Ageing E-Book

Christopher Phillipson

• Herausgeber: John Wiley & Sons
• Kategorie: Geisteswissenschaft
• Serie: Key Concepts
• Sprache: Englisch

Seitenzahl: 344

Veröffentlichungsjahr: 2013

Beschreibung

Ageing populations represent a key global challenge for the twenty-first century. Few areas of life will remain untouched by the accompanying changes to cultural, economic and social life. This book interrogates various understandings of ageing, and provides a critical assessment of attitudes and responses to the development of ageing societies, placing these in the context of a variety of historical and sociological debates.

Written in a highly accessible style, this book examines a range of topics, including demographic change across high- and low-income countries, theories of social ageing, changing definitions of 'age', retirement trends, family and intergenerational relations, poverty and inequality, and health and social care in later life. The book also considers the key steps necessary in preparing for the social transformation which population ageing will bring.

Ageing provides a fresh and original approach to a topic of central concern to students and scholars working in sociology, social policy and wider social science disciplines and the humanities.

Leseprobe

Table of Contents

Cover

Key Concepts series

Title page

Copyright page

Acknowledgements

1 Introduction: Understanding Ageing

Origins and arguments

Structure of the book

Part I: Demographic and Social Dimensions of Ageing

2 Ageing Societies in a Global Perspective

Introduction

Population ageing in the twenty-first century

Ageing in europe and the rise of the ‘oldest old’

Extended lives: Demographic and social contrasts

Conclusion: Is population ageing a ‘problem’?

3 Social Theories of Ageing

Introduction

Society and ageing: Context and theory

Social theory and social change

Ageing as a social construction

Social ageing and social inequality

Reconstructing later life: Consumption and the rise of the ‘third age’

Conclusion

4 The Development of Ideas About Age and Ageing

Introduction

Perspectives on age and ageing

Understanding age and ageing

Financial support in old age

Becoming ‘conscious of age’

Conclusion

5 The Social Construction of Ageing

Introduction

Transforming old age: The emergence of retirement and the welfare state

The emergence of retirement

Destabilizing ageing and retirement

From welfare state to risk society

Redefining later life

Conclusion

Part II: Inequalities and Divisions in Later Life

6 Ageing and Pensions: The Social Construction of Inequality

Introduction

Post-war developments in pensions

Globalization and pension reform

Privatizing pensions: The management of risk

Pension privatization and beliefs about ageing

Conclusion: The future of pensions

7 Families and Generational Change in Ageing Societies

Introduction

Generations and population ageing

Demographic and generational change

Changing family ties and social ageing

The rise of ‘personal communities’

The rise of transnational communities

Social ageing and social capital

Conclusion: Globalization and the future of intergenerational relations

8 ‘Late’ Old Age

Introduction

Constructing late old age

The medicalization of ageing

Ageing without dignity

Conclusion: The contingencies of ageing

Part III: New Pathways for Later Life

9 Preparing for Ageing Populations: Rebuilding Institutions

Introduction

Understanding ageing: Integration or segregation?

Extending working life: Myths and realities

Responding to population ageing: Issues for higher education

Conclusion

10 Conclusion: New Pathways for Later Life

Introduction

Recognizing new forms of solidarity

Conclusion

References

Index

Key Concepts series

Barbara Adam, Time

Alan Aldridge, Consumption

Alan Aldridge, The Market

Jakob Arnoldi, Risk

Colin Barnes and Geof Mercer, Disability

Darin Barney, The Network Society

Mildred Blaxter, Health, 2nd edition

Harriet Bradley, Gender, 2nd edition

Harry Brighouse, Justice

Mónica Brito Vieira and David Runciman, Representation

Steve Bruce, Fundamentalism, 2nd edition

Joan Busfield, Mental Illness

Margaret Canovan, The People

Alejandro Colás, Empire

Mary Daly, Welfare

Anthony Elliott, Concepts of the Self, 2nd edition

Ian Evans and Nicholas Smith, Knowledge

Steve Fenton, Ethnicity, 2nd edition

Katrin Flikschuh, Freedom

Michael Freeman, Human Rights, 2nd edition

Russell Hardin, Trust

Geoffrey Ingham, Capitalism

Fred Inglis, Culture

Robert H. Jackson, Sovereignty

Jennifer Jackson Preece, Minority Rights

Gill Jones, Youth

Paul Kelly, Liberalism

Anne Mette Kjær, Governance

Ruth Lister, Poverty

Jon Mandle, Global Justice

Anthony Payne and Nicola Phillips, Development

Judith Phillips, Care

Chris Phillipson, Ageing

Michael Saward, Democracy

John Scott, Power

Timothy J. Sinclair, Global Governance

Anthony D. Smith, Nationalism, 2nd edition

Deborah Stevenson, The City

Leslie Paul Thiele, Sustainability

Steven Peter Vallas, Work

Stuart White, Equality

Copyright © Chris Phillipson 2013

The right of Chris Phillipson to be identified as Author of this Work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988.

First published in 2013 by Polity Press

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Acknowledgements

I owe many debts of gratitude for help in the preparation and writing of this book. Keele University – where I was a member of staff until November 2012 – was a major source of support in my development as a sociologist of ageing. I am extremely grateful both for the help and assistance provided by the University over the years and also to colleagues, in particular in the Centre for Social Gerontology. Many of the ideas and arguments were developed at conferences organized by the British Society of Gerontology and the Gerontological Society of America. I very much appreciated the critical comments and thoughts received at these events – they certainly assisted in the process of sharpening and clarifying the themes developed throughout the book. A large number of people in the community of researchers working in the field of ageing have also helped shape many of the arguments put forward. Jan Baars, Carroll Estes and Dale Dannefer have been especially important in furthering my understanding of theoretical issues in critical gerontology; they have also been inspiring friends and colleagues through the highs and lows of producing research. I am enormously grateful to them for their advice and encouragement over the years. I have also been helped by Tom Scharf and have greatly benefited from his work examining the causes of inequality and exclusion in old age.

I am grateful to the team at Polity, in particular Jonathan Skerrett, for consistent support and encouragement. The manuscript benefited from close reading by referees and from their friendly advice concerning ways of improving the text. Tony Warnes also provided a number of excellent suggestions about clarifying certain points in the manuscript, and I am in his debt.

This book would have been impossible without help and assistance from my wife Jane and our children Isabel and Luke. They have been a major source of inspiration and advice. Writing certainly invades family life, but in this case nothing would have been written without their constant encouragement. The book is dedicated to them.

Chris Phillipson

1

Introduction: Understanding Ageing

Ageing populations now exert a major influence on all aspects of social and economic life. Concerns about the best way of resourcing such populations, their impact on standards of living, and relations between age groups and generations feature prominently in public debate and discussion. The twenty-first century will without question be a time when all societies take stock of the long-term impact of demographic change and the implications for managing and organizing a major area of social and economic activity. Thus far, discussions have been tentative at best, discriminatory at worst, focusing on the apparent ‘cost’ and ‘burden’ associated with population change. Doubts about the value and purpose of ageing seem, if anything, to have become more not less strident in the present century.

The reasons behind the continued anxieties about ageing are at least fourfold. First, demography is of course important. Demographic projections (reviewed in Chapter 2) indicate that many societies across the globe can anticipate having up to one-third or more of their populations aged 60 and over by 2050. And the numbers are substantial – China, for example, is likely to reach a total of some 480 million people aged 60 and over by the middle of the twenty-first century. Second, the ‘intensification’ of ageing – resulting from continuing falls in fertility and continuing gains in longevity – has coincided with a crisis in confidence affecting institutions arising from the financial crash of 2008 and subsequent economic recession. Suddenly, population ageing – often viewed as a ‘mixed blessing’ by western governments – has assumed even more negative connotations. Demographic change could not be said to have ‘caused’ the economic crisis, but – it is argued – finding solutions will become ever more difficult given the rising tide of elderly people and the health and social problems which they bring (Liedtke and Schanz, 2012). Increasingly, governments fall upon the spectre of population ageing as a way of explaining why resolving economic problems will be difficult and why the pain incurred in searching for solutions will create challenges for all age groups. Third, the potency of fears about the consequences of an ageing population has been reinforced because these are no longer viewed simply through the lens of the nation-state. As will be argued throughout this book, the role of global organizations in interpreting population change has become of major significance. Global actors take concerns about ageing to a new and often dystopian level – linking it to other vulnerabilities which seem to beset what is presented as a ‘runaway world’ (Beck, 2000). Finally, ageing seems to be a problem because the moral framework which once gave it security (family and community in particular) is now seen as fractured and detached, seemingly cutting individuals adrift at a time when their need for help and support is increasing.

In responding to the above arguments, this book has set itself three main aims. First, it tries to make sense of the wider context influencing discussions about ageing, whether in terms of the characteristics of demographic change, trends in relation to work and retirement, the complexities of pension provision or issues affecting the provision of health and social care. The second aim is to undertake a critical inquiry about what is meant by terms such as ‘age’, ‘old’ or ‘elderly people’. Indeed, one of the major points developed in this study is that misunderstandings about the nature of ‘age’, false assumptions about behaviours associated with particular ‘ages’, and the conflating of ‘individual ageing’ with ‘population ageing’ still influence many debates – lay as well as scientific. A third aim of the book is to provide a sense of the possibilities and potential inherent in ageing populations. Again, there is much work being undertaken in this area, to which reference will be made at appropriate points. But linking these discussions with a systematic overview of the nature and development of ageing populations, along with examination of the way in which ageing is socially constructed, provide a major focus of the present study.

Origins and arguments

This book builds upon my Reconstructing Old Age, published in 1998. That study pursued a particular argument: namely, that two key institutions supporting older people – mandatory retirement and the welfare state – appeared to be in decline, but with no obvious signs of replacement in respect of social and economic support. This book provides an opportunity to assess developments over the intervening period and to consider trends that might take place in the future. The changes affecting older people since the 1990s have been substantial. The institution of retirement has undergone further disintegration, with the policy of extending working lives now seemingly embedded in the discourse surrounding older workers. The welfare state has undergone similar transformation, with changes affecting a broad spectrum of activities from pensions to health and social care.

This study provides an opportunity to assess the implications of these developments. The argument put forward is that both sets of changes have created a sense of crisis for ageing populations. Mandatory retirement and the welfare state – for all their limitations (these are highlighted at different points of this book) – started to provide a framework around which ageing could be built. The uncertainty (to put the most neutral gloss possible on what have been seismic changes) affecting both institutions substantially deepened over the course of the 1990s and 2000s. Older people were enjoined to work even though the possibilities for employment appeared increasingly limited; they were tasked with creating their own sources of income over and above that provided by the state even while personal pensions declined in value; they were faced with organizing their own social care, under the guise of ‘personalization’, even though standards and quality of support were placed increasingly in doubt.

The above dilemmas and contradictions have been sharpened by two aspects which were less prominent when Reconstructing Old Age was written in the mid-1990s. First, although generational discord was highlighted in that book, it seems to have become a more prominent theme in UK and European debates since that time. True, there are prominent campaigns within the European Union and other bodies aimed at highlighting ‘intergenerational solidarity’. But the entry of the ‘baby boom’ generation into their 60s has given rise to new predictions of generational conflict, notably over meeting the welfare entitlements of what is increasingly presented as an over-privileged group (Howker and Malik, 2010; Mandelbaum, 2010). Second, the terms of the debate appear even sharper than in the 1990s as a result of the anxieties arising from long-term changes affecting work and social life. The late Tony Judt (with Snyder, 2012: 385) captured this point when he argued:

Gone is the sense that the skills with which you enter a profession or job would be the relevant skills for your working lifetime. Gone is the certainty that you could reasonably expect a comfortable retirement to follow from a successful working career. All these demographically, economically, statistically legitimate inferences from present to future – which characterised European life in the post-war decades – have been swept away.

The above quotation gets to the heart of worries about ageing – namely, that the institutions which might support this phase in life have been eroded to the point where insecurities and fears seem to have the upper hand. But the argument given in this book is that other possibilities also present themselves. ‘Ageing’ is viewed as a ‘problem’ because it seems to work against the grain of what is needed for a ‘growing’ and ‘productive society’. Yet the reverse point can also be made: ageing and continued gains in longevity raise the possibility for renewing and re-engaging with activities and institutions that were abandoned in the period of dysfunctional economic expansion which characterized the 1980s through to the early 2000s (Tett, 2010). Ageing populations may not restore balance to what is a chronic crisis affecting the economic system; but, as is argued in this book, they do provide new ways of thinking about social life, offering in the process radical solutions to supporting hard-pressed social institutions.

On this last point, it is important to point out that the arguments presented here are written from the standpoint of a sociologist trying to think about ageing, using the tools of social science, especially as applied to the field of social gerontology (the study of social aspects of ageing). The book does not assume extensive knowledge of sociology, let alone of gerontology. Rather, the aim has been to take the literature within and outside these areas and see how they can illuminate some of the issues and challenges raised by ageing populations. The sociological dimensions are also part of an underlying argument about alternative ways of viewing demographic change. The problem with conventional perspectives on ageing populations is precisely that they are primarily looked at from a public accounting perspective. But the concern here is to ask questions about how a group known as ‘older people’ engages with and changes social institutions (and vice versa). Crucially, the book puts to one side certain assumptions about ‘age’ and looks instead at the way these are built up through practices and activities which arrive at particular definitions and conventions for treating ‘old’ or ‘elderly’ people.

Structure of the book

The book is divided into three main sections. Part I sets out the context for understanding ageing populations, drawing on demographic, sociological and historical approaches. Part II extends the discussion by reviewing various examples of changes affecting ageing populations, including pensions, families and generations, and experiences in later life. Part III examines proposals for change in a number of key areas, including work, education and social relationships.

Part I starts off with a review of the development of population ageing, defining in the process what is meant by the term ‘ageing societies’ (Chapter 2). The chapter contrasts population ageing across the global south and north and examines gender and social class variations in life expectancy, and the rise of what is termed the ‘very elderly population’ (including the increasing number of centenarians). The chapter also examines population change within a sociological context, exploring various influences on beliefs and attitudes about ageing.

Chapter 3 examines the ranges of theories developed to understand social aspects of ageing. The chapter considers the context for the emergence of social theory applied to ageing, focusing in particular on the expansion of sociology in the US in the 1940s and 1950s. The initial influence of functionalist theory applied to ageing is highlighted, as is the emphasis upon individual adjustment to transitions associated with retirement and widowhood. The chapter then considers the shift in theoretical perspectives from the 1970s and 1980s, with the development of theories of the life course and the application of approaches drawn from phenomenology, Marxism and feminism. The rise of critical gerontology is assessed, with an emphasis on the social construction of ageing and the link between social ageing and social inequality. The chapter goes on to review further developments in theoretical perspectives on ageing, notably those focused around the rise of the so-called ‘third age’ and the importance of consumption in shaping the lives of older people. The concluding section reviews the future of theory in the field of ageing, highlighting the importance of theoretical perspectives for understanding the challenges facing older people and the societies in which they live.

Chapters 4 and 5 explore a series of arguments and illustrations about the way in which ‘age’ as a social category is defined and constructed. Chapter 4 provides a historical overview of the way in which ideas about ‘age’ and ‘ageing’ developed, drawing together various changes from the early modern period to the twentieth century. These trace the emergence of old age as a distinct part of life, albeit one which carried different meanings according to gender and social class. Chapter 5 extends the discussion by highlighting the way in which retirement and the welfare state formed the framework through which ageing was built, underpinned by the idea of a life course constructed around education, work and retirement. However, the chapter goes on to demonstrate the ‘destablization’ of retirement in the twenty-first century and the emergence of new forms of risk and insecurity associated with growing old.

Part II explores some of the above themes with a more detailed review of particular areas. Chapter 6 develops a critical analysis of the field of pensions, highlighting the impact of neo-liberal policies which emerged in the period from the 1970s onwards. The chapter examines problems affecting the provision of pensions and assesses their more general influence on expectations and attitudes about ageing. Chapter 7 then looks at the role of family and intergenerational relationships in the construction of ageing, asking questions such as: Do families still form a major part of people’s lives? Do generations work for or against each other? What are the implications of the changes accompanying globalization? In Chapter 8 we turn to what is referred to as ‘late’ old age and issues affecting people in their 80s and beyond. The chapter considers issues associated with the distinction between the ‘third’ and ‘fourth’ age, the impact of the ‘bio-medicalization’ of ageing and the crisis in the provision of care for people in institutions. The concluding section of the chapter explores the emergence of new fears and anxieties about ageing and how they link to the uncertainties surrounding the ending of life.

Part III of the book then considers some examples about how we might think in a different way about the potentials and possibilities of an ageing society. Chapter 9 sets out ideas for preparing for ageing populations, examining three main areas: new approaches to age integration, supporting older workers and lifelong learning. Chapter 10 continues the argument by identifying distinctive ‘pathways’ for later life, constructed through new forms of solidarity which can work across different generations and support a range of social groups and institutions. The areas identified are: mutual solidarities, family and friendship solidarities, caring solidarities and global solidarities.

This book was written at a time of intense debate about the costs and benefits of ageing populations. The entry of the baby boom generation into retirement contributed to soul searching about whether a ‘selfish’ generation was about to replace one that had been more ‘deserving’ of the benefits provided by the welfare state.1 At the other end of the age spectrum numerous reports appeared to suggest a breakdown in the care received by people towards the end of their life.2 More people started to write about their own ageing experiences or about caring for people with particular conditions associated with ageing.3 And the thing that is called ‘ageing’ itself became elusive as people came to redefine later life in a variety of ways, challenging many of the conventional labels. This book is, then, about the concept of ‘ageing’: where it comes from, what it means and where it might it take us in the years ahead. In short, it asks: What do we understand by the concept of ‘ageing’?

Notes

1 The literature on and by the boomer generation expanded at a rapid rate through the 2000s. Some examples include: Diski (2009) with a biographical account; Buckley (2007) and Grant (2010) with fictional accounts; Willetts (2010) a critical review of potential tensions between generations; Phillipson et al. (2008) an overview of the construction of boomers as a ‘problem’ generation; Bonvalet and Ogg (2011) on the housing and consumption experiences of boomers.

2 These reports will be discussed in Chapter 8 of this book.

3 Athill (2008) provides a powerful account of her own ageing; Davidson (1997) the challenge of caring for someone with dementia.

Part I

Demographic and Social Dimensions of Ageing

2

Ageing Societies in a Global Perspective

Introduction

The twenty-first century has witnessed the emergence of population ageing as a global economic and social trend. Most countries in the world – even those with long-established older populations – are still in the process of adjusting to the implications of the changes involved. These are likely to be substantial, reaching into all aspects of cultural, economic and social life. Yet it is important to provide a balanced assessment of the type of challenges that demographic change will bring. Issues concerned with maintaining health and social care will doubtless occupy a prominent place in debates and will be discussed at different points in this book. But ageing populations will be transformative for society in various other ways, bringing innovative lifestyles, creating different types of communities and relationships, expanding the range of leisure and cultural activities and developing new institutions.

As will be argued, there are in fact many different paths likely to be followed by ageing populations. These will reflect factors such as social and cultural variations across different societies, contrasting levels of resources within and between countries, differences in the speed of demographic change and contrasting attitudes towards older people and the idea of ageing. The purpose of this chapter is to review the key demographic drivers behind population ageing, setting these within the broader global context which forms the organizational framework for this book. The chapter first reviews the development of population ageing, defining in the process what is meant by the term ‘ageing societies’. It goes on to survey contrasts between different societies – both within high-income countries and in comparison with low-income countries of the global south. We will also consider gender and social class variations in life expectancy, and the rise of the very elderly population (including the increasing number of centenarians). The discussion then places population change within a sociological context, examining questions about the link between the development of ageing and individual beliefs and attitudes. Finally, the chapter considers a theme which will be returned to at various stages throughout the book: Why are ageing populations often presented as a ‘problem’? What is the historical context for this? What alternative arguments might be developed in response to such views?

Population ageing in the twenty-first century

The ageing of populations was one of the most important developments of the twentieth century and will raise major challenges for life in the twenty-first. The proportion of the global population aged 65 and over in 1900 was 1 per cent (UK 5 per cent); in 2000 it was 7 per cent (UK 16 per cent) and by 2050 it is estimated that it will be 20 per cent, a figure that the UK is likely to reach in 2020. Population ageing refers to both the increase in the average (median) age of the population and the increase in the number and proportion of older people in the population. This change arises during the move from a demographic regime of high fertility and high mortality to one of low fertility and relatively low mortality. The former is associated with fast-growing young populations; the latter with more stable populations including a larger proportion of people in the older age groups. This process is described in the demographic transition model, derived from observations of the experiences of West European countries over the course of the nineteenth and twentieth centuries. Two clear phases are identified in this model. In the first, mortality rates decrease as a result of economic growth, improved material well-being and advances in public health. Fertility rates stay high, however, leading to a rapid increase in the size of the population, reinforced by higher survival rates through childhood and beyond. Moving into the twentieth century, a second phase unfolds, with a decrease in the number of babies being born and greater prominence and awareness of older age groups (reflected, for example, in concerns about the danger arising from ‘declining populations’ expressed in the 1930s and 1940s).1 By the second half of the twentieth century, in most European countries, birth and death rates converged to produce either stable populations or ones with relatively slow rates of growth (but with both influenced by the impact of migration).

Lloyd-Sherlock (2010) highlights limitations in the demographic transition model given its origins in western experiences of economic development, with trends in Asia, Africa and Latin American often at variance with those found in Europe. He notes:

In a small number of countries with strong Islamic cultures or with extreme levels of poverty there is little sign of any significant or sustained drop in fertility … In many developing countries the ‘lag period’ between falls in mortality and falls in fertility lasted much longer than it did in Europe, greatly increasing population growth. In many of the same countries, the eventual fall in fertility was much faster than it had been in Europe. For example, in India the average number of children a woman could be expected to bear fell from 5.4 in 1970 to 2.7 in 2000. As a result, countries like India are now dealing with the consequences both of the long lag period (a very large total population) and of the halving of fertility in a single generation (rapid changes in its age structure). (Lloyd-Sherlock, 2010: 14)

Definitions of population ageing vary (see Victor, 2010 for a review), but a common approach in official surveys takes the relative size (percentage) of those aged 60 years and older (both sexes) or 60 (female) and 65 (male) and older within a given population. Gavrilov and Heuveline (2003, cited in Victor, 2010: 64) suggest that, by convention, an ageing population is one defined as 8–10 per cent (or more) of the total population aged 60 years or older. Using this criterion, in 2007 there were 66 countries in the world that had 10 per cent or more of their populations aged 60 years and over, with a further 16 per cent in the 8–10 per cent banding (United Nations, 2009). On the other hand, Lloyd-Sherlock (2010) highlights the difficulties arising from using a particular age category (e.g. 60-plus), especially when drawing comparisons between richer and poorer countries. As his analysis shows, being 60 years old means very different things for women in countries such as Japan, India and Senegal, with wide variations in the number of years they may expect to survive and remain healthy.

In numerical terms, and with the above qualification in mind, the proportion of the world’s population over the age of 60 is now increasing more rapidly than in any previous era. In 1950 there were around 200 million people over 60 throughout the world; this had increased to around 550 million by 2000. By 2025, their number is expected to reach 2 billion (United Nations, 2009). Globally, the population of older persons is growing at a rate of 2.6 per cent per year, considerably faster than the population as a whole, which is increasing at 1.2 per cent annually. The pace of demographic ageing is especially strong in the global south. Of the world’s 65-plus population, 62 per cent (313 million) live in developing countries (2008 figures), where current aggregate growth rates of older populations are more than double that of developed countries (Kinsella and He, 2009). It is most noticeable in countries such as China, where fertility is well below replacement levels and life expectancy greater than 71 years. Projections suggest that by 2025 China alone will contain a larger number of older people than the population of the whole of Europe, with the proportion aged 65 and over doubling – from 6.9 per cent to 13.2 per cent – over the period 2000–25. In Asia, which contains the bulk of the world’s population, median age2 will increase from 26.1 to 38.7 between 2000 and 2050. Europe will age at a slower rate but from an older starting point, with the median age over the same period rising from 37.7 to 47.7 years. Oceania and North America will follow a similar pattern.

In absolute terms, the countries with the largest numbers of people aged 60 and over are China (160 million), India (89 million), the United States (56 million), Japan (38 million) and the Russian Federation (25 million). These countries account for around 45 per cent of those aged 60 and over worldwide, compared with European countries which account for 9 per cent (United Nations, 2009). By 2050, 32 countries are expected to have more than 10 million people aged 60 or over, including five countries with more than 50 million older people: China (440 million), India (316 million), the United States (111 million), Indonesia (72 million) and Brazil (64 million).

The demography of countries comprising sub-Saharan Africa (SSA) is more complex, given the continuation of high fertility alongside the impact of HIV/AIDS and the high rate of mortality among younger age groups. Two consequences follow: first, with rapid population growth, the absolute numbers of older people will increase; second, high mortality among younger people is likely to increase the proportion of older people in the population of many African countries. The number of people aged 65 and over is projected to increase by about 10 million in SSA between 1999 and 2015. While the overall population size will increase by 47 per cent during this period, the growth in the number of people of 65 years or older is set to rise by 57 per cent. Aboderin (2010: 412) notes that while sizeable proportions of older people in SSA countries are ‘likely to be vulnerable to ill-health and poverty, this is not the case for all – or even most’. In this context, she makes the following point: ‘We know little about the precise nature of social disparities in old age in SSA and about the life course and contemporaneous factors that give rise to them. This is compounded by the questionable merit of currently available measures for capturing older individuals’ social and economic position or health status’ (2010: 412).

International migration is another factor influencing the composition of ageing populations. The impact of migration flows from Asia and Africa to Europe (and similar south to north movements in the Americas) means that ethnic diversity will be an increasingly important factor in the make-up of older populations. The UK illustrates this point well: the 2001 Census showed just half a million people aged 65 and over from ethnic minorities. This number is projected to increase to 1.3 million by 2026 and 3.8 million by 2051, with especially strong representation by groups from South Asia. Reviewing these figures, Lievesley (2010) suggests that there is likely to be a sharp rise in the number of black and minority ethnic groups after 2021, with significant implications for policy and planning. This is because of the clustering of these populations in particular urban areas, the diversity of their needs in respect of health and social services, and the impact of lifelong inequality in shaping resources in older age (Nazroo, 2006).

The speed of demographic change is an important aspect influencing the capacity of national institutions to provide adequate resources and support. Population change in developed countries took place over a relatively long historical timeframe: France (where the outlines of an ageing population first emerged) took 115 years for the percentage of the population aged 65 and over to go from 7 to 14 per cent; in the case of Sweden it took 85 years; for Australia 73 years; and for the UK 45 years. The contrast for many developing countries is striking: China took 26 years; Sri Lanka 24 years; Brazil 21 years; and Columbia 19 years. The Chinese case illustrates very fast population ageing set to occur over the course of the twenty-first century. The proportion of persons aged 65-plus stood at 6.9 per cent in 2000. However, Yi and George (2010) note that under medium fertility and mortality assumptions, Chinese aged 65 and older will account for about 16.4 and 23.9 per cent of the total population by 2030 and 2050, respectively. Yi and George (2010: 425) highlight particular pressures facing older people in rural areas in China, a consequence of the massive migration of rural young adults to the cities and the limited availability of pensions (an issue repeated – given rapid urbanization – across many countries of the global south). With a projected total population of approaching half a billion older people likely to be reached in China by 2050 (representing one-third of the population), providing greater security and support will become an urgent issue for social and economic policy in the intervening decades (Yi and George, 2010).3

Ageing in europe and the rise of the ‘oldest old’

The demographic transition from high to low mortality and fertility occurred first in Europe, and the region remains a ‘global leader’ in respect of the population aged 65 and over (Kinsella and He, 2009; see also Table 2.1). The demography of Europe, however, shows considerable variation (Office for National Statistics [ONS], 2012a). Within the EU-27, Germany and Italy – both with consistently low fertility – are the countries with the highest proportions aged 65 and over (21 and 20 per cent respectively); Slovakia, Cyprus and Ireland are the least aged, with 13, 12 and 11 per cent of their populations aged 65 and over respectively. By 2035, 23 per cent of the UK’s population is projected to be 65 and over, although this is at the low end of the European continuum – substantially so in comparison with Germany (at 31 per cent) and Italy (28 per cent). Beyond Europe, Canada, Australia, New Zealand and the United States have smaller proportions of older people than many of the EU-27 countries. In 2010, 14 per cent of the populations of both Canada and Australia were aged 65 and over, compared with 13 per cent in New Zealand and the United States.

Table 2.1 Percentage of population aged 65 and over. Selected European countries

Source: Office for National Statistics, 2012a

The constituent countries of the UK have experienced both population ageing and the progressive ageing of the older population – i.e., more people surviving into their 80s, 90s and beyond. On the first aspect, the percentage of the population aged 65 and over increased in England and Wales from 15.9 per cent in 2001 to 16.4 per cent in 2011, an increase of nearly 900,000 people (ONS, 2012b). By comparison, over the same period, the percentage of the population aged 0–14 decreased from 20.5 per cent in 1985 to 17.6 per cent in 2011. There is some variation across the constituent countries of the UK, illustrated in particular by Wales, where the combination of out-migration of young people and in-migration of retirees leads to a projection of 26 per cent of the total population 65-plus by 2035 (compared with 18.4 per cent in 2011).

The second dimension concerns the ageing of the older population, reflected in the growth in the numbers of people aged 80 or 85 and over. The UK has seen a doubling in the population aged 85 and over in the 25 years from 1985: from 690,000 to 1.4 million people, with a projected increase to 3.6 million (5 per cent of the total population) by 2035 (ONS, 2011a). While the UK population grew by 4.2 per cent between 2002 and 2009, the numbers of people aged 85 and over grew by 21.5 per cent (ONS, 2011a). On a global level, the 80-plus population is projected to increase by 233 per cent between 2008 and 2040, compared with 160 per cent for those aged 65 and over and 33 per cent for the total population of all ages. Japan represents the extreme end of the continuum: by 2040, 38 per cent of all older Japanese are expected to be at least 80 years old, up from 26 per cent in 2008 (Kinsella and He, 2009: 28). Alongside this has come the rise of centenarians (most of whom are female) as a distinct group within the older population (Serra et al., 2011). In the UK in 2011, the probability of an individual aged 80 living to 100 was 6.2 per cent for men and 9.2 per cent for women. UK estimates for the size of the group aged 100-plus was 12,640 in 2010, with projections suggesting a rise to least half a million by 2066 (Department for Work and Pensions, 2011a). At a global level, the population of centenarians was estimated at around 270,000 in 2005, with a projected increase to 2.3 million by 2040 (United Nations, 2009: cited in Kinsella and He, 2009).

Such increases raise considerable implications for the adequacy of pensions and the quality of health and social care services (as will be explored in Chapters 6 and 8), with particular challenges for both low-income countries (where more than half of the oldest-old can be found) and those on low incomes in the richer countries of the world. Indeed, the failure to provide adequate resources for those at the end of their life remains a major cause of concern. The so-called ‘oldest-old’ (those aged 85 and over) are, as a group, at greater risk of poverty than younger older people (aged 65–84) (Hills et al., 2010). Serra et al. (2011: 7) make the point that ‘poverty (as measured by income) among centenarians may be more amplified than among the oldest old group (85–89) given their longer spells of economic inactivity’. Women are especially vulnerable here, given the typical work histories of this cohort (and almost certainly succeeding cohorts) of low-income and limited pensions. Other sources of vulnerability for those aged 85 and over include severe limitations in activity (experienced by 55 per cent); high levels of depressive symptoms of clinical relevance (23 per cent); and the likelihood of a substantial decrease over time in the quality of life.4 Given the substantial rise in those 85 and over by 2035, designing effective income and welfare policies for this age group will become increasingly urgent, and an issue to which we shall return later in this book.

Extended lives: Demographic and social contrasts

A key dimension to ageing populations, as already noted, is the combination of low fertility on the one side and long lives on the other. The extension of life – amounting to some 30 years in Western Europe over the course of the twentieth century – can certainly be viewed as a major achievement for public health and state intervention in welfare. The figures are indeed striking. Christensen et al. (2009: 1196) calculate that if the pace of improvements in life expectancy continues through the twenty-first century, ‘most babies born since 2000 in France, Germany, Italy, the UK, the USA, Canada, Japan, and other countries with long life expectancies will celebrate their 100th birthdays’. They go on to note that data from more than 30 developed countries ‘showed that in 1950 the probability of survival from age 80 years to 90 years was on average 15–16 per cent for women and 12 per cent for men. In 2002, these values were 37 per cent and 25 per cent’ (Christensen et al., 2009: 1197). The case of Japan, where the probability of surviving from age 80 years to 90 years now exceeds 50 per cent for women, illustrates the scale of the change.

Gender differences in life expectancy remain important, though the rate of change for both