ENGLISH ARTICLES

Ageing

Introduction

Over the past few years, the world’s population has continued on its remarkable transition path from a state of high birth and death rates to one characterized by low birth and death rates. At the heart of that transition has been the growth in the number and proportion of older persons. Such a rapid, large and ubiquitous growth has never been seen in the history of civilization.

Millions of older people across the world face chronic poverty, untreated illness, homelessness or inadequate shelter, violence and abuse, lack of education, little or no access to the law, fear and isolation.

We live in an era of unprecedented, rapid and inexorable population growth. Growing old, once the sole prerogative of ‘developed’ countries, is now a shared benefit of development worldwide.

A revolution in global life expectations

A person born in 1950 could expect on average to live for 46 years. By 2050 average global life expectancy will have risen to 76 years

By 2050, one in five people worldwide will be over 60

In every region except sub-Saharan Africa, the rate of population increase among the over-65s is higher than that for the under-14s. Even in sub-Saharan Africa the number of older people is growing faster than the number of children.

Older women outnumber older men. In 2000, there were 83 men for every 100 women worldwide. In developing countries, where gap was less wide, the ratio will have increased to 86:100 by 2030.

Age discrimination

All societies discriminate against people on grounds of age. Ageism and stereotyping influence attitudes, which in turn affect the way decisions are taken and resources are allocated at household, community and national level.

Policies that deliberately or by default exclude people from active contributions to society because they are 50, 60, or 80 years old are not only in breach of human rights principles but are a waste of human and social resources.

A change in mindset is needed to welcome older people’s contributions and participation, and take a fresh view of relations between the generations.

Poverty and exclusion

In developing countries and in eastern and central Europe, most older people live in chronic poverty. This material poverty not only denies older people the basic necessities – food, adequate shelter, access to health care and medicines. It also prevents the effective participation of older people in society at all levels.

Social exclusion distances older people from the mainstream of their society, making it less likely that they can participate in decision-making and planning in their communities. Younger generations lose access to the valuable knowledge, skills and experience of older people.

Health

In poor countries, lifetime exposure to health problems means that many people enter old age already in ill health. This is particularly so for women who, after years of physical hard labour, poor nutrition and many pregnancies are on the threshold of old age by the end of their reproductive years.

Barriers to good health include lack of access to healthcare and its cost. Treatment is often unaffordable for older people even when it is nominally free. Hospitals are concentrated in towns, far from the rural areas when the majority of older people live. Public transport is poor and sometimes too expensive to allow easy access to health facilities.

For many poor older people, physical health is their single most important asset. It is closely linked to their ability to work, to function independently and to maintain a reasonable standard of living. Illness in old age is an ever-present threat.

Healthcare and social protection systems face future difficulties in supporting growing numbers of older people in need of long-term care. In developing countries, the rapid increase in the numbers of older people needing healthcare, combined with the high levels of absolute poverty make this a formidable challenge.

Income

Most older people in developing countries work until very old age, or until they die. Very few are eligible for pensions or social assistance and, at the same time, they face discrimination in obtaining credit and training. Older women are less likely to qualify for state support, as they mostly work outside the formal sector. Women are less likely to have assets, and if widowed, may not have access to their husband’s property.

HIV/AIDS

Older people are both affected and infected by HIV/AIDS. They are at risk when they care for those who are infected, and when they are sexually active. Older women, often in severe poverty, nurse their dying children and care for their orphaned grandchildren.

Violence and abuse

Abuse of older people can range from physical violence to psychological pressure, and is a major unacknowledged problem, especially within families. At the other end of the scale, public violence, lawlessness and conflict expose the frail, the isolated and the poorest older people, especially older women, to abuse.

Rights

Old age is frequently presented as a matter of special pleading rather than basic human rights. In practice, poverty among older people is accepted as the norm; routine discrimination against older people, for example, in health care, is tolerated. Policy change has to be based on equal rights for older citizens.

(HelpAge International, State of the World’s Older People 2002 Executive Summary)

The Ageing of the World’s Population

UN Programme on Ageing / Population Division, Department of Economic and Social Affairs, United Nati

Over the past few years, the world’s population has continued on its remarkable transition path from a state of high birth and death rates to one characterized by low birth and death rates. At the heart of that transition has been the growth in the number and proportion of older persons. Such a rapid, large and ubiquitous growth has never been seen in the history of civilization.

The current demographic revolution is predicted to continue well into the coming centuries. Its major features include the following:

One out of every ten persons is now 60 years or above; by 2050, one out of five will be 60 years or older; and by 2150, one out of three persons will be 60 years or older.

The older population itself is ageing. The oldest old (80 years or older) is the fastest growing segment of the older population. They currently make up 11 percent of the 60+ age group and will grow to 19 percent by 2050. The number of centenarians (aged 100 years or older) is projected to increase 15-fold from approximately 145,000 in 1999 to 2.2 million by 2050.

The majority of older persons (55 percent) are women. Among the oldest old, 65 percent are women.

Striking differences exist between regions. One out of five Europeans, but one out of twenty Africans, is 60 years or older.

In some developed countries today, the proportion of older persons is close to one in five. During the first half of the 21st century that proportion will reach one in four and in some countries one in two.

As the tempo of ageing in developing countries is more rapid than in developed countries, developing countries will have less time than the developed countries to adapt to the consequences of population ageing.

The majority of the world’s older persons (51 percent) live in urban areas. By 2025 this is expected to climb to 62 percent of older persons, although large differences exist between more and less developed regions. In developed regions, 74 percent of older persons are urban dwellers, while in less developed regions, which remain predominantly rural, 37 percent of older persons reside in urban areas.

Over the last half of the 20th century, 20 years were added to the average lifespan, bringing global life expectancy to its current level of 66 years. Large differences exist between countries, however. In the least developed regions, men reaching age 60 can expect only 14 more years of life and women, 16 more, while in the more developed regions, life expectancy at age 60 is 18 years for men and 22 years for women.

The impact of population ageing is increasingly evident in the old-age dependency ratio, the number of working age persons (age 15 – 64 years) per older person (65 years or older) that is used as an indicator of the ‘dependency burden’ on potential workers. Between 2000 and 2050, the old-age dependency ratio will double in more developed regions and triple in less developed regions. The potential socioeconomic impact on society that may result from an increasing old-age dependency ratio is an area of growing research and public debate.

Ageing and development
 

“In Africa, it is said that when an old man dies, a library disappears. This reminds us of the vital role older persons play as intermediaries between the past, the present and the future; of the veritable lifeline they provide in society. Without the knowledge and wisdom of the old, the young would never know where they come from or where they belong. But in order for the old to have a shared language with the young, they must have the opportunity to continue learning throughout life.”
-United Nations Secretary-General Kofi Annan

Ageing in developing countries

Today, human society is being “restructured” by three simultaneous processes: globalization, urbanization and population ageing. Developing countries, once again, are being hit hardest.

The process of population ageing in developing countries will bring with it new challenges that are different from those confronted by developed countries. And within the group of developing countries, there are also commonalities and differences among regions and circumstances, including economic conditions, cultural traditions, family structure, the effects of widespread armed conflict, natural disasters, patterns of migration, refugee populations, catastrophic disease such as the HIV/AIDS pandemic, and even national laws. Three factors that contribute to the urgency of the process are the portion of the world’s population living in developing countries, the widespread poverty that persists there, and the rapid pace at which the ageing process is taking place.

It is somewhat surprising that, at the beginning of the “urban millennium”, with extraordinary migration to cities and towns taking place throughout the developing world, and with lower fertility rates, that most of the older population is still living in rural areas. But it can be explained: many young adults migrate to urban areas for economic reasons, leaving older persons behind; many older migrants who are leaving the workforce in urban areas often return to rural areas, and the HIV/AIDS pandemic strikes hardest at young adults.

Developing countries are facing a two-fold challenge: they must continue the process of development, which includes growing economies, providing education, and protecting human rights, at the same time that they must prepare for the ageing of their populations. And the process is expected to proceed much more quickly – in fact, startlingly so – in developing countries than it did in the industrialized world.

Population ageing in rural areas is already well under way.

• In rural areas of Africa, Asia and Latin America, the numbers of older presons are expected to double by 2025.

• In Africa, the number of older persons is expected to increase to 50 million, and in Asia, to 337 million.

• In 10 countries, mostly in sub-Saharan Africa, the proportion of older persons in rural areas is at least twice as high as that in urban settings.

In rural areas, older women outnumber older men.
In 40 countries, the proportion of older women in rural areas is higher, and in certain cases much higher, than the proportion of older men.

Other transforming processes are taking place in developing countries that could further threaten the “secure ageing” of most the world’s older persons in the decades ahead. In addition to migration and urbanization, the shift from extended to smaller, mobile families and the lack of access to technology that can promote independence, such as information and communications technology, and other socio-economic changes can further marginalize older persons from the mainstream of development, robbing them of their purposeful economic and social roles and weakening their traditional sources of support.

Ageing apace

• In France, it took 115 years, from 1865 to 1980, for the proportion of older persons to approximately double, from 7 per cent to 17 per cent.

• In China, it is projected that it will take only 27 years, from 2000 to 2027, for the proportion of the population aged 60 years and over to double, from 10 per cent to 20 per cent.

• In developing countries such as Colombia, Malaysia, Kenya, Thailand and Ghana, the rate of increase in the number of older people between 1990 and 2025 is expected to be 7 to 8 times higher than in the UK and Sweden.

• Developing countries are expected to have an increase of from 200 to 300 per cent in their older populations over a period of only 35 years.

• By 2020, it is projected that three-quarters of all deaths in developing countries could be age-related.

What will rural population ageing mean?

Population ageing in rural areas will be a powerful force for change. It will have major implications for agricultural production, food security, health services, labour markets and the process of development itself. It will also, without a doubt, affect social organization and production patterns. And families, the basic structural unit of rural societies, will experience rapid and significant demographic change, in many cases leading to reduced family support for older persons. Because of the speed with which rural ageing is expected to take place, the need for developing countries to make decisions, put policies in place and take concrete steps to prepare is urgent.

Some changes may seem to be fairly obvious; others may be less so.

• If possible, older farmers will very likely change to crops that are less labour intensive.

• Family livelihood strategies (saving and investment) may become more conservative and subsistence-oriented.

• Older farmers, especially poor ones, may be less able to adapt to technological change and less willing to experiment with new modes of production, which in turn could slow down agricultural modernization.

• Older farmers are much more likely to stop farming at any given time, due to retirement, ill health or death. In areas where many of the land-owning farmers are older, there is an increased likelihood that farms may be sold, transferred, or taken out of production. Such a situation could result in farm consolidation, or a change in crops. Land that is left unused and exposed to environmental degradation could result in decreased production.

Social and economic effects of ageing

It maybe as a social problem that effects of rural ageing will be felt most acutely, as the young move to the cities leaving older persons alone, sometimes in isolated areas, to look after themselves.

Many older persons in rural areas may not benefit from any significant pensions, health insurance or social security support. As the “urban commitment” of younger migrants to towns and cities grows, remittances sent home to rural areas may decrease, leaving older persons without financial support and without alternate resources. Segments of the older population could become marginalized and limited in opportunity, both financially and in terms of access: to economic resources, housing, health care and the ability to participate in social and economic life. An increasing gap could emerge between economically active and non-active persons, resulting in widening income gaps, or already existing social inequalities within countries could be intensified.

In such a situation, additional pressure will be placed on family and community institutions. As family support mechanisms break down, the costs of providing basic support services for the elderly will increase and become more difficult to meet. If forced to compete for scarce resources with older persons in urban areas, older persons in rural areas may lose out. Finally, the ageing of the rural population could reduce the growth of output and income, and thus adversely affect the overall economic performance of a country.

If such adverse scenarios develop without sufficient social preparations, many difficult questions will be posed for the state and for older persons. It may prove to be very difficult to ensure “secure ageing” in rural societies without serious preparations and planning. In more affluent societies, older persons may have the option of moving to towns where they can have family support, but in less affluent societies such an alternative may not be available. It is also important to remember that in many such areas poverty is still the norm.

“We must be fully aware that while the developed countries became rich before they became old, the developing countries will become old before they become rich.”

Is it all bad?

At the same time that there is much to worry about, it would be a mistake to view rural ageing as an all-negative trend. It some situations, it may offer valuable opportunities for positive change, such as altering rural socio-economic structures to new ones that are more supportive of sustainable development. In addition, the typical view of older persons as a liability or a constraint in a development model is narrow, inaccurate, and should be challenged. There are many benefits of ageing that are usually not recognized, such as the wealth of skills and experience that older people bring to the workplace, to public life and to the family. Technological advances and new ways of organizing society can be put to good use to increase the participation of older people in work, and to make appropriate socio-economic changes in rural areas.

Positive effects of population ageing

• In Asia and Latin America, the projected significant decline in the number of young people, together with the stabilization in the number of adults, is expected to reduce the current demographic pressures on land.

• There are some countries in Asia where the rural population has already aged significantly, and agricultural production has not suffered; on the contrary, due to increasing farm size and economies of scale, it has improved.

Dependency ratios: a window of opportunity

From the traditional viewpoint of dependency, large numbers of young and/or older people tend to burden the economy, as the consumption needs of economically “non-productive” members of society reduce the overall capacity for saving and investing. To put it more simply, having a large number of very young or very old, or both, is very expensive. But in recent decades, the most significant change in age structures in developing countries has not been the increase in older persons, it has been the reduction in the numbers of young people. The size of the 0-14 group has been declining in all developing regions since 1970-75, while the ageing of the population is only beginning, or is still in the future.

This lopsided shift – less young people before there are more older people – provides a “window of opportunity”, when the total burden of dependents per person in the active age groups is reduced. There will be a brief period when overall expenditure will decrease relative to overall production. This economic respite opens up some new options. Developing countries should take advantage of this period to invest in economic development, training and education.

At almost every point in this demographic shift, decision-makers have options regarding the ways in which they will respond to these predicted demographic changes. The challenge for the international community, and the opportunity for the Second World Assembly on Ageing, is to better inform their choices among the various possible options so as to determine a beneficial result and a beneficial outcome in rural areas. It is also a unique opportunity to take positive advantage of a social restructuring that cannot be stopped.

To better promote progress and security for people of all ages, countries must respond competently to the challenges posed by rural ageing, and they must seize the opportunity to rethink their agricultural and rural development policies. At almost every point in this demographic shift, decision-makers have options regarding the ways in which to respond to the changes, and it will be their choices from the various possible options that will determine the resulting outcomes. There are areas where the status of older persons is high and their decision-making power is significant. In such areas, collaborative policies towards older persons could be extremely beneficial. But in all cases, policy-makers and programme managers must be careful to increase their sensitivity to the capabilities and needs of older persons. Doing so will ensure that they make wiser decisions.

As an example, public policies could give tax breaks and other incentives to rural families to make it easier for them to take care of their older family members. Special support could be extended to women, who tend to live longer and be poorer, but who also have better chances than men to continue working into old age as small-scale farmers, traders, traditional healers and providers of domestic help. It is quite feasible to turn “liabilities” into “assets”, if provided with the appropriate supports and opportunities.

Extended working life and lifelong learning

In developed countries, it has long been recommended that older people be allowed to continue to work as long as they wish to or are able. This could have a beneficial impact on their income, on the labour supply, and on pension or social security plans. But in rural areas in developing countries, it may not be feasible. Where heavy manual labour is involved, it may be impractical. In areas stricken by HIV/AIDS, such as in much of Africa, older persons may already be working as long and as hard as they can: many of them, caring for adult children ill with HIV/AIDS, have been forced to take over the farm production in addition to becoming surrogate parents for their grandchildren. But in cases where it may be possible for older persons to work longer, supportive and innovative technical and organizational approaches to work and retirement should be used.

The lifelong-learning approach that has been suggested for retraining and skill enhancement in developed countries has not yet been tested with older persons in the rural environment. Such an undertaking would require large shifts in human resource policies, such as agricultural extension programmes, but it could provide the stimulus for innovative and creative alternatives.

Land tenure, land transfers, and ageing

The potential impact of population ageing on depopulation and land tenure is itself deserving of study. Today it remains poorly understood, together with its gender implications. Much more detailed examination is needed, especially on the need to fund services for older persons in more isolated rural areas. Such marginal areas would probably not be high priorities for social development, but it is incumbent upon modern states and nations to take steps to ensure that older persons in rural areas do not become marginal people.

The transfer of land among different generations may have far-reaching effects on food production, food security and development. Population ageing could change the way, or the stage of life, at which land is ceded from one generation to another. As heads of families and property live longer, there are many possible scenarios. With their parents living longer, adult children might migrate to urban areas. On the other hand, smaller family size could mean less children to share an inheritance, and thus strengthen a family’s commitment to a rural and agricultural lifestyle. More generations living at the same time could mean more generations cooperating at the same time.

It is important to recognize that older persons play a dynamic role in the transfer of land from one generation to another, especially in traditional societies. Where land use is communal, it may be decided by the land chief and his fellow elders, based on the principle of seniority. It would be a mistake for policy-makers to overlook the role of older persons, who may hold the most promise for developing new strategies to assure food security and social stability. Establishing constructive policies that collaborate with older persons is crucial to ensure that land transfers are favourable to agriculture and to future food security.

Policy actions and development strategies must take into account the broad-based differences between the ageing process in the developed and developing worlds, and they should specifically suit the different circumstances. It is especially important that such policy actions be developed and carried out locally.

The Food and Agriculture Organization

The Food and Agriculture Organization, headquartered in Italy, is mandated to raise levels of nutrition and standards of living, to improve agricultural productivity, and to better the condition of rural populations. Rural ageing is one of its priorities. FAO has undertaken a series of studies on rural ageing and its effects.

Population ageing: facts and figures
 

Unprecedented demographic changes are transforming today’s world. The figures are mind boggling, but outside the arenas of social policy, academia and intergovernmental bodies, the topic of population ageing most likely will provoke nothing more than a great big yawn. That in itself is surprising, because the changes presented in a new United Nations Report – World Population Ageing: 1950-2050 and an accompanying wall chart, Population Ageing 2002 – will have extensive repercussions in all of our lives.

The report was prepared by the United Nations to “provide a solid demographic foundation for the debates” of the Second World Assembly on Ageing in Madrid. According to the report, the demographic changes of today and tomorrow are extraordinary and profound. Human society will itself be restructured, as social and economic forces compel us to find new ways of living, working and caring for one another. No one will remain untouched. And we will probably never again see societies demographically shaped as those in the past, with a large base of young people and fewer elders.

• The ageing of the population today is without parallel in the history of humanity. Increases in the proportions of older persons (60 or older) are being accompanied by declines in the proportions of the young (under age 15). By 2050, the number of older persons in the world will exceed the number of young for the first time in the history of mankind. You may not have noticed, but this historic reversal in relative proportions of young and old took place by 1998 in the more developed regions.

• Population ageing is a global phenomenon that has or will affect every man, woman and child anywhere in the world. The steady increase of older age groups in national populations, both in absolute numbers and in relation to the working-age population, will have a direct bearing on relationships within families, equity across generations, lifestyles, and the family solidarity that is the foundation of society.

• Population ageing is already having major consequences and implications in all areas of day-to-day human life, and it will continue to do so. In the economic area, population ageing will affect economic growth, savings, investment and consumption, labour markets, pensions, taxation and the transfers of wealth, property and care from one generation to another. Population ageing will continue to affect health and health care, family composition and living arrangements, housing and migration. In the political arena, population ageing has already produced a powerful voice in developed countries, as it can influence voting patterns and representation. Older voters usually read, watch the news, educate themselves about the issues, and they vote in much higher percentages than any other age group.

• The proportion of older persons continued to rise throughout the twentieth century, and that trend is expected to continue into the twenty-first century. In 1950, the proportion of older persons was 8 per cent; in 2000 it was 10 per cent; and by 2050 it is projected to reach 21 per cent.

Other key findings:

• The trend towards older populations is largely irreversible, with the young populations of the past unlikely to occur again.

• The increase in the older population is the result of the demographic transition from high to low levels of fertility and mortality.

• Number of persons aged 60 or older – Today (2002), the number of persons aged 60 years or older is estimated to be 629 million. That number is projected to grow to almost 2 billion by 2050, when the population of older persons will be larger than the population of children (0-14 years) for the first time in human history. Fifty-four per cent, the largest share of the world’s older persons, live in Asia. Europe has the next largest share, with 24 per cent.

• Rate of growth increasing – Around the world, the population of older persons is growing by 2 per cent each year, which is considerably faster than the population as a whole. The older population is expected to continue growing more rapidly than other age groups for at least the next 25 years. The growth rate of those 60 or older will reach 2.8 per cent annually in 2025-2030. Such rapid growth will require far-reaching economic and social adjustments in most countries.

• Life expectancy at age 60 – The world has experienced dramatic improvements in longevity. Life expectancy at birth has climbed about 20 years since 1950, from 46 years to its current level of 66 years. Of those surviving to age 60, men can expect to live another 17 years and women an additional 20 years. However, there are still large differences in mortality levels between countries. In the least developed countries, the numbers drop to 15 years for men at 60 and 16 years for women. In the more developed regions, life expectancy at age 60 is 18 years for men and 23 years for women.

• Regional differences- Marked differences exist between regions in the number and proportion of older persons. In the more developed regions, almost one fifth of the population was aged 60 or older in the year 2000; by 2050, this proportion is expected to reach one third. In the less developed regions, only 8 per cent of the population is currently over the age of 60; however, by 2050 older persons will make up nearly 20 per cent of the population.

• As the pace of population ageing is much faster in developing than in developed countries, developing countries will have less time to adjust to the consequences of population ageing. Moreover, population ageing in the developing countries is taking place at much lower levels of socio-economic development than was the case in the developed countries.

• Today the median age for the world is 26 years. The country with the youngest population is Yemen, with a median age of 15 years, and the oldest is Japan, with a median age of 41 years. By 2050, the world median age is expected to have increased by ten years, to 36 years. The country with the youngest population at that time is projected to be Niger, with a median age of 20 years, and the oldest is expected to be Spain, with a median age of 55 years.

• The older population is itself ageing. In fact, the fastest growing age group in the world is the oldest-old, those aged 80 years or older. They are currently increasing at 3.8 per cent per year and comprise 12 per cent of the total number of older persons. By the middle of the century, one fifth of older persons will be 80 years or older.

• Sex ratio – The majority of older persons are women. Because life expectancy is greater for women than for men, today there are 81 older men per 100 older women. Among the oldest old there are only 53 men for every 100 women. The ratio of men to women at older ages is lower in the more developed regions (71 men per 100 women) than in the less developed regions (88 men per 100 women), since there are larger differences in life expectancy between the sexes in the more developed regions.

• Percentage of older population currently married – Older men are much more likely than older women to be married. This is because women live longer, and women tend to be younger than the men they marry. Today, 78 per cent of older men are married, but only 44 per cent of older women are. Most unmarried older persons have been widowed. Men are more likely to remarry – someone younger.

• Potential support ratio – The potential support ratio, or PSR (the number of persons aged 15-64 years per one older person aged 65 years or older), indicates the dependency burden on potential workers. The impact of demographic ageing is visible in the PSR, which has fallen and will continue to fall. Between 1950 and 2000, the PSR fell from 12 to 9 people in the working ages per each person 65 years or older. By mid-century, the PSR is projected to fall to 4 working-age persons for each person 65 years or older. Potential support ratios have important implications for social security schemes, particularly traditional systems in which current workers pay for the benefits of current retirees.

• Parent support ratio – The health of older persons typically deteriorates with increasing age, inducing greater demand for long-term care as the numbers of the oldest-old grow. The parent support ratio, the ratio of the population 85 or older to those aged 50 to 64, provides an indication of the support families may need to provide to their oldest members. Globally, there were fewer than 2 persons aged 85 or older for every 100 persons aged 50-64 in 1950. By 2000, the ratio had increased to 4 per 100, and it is projected to reach 11 by 2050.

• Levels of worker participation -Countries with high per capita incomes tend to have fewer older workers. In the more developed regions, 21 per cent of men aged 60 years or older are economically active, while in less developed regions 50 per cent of men are. In the more developed regions, 10 per cent of older women are economically active, compared to 19 per cent in less developed regions. Older persons participate to a greater extent in labour markets in the less developed regions, largely owing to the limited coverage of retirement schemes and, when they are available, the relatively small incomes they provide.

• Statutory retirement age – In more developed regions, men become eligible for full pension benefits at age 65 or older in more than one half of countries, while the most common standard retirement age for women is between 55 and 59 years. The standard retirement age in less developed regions is often lower than in more developed regions, most commonly between 60 and 64 years for men. For women, the standard retirement age in less developed countries is 64 years or lower. The differential between more and less developed regions probably reflects differences in life expectancy, which is lower in less developed regions.

• Literacy – Although literacy has been increasing among the older population, illiteracy is still common. In 2000 in the less developed regions, about half of all persons 60 or older were literate. Only about one third of older women and about three fifths of older men could read and write at a basic level of competence. In the more developed regions, literacy was nearly universal in all but a few countries.

The unparalleled demographic changes that began in the 19th and 20th centuries and will continue well into the twenty-first century are transforming the world. The years added onto our life expectancies and the widespread declines in fertility are producing dramatic changes in the structure of all human societies-most notably the historic reversal in the proportions of young and older persons. The profound and enduring consequences of population ageing will present enormous opportunities and challenges for all societies.

Issues related to population ageing and older persons have played a prominent role in the three major international population conferences organized by the United Nations over the past quarter century. The 1994 International Conference on Population and Development recognized that the economic and social impact of population ageing is both an opportunity and a challenge to all societies. More recently, at the 1999 Special Session on Population and Development, the General Assembly adopted additional key actions for the further implementation of the 1994 Programme of Action and again stressed the need for all societies to address the significant consequences of population ageing in the coming decades.

The report World Population Ageing: 1950-2050 and the wall chart Population Ageing 2002 were prepared by the Population Division of the United Nations Department of Economic and Social Affairs, which has a long tradition of studying population ageing and projecting its consequences. In 1956, the Population Division published a groundbreaking report on population ageing, which focused mainly on the more developed countries.

Women, Ageing and Health

World Health Organization

Three basic considerations impel the greater recognition of health of ageing women as a major health and development issue for the future:

The numbers of ageing women are increasing worldwide;

Women’s life course beyond age 50 extends for a significant period and is increasing everywhere in the world; and

There is a very significant scope for improving the health of ageing women and thus ensuring that they remain a resource for their families and communities.

Most ageing women are living in the developing regions of the world. Currently, more than half of the world’s women aged 60 years and over are living in developing regions, 198 million compared with 135 million in the developed regions. And the percentage of older women living in developing regions will grow dramatically in the future, since two-thirds of the women in the age group 45-59 currently live in developing countries as compared with only one third in the developed countries.

There are significant differences in life expectancy of women and men. In the developed nations of the world, women live on average six to eight years longer than men. Life expectancy for women now exceeds 80 years in at least 35 countries and is approaching this threshold in several other countries. However, the life expectancy of women in countries at different levels of development is markedly different, ranging from just over 50 years in the least developed countries through the 60s and 70s in those undergoing rapid economic development.

But life expectancy at birth alone can be misleading, disguising the duration of women’s lives in developing countries. For women in developing countries who survive the early lifespan stages to reach middle age, life expectancy approaches that of women in developed countries. At age 65, women in developing countries now have about three quarters of the remaining life expectancy of their counterparts in developed countries, and the gap will narrow in the future as mortality steadily declines at younger ages.

Longer lives are not necessarily healthier lives. Since the likelihood of disability increases with age, it is hardly surprising that national surveys reveal increasing numbers of disabled women among the older populations. In a few developed countries, however, recent data reveals that the rates of disability among the older population are steadily declining. The available data, on the other hand, is still insufficient to assess the real extent of disability among the world’s older women.

The term “healthy life expectancy” has been developed to describe the number of years one can expect to live in relatively good health. Healthy life expectancy is not necessarily life expectancy free of disease. Rather, the concept of healthy life expectancy as normally used refers to life expectancy without limitation of functions that may be the consequence of one or more chronic conditions.

More than forty-five countries now have estimates of healthy life expectancy. One general conclusion is warranted based on these studies: women can generally expect to spend more years of their lives with some functional limitations than men. This is valid for developed as well as developing countries.

Among the types of disability, mobility disability, in particular walking disability, is currently acknowledged as one of the most important quality of life and public health concerns of older women. Slow walking speed is a risk factor for falls and other accidents, resulting in fractures, further disability and loss of independence. In developing countries, loosing the ability to walk may be associated with even greater risks of adverse outcomes as walking is often the most common means of transportation.

While older women may suffer more functional limitations than men, it is inaccurate to say that older women are generally frail. It must be emphasised that the vast majority of older women and men are in generally good health, especially during the “young-old” ages. Recent studies in developed countries have shown that the prevalence of disability for both women and men to be less than 5 per cent for persons aged 60 to 64, less than 10 per cent for persons aged 70 to 74, and then rising to slightly more than 20 per cent among those aged 85 and over. And in developed countries, the rates of nursing home use are generally very low for persons under the age of 80. But with more and more women reaching 80 plus there is concern about the quality of their extended lives.

There are powerful economic, social, political and cultural determinants which influence how women age, with far-reaching consequences for health and quality of life, as well as costs to the health care systems. For example, poverty at older ages often reflects poor economic status earlier in life and is a determinant of health at all stages of life. Countries that have data on poverty by age and sex (mostly the developed countries) show that older women are more likely to be poor than older men. But in many developing countries there are often simply no reliable data on poverty tabulated by sex and age.

Poverty is also linked to inadequate access to food and nutrition and the health of older women often reflects the cumulative impact of poor diets. For example, years of child bearing and sacrificing her own nutrition to that of the family can leave the older woman with chronic anaemia.

Another determinant of health is education; levels of education and literacy among current cohorts of older women in developing countries are low. Increased literacy for older women will bring health benefits for them and their families.

Lack of safe drinking water, a gender-based division of domestic chores (including the carrying of water), environmental hazards, such as contact with polluted water, agricultural pesticides and indoor air pollution, all have a cumulative negative impact on the health of women as they age in many developing countries.

Older women everywhere are far more likely to be widowed than older men and most women can expect widowhood to be a normal part of their adult daily lives. While most women adjust both emotionally and financially to their changed situation, traditional widowhood practices in some countries result in situations of violence and abuse and pose a serious threat to older women’s health and well-being.

Widowhood is often being preceded by a period of caregiving to the deceased spouse combined in many cases with caregiving to dependent parents, grandchildren and other dependent family members. Older women are an important source of caregiving and such activities are most often unremunerated.

In many countries, access to health care is tied to coverage by national social security and health insurance systems which in turn is linked to employment in the formal sector of the economy. As many older women in developing countries have worked all of their lives in the informal sector or in unpaid activities, access to health care often remains unaffordable and difficult at best.

What is a gender-sensitive life course approach to older women’s health? Because the major preventable causes of morbidity and mortality all take effect over the life course, prevention strategies will be most effective when initiated as early in the life course as possible. For example, the health benefits of exercise and physical activities are well known and exercise should be promoted in all age groups from children to centenarians. Barriers for girls and women to exercise should be removed and culturally appropriate strategies for exercise should be put into place. This would help prevent functional dependence in old age and maintain mobility of older women at an adequate level for management of daily life.

Other modifiable risk factors associated with poor mobility in old age include smoking and deviance from normal weight. Cessation of smoking, promotion of exercise and improved diet are in fact primary prevention strategies for many causes of death and disability. In addition, it is of paramount importance that younger women have the opportunity to build and maintain strong bones in order to maintain bone density and prevent osteoporosis at later ages.

Another example of preventable diseases is heart disease and stroke which are the major causes of death and disability in ageing women, accounting for close to 60% of all adult female deaths. The common view of heart disease and stroke as men’s health problems has tended to overshadow the recognition of their significance for ageing women’s health. Half of all deaths of women over 50 in developing countries are due to these conditions. Although communicable diseases are not yet fully controlled in these countries, they are no longer important causes of sickness and death in old age.

For many types of cancer, particularly breast cancer and cervical cancer, early detection is the main strategy for prevention. For breast cancer early detection include physical examination of the breasts by trained health workers, breast self examination and mammography. As general screening programmes by mammography are still far beyond the resources of developing countries, there is an urgent need to improve the effectiveness of breast self examinations strategies.

WHO’s response to maintain the health of older women

WHO’s Ageing and Health Programme (AHE) recognises that gender is one of the major determinants of health. In addition to biological differences, a gender approach to health includes an analysis of how different social and economic roles, decision-making power and access to resources affect the health status of men and women at older ages.

The AHE Programme is committed to apply the gender perspective in all of its activities, notably in the areas of research, information dissemination, training, advocacy and policy development. Moreover, the Programme promotes the concept of Active Ageing which stresses that older people are a resource for their families and communities and that policies should be developed which enable older people to remain active for as long as possible in their later years. To facilitate the implementation of Active Ageing policies and strategies at all levels — national and community — gender sensitive guidelines and strategies are being developed. The AHE Programme works in close partnership with Governments, academic institutions and civil society organisations.

 Elder abuse widespread and unreported, says new report by Secretary-General

An older person, perhaps one of the “oldest old”, frail and dependent on others for their most basic needs, discovers that their bank account has been looted – by someone on whom they depends. An older woman, moderately disabled and living in a nursing home, is physically neglected by the staff and left to suffer intense pain that goes unrelieved and untended, due to common bedsores – which, left untreated, can result in death. An older man, depending on his family for care, is emotionally abused and humiliated, but remains powerless to stop it, due to his dependent situation. Abuse of older persons – physical, sexual and emotional – and their financial exploitation, commonly go unnoticed and unreported, with only the most severe cases commanding attention.

Growing awareness of incidents such as these has for the first time placed the subject of “elder abuse” on the United Nations agenda. A report recently released by United Nations Secretary-General Kofi Annan* surveys abuse of older persons around the world based on studies conducted over the last 20 years. The report, which will contribute to the discussions and negotiations at the Second World Assembly on Ageing in Madrid this April, finds that abuse is widespread, is usually not reported, and has significant financial and human costs.

How much abuse is there?

So far, large-scale studies on the prevalence of elder abuse have been restricted to developed nations, and the available data are limited. But the information that is available shows that both older men and women fall victim to abuse, and that abuse of older persons in both developed and developing countries is surprisingly widespread. In Australia, Canada and the United Kingdom, surveys have found that the proportion of older persons reported as abused or neglected range from 3 to 10 per cent. In Canada, neglect was found to be the most common form of abuse, at 55 per cent of reported cases. Fifteen per cent of cases were physical abuse, and 12 per cent were financial exploitation.

In the United States between 1986 and 1996, the National Center on Elder Abuse recorded a 150 per cent increase in incidents of abuse reported by state adult protective services. In one 12-month period, 36 per cent of nursing staff said they had witnessed an incident of physical abuse; 10 per cent were found to have committed at least one act of physical abuse; 81 per cent had observed an incident of psychological abuse; and 40 per cent had verbally abused a resident.

In developing countries, where most of the world’s older persons live – most of them poor – there have not yet been any studies or systematic collection of statistics done. Even so, there is ample evidence from crime records, news reports filed by journalists, social welfare records and some small studies, that elder abuse – physical, emotional and financial – is widespread.

In India, in a sample of 1,000 older persons, it was revealed that 4 per cent had been physically abused. In another smaller sample of 50 persons aged 70 years and over living in an urban area, 20 per cent said they had been neglected in their households. Similarly, in Argentina, 45 per cent of an urban sample of older persons reported that they had been mistreated, most often through psychological abuse.

In Brazil, a survey found that 35 per cent of reported cases of abuse were psychological, physical or financial. The other 65 per cent of incidents involved “social abuse”, where the victims believed they were discriminated against by society because of their age.

Abuse takes many forms
Abuse has many faces. It can be physical, causing pain or bodily harm. It can be emotional or psychological, such as verbal abuse, humiliation or intimidation. Or it can be financial, where a trusted caregiver may illegally use or misappropriate an older person’s financial assets or property.

Abuse also takes place within the family. This can include neglect, such as the failure to provide attention, adequate food, clean clothing, a safe and comfortable place to live, good health care, personal hygiene, and the opportunity for social contacts. Sexual abuse by caretakers ranges from violent rape to indecent assault or sexual harassment. Spousal abuse can combine many forms, such as physical, emotional and sexual abuse, financial exploitation, or neglect, in a lifelong or more recent partnership.

What makes such abuse especially wrenching is the dependence of the abused victim on the abuser.

Older persons can also suffer from a loss of respect within the family, which can result in behaviour that is disrespectful, dishonouring, isolating or contemptuous. Social or domestic violence can occur when the relations between an older person and his/her family break down. Sadly, the perpetrators of violence and abuse against older persons are most often family members, friends or acquaintances.

Older persons can also abuse themselves, through self-neglect. Sometimes cultural abuse takes place, such as when an older person – usually a woman – has been accused of bringing trouble or bad luck to a community in the form of a drought, flood, or a spate of illness and death. Incidents have been reported where a woman has been ostracized, tortured, maimed, or even killed if she failed to flee the community.

Abuse can also be political, and political violence and armed conflict can affect older persons directly or indirectly, through forced displacement. The special needs of displaced older persons are rarely provided for in humanitarian relief plans. In refugee camps, older persons often lose out when forced to compete for food and health care distribution.

HIV/AIDS-related violence occurs in countries affected by the pandemic, where older women are commonly burdened with care-giving responsibilities for dying relatives as well as orphaned children. The stigma of HIV/AIDS often leads to the isolation of members of affected households.

Abuse has consequences and costs
Although not widely documented, the financial and human costs of abuse of older persons are estimated to be quite considerable. The direct costs of the abuse are many and various: they can be costs associated with prevention and intervention, including providing services, criminal justice procedures, institutional care, and prevention, education and research programmes. The indirect and human costs of abuse of older persons result from reduced productivity, diminished quality of life, emotional pain and suffering, distrust, the loss of self-esteem, disability and premature death.

The mistreatment of older victims has been shown to cause a range of long-term physical and psychological health problems, including permanent physical damage; medication and alcohol dependency; lowered immune system response; chronic eating disorders and malnutrition; self-harm or self-neglect; depression; fearfulness and chronic anxiety; suicidal tendencies; and death.

A global response to the problem: protecting the rights of older persons
In some cases, mistreatment of older persons may be part of a broader landscape of poverty, structural inequalities and other human rights abuses. Such circumstances are often accompanied by low detection of cases of mistreatment, an absence of formal structures and mechanisms to respond to them, and a lack of resources to respond to violence against older persons or to empower older persons to prevent their abuse.

Intervention to treat the social, economic and political conditions that are fertile ground for abuse of elders can improve the general conditions of life of older persons, and can reduce the violation of their rights as well as those of other population groups. Since the 1980′s, efforts to promote the human rights and to protect the rights of older men and women have led to the recognition of elder abuse as a human rights issue. The Universal Declaration of Human Rights sets out core entitlements of all human beings in the civil, political, social, economic and cultural spheres.

The International Plan of Action on Ageing, adopted at the first World Assembly on Ageing in Vienna in 1982, outlines the rights of older persons. Furthermore, the United Nations Principles for Older Persons, adopted by the General Assembly in 1991, elaborate their rights in matters of independence, participation, care, self-fulfilment and dignity.

Commitments and guiding principles have also been adopted at United Nations conferences and summits with particular reference to advancing the rights of older persons. Among these are the Copenhagen Declaration and Programme of Action of the World Summit for Social Development, 1995; the Beijing Declaration and the Platform for Action of the Fourth World Conference on Women, 1995; the Further Initiatives for Social Development of the twenty-fourth special session of the UN General Assembly, 2000; and the United Nations Millennium Declaration of the United Nations Millennium Summit, 2000.

Awareness, education and advocacy
The response to the abuse of older persons has been focused on raising awareness and understanding of elder abuse. These efforts are reflected in the wide media coverage given to serious acts of abuse and cases of scandalous neglect. The media has played a critical role in bringing attention and stimulating attendant policy response to the abuse of older persons.

Educational programmes to equip participants in the assessment and detection of abuse and neglect for effective intervention have targeted lawyers, politicians, law enforcement officers, social workers and other professionals. Materials have been developed to assist them in this effort, including screening tools to identify abusive and potentially abusivesituations, protocols for referral and intervention, and training resource kits for service providers. Handbooks have been useful for caregivers to assess risks of abuse and to identify community resources for assistance.

The World Health Organization (WHO) has recognized the need to develop a global strategy for the prevention of the abuse of older people. This strategy is being developed within the framework of a working partnership between the WHO Ageing and Life Course unit of the Department of Non-communicable Disease Prevention and Health Promotion, the WHO Department of Injury and Violence Prevention, the International Network for the Prevention of Elder Abuse (INPEA), HelpAge International and partners from academic institutions in a range of countries.

Information dissemination has increased through fact sheets, training videos and CD-ROMs, and directories of help resources and websites.

National telephone help-lines have been established in a number of countries to educate callers about the abuse of older persons and available resources, and to refer them to help agencies. Non-governmental organizations also offer awareness and education programmes in a number of settings. Community development programmes that address needs and concerns of older persons have also helped to raise awareness and educate about abuse.

Legislation, protective mechanisms and legal intervention
In some countries, growing awareness of the abuse of older persons and changing social policies have led to the enactment of new legislation to criminalize elder abuse and to increase penalties for certain crimes against older persons. In some cases, regulations and policies have been adopted to supplement state laws and to establish enforcement systems. In other countries, there is thus far little or no legislation designed specifically to protect older persons from abuse.

WHO’s initial step in developing its global strategy was to set up a study in eight countries: Argentina, Austria, Brazil, Canada, India, Kenya, Lebanon and Sweden. The study involved focus groups of older persons in each community, and primary health care workers, in order to establish the different forms of elder abuse as identified by older people themselves and the primary health care teams. A focus on primary health care was chosen, as it is within this context that elder abuse can first be identified – or overlooked altogether. Making primary health care workers aware of the problem is thus a crucial step in preventing and managing elder abuse.

Analysis of the major themes revealed remarkable similarities across the participating countries. Older people perceived three broad categories of abuse:

• Neglect – isolation, abandonment and social exclusion
• Violation – of human, legal and medical rights
• Deprivation – of choices, decisions, status, finances and respect

The study concludes with recommendations for action, some of which are already being implemented with others to follow in the near future. These recommendations can be summarized as follows:

• Develop a screening and assessment tool for use in primary health care settings;
• Develop an education package on elder abuse for primary health care professionals;
• Develop and disseminate a research methodology ‘kit’ to study elder abuse;
• Develop a Minimum Data Set concerning violence and older people;
• Ensure dissemination of the research findings through scientific journals;
• Develop a global inventory of good practices;
• Mobilize civil society through raising awareness of the widespread magnitude of elder abuse.

World Assembly on Ageing (Background Info)

Global Action on Ageing

The world is getting older. In the next 50 years, the number of older persons will nearly quadruple, growing from about 600 million to almost 2 billion people. Today, one in every ten is 60 years and older. By 2050, one out of every five will be an older, and by 2150, one third of the people in the world are expected to be 60 years of age or older.

In some developed countries and countries with economies in transition, birth rates have fallen below replacement levels, and the number of older persons will be greatest in developing countries, where the older population is expected to quadruple over the next 50 years.

The ageing of the world’s population is a matter of concern for everyone – all generations in all countries, both developing and developed. This transformation in the make-up of the population will have profound consequences on every aspect of life – for individuals and for societies.

Developing countries will face the most difficult resource challenge, as they will be forced to deal with development and population ageing at the same time. But as people live longer, healthier and more active lives, an ageing population also offers opportunities that must be harnessed.

To address the challenges associated with this momentous demographic shift, the United Nations General Assembly decided to convene the Second World Assembly on Ageing from 8 to 12 April 2002 in Madrid, Spain.

Why a World assembly ?

This is not the first time that the international community has examined the challenges of individual and population ageing. At the first World Assembly on Ageing, held in Vienna in 1982, countries adopted the International Plan of Action, which has guided thinking and action on ageing over the past 20 years. The Plan recommended a variety of initiatives in employment and income security, health, housing, education and social welfare.

Now, 20 years later, as the world face the profound ageing of its population, the Second World Assembly on Ageing is being held to help governments and societies plan policies that will ensure that older persons can continue to contribute to society in a meaningful way to the best of their ability. In addition to a review of the Vienna Assembly, it will adopt a revised plan of action that will consider the social, cultural, economic and demographic realities of the new century. The revised plan of action – submitted in draft form as the International Strategy for Action on Ageing to Member States – is intended to be a practical tool to assist policy-makers in developing responses to the demographic changes taking place in their societies. The Strategy will stress the need to ensure that ageing has a basis place in all policy agendas, both domestic and international, and in other major documents for social, economic and human rights development.