BMJ No 7106 Volume 315
Editorial Saturday 23 August 1997
The demographic timebomb
Will not explode in Britain for the foreseeable future
The apocalyptic forecasts about the economic consequences of population aging are unduly alarmist. Despite increasing life expectancy, the proportion of the British population aged over 60 increased from 19% in 1971 to only 20.5% in 1994.(1) This was a much smaller increase than that of preceding decades because of offsetting trends among the elderly population.
The number and proportion of young elderly people (aged 60-69) actually fell during this period, whereas the number of older elderly people (over 75) increased by almost 50% from 4.7% of the total population to 6.8%. (However, these national aggregates conceal considerable variations in the age structures of local populations. For example, in parts of inner London 14% of the population is aged over 60, whereas in some local authorities in the south west and south east of England the proportion is up to 35%.(2) )
Demographic events have demographic repercussions for several decades thereafter. The fall in numbers of young elderly people over the past two decades reflects the small birth cohorts of the 1920s and 1930s, whereas the increasing number of very old people reflects the larger cohorts born in the early 20th century. Current trends are projected to continue over the next decade, with some decline in the proportion of young elderly people, increases in the proportion of old elderly people, and little change in the overall proportion of people of pensionable age (table 1 ).(3)
| Table 1 - Proportions of different age groups in projected population of Great Britain (data from Population Projections 1994-2064(3)) | ||||||
| Age group (years) | Year | |||||
|---|---|---|---|---|---|---|
| 1995 | 2000 | 2005 | 2010 | 2015 | 2020 | |
| <16 | 20.5 | 20.3 | 19.5 | 18.5 | 17.9 | 17.7 |
| 16-64
(men) 16-59 (women) | 61.2 | 61.6 | 62.2 | 62.1 | 61.2 | 60.1 |
| 65 and over (men) 60 and over (women) | 18.3 | 18.1 | 18.4 | 19.5 | 20.8 | 22.2 |
| 60-74 | 13.5 | 13.1 | 13.5 | 15.1 | 16.0 | 17.0 |
| 75 and over | 7.0 | 7.4 | 7.4 | 7.5 | 7.7 | 8.3 |
The number of pensioners will rise by 3% between 1995 and 2005, but the number of people aged 45-59 (the ages of peak earning capacity) will increase by 13%. The latest population projections show that it is only after 2005 that patterns look set to change more dramatically, with the baby boom after the second world war reflected in substantially rising numbers and proportions of elderly people.(3)
| While Britain has a higher proportion of elderly people than Ireland, Spain, and the Netherlands, its population will continue to be younger than that of many other European countries for several decades (fig 1).(4) Our fertility has been below replacement level since the 1970s; even so, it is about 40% higher than in Italy, Spain, or Germany, and on current projections it will be 2025 before deaths exceed births and the population starts to decline.(3,4) This contrasts with Russia, where births have been running at about half the number of deaths since the early 1990s.(5) | ||
| Proportion of projected total population in European countries that will be aged 60 and over (data from Demographic Statistics 1995(4)). |
The volume of care needed for elderly people is not just a function of numbers; it depends also on their health status, marriage patterns, household composition, and living arrangements. Life expectancy is currently increasing by about two years each decade,(6) but the evidence on whether recent gains in life expectancy have resulted in extra years of healthy life is mixed.(7-10) Trends on other fronts are clearer.
Elderly people living alone need to make greater use of formal services. Since more of today's elderly people are married than in preceding cohorts, the proportion living with a spouse has increased.(1)(8) More of today's elderly people also have children. Furthermore, a substantial volume of care is provided by informal carers, including by the elderly themselves for other elderly people.(8)(10-12) In 1990, 20% of carers of elderly people and 44% of co-resident carers were themselves aged over 65,(1) and one person in seven aged over 60 and one in 16 aged over 80 was caring for someone.(12)
On the other hand, recent trends show that co-residence between elderly parents and children has declined, living alone is on the increase, and the proportion of very elderly people in institutions has risen. Rising divorce rates among the elderly and their children, and increased participation of women in the labour force, may also affect the ability of families to provide support.
What can we conclude from these facts? In many respects the elderly population of the future will be advantaged in comparison with preceding cohorts. Fewer will be unmarried, childless, or widowed; more will have occupational pensions and residential property; and there will be a significant increase over the next decade in people aged 45-64, the peak age for providing informal care. For the next decade or so, the pace and nature of these and other sociodemographic changes is likely to have a greater bearing on the needs of elderly people than their numbers.
Veena Soni Raleigh Senior research fellow
National Institute of Epidemiology,
University of Surrey,
Guildford GU2 5YD
References
1 Grundy E M D. The population aged 60 and over. Popul Trends 1996;84:14-20.
2 Department of Health/University of Surrey. Public health common data set for England 1995 Guildford: Institute of Public Health, University of Surrey, 1995.
3 Population projections 1994-2064 (1994 based). Population
projection by sex and age for Great Britain prepared by the government
actuary in consultation with the registrars general
4 Demographic statistics 1995. Belgium
5 Russia faces demographic crisis. BMJ
1996;313:385.
6 Central Statistical Office. Social trends: 1996
edition. London: HMSO, 1996.
7 Dunnell K. Are we healthier? Popul Trends
1995;82:12-8.
8 Department of Health. The health of elderly people. An
epidemiological overview. London: HMSO, 1992.
9 Wordsworth S, Donaldson C, Scott A. Can we afford the
NHS? London: Institute for Public Policy Research, 1996.
10 Arber S. Is living longer cause for celebration? Health
Serv J 1996:106:28-31.
11 Arber S, Ginn J. Gender and later life. A sociological
analysis of resources and constraints. London: Sage
Publications, 1991.
12 Jarvis C, Hancock R, Askham J, Tinker A. Getting around
after 60. A profile of Britain's older population. London:
Gerontology Data Service, Age Concern Institute of Gerontology, King's
College London, 1996.
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