Numbers of dependent older people in the UK and elsewhere have actually been falling in recent years
Analysis: Population ageing: the timebomb that isn’t?
The extent, speed, and effect of population ageing have all been exaggerated and we should not assume that it will strain health and social care systems, argue researchers on bmj.com today.
Jeroen Spijker and John MacInnes from the University of Edinburgh say the standard indicator of population ageing – the old age dependency ratio – does not take proper account of falling mortality, and that the numbers of dependent older people in the UK and other countries have actually been falling in recent years.
Population ageing is a concern in all developed countries. For the first time, there are now more people over the age of 65 in the UK than there are children under 15 years.
This has worried policy makers because for every worker paying tax and national insurance there are more older citizens, who make greater demands on social insurance, health, and welfare systems and have increasing morbidity and disability.
The standard indicator of population ageing is the old age dependency ratio (OADR). It takes the number of people who have reached the state pension age and divides it by the number of working age (16-64 years) adults to estimate the proportion of older people relative to those who pay for them.
It defines all people above the statutory pension age as dependent, regardless of their economic, social, or medical circumstances. This, say the authors, overlooks the fact that rising life expectancy makes these older people “younger,” healthier, and fitter than their peers in earlier cohorts.
For example, in 1900 average life expectancy for a 65 year old woman in England and Wales was 11 years. Today she could expect to live another 21 years (10 and 18 years respectively for men).
This is crucial, they say, because many behaviours and attitudes (including those related to health) are more strongly linked to remaining life expectancy than to age.
The OADR also assumes that everyone of working age actually works. But data show that in Britain, there are more dependents of working age (9.5 million) than there are older people who do not work. Using age to define the working population thus makes little sense, add the authors.
So they calculated an alternative measure – the real elderly dependency ratio – based on the sum of men and women with a remaining life expectancy of up to 15 years divided by the number of people in employment, irrespective of age.
When they used this measure, they found that old age dependency in the UK has fallen by one third over the past four decades – and is likely to stabilise close to its current level. The measure shows similar falls in many other countries.
“The different story of population ageing told by our real elderly dependency ratio has several important implications for health policy and clinical practice,” say the authors. “Our calculations show that over the past four decades the population, far from ageing, has in fact been getting younger, with increasing numbers of people in work for every older person or child.”
They accept that demand for services will rise but will “continue to be driven by other factors, chiefly progress in medical knowledge and technology, but also the increasing complexity of comorbid age related conditions.”
And they conclude: “The capacity of healthcare systems to cope with increasing longevity will depend on the changing relationship between morbidity and remaining life expectancy and, in particular, the effect of education.”