Demography of ageing

The world's elderly population, 60 years and older, reached 251.6 million by 1950, 488 million by 1990 and, according to United Nations projection estimates, it will reach 1205.3 million in 2025. These figures mean an increase of 144% between 1950 and 1990 and of 146% between 1990 and 2025. Asia accounted for the highest number of elderly persons: 49.2%, in 1990, Europe reported 19%, Africa 6.3%, and Latin America 6.5%. On the other hand, over the next 35 years, the European region figure will decrease to 12%, while other regions will show increased percentages: 58% for Asia and around 8% for Africa and Latin America. Fertility and mortality decreases in developing countries will result in the elderly population constituting 12% of the total population in the year 2025. In this same year, Latin America will have the same high proportion of elderly persons as the world will have in the year 2020. On the other hand, some of the developed regions, such as Northern America and Europe, will reach figures around 27%. Below the average value for these regions in the year 2025 will be the former Soviet Union with 20% and Oceania with 19.2%. Another way to confirm population aging is by computing the median age of a population. Thus, while in 1950 the world median age was 23.4 years, it increased up to 24.2 years in 1990, and is estimated to be 31.1 years by the year 2025. Developed regions show higher population aging than the less developed ones. In fact, in 1990, developed countries had a median age of 33.7 years and developing countries had a median age of 22 years. While the median age will be 40.7 years for developed countries in the year 2025, it will only be 29.7 years for less developed countries. Nevertheless, this relatively high median age indicates that the aging process has already started in less developed countries.     

Long-Term Care Insurance in Japan

Abstract

Among all the industrialized countries, Japan has the fastest rate of population aging and the highest life expectancy at birth. It is projected that the proportion of elderly people will reach 35.7% in 2050. In this demographic environment, Japan launched a social insurance program for long-term care for the elderly in 2000. What were the forces that led Japan to establish a long-term care program for elderly people? What are the provisions for financing, benefits, and service delivery? What aspects of policymaking in developing such a program are unique to Japan? This article presents answers to these questions.     

Verbal Mistreatment of the Elderly

Elder mistreatment is expected to rise with the aging of the American population. To date, the association between specific forms of mistreatment and decreased quality of life is poorly understood. The aim of the present study was to explore the association between verbal mistreatment among elderly individuals and depression and quality of life. A sample of 142 older adults (40% male) aged 65 or over was enrolled from a large medical practice and academic dental practice, mean (SD) age = 74.88 (6.98) years. Thirty-eight percent of the sample reported verbal mistreatment. Controlling for sociodemographic characteristics and depression, verbal mistreatment was a significant predictor of social functioning (r = –.28, p < .001), mental health (r = –.25, p < .001), and role limitations OR = 3.02, 95% CI [1.34–6.77]. The present findings highlight the prevalence of verbal mistreatment of elderly individuals.     

Chinese Communist Party Central Committee calls on Party and Youth League members to take the lead in having only one child (per couple), [open letter,September 25, 1980

This open letter from the Central Committee of the Chinese Communist Party concerns the question of controlling China's population growth. To limit the total population of China to 1.2 billion by the end of this century, the State Council has advocated 1 couple giving birth to only 1 child. China's total population will reach 1.3 billion after 20 years and will exceed 1.5 billion after 40 years. Besides the family needing to increase the cost of upbringing, increasing population also requires the state, in order to solve their education, employment, and otheer problem, to raise education expenditures, investments of equipment, and outlays for social and public utilities. The phenomenon of population "aging" will not occur within this century because at present 1/2 of the total national population is below the age of 21, while elderly people above age 65 consist of less than 5%. After 40 years of the practice of 1 child per couple, some families may experience the problem where the elderly lack people to care for them. In the future when production is developed and the people's lives are improved, social welfare and social security will certainly increase and improve continuously. To control population growth, the Party and government have already adopted a series of concrete policies; considerations and allowances are to be given to single children and their families with respect to admission to childcare centers and primar schools. Young comrades must begin with themselves, while old comrades must educate and supervise their own sons and daughters.     

Social security in Asia and the Pacific: a brief overview

In terms of numbers of people, the global challenges facing social security systems are largely Asian. Because of rapid population aging in Asia, while it accounted for 28% of the world's population aged 60 and older in 1985, that percentage will more than double to 58% in 2050. Provident funds are a prominent feature of retirement income systems in the region-Asia and the Pacific contain the majority of the world's countries with provident funds. These programs typically provide lump-sum benefits, and thus, do not provide annuity protection against outliving one's resources. Because of the influence of Confucian philosophy with its emphasis on family responsibility for elders, countries in the region have been relatively slow in developing social security programs. China does not have a social security program for workers who do not work for the government or in government-owned enterprises.     

Social Security in Asia and the Pacific

Abstract

In terms of numbers of people, the global challenges facing social security systems are largely Asian. Because of rapid population aging in Asia, while it accounted for 28% of the world's population aged 60 and older in 1985, that percentage will more than double to 58% in 2050. Provident funds are a prominent feature of retirement income systems in the region-Asia and the Pacific contain the majority of the world's countries with provident funds. These programs typically provide lump-sum benefits, and thus, do not provide annuity protection against outliving one's resources. Because of the influence of Confucian philosophy with its emphasis on family responsibility for elders, countries in the region have been relatively slow in developing social security programs. China does not have a social security program for workers who do not work for the government or in government-owned enterprises.     

Childless Elders in Assisted Living: Findings from the Maryland Assisted Living Study

We compared data drawn from a random sample of 399 current assisted living residents and a subsample of 222 newly admitted residents for two groups: childless residents and residents with children. The percentage of childless residents (26%) in our study was slightly higher than U.S. population estimates of childless individuals aged 65 years and older (20%). In the overall sample, the two groups differed significantly by age, race, and women's years of education. The childless group was slightly younger, had a higher percentage of African American residents, and had more years of education than the group with children. In the subsample, we looked at demographic, functional, financial, and social characteristics and found that childless residents reported fewer diagnoses of dementia and fewer visits from a relative but more reported paying less money per month for assisted living and having private insurance than residents with children. As childlessness among older adults continues to increase, it will become increasingly important to understand how child status affects the need for and experience of long-term care.     

The capacity of elderly citizens to access digital media in Andalusia (Spain)

In most of the European Union (EU) countries, including Spain, there has been an increase in the number of inhabitants aged 55 years or older. As of 2014, in the EU (27) more than 65% of the population uses the internet daily. However, among the elderly, the percentage is drastically lower. This type of occurrence is found in technologically advanced societies, and turns the older citizens into a forgotten collective. With the digital divide (defined as physical access to the internet) surmounted in these countries, a new divide is becoming apparent in terms of personal use and societal participation. In this article, through the use of multivariate analysis techniques, we identify a new divide in Andalusia, Spain, with respect to the frequency of access to new media and the use citizens make of them. We will discuss the influence of the elderly's immediate environment as a source of opportunity for the Information and Communication Technologies to improve our quality of life and as a medium for more active social participation.     

Preventing economic hardship among Chinese elderly in Hong Kong

Over the next 20 years, Hong Kong will face a rapidly aging population as the number of older adults aged 65 or above increases to approximately 1.4 million by 2021, that is, 17% of the total population. In 2001, there were 1.2 million adults aged 45-59. To assess the differences between these middle-aged adults and the current cohort of older adults, we identified the challenges that Hong Kong society will face in meeting the financial needs of older adults in the coming two decades. In this paper, we examine the retirement economic status of three groups of older adults: those who are financially independent, those who are financially supported by their adult children or children-in-law, and those who are receiving welfare assistance. We describe the current situations of these groups, prevailing social policy, future trends, and recommend policies for tackling problem areas.     

Foreign Domestic Workers and Home-Based Care for Elders in Singapore

As with other developed nations where rapid population aging has led to increasing health care and social care burdens, Singapore has searched for ways of paying for and providing long-term care for its increasing numbers of elders. The Singapore state, faced with the prospect of one-fifth of the population aged 65 or older by 2030, has reinforced its basic principle of rendering the family the “primary caregiving unit” and home-based care as the highly preferred option for eldercare. Our paper demonstrates why, despite the range of alternative care arrangements available or emerging on Singapore's eldercare landscape, the employment of live-in foreign domestic workers as care workers for the elderly has become one of the more common de facto modes of providing care for the elderly. In this context, we discuss the politics of eldercare in the privatized sphere of homespace and conclude with policy implications relating to the employment of foreign domestic workers as caregivers for the elderly.     

Preventing Economic Hardship Among Chinese Elderly in Hong Kong

Abstract

Over the next 20 years, Hong Kong will face a rapidly aging population as the number of older adults aged 65 or above increases to approximately 1.4 million by 2021, that is, 17% of the total population. In 2001, there were 1.2 million adults aged 45-59. To assess the differences between these middle-aged adults and the current cohort of older adults, we identified the challenges that Hong Kong society will face in meeting the financial needs of older adults in the coming two decades. In this paper, we examine the retirement economic status of three groups of older adults: those who are financially independent, those who are financially supported by their adult children or children-in-law, and those who are receiving welfare assistance. We describe the current situations of these groups, prevailing social policy, future trends, and recommend policies for tackling problem areas.     

Self-reported health problems,health care utilisation and unmet health care needs of elderly men and women in an urban municipality and a rural area of Bhaktapur District of Nepal

The study aimed to identify the felt common health problems, utilisation of health services and unmet needs of urban and rural elderly people of Bhaktapur district, Nepal. It was a cross sectional population study of people aged 60 years or more where 204 respondents were interviewed in 2009. The common felt problems were pain and swelling of joints (65.7%), indigestion (63.7%), excessive tiredness (38.2%) and hypertension (35.8%). Pain and swelling of joints (72.5%) and back pain (40.4%) were higher in rural elderly population whereas indigestion (67.6%) and hypertension (37.85%) were higher in urban population. Pain and swelling of joints (66.7%) and indigestion (69.6%) were higher in males, and hypertension (50.0%), back pain (38.2%) and chronic bronchitis/asthma (39.2%) were higher in females. The unmet needs varied between different health problems. In general women had more unmet needs than men, where 80 unmet needs were identified for the 102 men compared with 105 for the 102 women, and these unmet needs increased dramatically with age. This approach yields new insights into the health care needs of the elderly and will be helpful to health care planners.     

Economic implications of Japan's aging population: a macro-economic demographic modeling approach

This paper utilizes a macroeconomic demographic model to analyze the probable impact of population aging on various public programs in Japan. Rapid fertility decline aided by mortality decline has caused the proportion of the Japanese population aged 65 and over to increase from 4.9% in 1950 to 9.0% in 1980. A population projection based on the 1975 population census assumes a recovery of fertility from a total fertility rate (TFR) of 1.9 in 1976 to 2.16 in 1980 and a gradual decline to 2.1 by 1987, while an alternative projection assumes a continuing fertility decline to a TFR of 1.65 in 2025. According to these assumptions, in 2025 18.12% to 21.29% of the total population would be aged 65 or over and 38.66% to 43.80% of the working age population would be aged 45-64. A macroeconomic neoclassical growth model with some Keynesian features was formulated to evaluate the future impact of population aging on social security programs. Population changes are transmitted to economic variables in the model through the supply of labor, level of savings, public health care plans, and old-age pension schemes. The simulation experiments included the 2 population projections and 2 alternative production functions, 1 with the quality of labor incorporated and 1 without. The results indicated that, regardless of the population projection and production function used, the growth of the economy is likely to slow to 1 or 0% in the beginning of the next century due to decreased growth of the labor force and a change in its quality due to age-compositional variations. Public health insurance schemes and pension plans will require increasing financial resources as a result of accelerated population aging; depending on the choice of benefit levels, the proportion of national income allocated to them is expected to range from 14%-40% in the year 2010. Per capita gross national product will continue to grow despite decreased economic growth, but savings might be adversely affected if the provision of social insurance benefits continued to increase monotonically. Possible palliative measures would be to change present employment practices or to upgrade the quality of the labor force through vocational training programs for older workers.     

Long-term care insurance in Japan

Among all the industrialized countries, Japan has the fastest rate of population aging and the highest life expectancy at birth. It is projected that the proportion of elderly people will reach 35.7% in 2050. In this demographic environment, Japan launched a social insurance program for long-term care for the elderly in 2000. What were the forces that led Japan to establish a long-term care program for elderly people? What are the provisions for financing, benefits, and service delivery? What aspects of policymaking in developing such a program are unique to Japan?.     

Sex life after 65: How does erectile dysfunction affect ageing and elderly men?

Introduction. We report the findings pertinent to the ageing and elderly participants of a population-based study of erectile dysfunction (ED).

Method. We examined the sociodemographic characteristics, self-reported morbidities and responses to the 5-item International Index of Erectile Function (IIEF-5) of participants aged ≥65 years and ≥80 years.

Results. Most (73%) participants were married or had partners. Among the participants aged ≥65 years, the prevalence of ED (IIEF-5 scores <22) was 67% and of severe ED (IIEF-5 scores <8) 48%. About 32% were sexually active, and 11% had regular sexual intercourse. Cardiovascular disease (CVD) was reported in 37% and diabetes mellitus (DM) in 13%, with odds of ED at 3.91 and 4.68, respectively. Among those aged ≥80 years, the prevalence of ED was 68% and of severe ED 57%. About 12% were sexually active, and 3% had regular sexual intercourse. CVD was reported in 44% and DM in 11%, with corresponding odds of ED at 2.55 and 2.90.

Conclusions. Most ageing and elderly men are in a relationship and many are sexually active. ED is prevalent and severe. Morbidities are common and significantly associated with ED, impairing the sex lives of affected men.     

Evaluating Potential Environmental Variables and Active Aging in Older Adults for Age-Friendly Neighborhoods in Malaysia

As Malaysia's population is aging rapidly, and since there is no specific housing policy for the elderly, it is vital that neighborhoods meet the different needs of elderly for active aging to maintain their quality of life. This study aims to investigate the neighborhood environmental variables, the outcome active aging, and potential variables that inhibit active aging in the elderly that lead to their quality of life. It examined quality-of-life determinants that are influenced by the existence of certain neighborhood characteristics. In the study, 385 older adults aged 60+ years residing in two different cities in Malaysia were surveyed. Multiple regression was used to explore how much variance in active aging variables the neighborhood environmental factors explained as a group. The results showed that permeability, accessibility, and facilitators to walking are key determinants of active aging. There is a need to improve the physical design of the neighborhoods with regard to these three factors.     

Organization and delivery of long-term care in Taiwan

Taiwan reached the World Health Organization (WHO) benchmark of 7% aged 65 and over for defining an aging population only as recently as 1993. With this proportion projected to double to 14% by 2020, Taiwan faces a rapid increase in need for long-term care. This article presents an account of the current service delivery system, which is divided between health and social affairs administrations, with a substantial role also taken by the Veteran Administration, and growing provision of facilities that operate outside the government-registered system. While a basic level of both institutional and community care services has developed, they are not organized into an integrated service system. Problems arising from the divisions and overlaps in responsibility are identified in relation to competition for resources, differences in regulation and eligibility, funding arrangements and misallocation of resources, and divergent views about the philosophical basis of long-term care. Other aspects of services fall under each jurisdiction, but there is also some overlap. A case study of Taiwan's second largest city, Kaohsiung City, reports the outcomes of these divisions as a thin spread of a range of services rather than a coordinated service network. Several planning exercises have been undertaken in recent years to address these problems, and although at an early stage of implementation, the outcomes of these plans are seen as shaping the future directions of long-term care in Taiwan.     

失能老年人长期护理的需求规模评估、费用测算与经济效应预测

伴随着失能风险的增加,老年人长期护理问题成为人口老龄化研究的新课题.基于CHARLS等相关数据,改进Markov模型,测算2020—2060年失能老年人长期护理需求规模及费用,并预测经济效应,结果表明:(1)老年人数量呈倒"U"形增长趋势,并于2048年左右达到顶峰,约为4.34亿人;失能老年人呈逐年上升趋势,于2060年达到1.84亿人.(2)失能老年人长期护理费用由2020年的3906.57亿元增长到2060年的44973.16亿元,增长11.51倍,其中轻度、中度和重度失能老年人长期护理费用分别增长8.92倍、15.55倍和21.17倍.(3)老年护理劳动力需求量预测显示,由90.33万人上升到228.98万人,增长2.54倍;机构养老护理型床位需求量预测显示,由241.03万张增长到553.11万张,增长2.29倍;老年护理市场直接经济增量预测显示,由3906.57亿元增长到44973.16亿元,增长11.51倍.基于此,本文提出包括坚持"以制度为基础、以服务为核心、以救助为兜底、以法律为准绳"的基本原则,建立失能动态监控机制,完善养老服务财政补贴制度等政策建议.     

Private Lives and Public Programs

Abstract

Major late life events, reported in the Dubbo longitudinal study of older Australians, are used to examine the interaction of private lives with public programs. First, the data indicate strong supportive effects of publicly funded income, health, and aged care programs in reducing family burdens from major life changes. In particular, financial crises were rarely mentioned, directly or indirectly, as major threats. Next, the central role of informal social support in these events is demonstrated, first, as in previous studies, family support was responsive to risky events and to aging itself. Also, in new findings, one-third of surviving elderly respondents coped with the burdens of family crises as a substantial proportion of the “major” life changes that occurred over 13 years of the study. Within the security and support provided by the Australian welfare system, and with strong social networks, families with older persons in the Dubbo study manage multiple, major life changes. With rapid population aging, the development of more, and more easily accessible, services for a growing population of older people is a priority. The critical challenge will be to harmoniously grow public financing, private funding, and informal caregiving to deal with the growing burden arising from an aging society.     

The Role of Non-Governmental Organizations for the Welfare of the Elderly

Summary

Since there has been a gradual increase in the population aged 60 and older, a developing country like India is unable to cope with the needs and problems of its aged populations. While the government continues its efforts to introduce programs for the elderly, the nongovernmental organizations (NGOs) have played a key role in bringing to the forefront the socioeconomic and health problems of older people in the society at large. This paper looks at the role of the NGOs through their various welfare activities and beneficial programs in carving out a place for the elderly in India. The work of HelpAge India is highlighted to examine how voluntary organizations have worked in the field of aging in India and made an impact on the lives of the senior citizens, especially those below the poverty line who are economically and socially deprived.