Who will care for the oldest people in our ageing society?

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Abstract
Population ageingMost studies of population ageing use demographic indicators based on a three age group population model—young people, those of working age, and elderly people. This model does not reflect the current population changes.13 Indeed, the demographic dependency ratio (the ratio of young and elderly people to working people) will start to fall steeply only around 2010, as a result of ageing of the baby boomer generation (born after the second world war).14 This indicator cannot properly reflect the large increase in the numbers of frail elderly people who may be highly dependent on others in their daily life.The consequences of the demographic transition that occurred during the 20th century in Europe and North America were largely ignored. Population ageing is characterised by changes in the proportions of the different age groups. The sequence of changes begins with a decrease in the proportion of young people and a large increase in the working age group before leading later to an inescapable increase in the oldest age group. Within this group, younger retired people contribute increasingly to the long term care of very elderly people by providing informal care to their parents. This active retired generation, called the “sandwich” or “pivotal” generation, will have to play a greater part in the future as the oldest old are expected to make up an increasing proportion of the number of retired people.15These significant changes in the population age structure will have a big effect on intergenerational relationships. As the three age group population model cannot reflect this, it is time to move to a four age group population model comprising young people, those of working age, younger retired people, and the oldest people.