How in the World Will We Care for All the Elderly?
All over the world, people are living longer than ever before and posing caregiving challenges that span the globe.
We think of this phenomenon as particularly true of wealthy “first world” countries like the United States. But it’s not.
Consider these facts, drawn from a fascinating new portrait of global agingpublished by the United Nations Population Fund:
- Developing countries in Africa, Asia and other regions are experiencing the most rapid aging of their populations, not developed countries like those in Europe or North America. “Today, almost two in three people aged 60 or over live in developing countries, and by 2050, nearly four in five will live in the developing world,” the report says. (While 60 isn’t considered an entry point into older age here, it’s the cutoff used by the United Nations.)
- Developing countries are also seeing the fastest growth in the ranks of the “oldest old” — in this report, those 80 years old and above. By 2050, an estimated 280 million people in developing countries – most of them women, who tend to live longer than men – will be in this category, compared with 122 million in developed regions. Of course, this is the population group most likely to become frail by virtue of age and illness and to require the greatest assistance.
Here are some other facts that made my head spin: Almost 58 million people worldwide will turn 60 this year. By 2050, there will be more old people than children under the age of 15 for the first time in history.
It’s hard to wrap one’s mind around a demographic change of this magnitude and the caregiving challenges that it entails.
The true nightmare prospect is this: People live longer, with more chronic illnesses like high blood pressure or diabetes, in poorer health, requiring more attention from family members and costly medical care.
Should the globalization of aging follow that path, the strains on governments and families will be extraordinary and potentially devastating.
The best picture is this: People live longer, in good health, remaining productive, valued members of society who contribute in workplaces, communities and families through their later years, and are treated respectfully and supported economically and socially as they become frail.
The authors of the United Nations report argue that those goals are achievable, with well-thought-out policies and a firm commitment to care for the elderly while taking advantage of their wisdom, skills and experience.
But data in the report speaks to the enormous scope of this challenge. Witness this nugget: “Worldwide, more than 46 percent of people aged 60 years and over have disabilities and more than 250 million older people experience moderate to severe disability.”
Which conditions top the list in developing countries? Visual impairments like cataracts, glaucoma, refractive errors and macular degeneration, which currently affect 94.2 million people, hearing loss (43.9 million people), osteoarthritis (19.4 million) and ischemic heart disease (11.9 million).
Who will take care of older adults with these problems? Once it was a given that families would do so in the developing world, where nearly three-quarters of adults live in intergenerational households rather than on their own, which is the norm in the United States and Europe.
But as middle-aged adults leave rural areas for economic opportunities in the city – this is happening in Africa, large parts of China and other regions — older adults are left behind to tend to grandchildren and take care of themselves as best they can, without the aid of adult children.
“Informal support systems for older persons are increasingly coming under stress as a consequence, among others, of lower fertility, out-migration of the young, and women working outside the home,” the United Nations report observes.
What this means is that the old are taking care of the old in many instances.
Japan is currently the oldest country in the world, the only one where elders represent more than 30 percent of the total population. There, about 60 percent of so-called informal caregivers (friends or relatives who care for older people voluntarily, without being paid) are 50 or older.
“This percentage can be expected to increase steeply over the coming decades as a consequence of population aging,” the United Nations report says.
Thirty-eight years from now, 64 countries will stand alongside Japan with seniors exceeding 30 percent of their total populations.
It’s no surprise that the United Nations Population Fund reiterates the need for greater support for caregivers of the elderly. Progress is being made, it notes, with some countries (the Russian Federation, the Slovak Republic, Turkey, the United Kingdom and Canada) introducing paid “allowances” for caregivers, others passing laws supporting caregivers (Japan, Finland and Sweden) and still others developing national strategies relating to caregiving (Australia, New Zealand and Britain) But the needs outstrip resources being made available, in those nations, as well as here.
Countries around the world a decade ago developed a framework, known as the Madrid International Plan of Action on Aging, to respond to these trends and others, and a meeting is being held on Wednesday in New York to discuss the progress they’re making.
No one suggests enough is being done. But increasingly, there’s an awareness that the aging of the globe doesn’t lie off on the horizon: It’s a reality, here and now, and unfolding at breathtaking speed.
Enlightened policies, including those dealing with caregiving, may make a great difference in the experience of older adults in the years to come. Stasis and a failure to envision new ways of responding to these demographic shifts, both here in the United States and in the world that surrounds us, no longer seem an option, but the way ahead remains unclear.