From an Ageing Population to the Silver Economy

The key driver of population ageing is fertility rates that remain well below the replacement level. In both the OECD and the EU, the average number of children per woman is well below 2.1, which implies fewer entrants to the labour market over the next 10–20 years. In 2023, 3.67 million children were born in the EU, corresponding to a crude birth rate (live births per 1,000 people) of 8.2. By comparison, the EU’s crude birth rate was 10.5 in 2000, 12.8 in 1985 and 16.4 in 1970.

At the same time, life expectancy continues to increase, but healthy life expectancy progresses more slowly. In other words, people are living longer, but not necessarily better. This “health–life gap” translates into more years lived with functional limitations, and therefore a growing need for chronic care, better coordination between hospital staff and community-based caregivers, as well as prevention and rehabilitation. Systems that invest early in prevention, outpatient care and rehabilitation can reduce part of the future pressure.

This is why, in developed countries, three economic loops make this thesis investable:

1. Volume → productivity loop: The surge in age-related procedures (orthopaedics, structural cardiology, vision, hearing, screening) pushes payers to favour minimally invasive, outpatient and software/robot-assisted technologies that substitute capital for scarce labour and shorten hospital stays. Players able to demonstrate a better cost-outcome ratio capture prices, market share and superior margins, generating high returns on capital.

2. Prevention → recurrence loop: Diagnostics, sensors, remote monitoring and home-based coordination shift value upstream and generate recurring revenue streams (reagents, consumables, platforms, service contracts) with strong customer stickiness.

3. Longevity → guaranteed savings loop: Longer lifespans redirect financial allocation towards secure cash flows (annuities, pension products, real estate linked to healthcare/senior living), supporting life insurers’ balance sheets and demand for real assets tied to seniors’ needs.

In addition, the age pyramid is top-heavy: the 80+ age group is the fastest-growing. It is also the most intensive consumer of care and assistance: orthopaedics (hips/knees), interventional cardiology, imaging/diagnostics, geriatrics, assistive technologies, as well as adapted housing and care facilities. This dynamic supports procedure volumes that are relatively inelastic to the economic cycle, while raising the question of funding and workforce availability.

On top of that, demand for long-term care (LTC) is steadily increasing, while the “informal” supply of care, family caregiving, has been eroding due to smaller households, greater geographic mobility and higher female labour-force participation. This creates a need for dedicated infrastructure, better-trained professionals and efficiency technologies (tele-care, sensors, interoperable records, planning tools). The question of financing (long-term care insurance, co payments, public–private partnerships) is becoming central.

From a health perspective, the burden is shifting towards non-communicable diseases (cardiometabolic conditions, cancers, respiratory and neurodegenerative disorders) and towards multimorbidity. Care pathways are lengthening and fragmenting, which creates value for “procedure-intensive” devices, clinical data platforms, AI-based triage tools and adherence solutions. The challenge is not only about treatment; it involves organisation and data management.

For public finances, the trend is clear: age-related spending (pensions, healthcare, LTC) is rising as a share of GDP over the long term, with significant variation between countries. Authorities are balancing prices and volumes in healthcare, pushing value-based purchasing, and seeking to mutualise “longevity risk” through reinsurance and risk transfers. Systems that can boost healthcare productivity and optimise patient care pathways will better contain the long-term upward drift in costs.

Finally, climate change acts as a multiplier of vulnerabilities. Older people are more exposed to heatwaves, pollution episodes and sudden extreme events. This opens a broad field for adaptation: better-insulated and ventilated housing, “age-friendly” urban planning, early-warning systems, tailored insurance coverage and investments that make local communities more resilient.

In summary, the mechanics of ageing rest on three interlocking screws: fewer births, a growing population of the very elderly and a shrinking share of working-age individuals. This drives a massive reallocation of spending towards dependency and chronic conditions, demands higher productivity (automation, data, healthcare organisation) and strains public budgets, powerful structural forces that shape both investment opportunities and risks.