Who will care for the oldest people in our ageing society?

BMJ 2007; 334 doi: (Published 15 March 2007) Cite this as: BMJ 2007;334:570
  1. Jean-Marie Robine, research director,
  2. Jean-Pierre Michel, professor of geriatrics medicine,
  3. François R Herrmann, deputy head physician
  1. Department of Rehabilitation and Geriatrics, Geneva Medical School and University Hospitals, 1226 Thonex-Geneva, Switzerland
  1. Correspondence to: F Herrmann francois.herrmann{at}
  • Accepted 19 December 2006

The number of informal carers for frail elderly people is set to fall steeply. Jean-Marie Robine and colleagues propose a new way to assess the trend that should help policy makers plan for the deficit

Medical journals usually focus on the most dramatic consequences of population ageing,1 2 3 4 such as the effect on financing of health care.5 6 Many people fear that population ageing will generate a demand for long term care that will outpace the supply of formal care.7 8 Of course, unremitting prevention of disability could reduce demand,9 but the effect of a decline in disability on the solvency of social security programmes is still debated.10 This debate does not consider the quality of long term care or the availability of families to care for frail elderly people.11 12 We describe an indicator to monitor potential informal care resources using American and Swiss data as examples.

Population ageing

Most studies of population ageing use demographic indicators based on a three age group population model—young people, those of working age, and elderly people. This model does not reflect the current population changes.13 Indeed, the demographic dependency ratio (the ratio of young and elderly people to working people) will start to fall steeply only around 2010, as a result of ageing of the baby boomer generation (born after the second world war).14 This indicator cannot properly reflect the large increase in the numbers of frail elderly people who may be highly dependent on others in their daily life.

The consequences of the demographic transition that occurred during the 20th century in Europe and North America were largely ignored. Population ageing is characterised by changes in the proportions of the different age groups. The sequence of changes …

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