Description

Demographic ageing as a global phenomenon

In all societies, population size and structure is determined by a combination of fertility rate, mortality rate and international migration. The current demographic ageing of societies will have a lasting and profound effect on population structures and accordingly on the respective societies themselves. In industrialised nations, the ageing of the population is already at an advanced stage compared with that of nations with emerging economies where the age of the population is on average younger, but still much older than in developing countries. These developments are due in part to improved economic and social living conditions, which have contributed towards a shift in the age distribution in different areas of life towards older people.

Within this group, a shift in the age structure can also be observed. Advanced old age, the section of society aged 80 years or older, currently represents 1.3% of the global population but is expected to rise to 4.3% by the year 2050. Even the number of 100-year-olds is predicted to rise in the next 40 years by a factor of 13: from 287,000 in 2006 to 3.7 million according to figures published by the United Nations Department of Economic and Social Affairs in 2007.

In 2050, 4.3% of the global population will be of an advanced old age.

A comparison of the percentage of people over 60 years of age in different countries

Number of births in Europe in 2006 (light) and 2007 (dark)

In worldwide statistics for 2007 published by the Population Division in the United Nations Department of Economic and Social Affairs, Germany, closely followed by Sweden, Greece and Austria, is among those countries with a high proportion of old people. Only Italy and Japan have a higher proportion of over 60-year-olds. Japan is a special case as the highly-developed industrial nation with the highest level of population ageing and sharply rising life expectancy – over 23,000 Japanese are older than 100 years – has been tackling the challenges of population ageing through social insurance system reforms for nearly 35 years. As a consequence of the country’s continuing economic growth, professional life has slowly but steadily become ever more demanding so that fewer people are able to care for their parents. The traditional image of Japan, in which the elderly are looked after in the family, usually by the eldest child, is beginning to fade away. Very often there is little alternative to an old people’s home, but this is still generally frowned upon in society. The result is an irreversible decline in communal living in large family structures, which in turn leads to the increasing isolation of many old people.

The age distribution pyramid in Japan in 2000 and prognosis for 2025 and 2050

How does Japan deal with this situation? The government responded by encouraging the building of nursing homes, day-care centres and the development of care at home programmes. According to the Japanese­ Ministry for Health, Employment and Social Affairs, in the year 2000, 349 private homes for the elderly catered for around 26,000 senior citizens. By July 2004, over 52,000 residents lived in 990 assisted residential schemes for the elderly, a tendency that continues to rise. A large number of hotel-like facilities with a luxurious character have since been built, such as the “Sun City Ginza East” in Tokyo. In recent years, however, more barrier-free residential complexes have been built, such as the “IDU Terrace” in Mishima, a modern and attractive complex completed in May 2008.

It goes without saying that the increasing number of older people results in a greater demand for care personnel. This demand cannot be adequately fulfilled, at least by European standards, partly because Japan has very few migrant workers. Technical aids are therefore being increasingly employed to address the care needs and loneliness of old people. As a country renowned for its creative use of entertainment electronics, Japan has turned to robotic social aids such as the robotic dog “Aibo”, a replacement for a real four-legged friend, or “Paro”, an artificial baby seal that serves as a pet for elderly people in residential homes. Hardly a month goes by without news of a new “social robot” on the market: even “humanoid” robots that can recognise their owner and can speak a vocabulary of 10,000 words. Wealthy working people buy such robots to “look after” their ageing parents. A further sector constitutes household service robots such as the “Wakamaru”. Future generations of robots should be able to react sensitively to the needs of old people, help them with eating, remind them to take their medicine, even administer medicine and injections as well as attend to simple errands.

Has Japan succumbed to the attractions of technical possibilities? Does it run the risk of excluding or even dehumanising old people? Or is the development of robots just a logical consequence of demographic development? Maybe it really is about giving people greater independence. Would not assistive technology have the potential to save the state, as well as individuals, a considerable amount of money? One way or the other, the Japanese are much more used to the creative use of technology, and care robots are regarded from a far less ideological point of view than in Europe.

The ageing population as a challenge for society

In Europe the total population would fall significantly by 2050 were it not for migration. Germany, Spain, Greece and Italy are particularly affected by the low birth rate and rapid ageing of the population. But who will provide professional care for the increasingly older generations and the larger numbers of people in advanced old age? The care of old people is in general dependent on a number of different factors. These include cultural and contextual factors, the individual characteristics of parents and children, family struc-tures and state welfare provisions. Empirical analyses[1] show that inter-generational care is most common in south­ern and central European countries where state support is available for children to care for their parents. In addition, in countries such as Greece, Italy and Spain, care for the elderly has traditionally been a matter for the family.

In northern European countries, old people are more commonly cared for by trained care personnel and state­ support is provided for professional home care services.[2] To improve the quality of life for these people,­ residential concepts are called for that integrate nursing home and residences into existing urban districts. This means the small-scale networking of home care services, of inpatient nursing and informal services and a good infrastructure with social meeting places, efficient public transport and sufficient local shopping opportunities. For such approaches to be successful, it is of vital importance that all the agents involved are consulted and included in the planning.

Italy, which occupies second place in the international ranking of ageing societies, is employing a series of quite different, often regionally-specific solutions. The spectrum ranges from the revitalisation of northern Italian villages (Tiedoli for example), where old people can live together with younger generations, to living in high-tech barrier-free residential buildings, such as those being built in Pesaro. In Italy, migrant workers from low-wage economies, so-called “badanti”, are often employed to take care of the elderly.[3]

In Greece many women are no longer able to take care of the household and family in the same way as they used to as more and more women now wish to, or indeed have to, go to work. At the same time, old people are dependent on their families for care and support as most pensioners live beneath or just above the poverty line. Despite the irreconcilable nature of this problem, the traditional family model is still prevalent, even in the cities. As a result, young and old generations often live on different storeys of the same house. The resulting demand for larger apartments for more than three to four people is, however, not covered by the housing market.

The situation in Russia has changed markedly since the collapse of the Soviet Union. The loss of a fifth of the population, as reported in 2008 in the journal “Eurasisches Magazin”, has resulted in far-reaching demographic changes. The booming Russian cities of Moscow, St. Petersburg and Nizhny Novgorad have attracted young people from all over the land, as wage earnings are higher than elsewhere. Outside the aforementioned cities, however, poor economic conditions mean that the younger generation usually lives with their parents. The grandparents very often take over childcare duties, not least because their very low pension means that they cannot afford to live outside the family unit. This is nevertheless preferable to living in an old people’s home, which for many is their greatest fear. As there is no state support of any kind for tak­ing care of one’s relatives, solidarity within the family unit remains of crucial importance.

Finland, like several other countries, faces the dual problem of an ageing society and an uneven regional distribution of the population. The population of the country becomes increasingly sparse to the north, whereas in the southern provinces, particularly in the region of Helsinki, the population density rises. The provision of care for the elderly in outlying regions is considerably more difficult than in the conurbations. Old people in rural areas may often need to travel many kilometres to reach the required services. Although the state is traditionally responsible for social welfare, family and children play an important role. As a highly modernised country, Finland looks set to make increasing use of advanced technology in the foreseeable future to assist the older generation. Computers and the internet already augment the patient-doctor relationship, for example in the recording and transmission of blood pressure, heart rate and sugar levels. Studies have also revealed that four of every ten older people over 60 years feel lonely some of the time and one in ten constantly.[4] To counteract this development, in 2001 Finland introduced so-called “Elder’s Stations”, group therapy and community centres to counteract loneliness and isolation.

Demographic changes in Africa are far more turbulent than in the industrialised nations. Family support networks, which traditionally guaranteed social security in old age, are disintegrating. One reason is that young people are moving to the cities to benefit from better educational opportunities and higher earnings with which to support their families. Another reason is that the number of people, particularly younger people, at a reproductive age has reduced significantly as a result of the impact of Aids. The surviving older generation has to take over key tasks that they are largely unable to fulfil. Not only do they need to care for their grandchildren and great-grandchildren, but after a lifetime of work they are forced to continue working to cover the needs of their descendants. When old people fall ill themselves, they for the most part help one another. According to prognoses, Africa will, like other continents, also see a significant rise in the proportion of over 60-year-olds in the coming years. Women who are widowed face an even graver situation as they are both accorded a lower social status than men and have far fewer economic resources of their own. The ageing of the rural population will in particular have serious consequences. A major challenge will be to stimulate rural agricultural production to ensure a local nutritional basis and with it care and nursing for the elderly. The particular developments in family structures in Africa mean that it is important to strengthen the responsibility of the family and the community towards the elderly.

Only 25 years ago, China feared that it might have to care for too many children due to the high birth rate. Today the country faces the opposite problem. As a result of the success of the one-child-per-family policy, China’s population will age dramatically, which in turn will lead to serious problems in the provision of care for the elderly. At present, Beijing and Shanghai already have more pensioners than children under 15.[5] Today, 144 million Chinese people are over 60 years old, representing 11 % of the population. According to estimates by the World Bank, this number will rise to 460 million by 2050. In China, old age is not a separate phase of life, marked for example by the end of one’s working life as it is in Europe. The elderly switch back and forth between family and earning a living, often putting back their own interests. They rarely live alone and in most cases contribute significantly to looking after their grandchildren, easing the burden for their working children. However, the traditional generational bond that accorded old people in China value, respect and influence in the family has in many cases been reduced to one of economic convenience. Societal transformations are pervading the former emerging economy and China will need to develop ever more alternatives to elderly care in the family. The few private and state-funded homes for the elderly are of very different quality and for many old people and their families quite simply too expensive.

India, numbering 1,129,866,000 residents in the year 2007, is the second most populous nation on earth after China and is decidedly “young”. Half of the population was born after 1980, making it an unusually large section of society. Consequently, each year 15 million new jobs are created. As an emerging country, India is, of course, not exempt from the accompanying transformations in society. The prevailing system of care and support in the family is declining continually, and the respect and esteem accorded to the older generation is likewise disappearing rapidly. As values shift from wisdom, experience and tradition to foreign languages and computer skills, older people find their dignity and authority increasingly undermined. The younger generation has fewer children, is more career-oriented and increasingly westernised. Is the extended family soon to become a thing of the past?

In order to ensure adequate care and support for the elderly, the relief organisation HelpAge India, a non-government organisation, is implementing homes and other support. According to management of HelpAge­ India, 2000 homes for the elderly are already in operation.[6] In view of the current situation, the federal government intends to raise the current very low level of pension provision.

Old people from migrant backgrounds

The number of older and elderly people among migrants is increasing too. This applies particularly to the first generation of immigrants. According to estimates, around 42 million immigrants live in the current European Union.[7] The majority of migrant workers who went to other countries, predominantly Germany, Austria and Switzerland, between the 1950s and the 1970s settled in the respective country and were later joined by relatives and partners. Now in the third or fourth generation, the chosen country has become their home and the centre of their lives. Although originally intending to return to their country of origin after the end of their working life, particularly as a sense of alienation can grow stronger in old age, most migrants decided to remain. On the one hand, after many years in the guest country, they are already subject to a conflict of identities; on the other, they do not want to give up health care, particularly in old age, the proximity to their children as well as the social network they have built up over many years.

In general, residents who originate from foreign countries are not very common in nursing homes and inpatient care facilities. This is primarily due to the fact that the number of older migrants is relatively low. A care centre in Switzerland has, for example, set up a so-called Mediterranean wing especially for Italian, Spanish and Portuguese guest workers, who are also cared for in their respective mother tongue. More recently, a rise in the proportion of care staff from multicultural backgrounds can also be observed.

In Germany, the first multicultural home for the elderly (Haus am Sandberg) was opened in 1997 in Duisburg. The pilot project “Care for the Elderly with Ethnic Backgrounds” was a joint project funded by the University of Duisburg and the Foundation for Social Welfare. The centre provides care and nursing that is sensitive to the cultural needs of other backgrounds. In the Sossenheim district of Frankfurt, a nursing home for Turkish and German senior citizens was opened in 2007. Germany’s first nursing home for elderly people of Turkish origin was also opened in 2007 in Berlin-Kreuzberg.

Intercultural, trans-cultural, culturally-sensitive are a few of the many adjectives that describe the aim of providing suitable care and nursing for migrants. For a long time cultural integration activities gave little attention to the aspect of old age as the issue was not pressing. In the meantime, according to the German Federal Statistical Office, over 1.3 million foreigners living in Germany are over 60 years old, a number that will rise to 2.8 million by the year 2030. Numerous studies have underlined an urgent need for action, indicating that elderly migrants will be an increasingly important sector in care for the elderly. Most migrants are aware of nursing homes, but associate them primarily with loneliness and decrepitude. For a long time there were very few concepts for adapting care, living and nursing services to the needs of migrants. Very slowly, care facilities are showing a gradual awareness of the need to deal with this issue, particularly in view of the fact that more and more elderly migrants will need social, health and care facilities in the future. As a result of the historical separation of migrant work and care for the elderly, comparatively little is known about provisions and care for the elderly. Efforts should be made to intensify the link between policies for the elderly and migration. Furthermore, there is insufficient knowledge of cultural requirements for the adequate care of migrants in old age. For this reason, a systematic exchange of information at a regional level between facilities and projects who already have experience with the specific problems facing migrants as they grow older would be most desirable. In addition, migration should become anchored in social policy in order to integrate future generations of migrants from an early stage in the pre-existing culture of social care for the elderly.

In the south German city of Fürth, for example, many migrants from different backgrounds live for the most part in their own cultural groups and organisations. An attempt at counteracting this tendency has been made through the creation of an “intercultural garden”. A promenade along the banks of the River Rednitz serves as an important bridge between the cultures and is intended to become a meeting point for people from various cultural backgrounds.[8] Through the inclusion of facilities for the elderly and inter-generational recreational areas, this kind of garden could be a constructive way of enriching and transforming life in old age.

Outlook

Political, economic and societal transformations will continue to influence the development of life expectancy, but the transformations resulting from the ageing of society are already visible and can no longer be ignored. While the topic has had a degree of public exposure, the issue needs to be reconsidered from the point of view of society as a whole; in addition to numerical factors, greater consideration has to be given to environmental factors and cultural, social and psychological aspects. Furthermore, society has to work towards developing a more positive attitude towards older generations. All too often pensioners are regarded as a group that primarily costs money. It is indicative that around the world, only Japan has a day – the 15th September – dedicated to respecting the elderly.

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Originally published in: Eckhard Feddersen, Insa Lüdtke, Living for the Elderly: A Design Manual, Birkhäuser, 2011.