In the ageing population – falling fertility and

In mid-2014,
the average age of the UK population exceeded 40 for the first time, up from
33.9 years in 19742. The gradual increases in life expectancy and average age
seen during the 20th century are projected to continue. Over 70% of UK
population growth between 2014 and 2039 will be in the over 60 age group, an
increase from 14.9 to 21.9 million people ONS (2014). The two drivers of the
ageing population – falling fertility and mortality rates – are both long-term
trends. The UK has experienced almost 40 years of fertility rates below the
replacement level of 2.1 children per woman 4. In 2014, the total fertility
rate (TFR) in England and Wales was 1.83 children per woman, compared to a peak
of 2.93 in 1964. The long-term decline in mortality rates has been particularly
strong among the oldest age groups. For example, the mortality rate of women in
their early 80s declined from about 120 per thousand population in the 1950s to
75 by the 1990s, and fell from around 160 to 1205 per thousand men in the same
period ONS (2015). Additionally, it is estimated that one in
three children born today will live to 100 years (Department for Work and
Pensions, 2014).

Population ageing and
increasing life expectancy have a number of implications. One of the most
important is that there may be a lower proportion of individuals to pay taxes,
work and provide care for those who need it. For this reason, growing old in a
society which is itself growing old is fundamentally different to growing old
in a population where most people are young Harper, S. (2016). In 2012, the
ratio was 3.21 people of working age for every person of State pension age (SPA). Although planned
changes in SPA mean that the ratio will rise to a projected 3.47 in 2020, by
2041 it will have fallen back to 2.65 workers for every one person over SPA.
This is because, despite increases to SPA, the number of pensioners is
increasing faster than the number of working age people – a growth of 37% (to
16.8 million) from 2012 to 2041, compared to 13% (to 44.6 million).

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The changing health
demands of the UK population will affect the provision of health and care over
the next decade Carers UK (2015). Improvements in Healthy Life Expectancy at
ages 65 and 85 are not keeping pace with increasing Life Expectancy. Unless
this trend is reversed, an ageing population will mean increased overall demand
for health and care services. The Personal Social Services Research Unit
(PSSRU) projects that users of publicly funded home care services will grow by
86% to 393,300 in 2035 Wittenberg, R. and Hu, B. (2015).

As well as an increase
in the amount of ill health, population ageing will mean a greater prevalence
of age-related conditions. The ‘oldest old’, who have a substantial risk of
requiring long-term care, are the fastest growing age group in the UK ONS
(2012). As a result, there has been an increasing prevalence of age-related
conditions, including mental health conditions such as dementia. Between a
quarter and a half of people over 85 are estimated to be frail, which is
associated with disability and crisis admissions to hospitals Song, X. et al.
(2010). Average life time expenses for social care faced by people aged 65 and
over exceed £30,000 Comos-Herrera, A. and Wittenberg, R. (2010). The cost of
dementia in the UK was estimated at £26.3 billion in 2013, with 39% due to
social care and 44% to unpaid care159, and is projected to rise from 0.6% of
GDP in 2002, to 0.82-0.96 % of GDP by 2031170. Dementia patients often have
longer hospital stays than other inpatients, and are less likely to return to
their home after a hospital stay171. The inevitability of multi-morbidity with
advancing age will compound this, further increasing health care costs because
health care spending increases with each additional chronic condition a patient
has172.Chronic conditions affecting the heart, musculoskeletal and circulatory
systems are also more prevalent in older age Matthews, F. E. (2013).

Within the national
trends, there are significant variations in health and wellbeing in later life
by socio-economic position, ethnicity, gender and region160. Those living in
the most deprived areas of England have nearly two more years of ‘not good
health’ after 65 than those in the least deprived areas ONS (2016).
Geographical variations in perceptions of good health are more pronounced in
older populations, this suggests that older people in some parts of the UK are
at risk of spending more time in ill health than others ONS (2013).

Chronic illness
management is currently based on a single disease paradigm which may lead to
fragmented and ineffective primary care Robinson, L. (2015). Individuals with
multi-morbidity (having several chronic health conditions at the same time)
require a more complex care environment, with increased physician and
specialist visits, and are likely to have higher prescription costs and use
multiple medications NICE (2015).

The underlying
objectives – to prevent poverty in old age and to provide income security – at
a time when life expectancy is increasing and the ratio of contributors to
beneficiaries is shrinking, the UK government, more than most Organisation for
Economic Cooperation and Development (OECD) countries, has made policy changes  reformed pension provision and such as, ESRC
(2004) Pensions, Pensioners and Pensions Policy, A New Pensions Settlement for
the 21st Century Turner, A. (2005), Independent Public Service Pensions
Commission (2011) and a series of detailed reports from the Department for Work
and Pensions DWP (2014). In the light of rising life expectancy, the state
pension age (SPA) which was 65 years for men and 60 for women started to
increase in 2010 from 60 to 65 for women, and will be equal to that for men by
November 2018, after which the SPA for all is projected to increase to 66 by
2020 DWP (2016). The Government has recently proposed further increases from
2020 to 2028, suggesting potential increases beyond the age of 67 years. These
and other social policy and demographic changes provide an important backdrop
to changing attitudes to age.

 

The last 25 years have
also been a time of ‘growing activity’ and political interest in population
ageing (Macnicol, 2006). In the 1990s the Government campaigned to educate
employers about the benefits of having an age-diverse workforce, alongside
campaigns by pressure groups such as Age Concern. However, it was not until
1999 that a voluntary code of practice was drafted that committed employers to
removing age limits in job advertisements and also suggested that interview
panels should include people of varying ages. Through growing pressure, a
European Employment Directive on Equal Treatment (Directive 2000/78/EC) was
established in 2000, which stated that “any direct or indirect discrimination
based on religion or belief, disability, age or sexual orientation as regards
the areas covered by this Directive should be prohibited throughout the
Community” (EUR-Lex, 2000: 2). In 2006 the UK officially endorsed the European
Directive by introducing the Employment Equality (Age) Regulations 2006, which
formally prohibited employers from discriminating based on age. The Equality
Act 2010 then consolidated laws on discrimination in employment, education and
training for people with ‘protected characteristics’, e.g. disabilities,
religious beliefs, race. In 2011 the ‘default retirement age’ was abolished,
which previously had given employers the right to terminate employment on the
basis that an employee was over the age of 65.

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