[Evolution of disability and dependency. An international perspective].

In societies with a high level of population aging, the ability to live autonomously is a major goal of public health. The present article examines recent population-based studies analyzing a possible reduction in the prevalence of disability and provides evidence on the unmet needs of dependent individuals.In the last few decades, disability and reduced mobility have decreased in elderly persons living in high-income countries, including Spain. This decrease is clear in persons aged less than 85 years old but the trends in persons older than 85 years are difficult to study due to the lack of information. These trends depend on greater education among the population, a reduction in social and gender inequalities and the adoption of healthy lifestyle habits. A reduction in dependency also depends on changes in the physical and social environment to encourage active aging. The health gains in the generation aged between 40 and 65 years do not seem high. The reductions in disability in the next 25 years will not be as great as those observed between 1990 and the present time, except for a possible reduction in disability in women due to a decrease in gender roles. Dependence on help from third persons will tend to decrease, except in dementia. Use of technical aids is increasing and will continue to do so.