Mohammed T. Abou-Saleh

WORLD STATISTICAL TRENDS AND PROSPECTS 89Ratio2.52.01.51.00.5Table 16.2 Generational support ratios,more developed region, 1980–205045–49/65–70 65–69/80+1980 0.62 21990 0.58 1.562000 0.64 1.412010 0.64 1.12020 0.48 1.232030 0.41 1.082040 0.37 0.82050 0.35 0.71Source: United Nations, World Population Prospects:The 1998 Revision, Vol II.45–49/65–7965–69/80+0 1980 1990 2000 2010 2020 2030 2040 2050Yearchildren of older persons. A second ratio relates two generationsof older persons—those aged 65–69 to those aged 80 and over.Table 16.2 and figure 16.2 show these two sets of ratios over theperiod 1980–2050. The importance of these ratios is not in theirabsolute levels, but in the relative levels over time. The youngergenerational ratios reveal little meaningful change up to year2010, but thereafter decline steadily as the baby boom generationenters the older ages. The older generation ratios show morefluctuation. They have declined sharply from 1980 to the presentand will continue downward to 2010. They show a rise in 2020,but then slowly decline to below parity through the projectionperiod. In general, the shorter-term trends are somewhatreassuring in terms of the availability of potential caregivers butthe longer-term trends reveal the increasing pressures on supportsystems. It should be noted, however, that such ratios do notinform us about the capacity of younger generations to provideassistance, which can be affected by kin relationships andinvolvement in employment that precludes extensive assistance.SUMMARYPopulation aging is a pervasive and seemingly irreversible processfor countries in the world’s more developed region. Not only willolder persons increase dramatically in number and as a percentageof total populations, but dynamic forces will modify the sociodemographicand health status composition of aged populationsas well. Like the Struldbrugs or Immortals of Swift’s Gulliver’sTravels the advantages of life prolongation have complexconsequences, not only for the individuals involved but also forthe societies in which they are found.Figure 16.2 Generational support ratios, more developed region, 1980–2050. Source: United Nations, World Population Prospects: The 1998Revision, Vol IImembers or the strength of social networks, which appears tohave remained strong.Over the last few decades, increasing numbers of older personshave resided in institutions, although the proportions of suchpersons have not risen markedly in most developed countries 9 .While only 5–10% of older persons are in institutions at any giventime, approximately 40% of persons will be institutionalized atsome point in their lifetimes. Future prospects in light of thegrowing number of older persons living alone have given rise toconsiderable concern about the social, medical and economicissues of providing non-institutional vs. institutional care. Moreover,there is considerable policy debate over the optimal balancebetween family and state-provided care, whether in the home or ina more formal setting.This brief review of trends suggests that there are majordevelopments emerging from the growth of the older populationand increased longevity that signal important changes in thepotential care burden for vulnerable persons in the agedpopulation. In turn, it raises questions about potential caregivers,most notably members of younger generations. A broad indicationof the demographic indicators can be gained from examiningratios of the number of persons who are aged 45–49 to those aged65–79. The former can be thought of as a group consisting ofREFERENCES1. World Health Organization. Health of the Elderly: Report of a WHOExpert Committee. Technical Report Series No. 779. Geneva: WorldHealth Organization, 1989.2. United Nations. World Population Prospects: The 1998 Revision, VolII. New York: United Nations Secretariat, Department of Economicand Social Affairs, Population Division, 1999.3. Evans DA. The epidemiology of dementia and Alzheimer’s disease: anevolving field. J Am Geriatr Soc 1996; 44: 1482–3.4. Myers GC. Comparative mortality trends among older persons indeveloped countries. In Caselli G, Lopez A, eds, Health and MortalityAmong Elderly Populations. Oxford: Oxford University Press, 1996,87–111.5. United Nations. World Population Prospects: The 1998 Revision, Vol I.New York: United Nations Secretariat, Department of Economic andSocial Affairs, Population Division, 1999.6. Anderson RN. United States abridged life tables, 1966. National VitalStatistics Reports, Vol 47, No. 13. Hyattsville, MD: National Centerfor Health Statistics, 1998.7. National Institute on Aging. The declining disability of olderAmericans. Research Highlights in the Demography and Economics ofAging, No. 5, March 1999.8. Myers GC. Cross-national patterns and trends in marital status amongthe elderly. In Loriaux M, Remy D, Vilguin E, eds, Population Agees etRevolution Crise, Chaire Quetelet 86, Louvain-la-Neuve, Belgium:Institut de Demographie, Universite de Louvain, 1990, 469–81.9. Kinsella K, Velkoff VA. An Aging World 1999. US Bureau of theCensus, International Population Reports, Washington, DC: USGovernment Printing Office, 2000.