Long Term Care and Cognitive Impairment in Spain

Population ageing is raising demand for long-term care (LTC), and the growing prevalence of cognitive impairment (CI) is one of its key drivers. Clinical evidence estimates that 18.5% of Spaniards aged 65 and over attending primary care have some form of CI, rising to 45.3% among those aged 85 and above. Applying a survey-based threshold, we classify 19.0% of the population aged 65+ as cognitively impaired, close to clinical estimates but strongly graded by educational attainment. Using pooled pre-COVID data from a longitudinal sample of individuals aged 65+, we examine how CI and physical limitations affect health and LTC utilisation and estimate the associated costs and financial burden. We report four findings. First, socioeconomic status at older ages is strongly associated with CI. Second, although both CI and physical limitations increase health and LTC use, physical impairment is linked to higher overall care utilisation (72% versus 50% for CI) and nursing home residence (4.0% versus 3.3%). Third, informal caregiving is the largest component of LTC costs, accounting for 55% of the total. Finally, the replacement cost of informal care would exhaust the entire budget of Spain’s LTC system (SAAD).