Chapter One
Global Aging KAREN M. SOWERS and WILLIAM S. ROWE
The world is experiencing dramatically increased numbers of people living to an advanced old age. Often referred to as "the graying of the planet," this dramatic increase represents the most significant population shift in recent history (Obaid & Malloch-Brown, 2002). Population aging may be considered one of humanity''s major achievements while posing a major challenge for much of the world. This chapter provides an overview of global aging, shifts in the aging population, discusses similarities and differences among the elderly, and provides some suggestions for how you can become involved in promoting the well-being of the aged.
Aging is defined by the World Health Organization (WHO, 1999) as the process of progressive change in the biological, psychological, and social structure of individuals. According to the U.N. definition, persons 60 years and over are considered elderly (United Nations, n.d.).
GLOBAL DEMOGRAPHICS
Globally, the total population is growing at a rate of 1.2% annually. In 2000, the percentage of older persons was as follows:
Africa 5% Europe 20% Asia 9% North America 16% Latin America and Caribbean 8% Oceania 13%
More than 600 million persons in the world are 60 years of age or older. This represents about 10% of the world''s population. However, by the year 2050, 21% of the world''s population is expected to be 60 years old or over. In less than 50 years, one person in five will be over 60. Other basic facts about global aging include:
The increased life expectancy is a product of improved public health, sanitation, and development.
In 1950, 8 out of every 100 people were over 60. By 2050, 22 out of every 100 people will be over 60.
Life expectancy worldwide is expected to increase by 11 years, from 65 in 1995 to 2000 to 76 in 2045 to 2050, despite the impact of HIV/AIDS.
Most of the world''s older people live in developing countries.
Even in the poorest countries, life expectancy is increasing and the number of older people is growing. In 2000, there were 374 million people over 60 in developing countries-62% of the world''s older people. In 2015, there will be 597 million older people in developing countries-67% of the world''s older people.
In 2005, 1 in 12 people in developing countries were over 60. By 2015, 1 in 10 people in developing countries will be over 60 and, by 2050, 1 in 5 people in developing countries will be over 60.
In every region, the rate of population increase for the 65-and-over age group is higher than for the under-14 age group and the 15 to 64 age group.
Many older people in developing countries live in poverty:
80% of older people in developing countries have no regular income.
At best, older people live on between one-third to a half of average incomes.
Poverty rates in households with older people are up to 29% higher than in households without older people.
Over 100 million older people live on less than a dollar a day.
Lack of food is a serious cause of ill health in older people.
Older widows are among the poorest and most vulnerable groups in developing countries.
Older women outnumber older men:
In 2005, there were 83 men for every 100 women over 60 worldwide.
In developing countries, the gap is less wide: there are 91 men for every 100 women over 60. However, this gap is increasing-by 2015, there will be 89 men for every 100 women and, by 2030, 86 men for every 100 women.
Older people care for people with HIV/AIDS and orphans:
Older people are the primary caregivers for orphaned and vulnerable children affected by HIV/AIDS and those living with HIV/AIDS.
DEVELOPMENTAL ASPECTS OF AGING
Aging begins before we are born, is a lifelong process and continues throughout life. Throughout the life course, differing life experiences influence our capabilities and well-being in our later years. The functional capacity of our biological systems increases during the first years of life, reaches its peak in early adulthood and naturally declines thereafter (WHO, 1999). Throughout most countries (but not all), persons experience a long childhood and a long old age. These two lengthy developmental spans have provided great utility. Throughout history, it has enabled older persons to educate the younger and pass on values to them. The young are provided opportunities to learn from older persons when the elderly are in the home, the neighborhood, and in all forms of social life (International Federation on Ageing, n.d.). There is substantial evidence around the world that indicates that many older persons can and do lead productive lives and contribute financially, in child care and in emotional support to the family.
Gender does appear to effect the way people age. Throughout the world, women live longer than men. Eastern Europe, the Baltic States, and Central Asia have the largest differences in the life spans between men and women. Female life expectancy at birth ranges from just over 50 years in the least developed countries to well over 80 in many developed countries. As a result, the oldest people in most parts of the world are mostly women. Although women may live longer than men, they are affected more by disabling diseases in later life than are men. In fact, overall, the patterns of health and illness in women and men are markedly different. Because of women''s longevity, they are more likely to suffer from chronic diseases associated with old age. These include osteoporosis, diabetes, hypertension, incontinence, and arthritis (WHO, 1999). Many of these chronic disabling diseases significantly impact quality of life. To date, there is little scientific understanding of the life expectancy differences or the differences in relative health during the aging process (WHO, 1998).
Much of the developmental research to date has focused on the social and intellectual growth of children. But, as life expectancy increases, researchers are beginning to turn their attention to adult development and aging and as a result we are now beginning to understand how memory and learning abilities change over the lifespan, what types of memory decline, and what types are sustainable. Researchers are also beginning to study multiple related issues such as how social and family interactions contribute to successful aging, problems relating to work and retirement, and issues relating to living arrangements. But we urgently need for science to do more. It is critical for research to catch up to the worldwide aging phenomenon. For instance, we still need to know more about the factors conducive to achieving a satisfying and productive old age, how to improve and maintain memory and learning in later life, and how to best address sensory problems connected with failing vision and hearing and how these sensory impairments impact cognitive and social functioning (Canadian Psychological Association, n.d.).
What is known is that some life course factors which influence health and aging are modifiable by the individual. Research presents new opportunities for wellness promotion because people are able to influence how they age by adopting healthier life styles and by adapting to age-associated changes (WHO, 1999). Because the problems associated with development and aging are ones that all societies face, there is a critical need for interdisciplinary collaboration between the helping professions to apply current research findings to existing problems, identify the gaps in the knowledge base, and create new knowledge to better understand the developmental process of aging.
COMMON ELEMENT S OF GERONTOLOGY PRACTICE ACROSS THE GLOBE
Despite the many societal and cultural differences between countries, there does appear to be a common set of characteristics to gerontological practice. Those elements that appear to be fairly common across all countries include the areas discussed next.
Elder Maltreatment
Abuse of the elderly is found in almost all countries of the world. According to the World Health Organization (n.d.), elder abuse is expected to continue to increase, particularly as many countries experience rapidly aging populations. Throughout the world, both elderly men and women are at high risk of abuse, neglect, and exploitation. Although older men are at risk of abuse in about the same proportion as women, elderly women are at higher risk of abuse, neglect, and exploitation in cultures where women are devalued (Sowers & Rowe, 2006).
The World Health Organization (n.d.) estimates that between 4% to 6% of the elderly have experienced abuse in the home and that elderly are also at risk of abuse in institutions such as hospitals, nursing homes, and other long-term care facilities. Cultural and socioeconomic factors also appear to play an important role in elder abuse (Sowers & Rowe, 2006). According to the World Health Organization (n.d.) cultural and socioeconomic factors influencing abuse among the elderly include:
The depiction of older people as frail, weak, and dependent
Erosion of the bonds between generations of a family
Restructuring of the basic support networks for the elderly
Systems of inheritance and land rights, affecting the distribution of power and material goods within families
Migration of young couples to other areas, leaving elderly parents alone, in societies where older people were traditionally cared for by their offspring
Social Services
Countries that deliver social services to the elderly most commonly do so through existing health and social services networks. These generally include medical, legal, psychological, and financial help, as well as help with housing and other environmental issues. Because older persons who are more socially integrated enjoy a higher quality of life and better health, there is an emphasis on providing the elderly with the emotional and practical resources known to positively impact the aging process. These often include social clubs, religious activities, and family-based activities (WHO, n.d.).
Economic Services
Across the globe, the impact of population aging is increasingly evident in the old-age dependency ratio, the number of working-age persons (aged 15 to 64) per older persons (65 years or older) that is used as an indicator of the so-called dependency burden on potential workers. The rising dependency burden is most pronounced in Europe and Japan and least pronounced in Africa and the Middle East, but is a reality in nearly all countries (World Bank, n.d.). The United Nations (n.d.) estimates that between 2000 and 2050 the old-age dependency ratio will double in more developed regions and triple in less developed regions. In addition to the escalating dependency burden ratio, in many countries, traditional family support mechanisms are being eroded due to declining family size, rural to urban migration, urbanization, and declining co-residence, and in some countries younger family members dying of HIV/AIDS. As a result, many older people, and particularly older women, are faced with isolation, abandonment, loneliness, and no means of financial support. The potential socioeconomic impact on society that may result from an increasing old-age dependency ratio and other social shifts is an area of growing concern (Sowers & Rowe, 2006).
Pension systems play an important role in the economic stability of countries and the security of their aging populations. They serve to reduce poverty, eliminate the risk of rapidly falling standards in retirement, and protect vulnerable elderly people from economic and social distress. The World Bank (n.d.) suggests that the projected increase in the dependency burden ratio has two main implications: (1) They contend that pension systems that collect taxes from one generation to provide benefits to their parents will need to be adjusted to address the realities that elderly people live longer lives today than was anticipated when the systems were first designed. (2) They suggest that pensions systems be more flexible in the future to provide incentives for older workers to delay their retirement until later life in order to maintain a sufficient workforce. While calling for more flexible pension systems, the World Bank also notes that because countries have a number of different combination of elements that can impact their pension system that each country must develop their own pension system tailored to the needs of their specific country.
Health Services
Chronic and infectious diseases, many of which are direct results of life course events, influence the quality of life in older age. The types of conditions older people experience vary by country or region, economic status, gender, race, and ethnicity. In general, however, throughout the world those older persons with higher incomes report their health as being much better than do older people with less income (Dunkle & Norgard, 1995; Sowers & Rowe, 2006).
Long-term care for the elderly has been a challenge for all countries around the globe and the challenge will increase substantially in the years to come. In all developed nations, including the United States, the overwhelming majority of long-term care received by persons with disabilities of all ages is provided by informal caregivers, family members, or a combination of caregivers and family members. The United States does not have a comprehensive long-term care system. In general, the nation relies on Medicaid, a state administered safety net, as the primary source of financing for long-term care. Of the 29 nations that have older populations than the United States, most do not have strong or effective long-term care systems. Some, however do, for example, Germany and Japan have implemented comprehensive social insurance systems for long-term care. They cover a wide range of benefits in the home and community in addition to nursing home care. Many Scandanavian nations, as well as Austria, Japan, and Germany, have universal long-term care programs. These programs reach large numbers of their older populations and persons with disabilities. It may be useful to look to these countries that can serve as "natural laboratories" for tracking the impact of long-term care policy changes on coverage, cost, quality of care, and quality of life (Gibson, 2003).
Long-term health care for the elderly is problematic even in those countries that have traditionally placed a high value on the elderly. Most East Asian governments promote care for the aged as a family responsibility. As a result, they have not developed a sufficient number of long-term care facilities for frail older people (Choi, 2002; Ngan, 2004; Phillips, 1999). In China, there is a long-time tradition of children supporting their elderly parents. As a result, many families experience undue stress and financial strain (Choi, 2002; MacKenzie & Beck, 1991). Because of the rising incidence of suicide among the elderly as well as other family problems, many Asian governments are now exploring the need to introduce national policies on aging and long-term care to augment the traditional system (Howe & Phillips, 2001; Ngan, 2004). Japan, South Korea, Hong Kong, Singapore, and Taiwan are beginning to plan for a major increase in long-term care services (Ngan, 2004).
(Continues...)
Excerpted from Handbook of Gerontology Copyright © 2007 by James A. Blackburn. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Wishlist
Share
Tweet
Feedback
