By 2050, the number of people aged 60 and over is projected to surpass 2.1 billion — more than double the 2019 figure. Behind that statistic lies one of the defining social and policy challenges of the twenty-first century: how to provide dignified, effective, and equitable long-term care to hundreds of millions of older adults across vastly different health systems, economies, and cultural contexts.
Few organizations are better placed to examine this challenge than the International Association of Gerontology and Geriatrics (IAGG). Founded in 1950 and representing gerontological and geriatric societies across more than 70 countries, IAGG occupies a unique position at the intersection of clinical science, public health research, and aging policy. Its publications, position papers, and international congresses collectively constitute one of the most comprehensive global perspectives on how long-term elder care is functioning — and where it is critically falling short.
Drawing on IAGG’s body of work, this article examines what quality long-term care actually requires, who currently lacks access to it, and what meaningful reform must look like if societies are to meet the needs of an aging world.
Understanding the Scale of the Long-Term Care Challenge
Long-term care encompasses a broad spectrum of services — from home-based personal assistance and community day programs to assisted living facilities and specialized nursing and geriatric units. What these services share is a focus on supporting people who, due to age-related decline, chronic illness, or disability, can no longer fully manage daily life independently over an extended period.
IAGG research consistently highlights several converging forces that are accelerating pressure on long-term care infrastructure worldwide. These dynamics, taken together, represent a structural challenge that individual health systems can no longer address in isolation.
- The oldest old as the fastest-growing group: Those aged 80 and above — the demographic most reliant on formal care services — are increasing faster than any other age cohort globally.
- The burden of multimorbidity: Older adults increasingly live with two or more chronic conditions simultaneously, requiring more complex and coordinated care over longer periods.
- The dementia crisis: An estimated 55 million people live with dementia worldwide, with projections suggesting that figure will nearly triple by 2050. Dementia represents one of the most resource-intensive categories of long-term care.
- The fraying of informal support networks: Families have historically absorbed a substantial portion of elder care, but declining birth rates, geographic mobility, and rising female labor force participation are thinning this informal safety net at the very moment when demand is rising.
Taken together, these pressures reveal a growing mismatch between need and capacity — a mismatch that IAGG has repeatedly framed not as a future risk but as a present and accelerating reality requiring proactive systemic reform.
What IAGG Research Shows About the Quality of Care
One of the most consistent findings across IAGG’s research literature is the significant disparity between what constitutes good care — as defined by evidence and ethical standards — and what is actually delivered across many care settings globally. Quality is not simply variable between countries; it is often dramatically inconsistent within the same national system, shaped by geography, facility ownership structure, leadership culture, and available staffing.
According to IAGG, quality long-term care is best understood as a multi-dimensional construct. The following core dimensions are identified as essential to any genuinely person-centered care model:
- Dignity and personhood: Each resident or service user must be treated as a full person with history, preferences, and relationships — not reduced to a clinical diagnosis or a care task.
- Clinical safety: Preventing avoidable harms — including falls, pressure ulcers, medication errors, and infections — is fundamental and measurable.
- Functional rehabilitation: The goal should be to support independence wherever possible, rather than entrench dependency through routinized institutional care.
- Psychological and social well-being: Social connection, cognitive stimulation, and mental health support are not supplementary luxuries — they are core components of good care.
- Palliative and end-of-life care: Dying older adults deserve compassionate, well-coordinated support that honors their documented preferences.
Meeting these standards consistently requires far more than professional goodwill. It demands adequate staffing ratios, sustained workforce training, meaningful regulatory accountability, and organizational cultures in which resident outcomes genuinely take precedence over cost efficiency.
The Workforce: Long-Term Care’s Most Critical Constraint
Of all the factors shaping care quality, IAGG identifies the workforce as both the most important and the most endangered. The global supply of trained geriatric professionals — physicians, specialist nurses, allied health practitioners, and social care workers — is already insufficient to meet today’s demand, let alone the demand anticipated over the next two decades.
In high-income countries, care work is chronically undervalued, poorly compensated, and physically demanding, producing high turnover rates that destabilize care continuity. In low- and middle-income countries, formal geriatric training programs may be minimal or absent entirely, leaving families and community volunteers to fill systemic gaps without preparation or support. The International Association of Gerontology and Geriatrics has repeatedly called for investment in workforce development, training pipelines, and wage reform as prerequisites — not supplements — to broader care quality improvement.
Access to Long-Term Care: A Profoundly Unequal Global Landscape
Even where high-quality care exists, access to it is far from universal. IAGG research documents significant disparities in who can actually obtain long-term care services, shaped by income level, geographic location, gender, ethnicity, and the specific design of national health and social protection systems.
The table below offers a comparative overview of long-term care access dynamics across different global contexts, reflecting the broad landscape described in IAGG’s international research.
| Context | Dominant Care Model | Primary Access Barriers | Notable Structural Gaps |
|---|---|---|---|
| High-income countries (Western Europe, Japan, Canada) | Mixed public-private systems; nursing homes, home care agencies | Affordability, waitlists, urban-rural disparities | Workforce shortages; uneven dementia care quality |
| Middle-income countries (parts of Latin America, Eastern Europe) | Family-based care dominant; limited formal infrastructure | Weak regulation; minimal public funding streams | Absence of national long-term care strategies |
| Low-income countries (Sub-Saharan Africa, parts of South Asia) | Predominantly informal and family care | Virtual absence of formal system; extreme resource scarcity | No geriatric training programs; no policy frameworks |
| Rural communities (across all income levels) | Fragmented, geographically constrained services | Transportation barriers; specialist shortages | Persistent urban-rural care divide in quality and availability |
This comparative picture makes clear that access gaps in long-term care are not simply a function of national income. Even within prosperous countries, structural inequities leave substantial portions of the elderly population underserved or entirely excluded. IAGG has consistently advocated for frameworks that recognize long-term care as a social right — not a market commodity determined by individual ability to pay.
The Gendered Dimensions of Elder Care
IAGG research draws specific attention to the way gender shapes both care need and care labor. Women are overrepresented as recipients of long-term care services — primarily because they live longer on average and are more likely to outlive both spouses and their own informal support networks. Simultaneously, women perform the overwhelming majority of unpaid elder care work globally, often reducing or abandoning paid employment to support aging parents or partners.
The economic and health consequences of this dual burden are significant. Any reform agenda that ignores gender dynamics — in the design of formal services, in the compensation of informal caregiving, and in pension and social protection policies — will inevitably reproduce the inequities it aims to address.
IAGG’s Framework for Reforming Long-Term Care Systems
The International Association of Gerontology and Geriatrics has articulated a coherent set of principles that should underpin any serious national or international effort to reform long-term care. These are not aspirational ideals — they are grounded in decades of cross-national research and represent the features that consistently distinguish high-performing care systems from struggling ones.
- Person-centered care design: Systems must be genuinely organized around the preferences, goals, and cultural identity of the individual — not around institutional convenience, standardized pathways, or administrative efficiency.
- Integration across sectors: Long-term care cannot succeed in isolation. It must be structurally connected to primary health care, mental health services, housing, and social protection. Fragmented systems produce fragmented — and often dangerous — outcomes.
- Equity as a design principle: Services must be deliberately designed to reach those who are most likely to be excluded — rural residents, ethnic minorities, people with low incomes, and older adults without family networks.
- Evidence-based practice and continuous evaluation: Clinical and social interventions must be grounded in rigorous research, with regular monitoring mechanisms to ensure standards are maintained and updated as evidence evolves.
- Transparency and accountability: Providers and systems must be subject to genuine oversight, with meaningful quality data made accessible to regulators, families, and the public.
IAGG research demonstrates that systems which genuinely embed these principles into governance and daily practice — rather than treating them as checkbox compliance exercises — consistently achieve better outcomes across clinical safety, functional independence, and quality-of-life measures.
Technology as a Tool, Not a Solution
IAGG has increasingly engaged with the potential of digital and assistive technologies to support long-term care delivery. Remote monitoring tools, telehealth platforms, fall detection systems, and digital care coordination have demonstrated real value in extending professional reach into home and community settings, supporting earlier identification of clinical deterioration, and reducing avoidable hospital admissions.
However, the International Association of Gerontology and Geriatrics also issues careful cautions about over-reliance on technological solutions. Populations with limited digital literacy, access barriers, or cognitive impairment cannot be assumed to benefit equitably from digital care tools. More fundamentally, technology cannot replace the irreducible human elements of care — presence, empathy, and skilled professional judgment. The appropriate policy frame, IAGG suggests, is one where technology augments and supports human care workers rather than substituting for them.
Dementia Care: An Urgent Priority Within Long-Term Care
No examination of long-term elder care reform would be complete without addressing dementia as a distinct and particularly urgent sub-challenge. IAGG has consistently elevated dementia care to near the top of the global aging policy agenda, and for good reason — the scale of need is enormous, the current state of care in most countries is inadequate, and the consequences of continued inaction are severe.
IAGG research points to a cluster of critical gaps that characterize dementia care delivery in most health systems. Together, these gaps represent both a human rights concern and a public health failure that reforms must specifically target.
- Late or missed diagnosis, which delays access to appropriate support and prevents meaningful advance care planning
- Overreliance on pharmacological interventions rather than behavioral, psychosocial, and environmental approaches
- Inadequate training among long-term care staff in dementia-specific communication, behavioral support, and de-escalation techniques
- Near-total absence of culturally adapted care models for minority, indigenous, and migrant older adult populations
- Insufficient recognition and support for family caregivers, who frequently experience severe psychological distress, social isolation, and deteriorating physical health
Addressing these gaps requires national dementia strategies with dedicated funding, a fundamental shift in how care staff are trained and supported, and a policy commitment to community-based models that allow people with dementia to remain in familiar environments for as long as is safely possible.
The Economic Argument for Reform
Concerns about cost are often deployed to slow reform momentum, but IAGG research challenges the framing of long-term care investment as a fiscal burden. The evidence points in a different direction: failing to invest in quality care systems generates far greater costs over time — through preventable hospitalizations, emergency department overload, early nursing home admissions that could have been avoided with adequate home support, and the broader economic losses incurred when working-age family members exit the labor market to provide informal care.
Countries that have built integrated, well-funded long-term care systems — combining robust home care, community support services, and regulated residential provision — have demonstrated that strategic upfront investment translates into measurable downstream savings, better population health outcomes, and stronger labor market participation across generations. The question, IAGG suggests, is not whether reform is affordable, but whether the continued absence of reform is.
Conclusion
The accumulated research and policy work produced by the International Association of Gerontology and Geriatrics presents a clear and evidence-grounded picture of where long-term elder care stands today — and what must change. The findings are consistent across geographies and research traditions: quality is uneven, access is inequitable, and the systems currently in place in most parts of the world are not structured to absorb the demographic pressures heading toward them.
What makes IAGG’s contribution particularly valuable is that it does not stop at diagnosis. Its research identifies the specific features that distinguish high-performing care systems, the reforms that produce real improvements in older people’s lives, and the policy levers that governments and institutions can actually reach. The knowledge base for transformation exists.
What follows from that knowledge is a responsibility — for policymakers, health system leaders, care providers, and civil society — to act with the urgency that the scale of human need demands. Aging is universal, and so is the case for systems that care for older adults with the quality, respect, and equity they deserve.