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Health among the elderly in Norway

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About the health of the elderly in Norway. The diseases and health problems we experience in our later years, lifestyle choices and social inequalities.

illustrasjon eldres helse
Norwegian Institute of Public Health (NIPH) and Fetetyper.no Copyright: NIPH.

About the health of the elderly in Norway. The diseases and health problems we experience in our later years, lifestyle choices and social inequalities.

Main points 

  • A significant increase in the number and the proportion of elderly people is expected in the coming years.
  • Life expectancy is increasing.
  • Many people are living with chronic diseases.
  • Medicine consumption is high.
  • The risk of developing dementia is declining but the number of people with dementia is rising with the increase in the number of elderly people. 

Data sources

  • The Norwegian Study of Life-course, Ageing and Generation (NorLAG), conducted in 2002-2003, 2007-2008 and 2016-2017, is the only study that provides a comprehensive overview of the quality of life amongst the elderly. However, the study does not provide country-representative figures (45).
  • However, Statistics Norway’s surveys of living conditions include certain quality of life measures and provide nationwide figures.
  • The Health Survey in Nord Trøndelag.
  • The Norwegian Prescription Database with all prescription drugs dispensed by pharmacies. Concerns individuals living at home.
  • Statistics Norway: population statistics.

Increasing life expectancy, more elderly people

Over the past century, the demography of the population has changed considerably. In 1918, the largest proportion of the population consisted of younger people but by 2018 there was a higher proportion of elderly and middle-aged people; see the population pyramids in Figures 1 a and b below.  


Figure 1 aPopulation pyramid 1918. Men on the right (green), women on the left (purple), shown in groups of five years. Alder = Age. Source: Statistics Norway. Click to enlarge.

Befolkningspyramide 2018.png

Figure 1b. Click on the figure to enlarge.  Population pyramid 2018. Population distribution in Norway according to age and gender (men in green on the right and women in purple on the left), shown in groups of five years. Alder = Age. Source: Statistics Norway. Click to enlarge.

In 1918, one per cent of the population was aged 80 or older; by 2018, this figure had risen to four per cent. Forecasts show relatively strong growth in the older age groups (17). The number of people over 80 years of age will double over the course of two decades and by the end of the year 2100, the proportion of people aged 80 or over will have tripled and risen to 12 per cent.

There will be comparatively fewer people of working age. Today, there are two people of working age (16-66) for every person outside this age group, i.e. under 16 or older than 66. This figure will drop below 1.6 in 2060 and continue falling to 1.4 by the turn of the century in 2100; see Figure 2. 


Figure 2.  The proportion of people of working age (16-66) per person of other ages (0-15, ≥ 67) for the period 2016 to 2100. Projections based on the main scenario (MMMM). Source: Statistikkbanken, Statistics Norway (Population projections, table 11167). Menn = Men, Kvinner = Women, Begge kjønn = Both sexes. Click to enlarge.

Ageing, health and function - the current situation and trends

More healthy life years?

As we age, the risk of chronic diseases increases and these are often used as an indicator of health status. 

Figures from the Global Burden of Disease Study indicate that the increase in life expectancy during the period 2005 to 2015 was an increase in both healthy life years and years living with illness (18, 19):

  • For men, life expectancy rose by 2.1 years, of which 1.9 years were healthy life years.
  • For women, life expectancy rose by 1.7 years, of which 1.6 years were healthy life years.

On average, women live longer than men but women also tend to live more years with illness compared to men; 11.5 years versus 9.5 years, according to figures dating from 2015; see Table 1.

Figures for Norway from the Global Burden of Disease Study in 2015 show that:

  • 65-year-old men can expect to live for 18.6 years, of which 14.4 years will be healthy life years.
  • 65-year-old women can expect to live for 21.5 years, of which 16.7 years will be healthy life years.
Table 1. Life expectancy, health adjusted life expectancy, unhealthy life expectancy and expected percentage of life lived with disease, at birth and 65 years of age for men and women in Norway 2015. Source: GDB 2016, figures for Norway (18). 


At birth

At 65 years of age






Life expectancy (LE)





Healthy life expectancy (HALE)





Unhealthy life expectancy (LE-HALE)





Percentage of life lived with disease, at birth and at 65 years, respectively





Health and functioning are more than just absence of disease

Although the elderly today live for longer with one or several chronic diseases, there is considerable variation in how much each individual is  affected in their everyday life. Many diseases can be controlled using medication and the elderly may be able to live independently and with a good quality of life, without any need for care services (20). A Swedish study found that chronic diseases amongst the elderly affected self-reported health to a lesser extent in 2010 than in 2002 (21).

With regards to what determines survival rates amongst the elderly, physical functioning is a key factor (22). By ‘physical functioning’ we mean the body's physiological function or reserve and this can encompass muscle strength, walking speed, vision, hearing and cognition.

In the WHO’s World report on ageing and health 2015, “intrinsic capacity” was introduced as an indicator of the body's physiological reserve (14). Along with external adaptation and barriers, this will give the elderly an opportunity to be active and function in everyday life, i.e. to have good physical capabilities (functional ability).

Hand grip strength is a tangible measure of physical function. For example, results from the Tromsø study show a strong association between grip strength and life expectancy. This association was strong when grip strength was measured in both the young and the elderly and was found amongst both men and women (23). 

The importance of cognitive and physical function

Cognitive and physical function are important for an active old age (24). Reduced capacity for self-help and impaired physical and cognitive function entails high costs for the individual, for their close relatives and for society. Whilst expenditure on healthy and self-reliant elderly people is relatively modest, expenditure on disabled elderly people is much higher (25).

It is estimated that the cost of publicly funded care for the elderly will rise by 38 per cent if the next generation of elderly people has the same physical functional capacity as the elderly have today (25). However, if their functional capacity increases, the cost will remain unchanged or could even decrease.

It is also estimated that one extra year of working life by every Norwegian aged 50 or over would generate an annual economic growth of NOK 28-30 billion (26). 

Are the elderly healthier than before?

Studies that look at trends in health outcomes over time often face methodological challenges, which often produces widely differing results. Many participants drop out during the study, often those with the worst health. Including the eldest people in such studies is often a challenge.

Recent studies suggest that the last two decades have seen some improvement in cognitive function and a fall in the age-specific dementia incidence  among the elderly (27-30).

However, studies of physical functioning do not indicate the same positive trend (29, 31, 32), particularly for women (33, 34). The age of onset of diseases remains about the same today as previously (21).

With regards to self-reported physical functioning, the results vary from country to country and are strongly dependent on the function indicator used (21, 29, 31, 32, 35-41).

  • During the period from 2002 to 2015, there appear to be no major changes in the proportion of 65-79-year-olds reporting either good or very good health; see Figures 3 a and b. Around three in four people report good or very good health in this age group, both men and women.
  • Figures from Sweden show improvements in self-reported health and function in the age group 65 years and older (21, 41). This may partly be due to improvements in the environment in which people live rather than improvements in a person's own intrinsic function (42). 
figure self-assessed health men
figure self-assessed health women

Figures 3 a and bSelf-reported health: proportion with good/very good health. By age and gender (3a, top men, bottom women). Source: Norgeshelsa.no, 25.09.2017 based on Statistics Norway's living conditions surveys concerning health. The error margins (95% confidence intervals) for 65 – 79 years are approximately plus/minus four percentage points. Click to enlarge.

Quality of life  

Quality of life is about how life is perceived by the individual and encompasses both positive emotions, such as tranquillity and joy, positive assessments such as life satisfaction, and positive functioning such as life skills and meaning (43, 44). Subjective quality of life can be perceived as positive even during illness and despite health problems and other types of strain.

We do not currently know enough about the quality of life of the elderly in Norway, particularly the eldest (> 75 years), the most severely ill and those living in nursing homes.

The results of quality of life surveys in Norway show that:

  • Most people are satisfied with life but many people do not believe they have sufficient coping resources, strength or drive. As they age, many people also find that their social network becomes smaller (46, 47).
  • Satisfaction levels remain high even in the oldest age group (44, 46). However, the figures must be interpreted with care because of the size and composition of the sample (see above).
  • Compared with figures from other countries, life satisfaction appears to vary relatively little across age groups in Norway (48, 49).

The results of the survey on income and living conditions EU-SILC 2013 show that (50):

  • 36 per cent of participants in Norway were very satisfied with life. Amongst the elderly over 67 years of age, the proportion was 40.
  • The proportion who stated a high degree of meaningfulness was particularly high after retirement (46 per cent).
  • After retirement, the proportion who considered life to be “relatively meaningless and unrewarding" was nine per cent. The proportion in the 45-66 age range was six per cent.

The intensity and frequency of both positive (happiness) and negative emotions (anger) decrease somewhat with increasing age (51). Quality of life amongst the elderly is therefore characterised by less intense emotions, but the same degree of low-intensity positive emotions (calm) (52). Among the eldest (> 75 years), the level of negative emotions appears to rise again. Many people also experience reduced mastery and social support (46, 52).

As they age, many people find that their health deteriorates (46). Health problems and disability can significantly reduce a person’s quality of life (43).

However, quality of life varies widely between people with similar health problems (53). This is partly because health problems have different severities and partly because of differences in coping skills. The strain on a person’s quality of life depends upon the type and severity of disability or illness and, factors such as personality and access to resources such as good finances, practical help, social and emotional support.

Frailty – reduced individual resistance

Frailty is a condition that particularly affects the elderly. It is characterised by reduced muscle strength, low energy levels and increased susceptibility to fatigue, unintentional weight loss and low levels of physical activity (91; 92). The body’s physiological reserves are reduced, and resistance to stresses, such as disease and injury, is impaired.

Frailty has complex causes, including normal ageing, unhealthy lifestyle choices with low levels of physical activity and poor nutrition, as well as disease and injury. Prevention and treatment are aimed at these causes. Physical activity, healthy nutrition, good medical treatment and psychological and social support can reduce the support needs of the elderly and prevent their life prospects from being reduced.

We do not know enough about the prevalence of frailty in Norway, partly due to a lack of agreement over which method should be used to assess frailty. 

Diseases and ailments related to ageing

The risk of developing chronic diseases increases as people age. A significant proportion of years lived with disability amongst the population is therefore linked to diseases that are most common amongst the elderly over 70. Of these, musculoskeletal disorders, pain, diseases of the sensory organs, dementia and loss of life years due to cardiovascular disease and cancer are important. 

The elderly also often have several diseases concurrently, which collectively impact on functional capacity, quality of life and mental health. See also the section on therapeutic drug consumption below.

Musculoskeletal disorders

Overall, impaired musculoskeletal health is more common among middle-aged and older people than among younger people. Fractures, especially hip fractures, as a result of osteoarthritis, falls and osteoporosis are frequent. See Musculoskeletal health.


The most common pain disorders amongst the elderly are linked to diseases of the musculoskeletal system, particularly arthrosis and back problems; see Chronic pain

Most population surveys show a levelling off or slight decrease in the prevalence of chronic pain amongst the elderly compared with those of middle age (54). The findings are uncertain because elderly people with the most extensive health problems often live in institutions and do not take part in the studies. It is also possible that the elderly have lower expectations about their own health and under-report pain.

Studies of pain sensitivity suggest that a person’s pain threshold increases with age, while chronic and more intense pain stimuli are perceived as more painful amongst the elderly (54). There is also evidence to suggest that the elderly have a reduced ability to inhibit pain (55, 56).

Assessing pain in people with dementia poses a particularly big challenge. Pain is a subjective experience, and there are currently no good objective measurement methods available. Studies show that pain in people with dementia is often underestimated or misinterpreted as anxiety. Even mild painkillers such as paracetamol can have a significant effect on agitated behaviour (57).

Chronic pain is in itself a risk factor for dementia and elderly people who experience pain have more limitations in activities of daily life compared with those who are free from pain (58).

Mental health

Depression and anxiety disorders are characterised by depressed mood and anxiety, reduced concentration, as well as changes in energy levels, sleep, appetite and weight. These symptoms are in a grey area between normal age-related changes, dementia and somatic diseases (1). It is particularly difficult to diagnose among depressed people with dementia because concentration difficulties and psychomotor retardation are frequent symptoms of both depression and dementia (2).

If the criteria for anxiety and depression according to DSM-IV (3) or ICD-10 (4) are used, the prevalence of depression and anxiety can be both under- and overestimated amongst the elderly. Estimates are difficult to determine because most studies are not based on individual diagnostic interviews.

In recent years, several Norwegian, Nordic and European studies have  been published on self-reported mental problems and mental disorders amongst the elderly (5-8). The results of two Norwegian studies show that:

  • The prevalence of symptoms of depression amongst men and women in the age group 60-80 were 10 per cent and 15 per cent respectively in 2007, according to figures from the NorLag study (9).
  • The prevalence of symptoms of depression was 12 per cent in the age group 60-64, and 21 per cent amongst 86-90-year-olds, according to figures from the Health Survey in Nord-Trøndelag in 2006-08 (HUNT) (8).

Results from HUNT show that the prevalence of symptoms of depression among the elderly has increased over the generations, particularly among the oldest participants (8):

  • While the prevalence was 11-12 percent amongst 60-, 70- and 80-year-olds in 1995-97, there were considerable differences in prevalence between the different age groups between 2006 and 2008.
  • This was especially true for those aged 75 years and older, amongst whom the prevalence was 12 per cent in 1995 and 21 per cent in 2006.

Neither NorLag nor HUNT distinguish between mild and severe symptoms.

Recent knowledge summaries concerning studies in European countries and North America support the findings regarding the higher prevalence of depression amongst the elderly. The one-year prevalence of depression among people aged over 50 was almost 30 per cent in Western countries (7) but the mildest forms were most frequent. 

In many European countries, 35 per cent of the elderly had suffered from a mental disorder during the past year (6). The most frequent disorders were anxiety disorders, depression and substance abuse. This study is particularly important because it used a diagnostic interview (CIDI) (2, 10).

No studies have been conducted amongst nursing home residents, and there are no good studies of elderly people with dementia, for whom more comprehensive studies will be necessary (11).

Sight and hearing

Impaired vision and hearing are common amongst the elderly, and can reduce social interaction and ability to function normally in everyday life.

  • Currently, almost one in ten people over the age of 66 say they experience visual problems, even when wearing glasses (Statistics Norway, Statistikkbanken).
  • One in five people over the age of 66 reports having hearing problems, even with a hearing aid (Statistics Norway, Statistikkbanken).
  • Up to half of the population aged over 65 and around three quarters of those over 74 suffer from a hearing impairment which affects their ability to communicate.
  • The combination of longer life expectancy and large birth cohorts means that the proportion of elderly people in the population with sight or hearing impairment will increase in the coming years.

Other diseases

Dementia: Approximately 80,000 to 100,000 people live with dementia in Norway today. This number will rise as the number of elderly people increases. If age-specific prevalence remains unchanged, i.e. the risk of developing dementia remains the same as today, the increase in life expectancy in Norway will more than double the number of people with dementia in 2050 compared with 2006; see Dementia.

Cancer: The risk of developing cancer rises with age. More than 85 per cent of cancer cases in women and 90 per cent of cases in men occur after 50 years of age. Improved survival rates, combined with an ageing population, will mean that more people will live with a cancer diagnosis in the future; see the annual report from the Norwegian Cancer Registry and Cancer.  

Diabetes: The risk of type 2 diabetes increases sharply with age, peaking at around 80 years. In 2012, almost 11 per cent of 80-year-olds were taking blood glucose-lowering medication (59). Both the proportion living with type 2 diabetes and the number of new cases are highest in the high age groups. See Diabetes

Chronic obstructive pulmonary disease (COPD): The prevalence of COPD increases with age and the increase in the number of elderly people will cause the number of people living with COPD to increase. However, a reduction in the number of smokers amongst the population could contribute to a reduction in new cases of COPD; see COPD. 

Parkinson's disease: Parkinson's disease affects around one per cent of the population aged 50-70 years, rising to a little over three per cent amongst those aged over 85 years. The disease is incurable and causes brain damage which deteriorates over time and impaired cognitive functions. Over half of cases lead to dementia within a few years (60).

Cardiovascular diseases: Cardiovascular disease is by far the most common cause of death amongst the elderly. Since 2000, the mortality rate of myocardial infarction has almost halved and deaths are delayed to the later years. However, both the proportion and number of cardiovascular disease cases (morbidity; prevalence) will increase. See Cardiovascular diseases.

Therapeutic drug consumption

Drug consumption increases with age (61). 

In 2016, 90 per cent of people aged over 65 were dispensed at least one prescription drug, compared with 65 per cent of those under 65. Figures from the Norwegian Prescription Database show that elderly users mainly use drugs to treat:

  • cardiovascular disorders
  • infections
  • pain
  • anxiety, depression and insomnia

The proportion of elderly people using such therapeutic drugs for most pharmaceutical groups increased from 2006 to 2017; see Table 2. The figures from the Norwegian Prescription Database do not include medicines for people in nursing homes/hospitals.

Table 2. Use of therapeutic drugs amongst the elderly (≥ 70 years) in Norway in 2006, 2011, 2016 and 2017, measured as a percentage (%) of the population who were dispensed at least one prescription for a drug in the therapy group during the year concerned. Therapeutic areas which include more than 10 per cent of the elderly population are included in the table.

Drug groups (ATC codes)





Medicines to treat cardiovascular disorders (C03, C07, C08, C09)





Antithrombotic agents (B01A)





Lipid-modifying agents (C10)





Psycholeptics (N05B, N05C)





Antibacterials (J01)





Strong analgesics (opioids, N02A)





Mild analgesics (N02B)





Medicines to treat inflammations and rheumatic diseases (NSAIDs, M01A)





Drugs for peptic ulcer and gastro-oesophageal reflux disease (A02B)





Psychoanaleptics (N06A)





Thyroid therapy (H03)





Corticosteroids for systemic use (H02A)





Diabetes (A10)





Increased consumption: The increase in the proportion of users over time is most evident for mild analgesic drugs, drugs for the treatment of peptic ulcers and gastro-oesophageal reflux and lipid-modifying agents. The increase in the use of mild analgesic drugs can be seen in the context of the decrease in NSAIDs during the same period. The therapeutic area of use of these two drugs overlaps.

Reduction in use: The proportion using psycholeptics has declined and the proportion of antibiotics users was also slightly down in 2016-2017.

The type of drug varies slightly between men and women; see Figure 4. For example, a higher proportion of elderly men use drugs to treat cardiovascular diseases and diabetes, whereas a higher proportion of women are treated with analgesics, psycholeptics and antidepressants; see Figure 4.

figure drugs precribed

Figure 4. Proportion (%) of women and men aged 70 or over using drugs from various drug groups (ATC code in parentheses). Only medicines used by more than 10 per cent of the elderly population are included. Click to enlarge.


Polypharmacy is the use of five or more drugs (62).

Some diseases require treatment with several drugs. In addition, the elderly frequently suffer from several diseases at the same time, resulting in them often having to take many medicines.

Polypharmacy is often regarded as a risk factor for elderly people with regard to efficacy/side effects and inappropriate drug treatment.

Figures 5 and 6 show the proportion of elderly drug users receiving one or more medicines in 2016 (Norwegian Prescription Database):

  • 67 per cent of men aged over 65 were taking five or more types of drugs.
  • 28 per cent of men aged over 65 were taking ten or more types of drugs.
  • 62 per cent of women and 58 percent of men aged 65-74 years old were taking five or more medicines.

In the oldest age group (90 and over), 81 per cent of women and 78 per cent of men had polypharmacy; see Figure 5.

Around two in three of those in the age group 65-74 take one or more drugs which come with a high risk of falls. The proportion increases with age, and in the age group 75 years and over, three in four people use such drugs. These proportions have increased since 2006.

Approximately 30 per cent of all elderly people over the age 65 living at home fall at least once a year and that the prevalence of falls is higher in institutions (63).

When most elderly people are prescribed drugs that increase the risk of falling, measures that could help to ensure the correct use of this type of high-risk drug could help to reduce the number of falls, and thereby contribute to reduced costs of hospital admissions and other health services (64).

The Norwegian Prescription Database does not include people in nursing homes and institutions. The figures presented therefore describe therapeutic drug use amongst the healthiest elderly people, i.e. those who are able to cope at home unaided. This means that the Norwegian Prescription Database figures under-report the proportion of users in the oldest age groups, who are more likely to live in an institution. Individual studies of Norwegian nursing homes indicate high and varying use of high-risk medicines (65, 66). The proportion with polypharmacy and the proportion taking medicines with a high risk of side effects would therefore probably have been higher for the oldest age groups if those in nursing homes had been included.

figure percentage of drug users - number of drugs used

Figure 5.  Drug users in the age groups 65-74 and 75+, broken down according to number of drugs used in 2016. The figure shows the proportion of drug users who were prescribed a certain number of drugs in 2016, e.g. 9.8 per cent of the youngest and 8.6 per cent of the oldest were prescribed five different drugs in 2016. Click to enlarge.

Lifestyle choices among the elderly

Alcohol and tobacco

Many population surveys indicate that more elderly people drink alcohol now compared with previously and that the elderly drink more often but in smaller quantities than younger people (67). The proportion of daily smokers has also declined amongst the older age groups but around 10-15 per cent of people in the age group 65-74 still smoke daily; see  Smoking and snus use

Physical activity

The elderly are less physically active than younger people. After the age of 65, the average daily level of activity amongst both men and women fell from 36 to 31 minutes, with a marked drop for both sexes after the age of 75 (68). 

Table 4 shows figures from Statistics Norway's living conditions survey in 2015. In this case, physical activity was defined as activity (which makes a person perspire and become breathless) of more than 2.5 hours per week:

  • 48 per cent of 65-79-year-olds were physically active.
  • 53 per cent of 45-64-year-olds were physically active.
Table 3. Proportion of individuals in 2015 stating that they normally engage in physical activity which causes them to perspire and become short of breath during their spare time for more than 2.5 hours per week. (Source: Norhealth, Statistics Norway’s living conditions survey on health).


Number of men

Number of women

Proportion of physically active men

Proportion of physically active women

16-44 years





45-64 years





65-79 years





Overweight and weight loss

According to Statistics Norway's living conditions survey on health, the proportion of people who are overweight or obese (BMI >= 25 kg/m2) amongst 65-79-year-olds rose from 43 per cent to 56 per cent during the period 1998 to 2015. In the age group 45-64 years, the proportion increased by approximately the same amount: from 46 per cent to 57 per cent over the same period.

Amongst men, there was generally a somewhat higher proportion who were overweight or obese than amongst women. This applied to all age groups, including the elderly (69).

In the age group over 65 years, we find lower mortality rates with a slightly higher BMI than amongst younger people (70). Studies also suggest that weight loss in the elderly can be a warning of mortality, particularly if it is unintentional (71-74). Weight loss of just five per cent over the course of a three-year period is associated with increased mortality amongst the elderly (74, 75). Weight loss amongst those with a BMI below 30 kg/m2 probably poses a greater mortality risk amongst the elderly than not losing weight or maintaining weight between a BMI of 25 and 30 kg/m2 (74, 76).

However, obesity (BMI ≥ 30 kg/m2) remains a negative impact on morbidity and mortality amongst the elderly. Elderly people who are both obese (BMI ≥ 30 kg/m2) and have osteoarthritis, impaired mobility, diabetes and cardiovascular disease benefit from reducing weight, preferably when combined with exercise (74, 77-79).

Diet and malnutrition

There is a high risk of malnutrition among the elderly, particularly among patients in nursing homes and hospitals (80, 81). However, elderly people who live at home, especially those who are receiving support from the home-based service, are also at risk (82, 83). The risk is particularly high in conjunction with severe chronic diseases and multimorbidity, and in connection with dementia. Malnutrition has health-related consequences, and can accelerate frailty and malfunction, and increase mortality (80, 81). The health service has clear guidelines which recommend systematic assessment of the risk of malnutrition and consequent nutritional measures in hospitals, nursing homes and home-based services (80). 

Social inequalities

Results from studies in Norway show that groups with a longer education have better health and functional capacity amongst the elderly than those with a shorter education (84, 85).

There are also major social inequalities in life expectancy amongst the elderly. Groups with a longer education and healthy finances have a higher life expectancy than groups with a low education and poor finances (86, 87). The differences increased during the period 1961 to 2009; this also applied to those over 70 years of age (88).

Higher socio-economic status appears to be linked to having social networks that help prevent loneliness but the significance of this for health outcomes reduces in importance with advancing age (89). In Norway, there is greater social inequality in healthcare use amongst those aged over 45 compared with younger people (90). Among less healthy groups, the use of healthcare services increases with income.

Measures to promote a better and healthier old age

Good diet and physical activity can improve resistance to disease, unintentional injury and functional failure in later years, i.e. counteract frailty. Such measures have a preventive effect with respect to age-related diseases such as heart disease and stroke, type 2 diabetes, cancer, osteoporosis and fractures, as well as dementia and depression.

Social interaction and good meeting places in the community have a positive effect on mental health. A good social life and participation in meaningful activities improves a person’s ability to master their own life situation.


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