Every third woman and every fifth man over 80 years of age are treated with antidepressant medication

Sweden's elderly care is facing an economic time bomb. According to database Statista's mapping of costs, expenditures for elderly care amount to 146.6 billion kronor annually. Statistics Sweden's demographic forecasts show that the proportion of people over 65 in Sweden will increase by 50 percent over the coming decade. Swedes are living longer and are healthier at older ages, while low birth rates create an imbalance between needs and available workforce.

SKR, Sweden'smunicipalities and regions, notes in the reportLiving Life to the Endthat the municipal sector needs at least 15 billion kronor more in annual state grants by 2050 to maintain today's welfare level. Postponing investments means that an increasingly smaller proportion of the population must pay increasingly more in taxes.

The National Board of Health and Welfare's statistics from 2023 show that every third woman and every fifth man over 80 years old is treated with antidepressant medication.

A clinical study from the US gene database NCBI, National Center for Biotechnology Information, indicates that people with depressive symptoms have up to 50 percent higher care costs than average. Men over 85 are overrepresented in suicide statistics.

Today's reactive, passive system regarding how care is structured worsens the situation. A research report from the state research instituteRiseon preventive healthcare shows that only 3 percent of the country's healthcare budget goes to preventive measures. Thus, the system must handle expensive emergency interventions and long-term medication instead of preventive measures.

Medication and reactivecare often only treat the symptoms, not the causes of elderly people's mental illness. To reverse the development, a deeper understanding of the structural factors driving mental illness among the elderly is required:

1. Involuntary loneliness and isolation. The connection between loneliness and both physical and mental illness, dementia, and premature death is well known. According to some, it is a natural part of aging that those affected and their relatives must handle themselves. But it is a structural problem that requires society-wide solutions. Limited mobility, revoked driver's licenses, and economic barriers create an isolation that is difficult to break without help.
2. The housing situation. Many elderly people remain in homes that are neither accessibility-adapted nor promote social interaction. And it is something the market has not solved. Lund University is currently conducting an extensive study on how properly designed living environments with meeting places reduce loneliness and care needs. But affordable alternatives are lacking, forcing many to stay until an acute situation requires them to move.
3. The economy. Declining pensions meet rising care and housing costs. Increased private pension savings is not a solution when many are already struggling with their everyday finances. This particularly affects single women and low-income earners, where even minor expenses for social activities or care become obstacles.
4. Healthcare system unsuitable for seniors' needs. Lack of coordination and few preventive measures increase the risk that mental illness is detected too late. According to a report from the state research councilForte, the pandemic exposed the system's vulnerability - elderly people with mental illness fall between the cracks, where people in different parts of the country do not have the same access to care.

Afundamental shift is needed in how society thinks about elderly care.

1. Increase investments in preventive measures. Raise the share from today's 3 percent of the country's healthcare budget. Considering that each case of depression increases care costs by nearly 50 percent, it would quickly pay off through reduced care costs and reduced suffering.
2. Develop new forms of senior housing. Create housing alternatives that promote both independence and community. Build not only sheltered housing as rental apartments but also senior housing as condominiums to make it easier to move from houses.
3. Create a coherent care chain for elderly mental health through: better conditions for early detection of mental illness in primary care and health centers, preventive home visits focusing on both physical and mental health, better coordination between municipalities and regions.
4. Invest in social initiatives that counteract isolation:
   Introduce subsidies for transportation to social activities. Local meeting places with activity programs. Digital solutions with education that complement physical meetings.
5. Develop economic support forms that make it possible to:
   Adapt homes for preventive purposes. Participate more in social and cultural activities. Create conditions to be able to move to more suitable housing before a crisis arises.

If the developmentin Sweden continues, the annual costs for elderly care will increase by at least 70 billion kronor over the coming decade.

But preventive measures can both break the negative spiral of increasing mental illness and avoid a large part of the costs.

But it is not just about economics, but also about creating a society where aging does not automatically mean isolation and mental illness Sweden can afford to act now - but not to wait.

Michael Guldstrand