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Population aging is a pervasive, unprecedented global phenomenon. The trend is expected to continue into the twenty-first century. The older population is itself aging; the fastest growing age group is the oldest-old, those aged 80 years or older.

The chapter begins by highlighting the consequences and implications of the global aging of the population. In the economic area, population aging will have an impact on economic growth, savings, investments, and consumption, labor markets, pensions, and taxation. Also, this phenomenon will have a direct bearing on the intergenerational and intragenerational equity and solidarity that are the foundations of our societies. In the social sphere, population aging will affect health and health care, family composition and living arrangements, housing, and migration. Some of the inadequacies of health professional education and health care delivery systems in meeting the chronic health care needs of aging populations around the world are discussed.

The second section of the chapter describes how health care systems around the world are preparing to deal with patients with multiple chronic, degenerative diseases. Information is provided about developed countries in four continents including Canada and United States for North America; Iceland, Norway, United Kingdom, France, and Italy for Europe; Japan for Asia; and Australia for Oceania. The current situation in China is discussed as an example of the preparedness of the more densely populated developing countries and those with the fastest growing economies. For each country, the following information is presented: the principal characteristics of the health care system; the organizational approaches and the services available for older adults; and positive aspects, weaknesses, and specific peculiarities. Each nation's description ends with a description of what would happen in a hypothetical example of an 87-year-old widow hoping to return home after suffering a stroke with motor and speech deficits.

The third section of the chapter illustrates the difficulty in addressing these epidemiological changes without a global, standard way of assessing the needs of older individuals. The chapter describes the development of a minimum data set of information that can be applied, independent of nationality, language, and culture, to any health care setting. Data are presented to suggest that this global assessment is one strategy for capturing the essential aspects, variables, and solutions that make a local or a national health care system work more efficiently by responding to the needs of their older clients. Also, the chapter summarizes the results of the real-world application of such instruments by governmental mandate in the Canadian province of Ontario and in health services research conducted in Europe.

Finally, the chapter discusses the evidence that the unprecedented demographic changes, which had their origins in the nineteenth and twentieth centuries, are continuing well into the twenty-first century. The number of older persons has tripled over the last 50 years but it will more than triple again over the next 50 years. In contrast with the slow process ...

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