Image credits: Cristian Newman on Unsplash

An Aging Population Threatens Health Systems’ Stability

By Miriam Bello | Thu, 07/01/2021 - 12:37

Over the years, there has been a significant increase in life expectancy, coupled with a declining birth rate that transforms the entire health, social and economic environment. An aging population means higher costs for households; it strains public finances and healthcare providers, thus decreasing economic growth.  

For the first time in history, the world population has a life expectancy equal to or greater than 60 years. WHO estimates that by 2050, the world population in this age group is expected to reach 2 billion, an increase of 900 million against 2015. Today, there are 125 million people aged 80 and over. By 2050, there will be an almost equal number of people in this age group (120 million) in China alone and 434 million worldwide. By 2050, 80 percent of all older people will live in low- and middle-income countries. The largest increase (312 million people) is projected to occur in Eastern and South-Eastern Asia, growing from 261 million in 2019 to 573 million people aged 65 years or over in 2050.

In Mexico, there are around 13 million people over 65 years of age. Of them, 54 percent are women and 46 percent men. Around 58.8 percent of this sector of the population has some disability or limitations, with an affiliation to health services of 81.1 percent.

Why Are We Living Longer?

WHO attributes this rapid increase in the elderly population to a change in the leading causes of death, from infections to chronic noncommunicable diseases. These chronic conditions may include hypertension, high cholesterol, arthritis, diabetes, heart disease, cancer, dementia and congestive heart failure. Heart disease, strokes and cancer have been the leading chronic conditions impacting the aging population, especially in high-income countries. In addition, obesity rates are increasing. Overall, people tend to live longer in developed countries. According to the Berlin Institute for Population and Development, people in the predominantly wealthy regions of the world live 17 years more on average than those living in Africa.

A study by the UN found that women tend to live longer than men. At the global level, between 2015 and 2020, women’s life expectancy at birth exceeded that of men by 4.8 years. The female advantage in average longevity was largest in Latin America and the Caribbean (6.5 years), Europe and Northern America (6.1 years) and Eastern and South-Eastern Asia (5.3 years). In contrast, the gap is narrower in Central and Southern Asia (2.7 years), Oceania (3.0 years) and sub-Saharan Africa (3.5 years). The same study projects that in 2050, women will represent 54 percent of the global population aged 65 or over.

There are several factors driving this demographic shif: some of them are natural (genetic), while others involve health and social policies (lifestyle choices). Advances in medicine have also contributed to this trend. According to Alumniportal Deutschland, without medical care, longevity would hardly be predominant. Greater access to medical care means people enjoy better living conditions, with sustainable or prosperous economies, engaging in non-dangerous physical activities and making healthier consumption choices. The latter is directly linked to income, which, according to WHO, is a large influencer on life expectancy. According to the organization, a man in China is likely to live 20 percent longer if he has a college degree versus a man who had a lower degree of education. In avenger, people with a higher income, living in the same country and from the same age bracket, can live 37 percent longer that those earning less.

A study by BMC Geriatric exposed that at least in China, at age 65, an adequate access to healthcare increased life expectancy by approximately 2.0–2.5 years in men and women across urban-rural areas compared to those who reported inadequate access to healthcare. The study also shows that among women, the net increase in life expectancy attributable to adequate access to healthcare was 6 and 8 percent at ages 65 and 85, respectively. In men, the net increases in life expectancy were generally greater (10 and 14 percent).

The Implications of Aging

There are many health implications to longevity. In Mexico for instance, those who turn 60 in Mexico today can expect to live 22 more years, but will probably spend the last five years of their life with a disability. According to a study by the Ministry of Health, only four out of 10 men and three out of 10 older women are in good or very good health. This is a global trend that inspired the term “healthy aging,” which, according to WHO, refers to the process of developing and maintaining, for as long as possible, the functional capacity to be and do what a person considers valuable at each stage of life. Healthy aging is considered a broad, comprehensive and dynamic process that allows well-being through the maintenance of people's functional capacity, which must be maintained throughout a person’s life.

The concept of healthy aging implies a holistic approach that must take into account the determinants of health, influenced by society and policies, as well as the functional and intrinsic capacity of people and the environment they live in.

The following elements are considered to measure healthy aging:

  1. People’s environment
  2. Functional and intrinsic capacity
  3. Genetic inheritance
  4. Personal characteristics
    1. Trends related to their age, health habits, physiological changes, diseases and injuries, changes in homeostasis and geriatric syndromes.

In 2012, the Ministry of Health published a study to measure healthy aging based on self-perception to understand the social and cultural elements that influenced patients’ mental and physical health. From that study, four out of 10 men and three out of 10 women aged 60 and over say they are in good, very good or excellent health. Hard data reflected the true colors of general health, however. In 2013, 63.2 percent of deaths were among people 60 years of age or older. Eight out of 10 deaths in this age group were due to noncommunicable diseases, mainly arterial hypertension, diabetes mellitus and hypercholesterolemia. In addition, more than 17 percent of the elderly population reported depression and more than 15 percent cognitive impairment or dementia.

According to the Office of Disease Prevention and Health Promotion, by 2030, it is projected that more than 60 percent of the ‘baby boomer’ generation will suffer from more than one chronic condition. Managing these chronic conditions and patients’ existing disabilities will increase the financial burden on our healthcare system. The cost increases with the number of chronic conditions being treated, taking into account twice as many hospital admissions and physician visits for baby boomers by 2030.

Disability was also exposed as a frequent condition among the elderly population in Mexico. Nevertheless, an article by Pharmacy Times exposed that the prevalence of disability will decrease as medicine evolves enough to slow the diseases’ progression, from chronic conditions to disability. There will be increases in milder chronic diseases, however.

Financially, the IMF explains that “an aging population means slower labor force growth, which will affect GDP growth. Working-age people pay more to support the elderly and public budgets strain under the burden of the higher total cost of health and retirement programs for the elderly. Furthermore, an aging population may raise the amount of capital per worker, which would boost wages and output per hour worked (productivity) and reduce interest rates as higher wages lower the return on capital. At the same time, this generational shift could lead to secular stagnation if companies are discouraged from investing in abundant loanable funds.

Preparing for a Demographic Change

This epidemiological shift will require bring an entire shift on health systems. On an article by William Haseltine, current professor at Harvard Medical School, he advices governments to begin planning for this demographic change, as this requires decades and puts tons of pressure on health systems. “Countries will have to reconsider all aspects of their communities, from healthcare systems and methods of delivering care to how whole cities are structured.” Haseltine says that an aging population threatens to put an unsustainable burden at the household level. “The physical and emotional burden of providing care to an aging loved one is compounded by the fiscal burden, as well,” he says.

One of the most urgent issues to address in Mexico is the shortage of geriatricians. Currently, there are 537 certified geriatricians in a country with 13 million older adults. About 60 percent are in Mexico City and, to a lesser extent, in Monterrey, Guadalajara, San Luis Potosi and Leon. In Mexico City, there is one geriatrician for every 8,000 older adults; the rate is one doctor for every 20,000 elders in Jalisco and one for every 52,000 in Nuevo Leon.

During an interview with MBN, German Fajardo, Director of UNAM School of Health Sciences, explained that training geriatricians is difficult because there is nowhere do it. “The country has limited options to offer this training and we could feel the impact of this in the future as people live longer thanks to medical advances.”

According to UNAM, one smart, quick effort to combat this is through the "geriatrization" of general practitioners. Geriatrics were added to UNAM’s medicine program, with 280 hours of a specific course, so all graduates know how to better handle the elderly. However, there is still no integral and well-defined solution to this problem, yet.

Individually, companies are also seeking to respond to these demographic changes, just like e-pharmacy medimonth. “We have found that geriatrics lack a personalized approach. Our experience demonstrates that individual attention is the best way to approach this complex group,” said Emiliano Hernández Laos, Co-Founder of medimonth. Hernandez said that they have created a friendly online platform for adults over 60, who are harder to attract to online purchases despite being the age bracket that would benefit the most from this, considering mobility limitations.

Miriam Bello Miriam Bello Journalist and Industry Analyst