Older Migrants and Refugees: Health, Dementia and Care in a New Country

Many people who move to another country arrive in good health, but the advantage often does not last into later life. Across much of Europe, migrants over 50 are frailer and more often depressed than people born in the country where they live, and in one Dutch study dementia was three to four times as common in several non-western immigrant groups as among native Dutch participants. Older people forced from their homes carry long-term conditions into crisis, often without their medicines.

Older migrants are not one group. They include people who came decades ago to work and grew old in their new country, people who followed their children in later life, and people who fled war or persecution at 60, 70 or 80. What they often share is a health and care system built for someone else: forms in a language they read less easily, appointments that depend on a family member to interpret, entitlements tied to residence or legal status, and memory tests designed for people with a different education. The evidence below shows where those gaps lie. It does not show that migration itself makes people ill; it shows what happens when services are not built for the people who use them.

Arriving healthy does not always mean aging healthy

Researchers have long described a "healthy migrant effect": people who move abroad tend, on average, to be healthier than those who stay, and often healthier than the population they join. In later life, the picture is mixed and depends heavily on where people came from and where they settled.

Some register data show the advantage lasting into old age. In Finland, a study of all deaths among people aged 70 and over between 2002 and 2020 found a migrant mortality advantage across various causes of death, and its authors wrote that it "challenges the notion of a general diminishing healthy migrant effect in old age"^[3]. A companion study of the same 718,717 deaths found overall cancer mortality was lower among migrant men (incidence rate ratio 0.83) and women (0.89) than among people born in Finland, but stomach cancer mortality was more than twice as high among men and women born in the former USSR^[4]. In England and Wales, most migrant groups aged 50 and over had higher life expectancy and disability-free life expectancy than people born there, yet women born in Pakistan and Bangladesh lived longer but with fewer years free of disability^[5].

Living longer is not the same as living well. The Survey of Health, Ageing and Retirement in Europe (SHARE), in an analysis of 95,635 people, found that first-generation migrants over 50 were on average 16.4% frailer than non-migrants after adjusting for confounders, and 12.1% frailer once citizenship was taken into account^[6]. The gap was largest for migrants in Northern Europe (37.3%) and absent in Southern Europe. It was stronger for people from low- and middle-income countries, and stronger in countries with less healthcare coverage and access for migrants. Over time, the two groups converged, until migrants and non-migrants were equally frail by 80 to 90^[6]. A separate SHARE analysis of ten southern and western European countries found older migrants were more likely than older non-migrants to see their health deteriorate between 2004 and 2015, with non-western migrants at higher risk of developing diabetes^[7].

Depression is more common among older migrants in northern and western Europe

In SHARE data from 11 European countries (28,517 people aged 50 and over living in the community), first-generation migrants had 1.42 times the odds of depression (measured as symptoms on the EURO-D scale) of people who had not migrated, after adjusting for sociodemographic factors, physical illness, functional impairment, cognitive function and time lived in the country^[8]. The gap varied by region: the odds ratio was 1.85 in Northern Europe and 1.38 in Western Europe, while in Southern Europe (1.16) the difference was not statistically significant. The authors concluded the difference "was not due to other known predictors of depression in older age"^[8].

That regional pattern matches the frailty findings: the region where older migrants were frailest, Northern Europe, was also where the depression gap was widest. These studies cannot say why, and cross-sectional surveys cannot show cause. But the frailty study's finding that citizenship and healthcare access for migrants made a difference points towards the conditions people age in, not only towards migrants' own histories.

Language can leave people isolated, even at home

Language is one of the most consistent barriers in the evidence. In the United States, an analysis of American Community Survey data for 2010 to 2014 looked at people aged 65 and over from the 18 largest countries of origin. The share who were linguistically isolated, a measure that combines a person's own English, whether they live alone, and the English of anyone they live with, ranged from 12% of older people born in India to 68% of those born in Ukraine^[9]. The routes differed: older Mexican-born people had the highest rates of limited English but rarely lived alone, which kept linguistic isolation moderate; many older Chinese and Vietnamese people lived with other adults who also had limited English; older Europeans more often lived alone^[9].

This matters for health because so much of care runs on language: booking appointments, describing symptoms, understanding medicines, filling in forms for benefits or care. WHO notes that where migrants are excluded from national health programmes, the result is "high out-of-pocket costs, language barriers, and inadequate cultural or linguistic support"^[10]. It also matters for loneliness. Support can help: in a small randomised trial in Canada, 60 older Chinese immigrants aged 65 and over were split into two groups of 30, and those who received eight weeks of peer support from trained volunteers, through home visits and telephone calls, showed a statistically significant fall in loneliness compared with the control group^[11]. A single trial of that size is a promising signal, not proof. For more on living alone in later life, see our study of older people living alone.

Dementia is more common in some migrant groups, and less often treated

Dementia shows the healthy migrant picture at its most uneven. In the Netherlands, a study of 2,254 people aged 55 and over, recruited through their GPs and assessed with a screening tool validated for people with little formal education from different cultures, found dementia in 14.8% of people of Turkish descent, 12.2% of Moroccan-Arabic, 11.3% of Moroccan-Berber and 12.6% of Surinamese-Hindustani descent, compared with 3.5% of native Dutch participants and 4.0% of Surinamese-Creole participants^[12]. The authors summarised mild cognitive impairment and dementia as "three to four times more prevalent in the majority of non-western immigrant groups". These are figures from one cross-sectional study, and the published comparison used simple chi-square tests rather than models adjusted for age or education.

In the United States, the National Health and Aging Trends Study (7,609 Medicare beneficiaries) found that white, Hispanic and other immigrants had a higher prevalence of dementia than their US-born counterparts, while for Black Americans the pattern was reversed^[13]. Its authors point to education, stress and whether dementia tests work equally well across groups as questions that need answering.

Once dementia is recognised, the evidence suggests older migrants receive less. A Danish study of everyone aged 60 and over with dementia in 2012 (34,877 people) found that, after adjusting for age, sex, other illnesses and time since diagnosis, people of non-Western origin had 0.70 times the odds, and people of Western immigrant origin 0.74 times the odds, of receiving anti-dementia medicines that Danish-born people had. Non-Western immigrants had about half the odds of living in a nursing home (odds ratio 0.52)^[14]. In Norway, registry data for 2008 showed a smaller share of immigrants aged 50 and over had a recorded diagnosis of dementia or memory impairment, and among those diagnosed, Norwegians purchased anti-dementia medication 20-50% more often^[15]. The Norwegian authors called for research on "the cultural validity of the assessment tools, linguistic barriers and challenges for general practitioners". A lower recorded rate is not proof of lower risk. For how diagnosis rates are measured, see our study of dementia diagnosis rates.

Older people in displacement carry long-term conditions into crisis

WHO estimates that 117 million people were forcibly displaced by mid-2025, and that low- and middle-income countries host 71% of the world's refugees and others in need of international protection^[10]. UNHCR's age-disaggregated data for the end of 2025 include about 5.1 million people aged 60 and over, of whom more than half (56%) were women^[1]. UNHCR's 2025 data cover about 156 million people in total, but age is recorded for fewer than half of them, so the true number is uncertain.

Older people bring long-term illness with them into displacement. After Russia's full-scale invasion of Ukraine, researchers used Polish registration data and Ukrainian health ministry statistics to estimate that about 624,690 older Ukrainians (women 55 and over, men 60 and over) had fled the country by May 2022, with an average of 2.5 diseases each, most often cardiovascular disease^[16]. They estimated around 7,827 new cancer diagnoses and 4,578 new cases of tuberculosis a year in this group: modelled approximations, as the authors stress, but a guide to the care receiving countries need to plan.

Inside Ukraine, a HelpAge International needs assessment in May 2022 interviewed 569 internally displaced adults, 218 of them aged 60 or over, chosen by purposive sampling rather than at random^[17]. Among the older people:

• 89% had at least one health condition, and seven in ten had more than one, the most common being high blood pressure and heart problems.
• 45% of those who needed medication could only partly get it, and 12% could not get it at all.
• 43% had at least one disability, against 11% of the 30 to 59-year-olds surveyed, and 70% of those with a disability were not registered as disabled.
• Asked what single thing they most needed, 74% said cash.

HelpAge said its assessment was needed because of the "lack of available age disaggregated data"^[17]. When older people are not counted, their needs are easier to miss.

What the evidence asks of us

The figures point less to anything about migrants themselves than to how health and care systems treat them. Several things follow.

• Count older people in every displacement response. Humanitarian agencies and governments should collect and publish data by age, sex and disability, as HelpAge has called for^[17], so that older people's needs for medicines, mobility aids and long-term care are planned for, not discovered late.
• Keep medicines flowing for long-term conditions. With most displaced older people living with at least one chronic condition and many unable to get their medication^[17][16], continuity of treatment for high blood pressure, heart disease and other long-term conditions belongs at the centre of emergency health planning.
• Bring older migrants into mainstream services. WHO's position is that refugee and migrant health should be integrated "into national and local policies" and that parallel health structures in emergencies "must remain temporary"^[10]. Its global action plan on promoting the health of refugees and migrants runs from 2019 to 2030. The SHARE finding that frailty gaps were wider where migrants had less healthcare coverage and access^[6] suggests entitlement matters.
• Fund interpreting and translated information as part of care, not an extra. With linguistic isolation as high as 68% in some older groups in the United States^[9], relying on family members to interpret is not a safe default.
• Use dementia assessments that work across cultures and languages. Tools validated for people with little formal education exist^[12], and the gaps in treatment and nursing home care found in Denmark and Norway^[14][15] call for services designed with migrant communities, not only translated for them.
• Invest in community and peer support. Early trial evidence that peer support can reduce loneliness among older immigrants^[11] deserves larger, longer studies and funding for the community organisations that already do this work.

Many of these needs overlap with those of older people from minority ethnic groups more broadly; see our study of older people from minority ethnic groups.

Language: this piece says "older people" rather than "the elderly". It uses "migrants" for people living in a country other than the one they were born in, "refugees" and "displaced people" for those forced to flee, and keeps each study's own term ("immigrants", "non-western immigrants", "first-generation migrants") when reporting its findings, as organisations working with these communities generally do.

Why we're publishing this

Older migrants and refugees are often missing twice over: from migration research, which tends to focus on working-age people and children, and from aging research, which often does not record where people were born. Organisations that support migrant and refugee communities see the gaps every day but rarely have the figures in one place. This study gathers the best available evidence from several countries, so that those organisations, and the older people they work with, can make the case for services that fit.

How to read this data

The evidence here comes from different kinds of source and is not directly comparable. The Finnish, Danish and Norwegian figures come from national registers covering whole populations; SHARE and the US National Health and Aging Trends Study are large surveys; the Dutch dementia study is a single cross-sectional study; the Ukrainian figures are modelled estimates and a purposive (non-random) needs assessment. Odds ratios (depression, dementia treatment) are not the same as risks, and incidence rate ratios (Finnish cancer deaths) compare death rates. "Migrant" is defined differently from study to study, and most studies group people from very different countries together, which can hide large differences. Most of the research is from Europe and North America; evidence on older migrants in other regions, and on older refugees in low- and middle-income countries where most refugees live, is thin. UNHCR's age figures cover only people whose age was recorded, and the shares given here are our calculation from its published data. All findings describe associations at population level and cannot show that migration causes any outcome.

Use this data

Free to cite with attribution to Understanding Aging. Charities, carers' groups, campaigners and journalists are welcome to reuse these figures and charts. For the underlying figures as a spreadsheet, get in touch.

Important: This article summarises published research and statistics for general information. It is not medical, care or financial advice and cannot be used to diagnose, treat or predict anything about an individual. If you have concerns about your own or someone else's memory or health, please speak to a GP or another qualified health professional.

Sources

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