1 | Care of the Older Adult 1

UNIT 1: INTRODUCTION TO AGING

1.0 Intended Learning Outcomes

a. Distinguish individual aging from population aging;
b. Discuss the social and economic implications of both individual and population
aging; and
c. Explain the health implications of population aging through mortality and
morbidity profiles.

1.1. Introduction
One certainty in life is that we all age. From the moment we are born our life is
an inexorable progression toward aging. If we are careful with our lifestyle, if we
have the right combination of genes, or if we are just plain lucky, we may live longer
than others. But like death and taxes, growing old is something we cannot escape.

Aging is therefore one issue that should concern us all. Regardless of what stage
in our life we are, chronologically speaking, aging is something we should prepare
for.

1.2 Topics/Discussion

1.2.1 Individual Aging vs. Population Aging

A person’s aging is indicated by the passage of years and shown in
changes in the body and physical functions. A population also ages,
characterized by the increasing number of persons belonging to ages 60 years
and above. There are factors that affect individual aging, making the experience
different from one person to another. Likewise, there are factors that cause
population aging. This module is concerned with both individual and
population aging.

Individual Aging
Individual aging simply means growing older. We grow old
chronologically and this is reckoned by the number of years we have lived since
birth. If we know our birth date, we know exactly how old we are in terms of
years lived. We also grow old physically. There are many changes that we
experience as a result of the passage of time and how we live our lives.
 1 | Care of the Older Adult 2

Chronological age is not always congruent with physical age.

Chronologically, you may be 30, 40, or 50 years old. But two people of the same
chronological age may be quite different in the way their bodies are aging. You
may notice this discrepancy when, for example, you attend your high school
reunion and notice how you and your classmates look now. Some look older,
some look younger. Do you think you look older or younger than most of your
classmates?
What are the physical signs of aging? You may already be familiar with
at least some of these, perhaps because we experience them ourselves or
because we observe others undergoing such changes. For instance, there are
the tell-tale marks of greying hair, “laugh lines” that become permanently
etched around the eyes, poorer eyesight requiring the use of eyeglasses; lapses
in one’s ability to recall names and faces, and many more.
Some people look “old” at 50 while others appear “young” at 70. The
condition will depend on changes that the body has experienced as a result of
many interrelated factors like heredity, nutrition, habits and vices, lifetime
working conditions, lifestyle, and attitudes toward life in general. For example,
some people experience premature greying of hair, possibly an inherited trait,
and thus look physically old even if they are young in years. Long-term
smoking prematurely ages the skin. This makes a 50-year old smoker look more
wrinkled than someone of the same age who never smoked. Too much sun
exposure can have the same effect.
A third related notion of aging that of functional age, reflects our ability
to carry on an independent, self-sufficient life in which we take care of our own
basic personal needs like self-care. Some people are able to live a fully
independent life at 80 or 90 because they have minimal physical disabilities.
Others may require care at a much younger chronological age as a result of a
higher number of functional limitations such as difficulties in walking,
climbing stairs, and getting up from bed, among others.

Activity 1-1

Go to www.realage.com. Complete the questionnaire and find out what your

real age is, relative to your chronological age.

Reflect on the factors that affect your real age. Make a list of these factors.
 1 | Care of the Older Adult 3

SAQ 1-1

1. What are the factors that make physical age different from chronological
age?
2. Give specific examples of the above factors.
3. Which of these factors are most important in individual aging?
Why?

Population Aging

Unlike individual aging, population aging is a condition that describes

the state of a population. In demographic terms, one of the main distinguishing
features of the 20th century has been the unprecedented and worldwide long-
term decline in fertility and mortality which has led to a condition that has
never before been experienced by human populations – population aging or the
“greying” of the population.
Population aging refers to the phenomenon where the proportion of
older people to total population is increasing steadily so that a significant
percentage now lives up to advanced old age. A country is considered to be
aging if the proportion of people aged 60 and over is at least 7 percent of the
total.
Since the beginning of human civilization up till the early part of the 20th
century, the condition of human populations has been characterized by high
fertility or a high number of births and a relatively high mortality. Under this
regime, the distribution of the population into the different age groups, from
the youngest to the oldest, assumes a pyramidal shape.
Consider Figure 1-1 below which shows the population age and sex
structure of the Philippines 2000 and 2010. The left bars refer to males, the right
bars to females. Each bar represents the number of people in an age group,
differentiated by sex, with age arranged in ascending order. The bottom bar
represents males and females aged 0-5 and the topmost bar, males and females
aged 90+. Within each age group the relative length of the bar for males and
females is indicative of the sex ratio for that given age. If the left bar is longer
than the right bar, there are more males than females at that age, and vice versa.
If the bars are equal in length then the sex ratio is even between the sexes.
 1 | Care of the Older Adult 4

Figure 1-1. Population Pyramid, Philippines 2020,

(Population Pyramid, net)

In this population pyramid we see the effect of a high number of births

(the bottom most bar). The numbers gradually diminish with age until they are
smallest at the oldest ages. The difference in numbers from one age group to
the next higher age represents the force of mortality. In this population most
people are in the young ages. Not many live to old age.
Figure 1-2 presents the population pyramid of another country,
Israel, at about the same time (2010) as the Philippine pyramid (2010).
 1 | Care of the Older Adult 5

Figure 1-2. Population Pyramid, Israel 2020, (Population Pyramid, net)

Here we observe the same basic pyramidal shape but the differences in
the lengths of the bars from one age group to the succeeding one are not as
much as in the Philippine pyramid. This means that the force of mortality that
affects how many of the previous age group graduates to the next higher age is
not as strong as that shown in the previous figure.
Both the Philippines and Israel today are examples of young populations
characterized by high birth rates. Consequently, the bulk of the total population
is in the younger ages.

SAQ 1-2
1. What are the basic similarities between the population pyramids of the
Philippines and Israel today?
2. What are the basic differences between the population pyramids of the
Philippines and Israel today?
3. Which country has older persons?
 1 | Care of the Older Adult 6

Causes of Population Aging

Demographers describe long-term trends in birth and death rates across

populations in the theory of demographic transition. According to this theory,
the growth of populations over a long period of time is characterized by three
stages:

1. The pre-transition stage where the main distinguishing feature is

high birth and high death rates. In this stage there is almost zero
growth in the population. Although there are many births per
woman in the population, this is counterbalanced by an equally high
number of deaths. High death rates mean people on average live
shorter lives.

2. The transition stage where there is decline in births and decline in

deaths but not at an equal pace. In the transition stage deaths decline
much faster than births, resulting in explosive growth of the
population.

3. The post-transition stage where there is again very low growth in

population numbers because both birth and death rates are equally
low.

Stage 1 and 2 characterize young populations. Stage 3 describes an old

or an aging population. What causes the population to age is thus the interplay
of trends in births and deaths over time. Between the two, fertility or births play
the more important role because declining births mean there are fewer people
in the bottom of the population pyramid. Since aging is mainly a change in the
proportionate share of the different age groups in the population, decrease in
the bottom ages will result in increase in the higher ages.
A second related cause of population aging is mortality decline. While
births have been decreasing improvements in the human condition have also
resulted in declining deaths. Advances in food production, in public health and
in medical sciences all combine to significantly decrease the risk of death
especially among the young. Consequently, under a low mortality regime,
people on average expect to live longer.
As determinants of population aging, fertility forces have exerted a
greater impact in determining the pace at which a population age. Mortality is
only a secondary, albeit important factor.
The following figures illustrate the trends in fertility and mortality
among selected countries in various stages of the demographic transition. Four
countries – Vietnam, Brunei, Thailand, and Singapore are aging populations,
 1 | Care of the Older Adult 7

while Lao PDR, Philippines, Cambodia, Myanmar, Indonesia, and Malaysia are
in various stages of completing the demographic transition.

Trends in Fertility

Figure 1-3 shows past trends in total fertility rates for ten countries. The
total fertility rate (TFR) is the average number of children that a woman expects
to have if she were subjected to the same schedule of fertility as the women of
that population at that specific point in time. It can also be interpreted as the
average completed family size per woman. To achieve zero population growth,
TFR should be at replacement level, i.e., TFR=2.

Figure 1-3. Trends in total fertility rate across selected countries, 2005-2016,
(theaseanpost.com)

SAQ 1-3

1. Which countries had the highest fertility rates in 2005? The lowest?
2. Which countries reached replacement level in 2010?
3. When will replacement levels be reached by most countries?
 1 | Care of the Older Adult 8

Trends in Mortality

Long-term effects of fertility and mortality decline can be observed in

the life expectancy of a population. Life expectancy refers to the number of
years that a person expects to live if he/she were subjected to the same risks of
dying prevalent in the population at that time. Life expectancy can be
computed at any age but the most popularly quoted figure is life expectancy at
birth. This refers to the number of years a newborn is expected to live if he/she
were subjected to the same risks of dying prevailing at the time of his/her birth.
If mortality risks are high at all ages then life expectancy will be low and vice
versa.

Figure 1-4. Trends in life expectancy at birth across selected countries, 1950-2004.
(thelancet.com)

SAQ 1-4

1. What can you say about the trends in life expectancy in these countries?
2. In which countries would people expect to live the longest?
3. If you were born in Brunei in 2004 how many years would you expect to
live?
4. If you were born in the Philippines in 1950 how many years would you have
expected to live?
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1.2.2 Economic and Sociocultural Implications of Population Aging

The notion of when a person may be considered “old” is largely cultural.
For one who lives in a young population with a low life expectancy, for
example, Burkina Faso in Africa where life expectancy at birth was 48 years in
2000, one may be considered old at 50. But in Japan with its life expectancy at
birth of 81.5 years in 2000, a 60-year old is not necessarily “old.” But regardless
of the age or life course stage at which the culture may define one to be old, the
concerns of older people are the same across cultures. Foremost of these are the
issues of diminished earning capacity and of increasing risks of having health
problems. Another issue concern changing roles in society, such as
grandparents assuming parental roles in the lives of their grandchildren.

The consequence of having an aging population, as you learned in the

previous module, can be measured demographically in the slowing down of
the population growth rate and changes in the population age-sex structure.
The economic and social implications, on the other hand, derive from the
requirements of older people that must be addressed by any society. When
there is an increase in demand for services by a sector that for the most part is
no longer economically active.

Economic Implications

(t20japan.org)

In developed economies whose trajectory toward an aging society began

many, many decades ago when birth rates started to gradually decline, there
was time to evolve social safety nets to guard against poverty in old age. This
was done largely through the public pillar of the social security system
whereby younger economically active members contribute to public funds
 1 | Care of the Older Adult 10

through taxation and thereby provide pensions for those who are retired from
the labor force. This ensures that older people meet their basic economic
requirements through a system of public transfers such as the pension system
and medical insurance, among others. Since most employed people work in the
formal sector, most are able to contribute to this fund.

Many developed economies used and continue to use a pay-as-you-go

system. This is a system of collecting funds by taxing the working age
population of today to pay the pensions of the retirees of today. The amount of
pension in developed societies is pegged to inflation and constitutes a fixed
percentage of the last income prior to retirement. The amount of pension is
therefore enough to cover basic expenses even if inflation rates become high.

The system of public transfers worked well in these economies up to a

certain stage in their demographic transition. While the economically active
remained the dominant bulge in the population pyramid, these economies
profited from having relatively fewer dependents and a large productive labor
force. But as populations continue their aging trajectory, some of these systems
of public transfers are on the verge of collapse. More and more people are now
entering retirement age while the labor force continues to shrink. The new
entrants to the working age population are progressively fewer owing in turn
to fewer births.

Returning to the concept of a pay-as-you-go system, there are

indications that this system is not suitable for a population in an advanced state
of aging because the number of working people who are contributing to the
pension of the retired is proportionally smaller and they will need to contribute
more to maintain the level of retirement pension required by today’s
pensioners. Moreover, with shrinking birth rates, future entrants to the labor
force are projected to be even smaller than the current ones. This problem is
now faced by some European societies like Germany and France.

In most developing countries, the public pillar of the social security

system is still largely in the budding stage. In the Philippines, the Social
Security System (SSS) and the Government Service Insurance System (GSIS)
were established only in the early 60’s and covered only formal sector
employees in the private and public sectors, respectively. Moreover, pensions
are not automatically pegged to inflation rates. Thus, for those who contributed
to the System when they were still working, pensions are not nearly enough to
cover their basic economic needs after retirement.

Because of the young population structure of the Philippines, there is no

strain that comes from having too many old retirees relative to the working
population. But the main problem is the amount of contributions that can be
exacted from the working age population, given generally low wage levels and
 1 | Care of the Older Adult 11

the large size of the informal sector that is not covered by this system. Based on
survey data, only about 10 percent of elderly people who have reached
retirement age in the Philippines were receiving pension in 1996.

From the foregoing discussion, it is apparent that whether the

population is aging or not, the economic needs of the elderly have to be
addressed somehow. Using the public sector is only one way.

Generally, developing countries with young populations rely on the

traditional social support system of family and kin networks mainly children.
The most common living arrangement is co-residence with kin, most often
grown-up children. The family group covers all the consumption needs of its
members. As the productive capabilities of the old decline, they are supported
by the work of their children, as they once supported these children and their
own parents.

This cultural ideal works for the most part but there are people who fall
through the cracks in this informal system – those who never had children,
those whose children have died or moved, and those whose children do not
earn enough to support their aging parents as well.

Exacerbating the problem of economic insecurity is the cost of health

care which tends to rise in old age. Developed societies have a formal system
of health insurance to finance health care at all ages, not just for the elderly.
This has the effect of pooling risks and distributing the actual cost of health care
among those who pay into the system. By making enrolment into the health
insurance system compulsory for all and requiring substantial contributions
from members, the health insurance system can have a more comprehensive
coverage of health-related costs for all the insured-young and old alike.

Again, there is evidence of stress in the medical insurance system in

societies with large aging populations because there are now more old people
who require health care than there were when these systems were originally
designed. Advances in medical science also make health care more costly.
Longer life expectancies and more invasive life-saving procedures usually
translate to higher health care costs all around. Yet while the changes in the
population structure brought about by aging put stress on the health care
system by jacking up per capita health care expenses disproportionately among
the old, the strain is mostly borne by the system rather than by the individual.

In developing countries, health insurance, like social security, is also still

in a developing state. While private health insurance has made inroads in
countries such as the Philippines, the numbers enrolled are small and
insignificant. Thus, for the majority, most if not all health care costs at any age
are borne by the sick person and his/her family. It is not surprising then that
 1 | Care of the Older Adult 12

among the major sources of worry among the old in the Philippines, health and
health-related expenses rank very high indeed.

In the Philippines, PhilHealth, the mandated health insurance system

for all formal sector employees and optionally for informal sector employees,
covers only a small proportion of total health care costs because its
reimbursable expenses are limited to hospitalization costs, and even then, only
to a portion of total hospitalization expenses.

For the elderly with chronic illnesses such as diabetes or hypertension,

the cost of maintenance medicine is borne totally out-of-pocket. The 20 percent
discount on medicines mandated by the Senior citizens Act offers financial
relief only to those who have the means to buy medicines in the first place.

SAQ 2-1

1. What are the advantages and disadvantages of pension systems in

developed countries that have adopted the pay-as-you-go system?
2. Is the traditional support system in developing countries enough to provide
financial support for older persons? Discuss.

Sociocultural Implications

(starmulticare-fl.com)

As old people grow increasingly older, they lose some of their abilities
to function independently and will have to depend on others sooner or later. In
 1 | Care of the Older Adult 13

most cases, whom to depend on is culturally prescribed. These are likely to be

one’s closest kin: spouse, children, siblings, other relatives, friends, probably in
that order. In Asian countries with a Confucian ethic like China, Taiwan,
Vietnam, and Japan, the primary source of support in old age is the oldest son.
Other Asian societies like the Philippines and Thailand have no such gender
preference.

The nature of the dependency of older people on younger kin is very

much dictated by cultural norms well. In most societies in Asia and Africa,
older people depend on their families for much of their needs – economic, social
and emotional support and assistance with activities of daily living. A lot of
research has focused on the Asian model of elderly care that centers on cultural
notions of filial piety, social reciprocity and repayment of debts of gratitude.
These cultural beliefs translate into practice through such tangible forms as
living together with one’s own children when one reaches old age, almost as a
matter of course. The elderly in Asian societies are fully integrated in the life of
the household they co-reside with. Living alone or with one’s spouse only are
rare occurrences.

In other cultures, specifically in the developed countries of the western

hemisphere, the elderly appears less dependent on family networks for
economic, social and emotional support, compared to their Asian counterparts.
Different values underlie cultural notions of the ideal relationships between
parents and children in old age. For example, because of lifelong habits of
autonomy and individuality, the elderly strongly values their privacy and their
independence. In turn, this desire is respected by family members. The elderly
in these cultures prefer not to co-reside with child or other kin. Living alone or
with one’s spouse only are the ideal living arrangements. In these societies too,
the possible loss of independence, of the ability to live by oneself and take care
of one’s basic needs as a consequence of aging, are among the foremost worries
of older people.

Furthermore, there are other beliefs and values surrounding the nature
of the relationship between citizens and the State which bolster no reliance on
the family for support in old age. In European societies, there is a long-standing
belief in the social contract between the citizen and the State whereby in
exchange for paying taxes, the State guarantees care of citizens in need,
regardless of age. This is the underlying principle behind the welfare state.
Given these preconditions, it is not surprising that the kinds of living
arrangements for the elderly evolved by these western societies are generally
not dependent on family networks.

When population aging proceeds at a rapid pace in societies where the

cultural ideal is for children to take care of their own aging parents, some
complications are bound to arise. For one, because of long-term fertility decline,
 1 | Care of the Older Adult 14

the number of available children to provide support to aging parents is now

much lower. Moreover, there are other changes in society that normally
accompany fertility decline. Modernization fosters higher labor force
participation of women, and can deprive older people of traditional caregivers.
In Japan, for example, the traditional role of the daughter-in-law as the primary
caregiver of the oldest son’s elderly parents is now increasingly challenged by
working women unable or unwilling to perform such a role. It does not help
any that with increased longevity, the prospect of caring for older in-laws
involves a prolonged period of time during which the caregiver is also aging
herself. It is not uncommon for a 60-year old woman in japan to be caring for a
90-year old mother-in-law while she herself may have no married son whose
wife she can expect to care for her in time.

Increased longevity, moreover, does not routinely guarantee that the

life-years gained are spent in a healthy state. Many chronic diseases that plaque
the elderly can cause impairment in functioning that will require help from
others. In times past, the period between onset of disease and death was
normally short. In current times, advances in medical science allow many of
those with chronic illness to prolong their lives if they manage their disease
well. Having to care for an elderly household member who has a chronic
disease and is in some state of functional impairment can lead to stress and
strain in the household even when it is a generally accepted duty of children to
care for elderly parents. It is even more problematic for those who do not have
children at all or those whose children are not available or are hardly able to
meet their own basic needs.

1.2.3 The Epidemiologic Transition: Health Implications of

Population Aging

When population ages, there are certain implications on the health of the
people. From our discussion of population aging in Module 1, recall that one
of the two demographic forces that drive its pace is mortality decline. A related
concept to the demographic transition, one which describes the long-term trend
in mortality across populations, is the epidemiologic transition.
 1 | Care of the Older Adult 15

Epidemiologic Transition

(slideplayer.com)

Epidemiologic transition postulates that long-term decline in mortality

levels is closely linked to changes in the major causes of death in a population.
As in demographic transition, death rates are postulated to go through three
stages: the pre-transition, transition and post-transition phases. In the pre-
transition phase, the major cause of mortality are infectious diseases. Mortality
rates are generally high at all ages. Life expectancy is low and few people expect
to live to old age. In the transition phase, the population experiences a mix of
both infectious and chronic diseases as the major cause of mortality, whereas
in the post-transition phase, the major cause of death is chronic disease.

This concept is a useful tool for understanding the trends in mortality

decline in the past but it is not predictive of what will happen in the future.
Researchers caution against extrapolating that with population aging, all
causes of death will eventually shift toward chronic illnesses and all infectious
diseases will be eradicated or at least be easily treatable. The resurgence of
tuberculosis and malaria, especially drug-resistant strains, and the emergence
of new diseases like HIV-AIDS, SARS and Covid-19 only show that humans
are not likely to eradicate infectious diseases altogether.

However, some components of the general concept of the epidemiologic

transition are useful in explaining the trends observed so far in mortality
decline across populations over time. In the pre-transition and transition
phases, the population structure is characteristically young. Death rates are
elevated at all ages but are higher among the youngest – infants and children.
The major causes of death are infectious diseases as are diseases associated with
 1 | Care of the Older Adult 16

poverty like avitaminosis and malnutrition. They take their toll mostly on the
youngest ages, especially from birth to age one. Young populations usually
have higher infant mortality rates.

As experienced in actual populations, what brings about mortality

decline is the combination of many interrelated factors. These are mostly
associated with improvement in the food supply thus leading to better
nutrition, improvements in sanitation and public health, the invention and
discovery of medical interventions and drugs to combat infection, and later,
immunization against childhood diseases, among others.

When all these positive forces operate in a population for a length of

time, the net effect is that fewer children die. In fact, few people die at a young
age. A person born in a population with low infant and child mortality has a
very high probability of living to adulthood. Since humans are not immortal
and so far, there are limits to the human life span, when infant and child
mortality decline, the bulk of the deaths shifts toward older ages. We are now
describing an aging population.

SAQ 3-1

In what stage of epidemiologic transition is the Philippines? Support your

answer.

Emergence of Chronic Diseases (Non-communicable Diseases)

(slideshare.net)
 1 | Care of the Older Adult 17

What would now be the major causes of death when a population is

aging? As proposed by the transition, the major causes of death are chronic
diseases – diseases that are not caused by infectious agents but instead are
strongly related to lifestyles. In a young population characterized by high
fertility and relatively high mortality, the major causes of death are diseases
like tuberculosis, measles, malnutrition, and the like. In an aging population,
the major causes are heart disease, cancers, and complications arising from
diabetes. For populations in between – those in epidemiologic transition – the
major cause of mortality is a mix of both infectious and chronic diseases.

The main difference between an infectious and a chronic disease is that

an infectious disease is traceable to an infecting organism. When the infectious
agent is eradicated or controlled, the infected person is then cured. In contrast,
when one has a chronic disease, he/she cannot be “cured” in the way we
normally conceive of being cured, that is, the disease goes away completely as
when one has a cold that disappears when the viral infection has run its course.
A chronic disease is one that needs to be managed and controlled, so that its
insidious effects do not manifest or do not affect one adversely. It requires
vigilance and continuing effort on the part of the patient. It does not go away.

What do you think are the implications of the high prevalence of chronic
diseases in an aging population?

One implication is high health care costs. Having a chronic disease like
diabetes or hypertension means having to pay for medications or medical
consultations to effectively manage the condition. If there is no medical
insurance system to cover this cost, it has to be borne by the person
himself/herself at a considerable cost.

Another implication is the need to build the kind of health services and
health infrastructure required. The best way to deal with chronic disease is to
try to prevent it happening in the first place. In most young populations like
the Philippines, where infectious diseases are still among the top causes of
death, the major focus of health services is curative. Having a high rate of
chronic disease requires a shift toward inclusion of preventive services as an
integral part of medical care. Preventive services also entail a good deal of
health education and health campaigns to teach people how to protect
themselves from the risk of acquiring a chronic disease. One example would be
health campaigns to stop smoking because this is a risk factor for lung cancer
and aggravates the effects of heart disease.

A third implication is the increasing average length of time between the

onset of illness and death. With infectious disease as the cause of mortality, the
period between onset and death is not normally prolonged. But with chronic
disease, the duration between onset and death is generally longer. Reckoned in
 1 | Care of the Older Adult 18

terms of life expectancy, this is a positive development because even with a

chronic illness, people, on the average, will live longer.

Research on aging, in aging societies now distinguishes between the

traditional concept of life expectancy and active or healthy life expectancy. This
is because people may be living longer but the additional years of life they gain
may be spent in a state of disability or ill health. The issue at hand is therefore
the quality of life in one’s remaining years. Researchers on active life
expectancy usually estimate the remaining years of life at a given advanced
age, say 65, and estimate how many of these years will be lived in an
active/healthy state. Generally, findings from a comparison of many aging
populations show that women tend to live longer but they also tend to live
more years in a state of disability or ill health.

SAQ 3-2

1. Can you think of other possible implications of high prevalence of chronic

disease in a population?

2. Why do you think women tend to live longer than men? Support your
answer with research-based evidence.

1.3 References

D.E. Bloom, D.L. Luca, in Handbook of the Economics of Population Aging,

2016

Natividad, N. N. (2005). Caring for Older Person. University of the Philippines,

Open University

R. Lee, in Handbook of the Economics of Population Aging, 2016

https://academic.oup.com/gerontologist/article-
abstract/34/3/420/583893?redirectedFrom=PDF

Yashin AI, Begun AS, Boiko SI, Ukraintseva SV, Oeppen J.Mech Ageing Dev.
2002 Mar 31;123(6):637-47. doi: 10.1016/s0047-6374(01)00410-9.PMID: 11850027
 1 | Care of the Older Adult 19

https://hbr.org/2014/01/the-truth-about-aging-populations

https://www.healthaffairs.org/doi/full/10.1377/hlthaff.19.3.204

https://ourworldindata.org/fertility-rate

https://www.researchgate.net/publication/301680578_The_Impact_of_an_A
geing_Population_on_Economic_Growth_An_Explanatory_Review_of_the_M
ain_Mechanisms

https://www.nap.edu/read/13465/chapter/2

https://www.ecb.europa.eu/pub/pdf/other/ebart201802_02.en.pdf

https://globalriskinsights.com/2017/02/aging-global-population economic-
implications/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1575842/pdf/califmed00
166-0078.pdf

https://www.researchgate.net/publication/267869707_Economic_and_Social
_Consequences_of_Population_Aging_the_Dilemmas_and_Opportunities_in_
the_Twenty-First_Century

https://www.sciencedirect.com/science/article/abs/pii/0890406587900016

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2805833/

https://apps.who.int/iris/handle/10665/118829

https://www.parentgiving.com/elder-care/common-chronic-conditions-
and-aging-at-home/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6385883/

1.4 Acknowledgment

The images, tables, figures and information contained in this module

were taken from the references cited above.
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WORKSHEET:
Answers should be handwritten.

NAME OF STUDENT : _____________________________

YEAR & SECTION : _____________________________
COURSE : NCM 114 / BSN 3
INSTRUCTOR : DOLORES L. ARTECHE, DSN

ACTIVITY 1-1
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SAQ 1-1
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SAQ 1-2
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SAQ 1-3
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SAQ 1-4
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SAQ 2-1
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SAQ 3-1
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SAQ 3-2
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