1 Introduction
Currently, Sweden, a welfare-state country, faces a shift in demography with the rapid growth of the elderly population. According to the Swedish Central Bureau of Statistics, the percentage of the population aged 65 and over exceeded 20% in 2023, compared to less than 14% in 1970 (Statista, 2023), and by the year 2040 the population aged 65 and older will increase exponentially (SCB, 2024). This trend, while positive, creates challenges for the welfare state in providing healthcare and social services (Hort, 2019).
This health system in Sweden, funded by taxes (World Health Systems Facts, 2021), faces the challenge of continuing to provide high-quality care against a background of rising demand. The implications of this demographic shift are socioeconomic issues that affect future healthcare demands. Second, this transition is not going to take place uniformly across Sweden but differentially across regions and municipalities (Johansson et al., 2022), adding challenges to Sweden’s shortage of staff to provide for this ageing population (Statista, 2023). Johansson et al. (2022) highlight the policy changes in the last twenty years and the necessity for flexible approaches to accommodate this demographic shifts. These reforms aim to ensure sustainability and equity of the welfare system, particularly in the face of regional disparities in service access.
One of the main foundations of Sweden’s welfare policy is its elder care system, which centers on the idea of enabling the elderly to live an independent life, guided by the Social Services Act (Bergstra, 2021). However, with the growing 1.3 of informal caregivers in the country (usually family or very close friends), this demographic has a great need to be independent in everyday life, which leads to a different set of problems (Johansson Schön, 2017; von Saenger et al., 2023). These caregivers are not only physically and emotionally drained but also financially, which underscores the necessity of strategies and policies to assist them (Vicente et al., 2022).
1.1 Aim and Research Questions
This study undertakes an in-depth analysis of the challenges and implications of the rapidly ageing population in Sweden for healthcare and social services, including the role and burden of informal caregivers. The research questions were as follows:
- What are the demographic trends and regional disparities in the growth of the elderly population in Sweden, and how might this affect the demand for healthcare and social services?
- What are the major problems and challenges that the ageing population poses to the healthcare system and informal caregivers in Sweden?
- What policy interventions and strategies are required to ensure the sustainability and equity of the welfare system in Sweden?
2 Overview of the Statistical Data
Sweden’s eldercare system is faced with rapid demographic changes and regional differences in population ageing. Statistical data revealed several key trends.
2.1 Demographic Projections
Sweden is experiencing rapid demographic changes. The elderly population is increasing significantly. This number is expected to increase sharply by 2040, especially in the oldest age group (Figure 1). For example, while the 65-74 year and 75–84-year populations will increase by 16% and 9%, respectively, the population aged 85-94 years is expected to rise by 66%, while those aged 95+ years will double by 2040 (Table 1). These figures underscore the urgent need for adaptive strategies in elderly care with a focus on long-term and specialized care.
Table 1
Projected Growth of Sweden’s Elderly Population by Age Group (2024-2040)
| Age | 2024 | 2040 | Growth |
| 65-74 years | 1,054,205 | 1,222,798 | 16% |
| 75-84 years | 855,882 | 936,474 | 9% |
| 85-94 years | 267,480 | 445,200 | 66% |
| 95+ years | 24,104 | 48,252 | 100% |
Source: Data retrieved from “Population size by age, sex, region of birth and alternative assumptions (Year 2024 – 2120),” by Statistics Sweden (SCB) (2024).
Figure 1
Demographic Trends of the Elderly Population in Sweden by Age Group (2024-2120)
Source: Data retrieved from “Population size by age, sex, region of birth and alternative assumptions (Year 2024 – 2120),” by Statistics Sweden (SCB) (2024).
2.2 Regional Disparities in Population Growth
The growth in the elderly population did not increase uniformly throughout Sweden. While Uppsala County is projected to experience a 16.6% increase in the elderly population, Västernorrland and Norrboten counties are expected to experience 5.8% and 5.1% declines, respectively (Table 2). This unequal distribution makes it important to allow regional approaches equal access to care in different areas of the country.
Table 2
Projected Growth of the Elderly Population by County in Sweden
| County | Population | Population | Change | Change |
| 2021 | 2040 | 2021–2040 | 2021–2040 | |
| number | percent | |||
| Uppsala | 395,000 | 460,700 | 65,700 | 16.6 |
| Stockholm | 2,415,100 | 2,793,700 | 378,500 | 15.7 |
| Halland | 340,200 | 380,200 | 39,900 | 11.7 |
| Skåne | 1,402,400 | 1,563,400 | 160,900 | 11.5 |
| Västra Götaland | 1,744,900 | 1,906,700 | 161,900 | 9.3 |
| Östergötland | 469,700 | 506,300 | 36,600 | 7.8 |
| Västmanland | 279,000 | 299,100 | 20,200 | 7.2 |
| Södermanland | 301,800 | 322,300 | 20,500 | 6.8 |
| Gotland | 61,000 | 65,000 | 4,000 | 6.6 |
| Örebro | 306,800 | 325,100 | 18,300 | 6 |
| Jönköping | 367,100 | 388,300 | 21,200 | 5.8 |
| Kronoberg | 203,300 | 212,800 | 9,400 | 4.6 |
| Västerbotten | 274,600 | 286,300 | 11,800 | 4.3 |
| Jämtland | 132,100 | 132,300 | 200 | 0.2 |
| Dalarna | 288,400 | 288,100 | ‑300 | ‑0.1 |
| Kalmar | 247,200 | 246,000 | ‑1 100 | ‑0.5 |
| Värmland | 283,200 | 281,000 | ‑2 200 | ‑0.8 |
| Gävleborg | 287,800 | 284,300 | ‑3,400 | ‑1.2 |
| Blekinge | 158,900 | 156,100 | ‑2,800 | ‑1.8 |
| Norrbotten | 249,700 | 237,100 | ‑12,600 | ‑5.1 |
| Västernorrland | 244,200 | 230,100 | ‑14,100 | ‑5.8 |
| Sverige | 10,452,300 | 11,365,000 | 912,700 | 8.7 |
Source: Data retrieved from “More older person in all counties and municipalities by 2040”, Statistics Sweden (SCB) (2022).
2.3 Healthcare Expenditure and Sustainability
Despite its elderly population, Sweden’s healthcare expenditure as a percentage of GDP has remained stable, fluctuating slightly between 10.8% in 2019 and 11.3% in 2020. However, funding for residential long-term care facilities is falling slightly (Table 3), indicating some long-term sustainability concerns in this system and the possibility of hidden pressure on demand, despite an ageing population.
Table 3
Trends in Healthcare Expenditure per Capita in Sweden (Percentage of GDP)
| 2015 | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 | |
| Total Health Expenditure and Financing | 10.8 | 10.9 | 10.8 | 10.9 | 10.8 | 11.3 | 11.1 | 10.5 |
| Residential long-term care facilities | 2.0 | 2.0 | 2.0 | 2.0 | 2.0 | 2.0 | 1.9 | 1.9 |
Souce: Data retrieved from “Health Expenditure and Financing per Capita (Percentage of GDP)”, OECD (2018).
2.4 Informal Caregiving
The data revealed that informal caregivers are vital to the elderly care system in Sweden. Figure 2 illustrates the majority of informal carers as being ‘weekly carers’ among the population aged 50 and over during 2019. Figure 3 illustrates that in Sweden, the share of informal daily carers who work in addition to caring is higher than that in the average OECD countries and other Scandinavian countries. This suggests a growing reliance on informal caregivers’ roles and underlines the need for policies targeted at offering better support and recognition of their contributions within the healthcare system.
Figure 2.
Proportion of Informal Caregivers Among the Population Aged 50 and Over (2019)
Source: Data retrieved from “Health at a Glance,”OECD (2023).
Figure 3.
Share of Informal Daily Carers Working in Addition to Caring by Country (2019)
Source: Data retrieved from “Share of informal daily carers that report working in addition to caring”, OECD (2019).
2.5 Municipal Services
Municipalities bear an important part of elderly care provision, but their capacity to deliver services at the local level often varies widely across regions. The municipal costs for services to the elderly and people with disabilities have increased continuously and amounted to SEK 174.5 billion in 2023, as Figure 4 shows.
Figure 5 shows the utilization of support for informal caregivers. The highest percentage was related to care for the elderly. Furthermore, Figure 6 portrays the gender disparities in allowances among informal caregivers from to 2013-2023, where most women are involved in caregiving activities (Figure 6). This calls for a gender-sensitive targeted policy and further emphasizes the need for differentiated strategies to achieve equitable service delivery across the country.
Figure 4.
Total Costs of Municipal Services for the Elderly and Persons with Disabilities in SEK thousands (2014-2023)
Source: Data retrieved from “Costs and incomes of municipal services for the elderly and persons with disabilities. Year 2014–2023”, Statistics Sweden (2014).
Figure 5.
Distribution of Support Services for Informal Caregivers Across Various Care Areas 2014
Source: Data adapted from ”Stöd till personer som vårdar och stödjer närstående”, Socialstyrelsen, (2014).
Figure 6.
Informal Caregivers Receiving Financial Allowances by Gender (2013-2023)
Source: The data is from “Number of people who have received relatives’ allowance”, Försäkringskassan, (2024).
3 Overview of the Results and Methods in Previous Research
The challenges of ageing populations and their consequences have been widely discussed in academic literature, especially in the context of healthcare services and informal caregiving. These studies are useful for considering the various methods and approaches applied to analyze such complex issues.
One study by Murofushi (2021) examined the trends in prevalence, change, and variation in paid informal care schemes among Swedish municipalities between 2006 and 2016. Both primary and secondary data collection methods were applied in the study based on the use of allowance and salary provisions for informal caregivers at the municipality level. Bivariate and multivariate logistic regression analyses were used to examine the municipal factors associated with the adoption of paid informal care schemes. While large variations existed in the prevalence of such schemes between municipalities, this was influenced by political, structural, and financial factors. This study has limitations in terms of data comparability and generalizability.
Another related study was conducted by Vicente et al. (2022) to analyze the patterns of informal care provided by working carers (WKCs) in Sweden, with particular emphasis on gender differences in the impact of caregiving on work and study. Data were collected using a survey questionnaire adapted from a previous national study that included sociodemographic characteristics, caregiving contexts, and support. In the analysis, it was observed that men and women differed significantly, as there was a greater percentage of reduced work/study hours for men, while the decrease in one’s ability to work or study was significantly higher for women. The study employed descriptive statistics and chi-square tests to analyze the data, indicating the complex nature of the relationship between caregiving responsibilities and employment outcomes among WKCs.
Agerholm et al. (2024) discuss the responsibility for health and social care for older people in Denmark, Finland, and Sweden, discussing policy guidance, funding, and organization at the state, region, municipality levels. In this study, data were obtained through a literature review and consultations with experts, who demonstrated that while the state issues policy and co-funds these largely decentralized systems, the main responsibility for service delivery is left to the regions and municipalities. Care services have already been placed at regional and municipal levels in Denmark and Sweden, while Finland is moving in this direction to promote the coordination of care and equity. The findings highlight problems linked to local variation in the provision of care, which could relate to equity in health and social services for the ageing population.
The study by Kirvalidze et al. (2022) was conducted in line with data from the Swedish National Study on Ageing and Care in Kungsholmen (SNAC-K), which examined health trajectories and perceived burden in a sample of 629 informal caregivers during an average follow-up period of 12 years. In their analysis, the researchers employed adjusted linear mixed models to assess the association between caregiving-related exposures and changes in health status, whereas ordered logistic regression models tested cross-sectional associations with limitations to life and perceived burden. The key findings indicated that both subjective and objective health outcomes were influenced by similar caregiving factors. The perceived burden was heterogeneous, and health trajectories were diverse among older caregivers. Added to this is the generalizability of the results, as the population being tested was randomly selected. However, it also recognized that the study may have limitations due to confounding factors and the lack of diversity in the sampled subjects.
Finally, Ekman et al. (2021) developed a full cost calculation of the costs due to informal care in Sweden, estimating that about 15% of the adult population are caregivers, and the cost for one year reaches approximately SEK 152 billion. The methodology includes a three-step costing analysis: identification of cost items, measurement of costs in relevant units, and valuation of resources in monetary terms. Estimations of the replacement cost of informal care were based on data from Statistics Sweden, labor unions, and the existing literature regarding wages, working hours, and valuation of lost sleep. The findings contribute to important insights into which future policy development for social well-being and the economic burden of informal caregiving will be based.
4 Conclusion
The multifaceted analysis of the rapidly ageing population in Sweden has revealed various dimensions of demographic trends, challenges faced by the elderly care system, and implications for society that call for innovative and adaptive responses from policy. Indeed, this is a multidimensional challenge and, simultaneously, an opportunity to reshape the concept of eldercare in Sweden.
Within this demographic change, a significant increase in the elderly population is expected, particularly in the oldest age bracket. Whereas the population aged 85-94 years is projected to rise by 66% by 2040, those aged 95+ years will double. This dramatic growth among the most vulnerable age groups inherently demands radical rethinking of long-term care strategies and specialized healthcare services.
An important implication of this analysis is the pronounced regional variation in the growth of the elderly population. While some regions, such as Uppsala, show a projected increase of 16.6% among the elderly, Västernorrland and Norrbotten may experience a decline. This means that demographic changes vary across Sweden, bringing forth the need to implement healthcare planning and resource allocation based on the demand indicated by region. This may indicate that a uniform policy in eldercare is inadequate, instead, versatile strategies designed for the local levels are desirable, which may address regional needs in various ways.
The association between these demographic trends and healthcare expenditure data reveals a potentially concerning pattern. Although the number of aged populations in Sweden is increasing day by day, its healthcare spending as a percentage of GDP has remained stable, and funding for residential long-term care is shrinking. This apparent disconnect between increasing needs and resources presents critical questions regarding the long-term sustainability of Sweden’s health care system. Innovation in financing models is necessary to improve efficiency and ensure that quality does not deteriorate as the population ages.
One of the most salient insights derived from this analysis is the significant and growing role of informal caregivers in Sweden’s eldercare system. A percentage of people over the age of 50 years provide care on a weekly or daily basis to elderly individuals. Although this reliance on informal caregivers may be inexpensive for the healthcare system, it incurs considerable costs. The physical, emotional, and economic burdens that fall on these caregivers, disproportionately women, far outweigh whatever economic efficiency they might provide, and as such, they represent a critical social issue. The economic value of informal caregiving underlines such a hidden support system, which is estimated at an annual cost of SEK 152 billion. This amount not only reflects a significant contribution to the economy but also a very high risk of burnout and quality reduction in caregiving if these informal caregivers are not properly supported.
The decrease in paid schemes of informal care (Murofushi, 2021), in addition to the effects of caregiving on employment and career development (Vicente et al., 2022), should be seen as a looming crisis. With an ageing population, there is also an increased need for care, while simultaneously risking a shrinking workforce taking care of their family members. This will contribute to a decrease in labor market participation and productivity, which will place more burdens on Sweden’s economic resources.
This is a complex problem in Sweden, affecting healthcare, economics, social policy, and even gender equality. Variations in regional demography, sustainability issues considering the financing mechanism of the existing healthcare, and a growing dependency on informal caregivers, all of which indicate what elderly care requires in the future: an adaptive approach.
Suggested future research to address Sweden’s eldercare challenges: First, a comprehensive longitudinal study should be conducted to examine the long-term health and economic effects of informal caregiving for both caregivers and care recipients. This study will draw on national health insurance records, employment data, and quality of life surveys using a mixed methods approach. Second, a multi-site randomized controlled trial in technology-based interventions aimed at improving the quality of eldercare and reducing the burden on informal caregivers across different regions of Sweden. The study will analyze data in terms of design science and design thinking approach of pilot technology implementations, health outcomes, and regional demographics. Both studies address the gaps identified in the essay as critical: support for informal caregivers, accounting for regional variations in ageing populations, exploring innovative care solutions, and providing evidence-based insights for policy development. The suggested studies will underpin the development of a more sustainable, efficient, and equitable eldercare system in Sweden that can meet the complex challenges of its rapidly ageing population.
In conclusion, Sweden could use evidence-based research and focused interventions to overcome these challenges to create a more resilient, equitable, and sustainable eldercare system. This can be realized with the adoption of technological innovations complemented by supportive policy changes for informal caregivers and adaptable healthcare strategies at the regional level. As a matter of fact, these strategy will not only ensure the well-being of Sweden’s ageing population but also serve as a model for other countries facing similar demographic challenges over the coming decades.
5 References
Agerholm, J., Pulkkinen, J., Jensen, N. K., Keskimäki, I., Andersen, I., Burström, B., Jämsen, E., Tynkkynen, L.-K., Schön, P., & Liljas, A. E. M. (2023). The organisation and responsibility for care for older people in Denmark, Finland and Sweden: Outline and comparison of care systems. Scandinavian Journal of Public Health, 52(2). https://doi.org/10.1177/14034948221137128.
Bergstra, M. (2021). Ageing policies – access to services in different Member States Annex VIII -Country study on Sweden EN ANNEX. https://www.europarl.europa.eu/RegData/etudes/STUD/2021/662940/IPOL_STU(2021)662940(ANN08)_EN.pdf.
Ekman, B., McKee, K., Vicente, J., Magnusson, L., & Hanson, E. (2021). Cost analysis of informal care: Estimates from a national cross-sectional survey in Sweden. BMC Health Services Research, 21, 1236. https://doi.org/10.1186/s12913-021-07264-9.
Försäkringskassan. (2024). Number of people who have received relatives’ allowance. Statistikdatabas. https://www.forsakringskassan.se/statistik-och-analys/statistikdatabas#!/sjuk/np-antal-mottagare-belopp-dagar.
Hort, O. (2019). Sweden: Aging Welfare and Social Policy in the Twenty-First Century. International Perspectives on Aging, 73–90. https://doi.org/10.1007/978-3-030-10895-3_5.
Johansson, L., & Schön, P. (2017). Quality and cost-effectiveness in long-term care and dependency prevention. CEOUA L T C Sweden. https://aldrecentrum.se/wp-content/uploads/2020/07/quality_and_cost-effectiveness_in_long-term_care_and_d.pdf.
Kirvalidze, M., Giorgi Beridze, Anders Wimo, Morin, L., & Amaia Calderón-Larrañaga. (2022). Variability in perceived burden and health trajectories among older caregivers: a population-based study in Sweden. Journal of Epidemiology & Community Health, 77(2), 125–132. https://doi.org/10.1136/jech-2022-219095.
Murofushi, S. (2021). Paid informal care within Swedish eldercare: Prevalence, change and variation among Swedish municipalities 2006–2016. European Journal of Social Work, 25(2), 276-288. https://doi.org/10.1080/13691457.2021.1934410.
OECD. (2018). Health Expenditure and Financing per Capita (Percentage of GDP). https://data-explorer.oecd.org/vis?pg=0&bp=true&snb=120&tm=informal%20care&df[ds]=dsDisseminateFinalDMZ&df[id]=DSD_SHA%40DF_SHA&df[ag]=OECD.ELS.HD&df[vs]=1.0&dq=SWE.A.EXP_HEALTH.XDC%2BPT_B1GQ._T..HCR1%2B_T.HB%2BDAY%2BHBEDT%2BHBOUT%2B_T.HP2%2BHP21%2BHP81%2B_T…&pd=2015%2C2023&to[TIME_PERIOD]=false&ly[cl]=TIME_PERIOD&ly[rs]=PRICE_BASE&ly[rw]=COMBINED_UNIT_MEASURE%2CFUNCTION%2CPROVIDER&vw=tb.
OECD. (2019). Share of informal daily carers that report working in addition to caring, 2019 (or nearest year). https://www.oecd-ilibrary.org/social-issues-migration-health/share-of-informal-daily-carers-that-report-working-in-addition-to-caring-2019-or-nearest-year_a9df31ee-en.
OECD. (2023). Health at a Glance 2023. https://www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-2023_7a7afb35-en.
Socialstyrelsen. (2014). Stöd till personer som vårdar och stödjer närstående. https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/statistik/2014-12-6.pdf.
Statistics Sweden (SCB). (2014). Costs and incomes of municipal services for the elderly and persons with disabilities. Year 2014 – 2023-Statistikdatabasen. https://www.statistikdatabasen.scb.se/pxweb/en/ssd/START__OE__OE0107__OE0107B/TkrAldFunktRN/.
Statistics Sweden (SCB). (2022). More older person in all counties and municipalities by 2040. (2022). https://www.scb.se/en/finding-statistics/statistics-by-subject-area/population/population-projections/population-projections/pong/statistical-news/the-future-population-in-counties-and-municipalities-of-sweden-20222040—/.
Statistics Sweden (SCB). (2024). Population size by age, sex, region of birth and alternative assumptions (Year 2024 – 2120). (https://www.statistikdatabasen.scb.se/pxweb/en/ssd/START__BE__BE0401__BE0401E/BefPrognRevAltNb/table/tableViewLayout1/). Copyright 2024 by Statistics Sweden.
Statista. (2023). Sweden aging population 2023 | Statista. https://www.statista.com/statistics/525637/sweden-elderly-share-of-the-total-population-by-age-group/.
Statista. (2023). Sweden: problems with national health care system 2023 | Statista. (2023). https://www.statista.com/statistics/1272133/problems-with-national-health-care-system-in-sweden/.
Sweden Institute (SI). (2024). Elderly care in Sweden. https://sweden.se/life/society/elderly-care-in-sweden.
Vicente, J., McKee, K. J., Magnusson, L., Johansson, P., Ekman, B., & Hanson, E. (2022). Informal care provision among male and female working carers: Findings from a Swedish national survey. PLoS ONE, 17(3), e0263396–e0263396. https://doi.org/10.1371/journal.pone.0263396.
World Health Systems Facts. (2021, May 18). Sweden: Health System Challenges – World Health Systems Facts. https://healthsystemsfacts.org/national-health-systems/beveridge-model/sweden/sweden-health-system-challenges/.
Von Saenger, I., Dahlberg, L., Augustsson, E., Johan Fritzell, & Lennartsson, C. (2023). Will your child take care of you in your old age? Unequal caregiving received by older parents from adult children in Sweden. European Journal of Ageing, 20(1). https://doi.org/10.1007/s10433-023-00755-0.
Leave a Reply