Long Term Care and Cognitive Impairment in Spain

The growing prevalence of cognitive impairment (CI) is one of the main drivers of age-related demand for health and long-term care (LTC). In Spain, CI is estimated to affect 18.5% of Spaniards over 65, and 45.3% in those aged 85 and above. This paper draws on a pooled pre-COVID data from a longitudinal sample of individuals aged 65+ to examine the effect of CI and physical limitations on health and long-term care utilisation, estimates its costs, and financial burden. We report four sets of findings. First, we find that socioeconomic status at older age to be the strongest predictor of CI. Second, while both CI and physical limitations increase health and care adult care use, physical impairment is a stronger predictor of overall care utilisation (73% versus 55% for CI alone) and nursing home residence (2.0% versus 0.9%). Third, informal caregiving constitutes the overwhelming majority of dementia costs, accounting for 69–81% of the total. Finally, we estimate that the replacement cost of informal care would exhaust the full budget of Spain’s LTC system (SAAD).