Rehabilitation Service Delivery Models to Foster Healthy Ageing in the WHO European Region: Results From a Cross-Sectional Stakeholder Consultation Involving 45 Countries

Background: As populations age, rehabilitation needs are increasing sharply. Older people experience declining intrinsic capacity, multimorbidity, and environmental barriers, which intensify their reliance on rehabilitation to optimize and maintain functional ability. Despite its critical role in healthy ageing, access to rehabilitation remains limited across the WHO European Region (WHO EURO). Aim: To examine the availability, implementation, and challenges of rehabilitation service delivery for older people in WHO EURO from the perspectives of rehabilitation stakeholders. Design and Methods: We conducted a secondary mixed-methods analysis of a 2023/2024 global online survey called “Rehabilitation Service Delivery to Foster Healthy Ageing,” initially designed to identify and validate global rehabilitation delivery models, focusing on WHO EURO data. The survey, offered in 8 languages, targeted health and care workers providing rehabilitation for people aged 60 and above. Quantitative and qualitative data were analysed descriptively, thematically, and integrated using the Health System Dynamics Framework. Reporting followed CROSS and MMR-RHS guidelines. Results: 706 responses from 45 countries were analysed. Six validated rehabilitation delivery models were confirmed: outpatient, inpatient, home, telerehabilitation, community, and residential long-term care. Findings revealed disparities in the availability of these models and in the responsiveness – assessed through a self-designed responsiveness index – of rehabilitation services to ageing populations, varying by country and income level. Strengthening outpatient, home, and residential long-term rehabilitation was considered most urgently needed. Barriers and facilitators to strengthening rehabilitation were identified across all domains of the Health System Dynamics Framework and synthesized into 8 themes and 19 subthemes. Discussion: Rehabilitation models remain unevenly implemented across Europe, and inequities in provision persist. Systemic barriers span governance, financing, human resources, and service delivery, underlining the importance of integrated approaches that reflect older people’s realities and priorities. Conclusion: Rehabilitation plays a key role not only after illness or injury but also in maintaining functional ability during age-related declines in intrinsic capacity. Strengthening rehabilitation for older people is essential for Healthy Ageing and requires investment, intersectoral collaboration, and implementation science to overcome systemic barriers.