POPULATION AGEING: CARE
ROLES AND RESPONSIBILITIES OF
WOMEN AND MEN
Alice Nabalamba, Ph.D
Statistics Department
African Development Bank
Tunis, Tunisia
ESA/STAT/AC.219/30
POPULATION AGEING
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Population ageing is described as
the rise in the median age of a
population resulting in a shift in the
age structure of that population.
It is largely a consequence of
declining fertility rates and
increased life expectancies.
One of the important outcomes of an
ageing population is the shift in the
dependency ratio: (the number of people 15
years or younger and 65 years and older to every 100 people
of traditional working ages (15-64):
Dependency ratio declines in relation to
younger dependency as the median age
of the population rises
Dependence ratio increases in favor of
older population as the median age rises
OECD Countries
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In many developed countries, population
ageing is already taking shape - the
average age of populations is expected to
increase rapidly in coming years;
A direct consequence of the baby boom
from the late 1940s through the 1960s;
% of persons aged 65 years and older,
expected to increase rapidly over the next
few decades, reaching 25% of the total
population in most of the OECD countries.
In contrast, < 10% of the population was
65 years or older at the end of the 20th
century
Africa demographic trends
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
healthy life expectancy and life expectancy at
birth, have been relatively low for both men and
women,
the tendency has been that fewer people live to
reach age 65 years and older.
Nevertheless,
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
the overall life expectancy at birth in 1990 was 52.7
years and increased steadily to 54.8 years by 2009.
In 1990, women’s life expectancy at birth was 54.3
years compared to 51.1 years for men.
By 2009, women and men were expected to live up
to around 56.8 and 54.5 years respectively.
Healthy life expectancy was at 39.5 years for Africa
as a whole in 2000; 48.9 years by 2007.
Africa is also witnessing a shift in the
population structure: population aged 65
years and older is growing
Percent
4.00
3.50
3.00
2.50
YR
19
YR 99
20
YR 00
20
YR 01
20
YR 02
20
YR 03
20
YR 04
20
YR 05
20
YR 06
20
YR 07
20
YR 08
20
09
2.00
Proportion of Women and Men Aged 65 Years
and Over, 1999-2009, Africa, excluding
Seychelles and Somalia.
5.00%
Women
Men
4.00%
3.00%
2.00%
1.00%
0.00%
YR1999
YR2001
YR2003
YR2005
YR2007
Over the 10-year period, the growth in the elderly
population was highest among women
YR2009
Country Specific Demographic Changes:

Between 1999 and 2009, twelve countries recorded a
population aged 65 years or older of 4% or greater

In 1999, Tunisia had the largest elderly population
followed by Mauritius.
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By 2009, Mauritius had surpassed Tunisia as the
country with the highest proportion of the population
aged 65 years or older. (5.7% to 7.3%)
The number of older persons is also on the rise in
Morocco, Algeria, Libya and Egypt.
Elderly population is on the decline in Gabon, Cape
Verde, and Sao Tome and Principe; Burkina Faso,
Burundi, Chad, Equatorial Guinea, Kenya, Madagascar,
Mali, Rwanda, Sierra Leone, Senegal, Uganda, and
Zambia. (Range -0.1% to -0.7%)
Countries with population aged 65 years or older
exceeding 4% of the total population, Africa,
1999-2009
8.00%
YR1999
YR2009
7.00%
6.00%
5.00%
4.00%
SA
O
TO
AU
R
IT
IU
S
IS
IA
TU
N
M
M
O
R
O
C
TH
CO
O
IA
LE
SO
LG
ER
YP
T
A
A
TH
U
EG
A
A
FR
BO
IC
N
YA
G
PE
A
LI
B
DE
VE
R
A
ZI
M
B
C
SO
M
E
A
N
D
PR
IN
C
BW
IP
E
E
3.00%
Why we should be concerned about
an ageing population in Africa

Rapidly declining fertility rates;

An increasing life expectancy;

Rising median age (from 18.3 in
2000 to 27.5 in 2050);
Declining Fertility Rates, 1997-2009, Africa
1997
2000
2009
Africa
5.27
5.06
4.41
Mauritius
2.09
1.97
1.79
Tunisia
2.38
2.09
1.84
Morocco
3.02
2.70
2.33
Algeria
3.01
2.62
2.34
Egypt
3.49
3.32
2.82
South Africa
2.98
2.87
2.51
Libya
3.43
3.19
2.64
Botswana
3.75
3.41
2.82
Zimbabwe
4.12
3.86
3.36
Djibouti
5.20
4.80
3.79
Source: African Development Bank Group, Statistics Department, Social
and Economic Databases
Increasing Life Expectancy (Years),
Africa 1990-2009, 2002-2007
Life Expectancy at Birth
Total
Men
Healthy Life Expectancy
Women
Total
Men
Women
1990
2009
1990
2009
1990
2009
2002-2007
Africa
52.7
55.7
51.1
54.5
54.3
56.8
48.9
43.7
45.3
Libya
67.8
74.3
65.8
72.0
70.5
77.2
66.0
62.3
65.0
Tunisia
68.6
74.2
66.9
72.1
70.6
76.3
67.0
61.3
63.6
Algeria
67.0
72.7
65.9
71.2
68.3
74.1
63.0
59.7
61.6
Mauritius
69.2
72.1
65.5
68.5
72.9
75.8
65.0
60.3
64.6
Morocco
64.1
71.6
62.3
69.4
66.1
73.9
63.0
59.5
60.9
Egypt
62.9
70.3
61.6
68.6
64.3
72.2
62.0
57.8
60.2
Botswana
64.2
55.1
61.9
55.1
66.4
54.8
48.0
36.0
35.4
South
Africa
61.4
51.7
57.8
50.3
65.2
53.1
48.0
43.3
45.3
Lesotho
59.3
45.6
57.4
45.0
61.0
45.7
41.0
29.6
33.2
Swaziland
60.5
46.4
58.3
47.1
62.6
45.5
42.0
33.2
35.2
Zimbabwe
60.8
45.7
57.5
45.3
64.3
45.6
38.0
33.8
33.3
Population ageing is highly correlated with:

an increase in the prevalence of a
number of long-term chronic
conditions;
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physical and mental disability;

increased personal care needs.
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2006, the WHO projected that diseases associated with
ageing such as Alzheimer’s disease and other dementia,
Parkinson’s disease and others collectively accounted for
6.3% of disability-adjusted life years (DALYs).
The contribution of HIV/AIDS, all cancers, heart disease
and respiratory diseases to DALYs is (5.5%, 5.3%, 4.2%
& 4.0% respectively.)
More recent studies suggest that these conditions are on
the rise in the general population due to an ageing
population.
More alarming is that these conditions will increase more
rapidly in developing countries such as those in Africa,
Asia and elsewhere than they have been in developed
countries.
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Management of long term chronic conditions and
related disabilities requires a considerable amount of
resources from governments and families.
In much of Africa, governments still spend far less
per capita on health care and social protection.
Few African countries have public pension programs
or formal systems for caring for the elderly; most
rely on traditional family structures.
In 2005, governments in 48 of the 53 African
countries spent $25.70 per capita on households
while private households spent more than twice that
amount ($58.20) per capita (ICP-Africa, 2005).
Such a high disparity in health care expenditure
between governments and households has several
implications among which is the increasing burden
of care being shifted to those least able to afford it.
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Changing family structures resulting in
shrinking social support networks that many
older Africans have depended upon for
generations.
With increasing urbanization, and the ravages
of HIV/AIDS, this support network is being
dismantled.
In societies experiencing the HIV/AIDS
epidemic, older parents are increasingly
caring for grand children left behind by
victims of HIV/AIDS.
The rise in HIV/AIDS death rates has also led
to a rapidly increasing new category of
neglected elderly individuals or older adults
living alone without any caregivers.
Care roles and responsibilities of
Men and Women in Africa
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Care roles of men and women in the
context of population ageing are varied.
The general perception is that older people
are care receivers while younger ones are
care givers.
Recent evidence, in Africa, suggests that
older people are increasingly playing the
role of care givers as much as they are care
receivers.
A few sample surveys have been
undertaken in Africa to estimate the cost
and other challenges of care giving.
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The surveys are usually ad hoc
The samples are usually very small and
may not be representative of entire
country populations.
These sample surveys do not characterize
care givers to allow an assessment of the
varied responsibilities of men and women
in care-giving.
The surveys tend to focus on care giving
to terminally ill persons such as those
living with HIV/AIDS.
Measuring care roles and
responsibilities of women and men
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There is an urgent need to shed more light on the
important characteristics of care roles and responsibilities
of men and women.
It is important to establish who provides care to our aging
population in order to better understand the consequences
of care giving and how best to assist caregivers.
Available evidence on care giving in Africa suggests that
care giving is done by both young and old for various
reasons.
Younger caregivers may be working, in good health, have
children of their own and often providing care to someone
older than them; often juggle many demands in order to
provide care to their loved ones.
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The psychological and practical
dimensions of the relationship
between care giver and an older care
receiver are quite different than
those of a care giving relationship
between people within the same age
group such as siblings, friends, etc.
Elderly caregivers face different types
of constraints and challenges,
whether giving care to their own
adult children, orphaned
grandchildren, or contemporaries.
First, there is need to ascertain:
•
who the care receivers are, i.e., the proportion
of men and women in a population aged 65
years or older who report receiving assistance
during a reference period with at least one task
because of a long-term health problem.
•
the frequency of care receiving (daily, weekly,
biweekly, monthly, quarterly etc.,) by number
of hours.
•
the care provider(s), both young and old, men
and women, who report providing assistance,
during a reference period, with at least one
task because of a long-term health problem of
the care receiver.
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The frequency of care giving (daily,
weekly, biweekly, monthly, quarterly
etc.,) by number of hours spent.
Characterize the typical care-giving
tasks or responsibilities performed, by
male and female care givers;
Characterize the tasks for which care
receivers typically receive assistance,
taking into account the cultural and
social context of the population being
investigated.
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Given the unique experiences of younger and elderly
care givers, there is need to ascertain the physical,
emotional and psychological wellbeing of the care
givers, and the physical and mental challenges they
face everyday.
It is important to separate care giving involving
remuneration versus care giving without any
compensation.
The actual estimate of compensation should also be
obtained in order to impute the cost of care-giving for
those who do it voluntarily.
To fully appreciate care-giving and care receiving
roles, it is also imperative to obtain information on
other correlates such as age, sex, income (personal &
household), level of education, geography
(urban/rural) of the caregiver and care receiver;
Way Forward
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In light of the ageing population and
related disabling conditions, the
increased burden of HIV/AIDS in Africa,
it is important to establish who provides
care and to whom, as well as the type
of care, in order to better understand
the human, psychological and financial
cost of care giving and how best to
assist caregivers.