S.Y. 2020-2021. 1st Semester.

Mid –Term

Module 1 Aging Perspective and its Demography

Overview:
Populations all over the world will have more older people than children and more people at
extreme old age than ever before and in some countries like Japan, this phenomenon is now
happening. As both the proportion of older people and the length of life increase throughout the
world. The question as to whether population aging will be accompanied by a longer period of
good health, a sustained sense of well-being, and extended periods of social engagement and
productivity, or will it be associated with more illness, disability, and dependency.
Understanding of the changing relationship between health with age is crucial if we are to create
a future that takes full advantage of the powerful resource inherent in older populations. For us to
find cures and ways to prevent age-related illnesses such as Alzheimer’s disease and frailty

Learning Objectives:
At the end of this module, the learner will be able to

1. Describe the biological, humanistic, and scientific perspective of aging

2. Describe statistics related to aging in the world and in the Philippines
3. Discuss the implications of the increasing percentage of the aging population
4. Enumerate the current policies and programs that will cater to the needs and
provide benefits and privileges of the older adult

Content:
I. Aging perspective
The process of aging is unstoppable and inflexible in human beings. Is aging a normal
stage of human development or a disease that can be treated, delayed, or perhaps even cured?
This part of this module explores the aging process from different perspectives and discusses
the possible impacts of those varying perspectives in determining health and nursing care.
A. From a biological perspective, all humans grow, experience puberty,
mature, and age as the course of a normal, healthy life. If we do not view the other
stages of our development to be diseases or conditions to overcome, why do many
people, including scientists, seek to frame aging as a problem that needs solving
or a disease that needs curing? There are several answers to this question that can
be explored through humanistic and scientific lenses.
B. From a humanistic perspective, the primary answer is that aging is
inextricably linked to death. Although biological theories of aging are very
 persuasive, most humans do not view their sole purpose in life as procreation of
the species. Rather, human beings generally desire a complete life, understood in
the terms of the full life cycle (Meilaender, 2011). They want to not only
procreate, but to parent their children and bond with their grandchildren. They
want to gain wisdom through life experiences often only presented in their older
years.
C. The humanistic view also challenges ageism and the stigma associated
with old age. In particular, it challenges the arguments of bioethicists, health care
policymakers, economists, and clinicians who opine that ageism is necessary to a
sustainable healthcare model (Shaw, 1994; Shortt, 2001). In this argument,
ageism is defined in a value-neutral manner as the allocation of resources on the
basis of age-related ability to benefit. The argument for ageism, in this case, is a
moral obligation to distribute health care resources in a way that achieves
maximum benefit and is seen to be just (Shaw, 1994). In contrast, to those
persons opposed to age-based health policy and rationing, ageism holds a fa r
more negative connotation. Those proponents call for eliminating clinical services
where evidence-based rationale are less valued than an individual clinician's bias
about the patient's age, providing better information to older adults regarding less
costly end-of-life care, and ensuring that adequate provision is made for older
adults to access primary, home, and long-term care (Shortt, 2001).
D. From a scientific perspective, the exploration of aging as a disease
becomes complex. Some scientists argue that reframing aging as a disease
changes how the medical and scientific responds to it. If scientists view aging as a
biological condition that can be manipulated, treated, and delayed, it becomes the
duty of doctors to treat it and scientists to discover ways to delay it (Kelland,
2010). By identifying genes that control aging rates and enabling regulators in the
United States and Europe to license medicines for the treatment of aging, it is
possible that humans could live longer lives (Kelland, 2010; McMurdo, 2000).

II. Demography of Aging

The world is at the point of a demographic milestone. Since the start of recorded history,
young children have outnumbered the number of people aged 65 or older will outnumber
children under age 5. Because of falling fertility rates and remarkable increases in life
expectancy, population aging will continue, even accelerate (Figure 1). The number of people
aged 65 or older is projected to grow from an estimated 524 million in 2010 to nearly 1.5 billion
in 2050, with most of the increase in developing countries.
Global Demography of the Older Adult
Globally, there were 703 million older persons aged 65 or over in 2019.4 Eastern and South-
Eastern Asia was home to the largest number of the world’s older population (260 million),
followed by Europe and Northern America (over 200 million) (table 1).

Over the next three decades, the global number of older persons is projected to more than double,
reaching over 1.5 billion persons in 2050. All regions will see an increase in the size of their
older population between 2019 and 2050. The largest increase (+312 million persons) is
projected to occur in Eastern and South-Eastern Asia, growing from 261 million in 2019 to 573
million persons aged 65 years or over in 2050. The number of older persons is expected to grow
fastest in Northern Africa and Western Asia from 29 million in 2019 to 96 million in 2050 (+226
per cent). The second fastest rise in the number of older persons is foreseen in subSaharan Africa
(+218 per cent), with an expected growth from 32 million in 2019 to 101 million in 2050. In
contrast, the projected increase is relatively small in Australia and New Zealand (+84 per cent)
and Europe and Northern America (+48 per cent), regions where the population is already
significantly older than in other parts of the world.
Among development groups,6 less developed countries excluding the least developed countries
will be home to more than two-thirds of the world’s older population (1.1 billion) in 2050. The
fastest increase of the older population between 2019 and 2050 is projected to happen in the least
developed countries (+225 per cent), rising from 37 million in 2019 to 120 million persons aged
65 years or over in 2050.
 1. About one in three older persons is living in Eastern and South-Eastern Asia
today and in 2050.
2. As populations age, shares of working-age (25 to 64 years) and older (65+ years)
persons rise, while shares of children (0 to 14 years) and youth (15 to 24 years) fall.
3. The speed of population ageing is fastest in Eastern and South-Eastern Asia.
4. All regions have experienced an increase of life expectancy, with the largest gains
in sub-Saharan Africa.
5. Throughout most of the world, survival beyond age 65 is improving.
6. Women’s longevity advantage over men leads to a predominately female older
population. Women

The Top 50 With the Largest Number of Older Adults

Ran # 65+ (in % 65+ (of total # total population (in
k Country millions) population) millions)

1 China 166.37 11.9 1398.03

2 India 84.90 6.1 1391.89

3 United States 52.76 16.0 329.15

4 Japan 35.58 28.2 126.18

5 Russian Federation 21.42 14.6 146.73

6 Brazil 17.79 8.5 209.33

7 Germany 17.78 21.4 83.10

8 Indonesia 15.16 5.6 268.42

9 Itlay 13.76 22.8 60.34

10 France 13.16 20.3 64.83

11 United Kingdom 12.24 18.3 66.83

12 Pakistan 9.31 4.3 216.57

13 Mexico 9.17 7.2 126.58

14 Spain 8.99 19.1 47.07

15 Bangladesh 8.35 5.1 163.67

16 South Korea 7.83 15.1 51.85

17 Thailand 7.61 11.5 66.37

18 Turkey 7.27 8.8 82.61

19 Ukraine 6.94 16.5 42.04

20 Poland 6.72 17.5 38.40

21 Viet Nam 6.72 7.0 95.66

22 Canada 6.44 17.2 37.41

23 Philippines 5.51 5.1 108.12

24 Nigeria 5.43 2.7 200.96

25 Iran 5.12 6.1 83.91

26 Argentina 5.10 11.4 44.94

27 Colombia 4.63 11.4 44.94

28 Australia 4.00 15.8 25.31

29 Ethiopia 3.92 3.5 112.08

30 Egypt 3.86 3.9 99.06

31 Romania 3.52 18.2 19.36

32 South Africa 3.51 6.0 58.62

33 Taiwan 3.27 13.9 23.59

34 Netherlands 3.27 18.9 17.34

35 Myanmar 3.19 5.9 54.05

36 Algeria 2.67 6.2 43.41

37 Peru 2.66 8.4 31.78

Democratic Republic of the

38 Congo 2.60 3.0 86.79

39 Morocco 2.53 7.1 35.59

40 North Korea 2.44 9.5 25.67

41 Greece 2.33 21.8 10.70

42 Chile 2.26 11.8 19.11

43 Portugal 2.24 21.8 10.27

44 Belgium 2.15 18.7 11.46

45 Malaysia 2.11 6.4 32.75

47 Sweden 2.05 19.9 10.29

48 Venezuala 1.95 6.8 28.52

49 Hungary 1.89 19.3 9.77

50 Sri Lanka 1.71 7.8 21.90

The implications of an aging population

The world is experiencing a seismic demographic shift—and no country is immune to the

consequences.

While increasing life expectancy and declining birth rates are considered major achievements in
modern science and healthcare, they will have a significant impact on future generations.

Today’s graphic relies on OECD data to demonstrate how the old-age to working-age ratio will
change by 2060, highlighting some of the world’s fastest aging countries.
The demographic debacle

By 2050, there will be 10 billion people on earth, compared to 7.7 billion today—and many of
them will be living longer. As a result, the number of elderly people per 100 working-age people
will nearly triple—from 20 in 1980, to 58 in 2060.

Populations are getting older in all OECD ( Organization for Economic Cooperation and
Development) countries, yet there are clear differences in the pace of aging. For instance, Japan
holds the title for having the oldest population, with ⅓ of its citizens already over the age of 65.
By 2030, the country’s workforce is expected to fall by 8 million—leading to a major potential
labor shortage.

In another example, while South Korea currently boasts a younger than average population, it
will age rapidly and end up with the highest old-to-young ratio among developed countries.

A declining workforce

Globally, the working-age population will see a 10% decrease by 2060. It will fall the most
drastically by 35% or more in Greece, Japan, Korea, Latvia, Lithuania, and Poland. On the other
end of the scale, it will increase by more than 20% in Australia, Mexico, and Israel.

Israel’s notably higher increase of 67% is due to the country’s high fertility rate, which is
comparable to ―baby boom‖ numbers seen in the U.S. following the second World War.
As countries prepare for the coming decades, workforce shortages are just one of the impacts of
aging populations already being felt.

Managing the risks

There are many other social and economic risks that we can come to expect as the global
population continues to age:
● The Squeezed Middle: With more people claiming pension benefits but less people
paying income taxes, the shrinking workforce may be forced to pay higher taxes.
● Rising Healthcare Costs: Longer lives do not necessarily mean healthier lives, with those
over 65 more likely to have at least one chronic disease and require expensive, long-term
care.
● Economic Slowdown: Changing workforces may lead capital to flow away from rapidly
aging countries to younger countries, shifting the global distribution of economic power.
The strain on pension systems is perhaps the most evident sign of a drastically aging population.
Although the average retirement age is gradually increasing in many countries, people are
saving insufficiently for their increased life span—resulting in an estimated $400 trillion deficit
by 2050.

Pensions under pressure

A pension is promised, but not necessarily guaranteed. Any changes made to existing
government programs can alter the lives of future retirees entirely—but effective pension
reforms that lessen the growing deficit are required urgently.

Towards a better system

Certain countries are making great strides towards more sustainable pension systems, and the
Global Pension Index suggests initiatives that governments can take into consideration, such as:
● Continuing to increase the age of retirement
● Increasing the level of savings—both inside and outside pension funds
● Increasing the coverage of private pensions across the labor force, including self-
employed and contract employees, to provide improved integration between various
pillars
● Preserving retirement funds by limiting the access to benefits before the
retirement age
● Increasing the trust and confidence of all stakeholders by improving transparency
of pension plans

Although 59% of employees are expecting to continue earning well into their retirement years,
providing people with better incentives and options to make working at an older age easier could
be crucial for ensuring continued economic growth.
Live long and prosper

As 2020 marks the beginning of the Decade of Healthy Ageing, the world is undoubtedly
entering a pivotal period.

Countries all over the world face tremendous pressure to effectively manage their aging
populations, but preparing for this demographic shift early will contribute to the economic
advancement of countries, and allow populations—both young and old—to live long and
prosper.

Explore the latest strategic trends, research and analysis

● Worldwide, the working-age population will see a 10% decrease by 2060.
● With a rapidly aging global population due to declining birth rates and increased
life expectancy, a smaller workforce will slow down economies and raise healthcare
costs.
Epidemiological shift

The remarkable improvements in life expectancy over the past century were part of a shift in
the leading causes of disease and death. At the dawn of the 20th century, the major health threats
were infectious and parasitic diseases that most often claimed the lives of infants and children.
Currently, noncommunicable diseases that more commonly affect adults and older people
impose the greatest burden on global health. chronic noncommunicable diseases such as
changes in lifestyle and diet, as well as aging. The potential economic and societal costs of
noncommunicable diseases of this type rise sharply with age and have the ability to affect
economic growth. A World Health Organization analysis in 23 low- and middle-income
countries estimated the economic losses from three noncommunicable diseases (heart disease,
stroke, and diabetes) in these countries would total US$83 billion between 2006 and 2015.
Reducing severe disability from disease and health conditions is one key to holding down health
and social costs. The health and economic burden of disability also can be reinforced or
alleviated by environmental characteristics that can determine whether an older person can
remain independent despite physical limitations. The longer people can remain mobile and care
for themselves, the lower are the costs for long-term care to families and society.
Because many adult and older-age health problems were rooted in early life experiences and
living conditions, ensuring good child In the meantime, generations of children and young adults
who grew up in poverty and ill health in developing countries will be entering old age in coming
decades, potentially increasing the health burden of older populations in those countries.
With continuing declines in death rates among older people, the proportion aged 80 or older is
rising quickly, and more people are living past 100. The limits to life expectancy and lifespan are
not as obvious as once thought. And there is mounting evidence from crossnational data that—
with appropriate policies and programs—people can remain healthy and independent well into
old age and can continue to contribute to their communities and families.
The potential for an active, healthy old age is tempered by one of the most daunting and
potentially costly consequences of ever-longer life expectancies: the increase in people with
dementia patients eventually need constant care and help with the most basic activities of daily
living, creating a heavy economic and social burden. Prevalence of dementia rises sharply with
age. An estimated 25-30 percent of people aged 85 or older have dementia. Unless new and more
effective interventions disease, prevalence is expected to rise dramatically with the aging of the
population in the United States and worldwide
Aging is taking place alongside other broad social trends that will affect the lives of older people.
Economies are globalizing, people are more likely to live in cities, and technology is evolving
rapidly. Demographic and family changes mean there will be fewer older people with families to
care for them. People today have fewer children, are less likely to be married, and are less likely
to live with older generations. With declining support from families, society will need better
information and tools to ensure the well-being of the world’s growing number of older citizens

Aging population in the Philippines

In the Philippines, the number of older people is increasing rapidly, faster than growth in the
total population. In 2000, there were 4.6 million senior citizens (60 years or older), representing
about 6% of the total population. In two decades, this has grown to 9.4 million older people or
about 8.6% of the total population. The World Population Prospects 2019 projects that by 2050,
older people will make up around 16.5% of the total population.

Below are the key statistics on the Philippine’s population of older people:
2019 2050

Population aged 60 and above (total) 9,433,000 23,863,000

Population aged 60 and above (% of total population) 8.6 16.5
Older women aged 60+ (% of total population) 4.83 9.40
Life expectancy (males) 67.08 71.88
Life expectancy (females) 75.31 79.5
Old-Age Dependency Ratio (Age 65+ / Age 15-64) 8.6 17.7
Rural older people (% of total population) 6.48

Urban older people (% of total population) 6.54

Older persons living alone aged 60 and above (% of total 5.4

population aged 60+)
The Situation of Older adults in the Philippines is unlike the older adults in developed countries
like Japan, Italy, etc. Older people suffer from both degenerative and communicable diseases due
to the ageing of the body’s immune system. The leading causes of morbidity are infections,
while visual impairment, difficulty in walking, chewing, hearing, osteoporosis, arthritis and
incontinence are other common health-related problems. Older Adults increases the demand for
health services

Our Older adults struggle with poverty.

According to the Department of Social Welfare and Development (DSWD), a nearly a third
(31.4%) of older people were living in poverty in 2000. Currently, this number is estimated to be
1.3 million older people.

More than half of all older people (57.1%) were employed in 2000. More males were employed
(63.6%) than women (37.4%). The majority of those employed (41%) were involved in primary
economic activities such as farming, forestry work and fishing. According to the latest World
Social Protection Report 2017-19, just 39.8% of people older than the statutory pensionable age
in the Philippines receive an old-age pension (contributory, noncontributory or both).

National policy on older people

The Philippine Government has enacted laws that cater to the needs and provides privileges and
benefits to older persons.

Republic Act No. 344 or the Accessibility Law of 1982 provides for the minimum requirements
and standards to make buildings, facilities, and utilities for public use accessible to persons with
disability, including older persons who are confined to wheelchairs and those who have
difficulty in walking or climbing stairs, among others.

Republic Act No. 7876 entitled ―An Act Establishing a Senior Citizens Center in all Cities and
Municipalities of the Philippines, and Appropriating Funds Therefore‖ provides for the
establishment of Senior Citizens Centers to cater to older persons’ socialisation and interaction
needs as well as to serve as a venue for the conduct of other meaningful activities. The DSWD in
coordination with other government agencies, NGOs and people’s organizations shall provide
the necessary technical assistance in the form of social and recreational services, health and
personal care services, spiritual services, livelihood services and volunteer resource services.

Republic Act No. 8425 provides for the institutionalization and enhancement of the social reform
agenda by creating the National Anti-Poverty Commission (NAPC). Through its multi-
dimensional and cross-sectoral approach, NAPC provides a mechanism for older persons to
participate in policy formulation and decision-making on matters concerning poverty alleviation.
Republic Act No. 10155, known as ―The General Appropriations Act of 2012‖, under Section 28
mandates that all government agencies and instrumentalities should allocate one percent of their
total agency budget to programs and projects for older persons and persons with disabilities.

Republic Act No. 9994, known as ―Expanded Seniors Citizen Act of 2010″, an act granting
additional benefits and privileges to senior citizens, further amending Republic Act No. 7432 and
otherwise known as ―an act to maximize the contribution of senior citizens to nation building,
grant benefits and special privileges and for other purposes‖.

Presidential Proclamations and Executive Orders

Presidential Proclamation No. 470, Series of 1994, declaring the first week of October of every
year as ―Elderly Filipino Week.‖

Presidential Proclamation No. 1048, Series of 1999, declaring a ―Nationwide Observance in the
Philippines of the International Year of Older Persons‖.

Executive Order No. 105, Series of 2003, approved and directed the implementation of the
program providing for group homes and foster homes for neglected, abandoned, abused,
detached, and poor older persons and persons with disabilities.

The Philippine Plan of Action for Senior Citizens (2011-2016) aims to ensure giving priority to
community-based approaches which are gender-responsive, with effective leadership and
meaningful participation of senior citizens in decision-making processes, both in the context of
family and community. This plan of action aims to ensure active aging for senior citizens where
preventive and promotive aspects of health are emphasized in communities and where health
services are accessible, affordable and available at all times. Envisioning a population of senior
citizens who are self-sufficient and self-reliant, this plan aims to promote financial security and
financial independence of senior citizens by developing community-based local delivery systems
to address their needs.

Health and care

The Department of Social Welfare Development (DSWD) has issued Administrative Order No. 4
series of 2010, ―Guidelines on the Home Care Support Services for Senior
Citizens‖, establishing community based health care services for older persons.

The RA 9994 provides health care services for poor older persons such as free medical services
on government hospitals, discounted services on private hospitals and clinics, free vaccines,
discounted medicines, and mandatory PhilHealth coverage.

The Plan of Action on Ageing 1999-2004 included health promotion and disease prevention for
adults, by providing free flu vaccinations, osteoporosis screenings and eye tests. The National
Action Plan on Senior Citizens focused on aspects of quality of life such as living independently.
Older people’s associations
The Philippine Constitution supports the formation of community-based organisations. The
DSWD have facilitated the formation of older people’s associations in every city and
municipality. They are also tasked to provide technical assistance to support and strengthen
OPAs. The Philippine Plan of Aging included development of the Federation of Senior Citizens
Associations of the Philippines throughout the country.

Social pension
A social pension was introduced in 2011 by the Department of Social Welfare and Development,
in which those over 60 who are identified as poor by means testing and not receiving any other
pension or social insurance can receive 500 Ph Pesos a month. The Department of Social
Welfare and Development is the lead agency tasked with identifying and reviewing social
pension beneficiaries. Of those who are over the age of eligibility, 35.4% claim a social pension,
29% have a contributory pension scheme such as The Social Security System that covers the
private sector workforce, and all domestic and self-employed workers. 35.6% of the Indonesian
population do not have a pension at all.

Our network
The following organizations are part of the HelpAge network in the Philippines:

● Coalition of Services to the Elderly Inc. (COSE)

● Confederation of Older Persons Association of the Philippine (COPAP)

Learning Activities
To demonstrate the demography of aging at the micro-level the following activities are required

1. Each student will interview at least 5 senior citizens in their neighborhood (while
practicing correct health protocols like social distancing and use of face masks and
shields) to gather demographic data which includes age, sex, religion, educational
attainment
2. The group (Block) consolidate the gathered data
3. Analyze the data collected and described the demographic characteristics of the
aging population at the near-by locality.

Assessment
Post Test
Encircle the letter T if the statement is correct and the letter F if the statement is wrong or
incorrect
T F 1. Low fertility rate is one cause of the rapidly increasing number of older adults
T F 2. Males life span is longer than females
T F 3. In the Philippines, older adults are facing both communicable diseases and chronic
degenerative diseases
T F 4. The world’s most populated area with the older adult is South-Eastern Asia.
T F 5. Presidential Proclamation 470 declares first week of October as Elderly Filipino
Week

Choose the best answer. Encircle the letter of the best/correct answer.
A B C D 1. The most common disease older adults are afflicted with that will prevent them
from having an active life is

A. Dementia C. Diabetes C. osteoposis D. CVA

A B C D 2. The global number of the older adults is projected to more than double in the
year

A. 2030 B. 2040 C. 2050 D. 2080

A B C D 3. Whose perspective of Aging is the illustrated in the following statement: ― Aging
is a Disease and ways to treat or prevent it

A. Biological B. humanistic C. scientific

A B C D 4. Aside from aging, what other factors has contributed to the shift from CD to non
communicable diseases among the aging population

1. Changes in lifestyle 2. Changes in diet 3. Changes in the beliefs

A. 1 & 2 B. 2 & 3 C. 1 & 3 D. 1, 2 & 3

Summary
References
Gerontological Nursing: Concept and Practice, 3rd Edition, Adrianne Dill Linton and Helen W.
Lach
Gerontological Nursing Competencies for Care, 2nd Edition, Kristen L. Mauk
https://ageingasia.org/ageing-population-philippines/ https://www.prb.org/countries-with-the-
oldest-populations/