# 18.1: The Aging Population

• Boundless
• Boundless

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## Aging

Aging is the process of people growing older.

Learning Objectives

#### Key Points

• Population aging is a demographic phenomenon which involves the rise in the median age of a country or region.
• Traditionally, the extended family was primarly responsible for taking care of the elderly, a fact which is no longer the case in many societies.
• Today, the state and various charitable organizations are largely responsible for providing care for the elderly.
• In the U.S., two major problems associated with an aging population are the pension crisis and the strain on the healthcare system, particularly Medicare.

#### Key Terms

• Growing Old: In the 1961 book Growing Old, Cumming and Henry formulated the disengagement theory of aging. It was the first theory of aging that social scientists developed.
• disengagement theory: The disengagement theory of aging states that “aging is an inevitable, mutual withdrawal or disengagement, resulting in decreased interaction between the aging person and others in the social system he belongs to.”

### Aging

As people grow older, they become less self-sufficient in terms of taking care of their own finances, health, and general day-to-day needs and obligations. For example, most societies have a generally accepted age of retirement (based on both societal norms as well as a country’s tax laws and pension rules) after which point an individual ceases to engage in employment. The rest of society typically assumes some level of responsibility in ensuring that the elderly are cared for. The elderly can receive care from a variety of different sources, including their families, the state, the private sector, and charitable institutions. Nevertheless, even in societies that have a strong system in place to provide for the aged, an aging population poses a significant financial and economic burden. In the U.S. specifically, the pension system and the healthcare sector are two important examples of this problem.

### History of Elderly Care

Traditionally, the extended family would look after the older generation. While this role is still attributed to the family in many parts of the world, particularly in non-Western nations, the modern family has evolved in such a way that care for the aged is now provided for by the state and various charitable organizations. Some of the main reasons why elders are less likely to be taken care of exclusively by their families include the decreasing size of families, the increased longevity of the elderly, the geographic dispersion of families, and the fact that women have become more educated and commonly work outside the home. While this trend is widespread in Europe and North America, there is growing evidence of it in many parts of Asia, too. The various forms that elderly care services can take include assisted living, adult day care, long-term care, nursing homes, hospice care, and in-home care. The different institutions can further be classified as medical (skilled) care and non-medical (social) care.

Several countries today are facing an aging population, where the median age of the population has increased and a larger portion of the population is considered to be older. Two primary reasons for this are increased life expectancy and lower birth rates. Currently, the majority of the countries facing this demographic phenomenon consists of advanced economies, such as Japan and many parts of Europe. However, it is predicted that the greatest future impact will occur in Asia.

### Advantages of an Older Population

There may be some economic advantages to having an older population. For example, since older people have higher accumulated savings per head than younger individuals do, a large aged population can result in lower interest rates as well as a lower rate of inflation. However, for the most part, a substantial aged population leads to a lot of financial pressure on both the public and private sectors.

### Disadvantages of an Older Population

One of the problems that may arise from a large segment of society being aged is a pension crisis. In the U.S., it is probably going to become increasingly difficult to pay corporate, federal, and state pensions, because the number of workers relative to retirees is shrinking. In order to improve the sustainability of the pension system, a few measures can be undertaken. For example, the worker-retiree ratio can be rectified by increasing the retirement age or by changing employment and immigration policies. Alternatively, it may be possible to reduce the amount owed to retirees. Finally, it may become necessary to expand resources to fund pensions through increased contributions or higher taxes. Trying to implement any of these solutions will likely result in some level of controversy and public debate.

Another significant source of problems related to an older population resides in the healthcare sector. In 1965, Congress created Medicare under the Social Security Act in order to provide health insurance to U.S. citizens over the age of 65, regardless of their income and medical history. Aside from premiums paid by Medicare enrollees along with the fund source itself, Medicare is financed by revenue levied on employers and workers through the Federal Insurance Contributions Act and the Self-Employment Contributions Act. However, due to rising enrollment as the population ages and a decreasing ratio of workers to enrollers, Medicare is facing financial difficulties. While the Patient Protection and Affordable Care Act is supposed to address many issues confronting the healthcare sector today, the rising cost of healthcare remains a national problem, as patients are paying more in order to receive the same care as before.

## Composition of the Older Population

The elderly proportion of the population is growing around the world, but it is greater in developed countries.

Learning Objectives

Examine the sociological factors that allow people to live longer lives in industrialized versus non-industrialized nations, such as better access to health care

#### Key Points

• All over the world, people are living longer. Population experts estimate that more than 50 million Americans, or 17 percent of the population, will be 65 or older in 2020.
• Biological markers for old age (such as wrinkles, grey hair, memory loss, etc.) exist, but old age can also be defined by when an individual begins to fill certain social roles, such as becoming a grandparent or retiring.
• There is a disparity between industrialized and non-industrialized nations; people live longer in industrialized countries.
• The population of people aged 65 and older has been growing at a faster rate than the total population. While women still live longer than men, the gender gap among seniors is narrowing.
• There appear to be regional divides in the demographic breakdown of senior citizens.

#### Key Terms

• centenarian: Being at least 100 years old.
• United States Census: The United States Census provides more specific information about the make up of older Americans. According to the census, there has been rapid growth amongst the elderly segment of the population in recent years.

The number of individuals living into old age is growing worldwide. While the trend of an aging population is obvious, it can be difficult to assess because the definition of “old age” depends entirely on the cultural norms of a given society. Biological markers for old age (such as wrinkles, grey hair, memory loss, etc.) exist, but old age can also be defined by when an individual begins to fill certain social roles, such as becoming a grandparent or retiring. All of these factors vary by culture.

### Statistics on Age

Nevertheless, the fact is that people are living longer and are therefore more prone to encounter issues associated with old age. In industrialized nations, life expectancy has increased consistently over the last decades. In the United States, the proportion of people aged 65 or older increased from 4 percent in 1900 to about 12 percent in 2000. In 1900, only about 3 million Americans were 65 or older, out of a total population of 76 million Americans. By 2000, the number of senior citizens had increased to 35 million out of 280 million Americans. Population experts estimate that more than 50 million Americans, or 17 percent of the population, will be 65 or older in 2020. The number of older Americans has spiked in recent years due to the age of baby boomers—the generation that was born in the twenty years following World War II. As soldiers returned from war, families began to grow. This generation is now beginning to enter their older years.

The United States Census provides more specific information about the make up of older Americans. According to the census, there has been rapid growth among the elderly segment of the population in recent years. The population of people aged 65 and older grew at a faster rate than the total population. While women still live longer than men, the gender gap among seniors is narrowing. Further, there appear to be regional divides in the demographic breakdown of senior citizens. The South had the largest number of people aged 65 and up, while the Northeast had the largest percentage of people aged 65 and up. In 2010, 53,364 centenarians, or people over the age of 100, lived in the United States, a 5.8 percent increase from the number of centenarians in 2000. This means that 1 out of every 5,786 Americans is over the age of 100.

While the trend of an older population appears worldwide, people in industrialized nations are older than people in non-industrialized nations. While people in almost all countries are living longer than prior generations, people in industrialized nations still live longer than people in non-industrialized nations. According to the Population Research Bureau, the average life expectancy in Africa is 53, in North America is 78, in Latin America is 73, in Asia is 68, in Europe is 75, and in Oceania is 75. Some of this difference can be attributed to disparities in health care—easier access to pervasive biotechnology in industrialized nations means that people live longer. Other factors include poverty and a generally more strenuous lifestyle, which can cause health problems and a lower life expectancy.

## Gender Differences in Aging

Aging to sex ratios show women living longer than men, but this gap has been quickly narrowing since 1990.

Learning Objectives

Analyze the gender gap that exists leading to women generally living longer than men

#### Key Points

• Women tend to live longer than men, and the ratio of women to men is high among the elderly.
• The percentage of men aged 65 and up grew faster than the percentage of women aged 65 and up, according to the 2010 census.
• The longevity of women relative to men is likely due to their better cardiovascular health, the fact that they are less likely to engage in risky behavior, and the fact that traditionally, physical labor is more frequently performed by men.

#### Key Terms

• centenarian: Being at least 100 years old.

Women tend to live longer than men in almost every country. In Japan, men generally live to about 79, whereas women live to 83. However, in the United States, that gender gap is beginning to close. The percentage of men aged 65 and up grew faster than the percentage of women aged 65 and up, according to the 2010 census. For example, the number of men aged 85 to 94 grew 46.5% between 2000 and 2010, but the number of women in that age group grew only 22.9%.

However, for the very oldest members of the population, the gender gap still holds true. The United States Census reports that of the 53,364 centenarians, or people over the age of 100, 82.8% are women and only 17.2% are male. In other words, out of the entire American population, 1 out of every 3,551 females is a centenarian while only 1 out or 16,566 males is a centenarian. Thus, even though the gender gap is narrowing, women are still expected to live longer than men.

These figures could be due, in part, to the sex ratio. The sex ratio is the ratio of men to women in a given society or country. The current sex ratio for the world is 986 females to 1000 males. In the United States, the ratio is 105 males to every 100 females. However, men tend to live riskier lives, are more prone to heart disease and cancer, and women are therefore likely to live longer than men. In fact, cancer deaths among men are 200 per 100,000 cases, whereas women are only 150 per 100,000 (from the National Cancer Institute).

Why women live longer than men is not perfectly understood. Several factors contribute to the overall trend. For example, men statistically engage in more behaviors that put their lives at risk than women, which reduces their life expectancy. Men are also more “successful” when attempting suicide, which also brings down their life expectancy. Another factor that may contribute to the greater life expectancy of women is the different types of jobs men and women tend to have during their lifetimes, with men more frequently doing physical labor that could wear the body down or increase the odds of injury. Other biological factors likely play a role, including greater cardiovascular health among women.

## Aging and Race

Individuals with different racial backgrounds tend to have different experiences with old age.

Learning Objectives

Examine the racial implications of aging, particularly for minority groups

#### Key Points

• Minority populations are more likely to experience elder abuse from relatives and caretakers.
• Minority populations are also more likely to experience health problems associated with old age.
• Many of the medical differences between different racial groups are better explained by differences in socioeconomic status rather than race.

#### Key Terms

• elder abuse: Elder abuse is a general term used to describe certain types of harm to older adults.
• social determinants of health: The economic and social conditions that influence individual and group differences in health status.

Individuals of different racial backgrounds experience aging —and the health issues associated with it—differently. Before turning to the medical concerns that accompany aging, one should note that elders of different racial backgrounds also experience different frequencies of elder abuse. Elder abuse is a general term to describe certain types of harm that are inflicted upon older adults. The most common form of elder abuse is neglect or improper care for vulnerable seniors. Unfortunately, this is usually inflicted by people whom the elder trusts and who are responsible for caring for the elder, such as family members or caretakers at elder homes. Research indicates that black senior citizens are more likely to be abused than white citizens.

Further, medical concerns present differently for white seniors and minority seniors. Black and Hispanic seniors are more likely to encounter cardiac problems earlier than white seniors. However, these outcome disparities are not usually the result of biological determinants of health, which means that minority populations are not biologically less healthy than white populations. Rather, the disparity in medical outcomes is more likely attributed to social determinants of health, which are socioeconomic conditions that bear on health.

For example, black and Hispanic populations are more likely to encounter financial hardship and therefore eat less healthy food, which potentially leads to health problems. In addition, individuals from a poorer socioeconomic background are less likely to have had access to healthcare throughout their whole lives. This lack of access ultimately leads to medical concerns in old age. Thus, while one can make generalizations about elder health by comparing racial categories, these differences are frequently caused by differences in socioeconomic status rather than race.

## Aging and Wealth

In order to assist the elderly with their living and healthcare costs, the U.S. government established assistance programs like Medicare.

Learning Objectives

Examine the programs made available to the elderly to assist with quality of life, such as Social Security and Medicare, and the looming crises with these particular programs

#### Key Points

• American seniors face serious financial troubles due to the fact that they are no longer earning an income, but face increased expenses as a result of diminishing health.
• Social Security and Medicare are federal programs designed to help seniors, though both programs face financial difficulties themselves.
• The Patient Protection and Affordable Care Act, also known as Obamacare, would help cut down seniors’ expenses by lowering healthcare costs and increasing public services.

#### Key Terms

• Obamacare: a colloquial term for the Patient Protection and Affordable Care Act of 2010 which expands health care coverage for Americans
• baby boomer generation: The baby boomer generation, or those born during the spike in births in the twenty years following World War II, is starting to reach senior citizenship, and will soon pull from the public funds of Social Security and Medicare.
• Patient Protection and Affordable Care Act: an American law passed in 2010 that expands health care coverage

### Managing the Aging Population

The elderly have financial difficulties primarily because they are too old to hold a job, and thus have no regular income, yet they incur large medical expenses as a result of diminishing health. However, due to the improvement in medical technology, more seniors are living longer and more fulfilling lives, yet still struggle financially. Because of this trend of impoverishment, the United States has enacted social policies designed to help the elderly manage their financial woes. Major policy efforts include Social Security, a social welfare program that taxes the current working sector to give money to individuals in retirement, and Medicare, a federal program that subsidizes medical costs for seniors. Prior to the introduction of Social Security, the elderly were the poorest age group in the United States. With the introduction of Social Security, poverty rates of the elderly in the United States have dropped dramatically. Between 1960 and 1995, the official poverty rate of those aged 65 and above fell from 35 percent to 10 percent, according to the National Bureau of Economic Research. However, due to a lack of funds, that number is beginning to increase once again.

### Social Security

Social Security is designed to redistribute wealth temporarily in order to help seniors finance their lives after retirement. In this program, the current workforce is taxed, the results of which flow into a special fund designated for Social Security. Payments are then made from this fund to retirees. This is not, however, simple redistribution. The workforce that is currently contributing to the fund will then retrieve payments once they retire. Thus, Social Security has features of both a redistribution system and a savings account.

### Medicare

In addition to Social Security, the other primary social support for the American elderly is Medicare. Medicare is a social insurance program that provides health care for American citizens over the age of 65. Medicare subsidizes hospital visits, doctors’ appointments, and prescription drugs. Created in 1965, Medicare was intended to address the fact that seniors spend more on healthcare than any other segment of the population, despite having the least income. Recent studies have confirmed that Medicare enrollees typically have lower incomes and more healthcare expenses than the average American. In 2006, the average household income of Medicare enrollees was $22,600, far less than the median American income of$48, 201. In 2008, 16% of Medicare enrollees were living below the poverty line, compared to 13% of the general population. Further complicating things, the typical senior household has only $66,900 in savings, yet the average American male needs$124,000 to cover healthcare during retirement, and the average American female needs \$152,000.

Because Medicare enrollees are, by definition, senior citizens, their healthcare costs also far higher than average. About 87% of Medicare enrollees have at least one chronic condition and close to half have three or more. Thirty percent of enrollees visit the emergency room in any given year, and 21% have an inpatient stay. Roughly 66% of seniors require some form of long-term care over their lifetimes, and 18% live in a nursing home for at least one year. These disparities demonstrate the complicated problems most senior citizens encounter as they age.

### Looming Crises with Medicare and Social Security

Social Security could soon be in crisis if current trends to not change. Right now, more money is being garnished through taxing the current workforce than is being paid out to retirees. However, this will soon change. If the laws governing Social Security are not changed by 2017, the program will begin paying out more funds than it receives. Medicare faces even more dire financial problems than Social Security. Like Social Security, Medicare gains revenue through taxation, but by 2009, Medicare was expending more than it was earning, and its Trust Fund had already been tapped to access emergency funds. The Trust Fund for Medicare will be exhausted by 2017, at which point, the federal government will only be able to cover about 80% of the costs of medical treatment for its senior citizens, which is around 48 million Americans.

Part of the reason both Social Security and Medicare face looming crises is the rising population of seniors. The baby boomer generation, those born in the 20 years following World War II, is starting to reach senior citizenship and pull from these public funds. At the same time, the working population in the United States has decreased. Thus, Social Security and Medicare are both being called upon to support greater numbers of senior citizens while having fewer workers to tax in order to gain revenue. The respective conditions of Social Security and Medicare contributed significantly to the discussion surrounding the Patient Protection and Affordable Care Act, passed by President Barack Obama in 2010. The act, commonly referred to as Obamacare, provides a public insurance option through the government to help drive down insurance costs. By lowering healthcare costs and requiring insurance, the government hopes to better address the needs of the nation’s elderly. However, the constitutionality of the Act is currently being debated by the U.S. Supreme Court and the Act could be overturned. Regardless of what the Supreme Court decides, American seniors face serious financial troubles, compounded by their healthcare needs.

## Global Aging

Global aging differs depending on the access to economic and social resources; thus, industrialized countries tend to have older populations.

Learning Objectives

Discuss the impact of an aging population on the economy, for example, in terms of health care costs

#### Key Points

• People are living longer than ever before across the world.
• However, on average, people in industrialized nations live longer than people in non-industrialized nations. This is largely due to poorer health in non- industrialized countries, and fatalities associated with HIV/AIDS.
• Difference in lifespan is also attributed to better access of healthcare in different industrialized and non-industrialized nations.
• The economic effects of an aging population are considerable.

#### Key Terms

• biotechnology: The use of living organisms (especially microorganisms) in industrial, agricultural, medical and other technological applications
• HIV/AIDS: An infectious disease, caused by HIV, that causes the gradual degeneration of the body’s immune system.

All over the world, people are living longer than ever before. However, while the trend of a growing older population appears world over, people in industrialized nations are older than people in non-industrialized nations. According to the Population Research Bureau, the average life expectancy in Africa is 53, in North America is 78, in Latin America is 73, in Asia is 68, in Europe is 75, and in Oceania is 75. Worldwide, about 8% of the total global population is over the age of 65, while about 12% of Americans are over the age of 65.

Some of this difference can be attributed to disparities in health care. Easier access to pervasive biotechnology in industrialized nations means that people live longer. Unfortunately, in some countries HIV/AIDS has ravaged the population to the point where the average life expectancy drops. Most of these countries have lower levels of development and industrialization.

The economic effects of an aging population are considerable. Older people have higher accumulated savings per head than younger people, but spend less on consumer goods. Depending on the age ranges at which the changes occur, an aging population may thus result in lower interest rates and the economic benefits of lower inflation. Some economists see advantages in such changes, notably the opportunity to progress automation and technological development without causing unemployment. They emphasize a shift from GDP to personal well-being.

However population aging also increases some categories of expenditure, including some from public finances. The largest area of expenditure in many countries is now health care, the cost of which is likely to increase dramatically as populations age. This would present governments with hard choices between higher taxes, including a possible reweighing of tax from earnings to consumption, and a reduced government role in providing health care.

• Curation and Revision. by: Boundless.com. CC BY-SA

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• (CC BY-SA; Wikimedia via upload.wikimedia.org/Wikipedia/commons/0/0a/Median_age.png)
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• (CC BY-SA; Wikimedia via upload.wikimedia.org/Wikipedia/commons/0/0a/Median_age.png)
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• All sizes | Old Age - Support!!!n| Flickr - Photo Sharing!. (CC BY; Flickr via http://www.flickr.com/photos/ramnaganat/7058429559/sizes/m/in/photostream/)
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