Aging into the 21st Century
During the next 3 to 4 decades, we can expect a very dramatic increase
both in the number of elderly persons and in the proportion of elderly
persons in the population. Changes in the overall population 65 and over
and in the population 65 to 74 years of age will be muted until 2010,
but the arrival of the large baby-boom cohorts at age 65 will trigger
the large increases in the number and percentage of elderly in the next
half century. The record large proportion of elderly persons now in the
population, 13 percent, will rise to perhaps 20 percent by the year 2030,
and the number of elderly is expected to double by that year. These prospective
demographic changes have given rise to a general concern about the social,
economic, and physical "health" of our Nation's population.
The most rapid increases in the number and share of persons 85 years
and over will occur between 2030 and 2050, when the baby-boom cohort reaches
these ages. The cumulative growth of the population 85 years and over
from 1995 to 2050 is expected to be over 400 percent, and the group should
make up nearly 5 percent of the population in 2050 as compared with 1.4
percent today. These figures are drawn from the Bureau of the Census'
middle series of projections. Considering the whole range of this set
of projections, they essentially encompass the other leading "competitive"
These changes will be brought about mainly by historical and prospective
shifts in the number of births, birth rates, and the level and age pattern
of death rates. The volume and age pattern of net immigration will be
important in affecting the numbers too, but will be secondary in influencing
the age distribution, that is, the share of elderly persons in the population.
The rapid growth of the elderly, particularly the oldest old, represents
in part a triumph of the efforts to extend human life, but these age groups
also require a disproportionately large share of special services and
public support. There will be large increases by 2030 in the numbers requiring
special services in housing, transportation, recreation, and education,
as well as in health and nutrition. There will also be large increases
in some very vulnerable groups, such as the oldest old living alone, older
women, elderly racial minorities living alone and with no living children,
and elderly unmarried persons with no living children and no siblings.
These are also groups with high percentages living in poverty or with
low incomes. The number of persons requiring formal care (mainly nursing
home care) and informal care (mainly care at home) will rise sharply even
if the share of persons at each age remains unchanged. Accordingly, there
will be a large increase in the numbers participating in various entitlement
programs such as Social Security and Medicare.
Living alone presents an additional risk, and the risk mounts when the
person living alone has no children or siblings. These characteristics
are more common among those 85 years and over as compared with those under
age 85. At ages 65 and over only 2 percent of the population have these
characteristics in combination, but at ages 85 and over perhaps 6 percent
The outlook for the longevity and health of the elderly is not altogether
clear. There will probably be a substantial increase in life expectancy,
even at the older ages, but there are also likely to be large increases
in the number of persons with poor health and disabilities, including
Alzheimer's disease (and in persons requiring nursing home care and home
care), if only because of the massive population increases projected to
occur. If disability ratios fall sharply or mortality rates at the higher
ages rise, or if both occur, the numbers of disabled persons could fall,
but this now appears very unlikely.
Accompanying these general changes will be shifts in the racial/Hispanic
composition of the elderly population. As compared with 15 percent today,
in 2050, about one-third of the elderly will be other than non-Hispanic
white. The rapid growth of these groups, in particular, will "color"
the demand for special services. To the extent that these groups have
distinctive social and economic characteristics (e.g., living arrangements,
number of living children, income, education, and knowledge of English)
that affect their risk of requiring formal and informal support, these
services may require a different structure and orientation.
Most of the survivors at the highest ages are women and, in particular,
widowed women. This will remain the prevailing sex-marital balance because
its principal causes (the premature death of men, including married men,
and the very low remarriage rates of elderly women) are expected to persist.
The imbalance of the sexes and the low percent of married women have been
associated with reduced income, greater poverty, poorer health, and greater
risk of institutionalization of older women.
The need and cost of support of dependent elderly can be mitigated by
substituting home care for nursing home care and family, friends, and
neighbors as caregivers for private caregivers; by working energetically
to reduce the death rates of married men in mid-life; and in other ways.
Some groups in our society have gone further than others in the use of
family members, friends, and neighbors as caregivers.
The prospective changes in age structure and in labor force participation
will lead to shifts in the balance of nonworkers to workers and, more
specifically, the balance of OASDI beneficiaries to covered workers. The
latter ratio is expected to increase from 31 beneficiaries per 100 covered
workers in 1995 to 51 in 2050. The prospective increase in these balances
can be offset by future rises in the birth rate, the volume of immigration,
labor force participation ratios, worker productivity, and death rates
at the older ages, and by reduced unemployment and underemployment. These
are not all likely to occur, or to occur in sufficient degree to obviate
the need to deal directly with the demographic and socioeconomic changes
associated with aging into the 21st century.
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