and was projected to be 15.5% (95% CI 14.2-16.8) in 2040, corresponding to 135,500 persons. However, the downward trend in the prevalence of both limitations halted between the years 2022 and 2024, restraining the declining projection. Conclusions ADL and IADL limitations among older adults declined over the past decade but the decline stopped between the latest two surveys in 2022 and 2024, restraining the declining projection. Ongoing monitoring with emphasis on foresight is needed to help allocate resources, identify at-risk individuals, implement preventive measures, and plan services. Key messages • Prevalence of ADL and IADL limitations among older adults has declined and may still decline in the future, although the latest survey data indicated that this decreasing trend seems to have stalled. • Monitoring and future projections are needed to guide political action, ensuring adequate resources to identify at-risk individuals, implement preventive measures, and plan services.