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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" projections.

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 have them.

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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Last Modified: 12/31/1600