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POPULATION AGING PHENOMENON

ELENA FERCALĂ

County Clinical Emergency Hospital of Braşov

Abstract: There were 600 million people aged 60 and over in 2000; there will be 1.2 billion by 2025 and 2 billion by 2050. Today, about two thirds of all older people are living in the developing countries; by 2025, it will be 75%. In the developed countries, the very old (age 80+) is the fastest growing population group. Women outlive men in virtually all societies; consequently in very old age, the ratio of women/men is 2:1. As populations age and live longer, chronic diseases become increasingly prevalent. Older persons with complex pathologies and conditions will require multiple sources of care to meet their health care needs. They will need to depend on a health care delivery systems that can adequately address and reliably serve their multiple needs.

Keywords: older people, European Region, life expectancy, reduction of life expectancy.

Rezumat: În anul 2000 existau la nivel mondial 600 milioane persoane în vârstă de 60 de ani şi peste. Se estimează că numărul acestora va creşte la 1,2 miliarde în 2025 şi 2 miliarde în 2050. În prezent, aproape două treimi din totalul persoanelor vârstnice trăiesc în ţările în curs de dezvoltare şi se estimează că, în 2025 procentul acestora va ajunge la 75%. În ţările dezvoltate, grupa marilor vârstnici (80 ani şi peste) este grupa populaţională cu cea mai rapidă creştere. Femeile trăiesc mai mult decât bărbaţii în mai toate societăţile umane; în consecinţă, la vârste înaintate, raportul femei/bărbaţi este de 2 la 1. Pe măsură ce populaţia trăieşte mai mult, creşte prevalenţa bolilor cronice. Persoanele vârstnice cu patologie complexă vor avea nevoie de multiple surse de îngrijire care să vină în întâmpinarea nevoilor lor de sănătate. Va fi necesar un sistem de servicii de sănătate care să fie adecvat şi să deservească nevoile lor multiple.

Cuvinte cheie: persoane vârstnice, Regiunea Europeană, speranţa de viaţă, reducerea speranţei de viaţă.

INTRODUCTION

There are about 612 million people over 60 years old today; 61% of the old are living in the developed countries. By 2025, it is estimated that there will be 1,2 billion old people and the number of those exceeding the age of 80 will increase. The increase of the number of population over 65 years old will be of 2,4 % yearly. This progressive increase of life expectancy will bring about high percentages (27% in Japan) of the population of

more than 65 years old, the same for Australia, Sweden, Canada, Switzerland.

This absolute and percentage increase of the old population is due to the contemporary époque and is expressed through:

 The decrease of fertility and birth rate;

 The decrease of mortality in young people and adults;

 The successes of the medicine against diseases, especially regarding the acute ones.

Women generally outlive men with 5-7 years, due to a masculine “overmortality” in all ages; that is why, women form the majority of the old population. The population aging is irreversible and is common to all countries. This phenomenon has become perceptible in Europe in the 60’s. The population increase rate exceeds by far the increase of the number of the population, in general. In 1990, the old population aged 65 and more represented around 4% of the total of the population of the developing countries and 12% of the developed countries.

The UN demographic projections for the year 2007 estimated the weight of the old people in the developed countries at about 18% and for the year 2020 at around 20%. The age group with the most accelerated growing rate is that of 80 years old, at the most and above. The special attention paid to the old population is motivated not only by the numeric increase, but also by the fact that the old population:

 Is an important consumer of medical services;

 Is more vulnerable to the different stresses of the social and physical environment.

The changes recorded in the family structure are also added to all these, in the sense that today, the members of the family are less preoccupied by the old people, especially if they are ill, preferring to institutionalize them in special care units.

There is no consensus in the specialized literature regarding the age limit, from where a person is considered old. Two criteria are taken into consideration:

biological and chronological, the latter being the most frequently used, although it arbitrarily establishes a limit.

There are differences between countries. For example, if we take into consideration the retirement age criteria for men, in Italy the age limit is 60 years old, in Romania and Spain – 65 years old, Denmark, Norway and Sweden - 67

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years old. Regarding women, the retirement age in Romanian and Belgium is 60 years old, 62 years old is in Switzerland, 65 years old in Sweden. In 1985, The General Assembly of the UN recommended the following classification, according to age:

 adults 45-59 years old

 full aged 60-64 years old

 old people 65-90 years old

 very aged people > 90 years old Today, the UN recommends the age of 65 years old as the age limit, from where a person is considered old.

Methods for measuring the population aging.

 Establishing the weight of the full-aged population regarding the total of the population;

 The average age of the population;

 The relation between the number of the full aged population and the number of children;

 Dependence index that represents the relation between the number of the inactive population and the number of people of active age.

The full-aged population of the European countries

1. Weight of the full-aged population regarding the total of the population.

According to the W.H.O. data (Table 1), there were 11.94% men above 65 years old and 17.4% women above 65 years old, at the level of the European region in the year 2004 (a difference of 5.46% between the weight of the women as against that of the men above 65 years old). The largest percentage of the male population above 65 years old is represented by Greece (16.19%) followed by Italy (16.01%), Germany (15.19%), Sweden 14.81%) and Bulgaria (14.71%). The smallest weight of the full- aged people, at a distance of 13.11 percentages as against Greece, is recorded by Turkmenistan with 3.08%, followed by Tajikistan (3.64%), Uzbekistan (3.78%), Kyrgyzstan (4.39%) and Kazakhstan (5.65%). Regarding the weight of the female population above 65 years old, Italy occupied the first place in Europe with 21.53%, followed by Germany (21.31%), Estonia (20.6%), Latvia, (20.45%) and Greece 19.74%. (Picture 1, 2, 3, 4 and 5) Picture no. 1, 2, 3, 4, 5. Weight of the full-aged population regarding the total of the population (2004)

11,94 7,4

8,48

13,33 5,7

10,13 13,41

14,71 11,15 10,86

13,38 17,4 8,33

11,55

19,03 7,64

18,14 18,97

19,4 16,69 12,98

19,66

0 5 10 15 20 25

European Region Albania Armenia Austria Azerbaijan Belarus Belgium Bulgaria Ceck Republic Cyprus Croatia

% of the populaiton above 65 years old (M)

% of the populaiton above 65 years old (F)

6 6 6

11,94 12,57

13,3 11,96

12,74 13,63 11,76

15,19 16,19 9,8

10,57

17,4 17,03 18,12

20,6 18,58

18,72 16,33

21,31 19,74 12,48

12,87

0 5 10 15 20 25

European Region Denmark Switzerland Estonia Finland France Georgia Germany Greece Ireland Iceland

% of the population above 65 years old (M)

% of the populaiton above 65 years old (F)

11,94 8,54

16,01 5,65

4,39

11,57 11,06

11,74 9,57

11,2 13,98

17,4 11,24

21,53 9,46

6,57

20,45 18,56 16,56 11,83

15,1 17,96

0 5 10 15 20 25

European Region Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Macedonia Malta Great Britain

% of the populaiton above 65 years old (M) % of the populaiton above 65 years old (F)

6

11,94 7,68

12,46 11,83 10,2

14,62 12,27 9,39

14,36 14,34 8,88

17,4 11,85

17,02 16 15,72

19,06 16,68

17,16 17,91

18,49 13,89

0 5 10 15 20 25

European Region Moldova Norway Netherlands Polond Portugal Romania Russia San Marino Serbia and Montenegro Slovakia

% of the populaiton above 65 years old (M)

% of the populaiton above 65 years old (F)

11,94 11,71

14,46 14,81 3,64

3,08

11,56 11,94 3,78

17,4 18,49

19,13 19,5 4,33

4,56

19,32 18,6 5,06

0 5 10 15 20 25

European Region Slovenia Spain Sweden Tajikistan Turkmenistan Ukraine Hungary Uzbekistan

% of the populaiton above 65 years old (M)

% of the populaiton above 65 years old (F)

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Table 1. Statistic data regarding the full-aged population of the countries of the European Region in 2004 (Source HFA – W.H.O.)

N0. Countries of the European region (EUR) % of the population above 65 years old (M) % of the population above 65 years old (F) Life expectancy at 45 years old, in years (M+F) Life expectancy at 45 years old, in years (M) Life expectancy at 45 years old, in years (F) Life expectancy at 65 years old, in ears (M+F) Life expectancy at 65 years old, in years (M) Life expectancy at 65 years old, in years (F) Reduction of life expectancy due to death before 65 years old (M+F) Reduction of life expectancy due to death before 65 years old (M) Reduction of life expectancy due to death before 65 years old (F)

European Region

(EUR), average values 11.94 17.4 32.59 29.43 35.57 16.8 14.75 18.38 7.17 8.99 4.8

1 Albania 7.4 8.33 33.54 31.53 35.71 16 14.47 17.54 5.23 6.16 4.12

2 Armenia 8.48 11.55 30.48 27.94 32.74 14.18 12.68 15.37 6.1 7.65 4.44

3 Austria 13.33 19.03 36.27 33.74 38.51 19.03 17.15 20.47 4.33 5.34 3.1

4 Azerbaijan 5.7 7.64 30.98 28.79 33.03 15.12 13.92 16.1 7.7 9.17 6.11

5 Belarus 10.13 18.14 27.89 23.28 32.26 14.12 11.38 15.96 10.15 13.18 5.95

6 Belgium 13.41 18.97 34.58 31.69 37.28 17.61 15.23 19.59 5.06 6 3.83

7 Bulgaria 14.71 19.4 30.47 27.48 33.48 14.87 13.26 16.25 7.27 9.18 4.97

8 Check Republic 11.15 16.69 32.62 29.72 35.35 16.21 14.29 17.7 5.25 6.67 3.46

9 Cyprus 10.86 12.98 35.98 33.9 38.04 18.1 16.61 19.51 3.56 4.66 2.33

10 Croatia 13.38 19.66 32.57 29.48 35.44 16.05 13.98 17.65 5.39 6.85 3.57

11 Denmark 12.57 17.03 33.93 31.96 35.77 17.07 15.43 18.47 4.77 5.38 4.01

12 Switzerland 13.3 18.12 37.37 34.93 39.54 19.76 17.73 21.39 3.99 4.73 3.06

13 Estonia 11.96 20.6 30.94 26.2 35.11 16.13 13.11 18.14 8.24 10.8 4.91

14 Finland 12.74 18.58 35.86 32.74 38.73 18.99 16.66 20.81 5 6.27 3.35

15 France 13.63 18.72 36.46 33.26 39.5 19.56 17.18 21.53 5.01 6.3 3.39

16 Georgia 11.76 16.33 33.92 32.26 35.6 17.48 17.25 17.89 6.39 8.71 4.16

17 Germany 15.19 21.31 35.84 33.36 38.1 18.69 16.84 20.15 4.33 5.27 3.15

18 Greece 16.19 19.74 35.7 33.78 37.58 18.1 17.02 19.07 4.05 5.35 2.61

19 Ireland 9.8 12.48 34.19 31.97 36.4 16.91 15.07 18.59 4.7 5.51 3.67

20 Iceland 10.57 12.87 37.5 35.5 39.5 19.63 17.97 21.22 3.45 3.95 2.92

21 Israel 8.54 11.24 36.36 34.58 37.95 18.69 17.38 19.77 3.96 4.82 3.03

22 Italia 16.01 21.53 36.73 33.98 39.22 19.15 16.92 20.99 4.06 4.97 2.94

23 Kazakhstan 5.65 9.46 26.81 22.75 30.65 13.39 11.18 14.96 12.18 15.46 7.94

24 Kyrgyzstan 4.39 6.57 27.77 24.78 30.73 13.87 12.27 15.16 11.54 13.98 8.55

25 Latvia 11.57 20.45 29.89 25.46 33.78 15.45 12.67 17.24 9.19 11.67 5.93

26 Lithuania 11.06 18.56 30.73 26.2 34.79 16.22 13.52 18.04 9.12 12.14 5.25

27 Luxemburg 11.74 16.56 36.13 33.26 38.74 19 16.8 20.7 4.44 5.65 2.96

28 Macedonia 9.57 11.83 30.82 28.91 32.8 14.44 13.35 15.46 5.9 7.23 4.35

29 Malta 11.2 15.1 35.92 34.12 37.5 17.95 16.46 19.17 3.52 4.1 2.87

30 Great Britain 13.98 17.96 35.73 33.82 37.49 18.38 16.86 19.67 4.34 5.06 3.49

31 Moldova 7.68 11.85 27.24 24.23 30 13.06 11.36 14.31 9.48 11.73 6.82

32 Norway 12.46 17.02 36.33 34.14 38.36 18.73 16.83 20.36 4.02 4.67 3.19

33 Netherlands 11.83 16 35.79 33.58 37.78 18.37 16.39 20.04 3.95 4.37 3.39

34 Poland 10.2 15.72 32.28 28.6 35.74 16.62 14.23 18.44 6.63 8.56 4.16

35 Portugal 14.62 19.06 34.72 32.09 37.19 17.61 15.82 19.13 5.11 6.55 3.45

36 Romania 12.27 16.68 30.27 27.35 33.17 14.94 13.38 16.23 8.06 10.08 5.64

37 Russia 9.39 17.16 26.35 21.61 30.9 13.69 11.12 15.35 13.28 17.04 7.99

38 San Marino 14.36 17.91 39.02 35.71 42.23 21.3 18.64 23.7 4.02 5.71 2.12

39 Serbia and Montenegro 14.34 18.49 30.09 27.91 32.24 14.36 13.21 15.32 6.68 8.17 4.95

40 Slovakia 8.88 13.89 31.2 27.69 34.49 15.43 13.27 17.06 6.52 8.36 4.22

41 Slovenia 11.71 18.49 34.13 30.83 37.11 17.63 15.09 19.48 5.31 6.51 3.61

42 Spain 14.46 19.13 37.1 34.09 40.01 19.65 17.43 21.59 4.19 5.39 2.71

43 Sweden 14.81 19.5 36.38 34.4 38.23 18.69 17.01 20.16 3.6 4.16 2.9

44 Tajikistan 3.64 4.33 30.9 29.39 32.46 15 13.64 16.32 7.99 8.4 7.47

45 Turkmenistan 3.08 4.56 28.15 25.55 30.67 13.82 12.36 14.93 12.72 14.88 10.09

46 Ukraine 11.56 19.32 27.48 23.1 31.55 13.93 11.64 15.48 11.22 14.61 6.85

47 Hungary 11.94 18.6 30.02 26.3 33.52 15.32 13.08 16.98 7.73 9.69 5.23

48 Uzbekistan 3.78 5.06 30.02 28.24 31.8 14.74 13.78 15.58 8.47 9.88 6.88

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All countries register large percentages of the female full-aged persons as against the male people, with differences varying between a maximum of 8.88%

(Latvia) up to a minimum of 0.69% (Tajikistan), (Graphic 6).

Picture no. 6, 7. – The percentage difference between the weight of men and women above 65 years old, for those 5 European countries with the largest weight of the women above 65 years old and for those 5 European countries with the largest difference (W.H.O., 2004)

0,00%

1,00%

2,00%

3,00%

4,00%

5,00%

6,00%

7,00%

8,00%

9,00%

Italy 5,52%

Germany 6,12%

Estonia 8,64%

Latvia 8,88%

Greece 3,55%

Difference F-M

7,2 7,4 7,6 7,8 8 8,2 8,4 8,6 8,8 9

Latvia 8,88

Estonia 8,64

Belarus 8,01

Russia 7,77

Ukraine 7,76

Difference F-M

2. Life expectancy of the population of the European Region

a. Life expectancy at 45 years old in the year 2004.

The largest life expectancy at 45 years old (total) is registered in San Marino 39.02 years (35.71 men and 42.23 women – with 6.52 years more than the men), followed by Iceland (37.5 years), Switzerland (37.37 years), Spain (37.1 years) and Italy (36.73 years).

The smallest values regarding life expectancy in the year 2004 are registered by Russia (26.35 years – with 12.67 years less than San Marino and with the largest difference between men and women – 9.29 years), Kazakhstan (26.81 years), Republic of Moldova (27.24 ani) Ukraine (27.48 years) and Kyrgyzstan (27.77 years).

Picture no. 8 – The difference in years regarding the life expectancy in men and women, at 45 years old for those 5 European countries with the largest difference (W.H.O., 2004)

8 8,2 8,4 8,6 8,8 9 9,2 9,4

Russia 9,29

Belarus 8,98

Estonia 8,91

Lithuania 8,59

Ukraine 8,45

Difference M-F

b. Life expectancy at 65 years old.

The estimated values at 65 years old place San Marino on the first place in Europe (21.3 years) followed by Switzerland (19.76 years), Spain (19.65 years), Iceland (19.63 years) and France (19.56 years).

The differences between the life expectancy in women and men with values from 5.06 years (San Marino) up to 0.64 years (Georgia) remained the same (Picture no. 8)

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Comparative situation of the countries of the European Region regarding the life expectancy of the population at the age of 45 and 65, per genders.

Picture no. 9 – Life expectancy of the population of the European Region in the year 2004. (Source HFA – W.H.O.)

0 10 20 30 40 50

San Marino Iceland Switzerland Spain Italy France Sweden Israel Norway Austria Luxembourg Cyprus Malta Finland Germany Netherlands Great Britain Greece Portugal Belgium Ireland Slovenia Denmark Georgia Albania Check Republic Croatia Poland Slovakia Azerbaijan Estonia Tajikistan Macedonia Lithuania Armenia Bulgaria Romania Serbia and Montenegro Uzbekistan Hungary Latvia Turkmenistan Belarus Kyrgyzstan Ukraine Moldova Kazakhstan Russia

Life expectancy at 45 years old, in years (M+F) Life expectancy at 65 years old, in years (M+F)

6

Picture no. 10. Life expectancy at 45 and 65 years old, per gender, in the European countries with reduced weight of the full-aged population.

25,55

29,39

28,24

24,78

22,75

28,79

31,53

24,23

27,94

34,58

29,43 30,67

32,46

31,8

30,73

30,65

33,03

35,71

30

32,74

37,95

35,57 12,36

13,64

13,78

12,27

11,18

13,92

14,47

11,36

12,68

17,38

14,75 14,93

16,32

15,58

15,16

14,96

16,1

17,54

14,31

15,37

19,77

18,38

0 5 10 15 20 25 30 35 40

Turkmenistan

Tajikistan

Uzbekistan

Kyrgyzstan

Kazakhstan

Azerbaijan

Albania

Moldova

Armenia

Israel

European Region

Life expectancy at 45 years old, in years (M) Life expectancy at 45 and 65 years old, in years (M) Life expectancy at 45 years old, in years (F) Life expectancy at 65 years old, in years (F)

6 6

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Picture no. 11. Life expectancy at 45 and 65 years old, per gender, in the European countries with the average weight of the full-aged population.

25,46

30,83

33,26

32,26

33,58

29,43

26,3

26,2

27,35

34,14

31,96 33,78

37,11

38,74

35,6

37,78

35,57

33,52

35,11

33,17

38,36

35,77 12,67

15,09

16,8

17,25

16,39

14,75

13,08

13,11

13,38

16,83

15,43 17,24

19,48

20,7

17,89

20,04

18,38

16,98

18,14

16,23

20,36

18,47

0 10 20 30 40 50

Latvia

Slovenia

Luxembourg

Georgia

Netherlands

European Region

Hungary

Estonia

Romania

Norway

Denmark

Life expectancy ay 45 years old, in years (M) Life expectancy at 65 years old, in years (M) Life expectancy at 45 years old, in years (F) Life expectancy at 65 years old, in years (F)

6 6

Picture no. 12. Life expectancy at 45 and 65 years old, per gender in the European countries with the largest weight of the full-aged population.

29,43

33,82

27,91

35,71

34,09

32,09

27,48

34,4

33,36

33,98

33,78 35,57

37,49

32,24

42,23

40,01

37,19

33,48

38,23

38,1

39,22

37,58 14,75

16,86

13,21

18,64

17,43

15,82

13,26

17,01

16,84

16,92

17,02 18,38

19,67

15,32

23,7

21,59

19,13

16,25

20,16

20,15

20,99

19,07

0 5 10 15 20 25 30 35 40 45

European Region (EUR)

Great Britain

Serbia and Montenegro

San Marino

Spain

Portugal

Bulgaria

Sweden

Italy

Greece Life expectancy at 45 years old, in years (M) Life expectancy at 45 years old, in years (F) Life expectancy at 65 years old, in years (M) Life expectancy at 65 years old, in years (F)

6 6

CONCLUSIONS

 The aging phenomenon is an irreversible phenomenon, common to all countries.

 In the year 2004, at the level of the European Region, there were 11.94% men above 65 years old and 17.4% women above 65 years old, regarding the total of the population.

 At the European Region level, there are large variations of the weight of the full-aged population in comparison with the total population. In all countries, the female full-aged population is predominant. The percentage differences between the two genders vary between 8.88% (Latvia) and 0.69% (Tajikistan).

 The estimated values of life expectancy at 45 and 65 years old place San Marino on the first place in Europe (39.02 years regarding the age of 45 years old and 21.3 years old regarding the age of 65 years old) Russia, on the last place (26.35 years regarding the age of 45) and the Republic of Moldova (13.06 years regarding the age of 65 years old).

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 The differences regarding the life expectancy in women and men remain constant, with values between 9.29 years, regarding the age of 45 years (Russia) up to 0.64 years (Georgia).

 At international level, the increase of the population above the age of 65% is of 2,4% yearly. The progressive increase of life expectancy will bring about increased percentages of the population above the age of 65 years old in the European Region countries, as well.

BIBLIOGRAPHY

1. ANR - Cod de etică pentru asistenţii medicali, 1999 2. Titirca L. - Tehnici de evaluare şi îngrijire acordate

de asistenţii medicali, Ed.Viata Medicala 1996 3. Ebersole-Hess - O îmbătrânire sănătoasă, 2000 4. Stanhope-Lancaster - Nursing comunitar, 2001

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