Advancement in medical science and improved quality of life means that elderly people are a fast-growing part of the world's population. It is estimated that a quarter of the US population will be over 65 years by 2030; this phenomenon is not restricted to wealthier countries-80% of people turning 60 each month are from less-developed settings.

Various models of care for the elderly in different countries are discussed; a recent issue highlighted in the UK being the blurring of lines between care from social services (where under a new scheme individuals pay for the care they receive) and medical care provided free by the National Health Service. In the USA few Americans have long-term care insurance, and a few states are experimenting with "cash and counselling" schemes. Similar to programmes used in Germany and Italy, this demonstration project gives elderly people monthly allowances so they can purchase care from whomever they choose.

The editorial concludes: "A short window of opportunity, perhaps a decade or so, exists to address the challenges of long-term care before demand for it is soaring all over the world. Governments everywhere must take the initiative now to configure or restructure long-term care, first by examining their social and ethical values and public policies on care of the elderly. The subtitle of a WHO report on long-term care poses a compelling place to start: "What does justice require?" The question is on the table: now the imperative is to find an answer."

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Contact: Joe Santangelo
j.santangelo@elsevier.com
212-633-3810
Lancet
22-May-2003