Chapter 9: Older Adults

Meal Service

- 1972 amendments to the Older Americans Act outlined a nutritional program for older adults and provided funds for communities to establish meal services - Meal on wheels to homebound individuals. - Congregate meal programs - regulated by federal and state guidelines to ensure that meals meet standard nutritional requirements - cost varies by site and client income

Morbidity

- 65 and older: One in five men and one in three women are unable to perform at least one of the five PA (walking two or three blocks, writing, stooping or kneeling, reaching up, lifting something as heavy as 10 pounds). - Women re more likely than men to have physical limitations. Causes of reduced activity can be classified in two types: chronic conditions and impairments

Health Behaviors and Lifestyle Choices

- 76% of people age 65 and older consider their health as excellent, very good, or good. Rates are the same among men and women but as they age the ratings decrease in quality. - Older adults report more favorable health behaviors than their younger counterparts: less likely to consumer large amounts of alcohol, smoke, be overweight or obese. Note that all of these things decrease life expectancy (more likely to die hence the report). - Health behaviors that can most affect the older adults: healthy eating, exercise, and immunizations

Myths Surrounding Aging

- Ageism is the results of ignorance, misconceptions, and half-truths about aging and older adults. - Older adults are for the most part independent, capable, and valuable resources 1. "After age 65 life goes downhill" - age 85 is the new chronological definition of old age 2. "Old people are alike" - more differences among elders than any there segment 3. "Old people are lonely and ignored by family" - older adults are least likely to live alone (if they are, they have contacts) 4. "Old aged used to be better" - not treated any better than today 5. "Old people are senile" - impairments are the results of disease and not really part of older adulthood 6. "Old people have the good life" - face concerns: loss of loved ones, health, and value 7. "Most are sickly" - Majority of older adults live active lifestyles 8. ""Old people have no sexual interests or ability" - there is an alteration in sexual response 9. "Nursing homes" - 3 to 4% above the age of 65 live in homes, 1% of those 65-74 reside in homes, and 19% for the oldest old (85 and older) 10. "Unproductive" - productively engage at hoe and in community; engaged in professional employment is at all time high

Racial and Ethnic Composition

- As older adult population grows larger, it will be more diverse. In 2013, older adult population was mostly white. Expected that the percentage of older whites will decline and older American Hispanics will be the largest older minority group in the US.

Physical activity

- Balance, mobility, and daily functioning can be improved with regular physical activity. - Older adults are the least physically active of any age group. Loss because of the aging process or many suffer from chronic conditions. - 2008 Physical Activity Guidelines for Americans states that if older adults are fit and have no chronic conditions their physical activity recommendations are the same as any other aged adult. - Focus more on aerobic conditioning and muscle strengthening. And focus on balance training because of risk for and compilations from falls - 11% of elders in the US meet the physical activity guidelines.

Affordable Housing

- Biggest housing problem - Frail and disabled, have low incomes, and live in rural areas are the most in need for such housing - US Department of Housing and Urban Development (HUD) works to provide safe, decent, affordable housing for older adults and other groups - Eligibility and types of housing are based on income and other criteria.

Mortality Rates

- Expressed in deaths per 100,000 population. Decrease in annual mortality rate achieved over the 20th century was because of trumps in medical science and public health practice. - Life expectancy interacts with the mortality rate. Mortality rate in the US has been constant for 20+ years and life expectancy has continued to increase. - Life expectancy for men and black Americans has trailed behind women and white Americans. - Increase in life expectancy in the first half of the 20th century could be because of the decrease in infant and early childhood deaths. The increase in life expectancy since the 1970 can be because of the postponement of death among the middle aged and older adult population.

Personal Care

- Four different levels of tasks that older adults may need assistance with: 1) instrumental tasks - housekeeping, transportation, maintenance, assistance in business) 2) Expressive tasks - emotional support socializing and inclusion, trying to prevent feelings of loneliness and isolation 3) cognitive tasks - assistance that involves scheduling appointments, monitoring health conditions, reminding elders medications, and acting as a back up memory 4) Tasks of daily living - eating bathing dressing toileting walking getting outside

Health Care

- Health Care is a major issue for older adults - Older adults are the heaviest users of health services. More hospitalization and longer stays. Spend twice as much per person on prescription drugs as those younger than 65 years of age. Higher usage rates for dental care, vision aids, and medical equipment and supplies. - Usage of health care services increase with age and much money spent on health care is spent in the last year of life. - Private sources are the major source of health care payment for people younger than 65. Public funds are the major source for health care expenses for older adults. Medicare covers biased to hospital care and long term services are not covered. - Medicare had 55 million enrollees and expenditure was 597 billion. Medicaid is a federal state program that helps to cover the health care costs of poor older adults (mostly in nursing home care, home health care, and prescription drugs). Over 8 million older adults were covered by Medicaid.

Vaccinations

- Immune system tends to weaken over time, which increases the risk of infectious diseases - recommended that older adults receive vaccinations against influenza and pneumonia (illness that create increased complications in the elderly population) - Influenza vaccination is recommended every year and pneumococcal vaccination once in their lifetime. - Racial disparities occur: black and hispanics Americans have lower vaccination rates than white older adults

Housing

- Important source of continuity for older adults. - Housing: major needs are appropriateness, accessibility, adequacy, and affordability (intertwined) - Housing requirements may change more rapidly than housing consumption during the course of retirement as results of changes in household composition, decreasing mobility, and increasing morbidity - Biggest change in housing needs of older adults is the need for special modification because of physical limitations - Decision to remove older adults from their long-term residences is not easily made because their is psychological and social value to the home. - Categories of housing options for older adults: independent living, assisted living, continuing care retirement communities, nursing homes/skilled nursing facilities, affordable housing

Economic Status

- In 1970, about 25% of elders lived in poverty and by 2013 the statistics dropped to 9.5%. 5.6% were classified as near poor in 2013. - Major source sifters income: social security, income from assets, private pensions, government employee pensions, and earnings. - Social Security benefits accounted for 35% of the aggregate income of the older population. Bulk of the remainder consisted of earnings, asset income, and pensions. - Because more than one-fourth of older adult income comes from work earnings, they are economically more vulnerable to circumstances beyond their control (loss of spouse, deteriorating health and self-sufficiency, changes in Social Security, Medicare and Medicaid legislations and inflation).

Baby Boomers and Medicare

- Legislators have to choose: raising taxes to pay for the care, reallocating tax dollars form other programs to pay for care, cutting back on coverage offered, offering care to those that cannot afford it (means test) OR revamping the present system under which care is funded.

Housing

- Majority of older Americans live in adequate, affordable housing. For some, housing is an asset because they have no mortgage or rental payments, or they can sell their home.

Obesity

- Number of obese people age 65 and over has increased in recent decades - 2010, 38% of those age 65 and over were obese compared to 22% two decades earlier - Only 26% of US older adults re in health weight range

Size and Growth of the Older Adult Population in the US

- Number of older adults and proportion of the total population made up of older adults grew significantly during the 20th and 21st century. Suggest that populations will continue to age in this country and others. - 2011, baby boom generations bagel to turn 65 and by 2030 projected that 72.7 million people (1 in 5) will be age 65 or older. Population aged 85 and older is the fastest growing segment of the older population. Expected that the percentage of people age 18 and younger will decrease to around 22% (just slightly). - The projected growth of the older adult population is expected to raise the median age of the US population. 2010 the median age was 37.2 years and 39 years by 2035 and remain the same until 2050.

Introduction

- Number of older adults in America and proposition of the total population increased dramatically during the 20th and early 21st century. 1950, 12 million were over 65 and older (8%). 2010, 40,2 million (13.1%), over one in eight Americans. - A significant number of Americans will achieve older adult status. - Age will always be a restive concept.

Nursing Homes/Skilled Nursing Facilities

- Nursing homes, skilled nursing facilities, or long term care facilities - Last housing option for those who can no longer live on their own and nee 24 hour care and supervision. - Provides short term care for those that need rehabilitation or who just came from the hospital. Provide long term care for those that are not able to return to an independent state of living. Provides assistance with activities of daily living, medical monitoring and treatment is provided by a RN. - Concern is the payment and cost. Payment depends on the type of care needed, type of insurance coverage, and financial status. - Options for payment: private payments, long term care insurance, Medicare, Medicaid. Privately pay for nursing home until they are eligible for Medicaid and Medicare only covers stays in nursing home care for a limited time and if it follows a hospital stay.

Assisted living

- Offer housing options for individuals who need a wide range of support services to help them with activities of daily living (medication management, bathing, dressing, and meals). Residents do not require the level of care that nursing home resident need. - Services they provide: meals, housekeeping, transportation, security, exercise and wellness, laundry, social and recreational, staff, assistance, access health and medical services, emergency call systems, medication, care for cognitive impairments - Cost can vary.

Senior centers

- Older Americans Act of 1965 provided funds to develop senior centers where older adults can congregate for fellowships, meals, education, and recreation - can build with local tax dollars - Found less in rural areas - Communities can use this as a central location for legal assistance, income consoling, income tax return assistance, program referrals, employments services, and other services and information

Income

- Older adult status reduces the income needs. Major reeducation occurs in retirement. - Retirees do not need to buy job related items, pay union dues, join associations. No longer commute, buy as many meals, spend on business travel, children are no longer dependent, mortgage has been retired. Taxes are lower because income is lower and community services are at reduced prices. - Aging increases expenses for health care and home maintenance and repairs. - Mains sources for income: Social Security, pensions, earning from jobs, income from assets, and other sources. SS benefit account for about 39% of income for older adults. 90% of all people older than 65 receive SS benefits. - Income of older adults has improved. When income and assets are combined, economic status of older adults and those younger than 65 is not that far apart. - 9.5% of the older population lives in poverty. Unmarried and minorities have the highest poverty rates and married persons have the lowest poverty rates.

A Health Profile of Older Adults

- Older adults has improved, living longer and remaining functional. Percentage of chronically disabled older person (impairments for 3 months or longer that impede daily activities) has been slowly falling. - Most consistent risk factor of illness and death across the total population is age.

Education

- Older adults have completed fewer years of formal education than their younger counterparts. Education level has increased in recent decades. - Percentage of older adults who completed high school increased. One-fourth of older adults had a bachelor's degrees or higher. - Differs by are and ethnic origin with more whites finishing high school. High school completion rate has increased in all racial and ethnic groups. - Baby boomers are the most educated in the US and it is expected that future older adults will have achieved higher educational attainment.

Cigarette Smoking

- Over 9% of current older adults are cigarette smokers. Numbers have decreased because of the decreasing number of male smokers. - chronic lower respiratory diseases are the third leading cause of death among older adults

Geographic Distribution

- Proportion of older adults in the US population varies. 61% of persons age 65+ lived in 13 states: CA, Florida, Texas, New York, Pennsylvania, Ohio, Illinois, Michigan, North Carolina, NJ, Georgia, Virginia, and Arizona - 19 states have a proportion of their total 65+ population higher than the national average at over 15%. 81% of those aged 65+ in the US live in metropolitan areas

Older Americans Act Amendments of 2000

- Public Law - Established the National family Caregiver Support Program (NFCSp), administered by the Administration on Aging (AoA) of the US Department of Health and Human Services. - Provides grants to states based on the percentage of their population age 70 and over. Used to support services that assist families and informal caregivers to keep their loved one at home. - Five services: information to caretakers about services, assistance to caregiver in accessing services, counseling/support groups/ caregiver training, respite care, and supplemental services on a limited basis - Eldercare support for working caregivers is a growing concern in the US because more women are in the workplace and the percentage of 85+ population is growing.

Mistreatment of Older Adults

- Reports of elder abuse and neglect have increased greatly in recent years. Mostly because of all 50 states having passed some form of elder abuse prevention laws. - First line of contact in reporting elder abuse is with Adult Protection Services. - 1998 National Elder Abuse Incidence Study: 551,000 elderly persons older than age 60 had experienced abuse, neglect, or self-neglect in a domestic setting during the year of the study. Revealed that female elders are abused at a higher rate, elders 80 years and older are abuse or neglected at two or three times the rate of their proportion of the elderly population, perpetrator is a family member (two-thirds of the perpetrator are adult children or spouses), and victims are usually depressed, confused, or extremely frail - Dementia and cognitive impairment, a past experience with domestic violence, frailty, and experience social isolation appear to be at higher risk for mistreatment

Chore and Home Maintenance Service

- Services: yard work, cleaning gutters and windows, installing screens and storm windows, plumbing and electrical repair, furnaces and air conditioners, and helping to adapt a home to any impairments

Impairments

- They are deficits in the functioning of one's sense organs or limitations in one's mobility or range of motion. More prevalent in older adults. - Primary impairments that affect older adults: sensory impairment (vision, hearing, postural balance, or loss of feeling in the feet), physical limitations, and memory impairments. Oral health problems and no teeth. Glasses, hearing aids, and regular dental care are not covered service under Medicare. - Sensory impairments increase with age and the prevalence increase as life expectancy increases. Vision loss and hearing loss. Falls (balance impairments) are a concern. - One in three older adults fall each year and one in five falls cause serious injuries (95% cause hip fractures). Death rates form falling has been growing in the US. - Balance impairments may be why older adults have physical limitations. - Physical limitations: Older adults having difficulty performing any of the eight physical activities - walking a quarter mile or 3 city blocks, walking up 10 steps without resting, standing or being on their feet for about 2 hours, sitting for 2 hours, stopping/bending/kneeling, reaching over their heads, using fingers to grasp, lifting or carrying something heavy - Physical impairments increases with age. Memory impairments are not a natural part of aging, but connected to diseases, illness, or conditions commonly affecting older adults. Alzheimers disease is the leading cause of memory loss in older adults. - Rates for impairments differ by gender and race.

Marital Status

- Three-fourths of older men are married and under half of older women are married. Over one-third of older women are widowed. Three reasons why. - Three reasons: Men have shorter average life expectancies (76.4 years in 2013) than women (81.2 years). Men marry women who are younger than themselves. Men who lose a spouse through death or divorce are more likely to remarry than women. - Reveal that older men have a spouse for assistance where women do not. Widowed women tend to have closer and wider networks of social support but suffer from a lowered financial status upon widowhood. - Number of divorce elders was 14% of older adult US population and as more baby boomer move into their older years the number of divorce will grow. - Lack of retirement benefits, insurance, and net worth assets are associated with being married.

Mortality

- Top 5 causes of death for elders: heart disease, malignant neoplasms (cancers), chronic lower respiratory disease (CLRD), cerebrovascular disease (stroke), and Alzheimer's disease. Responsible for two-thirds of total deaths in older adults. - Overall age adjusted mortality rate for older adults has fallen. This is because of the declining death rates for heart disease and stroke - Heart disease remains the leading cause of death. Responsible for one in four deaths. Cancer death rate has stayed the same in recent years. Disease are impacted by behaviors and modifiable risk factors

Transportation

- Transportations enables the older adults to be more independent - Income and health status are the two factors that have the greatest effect on transportation. Maintaining or getting a automobile can be prohibitive on a fixed income and with age there can be physical problems that restrict the ability to operate a automobile safety. - There groups: those who can use the present forms of transportation, those who could use public transportation If the barriers of cost and access (no service available) were removed, and those who need special services beyond what is available through public transportation - Stimulated a number of private and public organizations that serve older adults. - Solution

dependency ratio

- a ratio that compares the number of individuals whom society considers economically unproductive (nonworking or dependent population) to the number it considers economically productive (working population) - productive population includes those 19 to 64 and unproductive 0 to 19 and the old 65+ years

Homemaker Service

- can be a factor that enables them to remain in their own homes - physical impairments restricts their ability to carry out normal housekeeping activities - availability of these services allows many older adults to live semi-independently and delays their moving

Independent Transportation Network (ITN)

- challenge older adults who give up driving - Older adults that gave up driving trade in their cars and the value is booked into an account from which they can draw to receive rides - a dollar amount is deducted for each car ride given by a paid driver - started by Katherine Freund

Dependency and Labor Force Ratios

- changes in dependency ratios show a indirect indication of periods when we expect the particular age distribution of the country to affect the need for social services, housing, and consumer products - can refer to this ratio as a guide for making gate best social policy decisions and as a way to allocate resources - Parents pay directly for the most expenditures to support their children. Support for the elders comes from tax supported programs (SS. Medicare, and Medicaid. - Dependency ratio data is a estimate and should not be accepted as the only estimate.

Independent Living

- community services are available in home to help older adults in maintaining their independence - private residence into a group setting refers to independent living apartments, retirement communities, or senior housing - independent living settings are for older adults who require little to no assistance with daily activities; but services are provided for residents like social activities, transportation, laundry, meals, and housekeeping

Caregivers

- informal caregiver and care provider and care provider and care manager - Caregivers for older adults face elevated levels of depression and anxiety, higher use of psychoactive medications, poorer physical health, compromised immune system, and risk of early death. Experience less freedom and privacy and are economically impacted. - Caregivers can have positive feelings: feelings of giving back and can extend personal networks to include others similar experiences and feel a sense of purpose and meaning in life. - Need for personal care and paying for long term care services for older adults is projected to increase. Long term care can be expensive. - Policies can be expensive if purchased late in life when need for long term services are the greatest. High premiums and copayment costs of long term care policies mean that many Americans cannot afford them unless they are willing to purchase them when they are younger and costs are lower.

Other Services

- limited by creativity - service packages which allow older adults to pick several services they need and to pay for them as if they were a single service

Living Arrangements

- linked to income, health status, and the availability of caregivers - Older women are more likely to live alone than older men. Those living alone are expected to increase over the next 20 years because of aging of the baby boomers and the improved economic status of older adults and their strong desire to live alone. - Small percentage of older adult in the US reside in nursing homes. 1.5 million of those aged 65 years and older are in nursing homes which represents 3.4% of the older adult population. Decrease because there is an increase in other housing options and community services. Older women at all ages have a higher usage rates than men do. Three-fourths of nursing home residents are women and more than half nursing home resident are older than 85 years.

Other demographic variables Affecting Older Adults

- marital status, living arrangements, racial and ethnic composition, geographic distribution economic status, and housing

Community Facilities and Services

- most common occurrence of the aging process is loss of independence - Basic activities become major tasks because of low income, ill health, and lack of transportation - they are special needs to community facilities and services - Growth in our nation's older population, combined with this population's financial ability to pay for service has created an entrepreneurial atmosphere surrounding adult care services.

Fertility Rates

- number of births per 1,000 women of childbearing age (15-44) - Highest rates beginning of the 20th century. Dipped during the Depression and rebounded after WW2. Baby boom years was the period of consistent high fertility rates after WW2. - Baby Boomers were born between 1946 and 1964. 76 million babies were born. As they age, a unman tidal wave will move up the age pyramid. - This generation had an impact on expanding obstetrics and pediatrics, creating split shifts for students in public schools, and disrupting government policy toward the Vietnam War

Visitor Service

- one individual taking time to visit with another who is unable to leave his or her residence - voluntary basis, many times with older adults doing the visiting, and serves both homebound and those institutionalized

Continuing Care Retirement Communities (CCRCs)

- planned communities for older adults that guarantee a lifelong residence and health care - offer levels of assistance in same building, campus, or community - May be individual homes or apartments, assisted living facilities, and a nursing home; they can move from one level to another based on their needs and stay within the CCRC - Focus is lifelong residence and health care. Paid through long term contracts or leases, large entry fees, and monthly fees - Financially beyond the reach of older adults

Nutrition

- poor eating habits accelerate age related decrements and increase chances of chronic illnesses later in life - Obesity and malnutrition can pose challenges with the older adult population in the US - Types of nutrients needed are the same for people of ll age groups but the amounts of each nutrient can vary as people age. - Older people should reduce sodium intake, reduce caloric needs, increase vegetable consumption, and increase water consumption

National Highway Traffic Safety Administration

- provides resources to have conversations about driver safety and community transportation issues with older adults and alternatives to driving

Adult Protection Services (APS)

- services provided to insure the safety and well-being of elders and adults with disabilities who are in danger of being mistreated or neglected, are unable to take care of themselves or protect themselves from harm and have no one to assist them - interventions include: Receiving reports of adult abuse, exploitation, or neglect, investigating these reports, case planning, monitoring, and evaluation. May arrange for the provisional of medical, social, economic, legal, housing, law enforcement, or other protective, emergency or supportive services

Instrumental Needs of Older Adults

- six instrumental needs that determine lifestyle for people of all ages: income, housing, personal care, health care, transportation, and community facilities and services - young old group do not experience appreciable changes in their lifestyles usually; middle old and old old do

Chronic Conditions

- systemic health problems that persist longer than 3 months (hypertension, arthritis, heart disease, diabetes, and emphysema). - Most older adults have at least one chronic condition and over three-fourths have at least two. May or may not be life threatening. Vary by gender and race. - Most common reported by 65 ad older is: hypertension, arthritis, heart disease, cancer, and diabetes. Number of chronic conditions increases with age (limitations from activities are prevalent with age). Chronic conditions can result in impairments, such as the loss of sight from diabetes. Create a burden on health and economic status, impede ability to engage with family and friends, and increase the demand for caregivers - 95% of health care costs for older adults in the US is for chronic diseases.

Ranges of "old"

- young old (65-74) - middle old (75-84) - old old (85 and over) - old old group makes up the fastest growing segment of the older adult population

solution to the transportation needs of older adults

1. fare reduction or discounts for all public transportations 2. subsidies to ensure adequate scheduling and routing of present public transportation 3. subsidized taxi fares for the disabled and infirm 4. funds for senior centers to purchase and equip vehicles to transport seniors properly

Demography of Aging

Defined as a study of those who are 65 and older and of the variables that bring about change in their lives.

Meal on Wheels

a community supported nutrition program in which prepared meals are delivered to individuals in their homes, usually volunteers

homebound

a person unable to leave home for normal activities

labor force ratios

a ratio of the total number of those individuals who are not working to the number of those who are - projected that burden of support for the labor force in the future will be more lighter than the projected dependency ratios because boomers plan to work longer

Congregate meal programs

community-sponsored nutrition programs that provide meals at a central site, such as a senior center - provided for individuals who can travel to a central site - meals are funded by federal and state monies and make use of commodity food services - They are better than home delivered meals because they provide social interaction and opportunity connect with other social services

Adult Day Care programs

daytime care provided to elders who are unable to be left alone - Offer meals, snacks, and social activities - provide or make arrangements for the clients to receive therapy, counseling, health education, or other health services - can be designed for special needs, blind, veterans - allows families to continue with daytime activities

functional limitations

difficulty in performing personal care and home management tasks -

Older Americans Act of 1965

federal legislation to improve the lives of elders - Created national nutrition programs, State Departments on Aging and Area Agencies on Aging - Passage of 1973 amendments established the State Departments on Aging and Area Agencies on Aging. Inform, guide, link older person to available, appropriate, and acceptable services to meet their needs. Written to provide state and area agencies flexibility to develop plans that allow for local variations. - States divide into planning and service areas (PSAs) so programs can be tailored to the needs of older persons residing in those areas. - Area Agencies on Aging are the agencies designated by the state to be the focal point for OAA programs within PSA

Factors That Affect Population Size and Age

fertility rates and mortality rates both play a role the "age" of any population

Home Health Care

health care services provided in a patient's place of residence - important alternative to traditional institutional care - services: medical treatment. therapy, and homemaker services - cared for at a lower cost than a nursing home or hospital - Run by health agencies like local health departments, hospitals, or private companies. Provides preventive, primary, and rehabilitative and therapeutic services in the client's home. - Care provided by nurses, home health aides, and personal care workers (licensed health care workers) - Some expenditures are paid by Medicare but most is out of pocket. Can use long term insurance policies, Medicaid, or reimbursement by supplemental insurance policy (Medigap)

instrumental activités of daily living (IADLs)

more complex tasks such as handling personal finances, preparing meals, shopping, doing house work, traveling, using the telephone, and taking medications

care provider

one who helps identify the health care needs of an individual and also personally performs the caregiving service

care manager

one who helps identify the health care needs of an individual but does not actually provide the health care services

informal caregiver

one who provides unpaid assistance to one who has some physical, mental, emotional, or financial need limiting his or her independence - takes on many roles

Respite care

planned short-term care, usually for the purpose of relieving a full-time informal caregiver - allows families who provide primary care to leave family member at home or alone in a supervised care setting for a day or a few weeks - provides full care, sleeping, meals, bathing, social actives, and medications - most frequently requested by informal caregivers

retirement communities

residential communities that have been specifically developed for individuals in their retirement years or of a certain age

activities of daily livings (ADLs)

tasks such as eating, toileting, dressing, bathing, walking, getting in and out of a bed or chair, and getting outside does not involve cognitive impairments

median age

the age at which half of the population is older and half is younger

total dependency ratio (DR)

the dependency ratio that includes both youth and old - calculated by adding the number of youth and old, divided by the number of persons 20 to 64 years, times 100 - DR was at the lowest (70.5) in 1900. DR in 2010 was 67 but climbed up to 85 in 2040 and stayed steady through 2050. Will be driven by old age dependency ratio and guide social policies.

old-age dependency ratio

the dependency ratio that includes only the old

youth dependency ratio

the dependency ratio that includes only youth