Average life expectancy reached 78.8 years in Europe in 2002
(WHO 2003); most Europeans can, therefore, now anticipate
living well past 75 years of age. Projections in industrialized
nations suggest a continuing mortality decline in the next decades
1 while birth rates will probably continue to decline, resulting
in further ageing of these nations. As those aged 80 years
and over are the fastest expanding segment of the older population,
concerns are growing about a potential dramatic increase
in the number of disabled persons. The ageing of the population
and the related increase in chronic disease burden have already
had major impacts on most Western health-care systems, and
will probably further affect these systems in the future as the
baby-boom generation becomes older. For instance, in Switzerland,
it is estimated that costs due to long-term care could more
than double by 2030, from 6.5 to 15.3 billion SFr.2 Similar trends
are expected in most European countries. As a consequence,
postponement of the onset of disability, with a compression
of functional dependency into a shorter period towards the
end of life, is becoming a major goal. To successfully achieve
this goal and improve the control of growing health and social
care expenditures, various strategies of health promotion and
disease prevention are developed and tested. Although several
of these experiences had some effects on functional decline
and institutional placement, they have not been shown to be
cost-effective. Additional strategies are, therefore, needed to
prevent or delay the onset of disability in older persons, reduce
functional impairment, and face the challenge of an increasing
disabled elderly population.