Birth, ageing, illness and death – the four bitters of life – once this journey has begun, there is no one that can turn back. But the transitions from ageing to illness, and from illness to death, are not necessarily instant, and in the end depend on whether one can invigorate body and mind in spite of physical changes, as well as whether the complete preparation of long-term care can accompany physical changes.
Every country in the world is currently facing the problem of an ageing population, but the issue is particularly serious in developed countries, due to prolonged life expectancy and a reduced birth rate. This can be seen from the “ageing index”, that is, the proportion of the population aged 65 or above divided by the population under the age of 14. The higher the index, the more serious is the extent of ageing.
In developed countries, the average ageing index is 106%. When it comes to that of individual countries, Japan’s is 200%, Germany’s is 162%, Canada’s is 100%, France’s is 95%, the United Kingdom’s is 94%, Korea’s is 93%, Singapore’s is 69%, and so on. In contrast, developing countries average 21%, with China at 59%, Malaysia at 23%, the Philippines at 12%, and so on.
In the case of Taiwan, its ageing index is 92%. But from the evidence, Taiwan’s rate of ageing is like an unstoppable train, with the speed surpassing that of any developed country.
Four key data trends indicating a super-aged society
1. Nine-year countdown to a super-aged society
As early as 1993, the proportion of elderly people in Taiwan reached 7%, making it an “ageing” society. This rate is expected to reach 14% by 2018, when it will become an “aged” society. By 2025, more than 20% of the population will cross the threshold, making Taiwan a “super-aged” society, where one in every five people will be elderly.
Between turning from “ageing” to “aged”, Taiwan only has 25 years, which is a much faster transition than Germany’s 40 years, the United Kingdom’s 47 years, the United States’ 72 years and France’s 127 years.
Even more surprising is that the transition from “aged” to “super-aged” is estimated to only take 7 years in Taiwan, which is much faster than Europe and the United States’ 20 to 50 years, as well as faster than all East Asian countries.
(Generally, people aged 65 years of age or older are defined as elderly, and the ratio of the elderly population to the total population is used as the ageing index).
2. In 45 years, an average of 1.2 young people will need to support every elderly person
About 35 years ago, Taiwan’s “old-age dependency ratio” was 6.9%, meaning that every 14.5 young adults needed to support one elderly person. However, this figure had more than doubled to 16.2% by 2014, meaning that every 6.2 young adults needed to care for one elderly person. It is estimated that in 2061, 45 years from now, this will surge to 81.4%, when every 1.2 young adults will need to bear the weight of one elderly person, such that the ratio will be close to 1:1.
(The “old-age dependency ratio” refers to the proportion of every 100 adults (15 to 64 years) needed to support the elderly population.)
Such a trend is closely related to a “low birth rate”. In 2061, it is expected that the number of young people under 15 will have reduced by 1.7 million and the number of young and middle-aged people by 8.31 million. On the contrary, the elderly population will increase by 4.54 million, among whom a large proportion of people with disabilities will be in need of full-time care.
3. Elderly people with disabilities continue to increase in number
In 2015, the number of people with disabilities over the age of 5 in Taiwan was 760,000, of which the elderly accounted for nearly 500,000. By 2031, it is expected that the total population with disabilities will increase to 1.2 million people, of which the elderly will account for 950,000. In 2060, the disabled population will rise to 1.96 million, of which the elderly will make up 1.8 million, more than 90%.
The proportion of elderly people among those with disabilities is gradually increasing. Although this indicates increased life expectancy, it does not necessarily mean that people are in good health.
(The term “physical or mental disability” refers to a physical or mental function that is partially or completely lost, resulting in the need for assistance in daily life.)
4. The average time spent bed-ridden is up to 7 years, while it is only 14 days in Nordic countries
In recent years, the life expectancy of the people of Taiwan has been increasing annually. In 2015, the national average was 80.2 years old, with males at 77.01 years old and females at 83.62 years old.
However, the level of health has not kept up. The Taiwanese average time bed-ridden is up to 7 years, whereas people in Nordic countries spend an average of 2 weeks bed-ridden before death. Confined to bed for an extended period, people with disabilities can only rely on the care of their families or caregivers, thus becoming a heavy burden.
“Active Ageing”, helping the elderly enjoy life
With an ageing population and a low birth rate, the population structure will gradually become an inverted pyramid. However, if an “Active Ageing” environment can be created, it may be possible to step on the brakes before the crisis.
In 2002, the World Health Organisation (WHO) advocated the concept of social support for the elderly through family, community, peer and social channels. In Taiwan today, there are already many social enterprises that have been established in response with all kinds of innovative services, such as the Hondao Senior Citizen’s Welfare Foundation, iHealth Express, Duofu Care & Services, and MABO Technology.
The Hondao Senior Citizen’s Welfare Foundation organises a series of “forever young” activities on a regular basis to encourage the elderly to show off their vitality. In addition, the concept of “All in One”, introduced from Denmark, allows caregivers to form a highly mobile team to take care of people in need. At the same time, Hondao has broken convention by changing the traditional piece rate system to a monthly salary, as well as given caregivers a more visible ladder for career promotion.
iHealth Express is the first “home-visit pharmacy service”. No matter whether the chronically ill live in urban or rural areas, pharmacists personally visit them in their homes to give advice related to medication knowledge, health information, and eating habits. This initiative is hoped to prevent patients neglecting treatment due to travel fatigue.
Duofu Care & Services is a “barrier-free” shuttle service that meets the needs of pregnant women, young children, elderly people and wheelchair users. As well as being a simple shuttle service, it has also developed accessible travel services for clients, arranging packages and customised itineraries so that those with reduced mobility can enjoy outdoor travel.
When Mabow Technology saw that many children and grandchildren could not spend time with their elderly relatives because of work commitments, they developed a TV set top box so that elderly people would only need to press the remote control to immediately connect via video with their children and grandchildren. In addition, MABO has launched a “virtual golden grandchildren” service, training selected personnel to video chat with the elderly in order to meet their social and psychological needs.
It is less than 10 years until we have a “super-aged society”. Instead of waiting for government help, many social enterprises pulled their sleeves up to help long ago. They use the concepts of Active Ageing, health promotion and more to care for the health of elderly people, as well as to attempt to build a kingdom of entertainment. Who said that the elderly cannot lead a happy, healthy life?