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Population Trends and Ageing Policy in Malta

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Abstract

Malta is no exception to the unprecedented demographic changes that are being experienced by industrial countries. As a result of declining fertility and mortality levels, the Maltese islands have registered a decrease in fertility rates and a major improvement of life expectancy at birth. Following a brief introduction, the second section presents clear demographic data that outlines Malta’s gerontological transition, noting how the Maltese population has evolved out of a traditional pyramidal shape to an even-shaped block distribution of equal numbers at each cohort except at the top. The third section focuses on population projections for Malta which highlight how in the near future the nation will continue to experience a decline in the numbers and percentages of the younger and working age population, with the opposite effect with respect to older persons. The final section outlines Malta’s social policy on active ageing, as it related to labor issues, participation in society, and healthy, independent and secure living in later life. This part notes how to-date many older people already participate in and contribute to society in a variety of ways such as providing support to their families by caring for spouses or grandchildren, working as volunteers or paid employees, and in receipt of various health and social care services that enable ‘ageing in place’. The study concludes that although several inroads have been made in welfare
Social Sciences
2013; 2(2): 90-96
Published online June 10, 2013 (http:// www.sciencepublishinggroup.com/j/ss)
doi: 10.11648/j.ss.20130202.19
Population trends and ageing policy in Malta
Marvin Formosa
European Centre for Gerontology, University of Malta, Msida, Malta
Email address:
marvin.formosa@um.edu.mt
To cite this article:
Marvin Formosa. Population Trends and Ageing Policy in Malta, Social Sciences. Vol. 2, No. 2, 2013, pp. 90-96.
doi: 10.11648/j.ss.20130202.19
Abstract:
Malta is no exception to the unprecedented demographic changes that are being experienced by industrial
countries. As a result of declining fertility and mortality levels, the Maltese islands have registered a decrease in fertility
rates and a major improvement of life expectancy at birth. Following a brief introduction, the second section presents clear
demographic data that outlines Malta’s gerontological transition, noting how the Maltese population has evolved out of a
traditional pyramidal shape to an even-shaped block distribution of equal numbers at each cohort except at the top. The
third section focuses on population projections for Malta which highlight how in the near future the nation will continue to
experience a decline in the numbers and percentages of the younger and working age population, with the opposite effect
with respect to older persons. The final section outlines Malta’s social policy on active ageing, as it related to labor issues,
participation in society, and healthy, independent and secure living in later life. This part notes how to-date many older
people already participate in and contribute to society in a variety of ways such as providing support to their families by
caring for spouses or grandchildren, working as volunteers or paid employees, and in receipt of various health and social
care services that enable ‘ageing in place’. The study concludes that although several inroads have been made in welfare
ageing policies, further initiatives are warranted for older persons to lead active, successful, and productive lifestyles.
Keywords:
Population Trends, Ageing Policy, Gerontology, Malta
1. Introduction
Population ageing has come to dominate the demographic
scenarios of all continents. While until the closing decades
of the 20th century population ageing was largely a phe-
nomenon affecting the most developed countries, many
developing countries entered the 21st century faced with the
prospects of substantial increments in their proportion of
older persons. Most empirical studies hinge the onset of later
life upon a particular ‘chronological’ or ‘calendar’ age, such
as 60 as in the case of the United Nations or 65 as in the case
of the Eurostat. However, chronological age has no ‘innate’
meaning but is derived from the social and historical gist of
specific contexts which, of course, vary. This study recon-
ciles structural and constructionist implications by defining
‘older persons/adults’ as ‘people, whatever their chrono-
logical age, who are either retired from the labor market or in
a post-career transition, and who are no longer involved in
the major responsibilities for raising their children’. The
concept of ‘population ageing’ focuses in particular on ex-
plaining and documenting the causes and consequences of
long-term shifts or transitions in health, mortality and fer-
tility, and how these bring about changes to the age and sex
structure of a given population. Malta is no exception to
such trends. The Maltese archipelago is a European Union
(EU) Member State, lies at the heart of the Mediterranean
Sea, and consists of three islands: Comino, Gozo and Malta.
Comino is uninhabited, and with Gozo having just a popu-
lation of 31,143 persons, leaves Malta as the major island of
this archipelago state, with as much as 384,912 residents [1].
According to the latest Maltese Census (2011), 16.3 per cent,
or 67,841 persons, of the local population were aged 65
years and over (ibid.). Persons aged 80 years and over
numbered 14,381 – 3.4 per cent of the Malta’s total popula-
tion [1]. This study reviews past, ongoing, and future de-
mographic shifts which transformed Malta into an ‘ageing
population’, whilst also discussing emergent key challenges
for ageing policy as the direct result of such a transition.
2. The Gerontological Transition
On average, the Census was taken every ten years be-
tween 1842 and 2011. Over the 20th Century the population
of Malta has nearly doubled, from 211,564 in 1911 to
416,055 in 2011 [1]. In 1985, the population comprised
345,418 persons, an increase of 31,202 persons over the
Social Sciences 2013; 2(2): 90-96 91
previous Census in 1967, and representing an average an-
nual increase of 0.6 per cent [2]. Post-1985, the Census was
carried three times, in 1995, 2005 and 2011. During this
period, a steady increase was experienced with the popula-
tion going up to 378,132 in 1995, exceeding the 400,000
mark in 2005 to 404,962, and reaching 416,055 in 2011.
Whilst just over half of the total population were females,
the Northern Harbor Region registered the largest number
of inhabitants - 120,063 persons (28.9 per cent), with Gozo
registering the lowest number of residents 31,143 inhabi-
tants (7.5 per cent). In terms of growth rates, an average
expansion rate of 0.9 per cent was experienced between
1985 and 1995, and slowing down to 0.7 and 0.4 per cent
during the ensuing decade and the 2005-2011 period re-
spectively [1]. This deceleration is attributed mainly to a
decline in the birth rate which has contributed to an ageing
population. Statistics also denote that the growth rate of the
male population is higher than that of the female population.
In open populations, such as Malta, this is often the result
of various factors such as gender ratio at birth, morbidity,
mortality, and international migration.
The growth in the Maltese population was not evenly
distributed amongst the various age cohorts. In 1901, 34.1
and 5.4 per cent of Malta’s population were in the 0-14 and
65-plus cohorts. As the 20th Century progressed, the pro-
portional representation fluctuated within very narrow mar-
gins, reaching 37.4 and 6.8 per cent in 1957 respectively. In
recent decades, the 0-14 and 65-plus age groups continued
to decrease and increase significantly, to reached 14.8 and
16.3 per cent in the year 2011. In the same year, the Mal-
tese median age stood at 40.5 years, up from 38.5 years in
2005. Such fluctuations were largely the result of a declin-
ing birth rate, together with an increasing life expectation
for both men and women. On one hand, whilst the crude
birth rate in Malta was relatively stable over the first half of
the 20th Century, at around 38 annual births per 1,000 pop-
ulation, it has declined steadily since, reaching 10.0 births
per 1,000 population in 2010 [3]. Total number of births
registered in 2009 stood at 4,171, with a total live birth
count of 4,143 babies. Although there was a slight increase
of 0.4 per cent in births compared to 2008, the fertility rate
remained unchanged at 1.4 in 2009, down from 1.7 in 2001.
On the other hand, whilst at the beginning of the 20th Cen-
tury life expectation in Malta was around 43 years for men
and 46 years females, in 2010 these figures reached 79.2
and 83.6 years respectively (EU-27 average: 70/78 years
for men/women) [3]. Malta also registers excellent and
record results in Health Life Expectancies (healthy life
years measure the number of years that a person can expect
to live in a healthy condition with disability). Among
Member States, the highest number of healthy life years at
birth in the year 2011 for women/men was registered in
Malta (71/70 years), followed by Sweden (70/71 years) [4].
At the age of 50, both women and men were expected to
have more than 20 additional healthy life years in Sweden
(26/25 years), Malta (23 years both), and Denmark (22
years both) [4].
The Demographic Review 2010 reports that, at end of
2010, nearly a quarter of the total population, or 98,547
persons, were 60 years old and over [3]. The largest share
of the older population is made up of women, with 55 per
cent of the total. In fact, the sex ratios for cohorts aged
65-plus and 80-plus numbered 76 and 56 respectively, to
the extent that amongst the oldest cohorts there is twice the
number of older women than men. However, amongst EU
countries Malta has the smallest gender difference with
respect to single households, and is the only country where
more women aged 80 and older live in ‘other or ‘couple’
households than alone. As a result of such demographic
developments, the Maltese population has evolved out of a
traditional pyramidal shape to an even-shaped block distri-
bution of equal numbers at each cohort except at the top.
From a policy perspective, the population pyramid helps to
visualize cohorts that will be entering pensionable age in
twenty years time. The top of the pyramid indicates a typi-
cal flag effect on the female’s side, whereby their longevity
is marked by higher numbers of old-old women and by the
presence of several centenarians. When translated some
twenty years in the future, this age-gender pyramid would
bring a new quadrangle-like shape and a narrowing of the
base of the pyramid. These are typical outcomes of slashing
birth rates and prolonged life. Differences in the average
ages between diverse regional and geographical districts
are also noteworthy. In 2011, the total average age for the
Maltese Islands stood at 40.5 years, with the figures for the
Malta and Gozo/Comino regions being 40.4 and 41.6 years
respectively [1].
Whilst the Southern Harbor region included the largest
concentration of older persons (14,869 persons, 18.8 per
cent of residents), the Northern Harbor region includes the
largest number of older persons (21,655 persons, 18.0 per
cent of residents) [1]. Due to higher levels of pollution and
lack of green spaces, both regions have become less popu-
lar with younger cohorts. Hence, it is no surprise that they
currently represent the ‘oldest’ inhabited regions. The Gozo
Region is unique in that although it includes the least num-
ber of older persons, persons aged 65-plus reach as much as
18.3 per cent of the total population. This region is not yet
facing the full repercussions of population ageing, as evi-
denced by the relative lack of demand for care services, due
to its small size and relative lack of females in the 45-plus
age cohorts in full-time employment. However, this is
bound to change in the foreseeable future, as younger fami-
lies continue to migrate to Malta and other EU countries,
increasing percentages of younger females in paid em-
ployment, and the increasing number of older Europeans
choosing to retire in Gozo [5]. In fact, the analysis of age-
ing indexes finds that Gozo registered an aging index of
125.9 - and hence, a much higher index of 110.3 and 109.1
as registered by the Maltese Islands and Malta respectively,
and only surpassed by the ageing indexes of the Northern
Harbor and Southern Harbor regions (both 132.0) [1]. One
envisages that in the coming years, the demand for ageing
welfare services in Gozo will increase dramatically.
92 Marvin Formosa: Population Trends and ageing Policy in Malta
3. Future Projections
Population projections indicate a continuously ageing
population where Malta’s population is expected to reach
429,000 persons by 2025 and down to just over 350,000 by
2060 [3]. The European Union anticipates that in the period
2010-2060 Maltese life expectancy at birth is projected to
increase from 77.6 to 84.9 years for males and 82.3 to 88.9
years for women [6]. Life expectancy at 65 years will in-
crease by 5.2 years for both males and females, from 17.0
years to 22.2 years for males and from 20.2 to 25.4 years for
females [3]. On the population front, children (0-14 years)
are projected to decrease from 15.5 per cent of the total
population to 13.1 per cent (-2.5 per cent), whilst the prime
age population (25-54 years) will also decrease, from 41.4
per cent of the total population to 34.6 per cent (-6.8 per
cent). The working population (15-64 years) will feature a
more dramatic decrease, from 69.4 to 55.8 per cent (-13.6
per cent). On the other hand, as expected, the older popula-
tion segment will incur extraordinary increases. The 65-plus
population will increase from 15.1 per cent of the total
population to 31.2 per cent (+16.1 per cent), whilst the
80-plus population will increase from 3.4 per cent of the
total population to 11.3 per cent (+7.9 per cent). The EC also
provided projected data for the 80-plus segment as a per-
centage of the 65-plus population and as a percentage of
65-plus segment: increases from 22.3 per cent to 36.3 per
cent (+14.0 per cent) and from 4.8 per cent to 20.3 per cent
(+15.4 per cent) respectively.
During the 2008-2060 period, the ‘old age’ dependency
ratio (people aged 65-plus as a percentage of the work-
ing-age population aged 15-64) is expected to increase by
39.3 percentage points to reach 59.1, six points more than
the EU-27 average [7]. This means that both Malta and the
EU would move from having four working-age people for
every person aged 65-plus to a ratio of 2 to 1. The Maltese
‘total’ dependency ratio (people aged 14 and below and
65-plus, as a percentage of the population aged 15-64) is
projected to increase by 39.1 percentage points to reach
82.1, three points higher than the EU-27 average. Finally, as
far as the ‘very old age’ dependency ratio (people aged
80-plus as a percentage of population aged 15-64 employed)
is concerned, this figure is projected to increase by 17.0
percentage points to reach 21.5, almost equivalent to the
EU-27 average of 21.5 in 2060.
5. Discussion
For many decades, policy responses to the challenges
arising from changing demographic trends have been pie-
cemeal and strongly compartmentalized in traditional policy
domains. However, in recent times one notices a strong
discourse on the need to integrate the multi-faceted strands
affecting ageing in a holistic policy. For many academics,
policy-makers, and supraorganizations such as the World
Health Organization [WHO], EU, and World Bank, the
answer to these policy challenges lies in the concept of ac-
tive ageing. The genealogy of active ageing can be traced to
the ‘successful ageing’ paradigm in the 1960s which focused
on denying the onset of old age and by replacing lost rela-
tionships, activities, and roles associated with middle age
with new ones that are pertinent to later life. Yet, it was in the
past two decades that the concept has become particularly
salient. Although initially policy emphasis was primarily a
productivist one, the ideological discourse surrounding
active ageing changed substantially when the WHO pub-
lished Active Ageing: A Policy Framework. For the WHO,
active ageing is the process of optimizing opportunities for
health, participation and security in order to enhance quality
of life as people age...The word ‘active’ refers to continuing
participation in social, economic, cultural, spiritual and civic
affairs, not just the ability to be physically active or to par-
ticipate in the labor force. [8]
The WHO approach made two key contributions to dis-
courses on active aging [9]. First, it added further weight to
the case for a refocusing of active ageing away from em-
ployment and toward a consideration of all of the different
factors that contribute to well-being in later life. Second, it
emphasized the need to influence individual behavior and
policy at earlier stages of the life course. In a nutshell, the
WHO approach paved the way for a comprehensive strate-
gy to maximize participation and well-being as people age,
operating simultaneously at the individual (lifestyle), orga-
nizational (management), and societal (policy) levels and at
all stages of the life course. In recent months, the EU took a
leaf out of WHO’s stance and started to advocate ‘guiding
principles’ stressing that active ageing requires measures to
be taken in a broad range of policy domains by many
stakeholders. Guiding principles were pinned upon the
triumvirate of employment, social participation, and inde-
pendent living, so that in March 2013 the EU and the Unit-
ed Nations Economic Commission (UNECE) issued a joint
statement: Active ageing refers to the situation where
people continue to participate in the formal labor market, as
well as engage in other unpaid productive activities (such
as care provision to family members and volunteering), and
live healthy, independent and secure lives as they age. [10]
Turning our attention to Malta, the nation’s credentials on
active ageing are far from satisfactory. In March 2013,
Malta placed 19th amongst EU-27 countries on the Active
Ageing Index [AAI] amongst the EU-27 Member States.
The AAI was developed in 2012 by the European Centre
for Social Welfare Policy and Research in Vienna in close
collaboration with, and advice from, the EU and UNECE.
To reflect the multidimensional concept of ageing, the AAI
is partly constructed from three key domains that refer to
the actual experiences of active ageing - namely, employ-
ment (employment rates for the 55-74 cohorts), participa-
tion in society (voluntary activities, care to grandchildren,
care to older adults, and political participation), and inde-
pendent/health/secure living (physical exercise, access to
health, financial security, physical safety and lifelong
learning). Presently, Malta holds a 26th, 15th and 17th
placing for these three dimensions respectively. The subse-
Social Sciences 2013; 2(2): 90-96 93
quent parts of this study discuss these three strands of poli-
cy making as they pertain to Malta [10].
5.1. Employment
In March 2013, the AAI placed Malta in a 26th position
amongst EU-27 countries as far as employment is concerned,
with Hungary positioned in the final place [10]. Such posi-
tioning was, of course, far from complimentary. In Decem-
ber 2011, the inactivity rate (persons who are classified as
neither employed or unemployed) among Maltese women in
the 55-64 age bracket was, at 84.6 per cent, one of the
highest in the European Union [11]. NSO statistics also
report that whereas inactivity among older women decreased
in the 55-59 age group between 2008 and 2010, inactivity
rates for those aged 60-64 and 65-plus increased. According
to Eurostat [12], employment indicators for Maltese older
workers for the 2005-2011 period show three key inferences:
a decrease and increase in the percentage of male and female
workers respectively, and an increase in the percentage of
‘total’ older workers. It is noteworthy that Malta’s rate of
older workers - especially with respect to the female and
total rates - is lower than the European Union [EU] averages.
More recent statistics demonstrate that while in 2012
(April-June) some 13.6 per cent of all employees were male
and in the 55-64 age group, the figure decreases to 7.5 per
cent among similar aged women [13]. The percentage of
male employees aged 65-plus was 1.8 per cent, whereas the
figure for females is so low that it is was not easily by sur-
veys, although a tentative figure of 0.4 per cent is forwarded.
Their employment distribution is largely in the public sector
(25.4 per cent) and professional services (20.9 per cent) [13].
Recent years witnessed various efforts on behalf of the
government to strengthen the presence of older workers and
adults in the labor market. Publicity campaigns to promote
active ageing have been carried out on various media such as
radio and street billboards. These campaigns have promoted
the qualities of older workers among employers, and tried to
encourage older workers to improve their employability
through lifelong learning. The 2008 Government Budget
included two measures meant to attract older people to the
labor market. The most significant measure was the change
in the legislation so that workers of pensionable age would
be able to continue working without losing their pension
entitlements, irrespective of the amount they earn. Until
2008, the full pension was safeguarded only if these workers’
salary did not exceed the national minimum wage. Although
collective agreements in Malta tend not to focus specifically
on older workers, there exists some industrial relations
practices, often based on the Maltese employment legal
framework, that assist older workers to remain employed.
For instance, the last-in first-out practice is advantageous for
older workers. The ‘Temporary Agency Workers Regula-
tions’ which came into effect in December 2011, was also
launched to help older people join or remain further in the
labor market, albeit on temporary contracts. As regards the
training and re-skilling of older workers, the ETC has de-
veloped a number of successful schemes which subsidized
the employment of persons aged 40 and over. For instance,
the Employment Aid Programme (EAP), launched in 2009,
aims to facilitate access to employment for several disad-
vantaged social groups by giving financial assistance to
those employing them (ibid). Nevertheless, despite such
positive measures, the Government has at times sent con-
tradictory messages with regards to older workers. Whereas
the official government position is to extend the employ-
ment exit age, it remains that the Government has embraced
and issues a policy of using early retirement schemes as a
means of reducing the deficits of ailing public sector com-
panies. Malta thus joins Spain, Greece, Italy, and France in
terms of a wide availability of a range of early exit and re-
tirement schemes, and its comparative belatedness in terms
of occupational retrenchment in later life [14]. Few policies
are present to encourage employers to recruit older indi-
viduals through subsidies, or to boost the protection offered
to older workers through anti-ageism legislation and training
measures. It is therefore recommended that Malta takes
responsibility for increasing the number of older persons in
the labor force at three operative levels. First, at an ‘em-
ployer’ level by decreasing the incentives to leave working
of early and to reduce strongly early retirement, and devel-
oping opportunities for persons above the statutory retire-
ment age to continue working. Secondly, at a ‘company’
level, in particular through the involvement by promoting
the implementation of lifelong learning for older workers,
improving working conditions, and modernize the organi-
zation of work to better meet the needs of older workers
while effectively using their expertise. And finally, at a
‘societal level’ by increasing the employment rate of older
workers by enabling society to think differently about the
potential contribution of older workers, and promoting a
shift in public opinion through educational campaigns.
5.2. Participation in Society
Malta holds a 15th place in the Ageing Index’s dimension
of ‘participation in society’, sandwiched between Spain and
Slovenia [10]. This mid-table position is due to the nation’s
average level of older volunteerism, care to older adults, and
political participation, although the same cannot be said to
social policies relating to grandparenthood. Recent statistics
for the year 2009 revealed that 27,250 persons aged 12 and
over (8 per cent of the total population in this age bracket)
were doing some form of voluntary work [5]. Just over half
these persons were contributing in voluntary organizations,
while 41 per cent were working in other institutions (e.g.
the Church). Fifty-two per cent of voluntary workers were
females. When analyzing the distribution by age, 36 per
cent were in the 25-49 age bracket, while 32 per cent fell
within the 50-64 bracket. As regards the number of volun-
teers aged 65 and over, this amounted to 3,690 - or 4.2 of the
total number of persons aged 65-plus [5]. Such a figure is, of
course, low. There is surely a need for policies that act as
a catalyst for older volunteering. Pragmatic measures may
include (i) providing information on volunteering oppor-
tunities and fostering training for older volunteers and those
94 Marvin Formosa: Population Trends and ageing Policy in Malta
coordinating and managing their activities, (ii) minimizing
the bureaucratic and financial constraints that volunteer
organizations face, (iii) tangibly supporting older volun-
teering as a way to promote healthy ageing and social in-
clusion of the individual, and (iv), ensuring that volunteers
are valued but not exploited as cheap labor. At the same
time it is also important that civil society expanding partic-
ipation by increasing the efforts of people who already vo-
lunteer, and outreaching those who, without specific efforts,
would not be involved in volunteering
Malta’s services targeting community care, whose objec-
tive is to enable older persons to ‘age in place’, are various.
The government coordinates a number of community ser-
vices for older persons aged 60-plus. These include Kar-
tanzjan (a card which entitle holders to certain rebates and
concessions), Incontinence service (supplying clients with
heavily subsidized diapers), Handyman service (supplying
clients with home-repair jobs ranging from electricity re-
pairs to plumbing, carpentry and transport of items), Tele-
phone rebate (providing clients with discounted telephone
rentals, Night-shelter (offering a secure and protective en-
vironment at night), Day Centers (preventing social isolation
and the feeling of loneliness, and reducing social interaction
difficulties), Telecare (automatic button that calls for assis-
tance when required), home care help (offering personal
help and light domestic work to clients with special needs,
and Meals-on-Wheels (support clients who are unable to
prepare a nutritious meal. Although existing research de-
monstrates that the community care system assists older
persons in ‘ageing in place’, it remains that the system suf-
fers several issues [5]. Quality can be variable, and there are
gaps in service coverage and limited choices for care reci-
pients. The system will be further challenged by an increase
in the numbers and expectations of older adults, and a rela-
tive decline in informal carers and the need for a larger
workforce. In brief, the community care policy for older
persons is based upon a ‘needs-led’ assessment, whereby the
state has the power to decide what services might be pro-
vided to meet need. One possible lacuna in this regard is that
‘need’ is an undefined concept so that the state has much
discretion how it will define and use the concept through the
application of ‘eligibility criteria’. Hence, Community care
for older persons thus runs the risk of becoming an unpre-
dictable element, varying from locality to locality, and va-
rying from time to time. Yet, there is an urgent need to im-
prove consistency and equity in access to and levels of home
care services by standardizing maximum levels of user
charges, rights to assessment, standardization of assessment
tools, and procedural rights.
As far as political participation is concerned, older per-
sons participate in above-than-average level as regards in-
stitutionalized politics. Some 94 per cent of persons aged
60-plus vote in general and local elections; moreover, older
adults are very active in party politics, many of whom are
members in political organizations and campaign strongly
on behalf of their party [5]. The same, however, cannot be
said as regards non-institutionalized (non-party) forms of
politics such as signing petitions or wearing badges with
political messages, contacting public officials or politicians,
and taking part in group activities such as street protests.
This is mostly due to the fact that older adults belong to a
generation that has distinctly traditional political preferences
which imbue them with a materialist value orientation and
‘old-school’ standpoints of representative democracy [5]. In
brief, older people in Malta are likely to be unfailing voters
and eager members in political parties, but less avid with
respect to ongoing political participation on issues which are
not the mainstay of traditional party politics. Finally, one
notes that despite the fact that 6 out of 10 grandmothers and
5 out of 10 grandfathers in Malta provide childcare for their
grandchildren, Malta is lagging behind when it comes to
recognizing the role of grandparents in intergenerational
care arrangements [5]. To-date, Malta have not joined other
EU countries to ensure grandparents’ role is supported
through such policy measures as parents being able to
transfer parental leave to grandparents, working grandpa-
rents being able to take leave if their grandchild is unwell,
and grandparents being paid for the care they provide under
certain circumstances (for example, to support teenage
parents). Undoubtedly, as our populations age there needs
more robust policies surrounding the grandparental role.
Herein, it is warranted that Malta commences as a serious
policy discussion on grandparental policy such as the pos-
sibility of having parental transferable allowance and leave
to grandparents (as in Hungary), grandparents providing
childcare will be able to claim national insurance credits (as
in the United Kingdom), and grandparents getting up to 10
days paid leave to care for a grandchild in an emergency (as
in Germany).
5.2. Independent, Healthy and Secure Living
Malta holds a 17th place in the Ageing Index’s dimension
of ‘independent, healthy and secure living’, sandwiched
between Romania and Estonia [10]. The ageing of popula-
tion is not the key reason for nations’ increasing expenditure
on health and welfare services. However, this is only the
case when nations invest significant financial and human
resources in lifelong health programs that, eventually, serve
to improve disability rates in later life. In 2000, the WHO
classified Malta as the 5th best performing health system
from a total of 191 countries. Indeed, health care in Malta
boasts exceptional levels of equity as it is available to all
citizens, irrespective of income. Total government expend-
iture on health as a percentage of GDP reached 8.6 per cent
in 2012 [5]. Major expenses include hospital services, sala-
ries, and medicinal products which are free for inpatients in
state hospitals, persons in low-income groups, chronically ill
persons, and those considered at risk because of their jobs.
Malta has gone a long way in the past quarter of a century as
far as geriatric services are concerned. Building on estab-
lished good practices in the health care of older persons, the
year 1987 witnessed the creation of a post of a Parliamentary
Secretary for the Care of the Elderly: Geriatric medicine has
Social Sciences 2013; 2(2): 90-96 95
been established in Malta since the year 1989 when the first
consultant geriatrician post was advertised and filled in the
state-run health services...the post of lecturer in Geriatrics
at the University of Malta was created and the subject
taught to medical students. [15]
Presently, geriatric medicine is recognized as a separate
specialty, with the government of Malta employing 11
consultant geriatricians who work mainly in the public re-
habilitation hospital and residential/nursing homes, con-
centrating on frail elders, and in specialty clinics - for ex-
ample, on memory, falls, and continence. This means that
there is a consultant geriatrician for every 6,000 persons
aged 60-plus, a figure that is better than most other EU
countries (Germany: 7,496, Spain: 7,701, United Kingdom:
8,871, Switzerland: 9,250, and Denmark: 12,001) [15].
Welfare services for older adults result from the dynamic
interplay of supports from the state and - to a lesser extent -
familial and voluntary sectors. In addition to community
care, which was discussed in the previous section, two key
facets of ageing welfare services include informal care and
long-term care. As elsewhere, the informal sector in Malta
consists of unpaid, or underpaid, family carers (usually
women) who in many cases experience high levels of stress
and burnout. The government offers a number of services
which family carers of frail older persons can apply to.
These include the (i) Non-contributory Carer’s Pension and
Social Assistance for Carers which provides economic
benefits to persons who are caring for older relatives on a
full-time basis, (ii) Social Work Unit which provides psy-
chological support, guidance, and assistance to informal
carers, (iv) training programs concerning the informal car-
ing of older persons, (v) Respite Services that temporarily
alleviate the burden on carers of older persons that are living
within the community, and (vi), domiciliary general nursing
services at a highly subsidized rate. There is no doubt that
compared to non-carers informal carers of older persons
experience higher levels of physical, emotional, and psy-
chological strains. One avenue that can be strengthened so
that the physical, social and psychological quality of life of
informal carers is improved is respite care. Available respite
care is temporary, short-term supervisory, personal and
nursing care provided to older adults with physical and/or
mental impairments. There is thus an urgent need for respite
programs that are situated in the older person’s home and in
residential/nursing settings. On one hand, in-home respite
care takes place in the home in which the older person lives.
Depending on the needs of the caregiver, in-home respite
care can occur on a regular or occasional basis and can take
place during the day or evening hours. Programs may pro-
vide personal and instrumental care for older persons, or
supervisory services. Caregivers view in-home respite care
as highly acceptable because they do not have to take the
older adult out of the environment in which he or she is most
comfortable. However, even in-home respite care has its
own limitations. It can be expensive, particularly if used
frequently and for several hours per day. Families may also
be reluctant to use in-home respite services because they
may not like having strangers in their homes or taking care
of their loved ones. On the other hand, residential and
nursing homes should also provide respite care, a service
that is usually opted for when care recipients require intense
care and supervision, and on a trial basis before permanent
nursing home placements.
For many years, long-term care [LTC] for Maltese older
persons was the sole responsibility of religious authorities,
and it was only in recent centuries that the state started to
provide residential/nursing care to frail elders. Presently, In
Malta, one finds four categories of LTC in Malta, depending
on whether they are owned by the government, the Church,
or private companies, and the 1,000-plus bed facility St.
Vincent de Paul Residence (SVPR) which is also govern-
ment owned. At the end of 2011, some 3.9/5.6 per cent of
persons aged 60/65-plus were presently in LTC [5]. With a
total of 2,097 beds for older persons, the Government has the
majority of the market share with 54.5 per cent of the li-
censed caring beds, followed by the private sector with 27.6
per cent (1,061 beds), and the church-run homes occupying
the remaining 17.9 per cent (690 beds). Whilst one cannot
doubt the great strides that health care services have expe-
rienced in recent decades, the existing system of LTC re-
mains under-resourced, inequitable, fragmented and inef-
fective. Unfortunately, a relative lack of planning and vision
for social care services in LTC is denying residents their
basic human rights. There is an urgent need to redress the
situation by meeting and overcoming three key challenges in
a coherent and consistent matter. Presently there is no leg-
islation on the setting up of nursing home services, with
Church-run and private LTC being governed by residential
requirements that are little more than health and safety leg-
islations. There is an urgent need for serious discussion, and
subsequently legislation, that establishes national quality
standards that focus on objectives of nursing residential care,
quality of care, education and training of staff, values,
staff-client ratios, monitoring and evaluation processes, and
physical environmental issues. The exclusion of older resi-
dents in the decision making in residential/nursing care must
be made a thing of the past. The daily running of residential
and nursing homes often involve intimate areas of residents’
lives, and tends to shape and influence their sense of identity
and worth. Residents in LTC, even those experiencing var-
ious physical and cognitive difficulties, must be involved in
the decision-making process so as to endow them with a real
sense of empowerment and autonomy. Indeed, improving
the quality of care in residential and nursing settings for
older persons is a fundamental priority for all health and
aged care services. There is a need to develop policies that
promote the human rights of residents in LTC settings. These
include the right to (i) human dignity, (ii) receive respect for
human dignity, physical and mental well-being, freedom and
security, and (iii) self determination.
7. Conclusion
Malta includes all the demographic characteristics of an
96 Marvin Formosa: Population Trends and ageing Policy in Malta
ageing population, with future projections noting that the
numbers and percentages of older persons are bound to
increase in the coming four decades. It is also clear that
changes in longevity, health and patterns of employment are
transforming how older Maltese citizens are experiencing
later life. It is therefore important that rather than viewing
older people as merely high users of services, the govern-
ment recognizes that older people have a range of characte-
ristics, perspectives and interests, which should be identified,
acknowledged and used to the benefit of society. To-date,
many older people already participate in and contribute to
society in a variety of ways. They provide support to their
families through caring for spouses or grandchildren, as well
as working as volunteers and supporting economic activity
as consumers. The challenge is to develop those structures
and supports that encourage older people to become new
role models and to remain fully engaged in their communi-
ties. To this end, an active ageing strategy facilitates greater
engagement of older people through the following: (i) pro-
viding a wide range of opportunities for older people, (ii)
seeking to increase motivation to participate in activities
based on the individual older person’s needs and wishes, (iii)
tackling any barriers to full engagement particularly for
those facing greater barriers such as those who are more frail
and dependent, and (iv), increasing awareness of the benefits
of engagement for older people and their communities. For
persons to really experience active ageing, it is imperative
that the Maltese government follows the advice of the WHO
[8] to provide education and learning opportunities
throughout the life course, possibilities for health literacy
sessions, and especially, pre-retirement planning. One must
enable the full participation of older people by providing
policies and programs in education and training that support
lifelong learning for women and men as they age. Older
persons are also to be provided with opportunities to develop
new skills, particularly in areas such as information tech-
nologies. Moreover, polices are to encourage as much as
possible people to participate fully in family and community
life as they grow older, even if they experience a range of
physical/cognitive issues and enter residential/nursing home
settings. Only so can we reach the United Nations’ dictum of
not simply ‘adding years to life’, but more importantly,
‘adding life to years’.
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... In 2016, the percentage of Malta's population aged over 65 was 19.4% (National Statistics Office Malta, 2017). By 2025 this demographic has been predicted to swell to 31.2%, highlighting a future decline in the percentage of the working population (Formosa, 2013). These developments and future predictions mean that ageing has become an issue for policy makers concerned with the effects of an ageing population on future economic growth and health and social care systems 1 . ...
... Malta's active ageing policy incorporates strategies and opportunities aimed at encouraging social participation, from the establishment of day centres and learning centres, to increasing motivation in older adults by noting their needs, addressing barriers to social engagement, and increasing awareness of the benefits of participatory lifestyles (National Commission for Active Ageing, n.d.). Critics have argued that the economic perspective is an intrinsic bias of the active ageing concept, which reflects neoliberal preoccupations with maintaining productivity in later life (Formosa, 2013;Gamble, 2009). They assert that the globalisation of neoliberalism can result in a neglect of crosscultural perspectives, detracting from a holistic approach which would incorporate other worthwhile pursuits (Formosa, 2013;Lamb, 2014). ...
... Critics have argued that the economic perspective is an intrinsic bias of the active ageing concept, which reflects neoliberal preoccupations with maintaining productivity in later life (Formosa, 2013;Gamble, 2009). They assert that the globalisation of neoliberalism can result in a neglect of crosscultural perspectives, detracting from a holistic approach which would incorporate other worthwhile pursuits (Formosa, 2013;Lamb, 2014). Trnka & Trundle, 2017 pp.10-11) argue that there is much evidence that refutes the notion of the totalising nature of neoliberal ideas, suggesting that "crosscutting forms of identities and collective and interpersonal ties can sometimes intersect, and at other times contest, neoliberal frames." ...
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... Among the latter cohort, while 6.8% and 53.5% of persons never went to school and held a primary education level, respectively, 71.5% held no educational qualifications. In 2015, immigration was the main driver behind population growth, with the number of immigrants (12,831) being almost triple the number of births (4325), and with the difference between immigration and emigration being the highest for the decade at 4176 [9] . Third-country nationals, European Union nationals, and Maltese citizens accounted for 44%, 43%, and 13%, respectively, of total immigration. ...
... As far as geriatric services are concerned, Malta has come a long way in the past quarter of a century. Geriatric medicine has been established in Malta since the year 1989 when the first consultant geriatrician post was advertised and filled in the state-run health services, and post of lecturer in geriatrics was created at the University of Malta [12] . The 1990s also witnessed the opening of an assessment and rehabilitation hospital specifically for older persons to enable them to return back into the community following hospitalization, and the inauguration of a Department of Gerontology at the University of Malta to run graduate and doctorate studies in gerontology, geriatrics, and dementia care [13] . ...
... Domiciliary health services include an interdisciplinary team made up of administrative staff, nurses, occupational therapist, podiatrists, personal caregivers, physiotherapists, social workers, and a dementia intervention team. Although the quality of these services can be variable, and there are gaps in service coverage and limited choices for care recipients, many community-dwelling older persons credit these services for improving their quality of life and the only reason whereby they can remain living in their residences and not enter residential or nursing care [12] . ...
... Among the latter cohort, while 6.8% and 53.5% of persons never went to school and held a primary education level, respectively, 71.5% held no educational qualifications. In 2015, immigration was the main driver behind population growth, with the number of immigrants (12,831) being almost triple the number of births (4325), and with the difference between immigration and emigration being the highest for the decade at 4176 [9] . Third-country nationals, European Union nationals, and Maltese citizens accounted for 44%, 43%, and 13%, respectively, of total immigration. ...
... As far as geriatric services are concerned, Malta has come a long way in the past quarter of a century. Geriatric medicine has been established in Malta since the year 1989 when the first consultant geriatrician post was advertised and filled in the state-run health services, and post of lecturer in geriatrics was created at the University of Malta [12] . The 1990s also witnessed the opening of an assessment and rehabilitation hospital specifically for older persons to enable them to return back into the community following hospitalization, and the inauguration of a Department of Gerontology at the University of Malta to run graduate and doctorate studies in gerontology, geriatrics, and dementia care [13] . ...
... Domiciliary health services include an interdisciplinary team made up of administrative staff, nurses, occupational therapist, podiatrists, personal caregivers, physiotherapists, social workers, and a dementia intervention team. Although the quality of these services can be variable, and there are gaps in service coverage and limited choices for care recipients, many community-dwelling older persons credit these services for improving their quality of life and the only reason whereby they can remain living in their residences and not enter residential or nursing care [12] . ...
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Background. Contemporary public policy in Malta is strongly geared towards improving the levels of healthy ageing of present and incoming cohorts of older persons. Methods. A content analysis of contemporary policy directions launched and implemented by the Government of Malta towards healthy ageing in Malta. Results. Healthy ageing policy in Malta follows the European Commission’s document Guiding principles for active ageing and solidarity between generations which underlined how societies must not be solely content with a remarkable increase in life expectancy, but must also strive to extend healthy life years, and to provide opportunities for physical and mental activities adapted to the capacities of older individuals. The government of Malta employs 14 consultant geriatricians who work mainly in the public rehabilitation hospital and residential/nursing homes, concentrating on frail elders, and in specialty clinics - for example, on memory, falls, and continence. Maltese policies on healthy ageing include the National Strategic Policy for Active Ageing, National Demetria Strategy, and the Minimum Standards for Care Homes in Malta, all of which include a range of recommendations that aim to lead older persons towards higher levels of healthy ageing, but which also include a number of limitations. Conclusions. In achieving better levels of healthy ageing - that is, the process of optimizing opportunities for physical, social and mental wellbeing to enable older people to enjoy an independent and good quality of life - this paper recommends four distinct and urgent pathways in healthy ageing policy: addressing the further prevention and reduction of the burden of excess disabilities, chronic disease and premature mortality; instigating an increased responsiveness to reducing risk factors associated with major diseases by taking comprehensive action to control the use of tobacco, increase physical activity for older adults, and the adoption of national nutrition action plans; investing more human and financial resources in long-term care services in the community and older persons’ homes; and upholding further national capacity for training in geriatric training.
... Nevertheless, in the case of Malta, the indicated geographical effect components determined the country's least favorable position in the ranking of the fastest-aging European countries. Malta is an example of a country suffering from inversion of the age pyramid, according to Formosa's findings [44]. The population of the Maltese islands has shifted due to decreased fertility and increased life expectancy. ...
... The Maltese government has been working to implement the concepts of active aging promoted by the World Bank, the WHO, and the EU since 2011, but it is a challenging effort. Policies adopted before the turn of the century require updating, modernization, and revision to be sustainable considering the current population trends, with the intent of encouraging active participation and involvement of older people [44]: ...
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... The advantage of women over men in life expectancy tables means that, similar to international statistics, married men and widowed women are overrepresented in later life. Most older women are constrained in a 'caring' straightjacket as they tend to marry men older than themselves who generally require various levels of social and health support, whilst also caring for siblings and, at times, even grandchildren (Formosa, 2013a). Malta's 'old age' dependency ratio (measured as the proportion of persons aged 65-plus as a percentage of the working-age population aged 15 to 64) has been experiencing a steady increase in recent decades. ...
... During the 2017-2018 academic year no less than 52 students were reading for a postgraduate degree at the Department of Gerontology, a considerable growth from six students in 2005. Research output by Maltese academics that publish local empirical data is also experiencing a notable upsurge, and include topics such as ageing policy and trends (Formosa, 2012a(Formosa, , 2013a(Formosa, , 2015a(Formosa, , 2017(Formosa, , 2018Formosa & Scerri, 2015), dementia care (Scerri, Innes & Scerri, 2016;Scerri & Scerri, 2017), educational gerontology (Formosa, Chetcuti Galea & Farrugia Bonello, 2014;Formosa, 2010Formosa, , 2012bFormosa, , 2012cFormosa, , 2016, intergenerational studies (Spiteri, 2016), income security (Formosa, 2014a;Grech, 2017), volunteering (Formosa, 2012d(Formosa, , 2014b, spirituality (Baldacchino & Bonello, 2013a, 2013bBaldachino, Bonello & Debattista, 2013), digital exclusion (Formosa, 2013b), public transport (Mifsud, Attard & Ison, 2017), assistive technology (Formosa, 2015b), long-term care (Pace, Vella & Dziegielewski, 2016), gerodontology (Santucci & Attard, 2015a, 2015b, and naturally, geriatric care management (Zammit & Zammit, 2012;Zammit, 2013;Zammit et al., 2013;Zammit & Fiorini, 2015). The publication of Active and healthy ageing in Malta: Gerontological and geriatric inquiries was motivated by the urgent need to continue expanding the dissemination of gerontological and geriatric research conducted in Maltese society. ...
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... Maltese demographic characteristics show an ageing population which will continue to develop in the next four decades (Formosa, 2013). Life expectancy has seen an increase in the past years and according to the National Strategic Policy for Active ageing (2014)(2015)(2016)(2017)(2018)(2019)(2020) it is anticipated to further increase in the coming years. ...
... A study conducted in 2012 assessing the needs of the 75+ older people in Malta found that irrespective of age and gender, the highest majority of them was able to see or hear from three to more than nine relatives on a very regular basis (Directorate for Health Information and Research, 2012). Formosa (2013) also found that six out of ten grandmothers and half of the grandfathers in Malta provided childcare for their grandchildren. ...
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... Malta includes all the demographic characteristics of an ageing population (Formosa, 2013). The rise in the older population puts them at an increased risk of inadequate diet and malnutrition. ...
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This edited volume provides a broad ranging view of the challenges and responses to the increasing age and age-associated morbidity of Malta's population, from considerations about the provision of a sustainable income in retirement to end-of-life and long-term care. The chapters range in scope from an overview of Malta's ageing population to considerations of various aspects of healthcare, ranging from oral health to dementia, nutrition to coronary disease, with a nice mix of both objective and subjective perspectives. The ageing of society will differ from country to country, and it is particularly valuable for countries with relatively well established programmes of gerontological education and training to be able to access information about the ageing of other, smaller countries. The opportunities afforded to small nations for developing a coherent, holistic approach to healthy active ageing enrich the field of gerontology, and this edited volume provides an excellent illustration of what can be done and what scope there is for further developments. This edited collection provides a full and comprehensive coverage of key issues related to health and activity in the context of ageing. With its broad perspective on the determinants and scope of health in later life, the collection is genuinely focused on preventive strategies as well as seeking to maximize the quality of life of older people who depend on health and care systems. The book will be of benefit to those working with older people in health and social care services in Malta as well as to researchers and students of gerontology. It is a unique and original contribution to gerontology. Active and Healthy Ageing in Malta: Gerontological and Geriatric Inquiries documents the outstanding progress in living conditions for older persons in Malta which resulted from policy advances in social and health care policies, and charts the challenges faced by Maltese society in providing improved and more equitable gerontological and geriatric services.
... Malta includes all the demographic characteristics of an ageing population (Formosa, 2013). The rise in the older population puts them at an increased risk of inadequate diet and malnutrition. ...
Chapter
Full-text available
In the Maltese Islands, the proportion of individuals aged 65 years and over is expected to increase significantly in the coming decades, placing significant burdens on healthcare and support services. One example of a costly consequence of ever-longer life expectancy is the increase in people with dementia, especially Alzheimer’s disease. The ageing process may involve changes in physiological, pathological and socio-environmental circumstances of an older adult. Such factors, alone or in combination, might affect nutritional needs with the consequence of malnutrition, encompassing undernutrition, overnutrition and nutrient-related deficiencies. Nutrition screening and assessment is vital in identifying and monitoring the nutritional status of older adults. Local data is scarce but required to inform policy and develop nutrition guidelines for the older population. Approaches to nutritional intervention involve a holistic approach and necessitates being individually adapted to the number of challenges encountered during ageing. Thus, meeting the dietary and nutrition needs of older people is crucial for the maintenance of health, functional independence and quality of life.
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Active aging is established as the leading global policy strategy in response to population aging. In practice, however, the term active aging serves as a convenient shelter for a wide range of policy discourses and initiatives concerning demographic change. The twin purposes of this article are, first, to examine its European origins and how it has been applied in the world's oldest region. This policy analysis illustrates the contrast between the primarily European discourse on active aging, which emphasizes health, participation, and well-being, and the U.S. discourse that prioritizes productivity. The application of active aging in Europe has, nonetheless, been predominantly in the productivist mold. The examination of the emergence of this key policy concept in Europe is contextualized by an outline of the changing politics of aging in this region. The second purpose of the article is to set out a new, comprehensive strategy on active aging that is intended to realize the full potential of the concept. Understanding of the need for this broad vision of active aging is facilitated by the historical policy review.
Effective labour market exit age (average exit age from the labour force
  • Eurostat
Eurostat, Effective labour market exit age (average exit age from the labour force). Accessed 12/08/12 from http://appsso.eurostat.ec.europa.eu/nui/show.do? data-set=lfsi_exi_a& lang=en, 2012.
Health Life Years in 2011
  • Eurostat
Eurostat, Health Life Years in 2011, Eurostat Newsrelease, 35, 2013.
The 2009 ageing report
European Commission, The 2009 ageing report. Luxembourg: Official Publications of the European Communities, 2008.
Active ageing in the European Union
  • K A Hamblin
Hamblin, K.A. Active ageing in the European Union. New York: Palgrave Macmillan, 2013.
Census of population and housing: Population. Malta: NSO
NSO, Census of population and housing: Population. Malta: NSO, 2007.
Active ageing: A policy framework
WHO, Active ageing: A policy framework. Geneva: WHO, 2002 (p. 12).
Ageing and social policy in Malta: Issues, policies and future trends
  • M Formosa
Formosa, M., Ageing and social policy in Malta: Issues, policies and future trends. Malta: BDL, 2014.
Labour force survey: Q4
  • Nso
NSO. Labour force survey: Q4/2011. Malta: NSO, 2012.