by Libor Stloukal
Population and Development Service
FAO Gender and Population Division
This note takes a closer look at the oldest old – defined here as persons aged over 70 years – with the aim to highlight the expected changes in their relative numbers and sketch the implications for development interventions. The analysis is based on the 2002 revision of the UN population projection for the period 2000 to 2050. The overall conclusion is that in order to ensure sustainable rural development, the needs of the rural oldest old will have to be increasingly incorporated into policies and programmes.
Population ageing is a consequence of the continuing – though geographically highly uneven – demographic transition, particularly the unprecedented declines in fertility levels which developing countries have been experiencing over the past 30 years. As a result, children and youth have come to represent a smaller proportion of the total population, while older people – the survivors of large birth cohorts – account for a greater proportion. This trend has been accelerated by falls in mortality levels and a transformation in both the age and cause structure of deaths – the so-called epidemiological transition from infectious diseases, such as diarrhoea and pneumonia, to chronic and degenerative diseases. In countries with high HIV prevalence levels, the AIDS epidemic tends to contribute to population ageing through the increased mortality of younger adults, combined with reduced fertility of HIV-positive persons who die before completing their reproductive goals, and increased mortality of children who die as a result of mother-to-foetus transmission of HIV.
Although there are commonly used definitions of old age, there is no general agreement on the age at which a person becomes old. The UN has not adopted a standard criterion, but most countries use 60+ years to refer to old persons. The ‘oldest old’ then represent a subgroup within the elderly population which can be defined variously, as either 65+, or 70+, or 75+, or 80+. In this note, the oldest old are understood as persons over 70 years of age.
Definitions such as the one adopted here are merely arbitrary. The use of calendar age to distinguish various life cycle stages presupposes equivalence with biological age, but it is well known that these two are not necessarily identical. Moreover, age is a socially constructed category. In the more traditional societies, definitions of old age often depend on the local culture and other social and economic factors, including the level of population ageing already achieved. Adding to the difficulty of establishing a clear-cut definition, actual birthdates may not be known as many older individuals in developing countries do not have an official record of their birth. It is therefore important to bear in mind that traditional or community definitions of ‘oldest old’ can differ widely from age-based definitions.
Table 1 and Graph 1 illustrate current levels and expected changes in the proportion of total population in the 70+ age group by region. Future trends are taken from the medium variant of the UN Population Division’s projections (UN 2003a). These projections are based on a number of assumptions about future levels of fertility, mortality, and migration. The details are specific to individual countries, but in general the projections assume that mortality improvements will continue (except for countries highly affected by the HIV/AIDS epidemic, which are projected to experience continued high mortality over the next 50 years); that fertility will gradually decline in countries with very high fertility and stabilize elsewhere in the developing world; and that the flow of migration will remain close to current levels.
At the present time, differences between developing regions are not very large as the proportions of the oldest old range from around 2 per cent in sub-Saharan Africa to 4-5 per cent in Eastern Asia and the Caribbean. In the coming decades, these proportions should generally rise – but at very different speed in different regions, reflecting disparities in fertility declines, mortality reductions, and demographic effects of the HIV/AIDS epidemic. Sub-regional prospects are as follows:
Some developing countries can expect an especially rapid growth of the oldest old population. For example in China, the world’s most populous country, the number of the oldest old is predicted to grow nearly fivefold between 2000 and 2050, in contrast to a 9.4 per cent increase of the total population (Table 2). By 2050, the number of seniors aged over 70 years in China is expected to be some 240 million. As a proportion of the total population, that number would represent 17 per cent – well above the corresponding levels in 2000 in Europe or North America (Table 1).
In virtually all populations women experience lower mortality levels than men and, consequently, represent a high percentage of the oldest old. As shown in Table 3, the excess of women among the oldest old is expected to persist during the period 2000-2050. Differences between developing regions will be relatively small in this regard. The only significant exception is Southern Africa where the paucity of men in the 70+ age group will be greater than elsewhere, echoing a particularly large gender gap in adult mortality levels within that region (Dorrington et al. 2001, Ngom and Clark 2003).
As the above analysis indicates, proportions of seniors aged above 70 years equivalent to those experienced by the developed world today are still a distant outlook for most developing countries, and a very distant one for some. Demographic ageing is an inevitable prospect for all populations, but its degree of urgency will vary widely between regions.
As discussed in several FAO papers (Marcoux 1994, 2001; Skeldon 1999; Stloukal 2001), population ageing tends to manifest itself earlier and proceed faster in rural areas than in the cities, chiefly because rural-to-urban migration can sharply reduce the proportion of younger adults and therefore increase the proportion of older persons ‘left behind’ in the villages. Although the rural-urban breakdown is not available from the UN population projections analyzed above, it can be assumed that numerical growth of the oldest old population will affect many rural areas, with potentially crucial implications for rural development policies and programmes:
Developing countries should carefully consider projected trends in the demographic composition of their populations. In countries where significant increases in the oldest old population are imminent, governments, civil society institutions, international agencies and other relevant bodies should pay special attention to the implications of this dimension of the population ageing process for rural development. The rural oldest old are likely to represent a particularly vulnerable group which may need extra help in daily living through appropriately targeted poverty reduction, food security, and health care interventions. Farming communities beset by the outmigration of young persons could face particularly serious problems and may thus require assistance from carefully tailored rural development policies, health programmes, etc. Special efforts should be made to ensure that any old-age policies being developed or adapted benefit older women and men equally. The disadvantages of the rural oldest old in socio-economic status and access to services deserve further studies, to provide sound evidence base for sound policy formulation.
Note: * excluding Japan
Source: see Table 1
Note: Based on medium fertility variant projection.
Source: UN 2003a.
Note: Based on medium fertility variant projection. * excluding Japan.
Source: Elaboration of data from UN 2003a.
Dorrington, R et al. 2001. The impact of HIV/AIDS on adult mortality in South Africa. Medical Research Council of South Africa: Tygerberg. www.mrc.ac.za/bod/complete.pdf
Knodel, J. and M. B. Ofstedal, 2003. Gender and aging in the developing world: where are the men? Population and Development Review 29 (4), pp. 677-698.
Marcoux, A. 1994. Ageing rural populations in the developing countries: patterns, causes and implications. Ageing and the Family, UN Department for Economic and Social Information and Policy Analysis: New York, pp. 144-148.
Marcoux, A. 2001. Population ageing in developing societies: how urgent are the issues? FAO/SDWP: Rome.
Ngom, P. and S. Clark, 2003. Adult mortality in the era of HIV/AIDS: sub-Saharan Africa. Workshop on HIV/AIDS and adult mortality in developing countries (8-13 September 2003). UN Population Division: New York.
Skeldon, R. 1999. Ageing of rural populations in South-East and East Asia. FAO/SDWP: Rome.
Stloukal, L. 2001. Rural population ageing in poorer countries: possible implications for rural development. FAO/SDWP: Rome.
UN 2002. World Population Ageing 1950-2050. UN Population Division: New York.
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UN 2003b. The Impact of HIV/AIDS on Mortality. UN Population Division: New York.
Zeng, Yi et al., 2002. Sociodemographic and health profiles of the oldest old in China. Population and Development Review 28 (2), pp. 251-273.