Background <p>High-income countries experienced unprecedented gains in life expectancy throughout the twentieth century. However, recent evidence suggests that these gains have slowed, especially at older ages. This paper focuses on recent trends in life expectancy and health in ageing populations in high-income countries.</p> Methods <p>We analysed mortality and health data from the Human Mortality Database and the Global Burden of Disease. Additionally, we reviewed recent literature to explore changes in life expectancy, health-adjusted life expectancy, physical and cognitive decline, and the impact of ageing on healthcare expenditure in countries with high life expectancies.</p> Findings <p>Although life expectancy continues to rise in high-income countries, the pace of improvement has slowed, especially among the oldest-old. While health-adjusted life expectancy has generally increased, the proportion of life spent in good health varies across countries, with notable differences in trends in physical and cognitive disabilities. In terms of economic implications, these findings highlight the importance of age and proximity to death as determinants of healthcare expenditures.</p> Interpretation <p>The deceleration in life expectancy gains, particularly among the oldest populations, raises important questions about future trends in longevity. As physical and cognitive health change in older ages healthcare systems will face new and diverse challenges. Understanding the role of ageing and time-to-death in shaping healthcare costs will be critical for anticipating future needs in high-income countries.</p>