SOWK 1015
LECTURE 11 POPULATION AGING
Dr. Shiyu Tracy LU
Assistant Professor
2024
Questions
• Q1: What is your expectation for your later life?
• Q2: What is your perception of the aged people
nowadays?
Q3: What do we need to do to narrow down these
gaps?
Why do we celebrate the 60/70/80th birthday of our older family
members while considering population aging as a social problem?
Outlines
• Understanding the population aging
• Welfare needs in later life
• Healthy aging perspective
• Long-term care systems
Understanding population aging (1/2)
• Population aging - the process by which older individuals become a proportionally
larger share of the total population
From UN report on World Population Aging: 1950-2050
• Common indicators
– The number of people aged 65+ & its percentage
– Old age dependency / Elderly support ratio
•In 2020, the number of people aged 65 years and older outnumbered children younger than 5 years
•Half of the older adults live in Asia.
Understanding population aging (2/2)
• Population ageing is an irreversible global trend as a result of
demographic transition.
• mainly caused by the low fertility rate and high life expectancy.
Life expectancy (at
birth/80)
Fertility rate
Comparison of ageing in Hong Kong and
selected economies
Time is running out! 12
New trends?
• All countries face major challenges to ensure that their health and social systems
are ready to make the most of this demographic shift.
• In 2050, 80% of older people will be living in low- and middle-income countries.
• The pace of population ageing is much faster than in the past.
• In 2020, the number of people aged 60 years and older outnumbered children
younger than 5 years.
• Between 2015 and 2050, the proportion of the world's population over 60 years
will nearly double from 12% to 22%.
Challenges to health and care systems
• Ageing is part of the natural order, and is accompanied by changing welfare needs due to:
• Physical decline
• Cognitive decline
• Changing social, financial, and psychological needs
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Physical Health conditions
• Prevalence of Chronic diseases
– 42.6% of HK people aged 60-64
– 53.9% of HK people aged 66-69
– 78.4% of HK people aged >=70
• Prevalence of Multimorbidity
– 45% of HK people in the 45 to
64 age group
– 75% of HK people aged 65 or
over
Source: Census and Statistics Department (2022). Special Topics Report No.
63, Persons with disabilities and chronic diseases; Thematic Household
Survey Report No. 74;
Disability and ageing
• In Hong Kong, the overall prevalence rate of
persons with disabilities was 7.1% in 2021, as
against 5.2% in 2007 (Census and Statistics
Department, 2021).
• The percentage of people with disability
(excluding intellectual disability), by age
groups
– 6.5% of HK people aged 60-64;
– 8.4% among those aged 65-69;
– 25.7% among those aged >=70
• Activities of Daily Living (ADLs):
– ADL disability increases with age
Notes: Adjusted age trends of ADL disability among Chinese adults aged 65–99 years, with 95% CIs, Elderly Health Centres 2001–2012. Yu et al., (2016). BMJ Open . doi: 10.1136/bmjopen-2016- 16
013259
Frailty
• Frailty is conceptually defined as a clinically
recognizable state of older adults with increased
vulnerability, resulting from age-associated
declines in physiologic reserve and function across
multiple organ systems (Chen, Mao, & Leng,
2014).
• Examples:
• weakness (e.g., low grip strength)
• Slowness (e.g., walking speed)
• Low level of physical activity
• Weight loss
• Impacts of frailty: Fall, hospitalization,
institutionalization, can strongly predict death
(Koller & Rockwood, 2013).
• Prevalence of frailty in Hong Kong
• Prevalence of frailty among those aged 65 and above
was 12.5% (Woo et al., 2015).
• The prevalence of frailty increases by 3 times from
among those aged 65–69 years to those over 75.
17
Cognitive impairment and Dementia
• Dementia is a clinically significant condition
diagnosed when acquired cognitive impairment
has become severe enough to compromise
social and/or occupational functioning.
• Mild cognitive impairment (MCI) is a state
intermediate between normal cognition and
dementia, with essentially preserved functional
abilities.
• Different from normal ageing?
• Examples: Retrieval of the content being
forgotten: Usually can recall the content
afterwards vs Rarely can recall the content
afterwards
• Measurements (e.g., MoCA)
18
Cognitive impairment and Dementia
Elderly depression
• Symptoms of elderly depression
• E.g., Depressed mood, fatigue, muscle ache, sleep disturbance,
loss of sense of worthiness, withdrawal from people and interests
they enjoyed previously, psychomotor retardation and cognitive
decline.
• Depression often co-occurs with cognitive impairment, and
it can be a risk factor for dementia
• Depression is also related to shortened telomeres, a marker
for biological ageing, increased risk of suicide and
increased mortality
• Over 10% of older adults in primary care settings show
signs of clinically significant symptoms (Sun et al., 2012).
• Risk factors: Painful events (e.g. death of spouse), Past
depression, Physical illness (e.g. chronic pain)
20
Other emergent social issues: Suicide
Source: https://csrp.hku.hk/statistics/ 21
Elderly poverty
What are the implications?
• Diverse welfare needs in older adults (Physiological, safety,
psychological needs etc.)
• Require diverse service and care (e.g., financial support,
healthcare, social care, end-of-life etc.)
• Changing welfare needs over the life course
• On average, many older people in their 60s and early 70s remain
healthy
• The turning point is in their late 70s or 80s
• Social cost.
• Challenges to the financial sustainability of healthcare and LTC
system
• E.g., Social cost of dementia
• 2010: HK$12,220 m -> 2036: HK$ 31,810 m
23
The true costs of population ageing
The true costs of population ageing
• Rethink how we think population aging
• Invest our society to prepare well for super aging society
• Building a supportive environment unlock older
adults’potentials
SOCIAL POLICY AND SERVICE PROVISION FOR
ELDERLY
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WHO Healthy Ageing framework
Global attention on
Healthy Ageing
• The United Nations and WHO
have declared the next decade
would be the Decade of Healthy
Ageing (2021-2030)
• Healthy ageing is relevant to
everybody and is about creating
the opportunities that enable
people to be and do what they
value throughout their lives.
• World Health Organization
(WHO) defines healthy aging “as
the process of developing and
maintaining the functional
ability (FA) that enables
wellbeing in older age”
• It considers older adults’ health
from a functional rather than a
disease-based perspective
28
Age-friendly city
• The World Health Organization ("WHO") launched the
Global Age-friendly Cities Project in 2005.
• According to the WHO, an age-friendly city
encourages active ageing by optimising opportunities
for health, participation and security in order to
enhance quality of life as people age. An age-friendly
city is not just "elderly-friendly", but friendly for all
ages.
• By 2020, over 1,000 cities and communities across 41
countries had joined the WHO Global Network for
Age-friendly Cities and Networks (WHO, 2020).
• In Hong Kong, 18 districts have joined WHO Global
Network
30
LONG-TERM CARE SYSTEMS CONTINUUM CARE
What is long-term care
• Long-term care includes a broad range of personal, social, and medical services and
support that ensure people with, or at risk of, a significant loss of intrinsic capacity
(due to mental or physical illness and disability) can maintain a level of functional
ability consistent with their basic rights and human dignity.
• Long-term care is provided over extended periods of time by family members,
friends or other community members (also called informal caregivers) or by care
professionals (also called formal caregivers).
• Formal long-term care aims to prevent, reduce, or rehabilitate functional decline and
it can be provided in different settings, such as home care, community-based care,
residential care, or hospital care.
Types of
LTC
• https://lcplfa.memberclic
ks.net/assets/images/202
1-LCPLFA-Elder-Care-
Continuum-
V310241024_1.jpg
o The ability to live in one’s own home and community safely, independently and
comfortably, regardless of age, income or capacity ( “Ageing in the right place”).
Key issues in home care
• Informal care remains predominant
o For example, 80% of long-term care
provided in Europe is estimated as
informal care, especially higher in those
countries where long-term care systems
are not as well-developed or resourced
(WHO, 2022).
Source: ILO, 2022
Challenges for long-term care systems
• Sustainability of the financial capacity
• Access and adequacy of the care provision
• Quality of care provision
• Workforce crisis
Functioning
Enhance the life years of quality of time
Bedridden due to
decreased function
Age
Cut the time being bedridden
Length of time being bedridden
A reform in nursing homes
Self reliant model
Individual healthy
aging suggestion
from Professor David
Sinclair
The six most important lifestyle factors that
predict longevity
• Physical activity
• Absence of alcohol abuse
• Absence of smoking
• Can cope with life’s up and downs
• Healthy weight
• A stable marriage or someone to reply on
Start with Food and movement
• Avoid sugars and refined grains
• Be plant focused
• Don’t snack. Have hot drinks instead
• Be active, build muscle
• Try to eat one main meal day
• Change lifestyle slowly
https://sinclair.hms.harvard.edu/
