The Oldest Old: Health, Care and Staying Well After 85

People aged 80 and over are the fastest-growing age group in the world. Most live with several long-term conditions at once, and the need for daily help rises steeply after 85. Yet in the best-studied cohort most 85-year-olds rated their own health as good, and most people of this age live in their own homes, not in care homes. What helps them stay well is known, but it is not yet built into how health and care services are organised.

Reaching 85 used to be unusual. For many families it is now expected: a parent or grandparent who is still at home in their nineties, managing arthritis, poor hearing and a list of medicines, often with help from a partner who is nearly as old. This study brings together evidence from Europe, East Asia and elsewhere on how health changes in very old age, what care people need, and what the evidence says would help.

The number of people living into very old age is rising fast

The World Health Organization (WHO) expects the number of people aged 80 or over to triple between 2020 and 2050, to reach 426 million^[1]. In 2050, it says, 80% of older people will live in low- and middle-income countries^[1]. Researchers in China describe people aged 80 and over as the most rapidly growing age group in the world^[4]. Very old age is no longer something that happens mainly in rich countries. Much of the growth will be in places where long-term care systems are still being built.

Japan shows how fast this can happen. Its Ministry of Health, Labour and Welfare counted 107,677 people aged 100 or over on 1 September 2026, using the national resident register. That was 7,914 more than a year earlier. In 1963 there were 153^[2]. Of today’s centenarians, 94,298 are women and 13,379 are men^[2]. That is about 88% women.

Survival to very old age is also rising within single generations. In Denmark, researchers studied everyone born in 1905 and in 1915 who reached their nineties. A person born in 1915 had a 6.50% chance of reaching 93, against 5.06% for someone born in 1905, which is 28% higher. The chance of reaching 95 was 32% higher (3.93% against 2.98%)^[5].

At 85, living with several conditions is the norm, yet most people rate their health as good

The Newcastle 85+ Study in north-east England is one of the most detailed studies of people in very old age. It recruited 1,042 people born in 1921 through their GP practices, including people living in care homes, and gave many of them a full health assessment at about age 85^[6]. The most common diagnosed conditions were high blood pressure (57.5%) and osteoarthritis (51.8%). Sensory loss was widespread: 59.6% had hearing impairment and 37.2% visual impairment. One in five (21.3%) had severe or profound urinary incontinence, and 11.7% had moderate or severe cognitive impairment^[6].

Few people had only one of these. A later analysis looked at 703 participants who had two or more of 16 chronic diseases and age-related conditions: the median was five, and 62.2% had five or more^[7]. Centenarians show the same pattern. In a study of 302 centenarians in Tokyo, more than 95% had chronic diseases. Diabetes was uncommon, and stroke and fracture were linked with poorer function^[8].

Yet 77.6% of the Newcastle participants rated their health as good, very good or excellent compared with others of the same age. The median person found only three everyday activities difficult^[6]. The researchers concluded that the cohort “showed good levels of both self rated health and functional ability despite significant levels of disease and impairment”^[6].

The number of conditions still matters for independence. Following 714 of the Newcastle participants from age 85 in 2006 to 95 in 2016, researchers found that each additional long-term condition was associated with a 16% higher risk of developing difficulty with getting around (hazard ratio 1.16). It was also linked to a lower chance of recovering from that difficulty (hazard ratio 0.74)^[9]. In their words, “multimorbidity is the norm in those aged ≥85”^[9]. This is an observational association, not proof that each condition causes decline.

Severe limitation in daily life is more than three times as common at 85 and over as at 65–74

Across the European Union, the EU Statistics on Income and Living Conditions survey asks people whether a long-standing health problem limits their usual activities. In 2025, 32.1% of people aged 85 and over reported a severe limitation. The figure was 16.9% at 75–84, 9.6% at 65–74 and 4.2% at 16–64^[3]. The survey covers people living in private households, so it leaves out care home residents, who tend to have greater needs. The true figure for everyone aged 85 and over is therefore likely to be higher. Put the other way round, though, about two in three people aged 85 and over living at home did not report a severe limitation.

Frailty, meaning reduced reserves that make a person more vulnerable to falls, infections and sudden decline, follows a similar age gradient. A review of 240 population studies from 62 countries and territories, covering 1,755,497 people, found a pooled frailty prevalence of 12% using physical measures and 24% using a frailty index. Prevalence “increased according to the minimum age at study inclusion”^[10]. An earlier review of community studies of people aged 65 and over put overall frailty at 10.7% and found it rose with age. It was higher in women (9.6%) than in men (5.2%)^[11]. The estimates differ mainly because studies define frailty differently.

This intersects with sex in a way that runs through all the evidence on very old age. Women live longer, so they make up most of the oldest old, and in England they spend longer than men with substantial care needs^[12]. In Newcastle, women at 85 had a higher median number of diseases than men (five against four)^[6]. In China, women had lower death rates than men at the oldest ages, but worse function in everyday activities, cognition and physical performance^[4]. There is more on this in our study of older women.

Later generations reach very old age in better shape in some ways, but not all

Do longer lives just mean more years of frailty? Comparisons of generations born a decade or two apart give a mixed answer.

In Denmark, the 1915 cohort was assessed at age 95 (1,584 people) and the 1905 cohort at age 93 (2,262 people). Even though they were two years older, the later cohort did better on cognitive tests: 23% scored in the top range of the Mini-Mental State Examination, against 13%. They also did better on activities of daily living. Physical performance tests did not differ consistently^[5]. The authors concluded that “more people are living to older ages with better overall functioning”^[5].

China’s Chinese Longitudinal Healthy Longevity Study compared 19,528 people aged 80 to 105 in 1998 and 2008. In the later cohorts, annual death rates were lower and disability in daily activities fell by between 0.8% and 2.8% a year. But cognitive impairment rose by between 0.7% and 2.2% a year, and physical performance fell by between 0.4% and 3.8% a year^[4]. The authors called these the “benefits” and “costs” of success: longer lives, but more frail people surviving with health problems^[4].

In England, the Cognitive Function and Ageing Studies compared people aged 65 and over in 1991 and 2011. On average, from age 65, men now spend 2.4 years and women 3.0 years with substantial care needs, and most of them live in the community^[12].

These studies used different measures in different countries and decades, so their results cannot be combined into one trend. Together they suggest that health in very old age is not fixed. It differs between generations and between countries, which means it can change.

Most care in very old age happens at home, and some conditions go undiagnosed

In Newcastle, 10.4% of the 85-year-olds who had a health assessment lived in institutional care^[6]. In England and Wales, the 2021 Census found that 10.8% of people aged 85 and over lived in a care home, down from 13.7% in 2011^[13]. People aged 85 and over still made up 56.4% of the 278,946 care home residents aged 65 and over. At age 90 and over there were more than four times as many women residents as men^[13].

A falling share in care homes does not mean needs are falling. The English cohort comparison found substantial reductions in the share of people with medium and high dependency who lived in care homes^[12]. More people with daily or round-the-clock needs are now supported at home. The authors noted that this has “considerable implications for families of older people who provide the majority of unpaid care”^[12]. Many of those family carers are old themselves; see our study of older unpaid carers. Many people in very old age also live alone, which we cover in older people living alone.

People in very old age see their GP often: 93.8% of the Newcastle participants had contact with a general practitioner in the previous year^[6]. Even so, the health assessment found people with possible conditions that were not in their medical records: high blood pressure in 25.1%, ischaemic heart disease in 12.6%, depression in 6.9%, dementia in 6.7% and atrial fibrillation in 3.8%^[6]. The researchers concluded that these conditions “may be underdiagnosed”^[6]. A single assessment cannot confirm a diagnosis, but depression and dementia that go unrecognised also go unsupported. Hearing and vision loss, which were very common, are also easy to overlook. Our study of older people with sight and hearing loss looks at this in more detail.

What the evidence asks of us

The evidence on people aged 85 and over points to the same few gaps again and again. Most of them are about how services are organised, not about what is medically possible.

• Organise care around the whole person, not single diseases. When many 85-year-olds live with five or more conditions^[7], services that treat each one separately do not fit. WHO’s guidelines on integrated care for older people set out community-level actions on mobility, sensory capacity, cognition and mood, incontinence, falls and support for carers^[14].
• Look for what is being missed. Regular GP contact did not stop high blood pressure, depression, dementia and heart conditions going unrecorded in a meaningful minority of 85-year-olds^[6]. Regular reviews of hearing, vision, mood and memory are a matter of service design.
• Never treat very old age as too late to improve. In a trial of 100 frail nursing home residents with an average age of 87, ten weeks of high-intensity resistance exercise increased muscle strength by 113% and walking speed by 11.8%. Strength in the comparison group rose by 3%, and its walking speed fell by 1.0%^[15]. The authors called such training “a feasible and effective means of counteracting muscle weakness and physical frailty in very elderly people”^[15]. Access to rehabilitation and supervised exercise should not end at a birthday.
• Plan for care at home, and for the families who give it. As a smaller share of very old people live in care homes^[13], home care, community nursing and support for unpaid carers have to grow to match. In 2017, the English cohort comparison estimated that an extra 71,215 care home places would be needed by 2025 if dependency and care home rates stayed the same^[12].
• Prepare now in low- and middle-income countries. With 80% of older people expected to live in these countries by 2050^[1], the UN Decade of Healthy Ageing (2021–2030)^[1] is the time to build long-term care and primary care that can serve people in their eighties and nineties.
• Count the oldest old properly. Many surveys stop at “65 and over” or “75 and over”, and many leave out care homes. Without separate figures for 85–89, 90–99 and 100 and over, the needs of the fastest-growing group stay hidden.

Language: this piece says “older people” rather than “the elderly”. It uses “people aged 85 and over”, “people in very old age” and, where researchers use it, “the oldest old”, as most organisations of older people prefer. It uses “centenarians” for people aged 100 and over.

Why we're publishing this

People in their late eighties and beyond are often talked about as a cost or a problem to be managed. The evidence tells a different story. Most people of this age live at home, and, where they have been asked, most judge their own health to be good. They keep responding to support, including exercise, when it is offered. Where they are let down, it is by services built around single illnesses, conditions nobody looked for, and statistics that lump everyone over 65 together. We publish this so that organisations of older people, and the families who support them, can make that case with the figures to hand.

How to read this data

Much of the detailed evidence comes from cohort studies in a few places: Newcastle in England, Denmark, China and Tokyo. These cohorts recruited whole birth years or age groups, including people in care homes, which makes them unusually representative. But each describes one place and one generation. The Newcastle figures describe people born in 1921 and assessed around 2006–07, and the conditions found at a single health assessment are possible, not confirmed, diagnoses. The Eurostat figures are self-reported and leave out care home residents. The two frailty reviews use different definitions, which is why their estimates differ. Japan’s centenarian count comes from the national resident register. The WHO projection to 2050 depends on assumptions about future death rates. Figures from different countries and studies are shown side by side to illustrate patterns, not as one comparable series. Associations, such as those between the number of conditions and mobility, do not prove cause. Evidence on people aged 85 and over in low- and middle-income countries, apart from China, is thin.

Use this data

Free to cite with attribution to Understanding Aging. Charities, older people’s organisations, 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 health, please speak to a GP or another qualified health professional.

Sources

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