Ageism: Where It Comes From and What It Does

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Introduction

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According to the United Nations, the number of older-age adults across the world has almost quintupled in the last 65 years and by 2050 1 in 6 people in the world will be over the age of 65, up from 1 in 11 in 2019.  Among the main drivers of the exponential growth in the older population in developed countries have been increases in the quality of life and life expectancy accompanied by decreases in infant mortality and birth rates, advances in combatting chronic diseases of middle age and beyond (i.e., cardiovascular problems and cancer) and early successes in what is expected to be a revolution in addressing diseases and conditions typically associated with old age using a variety of tools including better nutrition, medical care, education, technology, sanitation and socio-economic support.  Crucially, greater life expectancy in wealthier countries has been accompanied by a compression in morbidity, which refers to the health-related quality of life before death, and researchers are claiming that people will be healthier for even longer.  This aging of the population opens up opportunities, but also presents challenges to governments, society and older persons themselves.  The World Health Organization has called for engagement around four action areas: change how we think, feel and act towards age and ageing; ensure that communities foster older people’s abilities; deliver person-centered integrated care and services that respond to older people’s needs; and provide access to long-term care for older people who need it.  In order for these efforts to be successful, it is essential to have a better understanding of aging, how it is measured and experienced by older persons in their day-to-day lives and how deeply engrained personal and institutional ageism in society creates barriers to progress that harm everyone, not just those persons who are on the receiving end of discrimination and stereotyping.

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According to statistics compiled and published by the United Nations Development Programme, the number of older-age adults across the world has almost quintupled in the last 65 years, with the above average growth occurring in Latin America and the Caribbean, Africa and Asia.​[1]  As of 2015, the number of older adults above 60 years of age was 906 million worldwide, representing 12.3% of the world population; however, there were significant variations among geographic regions with respect to the share of older-age adults: over 20% in Europe (23.86%) and North America (20.74%), but just over 5% in Africa (5.39%).  Asia, with its 514 million older-age adults, had the largest proportion of the worldwide population (57%).  According to the United Nations (UN), by 2050 1 in 6 people in the world will be over the age of 65, up from 1 in 11 in 2019.​[2]

Source: Gateway to Global Aging Data (a platform for population survey data on aging around the world)

The UN has noted that population aging is a global phenomenon, with virtually every country in the world experiencing growth in the size and proportion of older persons in their population, and all countries will be passing through an extraordinary longevity revolution in which the chance of surviving to age 65 rises from less than 50%—as was the case in Sweden in the 1890s—to more than 90% as of 2019 in countries with the highest life expectancy.​[3]  The UN reported that the proportion of adult life spent beyond age 65 has increased from less than a fifth in the 1960s to a quarter or more in most developed countries as of 2019, a change that is having a profound impact on society as older persons continuing to a growing and influential demographic group.  And, in many ways, we are just at the beginning of a new phase for human society.  In 1914 the probability that someone born that year would live to 100 was about 1%; however, projections from the Human Mortality Database (University of California, Berkeley) and the Max Planck Institute for Demographic Research in Germany indicated that reaching centenarian status will no longer be a rarity, and in fact will be the norm, in 2107, a continuation of a dramatic shift in longevity that has been occurring since the middle of the 19th century.​[4]

Among the main drivers of the exponential growth in the older population in developed countries have been increases in the quality of life and life expectancy accompanied by decreases in infant mortality and birth rates, advances in combatting chronic diseases of middle age and beyond (i.e., cardiovascular problems and cancer) and early successes in what is expected to be a revolution in addressing diseases and conditions typically associated with old age using a variety of tools including better nutrition, medical care, education, technology, sanitation and socio-economic support.​[5]  Crucially, greater life expectancy in wealthier countries has been accompanied by a compression in morbidity, which refers to the health-related quality of life before death, and researchers are claiming that people will be healthier for even longer.​[6]  Developing countries, often thought to be immune from the challenges of aging due to their relatively higher birthrates and steady supply of younger workers, are also expected to see significant and rapid increases in the percentage of their elderly population due to the same combination of falling infant mortality and birth rates; however, it is not clear whether those countries will have the resources to maintain the wellbeing of older persons in their midst in the same way as wealthier countries.​[7]

In the US, the rate of population growth is slow; however, it is expected that the population will grow by nearly 79 million people in the next four decades and cross the 400 million mark in 2058, with net international migration projected to become the large driver of population growth starting in 2030 due to falling fertility rates and the rising number of deaths in an aging population.​[8]  Notably, the share of Americans in the 65-and-older group is expected to nearly double in size during that period, growing from 49 million in 2016 (15% of the total population) to 95 million (23% of the total population) in 2060, and the population 85 years and older will grow by nearly 200% by 2060 to reach 19 million.  Several factors are converging to accelerate what has been referred to as the greying of America including the aging of the large group of baby boomers into older adulthood, improvements in health care that have promoted longevity and rising life expectancy and slowing growth in the population under age 18 (by 2034, older adults are expected to outnumber children for the first time in US history).  Projections also show that while older women will continue to outnumber older men, the gap will be narrowing in the coming years, and that the US will be shifting from a youth-dependent population to an old-aged dependent population.​[9]

In its July 2017 Issues Brief on Ageing, Older Persons and the 2030 Agenda for Sustainable Development prepared with the support of HelpAge International and AARP, the UNDP cataloged a number of challenges that the aging of the population present to governments, society and older persons themselves​[10]:

Many countries are struggling to provide adequate social protection for older persons and adapt their public health systems to cope with the rising incidence and prevalence of non-communicable diseases, which requires a shift to meet the surging demands for age-appropriate care for older persons (e.g., long-term care outside of the household, services and technologies for prevention, detection and treatment of diseases)

Poverty is a major threat to the wellbeing of older persons, many of whom must cope with income insecurity, malnutrition, poor health and lack of access to clean water, sanitation and adequate housing, and the pensions provided to older persons unable to continue generating income through their own work are often not sufficient to meet their basic needs for various reasons including informality of labor markets and a lack resources for adequate public and private investment in pension programs

Older persons are especially affected by displacement caused by conflict and natural hazards due to reduced physical ability and limited mobility and are often ignored in humanitarian interventions

Persistent prejudice and discrimination towards older persons at individual and institutional levels erodes the multiple basic human rights of older persons including their rights to autonomy, participation, access to education and training, health and social care, security and decent employment

Aging also aggravates the challenges that many older persons face as a result of being part of other disadvantaged groups (i.e., discrimination on the basis of gender, sexual orientation, race, ethnicity, caste, disability, religion or socioeconomic status)  

Older women and men are vulnerable to physical, emotional and/or financial abuse including violence and neglect from their own family members and the extent of such abuse is likely underreported due to shortcomings in the collection and analysis of data on persons in older age groups

Source: UN Decade of Healthy Ageing (who.int)

The world is responding to these challenges in a number of different ways including the ambitious UN Decade of Healthy Ageing 2021-2030, which was endorsed by the both the World Health Assembly and the UN General Assembly in 2020.  The Decade is based on acknowledging that humans are now living longer than any time in history and recognizing that the steps taken to increase longevity are of little value unless they are accompanied by adding more life to years through healthy ageing ... [which] is ‘the process of developing and maintaining the functional ability that enables wellbeing in older age’.​[11]  Elements of functional ability include ability to meet one’s basic needs; ability to learn, grow and make decisions; mobility; ability