Living Longer, Living Better: A worldwide Perspective on Aging Population

In our society, especially among those aged 80 and above, we’re witnessing a rise in the number of elders. Unlike the past when young children outnumbered the elderly, a shift is occurring, and in a few years, those aged 65 and older will surpass children under 5. This trend, fueled by declining fertility rates and significant increases in life expectancy, is not only continuing but expected to accelerate. With people living longer, both the proportion and number of older individuals in the overall population are rapidly growing. Globally, in 2020, there were 727 million people aged 65 and over. By 2050, within the next three decades, this number is projected to more than double, exceeding 1.5 billion. A noteworthy aspect is the increasing presence of older women, who, due to longer lifespans, constitute the majority of the older population, especially at advanced ages. Across all regions, there will be a surge in the older population size from 2020 to 2050. In terms of percentage, the global share of those aged 65 and over is anticipated to rise from 9.3% in 2020 to approximately 16.0% in 2050.

The world is undergoing significant social and economic changes, and within this, there’s a demographic shift known as ‘Population Ageing’ taking place. Various factors, such as having fewer babies, changes in how people approach marriage and living together, increased opportunities for younger generations to get better education, moving from rural areas to cities or different countries, advancements in health, and fast economic growth, are reshaping the environment for older individuals. This includes changes in the size and structure of their households and where they choose to live.

What factors have led to population ageing?

The current age structure of the population is primarily shaped by recent trends in fertility and mortality. Over the past 50 years, global mortality rates have decreased, especially in developed nations. Fertility rates have also declined since the 1960s, now averaging around 2.5 births per woman globally. In the UK, fertility rates have somewhat stabilized since the mid-1970s, hovering at approximately 1.9 births per woman. In the United States, the total fertility rate for women is now 1.7 children per woman, falling below the replacement level of 2.1 children. According to a report from the US Census Bureau, life expectancy at age 65 increased from 11.9 years in the early 20th century to 19.1 years in 2010.

The growing gap between the elderly and the young will bring significant consequences in the years ahead. Carolyn Gallogly, a Social Gerontologist on Long Island, expresses concern, noting, “We aren’t having enough children to take care of us in our old age.” She highlights a shift from earlier families with several children (average 5-6) to today’s families having one or, at most, two children, sometimes none to carry on the generation. This trend, echoed by Carolyn, is not expected to change, and the ongoing COVID-19 pandemic might intensify it as economic uncertainties often lead people to postpone having children.

Rebalancing a country’s age distribution can be effectively achieved through immigration, as immigrants often belong to younger, working age groups. While this may provide a short-term solution by offsetting the impacts of an ageing population, it’s crucial to recognize that immigrants also age. Over time, fertility patterns of second-generation migrants tend to align with those of the host country. For instance, women of foreign origin migrating to the United States have about 40% more babies than U.S.-born women. Although this fertility advantage diminishes in later generations, the higher fertility among immigrants has contributed to stabilizing the total fertility rate in the U.S. since 2000.

Life expectancy, a hypothetical measure, varies significantly based on factors like sex, age, ethnicity, and location. Commonly measured at birth, a newborn male in the UK today can expect to live 79.2 years, and a girl, 82.9 years. Declining mortality rates contribute to increased life expectancies. Looking ahead to 2066, projections indicate a rise to 86.4 years for baby boys and 88.9 years for baby girls in the UK, with a substantial percentage expected to live to 100 years, though recent trends suggest a potentially slower rate of increase.

Life expectancy, a measure of the average years a person at a given age can anticipate to live, is inherently hypothetical and varies significantly based on factors such as sex, age, ethnicity, and geographic location. Commonly assessed at birth, it reflects the average years an infant is expected to live if birth-related death rates remain constant. The decline in mortality rates corresponds to heightened life expectancies. Presently, a newborn male in the UK is projected to live 79.2 years, while a girl is expected to reach 82.9 years. Projections for 2066 anticipate an increase to 86.4 years for boys and 88.9 years for girls, with a substantial percentage reaching 100 years.

Similar progress in life expectancy has transpired in the US throughout the past century. Advances in preventing childhood infectious diseases, coupled with improvements in nutrition, housing, hygiene, and medical care, led to a consistent four-year increase in life expectancy each decade during the first half of the 20th century. This trend is mirrored in several high-income countries, including Canada, France, Germany, Italy, Japan, and the United Kingdom, where mortality rates declined steadily from 1950 to 1995.

In Japan, life expectancy surged from 57.6 years for men and 60.9 years for women in 1950 to 79.2 years for men and 86.0 years for women in 2007. France witnessed a similar rise, with life expectancy increasing from 63.4 years for men and 69.2 years for women in 1950 to 77.4 years for men and 84.4 years for women in 2007. Australia experienced growth from 66.5 years for men and 71.8 years for women in 1950 to 79.3 years for men and 83.8 years for women in 2007. Across developed nations, advancements in medical technology, particularly in heart disease and stroke treatment, combined with healthier lifestyles and improved healthcare access, contributed to sustained improvements in life expectancy.

Despite spending considerably more on healthcare, Americans have a paradoxically lower life expectancy compared to citizens of other developed nations. This discrepancy can be attributed to higher death rates among Americans due to factors such as smoking, obesity, homicides, opioid overdoses, suicides, road accidents, and infant mortality. Additionally, individuals with lower incomes in the United States face premature death at a younger age compared to their counterparts in other affluent countries, exacerbated by factors like abject poverty and limited access to healthcare. Exploring the implications of an ageing population reveals multifaceted impacts on economies, public services, and societal dynamics. The challenges encompass areas such as pensions, social care, housing, and the overall well-being of older adults. However, this phenomenon also brings forth opportunities at both societal and individual levels, including the emergence of new markets, extended working periods, increased engagement in volunteering and community activism, and enriched leisure activities with family and friends, as well as grandparenting.

Examining the consequences involves navigating intricate relationships and trade-offs. For instance, if individuals work beyond retirement, it may reduce their availability for providing informal care to elderly family members or babysitting grandchildren. The engagement of older people in non-monetary pursuits like volunteering or hobbies raises questions about the potential decline in informal care availability and the subsequent increase in demand for formal social care.

Analyzing the implications across the domains of the economy and finance, services and needs, and society and the individual is crucial. Countries such as the US and Europe, with sizable elderly populations, face challenges as they rely on smaller pools of workers to generate taxes for escalating health costs, pension benefits, and other publicly funded programs. This common concern in advanced nations is exacerbated by retirees living on fixed incomes with narrower tax brackets compared to the working population. The combination of low tax revenues and escalating expenditures on healthcare, pensions, and benefits poses a significant challenge for countries. In essence, the impact of an ageing population, coupled with slower labor force growth, reverberates through economies, leading to slowed GDP growth, increased financial burden on the working-age population to support the elderly, and strained public budgets under the weight of rising costs associated with health and retirement programs for older individuals.

As the global population ages, many countries, including Russia and Germany, face financial challenges in sustaining their pension systems. In Russia, the president recently announced an increase in the retirement age to 65 for men and 63 for women, a necessary step to secure retirement benefits given that the pension fund relies on subsidies amounting to around 2.5 percent of GDP. The adjustment is crucial as the number of pensioners in Russia is outpacing the growth of the workforce contributing to the system, a trend observed in various nations.

Similarly, in Germany, pension payments, medical care, and related expenses for eligible elderly individuals constituted 26 percent of the country’s GDP in 2019, translating to 60 percent of government expenditures. Studies indicate that if current trends persist, this figure is projected to rise to 29 percent of GDP by 2060. With the global ageing population trend, countries like Russia, Germany, and the United States will face the challenge of securing additional funds to sustain government-sponsored pensions.

Italy is confronted with a comparable challenge. In 2019, the country’s total pension spending amounted to 16.5 percent of its GDP, ranking second-highest in the EU after Greece. In the foreseeable future, both private and public pensions in Italy must secure higher returns on investments over the long term to sustain viable payouts for retirees. Failing that, contributors to pension funds may be compelled to increase their contributions. In the later stages of life, individuals tend to consume more welfare spending, encompassing pension disbursements, health, and social care spending, while contributing less in taxes.

The aging process is often accompanied by a decline in health. As life expectancy rises, so does the duration of time spent in poor health, leading to increased frailty, disabilities, and chronic illnesses like cancer, Alzheimer’s, respiratory, and heart problems. Addressing these conditions involves intricate and costly health treatments to ensure proper care for elderly patients and enhance their comfort. Depending on a nation’s healthcare program, such treatments necessitate substantial funding, with countries like France, Germany, and the Netherlands allocating a significant portion of their budgets to healthcare. As Europe’s elderly population continues to grow, healthcare costs are anticipated to escalate further, prompting a pressing need for a comprehensive overhaul of healthcare systems to enhance competitiveness and cost-effectiveness for both the elderly and younger demographics.

Let’s examine dementia statistics in the UK, a chronic condition rendering individuals non-functional, often associated with aging, particularly in those in their mid- to late-70s and beyond. Approximately 850,000 people in the UK are estimated to have dementia, yet only about two-thirds of them have received a diagnosis, as some dismiss symptoms as age-related forgetfulness. Projections suggest that by 2025, the number of people in the UK living with dementia could reach 1 million, and by 2050, this figure might surpass 2 million. These staggering numbers highlight the urgent need for solutions to address this challenge.

In developed countries, as mentioned earlier, there is a substantial knowledge base concerning their older adult populations, covering demographic, social, and economic conditions, health needs, and living arrangements. However, in India, this knowledge is notably insufficient.

The need for social care intensifies with age, especially for older adults dealing with multiple chronic conditions (MCC), commonly known as multi-morbidity. While there are various definitions of multi-morbidity, it generally refers to the presence of two or more chronic health conditions that can significantly impact an individual’s daily life, particularly as the number of coexisting conditions increases. Older adults grappling with MCC often rely on support from others to manage their daily activities. Providing care for older adults, in the absence of appropriate support, can have adverse effects on their financial, emotional, and psychological well-being. Statistics indicate that approximately one in five individuals aged between 75 and 84 years face challenges leading to dependence, with projections suggesting an increase to 34% of men and 42% of women at ages 85 and above.

Currently, India has approximately 90 million elderly individuals, and by 2050, this number is projected to surge to 315 million, making up 20% of the total population. This forecast poses significant concerns and appears daunting for a developing nation like India, given its vast and diverse population (second only to China) characterized by distinct cultures and economic statuses. Complicating this demographic shift is the fact that three-quarters of the older population resides in rural areas, with 48% being women and 55% of them widowed. Alarmingly, nearly 70% of rural elderly individuals are reliant on others, and their health issues worsen due to inadequate healthcare in villages. It’s essential to highlight the plight of older women, who face challenges such as illiteracy, unemployment, widowhood, and disabilities, enduring lifelong gender-based discriminations that result in distinct patterns of ageing for men and women.

Moreover, a significant majority of individuals aged 60 and above in India face poverty and contend with social and educational disadvantages. On an individual level, the demographic transition in India exhibits considerable heterogeneity among states, leading to profound variations in the demographic landscape across social, economic, and spatial groups. For instance, in the smaller state of Kerala, where we both belong, the elderly population increased from 11% in 2001 to an estimated 18% by 2026, comprising around seven million elderly. In contrast, the larger northern state of Uttar Pradesh, with only 6% elderly population in 2001, is projected to reach around 10% by 2026. Although the proportion of the elderly population in Uttar Pradesh is smaller than in Kerala, the absolute number of elderly individuals in Uttar Pradesh is anticipated to be three times that of Kerala due to its size and population. Despite these demographic shifts, ageing in India is not widely perceived as a problem, given the prevalence of other pressing issues.

The majority of the oldest-old individuals lose their ability to live independently due to factors like impaired mobility, frailty, weakness, or declines in physical or cognitive functioning. Eventually, these oldest old individuals require some form of long-term care, encompassing home nursing, community care, assisted living, residential care, and long-stay hospital services. The costs associated with providing this support often fall on families and society. In developing countries lacking established and affordable long-term care services or infrastructure, these costs may manifest as other family members leaving employment or livelihood to care for older relatives. Moreover, as more residents from developing countries migrate to urban areas for jobs, their older relatives left behind may experience reduced access to informal care, leading to a challenging existence.

Addressing the needs of the elderly is a crucial consideration for any government operating within a welfare state. Virtually every nation is currently grappling with the challenges posed by a rapidly growing ageing population, leading to significant economic and health implications. Governments must make critical decisions, either reallocating resources from the young to the old or implementing policy changes. Eventually, countries are compelled to undergo major policy shifts, such as welcoming more immigrants to address the increasing number of elderly individuals or encouraging citizens to join the workforce and contribute taxes to sustain welfare programs, including pensions and national healthcare plans. Some nations have even begun offering incentives to encourage higher birth rates and reverse declining populations. While the solutions to this monumental problem are complex, delaying action will only exacerbate the situation, necessitating prompt intervention.

On an individual level, everyone aspires to reach advanced age in good health, a desire shared by every senior. Achieving this goal depends on various factors along the way. None of us wish to spend the years between our 80th and 100th birthdays bedridden, weak, or suffering from dementia. Losing independence in advanced age is even more daunting. Maintaining good health is crucial for a fulfilling old age, and today, some individuals in their 70s are as fit as 40-year-olds, while others in the same age group may require round-the-clock care. There is no ‘typical’ older person.

The benefits of seniors staying active and healthy extend beyond the individual to society as a whole. Each older person’s good health contributes to the well-being of society, preventing an undue burden on the healthcare system as life expectancy increases. Social gerontologists express concerns about the potential strain on healthcare systems in aging societies and emphasize the need to invest in the “60+ generation.” They call on countries to adapt their healthcare systems to meet the needs of the elderly, establish long-term care systems, and create age-friendly living environments to address the challenges posed by an ageing population.

These articles comprise a collection of narratives drawn from our interactions with older adults and their families, offering authentic real-time stories. In the context of a life-course perspective on ageing, families take a central role as the primary setting where individuals of various ages gather, fostering relationships over the years. The topics explored delve into the diverse ways in which age and aging are socially constructed, examining the transformative impact of globalisation on the aging process. The collection of topics delves into essential life issues with profound insights, utmost transparency, and thoughtful guidance, catering to the needs of all stakeholders involved.