Current Status of the Social Situation, Well-Being, Participation in Development and Rights of Older Persons Worldwide

Economic &

Social
Affairs
CURRENT STATUS OF THE SOCIAL SITUATION, WELLBEING,
PARTICIPATION IN DEVELOPMENT AND RIGHTS
OF OLDER PERSONS WORLDWIDE

United Nations

Current Status of the Social Situation, Well-Being, Participation in
Development and Rights of Older Persons Worldwide

Department of Economic and Social Affairs

United Nations
New York, 2011

DESA MISSION STATEMENT

The Department of Economic and Social Affairs of the United Nations Secretariat is a vital
interface between global policies in the economic, social and environmental spheres and national
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analyses a wide range of economic, social and environmental data and information on which
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policy options; (ii) it facilitates the negotiations of Member States in many intergovernmental
bodies on joint courses of action to address ongoing or emerging global challenges; and (iii) it
advises interested Governments on the ways and means of translating policy frameworks
developed in United Nations conferences and summits into programmes at the country level and,
through technical assistance, helps build national capacities.

NOTE

The designations employed and the presentation of the material in this publication do not imply
the expression of any opinion whatsoever on the part of the Secretariat of the United Nations
concerning the legal status of any country, territory, city or area, or of its authorities, or
concerning the delimitation of its frontiers or boundaries.
The designations “developed” and “developing” economies are intended for statistical
convenience and do not necessarily imply a judgment about the stage reached by a particular
country or area in the development process. The term “country” as used in the text of this
publication also refers, as appropriate, to territories or areas. The term “dollar” normally refers to
the United States dollar ($).
The views expressed are those of the individual authors and do not imply any expression of
opinion on the part of the United Nations.
Bibliographical and other references have, wherever possible, been verified.

A United Nations electronic publication
ST/ESA/339
December 2011

Copyright © United Nations, 2011
All rights reserved

ii

Explanatory notes
Unless otherwise indicated, the following country groupings and subgroupings have been used in
this report:

Asia: China, Hong Kong Special Administrative Region of China, Macao Special
Administrative Region of China, Democratic People’s Republic of Korea, Japan, Mongolia,
Republic of Korea, Afghanistan, Bangladesh, Bhutan, India, Islamic Republic of Iran, Maldives,
Nepal, Pakistan, Sri Lanka, Brunei Darussalam, Cambodia, Indonesia, Lao People’s Democratic
Republic, Malaysia, Myanmar, Philippines, Singapore, Thailand, Timor-Leste, Viet Nam;

Sub-Saharan Africa: Angola, Benin, Botswana, Burkina Faso, Burundi, Cameroon, Cape
Verde, Central African Republic, Chad, Comoros, Congo, Côte d’Ivoire, Democratic Republic of
the Congo, Djibouti, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Gambia, Ghana, Guinea,
Guinea-Bissau, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mali, Mauritania, Mauritius,
Mayotte, Mozambique, Namibia, Niger, Nigeria, Réunion, Rwanda, Saint Helena, Sao Tome and
Principe, Senegal, Seychelles, Sierra Leone, Somalia, South Africa, South Sudan, Sudan,
Swaziland, Togo, Uganda, United Republic of Tanzania, Zambia, Zimbabwe;

Latin America: Argentina, Belize, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, El
Salvador, Falkland Islands (Malvinas), French Guiana, Guatemala, Guyana, Honduras, Mexico,
Nicaragua, Panama, Paraguay, Peru, Suriname, Uruguay, Venezuela;

Middle East and North Africa: Algeria, Bahrain, Djibouti, Egypt, Islamic Republic of Iran,
Iraq, Israel, Jordan, Kuwait, Lebanon, Libyan Arab Jamahiriya, Malta, Morocco, Oman, Qatar,
Saudi Arabia, Syrian Arab Republic, Tunisia, United Arab Emirates, Occupied Palestinian
Territory, Yemen;

Eastern Europe and the Commonwealth of Independent States: Albania, Armenia, Azerbaijan,
Belarus, Bosnia and Herzegovina, Bulgaria, Croatia, Czech Republic, Estonia, Georgia,
Hungary, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Montenegro, Poland, Moldova, Romania,
Russian Federation, Serbia, Slovakia, Slovenia, Tajikistan, Turkmenistan, Ukraine, Uzbekistan,
former Yugoslav Republic of Macedonia;

Small island developing States: American Samoa, Anguilla, Antigua and Barbuda, Aruba,
Bahamas, Barbados, Belize, British Virgin Islands, Cape Verde, Comoros, Cook Islands, Cuba,
Dominica, Dominican Republic, Fiji, French Polynesia, Grenada, Guam, Guinea-Bissau,
Guyana, Haiti, Jamaica, Kiribati, Maldives, Marshall Islands, Mauritius, Federated States of
Micronesia, Montserrat, Nauru, Netherlands Antilles, New Caledonia, Niue, Northern Mariana
Islands, Palau, Papua New Guinea, Puerto Rico, Samoa, Sao Tome and Principe, Seychelles,
Singapore, Solomon Islands, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the
Grenadines, Suriname, Timor-Leste, Tonga, Trinidad and Tobago;

Developed market economies: Australia, Austria, Belgium, Cyprus, Denmark, Finland, France,
Germany, Greece, Iceland, Ireland, Italy, Japan, the Netherlands, New Zealand, Norway,
Portugal, Spain, Sweden, Switzerland, United Kingdom of Great Britain and Northern Ireland,
United States of America.

iii

The following abbreviations have been used in the report:

ECE (United Nations) Economic Commission for Europe
EU European Union
EURAG European Federation of Older Persons
FIAPA Federation of Associations for Elderly People
GDP gross domestic product
HIV/AIDS human immunodeficiency virus/acquired immune deficiency syndrome
IFA International Federation on Ageing
ILO International Labour Organization (or International Labour Office)
NGO non-governmental organization
NTA National Transfer Accounts (project)
OECD Organization for Economic Cooperation and Development
SABE Salud, Bienestar y Evejecimiento [Health, Well-Being and Aging] (Survey)
UNAIDS Joint United Nations Programme on HIV/AIDS
UNDP United Nations Development Programme
UNESCO United Nations Educational, Scientific and Cultural Organization
UNFPA United Nations Population Fund
WHO World Health Organization

iv

Contents
Page

Explanatory notes………………………………………………………………………………...iii

Introduction……………………………………………………………………………………….1

I. Demographics of older age…………………………………………………..……………2

A. Where do older persons live? ………………………………………..………………2

B. Life expectancy………………………………………………………………………4

C. Marital status…………………………………………………………………………4

D. Living arrangements…………………………………………………………...……..6

E. Trends in living arrangements………………………………………………………..8

F. Household headship. ……………………………………………………………….10

G. Living conditions …………………………………………………………………...11

H. Older migrants and the effects of migration………………………………………...13

I. Older persons in emergency situations…...…………………………………………15

II. The economic situation of older persons: employment, income and
poverty considerations……………………………………..…………………………….17

A. Employment……………………………………………..………………………….17
Labour force participation…………………………………………………………..17
Working conditions…………………………………………………………………18
Age discrimination in employment…………………………………………………19
Unemployment……………………………………………………………………...20
Retirement…………………………………………………………………………..21

B. Income………………………………………………………………………………24

Sources of income…………………………………………………………………...24
Pension systems and coverage………………………………………………………26
Access to financial services and credit……………………………………………...29
Intergenerational transfers…………………………………………………………..30

v

Contents (cont’d)
Page

C. Consumption……………………………………………………………..………….31

D. Poverty and income security in old age……………………………………………..31

III. Health status and access to health care…………………………………………………36

A. Health and survival………………………………………………………………….36

B. Chronic conditions and impairments………………………………………………..38

C. Trends relating to chronic conditions and impairments…………………………….39

D. Mental health………………………………………………………………………..40

E. HIV and AIDS………………………………………………………………………41

F. Overweight and obesity……………………………………………………………..42

G. Access to health care………………………………………………………………..43

H. Long-term care………………………………………..…………………………….45

I. Neglect, abuse and violence………………………………………………………...48

IV. Social and civil participation among the ageing, attitudes towards
older persons, and perceptions of old age………………………………………………50

A. Societal attitudes towards old age…………………………………………………..50

B. Education and literacy………………………………………………………………53

C. Organizations of older persons……………………………………………………...55

D. Political influence…………………………………………………………………...56

V. Human rights of older persons………………………………………………………….58

A. International human rights principles and standards……………………………….58

B. Non-discrimination…………………………………………………………………60

C. Vulnerabilities and special protection measures……………………………………62

vi

Contents (cont’d)
Page

D. Special measures for specific groups………………………………………………..63

E. The right to social security and the issue of social protection………………………64

F. The right to health and the right to adequate housing………………………………65

G. Final remarks……………………………………………………………………… 66

VI. Summary and concluding remarks……………………………………………………. 68

Bibliography……………………………………………………………………………………..70

Figures

I. Actual and projected global population aged 60 years or over,
1980, 2010 and 2050………………………………………..…………………………...2

II. Distribution of the world population aged 60 years or over,
by development region, 1950-2050……………………………………………………...3

III. Percentage currently married among men and women aged 60 years
or over, by region, circa 2005……………………………………………………………5

IV. Percentage of the population aged 60 years or over living alone,
by region, circa 2005…………………………………………………………………….7

V. Living arrangements of persons aged 60 years or over in
sub-Saharan Africa, circa 2003……………………………………………………….....8

VI. Long-term unemployed as a share of total unemployed: a comparison
between younger and older workers in OECD countries, 2009………………………..21

VII. Life expectancy at retirement in selected OECD countries,
by sex, 1970 and 2004…………………………………………………………………23

VIII. Old-age income poverty rates in OECD countries: percentage of persons
over age 65 with incomes of less than half the median (equivalized)
population income, mid-2000s…………………………………………………………32

IX. Relative risk of poverty by age in 23 OECD countries, mid-1980s
to mid-2000s……………………………………………………………………………34

X. Old-age poverty rates in selected sub-Saharan African countries, circa 2000…………34

vii

Contents (cont’d)
Page

XI. Old-age poverty rates in Latin America and the Caribbean, 2001-2005………………35

XII. Suicide rates per 100,000 males in selected countries between
2005 and 2009…………………………………………………………………………41

XIII. Proportion of older persons receiving formal long-term care in
selected OECD countries, by age group, circa 2006…………………………………..46

XIV. Proportion of persons aged 80 years or over receiving formal long-term care
in selected OECD countries, by sex, circa 2006………………………………………46

XV. Proportion of persons aged 65 years or over receiving formal long-term care
in selected OECD countries, by care environment, circa 2006……………………….47

XVI. Percentage of the voting population aged 60 years or over, 2005 and 2050…………56

Tables

1. Gender gap in life expectancy at birth: the number of years females
outlive males, 1950-1955 and 2005-2010……………………………………………...4

2. Labour force participation rates, by sex, age group and region, 2008………………...17

3. Old-age disposable income in OECD countries, by source of income, mid-2000s…..25

4. Summary of social pension schemes in Bolivia, Lesotho and Bangladesh…………..28

5. Probability of surviving to age 60 based on 1950-1955 and 2005-2010
mortality rates…………………………………………………………………………36

6. Life expectancy at age 60 based on 2005-2010 mortality rates………………………37

7. Causes of death among persons aged 60 years or over, by national income level,
2004…………………………………………………………………………………...37

8. Ten leading causes of moderate and severe disability among persons
aged 60 years or over, in order of importance………………………………………...39

9. Out-of-pocket health expenditure as a percentage of total expenditure on health,
by national income level and region, 2006……………………………………………44

10. Elder care seen as primarily or wholly a societal (versus family) responsibility……..52

11. Literacy rates among persons aged 65 years or over, by region, 2005-2007………….54

viii

Acknowledgements

For the preparation of this publication, we acknowledge the authorship of section V by the
Office of the High Commissioner for Human Rights.

The images on the cover were generously shared by HelpAge International. The
photographes were taken by Maxim Ahner, Kate Holt, Antonio Olmos, Sarah
Packwood and Tom Weller.

Introduction

The General Assembly, in its resolution 64/132 of 18 December 2009, entitled “Follow-
up to the Second World Assembly on Ageing”, requested the Secretary-General to submit to the
Assembly at its sixty-fifth session a comprehensive report on the current status of the social
situation, well-being, development and rights of older persons at the national and regional levels.
The present report is submitted in response to that request.

The report consists of six sections. Sections I to IV focus on the social and economic
well-being of the ageing population, documenting the demographics of older age, reviewing the
economic situation of older persons, exploring health-related issues, and examining societal
perceptions and the social integration of older residents. In each of these areas, the diversity of
situations characterizing older persons in society and across the world has been taken into
account, and an effort has been made to capture the evolving reality and perceptions of old age as
well as older persons’ own views. The report is based on recent research and empirical data from
various sources available to the United Nations Secretariat. It should be noted, however, that
while extensive data and analysis are available on population ageing, data and information
relating specifically to the lives and situations of older persons are relatively scarce and are
seldom included in ageing-related publications.

Section V of the report provides an overview of human rights norms as they pertain to
older persons, incorporating several illustrative examples of how international human rights
mechanisms have applied relevant norms to critical human rights issues affecting older persons.
Section VI offers some concluding remarks.

1

I. Demographics of older age

The older population has been growing at an unprecedented rate. In 1980, just prior to the
convening of the First World Assembly on Ageing, there were 378 million people in the world
aged 60 years or above. That figure has risen to 759 million over the past three decades and is
projected to jump to 2 billion by 2050 (see figure I).

Figure I
Actual and projected global population aged 60 years or over, 1980, 2010 and 2050

2,500

2,000
illions

1,500
M

1,000

500

0
1980 2010 2050
Year

Source: United Nations, World Population Prospects: The 2008 Revision—Population Database.

The average annual growth rate for the ageing population has also increased
considerably. During the period 1950-1955, the annual growth rate for persons aged 60 years or
over (1.7 per cent) was similar to the rate of growth for the total population (1.8 per cent). By
2005-2010, the annual growth rate for the older population (2.6 per cent) was more than twice
that recorded for the total population (1.2 per cent). In the mid-term future, the gap between
those two growth rates is expected to widen as the large post-war cohort reaches age 60 in
several parts of the world. 1

A. Where do older persons live?

The world’s older population—defined in the present context as those aged 60 years and
above—presently stands at around 760 million. Asia accounts for more than half of the total (414
million, including 166 million in China and 92 million in India). Europe is the region with the
second largest number of older persons (nearly 161 million), followed by Northern America (65
million), Latin America and the Caribbean (59 million), Africa (55 million) and Oceania (6
million).

1
United Nations, World Population Ageing 2009 (ESA/P/WP/212). Available from http://www.un.org/esa/
population/publications/WPA2009/WPA2009_WorkingPaper.pdf.

2

Although the older population is growing in all parts of the world, most of the increase is
taking place in the developing regions (see figure II). On average, 29 million older persons will
be added to the world’s population each year between 2010 and 2025, with those in less
developed countries accounting for more than 80 per cent of the total. As a result, the share of
the older population residing in the developing world will increase from 65 per cent in 2010 to
about 80 per cent by the year 2050.

Figure II
Distribution of the world population aged 60 years or over, by development region, 1950-2050

50

40
Percentage

30

20

10

0
1950 1970 1990 2010 2030 2050
Year

More developed regions Less developed regions

Source: United Nations, World Population Ageing 2009.

In 2005, 52 per cent of the world’s older population lived in urban areas, with roughly
equal proportions residing in less developed and more developed regions. However, the rural
areas of the less developed regions were home to nearly 40 per cent of the world’s older
population, while only about 10 per cent lived in the rural areas of the more developed regions.
Although most of the older population in the developing world may still be found in rural areas,
the number of older persons living in cities is growing very rapidly as a result of urbanization.
Between 1975 and 2005, the number of urban residents aged 60 years or over nearly quadrupled,
and most of the future increases in the numbers of older persons will take place in the urban
areas of developing countries. 2

In a majority of countries, the proportion of the population aged 60 years or over is
higher in rural than in urban areas. It might be assumed that the rural areas, with their higher
fertility rates, would have a younger age structure than the urban areas. However, as young
adults have migrated to the cities in search of employment, many rural areas have found
themselves with high numbers of both children and older persons relative to the working-age
population. In fifteen countries, including eight in Europe, the proportion of older persons in the
rural population exceeds that in the urban population by at least five percentage points. The

2
Ibid.

3

countries with the largest differences, ranging from 10 to 18 percentage points, are Belarus,
Bulgaria, Lebanon, the Republic of Korea, Romania and Spain. 3

B. Life expectancy

Women tend to live longer than men, and in 2009 older women outnumbered older men
by 66 million worldwide. With the declining mortality rates among women, the female
advantage in life expectancy at birth increased from 2.8 years in 1950-1955 to 4.4 years in 2005-
2010 at the global level. 4 As table 1 indicates, however, the gender gap in life expectancy is
characterized by substantial variations between regions within each time period and in the extent
to which the gap has narrowed or widened over time within each region. In 2005-2010, the gap
ranged from a low of 2.4 years in Africa to a high of 8 years in Europe. It is interesting to note
that the gender gap in life expectancy at birth actually narrowed in Northern America, declining
by 1.3 years over half a century.

Table 1
Gender gap in life expectancy at birth: the number of years females outlive males,
1950-1955 and 2005-2010
___________________________________________________________________________________

1950-1955 2005-2010 Difference
___________________________________________________________________________________

World 2.8 4.4 1.6
Africa 2.5 2.4 -0.1
Asia 1.3 3.7 2.4
Europe 5.0 8.0 3.0
Latin America and the Caribbean 3.4 6.5 3.1
Northern America 5.8 4.5 -1.3
Oceania 4.8 4.8 —
__________________________________________________________________________________
Note: An em dash (—) indicates that the amount is nil or negligible.

The share of women in the population rises significantly with age. In 2009, women
comprised 54 per cent of the population aged 60 years or over and 63 per cent of the population
aged 80 years and above, with the figure rising to 81 per cent among centenarians. 5

C. Marital status

Most older men in the world are married, while most older women are not. Instead, older
women are likely to be widowed. Worldwide, roughly four out of five men aged 60 years or over
currently have a spouse, but the same is true for under half of the women in the same age group.

3
Ibid.
4
United Nations, World Population Prospects: The 2008 Revision—Population Database (2009). (Datasets for 2008
are no longer available; corresponding data from The 2010 Revision may be retrieved from
http://esa.un.org/unpd/wpp/unpp/panel_population.htm.)
5
United Nations, World Population Ageing 2009.

4

At the regional level, as shown in figure III, the proportions of older men who are married range
from 73 per cent in Oceania to 85 per cent in Africa, while the corresponding figures for women
range from 39 per cent in Africa to 52 per cent in Asia. In Africa, older men are more than twice
as likely as older women to be married. These large differences exist because women usually
outlive their husbands—a circumstance linked both to women’s higher life expectancy and to the
fact that they tend to marry men older than themselves. In addition, men are more likely than
women to remarry after being divorced or widowed. 6

Figure III
Percentage currently married among men and women aged 60 years or over, by region,
circa 2005
85
Africa 39

76
Latin America and the Caribbean 43

77
Europe 44

75
Northern America 47

73
Oceania 50

81
Asia 52

0 20 40 60 80 100
Female Male


Marital status affects the socio-economic situation, living arrangements, and overall
health and well-being of older men and women. Research points to a host of physical and mental
health benefits associated with marriage. 7 Older persons who are married are less likely than
those who are unmarried to show signs of depression and to feel lonely, and are more likely to
report that they are satisfied with life. Being married has also been linked to lower mortality. The
health benefits of marriage tend to be greater for men than for women. 8 However, older women’s
economic situation is usually more strongly influenced by marital status than is men’s. For
women, widowhood often means at least a partial loss of old-age pension benefits once shared
with a spouse. In some settings, especially in developing countries, women lack legal and
enforceable property inheritance rights when the husband dies and have little or no recourse if
the husband’s relatives move to take over the dwelling, landholding or other property. 9

6
Ibid.
7
Kevin Kinsella and Wan He, An Aging World: 2008, U.S. Census Bureau, International Population Reports,
P95/09-1 (Washington, D.C.: U.S. Government Printing Office, June 2009). Available from
http://www.census.gov/prod/2009pubs/p95-09-1.pdf.
8
Ibid.
9
United Nations Centre for Human Settlements (Habitat), “Progress report on removing discrimination against
women in respect of property and inheritance rights”, Tools on Improving Women’s Secure Tenure, Series 1, No. 2

5

D. Living arrangements

In most developing countries a majority of older persons live with relatives, most
commonly with their own children. Multigenerational households traditionally have provided the
main social context for the sharing of family resources and the provision of mutual support as
needs arise over the life course. In developing countries it is not uncommon for at least one adult
child to stay with the parents as long as they are alive. By contrast, most children in the more
developed regions eventually leave the parental home, and parents grow older without any co-
residing child.

On average, around three quarters of those aged 60 years or over in the less developed
regions live with children and/or grandchildren, compared with about a quarter of the older
population in the more developed regions. Older individuals in the developed world are more
likely to be living as a couple or, especially after the death of a spouse, in a single-person
household. Since the surviving spouse is usually the wife, older women are very likely to
become widows and spend their older years alone, especially after the age of 75. 10 Although
clear regional tendencies exist with regard to residential arrangements among older persons,
there are substantial differences between the countries within each region. Among the more
developed countries, multigenerational co-residence is less common in Northern and Western
Europe than in Eastern and Southern Europe and Japan. Among the less developed regions,
multigenerational co-residence occurs somewhat less frequently in Latin America and the
Caribbean, where just under two thirds of older persons live with children or grandchildren, than
in Africa or Asia, where the average is around three quarters. 11

Around 2005, approximately one in every four persons aged 60 years or over lived alone
in the more developed regions, compared with one in twelve in the less developed regions (see
figure IV). In Africa, Asia, and Latin America and the Caribbean, the rates of solitary living
among older persons ranged from 8 to 11 per cent. Within Europe, the proportions of older
persons living alone varied widely, ranging from 19 per cent in Southern Europe to 34 per cent in
Northern Europe. In most developed countries, sex-based differences in rates of solitary living
were significant. In Europe and Northern America about a third of older women lived alone,
compared with around 15 per cent of older men. 12

Although many older persons who live alone are in good health and are actively engaged
in society, those living on their own can be vulnerable when ill health or other hardships arise. In
both developed and developing countries, studies show that older persons living alone are more
likely than those living with a partner or in a multigenerational household to be lonely and
depressed, to have a small social network, and to have infrequent contact with children. 13 They

(Nairobi, August 2006). Available from
http://www.unhabitat.org/downloads/docs/3983_71713_Inheritance%20Final%20071006.pdf.
10
United Nations, Living Arrangements of Older Persons around the World (Sales No. E.05.XIII.9). Available
(under document symbol ST/ESA/SER.A/240) from
http://www.un.org/esa/population/publications/livingarrangement/covernote.pdf.
11
Ibid.; and United Nations, World Economic and Social Survey 2007: Development in an Ageing World (Sales No.
E.07.II.C.1), available from http://www.un.org/en/development/desa/policy/wess/wess_archive/2007wess.pdf.
12
13
Albert I. Hermalin, “Ageing in Asia: facing the crossroads”, Comparative Study of the Elderly in

6

are also more likely to enter an old-age institution when they become ill or disabled. Older
women living alone, especially the oldest-old (aged 80 years or over), are at high risk of poverty.

Figure IV
Percentage of the population aged 60 years or over living alone, by region, circa 2005

Asia

Africa

Latin America and Caribbean

Northern America

Europe

0 5 10 15 20 25 30 35 40

Male Total Female


The type and direction of flows of support within the family cannot be inferred from the
mere fact of older persons’ co-residence with adult children. Support typically flows in both
directions, and the nature and amount of support often varies or changes in response to individual
needs. Frequently, older persons in multigenerational households are net providers of care and
support for the younger generation rather than the other way around. Even when older persons
are net recipients of material and financial support from the younger generation, they frequently
help with childcare and other household and community activities. Many older persons in
developing countries also remain active in the labour force, and the household often includes
younger children and grandchildren who depend partly or entirely on the older generation for
their livelihood. This is especially likely to be the case for people in their sixties, who may have
children that are still in school or that have not yet established themselves in the labour force.
Around the year 2000, roughly 45 per cent of the older population in the less developed regions
lived together with a child or children of peak working age (at least 25 years old), while nearly
30 per cent lived only with younger children or in skipped-generation households with
grandchildren. The proportion of older persons living with older children tended to be highest in
Asia and lowest in Africa, with intermediate levels recorded in Latin America and the
Caribbean. 14

Asia Research Reports, No. 00-55 (Ann Arbor, Michigan: Population Studies Center, University of Michigan,
August 2000), available from http://www.psc.isr.umich.edu/pubs/pdf/ea00-55.pdf; and Jenny de Jong Gierveld,
“Living arrangements, family bonds and the regional context affecting social integration of older adults in Europe”,
in How Generations and Gender Shape Demographic Change: Towards Policies Based on Better Knowledge—
Conference Proceedings (United Nations publication, Sales No. E.09.II.E.8), available for download from
http://www.ggp-i.org/bibliography/conference-2008.html.
14
United Nations, Living Arrangements of Older Persons around the World.

7

Skipped-generation households consisting of grandparents and grandchildren are
relatively common in many developing countries (see figure V). Older women are especially
likely to live in this type of household. Surveys conducted in the 1990s and 2000s indicated that
in some African countries—including Ethiopia, Ghana, Malawi, Rwanda, South Africa, Uganda,
Zambia and Zimbabwe—between one fifth and one third of women aged 60 years or over were
living in skipped-generation households. Such households are also found in some Asian and
Latin American and Caribbean countries; in the Dominican Republic, Haiti and Nicaragua, more
than 10 per cent of older women are living in skipped-generation households. In Thailand, 14 per
cent of older persons were living in skipped-generation households in 2007. 15 These
arrangements evolve as a response to various challenges. Children may stay with grandparents if
one or both of the parents have died, if parents have migrated for work, or if divorce makes it
difficult for parents to raise the children. The circumstances of these households vary in ways
that depend in part on the situation that prompted the arrangement. Parents who are working
elsewhere often send money and return to visit, but when grandparents take in orphaned children
there may be no one to help with support. In general, skipped-generation households tend to be
found in rural areas, and these households also tend to be poor. 16

Figure V. Living arrangements of persons aged 60 years or over in sub-Saharan Africa, circa 2003
72.6
68.9
60.9
56 55.2 55.4
50.2
45.7

36.1 37.5

20.4
16.9
14.1 12.5
8.8 9.5 9.9
5.6 7 7.3

Total Men, rural Men, urban Women, rural Women, urban

Alone With at least one child With at least one grandchild In skipped-generation households

Source: Kinsella and He, An Aging World: 2008.

E. Trends in living arrangements

In recent years the proportion of older persons living alone has risen in many countries,
and the proportion residing with children has declined. In the more developed countries, the
proportion of older persons living alone increased rapidly in the decades following the Second
World War, but in some cases the levels have stopped rising or have even declined slightly.
Factors that may work to counter further increases in solitary living in developed countries

15
Ibid.; and John Knodel, “Is intergenerational solidarity really on the decline? Cautionary evidence from
Thailand”, paper presented at the Seminar on Family Support Networks and Population Ageing, Doha, Qatar, 3-4
June 2009 (Seminar proceedings available from
http://www.unfpa.org/webdav/site/global/shared/documents/publications/2010/family_support_networks2009.pdf).
16

8

include lower mortality, which delays the age at which widowhood occurs, and trends in some
countries towards children leaving home at a later age. In the less developed regions declines in
intergenerational co-residence have been observed, though not in all countries; in some countries
there is no detectable trend upward or downward. The average pace of change is modest in most
cases, suggesting that co-residence may remain much more common in developing than in
developed countries in the decades to come.

The general trend notwithstanding, some countries have experienced a significant shift in
rates of co-residence over the past few decades. Asian countries that have recorded large declines
in co-residence include Japan, the Republic of Korea and Thailand—all of which underwent
rapid economic development and are now experiencing rapid population ageing. In Thailand the
percentage of persons aged 60 years or over who were living with a child decreased from 77 per
cent in 1986 to 59 per cent in 2007.17 In Japan the proportion of those aged 65 years or over co-
residing with their adult children declined from 70 per cent in 1980 to 43 per cent in 2005. 18 In
Japan and the Republic of Korea, there has been a pronounced attitudinal shift towards less
acceptance of the idea that children should be responsible for the care of older parents, and focus
groups in Thailand found that working-age adults anticipated receiving less support from their
offspring than they were providing for their own parents. 19 However, as economic conditions
and social services improve, older persons may not need to depend on their children as much as
in the past, and trends towards living apart may indicate a preference for greater privacy and
independence. For most countries there is no information about the extent to which changes in
co-residence reflect people’s preferences, or about the net effect of changes in social and
psychological well-being. One survey in the Philippines found that the number of older persons
who would prefer to live apart from their children was much greater than the number who
actually did so. 20 Those who live separately often have a child living nearby, and that is the
preferred arrangement for some people. 21

The proportion of older persons living in skipped-generation households has been rising
in countries heavily affected by HIV/AIDS. In those countries, many of the grandparents
supporting grandchildren are extremely poor. 22 Skipped-generation households have also

17
Knodel, “Is intergenerational solidarity really on the decline? Cautionary evidence from Thailand”.
18
Naohiro Ogawa, “Changing intergenerational transfers and rapid population aging in Japan”, paper prepared for
the United Nations Expert Group Meeting on Family Policy in a Changing World: Promoting Social Protection and
Intergenerational Solidarity, Doha, Qatar, 14-16 April 2009. Available from
http://social.un.org/index/LinkClick.aspx?fileticket=wtiORnfiX6Y%3D&tabid=215.
19
United Nations, World Economic and Social Survey 2007: Development in an Ageing World; and
Statistics Korea, summary of 2002 Social Statistics Survey, available from http://kostat.go.kr/.
20
Josefina N. Natividad and Grace T. Cruz, “Patterns in living arrangements and familial support for the elderly in
the Philippines”, Asia-Pacific Population Journal, vol. 12, No. 4 (December 1997), pp. 17-34. Available from
http://www.unescap.org/esid/psis/population/journal/Articles/1997/V12N4A2.htm.
21
Albert I. Hermalin, ed., The Well-Being of the Elderly in Asia: A Four-Country Comparative Study (Ann Arbor,
Michigan: University of Michigan Press, 2003); and Knodel, “Is intergenerational solidarity really on the decline?
Cautionary evidence from Thailand”.
22
United Nations, The Impact of AIDS (Sales No. E.04.XIII.7), available for download from
http://www.un.org/esa/population/publications/AIDSimpact/AIDSWebAnnounce.htm; and HelpAge International
and International HIV/AIDS Alliance, Forgotten Families: Older People as Carers of Orphans and Vulnerable
Children, policy report (Brighton, United Kingdom: International HIV/AIDS Alliance, 2003), available from
http://www.aidsalliance.org/includes/Publication/ssp0903_forgotten_families.pdf.

9

become more common in Thailand, where increased labour migration among young adults has
resulted in growing numbers of children being sent to stay with grandparents. 23

Even where residential situations appear stable in the aggregate, studies following the
same individuals over time have found that many older persons’ living arrangements change
within a period of a few years, often in connection with changes in health and economic status. 24
Study results from Eastern and South-Eastern Asia suggest that while co-residence generally
remains common, “the content of the household relationships appears to be altering. Older
women, instead of being deferentially waited upon by their children and children-in-law in
accord with traditional practices, are often involved in childcare for grandchildren and in cooking
for the busy dual wage-earner couple.” 25

F. Household headship

Most older men who live with their children are regarded as the head of the household. In
developing countries, on average, about 90 per cent of men aged 60 years or over are identified
as the head of household. 26 Although the proportion tends to be lower for the oldest-old than for
men in their sixties or seventies, well over half of the men aged 80 years or above are regarded as
the household head in most developing countries. Women are much less likely than men to be
identified as the head of household, though there are marked differences between countries in
this respect. On average around two thirds of older women in developing countries are either the
head of the household or the spouse of the head. While it is unclear to what extent headship
implies day-to-day control over resources and decision-making, these figures do suggest that
older persons, especially men, are usually regarded as playing a leading role in their
households. 27

Older persons who live with their own children are far more likely than those residing
with other relatives or non-relatives to be the head of the household. 28 The relative rarity of these
latter types of living arrangements (involving only around 5 per cent of older persons in
developing countries) suggests that they are not what people tend to prefer, though such
arrangements can provide a viable alternative to living alone for older persons who do not have
any children or are unable to rely on them for support. On average, such households are
relatively well-off economically, 29 but there is little information about the social position and
well-being of older persons within them—whether, for instance, the older household members
are treated with respect.

23
24
See, for example, Angelique Chan, “Singapore’s changing age structure and the policy implications for financial
security, employment, living arrangements and health care”, Asian MetaCentre Research Paper Series, No. 3
(Singapore: Asian MetaCentre for Population and Sustainable Development Analysis, 2001), available from
http://www.populationasia.org/Publications/ResearchPaper/AMCRP3.pdf; and Hermalin, The Well-Being of the
Elderly in Asia: A Four-Country Comparative Study.
25
Hermalin, “Ageing in Asia: facing the crossroads”, pp. 12-13.
26
27
Ibid.
28
Ibid.
29
Ibid.

10

G. Living conditions

There is broad agreement—based on consultations around the world with older persons,
their families and the professionals who work with them—about the types of housing and
community amenities that help older persons live comfortably and remain active and engaged in
the wider society. These include, but are not limited to, dwellings that can accommodate those
with limited mobility and strength, a clean and safe environment inside and outside the home,
transportation that is affordable and accessible, walkways in urban areas that are in good repair
and free of obstacles, traffic signals that allow enough time for older persons to cross streets
safely, places to rest outdoors, and public buildings that are accessible to those with limited
mobility. 30 There are numerous examples of good practices and of ageing-friendly innovations in
housing design, assistive devices, transportation and community services. A growing number of
national and local Governments have adopted policies to make housing and the urban
environment more accessible for older persons. For instance, many cities offer reduced fares for
older persons using public transit and special transportation arrangements for those with limited
mobility, and building codes have been revised at the local and national levels to ensure the
incorporation of age-friendly features in new construction. Governments and civil society
organizations have sometimes made significant investments in this regard, often introducing
modifications to existing housing and public facilities. Most such programmes are found in the
more developed countries, but cities such as Bangkok, Beijing, New Delhi and Singapore are
also adopting similar measures, in some cases on a pilot basis. 31

Although progress is being made on many levels, the fact remains that members of the
ageing population frequently live in older housing that is not adapted to their needs and
encounter obstacles in moving about their communities. Many city neighbourhoods are
perceived as unsafe by older persons. A study carried out in the European Union (EU) found that
older persons and women are significantly more likely than other groups to fear walking in their
area at night. 32 In the developing world, settlements often emerge and expand without planning
and can lack basic amenities. The United Nations Centre for Human Settlements (Habitat)
estimates that one third of the developing world’s urban population lives in slum conditions,
characterized by a lack of access to improved water, adequate sanitation, durable housing
materials, sufficient living area, and security of tenure. In sub-Saharan Africa over 60 per cent
and in Southern Asia over 40 per cent of urban dwellers lived in slums in 2005. 33 Access to
adequate housing and basic services is usually much more limited in rural than in urban areas.
Statistics indicate that in many Latin American countries, older persons are more likely than

30
World Health Organization, Global Age-Friendly Cities: A Guide (Geneva: WHO Press, 2007), available from
http://www.who.int/ageing/publications/Global_age_friendly_cities_Guide_English.pdf; and United Nations Centre
for Human Settlements (Habitat), Improving the Quality of Life of the Elderly and Disabled People in Human
Settlements—Volume I: A Resource Book of Policy and Programmes from around the World (Nairobi, 1993)
(HS/284/93E), available from http://ww2.unhabitat.org/programmes/housingpolicy/documents/HS-284.pdf.
31
United Nations, World Economic and Social Survey 2007: Development in an Ageing World.
32
European Foundation for the Improvement of Living and Working Conditions, First European Quality of Life
Survey: Social Dimensions of Housing (Luxembourg: Office for Official Publications of the European Communities,
2006). Available from http://www.eurofound.europe.eu/ewco/reports/TN0403TR01/TN0403TR01.pdf.
33
United Nations Centre for Human Settlements (Habitat), State of the World’s Cities 2008/2009: Harmonious
Cities (London: Earthscan, 2008) (HS/1031/08E). Available for download from
http://www.unhabitat.org/pmss/listItemDetails.aspx?publicationID=2562.

11

younger adults to live in dwellings constructed from low-quality materials, though they are also
more likely to own their home and in most countries are less likely to be living in poor
neighbourhoods (often shanty towns settled by recent migrants from the countryside). In some
countries in the region, older persons are also more likely to live in dwellings that lack basic
services including safe water and sanitation. 34 In Europe, older persons tend to live in less
crowded housing conditions than do younger adults, and in most European countries older
persons are more likely to own their home. In some countries, however, primarily those in
Southern Europe and the newer EU member States, older persons are more prone than others to
report housing deficiencies such as rotting woodwork and the lack of an indoor flush toilet, or to
report that home heating is unaffordable. 35 Older persons in Bulgaria, Estonia, Greece, Hungary,
Latvia, Lithuania, Poland, Portugal and Romania are often homeowners, but many cannot afford
to repair, maintain or modernize their property.

In recent decades, some developed countries have witnessed an expansion in housing
designed specifically for older persons, including facilities offering assisted-living services.
However, unless subsidized by the public sector or charitable institutions, such housing is
unaffordable for many of those who might benefit from it. In addition, because of high
construction costs, these facilities are often built in peripheral areas far from other services and
the residents’ old neighbourhoods, family and friends. 36

Nursing homes and similar institutions offer an alternative for older persons who require
assistance and/or specialized medical services. The quality and availability of institutional long-
term care vary enormously, however, and high-quality institutional care tends to be expensive.
Around 2006, the proportion of persons aged 65 years or over living in long-term care
institutions ranged from 5 to 8 per cent in Australia, New Zealand, and some Northern and
Western European countries; levels were considerably lower in Eastern and Southern Europe and
in developing countries. 37 Most of the residents of such institutions are women over 75 years of
age.

Many developed countries have been restructuring long-term care services to enable
more of those needing assistance to remain at home, and rates of institutionalization have
declined in the 1990s and 2000s in some countries. 38 Older persons who wish to continue living
at home can now arrange for personal care, meals, housekeeping, home maintenance, care
management, and treatment for health problems. Services and facilities in the community may
include day care, congregate meals, and social centres. In many cases formal in-home care serves
as a supplement to informal care provided by family and friends, and some programmes include
respite services for unpaid carers, who are often under great stress.

34
United Nations, World Economic and Social Survey 2007: Development in an Ageing World.
35
European Foundation for the Improvement of Living and Working Conditions, First European Quality of Life
Survey: Social Dimensions of Housing.
36
United Nations Centre for Human Settlements (Habitat), Improving the Quality of Life of the Elderly and
Disabled People in Human Settlements—Volume I: A Resource Book of Policy and Programmes from around the
World.
37
Organization for Economic Cooperation and Development, Society at a Glance 2009: OECD Social Indicators
(Paris: OECD Publishing, 2009); and United Nations, Living Arrangements of Older Persons around the World.
38
Ibid.; and Organization for Economic Cooperation and Development, Long-Term Care for Older People (Paris:
OECD Publishing, 2005).

12

In most developing countries there has so far been little development of institutional care
apart from limited facilities for sheltering destitute and abandoned elders. However,
policymakers in rapidly ageing countries in the less developed regions, including Eastern and
South-Eastern Asia, are considering different ways of responding to the growing need for long-
term care beyond what the family can provide.39 Figures for 2005 indicate that in Latin America
and the Caribbean public funding was being provided for institutional long-term care in nine of
the fourteen countries for which information was available, though the reach of the programmes
might have been limited in some cases. Five of the fourteen countries provided funding for
formal home-based care. 40

In New Zealand, a recent study of decision-making regarding entry into residential care
found that older persons often had a different perception of who had most influenced the
decision than did family members or professionals. The study also found that older persons with
good levels of knowledge about services and support, and good housing, were more likely to
continue to live in the community. These findings point to the need for greater attention to clear
communication, information and support services both for older persons who wish to remain in
the community and for caregivers. 41

H. Older migrants and the effects of migration

By mid-2010 there were an estimated 31 million international migrants aged 60 years or
over, accounting for 14 per cent of the total number of migrants worldwide. Older persons are
less likely than young adults to move over the course of a year, but many members of the ageing
population find it necessary to migrate in response to adjustments in life circumstances,
including retirement, widowhood or changes in health status. Older persons are also affected
when their children migrate out of the area, and parents may later move to join children who
have settled elsewhere.

Some retirees move to an area with a more pleasant climate or lower cost of living. Even
though the volume of such migration is fairly small in relation to moves for other reasons, the
absolute number of migrants is large enough to have a major impact on the destination areas. In
the United States of America, for instance, some areas in the south and west of the country have
experienced a large influx of retirees from further north, and many older persons from Northern
Europe have settled in Spain and other southern European countries. Most people who make
moves of this type are in their fifties and sixties and are in good health. 42 However, such
migrants sometimes live apart from the local society, and when health problems arise later on,

39
United Nations, World Economic and Social Survey 2007: Development in an Ageing World; and Kinsella and
He, An Aging World: 2008.
40
Nelly Aguilera and Jorge Huerta-Muñoz, CISS-CIESS Survey on LTC in Latin America and the Caribbean,
Working Paper CISS/WP/05102 (Mexico City: Inter-American Conference on Social Security, Inter American
Center for Social Security Studies, 2005). Available from http://www.ciss.org.mx/pdf/en/studies/CISS-WP-
05102.pdf.
41
Diane Jorgensen and others, “Why do older people in New Zealand enter residential care rather than choosing to
remain at home, and who makes that decision?” Ageing International, vol. 34, No. 1-2 (2009), pp. 15-32.
42
María Angeles Casado-Díaz, Claudia Kaiser and Anthony M. Warnes, “Northern European retired residents in
nine southern European areas: characteristics, motivations and adjustment”, Ageing and Society, vol. 24, No. 3
(2004), pp. 353-381. Available from http://eprints.whiterose.ac.uk/1516/1/warnes.a.m2.pdf.

13

international migrants may have difficulty accessing care, given the complex rules that govern
cross-border entitlements. 43

Older persons who move to urban areas within their home countries do not face all the
problems international migrants encounter, but they too experience a loss of social networks. A
lack of supporting infrastructure in cities, unsafe urban neighbourhoods, and inadequate
transportation can lead to their isolation and marginalization.

When young adults move away in search of work, older parents may be left living by
themselves. Studies in Mexico and Thailand show that with increased migration, many adult
children now live far from their parents. 44 In 2007, around 30 per cent of older Thais who lived
alone did not have any children living in the same province.45 However, though the migration of
working-age children has increased over time in Thailand, there has been little change in the
frequency with which parents receive financial help from their offspring. Nearly 90 per cent of
older parents receive some money from their children over the course of a year, with children
being the main source of income for over half of the older population. Even when separated by
some distance, ageing Thai parents and their children tend to maintain strong ties. The spread of
mobile phone technology to rural areas allows parents and children to stay in frequent contact.
When surveyed, about half of the older persons who had experienced serious illness reported that
an absent child had returned to provide care. Since studies such as those conducted in Thailand
are rare, it is unclear whether findings would be the same or similar elsewhere. A study of rural
areas in Indonesia 46 found a complex mix of situations among parents of migrants. Although
many absent children sent money to parents, the amounts were usually very small. There was a
stratum of highly vulnerable older persons who needed to rely on charity from others in the
community, a situation that entailed social stigma as well as material deprivation. Many elders in
this vulnerable group did receive contributions from children, but in amounts insufficient to
prevent extreme poverty. Children of poor parents are likely to be poor as well, and neither co-
residence nor remittances can be relied upon to provide adequate support for all older persons.

When migration involves the crossing of national borders, it may be difficult for older
parents and children to remain in contact. The parents who stay behind often experience
disruption, hardship and uncertainty at multiple levels. During the economic upheaval in Albania
after 1990, for example, there was massive outmigration of working-age youth and young adults
from rural areas, leaving older persons in a depopulated and increasingly impoverished
countryside. Many job-seekers crossed international borders without documentation, making
cross-border visits difficult or impossible. Migrant children often sent remittances that enabled

43
Irene Hardill and others, “Severe health and social care issues among British migrants who retire to Spain”,
Ageing and Society, vol. 25, No. 5 (2005), pp. 769-783.
44
John E. Knodel and others, Migration and Intergenerational Solidarity: Evidence from Rural Thailand, Papers in
Population Ageing, No. 2 (Bangkok: UNFPA Thailand and Country Technical Services Team for East and South-
East Asia, September 2007), available from http://www.psc.isr.umich.edu/pubs/pdf/UNFPA_migration.pdf; and
Shawn Kanaiaupuni, “Leaving parents behind: migration and elderly living arrangements in
Mexico”, CDE Working Paper No. 99-16 (Center for Demography and Ecology, University of Wisconsin-Madison,
April 2000), available from http://www.ssc.wisc.edu/cde/cdewp/99-16.pdf.
45
46
Philip Kreager, “Migration, social structure and old-age support networks: a comparison of three Indonesian
communities”, Ageing and Society, vol. 26, No. 1 (2006), pp. 37–60.

14

their parents to avoid extreme poverty, but when children established a family abroad the
remittances decreased because of the new family’s own needs. Many left-behind parents were
deeply ambivalent, wanting their children to succeed but missing them, and mourning the loss of
the elders’ expected roles as grandparents and as heads of an extended family. Some older
persons were left without social support and worried about what would become of them if they
fell ill. 47

In other cases, older persons may be able to join migrant children in the countries where
they have settled. However, older persons who move for this reason frequently face obstacles in
adjusting to life in an unfamiliar land. Often they do not know the local language, are compelled
to live in a socially circumscribed world, and face exclusion from social services and medical
care. Health and welfare facilities often lack interpreters, and older immigrants may encounter
uncomprehending and unsympathetic service staff. 48 Findings published in 2000 indicated that
older Chinese migrants living in the United Kingdom of Great Britain and Northern Ireland
experienced social exclusion because of language barriers, unfamiliarity with social and public
services, and lack of knowledge of their rights. They tended to have poor mental and physical
health and a poor self-image. 49 Family relationships in the new setting may be strained. 50 In
addition, older persons who move across national borders often have limited rights to social
security in the destination country, depending on where they came from, whether they moved as
workers or as retirees, and their resident status according to the laws of the receiving country. 51

I. Older persons in emergency situations

In 2009, approximately 1.1 million people aged 60 years or over were living as refugees
or internally displaced persons worldwide, accounting for 5 per cent of the population of concern
to the Office of the United Nations High Commissioner for Refugees. 52 In some areas they
comprise more than 30 per cent of the caseload.

A cursory review of recent emergency situations for which data are available suggests
that the attendant risks of injury and death are significantly higher for older persons than for the
general adult population. Of the estimated 1,330 people who died in the United States in the
wake of Hurricane Katrina in 2005, most were older persons. In the State of Louisiana, 71 per
cent of those who lost their lives were older than 60 years of age. 53 In Indonesia, mortality from

47
Russell King and Julie Vullnetari, “Orphan pensioners and migrating grandparents: the impact of
mass migration on older people in rural Albania”, Ageing and Society, vol. 26, No. 5 (2006), pp. 783-816.
48
Anthony M. Warnes and others, “The diversity and welfare of older migrants in Europe”, Ageing and Society, vol.
24, No. 3 (2004), pp. 307-326. Available from http://eprints.whiterose.ac.uk/1515/1/warnes.a.m1.pdf.
49
Wai Kam Yu, Chinese Older People: A Need for Social Inclusion in Two Communities (Bristol, United Kingdom:
Policy Press, September 2000).
50
Warnes and others, “The diversity and welfare of older migrants in Europe”.
51
Peter Dwyer and Dimitris Papadimitriou, “The social security rights of older international migrants in the
European Union”, Journal of Ethnic & Migration Studies, vol. 32, No. 8 (November 2006), pp. 1301-1319.
52
Office of the United Nations High Commissioner for Refugees, 2009 Global Trends: Refugees, Asylum-seekers,
Returnees, Internally Displaced and Stateless Persons (Geneva: UNHCR Division of Programme Support and
Management, 15 June 2010). Available from http://www.unhcr.org/4c11f0be9.html.
53
Mary Jo Gibson and Michele Hayunga, We Can Do Better: Lessons Learned for Protecting Older Persons in
Disasters (Washington, D.C.: AARP Public Policy Institute, 2006). Available from
http://assets.aarp.org/rgcenter/il/better.pdf.

15

the 2004 tsunami was highest among young children and older adults. Older persons accounted
for most of the tens of thousands of excess deaths in Europe during the 2003 heat wave. In
France, which was especially hard-hit, 70 per cent of the deaths were of people over the age of
75. 54 When an earthquake struck Kobe, Japan, in 1995, more than half of the immediate
casualties were among older persons, and this group accounted for 90 per cent of the subsequent
deaths. 55

Health problems—including chronic conditions and diseases, impairments, and
disabilities—increase the risk of injury and death during emergencies. Living alone constitutes
an additional risk factor for older persons in emergency situations. Older persons who have
disabilities and live by themselves are particularly vulnerable, since they are likely to need
assistance but may be overlooked. In some cases emergency responders have lacked guidelines
for evacuating older persons with limited mobility, such as residents of nursing homes. Older
persons also frequently fare poorly after the immediate crisis has passed. Assistive devices and
medicines may have been lost, emergency shelters sometimes have physical barriers such as
stairs, and both inside and outside the shelters access to water and sanitary facilities may be
limited. Evacuees may need to stand in queues for long periods to obtain food or other
assistance. Forms that need to be filled out to request compensation and benefits can be
impossible for uneducated older persons to complete.56

The needs of the older population in disasters and conflicts have typically been addressed
only through broader adult health and humanitarian programmes that were developed without
explicit attention to the political, economic and social marginalization of older men and
women. 57 However, there have been some notable exceptions. Following the 2010 earthquake in
Haiti, various non-governmental organizations (NGOs), including HelpAge International,
provided targeted assistance to older persons. More broadly, a review of responses to 16
emergencies—including natural disasters in Canada, Cuba and Japan and population
displacement due to conflict in Lebanon—indicated that explicit attention had been given to
relocating at-risk older persons to safe shelters in several instances.58 Assessing and developing
the capacity of older persons to prepare for, cope with, and recover from emergencies constitute
the starting point for policy intervention in this area. The World Health Organization (WHO) and
the Office of the United Nations High Commissioner for Refugees, among others, have
developed relevant policy recommendations, drawing on national plans and strategies as well as
examples of good policy practices that target older persons during emergencies. 59

54
International Federation of Red Cross and Red Crescent Societies, World Disasters Report 2004: Focus on
Community Resilience (Bloomfield, Connecticut: Kumarian Press, October 2004).
55
World Health Organization, Older Persons in Emergencies: An Active Ageing Perspective (Geneva: WHO Press,
2008). Available from http://www.who.int/ageing/publications/EmergenciesEnglish13August.pdf.
56
Ibid.
57
Gibson and Hayunga, We Can Do Better: Lessons Learned for Protecting Older Persons in Disasters.
58
World Health Organization, Older Persons in Emergencies: An Active Ageing Perspective.
59
David Hutton, Older People in Emergencies: Considerations for Action and Policy Development (Geneva: WHO
Press, 2008); Public Health Agency of Canada, Building a Global Framework to Address the Needs and
Contributions of Older People in Emergencies (Ottawa: Minister of Public Works and Government Services
Canada, 2008); HelpAge International, Older People in Disasters and Humanitarian Crises: Guidelines for Best
Practice (London, 2000); and Office of the United Nations High Commissioner for Refugees, Standing Committee,
UNHCR’s Policy on Older Refugees, 19 April 2000 (EC/50/SC/CRP.13, annex II)

16

II. The economic situation of older persons: employment, income and poverty
considerations

A. Employment

Labour force participation

For many older individuals, employment provides the income needed to escape extreme
poverty. Work-related accomplishments can also be a source of personal satisfaction and social
esteem.

Table 2 indicates that 30 per cent of men and 12 per cent of women aged 65 years or over
were economically active worldwide in 2008, compared with 95 per cent of men and 67 per cent
of women within the peak-working-age range of 25-54 years. For all age groups, labour force
participation is typically higher among men than among women, primarily because the latter tend
to devote more time to maintaining the household and caring for children and other dependants.
In addition, the extent of women’s non-household work may be underrepresented in censuses
and surveys, especially when this work is carried out on a family farm or in a small family
business.

Table 2
Labour force participation rates, by sex, age group and region, 2008

Age group_____________________
_ 25-54 55-64 65+_____
Region Men Women Men Women Men Women______
World 95 67 74 40 30 12
More developed regions 92 78 65 46 15 8
Less developed region s 96 64 77 38 37 14
Africa 95 63 84 51 53 28
Asia 96 64 76 37 34 11
Europe 91 80 58 39 9 5
Latin America and the Caribbean 94 64 78 40 47 19
Northern America 91 76 70 59 21 13
Oceania 90 75 70 53 18 8
_____________________________________________________________________________________
Source: Calculated from International Labour Office, Economically Active Population Estimates and
Projections (LABORSTA database, 5th ed., 2009 revision) and Key Indicators of the Labour Market (accessed 11
May 2010).

The statistics for 2008 show that labour force participation declined more rapidly with
advancing age in the more developed than in the less developed regions (see table 2). Among
men of peak working age (25-54 years), there were only small differences in labour activity rates
between the two regional groupings. However, among men aged 65 years or over, only 15 per
cent were economically active in the more developed regions, compared with 37 per cent in the
less developed regions. Labour force participation rates for men aged 55-64 years were also
higher in less developed regions (77 per cent) than in the more developed regions (65 per cent).

17

For women within the peak-working-age group, labour force participation was higher in the
more developed regions (78 per cent) than in the less developed regions (64 per cent), but for
those aged 65 years or over the rates were lower in the former (8 per cent) than in the latter (14
per cent). Africa was the region with the highest rates of economic participation among those
aged 65 years or over (53 and 28 per cent for men and women, respectively), followed by Latin
America and the Caribbean (with corresponding rates of 47 and 19 per cent).

Trends in labour force participation differ by sex. Women’s participation in the formal
labour market has been rising in most countries. In absolute terms the increases are largest for
those below the age of 65, but in most regions labour force participation has also risen among
women aged 65 years or over. The greatest increase has been in Latin America and the
Caribbean, where the rate of economic activity among older women rose from 10 per cent in
1980 to 19 per cent in 2008.

In contrast to the trends for women, labour force participation among men aged 55 years
or over declined significantly between the 1970s and the mid-1990s in most developed countries,
especially in Europe. In many European countries the decline reversed after the mid-1990s,
particularly within the older working-age group. Economic participation among men aged 65
years or over has also rebounded in some parts of Europe, and there have been notable recent
increases for this group in New Zealand and the United States as well. In most cases, however,
older men’s labour force participation remains substantially below the levels of 1970. 60 For
developing countries as a group there has been only a slight downward trend in labour force
participation among men aged 55-64 years, but among those aged 65 or over the decline has
been significant in many cases. One exception is Latin America and the Caribbean, where the
rate of labour market participation for men aged 65 or over increased by 5 percentage points
between 1980 and 2008.

Many factors influence labour force participation among older persons. Economic
conditions and retirement policies both play a key role. Health-related challenges and reductions
in physical strength and stamina are other important reasons why rates of economic activity
decline with age. Trends for older women also reflect broader economic and social changes that
have brought more women of all ages into the workplace.

Working conditions

Older workers are more likely than their younger counterparts to work in the agricultural
and informal sectors, and to work part time. Agriculture remains a mainstay of employment for
the older population in most developing countries, especially in Africa and Asia, where most
older people live in rural areas. Studies in several Asian countries in the 1990s found that over
half of older workers were engaged in agriculture. 61 In the more developed countries older

60
Organization for Economic Cooperation and Development, Live Longer, Work Longer (Paris: OECD Publishing,
2006).
61
Kinsella and He, An Aging World: 2008.

18

workers are also overrepresented in agricultural employment. 62 This often involves work on a
small family farm; statistics for the mid-2000s indicate that individuals aged 65 years or over
were the proprietors of a considerable number of small agricultural holdings in some European
countries. 63 At the same time, there is a tendency in developed countries for highly skilled
workers to retire later than the low-skilled, and within Europe older workers are overrepresented
not just in agriculture, but also in the expanding fields of education, health and social work.

Part-time work can provide a transition to retirement for older workers. However, the
increased job flexibility that comes with such a choice may need to be weighed against the
possibility of reduced employment security and benefits. Part-time work often means weaker job
tenure, lower wage rates and fewer opportunities for training and advancement. In addition,
depending on national regulations, working beyond the official pensionable age may mean
forgoing some social security and pension benefits. A 2002 survey of 15 European countries
revealed that 37 per cent of working women aged 50-64 years were employed part time, as were
63 per cent of those aged 65 years or over. Rates of part-time work were lower for men but also
increased with advancing age, rising from 7 per cent for the age group 50-64 to 45 per cent for
those aged 65 years or over. 64 Older workers are also more likely to be working part time in New
Zealand and the United States, and higher levels of part-time work among older women than
among older men have been reported in some Asian countries. 65

In developing countries, often the only employment available to older persons is in the
informal sector, which typically implies a lack of retirement benefits, relatively low pay, insecure
job tenure, and limited opportunities for advancement. A study in Thailand found, for instance,
that 90 per cent of workers aged 60 years or over were engaged in informal employment. 66

Age discrimination in employment

Older people often face discrimination in hiring, promotion, and access to job-related
training. A review by the Organization for Economic Cooperation and Development (OECD)
found evidence in nearly all the countries studied that most employers held stereotypical views
about older workers’ strengths and weaknesses. The review also found that employers’ negative
perceptions about older workers’ abilities and productivity affected decisions about hiring and
retention. 67

A growing number of countries are adopting laws to combat discrimination against older
workers. According to a recent review published by the International Labour Organization (ILO),

62
European Foundation for the Improvement of Living and Working Conditions, “Part-time work in Europe”.
Available from http://www.eurofound.europa.eu/ewco/reports/TN0403TR01/TN0403TR01.pdf (accessed on 17
March 2010).
63
64
European Foundation for the Improvement of Living and Working Conditions, “Part-time work in Europe”.
65
66
Rika Fujioka and Sopon Thangphet, Decent Work for Older Persons in Thailand, ILO Asia-Pacific Working
Paper Series (Bangkok: International Labour Organization, Regional Office for Asia and the Pacific, February
2009). Available from http://www.ilo.org/wcmsp5/groups/public/---asia/---ro-
bangkok/documents/publication/wcms_103920.pdf.
67
Organization for Economic Cooperation and Development, Live Longer, Work Longer.

19

some form of legislation against age discrimination in employment exists in approximately 50
countries around the world. In addition, Ecuador, Eritrea, Mexico and South Africa have
constitutional provisions that address age or age equality in labour markets.68 Members of the
European Union have adopted legislation in conformity with a 2000 EU directive on equal
treatment in employment and occupations.

Anti-discrimination laws vary in their specifics, and retirement may still be mandatory at
the official pensionable age. 69 It is difficult to assess the effectiveness of the legislation in
combating age discrimination. Effective means of publicizing relevant legal provisions and of
monitoring and enforcing compliance are needed if laws are to have an impact. Efforts to combat
negative stereotypes held by employers may also have an effect; in some countries informational
campaigns have been launched to address this issue. 70

Unemployment

In 2009, for the OECD countries as a group, the unemployment rate was lower for
workers aged 55 years or over (5.7 per cent) than for workers aged 25-54 years (7.3 per cent).
Such figures can be misleading, however; while the risk of unemployment may be lower for
older workers, those who do lose their jobs tend to remain unemployed for longer periods than
their younger counterparts. In the majority of OECD countries, the incidence of long-term
unemployment is higher—often much higher—for job-seekers aged 55 years or over than for
those in the peak-working-age range of 25-54 years (see figure VI). In OECD countries, on
average, the long-term unemployment rate is 31.3 per cent for persons aged 55 years or more,
compared with 26 per cent for persons aged 25-54 years.

The relatively high incidence of long-term unemployment among the older unemployed
is indicative of the added barriers older workers face in labour markets. Increasing rates of labour
participation among older persons will require action at a number of levels, including the
adoption of policies to stimulate their employability.

68
Naj Ghosheh, Age Discrimination and Older Workers: Theory and Legislation in Comparative
Context, Conditions of Work and Employment Series No. 20 (Geneva: International Labour Office, 2008).
Available from http://www.ilo.org/wcmsp5/groups/public/---ed_protect/---protrav/---
travail/documents/publication/wcms_travail_pub_19.pdf.
69
Ibid.; and Organization for Economic Cooperation and Development, Live Longer, Work Longer.
70

20

Figure VI
Long-term unemployed as a share of total unemployed: a comparison between younger and older
workers in OECD countries, 2009
(Percentage)

55+ 25-54

80

70

60

50
Percentage

40

30

20

10

0

N en a y
H taly

C nd
Sl blic

Au tes
ia

ea
St d

N en
he i a
G ry

Ire n

Sw lia
Be kia

EC m m

Ic a
M nd
U Fi ria
Ja d

L ing d

Au ds
l

Tu s

N Est y

.K o
Po any

te Po n
G ium

R nce

un g
ze F ce

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ga

e
e

te an

ad
ai

n

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en

et on
ga

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ra

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n

a
e

ed

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a
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a

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a
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ew m
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I

rla
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re
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al
an

el
or
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ov

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Sl

d
d
ni
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U

Source: United Nations, based on data obtained from the Organization for Economic Cooperation and
Development, “Labour force statistics (MEI)”, OECD.StatExtracts.

Retirement

Most countries have a statutory retirement age at which workers covered by the system
are entitled to receive a pension and other retirement benefits. In 2009, the statutory retirement
age ranged from 50 to 67 years worldwide, with age limits tending to be lower in developing
than in developed countries. 71 Workers who retire earlier than the specified age often can claim
reduced benefits. However, as noted below, only a minority of workers in most developing
countries are employed in jobs that entitle them to a pension, so the official retirement age holds
little relevance for the bulk of the labour force in these areas. In the absence of retirement
benefits many older people need to work as long as they are physically able. There is a strong
inverse relationship between labour force participation at older ages and the proportion of the

71
United Nations, Population Ageing and Development 2009, wall chart (2010), available from
http://www.un.org/esa/population/publications/ageing/ageing2009.htm; and United Nations, World Population
Ageing 2009.

21

older population receiving a pension, which is itself linked strongly to national levels of
development. 72

The age at which workers receive a full pension is the same for men and women in 111
(64 per cent) of the 173 countries for which data are available. In 49 countries (36 per cent), the
age is lower for women—typically by five years—even though women can expect to live longer
than men (see figure VII). This type of arrangement is more common in developed than in
developing countries. Recently, however, there has been a trend towards reducing or eliminating
the gender gap, with changes often phasing in over a period of several years. 73

Many countries have taken steps in recent years to increase the statutory pensionable age.
Under the OECD umbrella, this follows an earlier period in which many countries lowered the
retirement age. For men, the pensionable age in OECD countries declined by 2.5 years between
1958 and 2000, to around 62 years on average. However, between 2000 and 2009 the average
pensionable age increased by two years, and further increases are already planned in some
countries. 74

In developed countries—with some exceptions, including Japan—actual retirement tends
to occur earlier than the statutory retirement age. In 2001, the average effective age of retirement
in the EU was estimated at 60 years, and while that figure had risen to 61 years by 2005, it
remained well below the Barcelona European Council’s 2002 target of around 65 years by
2010. 75 On average, women in OECD countries withdraw from the labour force about two years
earlier than men. Lower official retirement ages for women contribute to their earlier retirement
in some countries. There is also a tendency for spouses to retire near the same time, which often
means an earlier retirement age for women since they are younger than their spouses in most
cases. 76

For workers with pension coverage, rules governing pension entitlement strongly
influence the timing of withdrawal from the labour force. In some cases, older workers are
effectively pushed out of the labour force by the mandatory retirement age. Other push factors
include negative attitudes on the part of employers towards hiring older workers, skill
obsolescence, limited access to opportunities for retraining, and inflexible job rules that make it
difficult to change working hours. In some situations, employers may perceive a financial
advantage to replacing senior workers with younger ones who can be paid less. 77 In addition to
the push factors, there may be implicit financial incentives to retire at the official retirement age,
72
International Labour Office, World Social Security Report 2010/11: Providing Coverage in Times of Crisis and
Beyond (Geneva, 2010), pp. 52 ff. Available from
http://www.ilo.org/public/english/protection/secsoc/downloads/policy/wssr.pdf.
73
74
Anna D’Addio and Edward Whitehouse, “Pensions at a glance” (23 June 2009), media briefing for Pensions at a
Glance 2009: Retirement-Income Systems in OECD Countries (Paris: Organization for Economic Cooperation and
Development, 2009). Available from http://www.oecd.org/dataoecd/12/60/43098050.pdf.
75
European Commission, Directorate-General for Employment, Social Affairs and Equal Opportunities,
Employment in Europe 2007 (Luxembourg: Office for Official Publications of the European Communities, 2007),
pp. 53 and 67. Available for download from
http://ec.europa.eu/social/main.jsp?catId=113&langId=en&newsId=542&furtherNews=yes.
76
77
Ibid.

22

or indeed before it. Long-term disability, sickness and employment benefits have played a role in
facilitating early retirement in some countries. 78

Figure VII
Life expectancy at retirement in selected OECD countries, by sex, 1970 and 2004

MALES

Japan
Portugal
United States
Sweden
Germany 1970
2004
Australia
Finland
Spain
Italy
France

0 5 10 15 20 25 30

FEMALES

Japan
Portugal
United States
Sweden
1970
Germany
2004
Australia
Finland
Spain
Italy
France

0 5 10 15 20 25 30

Source: Kinsella and He, An Aging World: 2008, p. 115.

78
Jonathan Gruber and David A. Wise, eds., Social Security Programmes and Retirement around the World: Micro-
Estimation, National Bureau of Economic Research Conference Report (Chicago: University of Chicago Press,
2004); and Organization for Economic Cooperation and Development, Live Longer, Work Longer.

23

Opinion surveys in Europe indicate that while a majority of retirees are happy to retire
when they do, a substantial minority might choose to work longer if they had the chance. One
survey conducted in the 1990s asked retirees in 12 European countries whether, at the time they
retired, they would have preferred to continue working either full or part time. Around 40 per
cent said they might have chosen to continue; in Greece, Italy and Portugal more than half said
so. 79

B. Income

Sources of income

In a majority of OECD countries, public transfers account for over half of disposable
income among individuals over the age of 65 (see table 3). This includes earnings-related
pensions provided through the public sector as well as basic, resource-tested and minimum
income programmes. On average, public programmes provide a little over 60 per cent of older
people’s income in OECD countries; earnings from work constitute around 20 per cent, and
other sources, including private pension schemes and investments, account for just under 20 per
cent. Naturally, these proportions vary widely among countries. Although public sector transfers
account for over 80 per cent of older people’s net income in Belgium, France, Hungary and
Slovakia, they make up only about 15 per cent of income in Finland and the Republic of Korea
and a little over one third in the United States. In the case of the Republic of Korea, the public
transfer share is relatively low because the public pension scheme was established only in 1988,
which means that many older people today are eligible for little or nothing in the way of
entitlements. In Finland, mandatory occupational plans cover most retirees but are operated by
the private sector. Private sector pensions and investments constitute around three quarters of
older people’s income in Finland, but the corresponding rate in many other OECD countries is
under 10 per cent. Earnings from work account for no more than 10 per cent of older people’s
income in France, the Netherlands and Sweden, but around one third of their income in the
United States, well over 40 per cent in Japan, and almost 60 per cent in the Republic of Korea.

In the OECD countries as a group, older persons enjoy a net income from all sources of
around 80 per cent of the average population income. Trends relating to this proportional
relationship vary at the country level, however; in 9 of the 20 OECD countries with trend data
available between the mid-1980s and mid-2000s, the average income for older persons increased
relative to the average national income.

As noted previously, public benefits account for a sizeable portion older persons’ income
in OECD countries; if public pensions were removed from the mix, poverty rates would be much
higher. This would also be the case in a number of middle-income countries that have achieved
high pension coverage rates.

79
Alan Walker and Tony Maltby, Ageing Europe (Buckingham, United Kingdom: Open University Press, January
1997).

24

Table 3
Old-age disposable income in OECD countries, by source of income, mid-2000s
(Percentage of total)
____________________________________________________________________________________

Public transfers Work Private pensions/savings
_____________________________________________________________________________________

Finland 15 11 74
Republic of Korea 15 59 26
United States 36 34 30
Canada 41 18 42
Australia 44 20 36
Netherlands 48 10 42
Japan 48 44 7
United Kingdom 49 12 39
Ireland 53 21 26
Denmark 56 12 32
Norway 59 12 29
Iceland 59 31 10
New Zealand 64 15 21
Portugal 66 29 5
Greece 66 26 8
Sweden 69 10 21
Spain 70 24 5
Italy 72 24 4
Germany 73 12 15
Czech Republic 75 25 —
Poland 79 20 1
Luxembourg 79 12 9
Austria 79 19 2
Belgium 81 12 7
Slovakia 82 17 1
France 85 6 8
Hungary 86 12 3
_____________________________________________________________________________________
Source: Organization for Economic Cooperation and Development, Pensions at a Glance 2009: Retirement-
Income Systems in OECD Countries.
Notes: The disposable income distribution figures in the table are for individuals over the age of 65. An em dash
(—) indicates that the item is nil or negligible. Some rows may not add to 100 due to rounding.

In Latin America and the Caribbean, the coverage and generosity of each country’s
pension system are key determinants of the incidence of poverty among older people and of
whether poverty rates for this group are higher than those for the general population. 80 Mid-
2000s data for the urban areas of 12 of the region’s countries showed that in every country

80
Gasparini and others, “Poverty among the elderly in Latin America and the Caribbean”; and Armando Barrientos,
“Ageing, poverty, and public policy in developing countries: new survey evidence”, paper prepared for presentation
at the Thirteenth International Research Seminar on Issues in Social Security—Social Protection in an Ageing
World, Sigtuna, Sweden, 16-18 June 2006, organized by the Foundation for International Studies of Social Security.
Available from http://www.eldis.org/vfile/upload/1/document/0708/DOC22602.pdf.

25

except Argentina, Brazil and Uruguay at least 30 per cent of persons aged 60 years or over had
no income from either pensions or work, and in Colombia, the Dominican Republic and El
Salvador the corresponding proportions were higher than 50 per cent. 81

Pension systems and coverage

Public pensions currently cover fewer than one in five older persons worldwide.
Although nearly 40 per cent of the working-age population lives in countries that have some
provisions for old-age pensions, only about a quarter of those eligible are contributing to a
pension system or accruing pension rights. 82 Rates of pension coverage tend to increase with
national levels of per capita income. Within countries, coverage tends to be lower among the less
educated, who typically earn less. Workers in the agricultural and informal sectors of developing
countries are rarely enrolled in pension schemes, so in those countries with large agricultural and
informal sectors pension coverage tends to be low.

In most non-OECD countries the share of the labour force covered by pension systems is
relatively low, averaging 44 per cent in Eastern Asia (including just 20 per cent in China), 34 per
cent in the Middle East and Northern Africa, 32 per cent in Latin America and the Caribbean, 13
per cent in Southern Asia, and only 6 per cent in sub-Saharan Africa. 83 Reforms to contributory
pension systems in Latin American countries since the 1980s have not led to increased coverage;
in fact, coverage has declined in some cases as employment in the informal sector has grown. 84
Some Asian countries have made significant efforts to extend coverage to the informal sector.
For instance, Sri Lanka has a scheme for farmers and fishers, India’s new pension scheme aims
to include informal sector workers, 85 and China recently began implementing a subsidized
contributory programme for farmers.

In most OECD countries over 90 per cent of the labour force is covered by a contributory
pension scheme, and all OECD countries have general safety nets to provide at least a minimum
income in old age. However, the structure of individual pension systems varies greatly. A
majority of the countries have a mandatory pension system that covers most workers, with the
level of eventual pension benefits linked to contributions during the working years. Only Ireland
and New Zealand have no mandatory contributory system. Contributory pensions are typically

81
Centro Latinoamericano y Caribeño de Demografía (CELADE), División de Población de la CEPAL, “El
envejecimiento y las personas de edad: indicadores para América Latina y el Caribe”, separata (Santiago: Latin
American and Caribbean Demographic Centre (CELADE)—Population Division of the United Nations Economic
Commission for Latin America and the Caribbean (CEPAL), April 2010). Available from
http://www.eclac.org/celade/noticias/documentosdetrabajo/3/39343/Separata_Indicadores_Envejecimiento.pdf.
82
International Labour Office, World Social Security Report 2010: Providing Coverage in the Time of Crisis and
Beyond, preliminary version (Geneva: ILO, Social Security Department, 25 February 2010), available from
http://www.gtzkenyahealth.com/blog/wp-content/uploads//2010/03/WorldSocialSecurityReport2010.pdf; and Robert
Holzmann, David A. Robalino and Noriyuki Takayama, eds., Closing the Coverage Gap: The Role of Social
Pensions and Other Retirement Income Transfers (Washington, D.C.: World Bank Publications, 2009).
83
Beyond, preliminary version.
84
Holzmann, Robalino and Takayama, eds., Closing the Coverage Gap: The Role of Social Pensions and Other
Retirement Income Transfers.
85

26

supplemented by a resource-tested, basic or minimum public scheme that tends to redistribute
income towards older persons who have low incomes from other sources.

Under the current pension systems in OECD countries, the net replacement rate—pension
benefits relative to earnings when working, net of taxes and other benefits—averages around 70
per cent for a worker with average earnings throughout his or her years of employment.
However, pension systems are evolving as Governments strive to balance the goal of protecting
the living standards of older persons with that of ensuring financial sustainability in the face of
population ageing. Some countries have recently increased contribution rates for workers
(though others have reduced those rates), and some are raising the age of pension entitlement,
adjusting the level of payments, or introducing changes designed to discourage early retirement.
In making these changes, Governments have usually tried to protect lower-income workers from
the risk of poverty once they retire, but in some countries the reforms could result in increased
poverty among future retirees. 86

In response to the limited coverage of the contributory pension system, some developing
countries have adopted non-contributory “social” pension schemes to provide a basic income for
older persons. 87 In Latin America social pensions are provided in Argentina, Bolivia, Brazil,
Chile and Uruguay, and in Africa participating countries include Botswana, Lesotho, Mauritius,
Namibia, South Africa and Swaziland. In Southern Asia they have been introduced in
Bangladesh, India and Nepal. The programmes differ in the nature and extent of benefits
provided as well as in eligibility criteria. For example, in Bolivia and Lesotho entitlements are
universal and coverage is high, while in Bangladesh a cap on the number of transfers available at
the local level means that only around 16 per cent of eligible beneficiaries are reached (see table
4). 88 Social pension programmes that provide wide coverage and relatively generous benefits,
such as those in Brazil, Mauritius and South Africa, can greatly reduce the risk of poverty in old
age. For example, it is estimated that the poverty rate among older persons in Brazil would be 48
per cent in the absence of its public pension system, compared with the actual rate of about 4 per
cent. 89 Even when benefit amounts leave some recipients below the poverty line, such pensions
reduce the depth of poverty and can lead to improved health and nutrition for everyone in the
recipient’s household.

86
Organization for Economic Cooperation and Development, Pensions at a Glance 2009: Retirement-Income
Systems in OECD Countries.
87
United Nations, Human Rights Council, “Report of the Independent Expert on the question of human rights and
extreme poverty, Magdalena Sepúlveda Carmona”, 31 March 2010 (A/HRC/14/31). Available from
http://www2.ohchr.org/english/bodies/hrcouncil/docs/14session/A.HRC.14.31_en.pdf.
88
Holzmann, Robalino and Takayama, eds., Closing the Coverage Gap: The Role of Social Pensions and Other
Retirement Income Transfers.
89
Leonardo Gasparini and others, “Poverty among the elderly in Latin America and the Caribbean”, background
paper for the World Economic and Social Survey 2007: Development in an Ageing World (United Nations
publication, Sales No. E.07.II.C.1). Available from
http://www.un.org/esa/policy/wess/wess2007files/backgroundpapers/lac.pdf.

27

Table 4
Summary of social pension schemes in Bolivia, Lesotho and Bangladesh
___________________________________________________________________________________
Feature Bolivia Lesotho Bangladesh____
Scheme and year established BONOSOL, 1996 Old-age pension, Old-age allowance,
(succeeded by Bono 2004 1998
Dignidad, 2008)

Gross national income per capita 3 810 1 810 1 230
(PPP 2006, US dollars)

Population 9 400 000 2 000 000 156 000 000

Share of population over age 60 (%) 6.9 7.6 5.8

Life expectancy at birth (years) 65.2 42.9 63.7

Target group Persons older than Age 70 and older Persons older than
age 21 in 1995, on age 57; 20 oldest and
reaching age 65 poorer in ward

Percentage receiving pension 80 93 16
(approximate)

Selection Cohort universal Universal Community committee

Transfer (US dollars) 230/year (under 25/month 2.30/month
Bono Dignidad; 320
if no other pension;
160 otherwise)

Beneficiaries 450 000 70 000 1.3 million
(700 000 expected)

Budget (percentage of GDP) 1.3 2.4 0.03

Finance Privatization fund Tax revenues Tax revenues
(plus 30 per cent of
energy tax under
Bono Dignidad)

Politics (at inception) Facilitated Presidential Five-year plan
privatization (scheme initiative
extended in 2008 by
new Government
committed to
renationalization)
____________________________________________________________________________________
Source: Holzmann, Robalino and Takayama, eds., Closing the Coverage Gap: The Role of Social Pensions and
Other Retirement Income Transfers, table 5.1.
Note: PPP, purchasing power parity; GDP, gross domestic product.

28

Access to financial services and credit

Although there is no comprehensive source of information about older people’s access to
credit and other financial services, there are numerous reports of older people being excluded
from such services, especially in low- and middle-income countries. In Africa, older women
often cannot obtain bank loans or mortgages, and under customary law may be denied secure
tenure of property. 90 Evidence from Bangladesh shows that older individuals are often unable to
participate in the microcredit schemes that have been developed to foster self-employment and
income generation. In some cases there are formal age limits for participation. In other cases it is
simply assumed that older people will not be able to repay the loan. There are sometimes
physical barriers that discourage older persons’ participation in microcredit schemes, such as
required weekly meetings that may be difficult for older persons to attend because of distance
and the lack of transport. 91

Older people in developed countries also experience discrimination in accessing financial
services and resources. For example, it has been found that older residents of the United
Kingdom face discrimination in obtaining insurance, especially auto and travel insurance. 92 A
recent analysis of EU member States affirms that in countries where even younger adults often
face exclusion from financial services 93 —including Hungary, Latvia, Lithuania and Poland—
older people tend to fare even worse. Other factors that lead to financial exclusion, including
disability, low household income and lack of paid employment, may compound the effects that
can be attributed solely to advanced age. 94

Older people who cannot obtain credit through normal channels sometimes turn to
lenders that charge unaffordably high rates. In fact, the ageing population has become an
attractive target for such lenders. Older people—even those who could qualify for an affordable
loan—are sometimes sought out by unscrupulous lenders offering high-interest loans, as is

90
Tavengwa M. Nhongo, “Age discrimination in Africa”, paper presented at the International Federation on Ageing
8th Global Conference—Global Ageing: the North-South Challenge, Copenhagen, 30 May – 2 June 2006. Available
from http://www.ifa-fiv.org/attachments/061_Age%20Discrimination%20in%20Africa%20-
%20Age%20Concern%20England,%20DaneAge%20Association,%20IFA%202006.pdf?phpMyAdmin=Hj3UN29f
Xcm3NoRoBeayeKKgLL6&phpMyAdmin=44935d2d09de8a255fdb5c021ececb2d&phpMyAdmin=fd874e5b4e657
d4862d7137acbc46801.
91
HelpAge International, Resource Integration Centre, Older People and Micro-Credit: Bangladesh Experience
(London, 2008). Available for download from
http://helpage.bluefountain.com/es/Site/Worldwide/AsiaPacific/Resources?autocreate_RelatedHelpagePublicationLi
st_start=41.
92
Barry Fitzpatrick and Irene Kingston for the Equality Commission for Northern Ireland, “Older people’s access to
financial services (Dublin, 2008). Available from
http://www.equalityni.org/archive/pdf/OLDERPEOPLEFinancialservices(F).pdf.
93
“Financial exclusion refers to a process whereby people encounter difficulties accessing and/or using financial
services and products in the mainstream market that are appropriate to their needs and enable them to lead a normal
social life in the society in which they belong” (European Commission, Directorate-General for Employment, Social
Affairs and Equal Opportunities, “Financial services provision and prevention of financial exclusion” [March 2008],
available from http://www.scribd.com/doc/46148457/Financial-Exclusion-Study-En).
94
Ibid.

29

reported to have happened frequently in the United States during the expansion of mortgage
lending in the 1990s and 2000s. 95

Intergenerational transfers

When the situation of older persons is considered, the topic of intergenerational support is
often framed in terms of support flowing from children to dependent elders and the extent to
which expectations of filial support are fulfilled in practice. In this regard, concern is often
expressed that economic development and the social changes that accompany it have undermined
traditional systems of family support for older persons. 96 However, survey research generally
does not support the notion that development has led to large-scale abandonment of the old by
the young. Research in both developed and developing countries generally finds that family ties
have been adaptable and resilient in the face of social and economic change and that family
members frequently assist one another financially in times of need, even if they are less likely
than in the past to live together in the same household. 97 This is not to say that families
invariably can or do provide adequate support.

It is misleading to limit consideration of intergenerational transfers to the situation of
older dependants. Many older persons have an adequate income from pensions or employment,
and some have savings or other assets that provide them with an income. Indeed, recent research
has found that older people, especially the younger-old, are more likely on balance to provide
financial support to younger family members than they are to receive it. In both developed and
developing countries, the net direction of economic transfers within the family is primarily from
older to younger family members. Older parents often provide significant economic help around
the time children marry and start a family, for instance, and grandparents may help cover the
costs of raising and educating grandchildren. However, in some Asian countries, including the
Republic of Korea and Thailand, net family transfers do flow towards those aged 65 years or
over, and such transfers are an important source of support for the older generation. In some
other countries, including Costa Rica, Japan and Mexico, persons over the age of 75 or 80
receive net transfers from the family, while the reverse is true below those ages. 98 In developed
95
See Scott James, “A foreclosure crisis rooted, the family says, in predatory lending”, New York Times, 8 January
2010, available from http://www.nytimes.com/2010/01/08/us/08sfmetro.html; and National Consumer Law Center,
Helping Elderly Homeowners Victimized by Predatory Mortgage Loans, Consumer Concerns: Information for
Advocates Representing Older Americans (2006), available from
http://www.nclc.org/images/pdf/older_consumers/brochure_conversions_new/consumer_concerns/pdf/reg_size/cc_h
elping_elderly_homeowners_victimized_predatory_mtg.pdf (accessed 6 June 2010).
96
97
Ibid.; Martin Kohli, Harald Künemund and Claudia Vogel, “Intergenerational family transfers in Europe—a
comparative analysis”, paper presented at session 6 of the Research Network on Ageing in Europe within the
framework of the 7th Conference of the European Sociological Association—Rethinking Inequalities, Torun, Poland,
9-12 September 2005, available in draft form from http://www.ageing-in-
europe.de/torunpapers/ESA_RN_Ageing_Torun2005_Kohli.pdf, and through archive links at http://www.ageing-in-
europe.org.; Vern L. Bengtson and Norella M. Putney, “Who will care for tomorrow's elderly? Consequences of
population aging East and West”, in Aging in East and West: Families, States, and the Elderly, Vern L. Bengtson
and others, eds. (New York: Springer Publishing Company, Inc., 2000), pp. 263-285; and Hermalin, ed., The Well-
Being of the Elderly in Asia: A Four-Country Comparative Study.
98
Ronald D. Lee, “Intergenerational relations and the elderly”, in Between Zeus and the Salmon: The
Biodemography of Longevity, Kenneth W. Wachter and Caleb E. Finch, eds. (Washington, D.C.: National Academy
Press, 1997), pp. 212-244; Lee and Mason, “Population aging, old age support systems, and wealth: cross-national

30

countries, the value of public pension and health benefits means that older people are net
recipients of financial support from public and private sources combined, even though support
transfers within the family flow mainly from the older towards the younger generations.

C. Consumption

Older people generally spend a higher share of their income on housing, social services
and energy than do those in the younger age groups. In developing countries, average per capita
levels of consumption spending for older persons tend to be approximately the same as or a little
lower than the levels for younger adults. In some of the more developed countries, private
consumption spending typically decreases following retirement. 99 However, if the value of
public spending on health, long-term care and other social services is taken into account, per
capita consumption tends to rise at advanced ages in the more affluent countries, especially at
age 80 and above. 100

D. Poverty and income security in old age

Data for the mid-2000s indicate that in OECD countries an average of 13.3 per cent of
people over the age of 65 were poor, in comparison with 10.6 per cent of the general population
(see figure VIII). In that assessment, persons classified as poor were those with incomes, net of
taxes and benefits, below half the national median income. Among the OECD countries, the old-
age poverty rate was above 20 per cent in Australia, Greece, Ireland, Japan, Mexico, the
Republic of Korea and the United States. In Australia, Greece and Ireland the incidence of
poverty among older persons was more than 10 percentage points higher than the population
average, and in the Republic of Korea it was 30 percentage points higher. In 11 OECD countries,
however, poverty rates for the older population were below the national average.

The level and coverage of benefits provided by old-age “safety net” programmes have a
significant impact on old-age poverty rates in OECD countries. Comparatively generous safety-
net benefits are linked to a relatively low risk of poverty for older people in Canada,
Luxembourg, the Netherlands and New Zealand, for example. However, safety-net benefits are
worth only a little over half of the OECD poverty threshold in Japan and the United States and
only about one third of the threshold in Greece. 101 Another factor affecting the risk of relative
poverty in old age is the timing and pace of economic development. In rapidly developing
countries such as the Republic of Korea, the generational gap in incomes tends to be especially
large, and older people often have little or no accumulated wealth or pension entitlements to fall
back on.

comparisons”; and Jorge Bravo and Mauricio Holz, “National transfer accounts: concepts and some examples from
Latin America and Asia”, paper presented at the Seminar on Family Support Networks and Population Ageing, 3-4
June 2009, Doha, Qatar, available from
http://www.eclac.cl/celade/noticias/documentosdetrabajo/1/37141/QatarBravo_Holz.pdf.
99
United Nations, World Economic and Social Survey 2007: Development in an Ageing World, p. 70.
100
Ronald Lee and Andrew Mason, “Population aging, old age support systems, and wealth: cross-national
comparisons”, paper presented at the XXVI IUSSP International Population Conference, Marrakech, Morocco, 27
September – 2 October 2009. Available from http://iussp2009.princeton.edu/download.aspx?submissionId=91768.
101
Organization for Economic Cooperation and Development, Pensions at a Glance 2009: Retirement-Income
Systems in OECD Countries (Paris: OECD Publishing, 2009).

31

Figure VIII
Old-age income poverty rates in OECD countries: percentage of persons over age 65 with
incomes of less than half the median (equivalized) population income, mid-2000s

Rep. of Korea
Ireland
Mexico
Australia
United States
Greece
Japan
Switzerland
Spain
Portugal
Turkey
OECD average 13.3 %
Belgium
Italy
Finland
U.K.
Denmark
Germany
Norway
France
Austria
Sweden
Slovakia
Iceland
Poland
Hungary
Canada
Luxembourg
Czech Republic
Netherlands
New Zealand
0 10 20 30 40 50

Old‐age income poverty rates (percentage)
Source: Organization for Economic Cooperation and Development, “Income distribution: poverty”, OECD
Social Expenditure Statistics (database); see Growing Unequal? Income Distribution and Poverty in OECD
Countries, table 5.3.

In most OECD countries, older women are more likely than older men to be poor. On
average, 15 per cent of older women and 11 per cent of older men live in poverty, while for
women and men of working age the corresponding proportions are 10 and 9 per cent. Pension
entitlements tend to be less generous for older women than for older men because of women’s
lower rate of participation in the formal labour force and their generally lower earnings when
employed. Within the older population, the gender gap in poverty is usually larger among those
over age 75 than among the younger-old, mainly because widowhood is much more common at
higher ages. Many widowed women depend on survivors benefits from the husband’s pension,
and those benefits may be too meagre to prevent poverty.

Old-age poverty in OECD countries is also strongly associated with employment and
living arrangements. Among persons over 65 years of age, only 7 per cent are poor, on average,
if the household contains a working adult, compared with 17 per cent if no one in the household
is employed. Poverty averages 25 per cent among older persons living alone but only 9 per cent
among those living as a couple.

32

As shown in figure IX, the relative risk of old-age poverty has declined in OECD
countries. In the mid-1980s, average poverty rates for individuals over the age of 75 were nearly
double those for the general population. Rates for individuals aged 66-75 years, while lower than
for the oldest group, were also substantially higher than the population average. By the mid-
2000s, however, poverty rates among the older-old were about 50 per cent above the national
average, and rates for the younger-old were slightly below that average.

Because of conceptual and methodological differences in the way poverty is measured,
statistical data are often not comparable between countries and regions. In addition, information
about income poverty among older persons in developing countries is typically sparse.
Nevertheless, it is possible to provide an overview of old-age poverty in the developing world
based on general intraregional observations coupled with more specific country data. Statistics
from around the year 2000 indicate that in 11 out of 15 low-income sub-Saharan African
countries—Burkina Faso, Côte d’Ivoire, Cameroon, Ethiopia, Gambia, Ghana, Guinea, Kenya,
Malawi, Nigeria and Zambia—rates of poverty among households that included an older person
were significantly above the population average (see figure X). 102 In Latin America and the
Caribbean, poverty rates during the period 2001-2005 were found to be higher for older persons
than for the general population in 14 out of 18 countries (see figure XI). Rates of old-age poverty
ranged from12 percentage points below the average in Haiti to 27.5 percentage points above the
population average in Argentina. 103 Patterns are also mixed in other regions. In the Middle East
and Northern Africa, poverty rates for older persons are lower than those for the general
population in Djibouti, Egypt, Jordan, Morocco and Yemen. 104 This is also the case in most parts
of India 105 and in Viet Nam, 106 but in China and Thailand the poverty rate for older persons is
above the national average. 107 In addition, in China, older women are more likely than older men
to be poor, and poverty rates rise sharply with age among the older population. The incidence of
Chinese old-age poverty is also substantially higher in rural than in urban areas.

102
Nanaki Kakwani and Kalanidhi Subbarao, Ageing and Poverty in Africa and the Role of Social Pensions,
International Poverty Centre Working Paper No. 8 (Brasilia: United Nations Development Programme, International
Poverty Centre, 2005). Available from http://www.ipc-undp.org/pub/IPCWorkingPaper8.pdf.
103
Gasparini and others, “Poverty among the elderly in Latin America and the Caribbean”.
104
David A. Robalino, Gudivada Venkateswara Rao and Oleksiy Sluchynsky, “Preventing poverty among the
elderly in MENA countries: role and optimal design of old-age subsidies” (Washington, D.C.: World Bank, Human
Development Department, Middle East and North Africa Region, 2007).
105
Sarmistha Pal and Robert Palacios, “Understanding poverty among the elderly in India: implications for social
pension policy”, IZA Discussion Paper No. 3431 (Bonn: Forschungsinstitut zur Zukunft der Arbeit [Institute for the
Study of Labor], April 2008). Available from http://ftp.iza.org/dp3431.pdf.
106
Martin Evans and others, The Relationship between Old Age and Poverty in Viet Nam (Ha Noi: United Nations
Development Programme in Viet Nam, 2007). Available for download from
http://www.un.org.vn/index.php?option=com_docman&task=doc_details&gid=6&Itemid=211&lang=en.
107
Fujioka and Thangphet, Decent Work for Older Persons in Thailand ; and United Nations Population Fund,
Demographic Change in China: Ageing of the World’s Largest Population, Papers in Population Ageing, No. 4
(prepared by the China Research Center on Aging for UNFPA China [Beijing] and the UNFPA Country Technical
Services Team for East and South-East Asia [Bangkok], December 2007). Available from
http://asiapacific.unfpa.org/webdav/site/asiapacific/shared/Publications/2007/papers%20in%20pop%20agening%20
no.%204%20(2007).pdf.

33

Figure IX
Relative risk of poverty by age in 23 OECD countries, mid-1980s to mid-2000s

23 OECD countries: mid‐1980s to mid‐2000s

225
Relative risk >75
200 of poverty (population=100)
175

150
66‐75
125

100 51‐65

75
41‐50
50

25

0
mid‐1980s mid‐1990s around 2000 mid‐2000s

Source: Organization for Economic Cooperation and Development, “Income distribution: poverty”, OECD
Social Expenditure Statistics (database); see Growing Unequal? Income Distribution and Poverty in OECD
Countries, figure 5.5.

Figure X
Old-age poverty rates in selected sub-Saharan African countries, circa 2000

90
80
70
60
50 All households
40 Households with older persons
30
20
10
0
Ug ria
Ni w i
m ire

G na
G ea

Z a da
Co a F d i

E t oo n

M a ga a

a
G ia

M K e ia

am car

M ue
d o

bi
y
rk ru n

te as

op

b

a
ge
Ca ' Ivo

an
ad n
n
ha

q

m
am

al
oz s
er

ui

bi
hi
Bu Bu
in

Source: Kakwani and Subbarao, Ageing and Poverty in Africa and the Role of Social Pensions, p. 10.

34

Figure XI
Old-age poverty rates in Latin America and the Caribbean, 2001-2005

Argentina
Bolivia
Brazil
Chile
Costa Rica
Dominican Republic
Ecuador
El Salvador
Guatemala

Haiti
Honduras
Jamaica
Mexico
Nicaragua
Panama
Paraguay
Uruguay
Venezuela, R.B. de

0 20 40 60 80 100

Age 0-64 Age 65+

Source: Holzmann, Robalino and Takayama, eds., Closing the Coverage Gap: The Role of Social Pensions and
Other Retirement Income Transfers, p. 44.

Gaps in information about old-age poverty are partly attributable to the infrequency with
which poverty measures are disaggregated by age and sex. It should be noted, though, that
income poverty is generally assessed from data gathered at the household level, and to derive
age- and sex-disaggregated measures analysts assume that resources are shared equitably
between younger and older household members. Different data-collection methods are needed in
order to tell whether, or how often, older persons’ needs may be given a lower priority in
spending within households.

35

III. Health status and access to health care

Advancing health and well-being into old age is among the priority directions of the
Madrid International Plan of Action on Ageing. Achieving high health status is both a central
aim of development and a key promoter of economic growth and social progress. Older
individuals in good health enjoy a greater sense of personal well-being and can participate more
actively in the economic, social, cultural and political life of society.

A. Health and survival

The twentieth century witnessed an unprecedented decline in mortality. Between 1950
and 2005, the chances of surviving to old age improved substantially in all world regions (see
table 5). Presently, those who survive to age 60 can also expect to live longer than in years past.
However, it is unclear how many of the additional years of life are spent in good health.

In the middle of the twentieth century, fewer than half of those born could expect to live
to the age of 60. Currently, at the mortality rates for 2005-2010, three quarters of those born (73
per cent of males and 79 per cent of females) can expect to reach that age. Survival probabilities
vary widely from one area to another, however, ranging from 55 per cent in Africa to 91 per cent
in Northern America for both sexes combined. In all regions, survival prospects are better for
females than for males (see table 5).

Table 5
Probability of surviving to age 60 based on 1950-1955 and 2005-2010 mortality rates
(Percentage)
________________________________________________________________________________
1950-1955________________2005-2010______________
_________________________________Both sexes Both sexes Males Females___

World 46 76 73 79
More developed regions 75 88 83 92
Less developed regions 37 74 71 77
Africa 35 55 53 57
Asia 38 78 76 81
Europe 74 85 79 91
Latin America and the Caribbean 54 83 78 87
Northern America 78 91 89 93
Oceania 65 87 85 89
________________________________________________________________________________

Mortality statistics for 2005-2010 indicate that women who reach the age of 60 can
expect to live another 21 years and men another 18 years, on average. The comparable figures
for 1950-1995 were only 16 years for women and 14 years for men. 108 In terms of interregional
variations, life expectancy at age 60 ranges from 15 years for men and 17 years for women in

108
United Nations, World Population Prospects: The 2008 Revision—Population Database.

36

Africa to 21 years for men and 25 years for women in both Northern America and Oceania (see
table 6).

Table 6
Life expectancy at age 60 based on 2005-2010 mortality rates
(Years)
_____________________________________________________________________________________

Region Males Females Difference
_____________________________________________________________________________________

World 18.1 21.2 3.1
More developed regions 19.6 23.7 4.1
Less developed regions 17.3 19.6 2.3
Africa 15.2 17.1 1.9
Asia 17.6 20.3 2.7
Europe 18.3 22.6 4.3
Northern America 21.2 24.7 3.5
Oceania 21.1 24.6 3.5
_____________________________________________________________________________________

Table 7
Causes of death among persons aged 60 years or over, by national income level, 2004
(Percentage of total)
_________________________________________________________________________________
High- Middle- Low-
World income income income
_______________________________________________ _____countries countries countries

Total 100 100 100 100
Communicable and nutritional conditions 10 6 7 19
Non-communicable diseases 86 91 89 77
Injuries 4 3 4 4
_________________________________________________________________________________
Source: Calculated from World Health Organization, The Global Burden of Disease: 2004 Update, table A5.

Success in controlling communicable diseases has led both to lower mortality and to a
shift in the major causes of death. As the share of deaths from communicable diseases has
declined, non-communicable illnesses such as cardiovascular disease, stroke and cancer have
come to account for a greater proportion of the total. 109 Among older people, non-communicable
diseases already account for most deaths and the bulk of the disease burden, even in low-income
countries. In 2004, non-communicable diseases caused an estimated 86 per cent of deaths among
persons aged 60 years or above worldwide, accounting for 77 per cent of deaths in low-income
countries, 89 per cent in middle-income countries, and 91 per cent in high-income countries (see

109
United Nations, Economic and Social Council, “Report of the Secretary-General on health, morbidity, mortality
and development” (E/CN.9/2010/3). Available for download from
http://www.un.org/esa/population/cpd/cpd2010/comm2010.htm.

37

table 7). Controlling for differences in population age distributions, the burden of non-
communicable diseases—in particular heart disease and stroke—is greater in low- and middle-
income countries than in high-income countries. The burden of vision impairment and hearing
loss is also greater in low- and middle-income countries. 110

B. Chronic conditions and impairments

People living in developing countries not only have lower life expectancies than those in
developed countries, but also live a greater proportion of their lives in poor health. For all age
groups, levels of moderate and severe impairment are higher in low- and middle-income
countries than in high-income countries, and they are higher in Africa than in other low- and
middle-income countries. The average global prevalence of moderate and severe impairment is
about three times higher among persons aged 60 years or over than among those aged 15-59
years. Studies in both developed and developing countries show that women’s advantage in life
expectancy is accompanied by a greater burden of chronic disease and impairment in old age.
Women can expect to live longer than men and to spend a greater total number of years in good
health; however, women spend a greater proportion of their older years in poor health. 111

Hearing loss, vision problems and mental disorders are the most common causes of
impairment overall. Persistent conditions such as dementias, chronic obstructive pulmonary
disease and cerebrovascular disease are especially common at higher ages. Hearing loss is
extremely prevalent and increases with age; WHO estimates that more than 27 per cent of men
and 24 per cent of women aged 45 years or over have some degree of hearing loss. Low-income
populations tend to have high rates of impairment attributable to preventable causes such as
injuries, and those living in poorer countries often lack access to basic interventions such as
eyeglasses, cataract surgery, hearing aids or assistive devices that can keep functional limitations
from becoming disabling. 112 Several of these long-term physical, mental, intellectual or sensory
impairments, in interaction with various barriers, may constitute a disability and interfere with
the full and effective participation of older persons in society.

Many of the conditions that represent the leading causes of disability among older
persons are the same in high-income and low-/middle-income countries, with hearing loss, vision
problems, arthritis, ischaemic heart disease, and obstructive lung disease being among the most
common in both groups of countries (see table 8). Alzheimer’s and other dementias rank higher
in the list for high-income countries, possibly because such conditions are much more common
among the older-old than the younger-old, and the richer countries have a relatively large
number of people over 80 years of age. Unintentional injuries are among the top ten causes of
disability among the older population in low- and middle-income countries.

110
World Health Organization, The Global Burden of Disease: 2004 Update (Geneva: WHO Press, 2008), p. 48.
Available for download from http://www.who.int/healthinfo/global_burden_disease/2004_report_update/en/.
111
Kinsella and He, An Aging World: 2008; and United Nations, World Economic and Social Survey 2007:
Development in an Ageing World.
112
World Health Organization, The Global Burden of Disease: 2004 Update.

38

Table 8
Ten leading causes of moderate and severe disability among persons aged 60 years or over,
in order of importance
____________________________________________________________________________

High-income countries Low- and middle-income countries
__________________________________________________________________________________

Hearing loss Hearing loss
Osteoarthritis Vision: refractive errorsa
Vision: refractive errorsa Cataracts
Alzheimer’s and other dementias Osteoarthritis
Macular degenerationb Macular degenerationb
Chronic obstructive pulmonary disease Ischaemic heart disease
Ischaemic heart disease Chronic obstructive pulmonary disease
Cerebrovascular disease Glaucoma
Rheumatoid arthritis Alzheimer’s and other dementias
Glaucoma Unintentional injuries

Source: World Health Organization, The Global Burden of Disease: 2004 Update, table 9.
a
Adjusted for the availability of eyeglasses and other corrective devices.
b
Includes age-related causes of vision loss other than glaucoma, cataracts and refractive errors.

The broad conclusions from the WHO Global Burden of Disease project, summarized
above, are increasingly being supplemented by more direct and detailed data from surveys of
older persons in developing countries. For instance, the Health, Well-Being and Aging (Salud,
Bienestar y Envejecimiento, or SABE) Survey carried out in metropolitan areas of seven Latin
American and Caribbean countries in the early 2000s found that at least 20 per cent of the
population aged 60 years or over had limitations that affected the basic activities of daily living,
such as bathing and dressing without assistance. 113 Two thirds of the older adults reported having
one or more of the major chronic conditions, including hypertension, diabetes, heart disease,
cerebrovascular disease, joint problems and chronic obstructive pulmonary disease. 114 In a
survey conducted in Thailand, more than a third of older persons reported having at least one
functional limitation. 115 These surveys also found that individuals over the age of 70 were much
more likely than those in their sixties to be disabled, and that women more frequently reported
problems and poor health status than did men.

C. Trends relating to chronic conditions and impairments

Education is strongly associated with health and mortality in cross-sectional data. This
has led to the supposition that increases in the average level of education can contribute to

113
C. Albala and others, “Encuesta Salud, Bienestar y Envejecimiento (SABE): metodología de la encuesta y perfil
de la población estudiada”, Revista Panamericana de Salud Pública, vol. 17, No. 5-6 (May-June 2005), pp. 307-
322. Available from http://www.scielosp.org/pdf/rpsp/v17n5-6/26268.pdf.
114
Enrique Vega, “Health and aging in Latin America and the Caribbean”, in Global Health and Global Aging,
Mary Robinson and others, eds. (San Francisco: Jossey-Bass for the AARP Foundation, 2007).
115
John Knodel and Napaporn Chayovan, “Population ageing and the well-being of older persons in Thailand”,
Population Studies Center Research Report 08-659 (Ann Arbor, Michigan: Population Studies Center, University of
Michigan, October 2008). Available from http://www.psc.isr.umich.edu/pubs/pdf/rr08-659.pdf.

39

extending the number of years spent in good health in old age. Not all trends are favourable,
however. Rising levels of obesity, increased tobacco and alcohol consumption in some
populations, the emergence of new infectious diseases including HIV/AIDS and the resurgence
of old ones such as malaria and tuberculosis, as well as the disruption of health care systems and
public safety in times of economic or political crisis, all threaten to undermine advances in
health, including among older persons. Recent decades have witnessed serious increases in
mortality in some countries and regions. Many countries in Eastern Europe and the former Soviet
Union experienced an escalation in adult mortality rates after the 1970s, especially among men,
and life expectancy also declined after the early 1990s in the countries hardest hit by
HIV/AIDS. 116

Evidence linked to the latest disability trends has been mixed. The prevalence of severe
disability, as measured by indicators of the need for assistance with activities of daily living, has
decreased in some countries but not in others over the past several years. A recent OECD review
found clear evidence of a decline in disability among older people in only five of the twelve
countries studied (Denmark, Finland, Italy, the Netherlands and the United States). In three
countries (Belgium, Japan and Sweden) rates of severe disability among older people had
increased during the preceding five to ten years, and two countries (Australia and Canada)
reported a stable rate. In France and the United Kingdom, data from different surveys were
inconsistent with regard to the direction of the trend. 117 The same review identified a trend
towards an increase in the number of chronic, but not necessarily disabling, conditions reported.

The health conditions of growing concern for older persons include mental disorders,
HIV/AIDS and obesity.

D. Mental health

Depression is known to be common among older persons, though in developing countries
precise data are scarce. Country studies show that a high proportion of older people suffer from
depression, loneliness and anxiety. 118 These problems may arise in connection with major life
changes such as the death of a spouse or a sudden decline in health. Depression often occurs
together with other disorders such as dementia, heart disease, stroke, diabetes or cancer, further
degrading the quality of life among afflicted older persons. Although depression often improves
with treatment, the condition is frequently overlooked among the old because of a lack of
knowledge among caregivers and health professionals and the widespread belief that it
constitutes a normal part of ageing. In developed countries an estimated 1-3 per cent of those
over the age of 65 suffer from severe depression, and an additional 10-15 per cent suffer from

116
United Nations, World Population Prospects: The 2008 Revision—Population Database.
117
Gaétan Lafortune, Gaëlle Balestat and the Disability Study Expert Group Members, “Trends in severe disability
among elderly people: assessing the evidence in 12 OECD countries and the future implications”, OECD Health
Working Papers No. 26 (Paris: Organization for Economic Cooperation and Development, Directorate for
Employment, Labour and Social Affairs, 2007) (DELSA/HEA/WD/HWP[2007]2). Available from
http://www.oecd.org/dataoecd/13/8/38343783.pdf.
118
Peter Lloyd-Sherlock, Population Ageing and International Development: From Generalisation to Evidence
(Bristol, United Kingdom: Policy Press, January 2010).

40

milder forms. Depression is linked to the rise in suicide rates with advancing age that has been
seen in many countries, especially among men (see figure XII). 119

Figure XII
Suicide rates per 100,000 males in selected countries between 2005 and 2009

Republic of Korea

Russian Federation

Sw itzerland

Denmark

Germany

Japan

Finland

United States of America

Argentina

0 20 40 60 80 100 120 140 160 180 200

Male 75+ Male Total

Source: World Health Organization, “Mental health: country reports and charts available”.

Alzheimer’s and other dementias cause profound disability and often place a severe
burden on caregivers. In 2010 an estimated 36 million people worldwide were living with
dementia, and the number is projected to nearly double every 20 years. 120 Much of the increase
will occur in low- and middle-income countries. People with dementia are often specifically
excluded from residential care and are sometimes denied admission to hospitals. Awareness of
the signs of dementia is limited in many countries, and the signs are often dismissed as a normal
part of ageing. One study in the United Kingdom, for example, found that 70 per cent of
caregivers were unaware of the symptoms of dementia before diagnosis, and 58 per cent of
caregivers believed the symptoms were a natural consequence of ageing.

E. HIV and AIDS

The growing burden HIV represents for older persons is another health issue that is often
overlooked. The Joint United Nations Programme on HIV/AIDS (UNAIDS) has observed that a
substantial proportion of those living with HIV/AIDS are over 50 years old. Statistics indicate
that in 2006 an estimated 2.8 million people in this age group were infected with HIV
worldwide. The 2007 Kenya AIDS Indicator Survey showed a national HIV prevalence rate of 8
per cent for individuals aged 50-54 years—almost double the rate for the age group 15-21.
UNAIDS figures for 2005 reveal similar prevalence rates for youth and adults up through their

119
120
Martin Prince and Jim Jackson, eds., World Alzheimer Report 2009 (London: Alzheimer’s Disease International,
2009). Available from http://www.alz.co.uk/research/files/WorldAlzheimerReport.pdf.

41

early to late fifties in countries such as Botswana (21-25 per cent) and Uganda (around 7 per
cent). 121 In Swaziland in 2006-2007, one in four adults aged 50-54 years and one in ten adults
aged 60 years or over were infected with HIV. 122 HIV prevention, care and treatment
programmes the world over pay little attention to older persons owing to the mistaken belief that
they are at little or no risk. In the United States, research has shown that those aged 50 years or
over are generally not screened for HIV infection because doctors are less likely to think it
necessary for older persons. Likewise, older people are often left out of assessments of HIV
prevalence and risk. For instance, the National Health and Nutrition Examination Survey in the
United States does not collect relevant data from individuals older than 49, even though the
estimated number of people over age 50 living with HIV/AIDS in that country jumped from 20
to 25 per cent of the total between 2003 and 2006. Women over age 49 and men over age 54 or
59 are rarely included in the HIV screening conducted as part of many recent Demographic and
Health Surveys in developing countries. 123

F. Overweight and obesity

Many experts worry that rising levels of obesity are undermining prospects for improved
health in old age. Rates of obesity typically increase with advancing age, reaching a peak in the
late sixties to late seventies, depending on the country. 124 Overweight and obesity are linked to a
higher risk of cardiovascular disease (mainly heart disease and stroke), diabetes, arthritis, and
some cancers. Obese people are also more likely to be disabled from carrying out activities of
daily living.

The upward trend in overweight and obesity is best documented in the United States and
Europe. In the United States, adult obesity rose by 20 percentage points between the early 1970s
and 2005-2006; 125 by the end of that period, two thirds of adults aged 20 years or above were
overweight and just over a third were obese. In Europe, rates of obesity are not as high but are
also increasing at an alarming pace. 126 Statistics for 10 European countries indicate that in 2004,
among adults aged 50 years or over, 59 to 71 per cent of men were overweight or obese, as were
41 to 67 per cent of women. While the combined rates of overweight and obesity were higher for
men, in some countries women were more likely than men to be obese.

In developing countries undernutrition has long been the main nutrition-related problem.
That is still the case in many countries, especially in sub-Saharan Africa and Southern Asia.

121
HelpAge International, Mind the Gap: HIV and AIDS and Older People in Africa, HelpAge briefing (London,
December 2008). Available for download from http://www.helpage.org/download/4c3cfb8656b72/.
122
Erica Nybro and Bernard Barrère, HIV Prevalence Estimates from the Demographic and Health Surveys
(Calverton, Maryland: Macro International, 2008).
123
Of the 32 surveys included in Nybro and Barrère’s HIV Prevalence Estimates from the Demographic and Health
Surveys, the upper limit for men was 49 in seven cases, 54 in four cases, 59 in nineteen cases, and 64 or over in two
cases.
124
Franco Sassi and others, “The obesity epidemic: analysis of past and projected future trends in selected OECD
countries”, OECD Health Working Papers, No. 45 (Paris: OECD Publishing, 2009). Available for download from
http://dx.doi.org/10.1787/225215402672.
125
United States, Centers for Disease Control and Prevention, “Prevalence of overweight, obesity and extreme
obesity among adults: United States, trends 1960-62 through 2005-2006”, NCHS Health E-Stat (2010). Available
from http://www.cdc.gov/nchs/data/hestat/overweight/overweight_adult.htm#table1 (accessed 27 May 2010).
126

42

Recently, however, obesity has also become a serious health problem in developing countries,
especially in urban areas. In the less developed countries undernutrition may exist side-by-side
with rising levels of obesity. Inadequate nutrition early in life, followed by exposure to high-fat,
energy-dense, micronutrient-poor foods and the lack of physical activity later on, yields a high
risk of obesity at older ages. 127 As national income levels increase, obesity within developing
countries is shifting from being a problem of the relatively affluent to becoming one primarily
concentrated among those with lower social and economic status—which is already the typical
pattern in high-income countries. 128

G. Access to health care

Although health care should be available, affordable and accessible to individuals of all
ages, meeting the needs of older people is especially critical because chronic health conditions
and disabilities become more prevalent with advancing age. Financial barriers often make it
impossible for poor families to obtain essential medical and other health-related care. As shown
in table 9, out-of-pocket expenditure as a proportion of total health-care expenditure averages 43-
48 per cent for families on the lower half of the income scale but only 14 per cent for those in
high-income countries. In Southern Asia, out-of-pocket spending accounts for more than two
thirds of the total. 129 Such statistics reflect spending by those who are able to pay. In settings
where much of the population lives on the equivalent of less than US$ 1 or US$ 2 per day, vital
health services are unaffordable for many families. In countries that have introduced user fees for
services that were once publicly funded, the use of such services has often dropped dramatically,
particularly among the most vulnerable population groups. 130 According to the results of a
survey in China, the introduction of user fees was the main reason older persons did not visit
doctors or attend hospitals. 131 In some cases fee exemptions are guaranteed by Government
regulation, but if this is not well-publicized, older persons do not know to request an exemption.
A survey of older people in Ghana found that most were unaware they were exempt from paying
user fees in public hospitals, effectively resulting in greatly reduced access. 132 Even though
developed countries provide much higher levels of health-care coverage, there is evidence that
some needs go unmet for those with low incomes. The Survey of Health, Ageing and Retirement
in Europe found that the poorest spent the highest share of their income on health care and that
out-of-pocket expenses were heaviest for the oldest, the less healthy, and women. 133

127
World Health Organization, “Obesity and overweight”, Fact Sheet No. 311 (2006). Available from
http://www.who.int/mediacentre/factsheets/fs311/en/index.html (updated March 2011).
128
Carlos A. Monteiro and others, “Socioeconomic status and obesity in adult populations of developing countries: a
review”, Bulletin of the World Health Organization, vol. 82, No. 12 (December 2004), pp. 940-946. Available for
download from http://www.who.int/bulletin/volumes/82/12/en/index.html.
129
The estimated share of out-of-pocket spending is lower in sub-Saharan Africa than in Southern Asia. This largely
reflects the recent infusion of foreign assistance to combat and treat HIV/AIDS, especially in the least developed
countries in sub-Saharan Africa. Most of that targeted spending does not directly benefit the older population.
130
131
Lloyd-Sherlock, Population Ageing and International Development: From Generalisation to Evidence.
132
Ibid.
133
Axel Börsch-Supan and others, eds., Health, Ageing and Retirement in Europe—First Results from the Survey of
Health, Ageing and Retirement in Europe (Mannheim, Germany: Mannheim Research Institute for the Economics of
Aging, April 2005). Available from http://www.share-
project.org/t3/share/fileadmin/pdf_documentation/FRB1/FRB1_all_chapters.pdf.

43

Table 9
Out-of-pocket health expenditure as a percentage of total expenditure on health,
by national income level and region, 2006
_________________________________________________________________________________

World 17
High-income countries 14
Upper-middle-income countries 32
Lower-middle-income countries 48
Low-income countries 43
Region (low- and middle-income countries)
Eastern Asia and the Pacific 48
Europe and Central Asia 29
Latin America and the Caribbean 36
Middle East and Northern Africa 44
Southern Asia 68
Sub-Saharan Africa 27
_________________________________________________________________________________
Source: World Bank, World Development Indicators.

Access to health care is also constrained by a shortage of qualified medical staff.
According to WHO, 57 countries (mainly in Africa and Asia) have a critical shortage of health
workers and are unable to meet the essential health needs of their populations. 134 Using a higher
threshold to measure staff sufficiency, ILO estimates that around one third of the world’s
population lacks access to the services of an adequate number of trained medical providers. 135
Staff shortages are particularly acute outside urban centres; older rural residents, whose mobility
is often limited, are especially likely to have trouble reaching service providers.

One problematic issue in developing countries is that health-care systems have been set
up with a primary focus on combating communicable diseases and are poorly adapted for the
care and prevention of chronic disease. Furthermore, international assistance for health care has
tended to concentrate on targeting specific communicable diseases, often through vertically
integrated programmes that do little to support the primary health-care services upon which both
older and younger people rely for routine care. Services that are inaccessible to the older
population, dismissive or impolite treatment by health service staff, and the lack of appropriate
medicines for dealing with chronic health conditions are among the problems mentioned
repeatedly in regional assessments of services for older people in Africa, Asia, and Latin
America and the Caribbean. 136

Age discrimination in health care has also been reported in a growing number of
developed countries. Age-based inequalities in clinical treatment derive in part from the lack of
gerontological or geriatric training for medical staff and a consequent lack of knowledge about
the specific care needs of older persons. A review of published medical research from 18

134
World Health Organization, The World Health Report 2006: Working Together for Health (Geneva: WHO Press,
2006). Available for download from http://www.who.int/whr/2006/en/.
135
136
Hermalin, “Ageing in Asia: facing the crossroads”.

44

developed countries offers evidence that many physicians have preconceived beliefs and
negative attitudes with regard to older people, and that this sometimes leads to a de facto
rationing of care based on age rather than on an objective assessment of the patient’s likelihood
of benefiting from treatment. 137 Compounding this problem is the fact that because older people
are severely underrepresented in clinical trials of new medicines and procedures, there is very
little information available on treatment outcomes among older patients.

Even when there is solid evidence that older people would benefit, they may be referred
for diagnosis and treatment at a lower rate than are younger people with similar symptoms. The
aforementioned research review found, for instance, that statin drugs used to lower cholesterol
and help prevent cardiovascular disease are less often prescribed for older than for younger
patients. There is evidence from several countries that older people who would benefit from
cardiac testing, interventions and rehabilitation services have frequently not been offered them;
that older women with breast cancer have tended to receive different treatments than younger
women; and that eligible older people have been less likely than younger patients to receive
kidney transplants or to be referred for joint-replacement surgery. A survey in the United
Kingdom in 2009 found that more than half of the doctors who cared for older persons believed
that the National Health Service was “institutionally ageist”; 66 per cent claimed that older
persons were less likely to have their symptoms investigated, and 72 per cent thought that older
people were less likely to receive referrals for surgery or chemotherapy. 138

H. Long-term care

In many developed countries long-term care is most often provided informally in the
home by family and friends, principally by spouses and adult children. Formal care options are
also available in the developed world; specific systems vary considerably among countries but
generally include provisions for both institutional and home-based care. Individuals aged 80
years or over are much more likely than the younger-old to receive long-term care, and women
in every age group are more likely than men to receive formal care services and to be in an
institution (see figures XIII-XV). 139 The likelihood of women being widowed and living alone in
old age is relatively high, and it may be infeasible for such women to remain at home when
serious illness or impairment strikes. Being married reduces the likelihood of living in an
institution for both sexes, but especially for men. 140

137
Constantina Safiliou-Rothschild, “Age-based inequalities in medical treatment”, AARP International: The
Journal (Winter 2010), pp. 56-59. Available from
http://journal.aarpinternational.org/File%20Library/Journals/AARPJournal_winter2010.pdf.
138
Lloyd-Sherlock, Population Ageing and International Development: From Generalisation to Evidence.
139
United Nations, Living Arrangements of Older Persons around the World; and Organization for Economic
Cooperation and Development, Society at a Glance 2009: OECD Social Indicators.
140
United Nations, Living Arrangements of Older Persons around the World; and Kinsella and He, An Aging World:
2008.

45

Figure XIII
Proportion of older persons receiving formal long-term care in selected OECD countries, by age
group, circa 2006

60

50

40

30

20

10

0
g

y

ds

nd
um

nd

k

y
y
d

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n
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ar

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nm
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w
Sw

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65‐79 80 a nd over

Source: Organization for Economic Cooperation and Development, Society at a Glance 2009: OECD Social Indicators.

Figure XIV
Proportion of persons aged 80 years or over receiving formal long-term care in selected OECD
countries, by sex, circa 2006

60

50

40

30

20

10

0
g

s
y

nd
nd

y

ay
nd

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Fe ma l e Ma l e

Source: Organization for Economic Cooperation and Development, Society at a Glance 2009: OECD Social Indicators.

46

Figure XV
Proportion of persons aged 65 years or over receiving formal long-term care in selected OECD
countries, by care environment, circa 2006

Figure 4. Proportion of persons aged 65 and over receiving formal long‐term care
around 2006
Selected countries
25

20

15

10

5

0

No d
ay
Ca d

G urg
Ic a

Au y
d

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ite
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Un

At home In institutions

Source: Organization for Economic Cooperation and Development, Society at a Glance 2009: OECD Social
Indicators.

Figures from around 2006 indicate that among OECD countries, the proportion of those
aged 65 years or over receiving formal care either at home or in an institution was highest (above
15 per cent) in the Nordic countries and in Austria, New Zealand, the Netherlands and
Switzerland (see figure XV). 141 Countries with universal and relatively comprehensive long-term
care systems include Austria, Germany, Japan, Luxembourg, the Netherlands, and the Nordic
countries. In Italy, the Republic of Korea and most of Eastern Europe (excluding Hungary),
systems of long-term care are less widespread, and in those countries the proportion of
individuals aged 65 years or over receiving services ranged from under 1 per cent to about 4 per
cent in 2006.

Both for purposes of cost containment and because older persons generally prefer to
continue living at home, there has been a gradual shift away from institutional care in many
OECD countries. However, this trend has not been universal within the developed world; during
the first decade of the twenty-first century, countries with a relatively low proportion of older
people receiving formal long-term care registered an increase, while the reverse was true for
many of the countries that started the decade with a relatively high proportion of recipients.

141
Organization for Economic Cooperation and Development, Society at a Glance 2009: OECD Social Indicators.

47

In developing countries, the responsibility for providing long-term elder care usually falls
entirely on the family. This can be a heavy burden for families with already stretched resources,
especially when it prevents adults from working and children from attending school. A series of
case studies sponsored by WHO found nascent efforts to develop some type of assistance
services in several developing countries. 142 However, the reach of those programmes remained
limited up through the early 2000s, when the proportion of persons aged 60 years or over living
in institutions was only about 1 per cent in Africa and not more than 2 per cent in Asia and in
Latin America and the Caribbean. 143

Within the family, women provide most of the day-to-day care for older persons who
need assistance in both developing and developed countries. The SABE Survey found that the
typical caregiver was a woman over the age of 50, and that caregivers experienced high levels of
stress. 144 Sixty per cent of caregivers reported that they could not do more than they were already
doing, and more than 80 per cent reported having difficulty meeting expenses.

I. Neglect, abuse and violence

In some instances, stress related to caregiving can lead to the neglect of older care
recipients and their exposure to different forms of abuse, including violence. In countries that
have established residential/institutional long-term care facilities for older people, elder abuse is
documented as having been perpetrated by staff, visiting family members and friends, and other
residents.

Some research suggests that the occurrence of elder abuse may be higher in residential
than in domestic settings, and that certain forms of abuse may be more common in institutional
care. In the late 1990s, 7 per cent of the complaints to long-term care ombudsmen in the United
States involved abuse, gross neglect and exploitation. 145 In a survey of American nursing home
personnel, 10 per cent of nurses and nursing assistants admitted to at least one incident of
physical abuse and 81 per cent admitted to at least one incident of psychological abuse during the
preceding year. 146 In a German survey of nursing home staff, 79 per cent acknowledged having
abused or neglected a resident at least once during the prior two months, and 66 per cent claimed
to have witnessed comparable actions by other members of staff, with neglect and psychological
abuse representing the most common forms. 147 Similarly high percentages of resident abuse were
found from a survey of licensed facility managers in New Zealand: 92 per cent identified at least

142
Jenny Brodsky, Jack Habib and Miriam Hirschfeld, eds., Long-Term Care in Developing Countries: Ten Case-
Studies, World Health Organization Collection on Long-Term Care (Geneva: WHO Press, 2002). Available for
download from http://www.who.int/chp/knowledge/publications/Case_studies/en/.
143
United Nations, Living Arrangements of Older Persons around the World, figure II.17.
144
Albala and others, “Encuesta Salud, Bienestar y Envejecimiento (SABE): metodología de la encuesta y perfil de
la población estudiada”.
145
George S. Ingalls, Linda T. Layton and Nomiki B. Weitzel, “Elder abuse originating in the institutional setting”,
North Dakota Law Review, vol. 74 (1998), pp. 312-339.
146
Karl A. Pillemer and David W. Moore, “Highlights from a study of abuse of patients in nursing homes”, Journal
of Elder Abuse & Neglect, vol. 2, No. 1/2 (1990), pp. 5-29.
147
Thomas Goergen, “Stress, conflict, elder abuse and neglect in German nursing homes: a pilot study among
professional caregivers”, Journal of Elder Abuse & Neglect, vol. 13, No. 1 (2001), pp. 1-26.

48

one resident who had experienced elder abuse—usually psychological abuse—during the
previous year; however, in 63 per cent of the situations a family member was responsible. 148

WHO estimates that between 4 and 6 per cent of older persons worldwide have suffered
physical, psychological, emotional, financial or other forms of abuse or neglect. 149 Some risk
factors for elder abuse include social isolation, the societal depiction of older persons, and the
erosion of bonds between generations. In many societies, older women are at special risk of
being abandoned and having their property seized when they are widowed. Institutional abuse
occurs most often when there are poorly trained and/or overworked staff and when care
standards are low or inadequately monitored.

Only a few risk factors have been validated by substantial research for domestic elder
abuse. These include shared living arrangements between the victim and perpetrator, with the
frequency of contact serving to inflame tensions, conflict and abuse; social isolation, which can
increase family stress and decrease problem visibility or intervention; dementia on the part of
either the victim or the perpetrator, with its symptoms of aggressive and difficult behaviours that
can foster abuse or retaliation against abuse by the caregiver; and pathology on the part of the
perpetrator, where substance abuse, mental illness, or personality disorders can provoke anger or
frustration and reduce inhibitions for abuse occurrence.

148
Mark Weatherall, “Elder abuse: a survey of managers of residential care facilities in Wellington, New Zealand”,
Journal of Elder Abuse and Neglect, vol. 13, No. 1 (2001), pp. 91-99.
149
World Health Organization, “Abuse of the elderly”, fact sheet (2002). Available from
http://www.who.int/violence_injury_prevention/violence/world_report/factsheets/en/elderabusefacts.pdf (accessed 4
December 2006).

49

IV. Social and civil participation among the ageing, attitudes towards older
persons, and perceptions of old age

A. Societal attitudes towards old age

There are few dedicated studies available on attitudes to old age and older persons, and
those that do exist tend to be based on surveys in developed countries, though there are some
surveys that include relevant information on selected developing countries. Studies and anecdotal
evidence relating to ageism in specific national contexts also shed some light on the way older
persons are perceived in a given country.

One study on ageism in the United States explores how the evolution of society has
affected attitudes towards older persons. In primitive societies old age was often highly valued,
with older persons representing a source of knowledge and experience. As the number and
percentage of older persons grew and their frailty became a liability, they began to be seen as a
burden to the family and society. The decline in elder status became widespread as societies
moved from an agrarian economy, where older men traditionally owned land, to an industrialized
economy, where work was no longer centred in or around the home and older persons lost
authority. In this study the status of older persons and attitudes towards them are defined in
historical and economic terms. At a more fundamental level, however, perceptions of ageing and
older people are a reflection of the concerns and fears everyone has about vulnerability and old
age. 150

Although attitudes are based in part on the social and economic position of older persons
in society, ageist stereotypes abound in all societies and play a key role in dictating how older
persons are perceived and treated—even when societal agreement on the necessity of material
support for the ageing population is strong. Key findings from a study carried out in the United
Kingdom 151 included the following:

• Almost half (48 per cent) of the respondents viewed age discrimination as a serious issue.

• For individuals of all ages, ageism was experienced more frequently than any other form
of prejudice.

• Stereotypes of older persons seemed to be based largely on the perception that they were
“warmer” and more moral but less competent than younger people.

• People over age 70 were perceived as posing a threat to society more in terms of the
burden they placed on the economy than in terms of their impact on others’ access to

150
Robert N. Butler, “Introduction”, in Ageism in America (New York: International Longevity Center-USA, 2006).
Available from http://www.ilcusa.org/media/pdfs/Ageism%20in%20America%20-%20The%20ILC%20Report.pdf.
151
Dominic Abrams, Tiina Eilola and Hannah Swift, Attitudes to Age in Britain, 2004-08, Department for Work and
Pensions, Research Report No. 599 (Norwich, United Kingdom: Her Majesty’s Stationery Office for the Department
of Work and Pensions, 2009). Available from http://research.dwp.gov.uk/asd/asd5/rports2009-2010/rrep599.pdf.

50

services or way of life. Younger people perceived this threat more seriously than did
older respondents.

• The social separation between older and younger people was significant; respondents
viewed people under age 30 and people over age 70 as having little in common.

• While media images of older persons were generally seen as positive, 51 per cent of
respondents agreed that people over the age of 50 were “written off as old”.

In 2004, researchers at the University of Southern California conducted a survey for
AARP that sought to better understand the knowledge, perceptions and attitudes relating to
ageing and older people in the United States. Among those surveyed, 91 per cent believed that
older persons received less than or about their fair share of local Government benefits, and 89
per cent believed that older persons had too little or the right amount of influence in the country.
The survey also revealed that certain misconceptions remained. One third of the respondents felt
that older persons were all alike and considered themselves bored or miserable. More than one in
four believed that the majority of older people were senile. Younger respondents were more
likely than older respondents to perceive the ageing population as having more problems than
other groups. 152

Over the past few years, the HSBC Group has undertaken a series of studies 153 about
retirement and older persons in selected developed and developing countries, allowing some
cross-cultural comparisons. The countries and areas surveyed include Brazil, China, Canada,
France, Hong Kong (Special Administrative Region of China), India, Japan, Mexico, the United
Kingdom and the United States. The findings indicate that countries have different perceptions
about what constitutes old age. In developed countries, in particular, retirement is viewed as a
new beginning, and the onset of old age is defined as the point at which personal abilities begin
to decline. In countries such as India, however, old age is more likely to be linked to family
events such as becoming a grandparent. In those developing countries with limited financial
security coverage for ageing residents, relatively few see old age as a period of life to look
forward to. Clearly, cultural and socio-economic considerations play an important role in
determining how old age is perceived. For instance, even though life expectancy is only seven
years less in China than in France, the Chinese believe that old age typically begins at age 50,
while the French say it is age 71.

The HSBC study reveals some significant generational tendencies in views of old age in
Asia. In China, for instance, members of the younger generation are inclined to believe that their
elders have too little to do and spend too much time living in the past. However, both generations
still see the family as central to the operation of society and expect to rely on their children for
care and support in old age. Some of the same generational similarities and differences are

152
AARP Press Center, “Intergenerational conflict? Think again!”, 22 November 2004. Available from
http://www.aarp.org/about-aarp/press-center/info-2004/aging_1.html.
153
HSBC, The Future of Retirement in a World of Rising Life Expectancies: Attitudes Towards Ageing and
Retirement—A Study across 10 Countries and Territories (2005). Available from
http://www.hsbc.com/1/PA_1_1_S5/content/assets/retirement/hsbc_future_of_retirement.pdf.

51

evident in Japan, with the study findings indicating that the status of Japanese elders has
diminished.

The United Nations Economic Commission for Europe (ECE), which has been dealing
with population ageing and related policy implications for a longer period than other regional
commissions, has carried out extensive research on the status of intergenerational relations, most
notably through its Generations and Gender Survey of 12 ECE member States. Initial
conclusions from the Survey show that there are culturally driven differences of opinion in the
region with regard to how much responsibility the State versus the family should bear to ensure
the well-being of older persons. There are widely disparate views on this issue between countries
such as Norway and Georgia and between countries in Eastern and Southern Europe, for
example (see table 10). Nevertheless, throughout the region, overall levels of family and societal
solidarity remain high and resilient to change. The Survey also reveals that older persons are
generally reluctant to depend on others, including their own children, and that they value
personal contact and emotional support more highly than practical and financial support. 154

Table 10
Elder care seen as primarily or wholly a societal (versus family) responsibility
(Percentage)
_____________________________________________________________________________________

Norway France Bulgaria Georgia
_____________________________________________________________________________________

Care for older persons in need of care
at their home 71 13 17 5

Care for pre-school children 27 11 6 1

Financial support for older people below
subsistence level 90 51 59 46

Financial support for younger people with
children below subsistence level 82 47 65 50
_____________________________________________________________________________________
Source: Daatland, Slagsvold and Lima, “Population ageing, intergenerational solidarity and the family-welfare
state balance: a comparative exploration”, table 51.

According to research conducted under the National Transfer Accounts (NTA) project,
covering a large portion of both the developed and developing world, “in most countries, even
Third World countries, older people on average are making transfers to their younger family
members rather than the reverse”. 155 Typically, older persons rely on their own assets combined

154
Svein Olav Daatland, Britt Slagsvold and Ivar A. Lima, “Population ageing, intergenerational solidarity and the
family-welfare state balance: a comparative exploration”, in How Generations and Gender Shape Demographic
Change: Towards Policies Based on Better Knowledge—Conference Proceedings (United Nations publication,
Sales No. E.09.II.E.8). Available for download from http://www.ggp-i.org/bibliography/conference-2008.html.
155
Ronald Lee, “Population aging, intergenerational transfers, and economic growth: Latin America in a global
context”, paper prepared for the Expert Group Meeting on Population Ageing, Intergenerational Transfers and

52

with varying amounts from public transfers to support themselves in old age and provide for
younger family members. However, this situation may be changing somewhat; the research data,
though limited to 23 countries, are fairly representative of the situation in Latin America, Asia
and Europe and indicate a downward trend in intergenerational transfers from the older to the
younger generation.

An overview of transfers in Latin America indicates that in countries with extensive
social security coverage, such as Uruguay, older persons do not rely on family transfers for their
own support, but instead provide private transfers to other family members for an extended
period of time. Older persons rely more on family transfers in Asia than in Latin America, but
even in Asia public transfers and other sources of income play a large role in financing
consumption for older generations.

B. Education and literacy

Although global levels of education and literacy have risen significantly over the past
century, they tend to be lower for older persons than for younger cohorts, largely because
younger individuals have benefited from the increased attention given to education in recent
decades. There are also considerable differences between developing and developed countries in
terms of educational attainment and literacy levels among older people.

By 2005, at least half of the population aged 55-64 years had obtained a secondary or
higher education in the majority of OECD countries. Secondary education completion rates for
this age group were considerably lower in most developing countries, ranging from 0.6 per cent
for females in Bangladesh to 22 per cent for males in Peru. The corresponding rates for
individuals aged 65 years or over were generally about half those recorded for the age group 55-
64 in developing countries. In most of the countries sampled, fewer than 4 per cent of women
aged 65 years or above had completed secondary school. 156

Literacy levels are also low for much of the older population in developing countries—in
particular older women. For the reference years 2005-2007, the United Nations Educational,
Scientific and Cultural Organization (UNESCO) reported a global literacy rate of 71 per cent
among those aged 65 years or over, based on averages of 97 per cent in the more developed
regions and 54 per cent in the less developed regions. The female literacy rate was also 97 per
cent in the developed world but only 42 per cent in the developing world (see table 11).

As shown in table 11, rates of literacy among the older population vary widely between
world regions. For the reference years mentioned above, literacy rates for individuals aged 65
years or over were 33 per cent (43 per cent for males and 22 per cent for females) in Africa, 56
per cent (71 per cent for males and 47 per cent for females) in Asia, 96 per cent (98 per cent for
males and 95 per cent for females) in Europe, and 73 per cent (77 per cent for males and 71 per
cent for females) in Latin America and the Caribbean. In Northern America the corresponding

Social Protection, Santiago, Chile, 20-21 October 2009, p. 7. Available for download from
http://www.ntaccounts.org/web/nta/show/WP09-06.
156

53

rates were 99 per cent for women and men alike, and in Oceania they were just under 96 per cent
for both sexes. 157

Table 11
Literacy rates among persons aged 65 years or over, by region, 2005-2007
_____________________________________________________________________________________

Total Male Female
_____________________________________________________________________________________

World 71.3 78.0 65.4
Less developed countries 53.8 66.5 41.8
More developed countries 97.2 98.1 96.6

Regions
Africa 32.7 42.5 22.0
Asia 58.5 71.1 46.7
Europe 96.1 97.5 95.2
Northern America 99.0 99.0 99.0
Oceania 95.5 95.4 95.6
_____________________________________________________________________________________
Source: UNESCO Institute for Statistics, “Education indicators and data analysis: literacy statistics metadata
information table, pre-April 2009 data release (reference years 2005-2007)”.

During the period 2005-2007, the countries with the highest levels of literacy among
those aged 65 years or over were Cuba, Estonia, Latvia and Lithuania (100 per cent for both
women and men). Countries with the lowest literacy levels for this age group included Burkina
Faso, with 9 per cent (12 per cent for males and 5 per cent for females), Ethiopia, with 10 per
cent (16 per cent for males and 4 per cent for females), and Guinea-Bissau, with 9 per cent (14
per cent for males and 5 per cent for females). 158

As indicated above, levels of educational attainment and literacy are relatively low for the
older cohorts, especially in developing countries. Literacy rates are likely to improve among the
ageing population during the next few decades, however, as the better educated younger
generation grows older. In 2000, the population aged 25-44 years in China was almost
completely literate. The oldest members of this age group will turn 65 in 2021, which means that
in the decades to come, illiteracy within the older population will decline substantially.

Levels of educational attainment among older people are expected to rise as well,
building on the substantial gains already made. Data indicate that in the United States, the
proportion of individuals aged 55 years or older who completed at least secondary school rose

157
United Nations Educational, Scientific and Cultural Organization, Institute for Statistics, “Education indicators
and data analysis: literacy statistics metadata information table, pre-April 2009 data release (reference years 2005-
2007)” (Toronto: UNESCO Institute for Statistics, Literacy and Adult Education Statistics Programme, 2009).
Available for download from
http://stats.uis.unesco.org/unesco/ReportFolders/ReportFolders.aspx?IF_ActivePath=P,55&IF_Language=eng.
158
Ibid.

54

from around 15 per cent in 1940 to more than 80 per cent in 2007. The overall trend towards
higher educational attainment is apparent throughout the developed world; for all OECD
members (27 countries during the period of comparison), the percentage of those aged 55-64
years who completed the upper secondary cycle was higher in 2005 than in 1998. 159 Similar data
compiled by UNESCO for a subset of developing countries generally show the same trend. 160

For most countries, particularly in the developing world, levels of literacy and
educational attainment are lower in rural than in urban areas, though age and sex are also factors.
In India, for example, literacy rates are lower for rural males and females than for their urban
counterparts. However, among Indian residents over the age of 50, rural men are more likely
than urban women to be literate. Fewer than 15 per cent of India’s rural women over age 60 can
read and write.

C. Organizations of older persons

Organizations of older persons facilitate participation through advocacy and the
promotion of multigenerational interaction. Such groups can help harness the political influence
of older persons and ensure that they are able to contribute meaningfully to decision-making
processes at all levels of Government.

There are a number of highly influential organizations of older persons around the world.
AARP in the United States has a total of 40 million members, and half of Sweden’s older
residents belong to the National Pensioners’ Organization. HelpAge International is a global
network of NGOs whose mission is to improve the lives of disadvantaged older persons by
supporting practical programmes, giving a voice to older persons, and influencing policy at the
local, national and international levels. Another prominent NGO is the International Federation
on Ageing (IFA), a network of organizations charged with improving the quality of life of older
persons around the world through policy change, grass-roots activities, and strengthening public-
private partnerships to support ageing issues. The International Federation of Associations for
Elderly People (FIAPA) consists of 150 associations or federations comprising about 300 million
older persons from 60 countries in both developing and developed regions. The mission of the
European Federation of Older Persons (EURAG) is to improve the quality of life for older
persons at the societal, social and political levels.

Some countries also have political parties of older persons. Among these are the Grays in
Germany, the Party of Pensioners of Ukraine, and the Russian Pensioners’ Party, which recently
merged with another party to become one of the most important political parties in the Russian
Federation.

159
Organization for Economic Cooperation and Development, Education at a Glance 2001: OECD Indicators and
Education at a Glance 2007: OECD Indicators (Paris: OECD Publishing, 2001 and 2007).
160
Organization for Economic Cooperation and Development, Investing in Education: Analysis of the 1999 World
Education Indicators (Paris: OECD Publishing, 2000), available from
http://richardphelps.net/WEIndicatorsReport1.pdf; and United Nations Educational, Scientific and Cultural
Organization, Education Counts: Benchmarking Progress in 19 WEI Countries—World Education Indicators, 2006
(Montreal: UNESCO Institute for Statistics, 2006), available from
http://unesdoc.unesco.org/images/0014/001470/147071e.pdf.

55

D. Political influence

In 2005, those who were age 60 or over and eligible to vote constituted 17 per cent of the
global voting population, accounting for slightly more than 15 per cent of eligible voters in the
least developed countries, a little under 20 per cent in the less developed regions, and around 25
per cent in the more developed regions (see figure XVI). By 2050, roughly one third of the
voting population worldwide will be at least 60 years of age, accounting for slightly more than
15 per cent of eligible voters in the least developed countries, around 27 per cent in the less
developed regions, and slightly over 40 per cent in the more developed regions.

Figure XVI
Percentage of the voting population aged 60 years or over, 2005 and 2050

45
40
35
Percentage

30
25
20
15
10
5
0
World Least developed Less developed More developed
countries regions regions

2005 2050

Source: HelpAge International, “Global ageing statistics”, available from
http://www.helpage.org/resources/ageing-data/ (from United Nations, World Population Prospects: The 2004
Revision—Population Database, available from http://esa.un.org/unpp/index.asp?panel=2 [accessed 23 November
2006]).

The high rate of voter turnout among older persons is an indicator of their abiding interest
in public affairs and their desire to influence the political process. Many countries have large
constituencies of older persons who regularly exercise their democratic right to vote, which helps
to ensure that their voices are heard and their concerns are addressed. Policies supporting older
persons have garnered increased attention in some parts of the world; such policies have been
adopted in part because of changing demographics, but perhaps even more importantly because
older people in certain countries are, on the whole, more politically and socially active than are
members of other age groups.

In those few countries for which relevant data are available, the political participation of
older persons has greatly influenced decision-making processes relating to pension schemes and
the provision of social security. When countries that provide social protection for older persons
are compared with those that do not, clear distinctions emerge. Not surprisingly, the highest-

56

income countries—which also happen to be those with the highest proportion of residents over
the age of 60—are far more likely than lower-income countries to provide their citizens with
social protection coverage. In the 27 EU countries as a group, 21 per cent of the population is
older than 60 years of age, and in 2001 expenditures on social protection averaged 27.3 per cent
of gross domestic product (GDP). The countries of the EU not only have the financial capacity to
provide sufficient social protection coverage, but with one in five persons over the age of 60,
they also have large constituencies of older persons that regularly exercise their democratic
rights to ensure that their concerns are acknowledged and their needs are met.

By contrast, most countries in sub-Saharan Africa are struggling to build both the
financial resources and the political will to implement social protection policies. A recent
analysis by the United Nations Development Programme (UNDP) indicates that the cost of
providing a universal non-contributory social pension for all older persons in the region would be
2-3 per cent of GDP, an amount rivalling public spending on education and health care in some
countries. 161 Given that only 5 per cent of the population in the region is aged 60 years or above,
while 41 per cent are under the age of 15, the relatively low priority given to policies for older
persons is not entirely unexpected. Their proportional minority status is compounded by the fact
that these older persons are unlikely to be empowered to draw attention to their concerns.

Some countries in Eastern Europe and Western Asia are facing the dual challenge of a
rapidly ageing population and limited financial resources to meet their needs through social
security coverage. In several countries of the former Soviet Union the ageing population
exercises significant political influence; voter participation rates tend to be very high among
older persons, who feel an obligation to go to the polls on election day. In Kazakhstan, for
instance, older persons constitute an active electorate, with 72 per cent of those over age 65
having voted in recent elections, compared with just over 50 per cent of those in the age group
35-40. 162

161
Kakwani and Subbarao, Ageing and Poverty in Africa and the Role of Social Pensions.
162
Aikan Aikanov and others, The Great Generation of Kazakhstan: Insight into the Future, National Human
Development Report (Almaty: United Nations Population Fund and United Nations Development Program in
Kazakhstan, 2005). Available for download from
http://hdr.undp.org/en/reports/national/europethecis/kazakhstan/name,3351,en.html.

57

V. Human rights of older persons

A. International human rights principles and standards

The present section offers an overview of international human rights norms as they
pertain to older persons. It includes a number of illustrative examples of how international
human rights mechanisms have applied relevant norms to critical human rights issues affecting
the older population.

Human rights are by definition universal, and the core international instruments developed
to protect human rights therefore apply to all members of society—including the ageing
population. However, older persons do not constitute a homogeneous group, so the challenges
they face in exercising their human rights are highly variable and often complex. In any analysis
of older persons’ human rights, multiple forms of discrimination figure prominently; in
particular, age-related discrimination may be linked to discrimination based on sex, ethnicity,
disability, health status, or socio-economic status.

The International Covenant on Economic, Social and Cultural Rights and the
International Covenant on Civil and Political Rights include highly relevant provisions for
protecting the human rights of older persons, acknowledging the right of all individuals to good
health, an adequate standard of living, freedom from torture, legal capacity, and equality before
the law. The Convention on the Elimination of All Forms of Discrimination against Women, the
International Convention on the Elimination of All Forms of Racial Discrimination, and the
Convention on the Rights of Persons with Disabilities also contain provisions that can be
operationalized to promote and protect the human rights of older persons.

The norms in existing international human rights treaties apply to older persons in the
same way they apply to others; nonetheless, it has been suggested that there is a conspicuous gap
in the international human rights system. More precisely, there are no universal human rights
instruments or comprehensive provisions that focus specifically on older persons, 163 as there are
for other vulnerable groups such as women or persons with disabilities. However, two
international human rights instruments do contain explicit references to age. Article 7 of the
United Nations International Convention on the Protection of the Rights of All Migrant Workers
and Members of Their Families includes “age” in the list of prohibited grounds for
discrimination. The Convention on the Rights of Persons with Disabilities includes references to
age in subparagraph (p) of the preamble and in articles 8, 13 and 16, as well as specific
references to older persons in article 25 (b) on the right to health and in article 28 (2) (b) on the
right to an adequate standard of living and social protection. 164

163
Conversely, older persons are specifically mentioned in many regional human rights instruments, including the
African Charter on Human and Peoples’ Rights (article 18, para. 4), available from
http://www.achpr.org/english/_info/charter_en.html; the Additional Protocol to the American Convention on Human
Rights in the Area of Economic, Social and Cultural Rights (the Protocol of San Salvador) (article 17), available
from http://www.cidh.oas.org/Basicos/English/basic5.Prot.Sn%20Salv.htm; and the Revised European Social
Charter (article 23), available from http://conventions.coe.int/treaty/en/treaties/html/163.htm.
164
See United Nations, Treaty Series, vol. 2220, p. 3, available from
http://treaties.un.org/doc/Treaties/1990/12/19901218%2008-12%20AM/Ch_IV_13p.pdf; and United Nations

58

Not all older persons are disabled, and ageing in itself does not constitute a disability;
however, the Convention on the Rights of Persons with Disabilities offers a number of
significant opportunities for the promotion and protection of the human rights of older persons.
Provisions focusing on such concepts as accessibility and universal design, for instance, are
likely to benefit all older persons, whether they are disabled or not. Although growing older
should not be equated with disability, it is not uncommon for physical, mental, intellectual or
sensory impairments to develop during the ageing process, sometimes resulting in disability as
older persons find it increasingly difficult to negotiate external barriers. Along with the articles
that expressly refer to age and older persons, the Convention contains numerous provisions that
address challenges and establish protection safeguards relevant to situations of risk often faced
by the older population. Notable examples include article 12, which affirms the right to equal
recognition before the law, and article 19, which relates to independent living and community
inclusion. The potential offered by this Convention to address human rights issues affecting older
persons should be fully explored.

In the absence of a specific instrument on the rights of older persons, the formal bodies of
independent experts responsible for monitoring the implementation of international human rights
instruments by States parties have ensured that existing norms are explicitly applied to older
persons. In 1995, the Committee on Economic, Social and Cultural Rights adopted General
Comment No. 6, 165 which offers a detailed interpretation of the obligations of States parties to
the International Covenant on Economic, Social and Cultural Rights as they apply to older
persons. Similarly, in late 2010, the Committee on the Elimination of Discrimination against
Women adopted General Recommendation No. 27, which deals with older women and the
protection of their human rights under the Convention on the Elimination of Discrimination
against Women.

Human rights treaty bodies have also referred to non-binding United Nations documents
and other international documents on ageing to clarify existing provisions, and to assist them in
the interpretation of the content of a given right. For example, the Committee on Economic,
Social and Cultural Rights, in its General Comment No. 6, has made extensive reference to the
1982 Vienna International Plan of Action on Ageing, the 1991 United Nations Principles for
Older Persons, the 1992 global targets on ageing for the year 2001, and the 1992 Proclamation
on Ageing. 166

General Assembly resolution 61/106 of 13 December 2006, 24 January 2007 (A/RES/61/106), annex I, available
from http://treaties.un.org/doc/Publication/CTC/Ch_IV_15.pdf.
165
United Nations, Committee on Economic, Social and Cultural Rights, General Comment No. 6, “The economic,
social and cultural rights of older persons”, in Official Records of the Economic and Social Council, 1996,
Supplement No. 2 (E/1996/22), annex IV, available for download from
http://www2.ohchr.org/english/bodies/cescr/comments.htm; and United Nations, Committee on the Elimination of
Discrimination against Women, General Recommendation No. 27, “Older women and the protection of their human
rights” (CEDAW/C/GC/27), available for download from
http://www2.ohchr.org/english/bodies/cedaw/comments.htm.
166
See Committee on Economic, Social and Cultural Rights, General Comment No. 6, paras. 4-7, 19, 21, 31-34 and
37-42.

59

B. Non-discrimination

The prohibition of discrimination is one of the pillars of international human rights law.
Discrimination has been defined as “any distinction, exclusion or restriction ... which has the
effect or purpose of impairing or nullifying the recognition, enjoyment or exercise, on an equal
basis with others, of all human rights and fundamental freedoms in the political, economic,
social, cultural, civil or any other field”. 167

The principle of non-discrimination applies to every individual in the consideration of
their civil, economic, political, social and cultural rights. It is linked to and complemented by the
principle of equality and must be carefully crafted into legislation, policies, programmes,
procedures and practices. States are required to refrain from discrimination (negative obligations)
and to take action to combat formal and substantive discrimination and exclusion (positive
obligations). 168 Any distinction, exclusion or restriction may constitute a violation if it has the
effect or the intent of impairing or nullifying the exercise of any right by a particular individual.

Specific reference is made to age as a prohibited ground of discrimination in article 7 of
the International Convention on the Protection of the Rights of All Migrant Workers and
Members of Their Families and in various articles of the Convention on the Rights of Persons
with Disabilities; the latter articles mention age, inter alia, as a potential source of multiple or
aggravated discrimination when combined with disability. 169 Other international human rights
instruments typically incorporate lists of prohibited grounds of discrimination that include race,
colour, sex, language, religion, political or other opinion, national or social origin, property, birth
or other status. 170 Although “age” is not explicitly listed as a prohibited ground in these
instruments, the lists are illustrative and non-exhaustive and usually include an open-ended
category (“other status”), which has provided the monitoring and implementation committees
with the opportunity to consider age-related discrimination.

167
See, for example, article 2 of the Convention on the Rights of Persons with Disabilities; also see article 1 of the
Convention on the Elimination of All Forms of Discrimination against Women (United Nations, Treaty Series, vol.
1249, p. 13, available from http://treaties.un.org/doc/Treaties/1981/09/19810903%2005-18%20AM/Ch_IV_8p.pdf).
168
See United Nations, Human Rights Committee, General Comment No. 18, “Non-discrimination”
(HRI/GEN/1/Rev.6 at 146) (2003), paras. 7-10, available for download from
http://www2.ohchr.org/english/bodies/hrc/comments.htm; and Committee on Economic, Social and Cultural Rights,
General Comment No. 20, “Non-discrimination in economic, social and cultural rights” (E/C.12/GC/20), paras. 7-9,
available for download from http://www2.ohchr.org/english/bodies/cescr/comments.htm.
169
See the preamble, item (p), and article 8 (1) (b) of the Convention on the Rights of Persons with Disabilities. The
Convention also requires States parties to provide “age-appropriate accommodations” in facilitating access to justice
(article 13 (1)), “age-sensitive assistance” to prevent “exploitation, violence and abuse” (article 16 (2)), and
“services designed to minimize and prevent further disabilities, including among … older persons” in the context of
the right to health (article 25); article 28 (2) (b) requires States parties to “ensure access by persons with disabilities,
in particular women and girls with disabilities and older persons with disabilities, to social protection programmes
and poverty reduction programmes”.
170
See, for example, article 2 (1) of the International Covenant on Civil and Political Rights (United Nations, Treaty
Series, vol. 999, p. 171, and vol. 1057, p. 407, available from
http://treaties.un.org/doc/Treaties/1976/03/19760323%2006-17%20AM/Ch_IV_4p.pdf); and article 2 (2) of the
International Covenant on Economic, Social and Cultural Rights (United Nations, Treaty Series, vol. 993, p. 3,
available from http://treaties.un.org/doc/Treaties/1976/01/19760103%2009-57%20PM/Ch_IV_3p.pdf).

60

The Committee on Economic, Social and Cultural Rights has consistently applied this
interpretation, 171 holding that age is a prohibited ground of discrimination in several contexts.172
In this regard, it has called attention to “discrimination against unemployed older persons in
finding work or accessing professional training” and “unequal access to universal old-age
pensions due to … place of residence”. 173

Article 26 of the International Covenant on Civil and Political Rights provides for the
protection of equality before the law, including the guarantee of “equal and effective protection
against discrimination on any ground”. The Human Rights Committee has asserted that “a
distinction related to age which is not based on reasonable and objective criteria may amount to
discrimination on the ground of ‘other status’ under the clause in question, or to a denial of the
equal protection of the law”. 174 This assertion has been affirmed in a number of individual cases
brought before the Committee for consideration. 175

Multiple discrimination often constitutes a special challenge in terms of both
identification and remediation. In the preamble to its resolution 7/24, the Human Rights Council
expressed its deep concern “that all forms of discrimination, including ... multiple or aggravated
forms of discrimination and disadvantage, can lead to the particular targeting or vulnerability to
violence of girls and some groups of women, such as … women with disabilities, elderly women,
[and] widows”. 176 Violence against women has been “understood to encompass, but not be
limited to ... physical, sexual, and psychological violence occurring in the family, ... within the
general community, ... [or] perpetrated or condoned by the State, wherever it occurs”. 177 Some
elements of this definition could be used to generate a better understanding of abuse and violence

171
See Committee on Economic, Social and Cultural Rights, General Comment No. 6, paras. 11-12; and General
Comment No. 20, para. 29.
172
See Committee on Economic, Social and Cultural Rights, General Comment No. 20, para. 29.
173
Ibid.; also see General Comment No. 6, para. 22.
174
United Nations, Human Rights Committee, Love et al. v. Australia, Communication No. 983/2001, Views of 25
March 2003 (CCPR/C/77/D/983/2001), para. 8.2. Available from http://www.humanrights.is/the-human-rights-
project/humanrightscasesandmaterials/cases/internationalcases/humanrightscommittee/.
175
Including Schmitz-de-Jong v. The Netherlands, Communication No. 855/1999, Views of 16 July 2001
(CCPR/C/72/D/855/1999), relating to the minimum age limit for a senior citizen’s partner’s pensioners’ pass; Love
et al. v. Australia, Communication No. 983/2001, Views of 25 March 2003 (CCPR/C/77/D/983/2001), relating to the
compulsory age-based retirement policy for pilots; Solís v. Peru, Communication No. 1016/2001, Views of 27 March
2006 (CCPR/C/86/D/1016/2001), relating to age as a criterion for dismissal from public service for reasons linked to
the reorganization of public bodies; and Althammer et al. v. Austria, Communication No. 998/2001, Views of 8
August 2003 (CCPR/C/78/D/998/2001), relating to the abolition of monthly household payments. All case
documents available for download from http://www.humanrights.is/the-human-rights-
176
United Nations, Human Rights Council, resolution 7/24 of 28 March 2008 on the elimination of violence against
women, adopted by the Council at its seventh session (A/HRC/RES/7/24), available from
http://ap.ohchr.org/Documents/E/HRC/resolutions/A_HRC_RES_7_24.pdf. Multiple discrimination is also a critical
dimension in the consideration of reports by the Committee on the Elimination of All Forms of Discrimination
against Women and the Committee on Economic, Social and Cultural Rights; see, for example, the latter
Committee’s General Comment No. 20, para. 17.
177
United Nations, General Assembly, Declaration on the Elimination of Violence against Women, resolution
48/104 of 20 December 1993, adopted by the Assembly at its forty-eighth session (A/RES/48/104), article 2.
Available from http://www.un.org/documents/ga/res/48/a48r104.htm. and http://daccess-dds-
ny.un.org/doc/RESOLUTION/GEN/NR0/711/88/IMG/NR071188.pdf?OpenElement.

61

directed against older men and women, its human rights connotations, and its direct link with
discrimination.

C. Vulnerabilities and special protection measures

Human rights mechanisms have identified older men and women as being a group at
particular risk of human rights violations and requiring specific measures of protection. The
heightened risk to which older persons are exposed is explicitly recognized, for example, in
article 16 (2) of the Convention on the Rights of Persons with Disabilities, which requires “age-
sensitive assistance and support for persons with disabilities and their families ... [to prevent]
exploitation, violence and abuse”.

The aforementioned definition of violence against women—physical, sexual,
psychological or other forms aggression that occur within the family or the general community,
or that are carried out or condoned by the State—applies to all. From a human rights perspective,
States are required to take appropriate legislative, administrative, social, educational and other
measures to combat violence and to protect all individuals in their private and public spheres,
including from the abusive behaviour of their families, relatives and caregivers. 178 WHO
estimates that 4-6 per cent of older persons at home and in community settings have suffered
some form of abuse—including physical, psychological, emotional, sexual or financial abuse or
neglect—and the corresponding figure for elder abuse in institutional settings is believed to be
significantly higher. Some risk factors for elder abuse include social isolation, the societal
depiction of older people, and the erosion of bonds between generations. 179

The Committee on Economic, Social and Cultural Rights has maintained that “side by
side with older persons who are in good health and whose financial situation is acceptable, there
are many who do not have adequate means of support, even in developed countries, and who
feature prominently among the most vulnerable, marginal and unprotected groups”. 180 The
Committee has consistently included older persons in its list of groups that could potentially
suffer disadvantages, vulnerability or marginalization. 181 Similarly, the Committee on the
Elimination of Discrimination against Women has identified older women as a potentially
vulnerable and disadvantaged group in two of its general recommendations. 182

178
Ibid., articles 2 and 4.
179
World Health Organization, “Abuse of the elderly”.
180
181
See Committee on Economic, Social and Cultural Rights, General Comment No. 4, “The right to adequate
housing”, in Official Records of the Economic and Social Council, 1992, Supplement No. 3 (E/1992/23), annex III,
paras. 6 and 8 (e); General Comment No. 7, “The right to adequate housing (article 11 (1) of the Convention): forced
evictions”, in Official Records of the Economic and Social Council, 1998, Supplement No. 2 (E/1998/22), annex IV,
para. 10; General Comment No. 12, “The right to adequate food” (E/C.12/1999/5), para. 13; General Comment No.
14, “The right to the highest attainable standard of health” (E/C.12/2000/4), para. 12 (b) (ii); and General Comment
No. 15, “The right to water” (E/C.12/2002/11), para. 16 (h). The full text of each General Comment may be
downloaded from http://www2.ohchr.org/english/bodies/cescr/comments.htm.
182
See Committee on the Elimination of All Forms of Discrimination against Women, General Recommendation
No. 24 on article 12 of the Convention, “Women and health” (A/54/38 at 5) (1999), para. 6; and General
Recommendation No. 27, “Older women and the protection of their human rights”. The full text of each General
Recommendation may be downloaded from http://www2.ohchr.org/english/bodies/cedaw/comments.htm.

62

Several human rights mechanisms have addressed the situation of older persons in old-
age institutions and detention facilities. The Committee against Torture has recommended that
States parties should “prohibit, prevent and redress torture and ill-treatment in all contexts of
custody or control, for example, in ... institutions that engage in the care of ... the aged”. 183 The
Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment
has underscored that the elderly are among the highly vulnerable (“the bottom of the hierarchy”)
in general detention facilities and in psychiatric institutions, noting that they suffer double or
triple discrimination. 184 The Human Rights Committee has underlined “the vulnerable situation
of elderly persons placed in long-term care homes, which in some instances has resulted in
degrading treatment and violated their right to human dignity”. 185

D. Special measures for specific groups

Some human rights mechanisms have acknowledged the relative vulnerability of younger
and older persons by incorporating provisions for specific age groups. For example, article 25 (b)
of the Convention on the Rights of Persons with Disabilities requires that health services be
“designed to minimize and prevent further disabilities, including among children and older
persons”. The Committee on Economic, Social and Cultural Rights has recommended that health
policies take into account the needs of the elderly, “ranging from prevention and rehabilitation to
the care of the terminally ill”, 186 and has reaffirmed the importance of “periodical check-ups for
both sexes; physical as well as psychological rehabilitative measures aimed at maintaining the
functionality and autonomy of older persons; and attention and care for chronically and
terminally ill persons, sparing them avoidable pain and enabling them to die with dignity”. 187

Similarly, the Committee on Economic, Social and Cultural Rights has held that “older
persons should have access to suitable education programmes and training and should, therefore,
on the basis of their preparation, abilities and motivation, be given access to the various levels of
education through the adoption of appropriate measures regarding literacy training, life-long
education, access to university, etc.” 188

The Committee on Economic, Social and Cultural Rights has also consistently identified
accessibility—including physical and economic accessibility, access to education and
information, and non-discrimination—as a key component of the normative content of the rights
contained in the International Covenant on Economic, Social and Cultural Rights. Essentially,

183
See United Nations, Committee against Torture, General Comment No. 2, “Implementation of article 2 by States
parties” (CAT/C/GC/2), para. 15. Available for download from
http://www2.ohchr.org/english/bodies/cat/comments.htm.
184
United Nations, Human Rights Council, “Report of the Special Rapporteur on torture and other cruel, inhuman or
degrading treatment or punishment, Manfred Nowak: study on the phenomena of torture, cruel, inhuman or
degrading treatment or punishment in the world, including an assessment of conditions of detention”
(A/HRC/13/39/Add.5), paras. 231, 237 and 257. Available from
http://www2.ohchr.org/english/bodies/hrcouncil/docs/13session/A.HRC.13.39.Add.5_en.pdf.
185
See United Nations, Economic and Social Council, “Concluding observations of the Human Rights Committee:
Germany” (CCPR/CO/80/DEU), para. 17. Available from
http://www.unhchr.ch/tbs/doc.nsf/(Symbol)/CCPR.CO.80.DEU.En?Opendocument.
186
See Committee on Economic, Social and Cultural Rights, General Comment No. 6, para. 34; also see para. 35.
187
188

63

accessibility should be ensured to allow older persons the full exercise and enjoyment of their
rights, including a reasonable standard of living (adequate food, water and housing), health and
education. 189

E. The right to social security and the issue of social protection

Age plays a prominent role in the right to social security; “survival beyond a prescribed
age” is generally acknowledged as one of the minimum standards for social security eligibility in
international law. 190 The Committee on Economic, Social and Cultural Rights has recognized
that old age is one of the contingencies to be covered by social security, 191 and has held that
article 9 of the International Covenant on Economic, Social and Cultural Rights “implicitly
recognizes the right to old-age benefits”. 192 The Committee has also clarified that social security
encompasses both contributory insurance-type schemes and non-contributory tax-funded
schemes (sometimes referred to as “social assistance”), and has emphasized the importance of
the following:

• Taking appropriate measures to establish general regimes for compulsory old-age
insurance, starting at a particular age, to be prescribed by national law;

• Establishing a retirement age range that is flexible, taking into account national
circumstances (including demographic, economic and social factors), the type of work
performed (with special consideration given to hazardous occupations, for example), and
the ability of older persons to remain in the workforce;

• Ensuring that survivors and orphans receive benefits upon the death of a breadwinner
who was covered by social security or receiving a pension;

• Providing non-contributory old-age benefits, within available resources, and other
assistance for all older persons, who, when reaching the age prescribed in national
legislation, have not completed a qualifying period of contribution and are not entitled to
old-age pension or other social security benefits or assistance and have no other source of
income. 193

189
See Committee on Economic, Social and Cultural Rights, General Comment No. 4, para. 8 (e); General Comment
No. 12, para. 13; General Comment No. 14, para. 12 (b); General Comment No. 15, para. 12 (c); and General
Comment No. 21, “Right of everyone to take part in cultural life” (E/C.12/GC/21), para. 16 (b), available for
download from http://www2.ohchr.org/english/bodies/cescr/comments.htm.
190
See International Labour Organization, Social Security (Minimum Standards) Convention (Convention No.
C102, adopted in Geneva on 28 June 1952), part V, article 26 (1). Available from http://www.ilo.org/ilolex/cgi-
lex/convde.pl?C102.
191
See Committee on Economic, Social and Cultural Rights, General Comment No. 6, paras. 26-30; and General
Comment No. 19, “The right to social security” (E/C.12/GC/19), para. 15, available for download from
http://www2.ohchr.org/english/bodies/cescr/comments.htm.
192
193
Quoted or paraphrased from Committee on Economic, Social and Cultural Rights, General Comment No. 6,
paras. 27-30; and General Comment No. 19, paras. 4 and 15.

64

In its concluding observations on the implementation of the International Covenant on
Economic, Social and Cultural Rights by various States parties in both developed and developing
regions, the Committee on Economic, Social and Cultural Rights has expressed concerns relating
to the low coverage of old-age pensions and the broader context of social protection systems for
older persons. Over the past several years, the Committee has recommended the extension of
“the network of integrated health and social care services, including home help, for older persons
with physical and mental disabilities”; the adoption of “a welfare programme enabling older
persons to live a decent life”; and the application of special measures in Poverty Reduction
Strategies “to alleviate the extent of poverty among older persons ... [with] priority ... given to
home care rather than institutionalization of older persons in need of care”. 194

The Committee has also raised concerns about the potential for discrimination against
specific groups in the distribution of old-age pension benefits. 195 In its concluding observations
on Austria’s implementation of the International Covenant, the Committee requests
“comparative statistical data on the levels of old-age pensions, disaggregated by sex, number of
children, income groups and other relevant criteria, so as to enable an assessment of the impact
of the Law [on the Harmonization of Pensions of 2005] on the pension benefits of women and of
members of disadvantaged and marginalized groups who are frequently exposed to interruptions
of their professional careers”. 196

The Independent Expert on the question of human rights and extreme poverty has
contended that non-contributory or social pensions for older persons constitute an important
dimension of social security systems. Her report highlights the low coverage of contributory
pension schemes and asserts that “non-contributory pensions can significantly reduce poverty
and vulnerability among old people, in particular for women, who live longer and are less likely
to benefit from contributory systems”. 197

F. The right to health and the right to adequate housing

Various reports issued by the former Special Rapporteur on the right of everyone to the
enjoyment of the highest attainable standard of physical and mental health underscore the need
for measures to ensure the health and well-being of older persons and other vulnerable groups,
with particular attention given to the provision of targeted training for health professionals, the

194
United Nations, Economic and Social Council, “Concluding observations of the Committee on Economic, Social
and Cultural Rights: Slovenia” (E/C.12/SVN/CO/1), para. 35, available from
http://www.universalhumanrightsindex.org/documents/827/857/document/en/pdf/text.pdf; “Concluding observations
of the Committee on Economic, Social and Cultural Rights: Nicaragua” (E/C.12/NIC/CO/4), para. 22, available
from http://www.universalhumanrightsindex.org/documents/827/1533/document/en/pdf/text.pdf; and “Concluding
observations of the Committee on Economic, Social and Cultural Rights: Serbia and Montenegro”
(E/C.12/1/Add.108), para. 8, available from
http://www.universalhumanrightsindex.org/documents/827/739/document/en/pdf/text.pdf.
195
United Nations, Economic and Social Council, “Concluding observations of the Committee on Economic, Social
and Cultural Rights: Austria” (E/C.12/AUT/CO/3), para. 25. Available from
196
Ibid.
197
See United Nations, Human Rights Council, “Report of the Independent Expert on the question of human rights
and extreme poverty, Magdalena Sepúlveda Carmona” (A/HRC/14/31), summary. Available from

65

integration of a human-rights-based approach in the design and implementation of national
health systems, and the role of pharmaceutical companies in addressing the needs of those at
risk.

The former Special Rapporteur notes in his 2006 report that a national health system
“must be responsive to both national and local priorities. Properly trained community health
workers such as village health teams know their communities’ health priorities. Also, inclusive
participation can help to ensure that the health system is responsive to the particular health needs
of women, children, adolescents, the elderly and other disadvantaged groups. Inclusive, informed
and active community participation is a vital element of the right to health”. 198

An interim report submitted to the General Assembly by the former Special Rapporteur
in 2008 includes a set of Human Rights Guidelines for Pharmaceutical Companies in Relation to
Access to Medicines. It is recommended in Guideline 5 that “whenever formulating and
implementing … strategies, policies, programmes, projects and activities that bear upon access to
medicines, … [pharmaceutical companies] should give particular attention to the needs of
disadvantaged individuals, communities and populations, such as children, the elderly and those
living in poverty”. 199

The former Special Rapporteur on adequate housing as a component of the right to an
adequate standard of living, recognizing the special challenges faced by vulnerable populations
in securing sufficient shelter, incorporated a set of basic principles and guidelines on
development-based evictions and displacement in his 2007 report to the General Assembly,
recommending that “priority in housing and land allocation should be ensured to disadvantaged
groups such as the elderly, children and persons with disabilities”. The same section of the report
emphasizes that “impact assessments must take into account the differential impacts of forced
evictions on women, children, the elderly, and marginalized sectors of society. All such
assessments should be based on the collection of disaggregated data, such that all differential
impacts can be appropriately identified and addressed”. 200

G. Final remarks

In recent years, concerns relating to older persons have been increasingly addressed from
a human rights perspective by civil society, with growing public support. NGOs and other
stakeholders have pushed for the adoption of a new, comprehensive international instrument to

198
United Nations, Economic and Social Council, “Economic, social and cultural rights: report of the Special
Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental
health, Paul Hunt” (E/CN.4/2006/48), para. 7. Available from http://daccess-dds-
ny.un.org/doc/UNDOC/GEN/G06/114/69/PDF/G0611469.pdf?OpenElement.
199
United Nations, General Assembly, “The right to health: note by the Secretary-General. Interim report of the
Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and
mental health, Paul Hunt, submitted in accordance with Human Rights Council resolution 6/29” (A/63/263), annex,
para. 5. Available from http://daccess-dds-
ny.un.org/doc/UNDOC/GEN/N08/456/47/PDF/N0845647.pdf?OpenElement.
200
United Nations, Human Rights Council, “Report of the Special Rapporteur on adequate housing as a component
of the right to an adequate standard of living, Miloon Kothari” (A/HRC/4/18), annex I, paras. 31 and 33. Available
from http://daccess-dds-ny.un.org/doc/UNDOC/GEN/G07/106/28/PDF/G0710628.pdf?OpenElement.

66

protect the rights of the ageing population. Advocates point to the current lack of a specific
instrument, the fragmentation of relevant issues across existing human rights treaties, the
inconsistency in focus among the different mechanisms, and the rising demand for States to
implement comprehensive measures to address the demographic shift. They contend that a
specialized committee could provide a focal point and centre of authority for advocacy, offering
guidance to policymakers, legislators and courts about the rights of older persons and working to
increase the visibility of issues affecting older persons in national law-making and policy design.

Others have advocated for the creation of a special procedure mandate under the Human
Rights Council with a focus on the rights of older persons, which would signal the support of the
international human rights machinery for raising the visibility of the older population and their
key concerns. It has been pointed out that a special rapporteur could play a critical role in
bringing to light the many human rights issues faced by older men and women around the world,
drawing from multiple instruments to develop the scope and content of his or her mandate,
analysis and recommendations. The rapporteur could potentially provide guidance and support to
States in the design, implementation and monitoring of legislation, policies and programmes
developed to address the issues of older persons.

67

VI. Summary and concluding remarks

The ageing population is growing at an unprecedented rate. There are presently 740
million individuals in the world aged 60 years or over, and that number is expected to rise to 1
billion by the end of the present decade and possibly to 2 billion by mid-century. Most older
people live in developing countries, where the bulk of the increase will occur.

An analysis of the current social and economic status and participation of older persons
points to a high degree of heterogeneity and the occurrence of rapid and complex changes. A
sizeable majority of older persons are female, especially among those aged 80 years or above.
Older men are more likely than older women to be married, in part because women tend to live
longer and are often widowed. A growing number of older persons live in urban areas, though
many are still rural residents. As is true for other populations, the health status, living conditions
and socio-economic circumstances of older persons vary considerably.

Older persons in developing countries tend to live in multigenerational households,
though this practice has begun to decline with the changes in family structure driven by
migration and other factors. In developed countries, older residents are more likely to live alone
or with a spouse than with their children. The quality of housing for older persons is often better
than that for the general population in developed countries, while the opposite is true in
developing countries.

Older persons, in particular women and the oldest-old, tend to be poorer than the
members of other age groups. Ageist stereotypes and high levels of unemployment continue to
undermine older persons’ access to the labour market. In countries where social security and
pensions cover the vast majority of the labour force, older persons tend to retire from the
workforce at around age 60 or 65, with women typically retiring earlier than men. However, in
the more developed countries, older persons who want to continue working are often subject to
age discrimination and mandatory retirement rules. In less developed regions of the world, where
social security and pension coverage is relatively limited, many older persons—especially older
men—continue to work out of economic necessity. Many countries faced with rapid
demographic ageing are taking steps to revise existing retirement provisions as part of their effort
to achieve greater pension system sustainability.

Life expectancy, especially at older ages, has improved significantly in most countries
over the past several decades. The extent to which the increased survivorship of older persons
has been accompanied by good health remains unclear, however. Presently, the health conditions
of greatest concern for older persons include vision and hearing loss, cardiovascular diseases,
dementia, and obesity. In most countries, members of the older population do not have sufficient
access to health services, and training in geriatric medicine is lagging behind the demand for this
type of care. Worldwide, there is a growing need for long-term care services, which have
traditionally been provided by family members but are increasingly being carried out by paid
caregivers. Significant levels of elder abuse and neglect have been reported in both developed
and developing countries, cutting across all economic and social strata.

68

Older persons still face a number of major challenges, but the outlook for the ageing
population is positive in many respects. Ageist stereotypes persist, and low levels of literacy and
educational attainment have hindered the full participation of older persons in society. However,
the older generation is gradually coming into its own. Within the next few decades, as the better
educated younger population ages, education and literacy rates will increase significantly. Even
now, as the number of older persons increases, there is a growing awareness of the importance of
active ageing. Older individuals are gradually being recognized for their considerable
contributions to intergenerational caregiving and for their ongoing involvement in community
life. They are becoming a powerful and ever-expanding political force, especially in developed
countries, and organizations of older persons are helping to ensure that the ageing population has a
greater voice in decision-making processes.

69

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ST/ESA/339
United Nations, December 2011

Current Status of the Social Situation, Well-Being, Participation in Development and Rights of Older Persons Worldwide

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