Surely you have read or heard about the demographic transition and the challenges that this generates for health systems. The demographic transition begins when the infant mortality rate falls, resulting in cohorts of children and young people that are very numerous in relation to the adult population. As time goes by, the life expectancy of the population increases as socioeconomic conditions and access to health services usually improve.
At the same time, the fertility rate declines, which is partly due to couples realizing that it is no longer necessary to have many children to ensure that some survive, and that they have greater access to contraceptives. To this is added the cultural and social progress that motivates women to develop their skills in different areas and have fewer children or postpone their pregnancies.
The demographic transition, therefore, leads to societies where relatively fewer children are born and almost all survive, but where there are still many older adults. During this stage, children born with high probabilities of survival, in an environment where fertility has not decreased, are incorporated into the economically active population. This generates a demographic “bonus” – that is, relatively, there are many people of working age in relation to the population that is not of working age (children and older adults).
Later, the transition ends when fertility decreases and life expectancy increases, at which point the generation of young people ages and the percentage of older adults increases. A population that has 10 percent or more of older adults is already considered an aging population.
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Challenges of the Demographic Transition
When a country is in an advanced stage of demographic transition with a large proportion of older adults (such as Uruguay, Chile, and Costa Rica), new challenges arise. One of them is care for the elderly, who in many cases have difficulties performing basic activities of daily living, including eating, bathing, dressing, using the toilet, and moving in and out of bed.
Another challenge is the increase in chronic diseases as a result of greater exposure to risk factors. Until recently it was considered that older adults were more prone to these diseases, but in fact such diseases occur in all age groups, though they are more frequent among older adults.
This situation of increased chronic diseases and a reduction of infectious diseases is known as the epidemiological transition. It occurs when countries reduce the burden of infectious diseases, such as diarrhea, usually associated with poor hygiene and sanitary conditions, and see an increase in the burden of chronic diseases such as diabetes, hypertension, heart conditions, and lung diseases, which are usually associated with unhealthy and sedentary lifestyles, smoking, consumption of high-calorie foods, and excessive consumption of alcohol.
The Case of Mexico
In countries such as Mexico, the main challenges of aging consist not so much in the increase in the number of older adults but in the deterioration of the health status of these groups. The National Health and Aging Study (Encuesta Nacional sobre Salud y Envejecimiento en México – ENASEM) yields some alarming data about this phenomenon. The survey is representative at a national level for the population age 50 and older and collects longitudinal information, following the same people over time (incorporating new cohorts periodically to maintain representativeness), as shown in the graphs below.
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In short, the main challenge is not the increase in the proportion of older adults, which in itself is nevertheless a challenge, but rather the deterioration in their health conditions. In a period of only 15 years, which is a very short period for such substantive changes in health and demography, significant changes have been observed, including a considerable increase in the proportion of dependent older adults.
How to Interpret This Phenomenon
The most alarming trend among all age groups, and especially among persons age 60 and over, is the increase in the percentage of the population requiring support. It is clear that the youngest of the older adult cohorts showed worse health indicators in 2015 than in 2001. At the same time, while in 2001 only 11 percent of adults between 70 and 79 years old were in a situation of dependency, that percentage increased to 23 percent in 2015.
The same happens in the case of hypertension and diabetes, which are two of the most prominent chronic diseases. For example, in the case of the population age 60-69, the percentage of people with diabetes increased 62.5 percent (from 16 to 26 people per 100) and that of hypertension increased by 17.5 percent (from 40 to 47 people per 100).
Today we are facing significant health and care challenges that are the product of demographic and epidemiological changes. The former, which come to the fore gradually, are a consequence of the increase in the proportion of elderly people. For example, among the total population age 50 and over in Mexico, the relative share of the 60-69 age group increased from 31 to 33 percent, and that of the 70-79 age group from 16 to 20 percent, over the period from 2001 to 2015. Epidemiological changes are more drastic and reflect the absence or limitations of preventive policies, as well as unhealthy lifestyles in terms of nutrition and exercise in recent decades.
What’s the population of older adults like in your country? What demographic transformations has the area where you live experienced? What are the biggest challenges? Tell us in the comments section or at @BIDgente on Twitter.