ArticlePDF Available

Economic and social implications of aging societies

Authors:

Abstract

The challenge of global population aging has been brought into sharper focus by the financial crisis of 2008. In particular, growing national debt has drawn government attention to two apparently conflicting priorities: the need to sustain public spending on pensions and health care versus the need to reduce budget deficits. A number of countries are consequently reconsidering their pension and health care provisions, which account for up to 40% of all government spending in advanced economies. Yet population aging is a global phenomenon that will continue to affect all regions of the world. By 2050 there will be the same number of old as young in the world, with 2 billion people aged 60 or over and another 2 billion under age 15, each group accounting for 21% of the world’s population.
21. L. K. Tyler, H. Cobb, N. Graham, Spoken Language
Comprehension: An Experimental Approach to Disordered and
Normal Processing (MIT Press, Cambridge, MA, 1992).
22. J. E. Peelle, V. Troiani, A. Wingfield, M. Grossman, Cereb.
Cortex 20, 773782 (2010).
23. L. K. Tyler et al., Cereb. Cortex 20, 352364 (2010).
24. K. D. Federmeier, C. Van Petten, T. J. Schwartz, M. Kutas,
Psychol. Aging 18, 858872 (2003).
25. D. Foygel, G. S. Dell, J. Mem. Lang. 43, 182216
(2000).
26. P. Indefrey, W. J. M. Levelt, Cognition 92, 101144
(2004).
27. W. J. M. Levelt, P. Praamstra, A. S. Meyer, P. Helenius,
R. Salmelin, J. Cogn. Neurosci. 10, 553567 (1998).
28. S. Kemper, A. Sumner, Psychol. Aging 16, 312322
(2001).
29. H. Bortfeld, S. D. Leon, J. E. Bloom, M. F. Schober,
S. E. Brennan, Lang. Speech 44, 123147 (2001).
30. Y. Neumann, L. K. Obler, H. Gomes, V. Shafer, Aphasiology 23,
10281039 (2009).
31. D. M. Burke, D. G. MacKay, J. S. Worthley, E. Wade,
J. Mem. Lang. 30, 542579 (1991).
32. E. A. Lovelace, P. T. Twohig, Bull. Psychon. Soc. 28, 115118
(1990).
33. E. S. Cross, D. M. Burke, Brain Lang. 89, 174181 (2004).
34. L. E. James, D. M. Burke, J. Exp. Psychol. Learn. Mem. Cogn.
26, 13781391 (2000).
35. M. Bozic, L. K. Tyler, D. T. Ives, B. Randall, W. D. Marslen-Wilson,
Proc. Natl. Acad. Sci. U.S.A. 107,1743917444 (2010).
36. P. Wright, B. Randall, W. D. Marslen-Wilson, L. K. Tyler, J. Cogn.
Neurosci. 23, 404413 (2011).
37. S. K. Scott, R. J. S. Wise, Cognition 92,1345 (2004).
38. G. Hickok, D. Poeppel, Nat. Rev. Neurosci. 8, 393402
(2007).
39. J. R. Binder, R. H. Desai, W. W. Graves, L. L. Conant,
Cereb. Cortex 19, 27672796 (2009).
40. T. Rolheiser, E. A. Stamatakis, L. K. Tyler, J. Neurosci. 31,
1694916957 (2011).
41. A. D. Friederici, S. A. Rüschemeyer, A. Hahne, C. J. Fiebach,
Cereb. Cortex 13, 170177 (2003).
42. L. K. Tyler et al., Brain 134, 415431 (2011).
43. L. K. Tyler, T. P. L. Cheung, B. J. Devereux, A. Clarke,
Front. Lang. Sci. 4, 271 (2013).
44. J. Zhuang, L. K. Tyler, B. Randall, E. A. Stamatakis,
W. D. Marslen-Wilson, Cereb. Cortex 24, 908918 (2014).
45. P. Hagoort, Neuroimage 20 (suppl. 1), S18S29 (2003).
46. R. Cabeza, N. A. Dennis, in Principles of Frontal Lobe Function,
D. T. Stuss, R. T. Knight, Eds. (Oxford Univ. Press, Oxford,
ed. 2, 2012), pp. 628652.
47. M. Grossman et al., Neuroimage 15, 302317 (2002).
48. P. Wright, E. A. Stamatakis, L. K. Tyler, J. Neurosci. 32,
81498157 (2012).
49. G. Hickok, Phys. Life Rev. 6, 121143 (2009).
50. J. K. Taylor, D. M. Burke, Psychol. Aging 17, 662676
(2002).
51. M. A. Shafto, D. M. Burke, E. A. Stamatakis, P. P. Tam,
L. K. Tyler, J. Cogn. Neurosci. 19, 20602070 (2007).
52. E. A. Stamatakis, M. A. Shafto, G. Williams, P. Tam, L. K. Tyler,
PLOS ONE 6, e14496 (2011).
53. S. Abel et al., Neurosci. Lett. 463, 161171 (2009).
54. A. Maril, A. D. Wagner, D. L. Schacter, Neuron 31, 653660
(2001).
55. M. A. Shafto, E. A. Stamatakis, P. P. Tam, L. K. Tyler, J. Cogn.
Neurosci. 22, 15301540 (2010).
56. M. Lindín, F. Díaz, A. Capilla, T. Ortiz, F. Maestú,
Neuropsychologia 48, 17571766 (2010).
57. C. E. Wierenga et al., Neurobiol. Aging 29, 436451
(2008).
58. K. A. Cappell, L. Gmeindl, P. A. Reuter-Lorenz, Cortex 46,
462473 (2010).
ACKNOWL EDGMEN TS
Preparation of this review was supported by grants to L.K.T.
from the Biotechnology and Biological Sciences Research Council
(grant number BB/H008217/1) and the European Research
Council under the European Community's Seventh Framework
Programme (FP7/2007-2013)/ ERC Grant agreement no. 249640.
The authors thank W. Marslen-Wilson, M. G. Shafto, and S. Shafto
for helpful comments on an early draft and D. Samu and
D. Meunier for help with figure preparation.
10.1126/science.1254404
REVIEW
Economic and social implications
of aging societies
Sarah Harper
The challenge of global population aging has been brought into sharper focus by the financial crisis
of 2008. In particular, growing national debt has drawn government attention to two apparently
conflicting priorities: the need to sustain public spending on pensions and health care versus the need
to reduce budget deficits. A number of countries are consequently reconsidering their pension
and health care provisions, which account for up to 40% of all government spending in advanced
economies. Yet population aging is a global phenomenon that will continue to affect all regions of the
world. By 2050 there will be the same number of old as young in the world, with 2 billion people aged
60 or over and another 2 billion under age 15, each group accounting for 21% of the worlds population.
By the end of the 21st century, demographic
trends will converge with declining births,
stabilization in population size, and aging
populationsacrosstheglobe(1). The age
composition of the worlds population will
alter as median ages rise and a proportionate shift
from younger to older people continues. At the
turnofthemillennium,thereweremorepeople
over 60 than under 15 in Europe. North America
will follow by 2030, Latin America and Asia by 2040.
In terms of absolute numbers, the Asian/Pacific
region is already the oldest, and by the middle of
the century will hold two-thirds of the worlds
then 2 billion elders (aged 60 years or over). The
worldwide numbers of those aged 80 and above will
show an even greater rate of increase, rising from
69 million to 379 million by 2050, when nearly 10%
of the developed world will be over 80 (1)(Fig.1).
Europes demographic structure in particular
is predicted to age substantially. By 2060, those
under 15 in the EU27 countries (European Union
members, 20072013) will be around 14%. There
will be nearly twice that proportion over 65, as
this age group will increase from 87.5 million in
2010 to 152.6 million by 2060. Perhaps most
striking of all, those aged 80 and over will constitute
around 12% of the European population; this group
is expected to almost triple in size, from 23.7 million
in 2010 to 62.4 million in 2060. The demographic
outlier is Africa, which will continue to grow and
remain young, with one-third of its population still
under 15 by the middle of the century (1).
Drivers
The conventional belief is that population aging
is driven by falling mortality rates and increasing
longevity. Although this is an important com-
ponent of the process, it is widely accepted that
the major driver is falling fertility, which funda-
mentally alters the subsequent age structure of a
population and, if sustained, leads to increasing
median ages and demographic aging (2).
Falling fertility or childbearing
Two-thirds of the worlds countries now have
childbearing rates or total fertility rates (3)near
or below replacement level, crudely defined as
2.1. These are diverse and drawn from most world
regions, including Asia (for example, Hong Kong,
SCIENCE sciencemag.org 31 OCTOBER 2014 VOL 346 ISSUE 6209 587
Oxford Institute of Population Ageing, University of Oxford,
Oxford OX2 6PR, UK. E-mail: sarah.harper@ageing.ox.ac.uk
Males Females
Males Females
2010
Age group
100+
95-99
90-94
85-89
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
0-4
300 300200 200100 1000
2050
100+
95-99
90-94
85-89
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
0-4
300 300200 200100 1000
Population (millions)
Fig. 1. World population pyramids. Population
age structure for 2010 and projections for 2050
are shown. The working-age proportion is shown
in red. Source: (1).
on May 8, 2017http://science.sciencemag.org/Downloaded from
Singapore, Korea, Japan, Thailand, Myanmar,
and Vietnam), the Americas (Argentina, Chile,
Canada, and the United States), the Middle East
and Africa (Mauritius, Iran, Tunisia), and Europe
(every EU27 country, with a EU average of 1.6) (4)
(Fig. 2).
Such low fertility may be due to technological
advances and changes in the labor market that
have altered the costs and rewards of marriage
and child rearing (57). It may be that ideational
changes have accompanied increased affluence,
leading to a focus on individual autonomy and
self-realization (8,9). Some demographers ar-
gue that the evolutionary link between sexual
activity and procreation has been broken through
the introduction of modern contraception, and
that reproduction is now merely a function of
individual preferences and culturally determined
norms (10,11).
Some Asian and European countries may
well be in a so-called low-fertility trap (12). This
can result from both demographic and soci-
ological factors: Fewer potential mothers in
thefuturewillresultinfewerbirths,while
ideal family size is declining among younger
generationsasaconsequenceofthelower
childbearing they see in previous generations
(12,13).
Falling mortality
A second key driver is falling mortality or death
rates. Until recently, declines in mortality were
focused on infant and child deaths. As more
and more young people survived, the average
life expectancy of the population increased. In
advanced economies throughout the 20th cen-
tury, there was a steady reduction in mortality
across the life course. In mid-19th-century En-
gland, for example, half the population had died
before their mid-40s. Today, half the English
population can expect to survive until their
mid-80s.
The drivers of life extension appear to be
fourfold: healthy living, disease prevention and
cure, age retardation or senescence prevention,
and regenerative medicine. The first two brought
us gains in life expectancy from birth seen over
the past 150 years. They now promise to extend
life expectancy for many in the advanced econ-
omies to over 100 this century (14).
Will increases in life expectancy be accom-
panied by increases in life extension, or will we
see a compression of longevity after age 100? In
countries such as Japan where there are suffi-
cient numbers of very old people, the distribu-
tion of deaths above the mode is sliding to
higher ages. This shifting mortalityscenario
suggests that with an increase in centenarians
we should also expect to see an increase in su-
percentenarians. However, successful age re-
tardation and regenerative medicine may be
needed to achieve real radical extension of hu-
man life (15).
Implications
It has long been recognized that population
aging has implications for societies and econo-
mies (16). It affects labor markets, patterns of
saving and consumption, families and house-
holds, networks and social interaction, health
and welfare services, housing and transport, and
leisure and community behavior. In addition, the
knowledge of both longer lives and the aging of
the population influences not only social and
economic policy and political decisions, but also
the attitudes and behaviors of individuals (17,18).
Are the financial and health institutions and
programs designed for the demographic struc-
ture of the 20th century appropriate for the
21st century? Of particular interest is the ca-
pacity of individuals and households to make
the relevant adjustments (e.g., to savings be-
havior, labor productivity, family and intergen-
erational transfers, and investment in their own
human capital) and the capacity of 21st-century
institutions to make the relevant adjustments
to facilitate this.
As discussed above, the aging of populations
is caused by two distinct trends: Older people
are living longer, and at the same time younger
people are having fewer children. The resulting
challenges can be grouped into those that arise
from (i) persistent below-replacement fertility
and the changing age structure of the popula-
tion, (ii) the increasing longevity of the older
population, and (iii) the interaction of the two.
Decreased fertility leads to demographic defi-
cits and labor market concerns, in particular
over reduced economic growth and the ability
of nations to finance public welfare programs
at a time when the number and percentage of
those who are economically active are declin-
ing. Increased longevity raises concerns about
the capacity of nations to finance and recon-
figure health and long-term care provision, in
advanced as well as emerging economies. Em-
erging economies will still be tackling acute
and infectious diseases and relatively high lev-
els of infant and child mortality, while at the
same time addressing a growing number of
frailer older adults who require long-term care.
The interaction of the two trends creates chal-
lenges around issues of inter- and intragenera-
tional fairnessthat is, fairness and equity within
and between different generations.
Demographic deficits and labor
market concerns
Declining and aging populations are often viewed
as having negative effects on economic growth
and employment (19,20). These concerns are
encompassed in the notion of the demographic
deficit(21). This relates to the age-structural
transition approach that examines the cohort
composition of a population, considering the
proportion of old and younger dependents in
relation to productive adults, and how this will
alter over time. In general, productive capacity
varies across the life course, flowing from a pe-
riod of childhood dependency through high
productive potential in adulthood, then return-
ing to a decrease in productive capacity in old
age. The macroeconomic effects will differ de-
pending on the age composition of the popu-
lation. The decline in the proportion of younger
people in a population is perceived as leading
to a reduction in economic activity, whereas an
increase in the proportion of older people is
perceived as resulting in an economic burden
through the higher requirement for pensions
and health care.
588 31 OCTOBER 2014 VOL 346 ISSUE 6209 sciencemag.org SCIENCE
Total fertility rates
2005 –2010
2.1 and under
2.2–3.1
3.2–4.1
4.2 and over
N/A
Fig. 2. Map of total fertility rates, 20052010. Total fertility rate, expressed as number of children per
woman, represents the average numberof children a hypothetical cohort of women would have at the end
of their reproductive period if they were subject during their whole lives to the fertility rates of a given period
and if they were not subject to mortality. Source: (1).
THE AGING BRAIN
on May 8, 2017http://science.sciencemag.org/Downloaded from
Much of this concern arises from an assump-
tion that the older labor forces of the future will
be less productive and less innovative, and that
an older population will have lower rates of con-
sumption. These preconceptions, however, are
contested by arguments that future cohorts with
higher levels of education, skills, and training will
be able to maintain high levels of productivity
given supportive and conducive working environ-
ments (21). In addition is the concern that older
people will be recipients of publicly funded pen-
sions for an increasing length of time, and will
also draw down on savings accumulated in both
private and national accounts (22).
In terms of the proportion of old and younger
dependents in relation to productive adults, most
industrialized countries will experience a rapid
shift toward increased elderly dependency ratios
[EDRs, defined as the number of persons of
working age (aged 15 to 64) per person aged 65
or over] over the coming decades (Fig. 3). For
example, the EU25 (European Union members,
20042006) (23) EDR is set to reach 51% by 2050,
as the working-age population (15 to 64 years)
decreases by 48 million between now and 2050,
and the number of those of working age per
older person 65+ will halve from 4 to 2 (24). Out-
side Europe, Japan and Korea will also age no-
tably. Korea, the most rapidly aging country, will
move from being the third youngest country in
the Organisation for Economic Co-operation and
Development (OECD) to the second oldest after
Japan by 2050, when Japan will have one of the
highest total dependency ratios (number of per-
sons aged 15 to 64 per person outside that range)
in the world at 74% in 2050.
Addressing the demographic deficit
At the macro level, many governments are ex-
ploring policies to compensate for, or even to
alter, the age composition of the population by
encouraging changes in fertility and migration
rates. Another approach is to tackle the labor
market directly, and to extend both the economic
activity and the general productivity of the older
population for as long as possible. This both re-
duces the need for social security provision for
some, and enables further financing of those who
arenolongerabletoremaineconomicallyactive.
In addition, there is a growing recognition tha t
many labor markets have the potential to increase
productivity through technological innovation.
Increase childbearing
The two main demographic solutions to the
dependency balance are to increase childbearing
and to increase migration. Although increasing
fertility rates can have a strong influence on al-
tering old-age dependency ratios, very few coun-
tries are currently pursuing an active fertility
promotion policy. However, there is recogni-
tion that family-friendlypolicies, aimed at
supporting both child and parents, can allow
women to have the number of children they de-
sire, which in most OECD countries tends to be
higher than the actual number of achieved
births (2527). These policies include affordable
child care, parental leave, financial transfers, and
tax provisions.
Increase immigration
Alternatively, immigration is seen as a valid
policy approach (28). Because of the relatively
young age structure (and thus the labor poten-
tial) of immigrants, immigration has the poten-
tial to prevent population decline, maintain the
size of the labor force (and thus the support
ratio), and slow population aging. There are also
the indirect effects of migration on innovation,
economic growth, employment, and welfare. Im-
migration can affect the sustainability gap of
public finances as it increases the number of
potential taxpayers, even if the migrantscon-
tributions to the present budget are negative
(29). However, research has suggested that even
a considerable expansion of immigration will do
little to alter the predicted major capital short-
ages, tax increases, and reductions in real wages
that can be expected as countries progress through
the demographic transition (30).
Immigration can improve competitiveness and
productivity through new trade and international
linkages, encourage new investment, and increase
innovation and entrepreneurship. In advanced
aging economies, migrant workers fill the demand
for both highly skilled workers and unskilled
employment, particularly in the growing per-
sonal care sector.
Change dependency ratios by
working longer
In many advanced economies, the rising elderly
dependency ratios and the upcoming skills short-
age have already led to reconsideration of retire-
ment policies, leading to longer working lives
and a more gradual entry into retirement (31).
New cohorts of highly educated, skilled, and
increasingly healthy populations are delaying
retirement (32). This is in part a response to
government social security changes, but is also
due to the increased health status of these older
generations. Future generations of older adults
may have even higher levels of human capital
in terms of education, skills, and abilitiesand
better health profiles, and this will enable them
to remain active, productive, and contributory
for far longer, given supportive and conducive
working environments (2). This has ergonomic
and human resource implications for improving
physical and psychological working environments.
It also raises important questions around the
growing need for skills and training across
thelifecourse,andofwhowillpayforthis
individuals, employers, or governments. In addi-
tion, the substantial contribution made by older
adults via the informal sector through providing
family and community support and care is now
increasingly being recognized (33).
Finance and reconfigure health and
long-term care provisions
Population aging heralds a series of challenges
for economies and societies in relation to the
provision of health and social care (34).
(i) The total amount of ill health and dis-
ability in the population will rise because as
societies improve their population life expect-
ancy, the proportion of the population with se-
rious health problems will increase unless there
is a considerable improvement in the health of
successive birth cohorts (which would manifest
as a decrease over time in age-specific preva-
lence rates). This has been termed epidemic of
frailty(35).
(ii) Changes in the type of ill health will arise
from the shift from acute infectious disease to
complex chronic long-term ill health and dis-
ability. This has been termed the chronic disease
burden (36,37) and will exert pressure for a
major shift in the allocation of health care re-
sources and the configuration of services.
SCIENCE sciencemag.org 31 OCTOBER 2014 VOL 346 ISSUE 6209 589
OECD demographic decit
2000–2030
75 million
70
65
60
55
50
45
40 2000 2005 2010 2015 2020 2025 2030
Age 60-64
Age 20-24
Fig. 3. Demographic deficit in OECD member nations. Observed and projected size of the incoming
(2024) and outgoing (6064) working-age cohorts in OECD countries, 20002030.Source: OECD
figures, Oxford Institute of Population Ageing, 2012.
on May 8, 2017http://science.sciencemag.org/Downloaded from
Therefore, even if population aging does not exert
pressure for additional resources to be channeled
into the health care system, it is likely to exert pres-
sure for the development and improvement of ser-
vices for people with complex health needs, and thi s
may require a large shift in the allocation of
resourcesaswellaslarge-scaleorganizational
change.
(iii) Population aging will affect a societys
capacity to provide workers to care for the older
population, as well as its ability to generate in-
come to finance this. The changes in the depen-
dency ratios discussed earlier will particularly
affect the health care sector. In addition, demo-
graphicchangewillreduceinformalfamilycare
through a reduction in the availability of younger
family members to provide such care. This will
increase the demand for formal care services, at a
time when the provision of overseas migrants
providing health care is reduced as their own
societies start to age. This will also occur at a
time when the epidemiological transition is toward
labor-intensive chronic disease c are.
Addressing the health and social
care challenge
One approach is to maintain health among older
populations for as long as possible, thus reducing
the requirement to provide and finance long-
term health and social care. A second approach
focuses on the economic relationship between
changing age structure and health care costs,
and how this might evolve with changing popu-
lation age structures.
Postponement of frailty and disability
Will declines in mortality be accompanied by
declines in morbidity (i.e., disease and disabil-
ity)? There is currently evidence that through
healthy living and disease prevention, the onset
of disability is being pushed back into our 80s
(38). Will these gains in healthy years continue as
we increasingly turn to science and technology
to extend our lives? The compression of mor-
bidityhypothesis (39,40) suggests that disabil-
ityandfrailtyarecompressedtowardtheendof
life at a faster pace than death rates. Therefore,
people are expected to live not only longer, but
also in better health. Alternatively, the expan-
sion of morbidityhypothesis (4143)claimsthat
thedeclineinmortalityislargelyduetothede-
creasing death rate of diseases, rather than due
to a reduction in their incidence. As a result,
fallingmortalityisaccompaniedbyanincrease
in morbidity and disability. The dynamic equi-
libriumhypothesis (44) suggests a counterbal-
ancing effect between the decreasing prevalence/
incidence of chronic diseases and the decreasing
fatality rates of such diseases. This is leading to
longer periods of living with disability toward
the end of oneslife.
The evidence is equally mixed. Studies from
the United States suggest that younger co-
horts of elderly persons are living longer in bet-
ter health (45); studies from Japan, the worlds
oldest country, suggest that as life expectancy
reaches very high ages, most of the gained years
are lived in poor health (46). For now we can
conclude that although both life expectancy and
healthy, disability-free life expectancy may be
increasing, disability as a proportion of life after
age 65 is also slowly increasing (47). Science,
technology, and medicinethe modern drivers
of longevityare not only increasing our life ex-
pectancy but are also enabling us to live longer
at the end of our lives with disease, disabilities,
and frailties (Fig. 4).
Health care costs
Over the past 40 years, health care costs in most
advanced countries have been rising on average
between 1 and 2% faster than GDP (48). The age
structure of a population is seen to be an im-
portant determinant of health care costs. Costs
are high for infant and maternal care, and rise
again as we age, from around age 55 for men and
60forwomen.Yet,althoughpercapitahealth
spending does increase quite steeply once people
reach their 60s, repeated analyses of age-related
data on health spending have shown that prox-
imity to death is more important than age per
se as a predictor of the consumption of health
resources (4951). In other words, health care
spending is heavily concentrated in the last few
years of life, so much so that some analysts have
argued that aging per se has virtually no effect on
the way that the consumption of health care
resources increases with age (52). However, in
many advanced economies, aging of the large
cohorts born in the middle of the 20th century
wil l over the coming decades increase the propor-
tion of the population in close proximity to their
death and will inevitably increase health care
consumption.
Although a number of cross-national studies
have considered the determinants of health care
costs, only one has found that the proportion of
population aged 65 and over is the explanatory
factor (53). Indeed, in advanced economies at
least, per capita health care costs for those aged
65 years and over have increased at the same rate
as for those aged less than 65 (54). In many
countries, per capita spending on health care is
reduced after age 85. This is partly due to the
view still held in many societies that spending
should be directed to the young when resources
are limited; partly due to the lack of research,
andthusinnovation,intreatmentsforthevery
old; and partly due to the lower demands made
by these cohorts relative to working-age adults.
All three factors are likely to change as the more
demanding younger cohorts reach old-old age.
It is the wider effects of income, lifestyle char-
acteristics, and new technology, alongside the
effects of environmental factors, that are driving
up the demand for new advanced medical appli-
cations. Indeed, technological change in health
care delivery has been the main driver, with up to
halfoftheincreaseinhealthcarespendingin
advanced economies over the past 50 years aris-
ing from medical technology (55). In addition,
medical innovations now allow for the treatment
of previously untreatable conditions, which also
increases medical costs (56).
Addressing the social challenge
Change in age composition is altering the struc-
ture of families and the life course. Such change
also brings into question the traditional contract
between the generations, and raises queries around
the reconfiguration of social institutions to deal
with issues of inter- and intragenerational fair-
ness that may arise as a result of population aging.
In particular, inequalities in access to health, eco-
nomic, and social resourcesboth between and
within generationsare likely to remain a press-
ing concern over the coming decades.
590 31 OCTOBER 2014 VOL 346 ISSUE 6209 sciencemag.org SCIENCE
Increasing life expectancy and healthy life expectancy
2010 versus 2012
Life expectancy at birth
Healthy life expectancy at birth
years
90
80
70
60
50
40
30
20
10
02000 2012 2000 2012 2000 2012 2000 2012
LOW INCOME LOWER
MIDDLE INCOME
UPPER
MIDDLE INCOME
HIGH INCOME
Fig. 4. Life expectancy versus healthy life expectancy. Source: Life expectancy data by World Bank
income group; World Health Organization, Global Health Observatory Data Repository (http://apps.who.
int/gho/data/view.main.700?lang=en).
THE AGING BRAIN
on May 8, 2017http://science.sciencemag.org/Downloaded from
Changing family structures
Changes in fertility and mortality are leading to a
decrease in the number of living relatives within
each generation (16,57).As fertility falls, and as
the intervals between the generations increase
because of late first childbearing, we may well
see a contraction in the number of family gen-
erations alive at one time. Longevity is increasing
the duration spent in certain kinship roles, such
as spouse, parent of nondependent child, and
sibling. Falling fertility has reduced the duration
of others, such as parent of dependent child, or
even the opportunity for some roles, such as
sibling.
Delaying life transitions
Paradoxically, while public and legal institutions
are generally lowering the age threshold into full
legal adulthood, individuals are choosing to de-
lay many of the transitions into full adulthood
full economic independence from parents, formal
adult union through marriage or committed long-
term cohabitation, and parentingwith a conti-
nued increase of age at first marriage, at leaving
the parental home, and at first childbirth. Within
the family, delayed transitions in younger life
lead to subsequent transition delay for both the
individual and other kin members. For example,
delayed birth of a first child may lead to a long
intergenerational interval and a later transition
to both parenthood and grandparenthood. Sim-
ilarly, extended economic dependence on parents
not only delays the individualsfulltransitionto
independent adulthood, but also delays the ex-
perience of the empty-nest syndrome for the par-
ents themselves. Awareness of ever-lengthening
life spans may have given individuals at all ages
the time and the liberty to delay these transitions
as they progress through adulthood (16,18).
Inter- and intragenerational fairness and
the changing intergenerational contract
The question of intergenerational fairness raises
the issue of ensuring that both those generations
who are working and those who are now retired
will benefit from the proceeds of any economic
growth. These factors need to be addressed to-
gether with intragenerational inequalities, which
arise through differential access to education and
employment opportunities.
Thereisalsosomequestioningofthetradi-
tional contract between the generations, which
has been based historically on a system of inter-
generational reciprocity. Adults provide for young
dependents (children) and in return, when those
young dependents become adults, they provide
for older dependents. This is maintained in most
societies both directly at the familial level and at
a societal level, with adults within the labor mar-
ket providing via public transfers for both older
and younger dependents. The question for an
aging population is whether successful cohorts
(in terms of both fertility and mortality reduc-
tion) pass the cost of such success onto future
cohorts via the traditional intergenerational con-
tract or a renegotiated one. This latter contract
would require older cohorts to bear the costs of
their longer lives, through (for example) higher
postretirement contributions to their own wel-
fare and/or a longer working life.
Conclusion
A variety of new policies are now being devel-
oped in the light of population aging, including
broad, coherent, and integrated multi-pillar ap-
proaches to labor markets, health, and social
security (58).These should enable and promote
longer working lives through life long training,
education and skills updating, and the provision
of appropriate working environments for older
workers. They should further ensure that private
family or household transfers are integrated into
old-age security systems where possible; pro-
mote well-being and enable healthy active living
to reduce chronic illness and health care costs
and support active contributory life for as long as
possible; and provide access to education across
thelifecoursetoensurethatallindividualsare
prepared physically, mentally, socially, and finan-
cially to cope with increasing individual respon-
sibility for old age.
Moreover, it should be recognized that the
major concerns listed above are dynamics of
current cohorts and current behaviors. They
are not fixed. Europe, which has had more than
100 years to prepare for its aging population,
is still struggling with these questions. Yet the
greatest challenges of global population aging
may not be in Europe, but rather in the rap-
idly changing demography of Asia and Latin
Americaregions that are moving from being
predominantly young to being predominantly
old within just 25 years.
REFERENCES AND NOTES
1. United Nations, World Population Prospects: The 2012 Revision
(medium variant) (2013); http://esa.un.org/wpp.
2. D. E. Bloom, D. Canning, G. Fink, Oxf. Rev. Econ. Policy 26,
583612 (2010).
3 Total fertility rate is the conventional annual measure of the
birth rate, calculated as the average number of children per
woman implied by current birth rates of women of all ages in a
given year.
4. Eurostat, Total fertility rate(Publications of the European
Communities, 2013); http://epp.eurostat.ec.europa.eu/tgm/
table.do?tab =table&init=1&lang uage=en&pcode=
tsdde220&plugi n=1.
5. H. P. Blossfeld, E. Klijzing, M. Mills, K. Kurz, Globalization,
Uncertainty and Youth in Society: The Losers in a Globalizing
World (Routledge, New York, 2005).
6. M. Kreyenfeld, Eur. Sociol. Rev. 26, 351366 (2010).
7. T. Sobotka, V. Skirbekk, D. Philipov, Popul. Dev. Rev. 37,
267306 (2011).
8. J. C. Caldwell, Popul. Dev. Rev. 6, 225255 (1980).
9. M. Mills, R. R. Rindfuss, P. McDonald, E. te Velde,
Hum. Reprod. Update 17, 848860 (2011).
10. S. P. Morgan, H. Rackin, Popul. Dev. Rev. 36,91118 (2010).
11. M. Iacovou, L. P. Tavares, Popul. Dev. Rev. 37,89123 (2011).
12. W. Lutz, V. Skirbekk, M.R. Testa, The low fertility trap
hypothesis: Forces that may lead to further postponement and
fewer births in Europe. Vienna Yearb. Popul. Res. 4, 167192
(2006); www.iiasa.ac.at/publication/more_XJ-06-027.php.
13. S. Basten, L. Lutz, S. Scherbov, Demogr. Res. 28,11451166
(2013).
14. J. W. Vaupel, Nature 464 , 536542 (2010).
15. K. Howse, Policy-making for a new generations of interventions
in age-related disease and decline. In Enhancing Human
Capacities, J. Savelscu, R. ter Meulen, G. Kahane, Eds.
(Wiley-Blackwell, Oxford, 2011).
16. S. Harper, Ageing Societies: Myths, Challenges and
Opportunities (Hodder Arnold, London, 2006).
17. S. Harper, Families in Ageing Societies (Oxford Univ. Press,
Oxford, 2004).
18. S. Harper,A diverse world.In People and the Planet (RoyalSociety,
2012), chap. 2; www.interacademies.net/File.aspx?id=25028.
19. J. C. Chesnais, Rev. Popul. Soc. Policy 7,83101 (1998).
20. L. Fina-Sanglas, Europes population and labour market beyond
2000: Main issues and policy implications. In Europes
Population and Labour Market Beyond 2000, Population
Studies, 33, A. Punch, D. L. Pearce, Eds. (Council of Europe,
2000), pp. 43111.
21. R. Lee, A. Mason, Eur. J. Popul. 26, 159182 (2010).
22. R. Lee, A. Mason, Population Aging and the Generational
Economy: A Global Perspective (Edward Elgar, Cheltenham,
UK, 2011).
23. EU25 data are available for this measure, rather than EU27.
24. Eurostat, Projected old-age dependency ratio(Publications
of the European Communities, 2013); http://epp.eurostat.ec.
europa.eu/tgm/table.do?tab=table&init=1&plugin=
1&language=en&pcode=tsdde511.
25. A. C. DAddio, M. Mira dErcole, Trends and Determinants of
Fertility Rates in OECD Countries: The Role of Policies
(Organisation for Economic Cooperation and Development,
Paris, 2005).
26. A.C. DAddio, M. Mira dErcole, Policies, Institutions and Fertility
Rates: A Panel Data Analysis for OECD Countries (Organisation
for Economic Cooperation and Development, Paris, 2005).
27. OECD, Babies and BossesReconciling Work and Family Life:
A Synthesis of Findings for OECD Countries (Organisation for
Economic Cooperation and Development, Paris, 2007).
28. C. Dustmann, T. Frattini, C. Halls, Fiscal Stud. 31,141 (2010).
29. H. Brücker, Can international migration solve the problems of
European labour markets?(United Nations Economic
Commission for Europe, 2002); www.unece.org/fileadmin/
DAM/ead/sem/sem2002/papers/Brucker.pdf.
30. H. Fehr, S. Jokisch, S. Kotlikoff, The role of immigration in
dealing with the developed worlds demographic transition
(NBER Working Paper 10512, National Bureau of Economic
Research, 2004); www.nber.org/papers/w10512.
31. S. Harper, Int. Soc. Secur. Rev. 63, 177196 (2010).
32. D. E. Bloom, A. Boersch-Supan, P. McGee, A. Seike,
Population aging: Facts, challenges, and responses(Program
on the Global Demography of Ageing Working Paper 71,
Harvard Initiative for Global Health, 2011); http://cdn1.sph.
harvard.edu/wp-content/uploads/sites/1288/2013/10/
PGDA_WP_71.pdf.
33. K. Haberkern, M. Szydlik, Ageing Soc. 30, 299323 (2010).
34. K. Howse, Perspect. Pub. Health 132, 171177 (2012).
35. J. M. Robine, C. Jagger, Ageing Horizons 3,1421 (2005).
36. E. Nolte, C. M. McKee, Health Aff. 27,5871 (2008).
37. D. Stuckler, Milbank Q. 86, 273326 (2008).
38. J.M.Robine,Y.Saito,C.Jagger,Exp. Gerontol. 38,735739 (2003).
39. J. F. Fries, N. Engl. J. Med. 303, 130135 (1980).
40. J. F. Fries, Milbank Q. 67, 208232 (1989).
41. R. M. Gruenberg, Milbank Mem. Fund Q. 55,324 (1977).
42. L. Verbrugge, Milbank Mem. Fund Q. 62, 475519 (1984).
43. S. J. Olshansky, M. A. Rudberg, B. A. Carnes, C. K. Cassel,
J. A. Brody, J. Aging Health 3, 194216 (1991).
44. K. G. Manton, Milbank Q. 60, 183244 (1982).
45. K. G. Manton, Annu. Rev. Public Health 29,91113 (2008).
46. V. Yong, Y. Saito, Demogr. Res. 20, 467494 (2009).
47. C. Jagger et al., Age Ageing 38, 319325 (2009).
48. E. Jenkner, A. Leive, Health Care Spending Issues in Advanced
Economies (International Monetary Fund, Washington, DC, 2010).
49. K. Howse, What kinds of policy challenge does population
ageing generate for healthcare systems?(IARU Working
Paper, Oxford Institute of Population Ageing, 2010).
50. P. Zweifel, S. Felder, A. Werblow, Geneva Pap. Risk Insur. Issues
Pract. 29, 652666 (2004).
51. M. Seshamani, A. Gray, Age Ageing 33, 556561 (2004).
52. P. Zweifel, S. Felder, M. Meiers, Health Econ. 8, 485496 (1999).
53. G. W. Leeson, Cost effectiveness and interventions(Working
Paper WP204, Oxford Institute of Population Ageing, 2004);
www.ageing.ox.ac.uk/files/workingpaper_204.pdf.
54. M. Seshamani, A. Gray, Appl. Health Econ. Health Policy 2,916 (2003).
55. S. Smith, J. P. Newhouse, M. S. Freeland, Health Aff. 28,
12761284 (2009).
56. F. Breyer, J. Costa-Font, S. Felder, Oxf. Rev. Econ. Policy 26,
674690 (2010).
57. V. L. Bengtson, J. Marriage Fam. 63,116 (2001).
58. S. Harper, K. Hamblin, International Handbook on Ageing and
Public Policy (Edward Elgar, Cheltenham, UK, 2014).
10.1126/science.1254405
SCIENCE sciencemag.org 31 OCTOBER 2014 VOL 346 ISSUE 6209 591
on May 8, 2017http://science.sciencemag.org/Downloaded from
(6209), 587-591. [doi: 10.1126/science.1254405]346Science
Sarah Harper (October 30, 2014)
Economic and social implications of aging societies
Editor's Summary
This copy is for your personal, non-commercial use only.
Article Tools
http://science.sciencemag.org/content/346/6209/587
article tools:
Visit the online version of this article to access the personalization and
Permissions http://www.sciencemag.org/about/permissions.dtl
Obtain information about reproducing this article:
is a registered trademark of AAAS. ScienceAdvancement of Science; all rights reserved. The title
Avenue NW, Washington, DC 20005. Copyright 2016 by the American Association for the
in December, by the American Association for the Advancement of Science, 1200 New York
(print ISSN 0036-8075; online ISSN 1095-9203) is published weekly, except the last weekScience
on May 8, 2017http://science.sciencemag.org/Downloaded from
... This observation is of critical importance as the aging of the population has implications for both demographic and socioeconomic aspects [32]. The increased median age in an area may be attributed to several factors, including a noteworthy out-migration of younger individuals due to a lack of services and opportunities [33] and in search of better employment opportunities and education [34], a declining fertility rate coupled with a reduced mortality rate [35] as well as retirees moving into their second homes [36]. In the context of the Watershed, Hoffman reported that young people are leaving the area to apply their education elsewhere. ...
... The implications of an aging population for societies and economies are not a new phenomenon or unique to the Watershed [37]. It has wide-ranging effects, influencing the labor force, savings and consumption patterns, family and household structures, social networks and interactions, health and welfare services, housing, and transportation, as well as leisure and community behavior [35]. The concept of a demographic deficit views the decrease in the proportion of younger individuals as a potential cause for a decline in economic activity [37]. ...
Article
Full-text available
The historic New York City (NYC) Watershed Memorandum of Agreement signed in 1997, which established the Watershed Protection and Partnership Program (WPPP), aimed to safeguard water quality for downstream NYC communities and enhance community vitality within the upstream watershed. Up to now, the focus has been on maintaining water quality, with less attention on the socioeconomic and demographic well-being of the upstream communities. This study bridges this gap by examining the socioeconomic and demographic trends within the upstream watershed communities. We collected census data from the U.S. Census Bureau and American Community Survey (ACS) from 1990, 2000, 2010, and 2020. The data were collected primarily for the Catskill-Delaware Watershed region, as well as the five immediate watershed counties, New York State, the U.S., and two rural counties similar in population density to the Watershed to serve as comparison areas. This study analyzed demographic factors and economic, and community characteristics to identify trends and shifts over time. Our findings reveal the demographic shift towards an older retiree population, decreasing labor force, higher unemployment rates, higher disparities in income distribution, and longer commute times in the Watershed compared to our comparison areas. The Watershed also experiences higher home vacancies than the comparison areas, suggesting a shift towards seasonal or second-home use of properties. While this study offers insights into socioeconomic and demographic shifts in watershed communities, its reliance on census data may limit the precision in establishing causal links between watershed protection measures and these shifts. Incorporating qualitative analysis in future research will deepen our understanding of these relationships.
... Additionally, extreme climate and prolonged exposure to environmental pollutants can exacerbate health issues in older people [25,26]. Other factors such as low gross domestic product (GDP) and inadequate social protection systems can hinder the ability of countries to effectively support their aging populations effectively and accelerate the demographic transition (e.g., increased immigration and old retirement age) [27]. ...
... Embracing more holistic policies in response to the accelerating global aging trend Figure 7 shows the three key fields highlighted herein to confront the accelerating global rate of aging, which influence each other and may also be affected by demographic changes as follows. 1) Social care and economic development: As aging populations grow, the demands for health care services, pensions, and social support increase; strong economic development is needed to sustain these services [27]. Developed economies typically have more robust pension systems and healthcare coverage, which enables older people to maintain their quality of life after retirement [19]. ...
Article
Full-text available
Introduction The global increase in the aging population presents critical challenges for healthcare systems, social security, and economic stability worldwide. Although the studies of the global rate of aging have increased more than four times in the past two decades, few studies have integrated the potential combined effects of socio-economic, climatic, and environmental factors. Methods We calculated the geographic heterogeneity of aging population growth rates from 218 countries between 1960 and 2022. Public databases were then integrated to assess the impacts of seven global stressors: socio-economic vulnerability, temperature, drought, seasonality, climate extremes, air pollution, and greening vulnerability on growth rates of aging population (a totally 156 countries). Linear regression models were primarily used to test the statistically significant effects of these stressors on the rate of aging, and multiple model inference was then used to test whether the number of stressors exceeding specific thresholds (e.g., > 25, 50, and 75%) was consistently significant in the best models. The importance of stressors and the number of stressors exceeding thresholds was verified using random forest models for countries experiencing different population aging rates. Results Our analysis identified significant heterogeneity in growth rates of aging population globally, with many African countries exhibiting significantly lower aging rates compared with Europe. High socio-economic vulnerability, increased climate risks (such as high temperature and intensive extreme climate), and decreased environmental quality were found to significantly increase growth rates of the aging population (P < 0.05). The positive combined impacts of these stressors were diminished at medium–high levels of stressors (i.e., relative to their maximum levels observed in nature). The number of global stressors exceeding the 25% threshold emerged as an important predictor of global aging rates. Demographic changes in regions with relatively rapid aging (e.g., Africa and Asia) are more sensitive to climate change (e.g., extreme climate and drought) and the number of global stressors, and regions with low to medium rates of aging (e.g., Europe and the Americas) are more sensitive to socio-economic vulnerability and environmental stability (e.g., drought, green fragility and air pollution). Conclusions Our findings underscore that policy tools or methods must be developed that consider the holistic dimension of the global factor. Further investigations are essential to understand the complex interactions between multiple stressors and their combined effects on global aging.
... The world population aged 65 and older is projected to double to 1.5 billion between 2019 and 2050 (United Nations, Department of Economic and Social Affairs, Population Division 2020). While science, technology and medicine-the modern drivers of longevity-enable people to live longer and with chronic disease, disabilities, multimorbidity and frailties (Harper 2014), the demand for complex healthcare services is increasing, and healthcare systems struggle to provide optimal care (European Commission Directorate-General for Employment, Social Affairs and Inclusion 2021; Ricciardi, Specchia, and Marino 2014). ...
Article
Full-text available
Aim To capture older people's, informal caregivers' and health professionals' ideas on potential interventions for empowering older people and informal caregivers in transitional care decision‐making. Design A descriptive qualitative design was adopted. Methods The study was conducted between February and May 2022 in the region of Flanders, Belgium, as part of the TRANS‐SENIOR consortium's collaborative research. Data were collected using focus groups, including older people, informal caregivers and healthcare professionals involved in any physical relocation of the older person across home, hospital or nursing home settings. Thematic data analysis was performed based on Braun and Clarke's six‐step method. Results A total of 40 people participated in the focus groups. Four main themes were identified, which describe ideas on how to empower older people and informal caregivers in transitional care: Providing clear and timely information, preparing people for what is to come, person‐centredness and providing professional and peer support for informal caregivers. Conclusions Healthcare (professionals) should facilitate older people's and informal caregivers' empowerment in transitional care decision‐making by setting them at the core and inception of the decision‐making process. While informal caregivers support their loved ones in decision‐making processes, they should also be supported and monitored for burdensome issues. Implications to Patient Care Multicomponent, well‐planned and personalised interventions are needed to empower older people and informal caregivers in transitional care decision‐making. The ideas raised by all stakeholders who participated in this study can inform these interventions. Reporting Method Adhered to consolidated criteria for reporting qualitative research checklist. Patient or Public Contribution Organisations advocating for the interests of older people and informal caregivers played a pivotal role in shaping the TRANS SENIOR project. Furthermore, the study benefitted from the collaborative input of AGE Platform Europe, which amplified the voices and representation of older people during the project design phase.
... The process of population ageing is accelerating globally (Christensen et al., 2009). As the baby boomer generation enters old age, most countries around the world are facing the problem of increasing population aging (Harper, 2014). According to the Department of Economic and Social Affairs of the United Nations, the number of persons aged 60 or over, on a global scale, will reach 2 billion in 2050, and close to 3 billion in 2100. ...
Article
Full-text available
Population aging is a global trend and a world-wide challenge to many governments. The high-quality life of the elderly cannot be separated from the support of basic services and facilities. Therefore, it is necessary to conduct analysis and research on the accessibility of urban community services and facilities. It is worth noting that the research in this article is based on master thesis (Bai, 2013). Drawing on the data, methods, and conclusions from the master's thesis, in this paper, an approach is designed for measuring spatial accessibility to services/facilities by a spatially dispersed ageing population in urban areas. The local government area (LGA) of Monash in the Melbourne metropolitan area has been selected the case study area. This study combines GIS-based spatial analytical procedures and two-step floating catchment area (2SFCA) method, in conjunction with mesh block level 2011 population data, service/facility data and transportation network data, to measure and map spatial variations in potential accessibility to services and facilities deemed essential to the aged population. Service facilities considered in the study include bus stops, train stations, bank facilities, shopping centres, post offices, churches, parks, public libraries, community centres, pharmacies, GP clinics and hospitals in Monash LGA. The research results can be used to optimize the spatial planning and layout of public facilities for ageing population.
... According to current models, this burgeoning older population cohort, which presently comprises approximately 9% of the global population, is expected to reach an estimated 16% by the year 2050 (World Health Organization 2019). Yet a more detailed analysis of these statistical forecasts also reveals the staggering reality that the global population aged 60 and beyond has already exceeded the one billion mark (Harper 2014). Given such immense magnitude and rapid progression, this aging population megatrend signals an extraordinary social transformation, sparking urgent policy discussions in both the public and private sectors (Bloom et al. 2015, Kaplan & Inguanzo 2017. ...
Article
Full-text available
As global demographics gravitate toward aging populations, developing nations, Indonesia included, face the demanding obligation of providing adequate healthcare and social services for their elderly demographic, particularly in rural areas. This paper delves into the complexities of elderly care in Trenggalek Regency, situated in East Java, Indonesia, where it centers on describing the firsthand experiences of the elderly residents and their challenges in accessing healthcare, maintaining financial stability, and navigating the adequacy of infrastructure. Insights revealed the notions of elderly public service, pointing out both progress and challenges in affordable care, with many seniors relying on limited family support and resorting to informal work to sustain themselves, while mobility issues, including transportation deficits and challenging terrain, deepen their social isolation. However, it also spotlights ongoing local policy endeavors, crafted to address these challenges, acknowledging the pressing need for change and striving to elevate the quality of elderly care services. In doing so, the paper offers practical insights into elderly care disparities in developing country contexts and emphasizes the vital role played by rural elderly communities in shaping proper interventions, valuing their insights and experiences in sculpting the future of geriatric care in Trenggalek and beyond.
... Population aging is a global phenomenon driven by decreasing mortality and fertility [1]. Based on statistical data, population aging is increasing. ...
Article
Full-text available
Background Social engagement is closely related to well-being among older adults. However, studies on the changing trajectory and influencing factors (especially time-varying factors) of social engagement are limited. This study aimed to examine the social engagement trajectory of older Chinese adults and explore its time-fixed and time-varying factors, thus providing evidence for the development of strategies to promote a rational implementation for healthy aging. Methods This study included 2,195 participants from a subset of four surveys from the Chinese Longitudinal Healthy Longevity Survey conducted from 2008 to 2018 (with the latest survey completed in 2018), with follow-ups conducted approximately every three years. Growth mixture modeling was used to explore the social engagement trajectory of older adults and the effects of time-varying variables. In addition, multinomial logistic regression was employed to analyze the association between time-fixed variables and latent classes. Results Three distinct trajectories of social engagement among older adults in China were identified: slow declining (n = 204; 9.3%), which meant social engagement score decreased continuously, but social engagement level improved; slow rising (n = 1,039; 47.3%), marked by an increased score of social engagement, but with an depressed engagement level; and middle stabilizing (n = 952; 43.4%), which meant social engagement score and engagement level remained quite stable. A time-fixed analysis indicated that age, marital status, educational level, and annual family income had a significant impact on social engagement (P < 0.05). In contrast, the time-varying analysis showed that a decline in functional ability, insufficient exercise (means no exercise at present), deteriorating self-reported health and quality of life, negative mood, monotonous diet, and reduced community services were closely related to the reduction in social engagement levels (P < 0.05). Conclusion Three trends were observed at the social engagement level. Older adults with initially high levels of social engagement exhibited a continuous upward trend, whereas those with initially low levels experienced a decline in their social engagement, and those with initially intermediate levels remained quite stable. Considering the primary heterogeneous factors, it is imperative for governments to enhance basic services and prioritize the well-being of older adults. Additionally, families should diligently monitor the emotional well-being of older adults and make appropriate arrangements for meals.
Article
Aim As aging populations shift health care from hospitals to communities, Japan has implemented policies to promote home health care. This study explored regional differences in home health care recipients among older adults and related factors. Methods We used nationwide data from 2020 to describe the proportion of older adults receiving regular home visits and the medical institutions utilized across secondary medical areas: urban, middle and depopulated areas. We examined factors associated with the proportion of patients receiving regular home visits. Exposures included each secondary medical area's medical and long‐term‐care (LTC) resources, adjusted for the older adult population; proportion of single‐person households; and regional factors. We performed a multivariate negative binomial distribution analysis. Results A total of 333 secondary medical areas were included. Urban areas had more patients receiving regular home visits, primarily from enhanced home care support clinics/hospitals (HCSCs). Fewer patients received regular home visits in depopulated areas, and conventional HCSCs were more common. Multivariate analysis revealed that the number of conventional HCSCs (coefficient, 0.17 [95% confidence intervals (CI), 0.08 to 0.26]), enhanced HCSCs (coefficient, 0.21 [95% CI, 0.14 to 0.29]) and population density (coefficient, 0.10 [95% CI, 0.02 to 0.19]) were positively associated with higher home‐visit rates. Beds in LTC welfare facilities (coefficient, −0.10 [95% CI, −0.19 to −0.01]) and beds in LTC health facilities (coefficient, −0.09 [95% CI, −0.17 to 0.00]) were negatively associated. Conclusions Policies to promote home health care have led to high home‐visit rates in urban areas. Medical and LTC resources and regional factors influence disparities. As Japan's population ages, it is crucial to recognize these disparities and develop medical and LTC systems tailored to each region's characteristics. Geriatr Gerontol Int 2024; ••: ••–•• .
Article
Purpose The primary purpose of this study is to explore the effects of demographic transition toward aging populations on the performance of stock market indices across various economic developments. The research aims to provide valuable insights into the life-cycle hypothesis on savings patterns, investment behavior and the potential reverberations on global financial markets. Design/methodology/approach The study adopts a comprehensive global perspective, scrutinizing the effects of aging populations on stock market indices across developed, developing and transitional economies through the panel data analysis. Using annual data spanning the period from 1991 to 2020, encompassing a sample of 10 countries from each economic development level, the study employs the panel autoregressive distributed lag (ARDL) model with fixed effect estimation. Findings The findings unveil a statistically significant positive impact of the elderly population proportion on global stock market indices. However, the magnitude and contours of this impact exhibit considerable heterogeneity across different country groups. Specifically, the study finds that while the aging population significantly influences stock market performance in developed nations, its effect is overshadowed by other economic factors, such as consumer price indices and interest rates, in developing countries and economies in transition. Originality/value The originality and value of this study lie in its comprehensive global perspective, which encompasses a diverse array of economies at varying developmental stages. The research contributes to an understanding of the effects of demographic transitions on stock market performance on a global scale. The insights derived from this study hold significant implications for policymakers, financial institutions and investors seeking to navigate the challenges and opportunities posed by aging societies in an increasingly interconnected global economy. Additionally, the findings highlight the need for specific strategies and policies that account for the unique economic characteristics and developmental stages of different nations.
Article
Full-text available
The age of individuals has consequences not only for their fitness and behaviour but also for the functioning of the groups they form. Because social behaviour often changes with age, population age structure is expected to shape the social organization, the social environments individuals experience and the operation of social processes within populations. Although research has explored changes in individual social behaviour with age, particularly in controlled settings, there is limited understanding of how age structure governs sociality in wild populations. Here, we synthesize previous research into age-related effects on social processes in natural populations, and discuss the links between age structure, sociality and ecology, specifically focusing on how population age structure might influence social structure and functioning. We highlight the potential for using empirical data from natural populations in combination with social network approaches to uncover pathways linking individual social ageing, population age structure and societal functioning. We discuss the broader implications of these insights for understanding the social impacts of anthropogenic effects on animal population demography and for building a deeper understanding of societal ageing in general. This article is part of the discussion meeting issue ‘Understanding age and society using natural populations’.
Preprint
Full-text available
Rural China's demographic structure is ageing at a rate far exceeding national averages, posing serious challenges to sustainable agricultural production. As a top global producer and carbon emitter, China must ensure food security while reducing agricultural emissions. However, current understanding of these dynamics remains limited. This study establishes the year 2000 as the benchmark for when rural ageing began in China. Through analysis of data from over 1,400 surveyed Chinese counties through 2020, we examine related trends. Findings show ageing correlated with a 10.2% rise in agricultural diesel usage intensity and 13.3% increase in plastic film use, together raising CO2 emissions 7.0%, posing threats to both the environment and arable land. To address these concerns and explore options for achieving sustainable agriculture amid ageing rural populations, we quantitatively assess future impacts and potential mitigation through increased adoption of new family farming models. As simulated, compared with 2020, projections for 2100 indicate that fertilizer, diesel and pesticide use intensities may fall 28-29%, 7-26% and 35-51%, lowering agricultural CO2 emissions by 17-27%. These findings indicate that the scaled and specialized organization and production technologies employed under new family farming models have the potential to help offset the negative impacts associated with ageing rural populations.
Chapter
This chapter considers how one should frame and deal with the policy decisions that are raised by the prospect of a new generation of technologies with enhanced capabilities for changing and extending the normal human lifespan. The focus on policy decisions is intended to emphasize a contrast with a related set of questions about the desirability of what we stand to gain as individuals by an enhanced capability to intervene in the aging process. The chapter discusses the following questions: Should public funds be committed to support the development or use of this capability to intervene in the aging process in humans? Should legal restraints be imposed on private attempts to develop or use such a capability? The chapter considers the fairness of allowing some individuals to purchase for themselves technologies that could substantially extend their lifespan if it is decided not to make public funds available for this purpose.
Book
The International Handbook on Ageing and Public Policy explores the challenges arising from the ageing of populations across the globe for government, policy makers, the private sector and civil society. It examines various national state approaches to welfare provisions for older people, and highlights alternatives based around the voluntary and third-party sector, families and private initiatives. The Handbook is highly relevant for academics interested in this critical issue, and offers important messages for policy makers and practitioners.
Book
'Lee and Mason have done scholars and practitioners a magnificent service by undertaking this comprehensive, compelling, and supremely innovative examination of the economic consequences of changes in population age structure. The book is a bona fide crystal ball. It will be a MUST READ for the next decade!'
Article
This book explores the interactions between family and ageing in Western industrialised societies. It features 10 chapters. Chapters 1-3 provide and overview of the demographic and social factors in aging societies. Chapters 4-5 address the specific roles and relationships emerging within contemporary families. Chapters 6-8 discuss the care and support for older relatives. Chapters 9-10 focus on topics that have received little attention - inheritance and the impact of family on the health of its members.
Article
This chapter emphasizes key methodologic features of cost-effectiveness analysis (CEA), its potential to inform policy and direct future research, and the current state of the CEA literature in obesity. The comparative performance of alternate interventions is summarized by a cost-effectiveness ratio, which is defined as the additional cost of a specific intervention divided by its additional clinical benefit, compared with a relevant alternative. Although diet, physical activity, behavior modification, and pharmacotherapy are considered first-line treatments for obesity, non-surgical therapy for severe obesity has shown limited success. There are a number of surgical procedures available to treat severe obesity. As data gaps are filled and methodological challenges are addressed by increasingly sophisticated techniques and increasingly diverse research teams, the rigor and scope of CEAs will expand. CEAs will help policy makers prioritize public health decisions in both high-and low-resource settings.