TILDA findings highlight the urgent need to rethink health and social care for older people

Posted on: 09 September 2025

Ireland is one of the fastest ageing countries in Europe, with the population aged 65 and over projected to double by 2051. This demographic shift will place increasing pressure on public services particularly health and social care and will require significant planning and adaptation.

So, how do we provide the best type of health and social care and quality of life that those over 50 years of age in our population expect and deserve into the future? The latest findings released from The Irish Longitudinal Study on Ageing  (TILDA), and their comparisons with their earlier ‘waves’ over the last 14 years may provide some answers.

TILDA observes patterns and changes in health social and economic characteristics of older adults in Ireland. By measuring the same information every two years, TILDA can reveal patterns, trends and cause -and - effect relationships that a single snapshot in time, like a cross-sectional study, might miss.

KEY AREAS OF FOCUS FOR WAVE 6

Drawing on 14 years of longitudinal data from over 8,000 adults aged 50 and older, the new report will highlight widespread unmet need in key areas such as cardiovascular disease prevention, falls and fracture care, osteoporosis treatment, chronic pain, and mental health. Early findings indicate that many older adults remain undiagnosed or inadequately treated, with serious consequences for wellbeing and independence. The report will also address the ongoing burden of loneliness and emotional distress, showing that depression in later life is underdiagnosed, under-treated, and often not reported at all. It will also draw attention to the vital role of family carers, many of whom are older adults themselves providing more than 50 hours of care each week. This level of caregiving is associated with poorer mental health, particularly among women.

Regius Professor Rose Anne Kenny, Principal Investigator of TILDA, said:

“This is the most comprehensive and wide-ranging report TILDA has produced to date. It's the first time we’ve brought together such an extensive, longitudinal view of the key issues shaping the lives of adults in Ireland. From loneliness and emotional wellbeing to healthcare access and the realities of caregiving, these are topics that matter deeply to the individual, but also to health and social care.

“What makes the Wave 6 findings so compelling is that the majority of the issues we’ve identified, like untreated hypertension, high cholesterol, chronic pain, and depression, are largely modifiable. These are not inevitable aspects of ageing; they are challenges we can address with the right health and social care systems in place. This study shines a light on where immediate, evidence-based action can transform outcomes for older adults in Ireland.”

KEY FINDINGS

There were four key areas of focus that the TILDA team examined in Wave 6. Their key findings are listed below.

1.Loneliness:

Loneliness has emerged as a persistent and powerful factor influencing the health and wellbeing of older adults. The study tracked how loneliness has affected older adults in Ireland over 14 years, including the impact of the COVID-19 pandemic.  

• Loneliness scores more than doubled during the pandemic, however levels and frequency of loneliness returned to pre-pandemic levels by Wave 6.
• Despite being quite static over time, a significant proportion of older adults experience loneliness and this experience is associated with poorer health outcomes including functional limitations, poorer self-rated health, and a higher number of depressive symptoms.

2.Unmet Need

The study explored the scale of undiagnosed and poorly managed health conditions among older adults, representing missed opportunities for prevention and intervention, with serious implications for wellbeing and health system efficiency.

• A significant proportion of older adults remain undiagnosed or under-treated for key conditions including hypertension, hypercholesterolaemia, diabetes, osteoporosis, depression, and chronic pain.
• At Wave 6, 36% of older adults had undiagnosed hypertension and 45% had undiagnosed high cholesterol based on clinical thresholds.
• While 12% of older adults had clinically significant depressive symptoms, fewer than half received appropriate treatment, and over 45% had not reported their symptoms to any healthcare provider.

3.4Ms Framework

Using the 4Ms—Mobility, Medications, Mentation, and What Matters— the study offers a comprehensive view of how ageing affects older adults over time.

• Ageing is non-linear and multidimensional: while mobility and cognitive function decline, Quality of Life (QoL) can initially improve before declining in later years.
• Evidence supports the male–female health–survival paradox: women live longer but experience more health-related decline.

4.Caring

The study examined the emotional and mental health impacts of caregiving, and makes the case for stronger policy supports to reduce caregiver strain and improve wellbeing.

• Carers who provide more than fifty hours of care each week report poorer mental health and reduced overall well-being, highlighting the emotional strain of high-intensity caregiving.
• Among these caregivers, women in particular were more likely to report increased symptoms of depression, pointing to a gendered impact of prolonged caregiving responsibilities.

“This report reveals how health evolves over time, uncovering the complex interplay of biology, behaviour, and environment that shapes the aging process,” said Cathal McCrory, Professor in Life Course Development and Ageing at Trinity and Co-PI of TILDA. “By tracking the same individuals over time, TILDA distinguishes typical patterns of aging from those that are atypical and potentially concerning. This report highlights that ageing is not a unidimensional process of decline, but a diverse and dynamic experience that involves growth, adaptation, resilience and vulnerability. These insights provide an essential evidence base for designing policies that optimise the health, wellbeing, and opportunities of older people in Ireland.”

The TILDA team thank their participants for their generosity of time, openness, and ongoing commitment to the study which has been the cornerstone of TILDA’s success. Without their continued engagement, none of this research would be possible.

Further information

You can read the report TILDA Wave 6 Report – Shaping the Future: Longitudinal Trends and Opportunities for Transformation in Health and Social Care in Ireland at the following link: https://tilda.tcd.ie/publications/reports/W6KeyFindings/index.php.

You can find out more about TILDA or ask a question at the following link: www.tilda.ie

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