Choice in a demographic timebomb?

demographic timebomb

There’s lot of talk about the demographic timebomb — with increases in life expectancy, and the trend (in the West) for smaller family sizes.

Globally the percentage of the population that is 65 or older will double from 10% to 20% by 2050. In the UK, forecasts suggest there will be only 3.3 working age adults earning money to support the pensions and care of each elderly person.

This is better than in Japan, where there are only 2.1, but much less secure than the 11.3 in Bangladesh.

This demographic timebomb is not only an economic problem. Where are all the carers going to come from as these older people get sicker and frailer, and need support?

Etkind has projected how many people will need palliative care. He suggests that:

  • 75% of people would benefit from palliative care
  • Annual deaths in England and Wales are predicted to rise by over 25% by 2040.
  • If current (increasing) trends around palliative care continue, an extra 42% of people will have palliative care. That’s an extra 162,000 people every year!
  • The biggest increases are for people with dementia. 59,199 people died with dementia in 2014. By 2040, it is projected that 219,409 people will die with dementia. That’s each year!

Etkind’s paper is about palliative care — and all the specialist doctors and nurses needed for this. He says: “Current models of palliative care must adapt to these projected changes, and greater focus on non-specialist health professional education is needed.”

I’m even more concerned on the hands-on care that will be needed. People with dementia, especially, will need good quality hands-on care for many years.

But UK government policy is still fixated on ‘choice’. Even though the choices for someone with advanced dementia are actually really quite limited. Especially in todays climate of social service cuts, and with so many care homes closing.

At the recent annual review of government policy, Scott Sinclair, Head of Policy and Public  Affairs at Marie Curie, said:

“We welcome the Government’s focus on end of life care… However, in the two years since the publication of the Independent Review on the Choice of Life, there has been a disappointing lack of progress on preparing for the increased demand in palliative and end of life care services that our ageing population will surely require. With the amount of nurses applying to work in the UK from the EU dwindling, and fewer Brits opting to undertake nursing training, the Government needs a sharp focus on preparing the NHS to tackle increasing demand for palliative care services in a world in which there are fewer resources and fewer people undertaking caring roles. We are deeply concerned that the Government and NHS England are not currently demonstrating when or even how they will tackle this problem. ”

I have heard it suggested that the demographic timebomb could also be a demographic opportunity. Since older people are more likely to volunteer, they could — or is it should? — volunteer to help as their relatives, friends, and relatives get older.

This burden is surely going to fall disproportionately on women.

And how will it work in deprived areas where healthy life expectancy is only 53? The middle-aged sick struggling to help even older, even sicker people?

Life and death as we grapple with the demographic timebomb is not an attractive picture, is it!

And its not only older people who are going to be affected. Younger people will be working. And some of them will inevitably be caring for their elders.

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