World Demographics

Geriatric Essentials

• By 2025, the world's population is expected to include > 830 million people >= 65.
• The percentage of the population >= 65 will be highest in developed countries, but the absolute number will be higher in developing rather than developed countries.

Population Characteristics

The world's population is aging. In Italy, Greece, and Sweden, > 17% of the population is >= 65 (see Figure 2-3), compared with 12.4% in the US. Between 2002 and 2025, the total number of people >= 65 is expected to increase by 11 to 70% in European countries and by up to 170% in some developing countries (see Table 2-5). By 2025, the countries with the highest percentage of people >= 65 are expected to be Japan (with 28%), Italy (with 24.7%), and Germany (with 24.6%). However, because developing countries such as China and India have the largest total populations, they have and will continue to have the largest absolute number of elderly people. In 2002, the greatest number of people >= 80 lived in China, followed by the US and India. By 2025, the world's population is expected to include over 830 million people >= 65; most will live in developing rather than developed countries.

The exceptional growth in the percentage of the elderly worldwide is related to the substantial decrease in birth rates during the past 25 yr in many countries, the migration of younger people out of certain areas because of economic reasons, and the decrease in overall mortality (including that due to infectious diseases in developing countries and that due to coronary artery disease and stroke in European and other developed countries). In the US, Canada, and Australia, mortality due to coronary artery disease has decreased by an average of 50% during the past 25 yr.

Mortality and Morbidity Rates

In the US, about 70% of all deaths occur after age 65. By 2025, the percentage of deaths postponed to older age is expected to increase for the rest of the world, with > 60% of all deaths occurring after age 65. In most countries, the total mortality rate is decreasing.

Causes of death, especially at older ages, vary from country to country. The mortality rate for cardiovascular disorders, the most common causes of death, varies. For example, in 2000, the rate for men >= 75 ranged from 5,014/100,000 in Ireland to 4,766.5/100,000 in Finland and from 3,077.2/100,000 in France to 2,516.2/100,000 in Japan. The mortality rate for cerebrovascular disease for men >= 75 ranged from 2,570.8/100,000 in Portugal to 699.8/100,000 in France. Rates for women were lower but had similar disparities. Information about death in the oldest old (>= 85 yr) is not generally available; cooperation among countries is needed to collect and compare data so that international differences in this age group can be determined.

Life expectancy: Life expectancy, determined from mortality rate data for 2002, is longest for Japanese, Canadian, Australian, French, and Spanish women (see Table 2-5). In most countries, men have a shorter life expectancy. However, in some developing countries (eg, India, Bangladesh), life expectancy for men and women is nearly identical.

In countries such as those of the former Soviet Union, life expectancy decreased by about 4 yr in the early 1990s, probably because of a higher incidence of fatal disorders related to alcohol or cigarette use and because social and economic disruptions increased. Ramifications for the elderly in these countries are uncertain, but the mortality rate for this group has increased.

Active or disability-free life expectancy: Active or disability-free life expectancy (average number of years a person is likely to remain in an active or a nondisabled state) is calculated by using life table techniques that consider all possible transitions in and out of a disabled state. The concept of active life expectancy has expanded to include higher orders of functioning, such as cognitive (eg, dementia-free) life expectancy. In certain US communities, active life expectancy at age 65 seems to vary from 11.3 to 13.0 yr for men and from 15.3 to 17.1 yr for women. In Japan, active life expectancy at age 65 seems to be slightly longer: 14.7 yr for men and 17.7 yr for women. However, the usual self-reported measures of physical disability can be interpreted differently from country to country, possibly resulting in variation. For all countries studied, physical disability (measured by calculating difficulty with activities of daily living) increases with aging. The goal of medical care is to maintain physical functioning as long as possible and to postpone the onset of disability close to the time of death (called compression of morbidity or squaring of the morbidity curve).

Use of Health Care Services

As the number of elderly people increases, the global burden of age-associated chronic disorders (eg, cardiovascular disease, hip fracture, Alzheimer's disease) also increases. People with these disorders are likely to need more medical services and home or institutional care. For example, hip fractures commonly cause physical limitation, hospitalization, and a lengthy period of morbidity. Hip fracture rates in 6 countries were compared, based on national hospital discharge data, and were corrected for national differences in counting transfers between hospitals. Rates were high but somewhat variable. They increased with aging and were higher in women than men. Age-adjusted hip fracture rates were highest in Finland, the US, and Sweden for men and in Switzerland, the US, and Scotland for women. Rates were lowest in Venezuela and Chile.

The percentage of all people hospitalized each year varies widely throughout industrialized countries. In 1996, hospitalization rates were highest in Austria, Finland, and Iceland (1 in 4 people) and lowest in Japan (1 in 10) and Mexico (1 in 17). The median for industrialized countries was 1 in 6. In the US, the rate was 1 in 8. The average inpatient stay also varies widely; in 1996, the average was 10.6 days. The average stay was longest in Japan and the Netherlands (> 32 days) and lowest in Denmark, Ireland, Mexico, New Zealand, Sweden, Turkey, and the US (< 8 days).

Average daily hospital expenditures were > $1000 in the US; $632 in Denmark; and $300 to $500 in Canada, Spain, Italy, and the United Kingdom. The lowest daily hospital expenditures were $100 to $200 in Iceland, Luxembourg, Finland, Greece, Norway, Korea, and Austria and < $100 in Japan, the Czech Republic, and Turkey.

Institutionalization: Hip fractures and physical disabilities affect the need for institutionalization, but the most important factor by far is cognitive dysfunction. About 2 to 8% of people >= 65 in various countries live in institutions (see Table 2-6); however, the percentage of those >= 65 who live in the community but need long-term care is higher. Sources for nursing home admissions also vary. In the US, the Netherlands, and Italy, the most common source is hospitals, possibly because of these countries' reimbursement systems or, most likely, because of social factors.

The US government's Minimum Data Set and Resident Assessment Instrument is used in nursing homes in the US and is being adapted for other countries. As this instrument is more widely used, it may help determine whether governmental policies, declining acceptance of responsibility by adult children for their parents, or other social factors affect the need for long-term care programs (eg, nursing homes, home care).

Work and Pensions

The financial consequences of retirement indirectly affect health in the elderly. Practices concerning labor force participation, retirement, and pensions vary by country. In 2000, the percentage of people >= 65 participating in the labor force was 3.3% in Italy and 1.3% in France and, for men only, 17.5% in the US and 10% in Australia. However, they may not have been working all the time. Because definitions of people who are working differ by region, comparing effects of retirement is difficult. Some countries have comprehensive pension programs; others provide hardly any coverage. In the US and United Kingdom, nearly 100% of working people are covered by Social Security or other pensions, but in China and India, only 20% are covered. Other governments are beginning to understand the importance of pension coverage.

This topic was last updated September 2005.