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The Demography of Current arid Future Aging Cohorts William J. Serow and David F. Sly For a number of years, demographers have been making peri- odic forays into the realm of aging issues (HermaTin, 1966; Key- fitz, 1968; Lopez and Hanada, 1982; Manton, 1982; Pearl, 1940) and in fact much of their general subject matter deals either directly or indirectly with population aging (Coale, 1964; Cowgill, 1974; Myers, 1985a). Yet systematic efforts to define and give legitimacy to "population aging" as a subfield of de- mography are of relatively recent vintage (Myers, 1985b; Siegel, 19801. These excellent essays nonetheless accomplish their objec- tive of providing clear, concise statements about the substantive domain of the field and the approaches that demographers can use to analyze and explain the causes and consequences of pop- ulation aging. Moreover, some legitimacy has been given to the field by the extent of agreement these researchers show concern- ing the basic parameters that define it. For example, demographers generally agree that they should be primarily concerned with aging as an aggregate phenomenon and that there are two aggregates of primary concern: (1) the total population and (2) the population older than some specified William Serow is professor of economics and associate director at the Center for the Study of Population at Florida State University, Tallahassee. David Sly is profes- sor of sociology and director of the Center for the Study of Population. Their research for this paper was supported by National Institute of Aging research grant AG05395. 42

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DEMOGRAPHY OF CURRENT AND FUTURE COHORTS 43 age. With respect to the former, demographers concern them- seIves with how general population processes influence the age composition of populations and the causes and consequences of changes in that composition. In terms of the latter, demogra- phers consider the older population as a subpopulation and study the causes and consequences of changes in its size, composition, and distribution. Although there is agreement that these two aggregates are clearly distinguishable as different points of an- alytical departure, there is also consensus that neither can be viewed in total isolation from the other. That is, an understand- ing of how aging evolves in a population is crucial to under- standing changes in the older population and the causes and consequences of such changes. Just as these essays reflect a high level of agreement about the general domain of the demography of aging, so too do they reflect accord when it comes to general analytical strategies and techniques of analysis. Clearly, then, the demography of aging has gained legitimacy as a specialized subfield in an academic sense, but a question essential to our undertaking here is whether it can also be given legitimacy in a more practical sense. More specifically, we need to ask how an awareness of the knowledge provided by the demography of aging can help policy- makers and others charged with the responsibility of planning for the needs of this group as well as for the consequences of changes in it. It is not possible here to present a fully developed response to this question, but it is possible to provide a broad overview of some of the general ways in which knowledge of the demo- graphic structure of the population as a whole and of the chang- ing demographic structure of the elderly will assist policymak- ers and planners. For example, the needs of this subpopulation and its resulting demands are going to be strongly influenced by its size. In this sense, it is important for us to know much more about patterns of mortality and longevity and how these are changing. This may sound simple, but the complexity of such knowledge is evident when we consider that the size of this population is influenced by historical patterns of fertility and morality to the point at which persons enter o]Ld age, as well as by patterns of mortality throughout the older years of life- to say nothing about the patterns of immigration and emigration over the whole course of life. Similarly, the structure of the .

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44 WILLIAM J. SEROW AND DAVID F. SLY processes that are responsible for growth in the elderly popula- tion (fertility, mortality, and migration) and the changes that are likely to occur in that structure will influence the demand for "needs" and even influence what these needs are and will be. For example, temporal patterns of childbearing (when com- bined with increased longevity) across generations influence how old children are when their parents reach old age and may have profound influences on the physical, economic, and social ability of children to care for their aging parents. Similarly, changing patterns of mortality may not only influence the number of people who reach old age but may also affect how many people survive for longer periods after reaching old age. In addition, changes in mortality may have an impact on the physical, eco- nomic, and social abilities of this sub-population's members to care for themselves. In short, we must understand how trends in basic demo- graphic processes have operated (and will operate) over time so we can better estimate the size of this subpopulation and the level of demand it will create for various needs. Similarly, vari- ations over time in the levels and structures of basic demo- graphic processes have important implications for both the types of specific needs likely to arise and the types of options available for meeting them. Population composition and distribution will also affect de- mand. The socioeconomic status of the elderly subpopulation will influence both the level of demand for needs and the types of needs that will emerge. In this sense, it is important for us to understand more clearly how the economic composition of the elderly population is changing and the factors that are respon- sible for this change. Different cohorts have quite different sav- ings and labor force opportunity patterns, which can have quite different consequences for the financial abilities of the popula- tion during the early years of old age. In a similar fashion, increased longevity among the aged will have important conse- quences for how long savings and retirement income will have to last, which in turn may have important consequences for how the elderly dispose of income and savings throughout old age. Levels of income and savings are also likely to have important consequences for how much support will have to be provided through the public sector; longevity will influence not only how

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DEMOGRAPHY OF CURRENT AND FUTURE COHORTS 45 many persons will have to be supported, but also when in old age such support wit! begin and for how Tong it will be needed. We can also expect the economic composition of the elderly population to have important consequences for the private sec- tor. Although we cannot explore the full range of such possibili- ties here, it should be obvious from what has already been said that everything from product development and retailing to fi- nancial markets and the structure and availability of credit could be significantly affected by changes in the economic com- position of the elderly population. The economic structure and circumstances of the elderly are not the only compositional factors that will influence the social and built environment. Other important elements include the level of labor force participation and the structure of the elderly labor force including the age of exit. In addition, we must take into account changes in the marital status composition of the elderly, which are affected by cohort patterns of divorce and singleness as well as by changes in mortality differentials by sex. All of these factors are likely to influence the demand for and types of needs in such areas as housing, health care, recre- ation and leisure, and living arrangements. Population distribution will also be an important considera- tion in determining the level and types of needs prevalent in the elderly population. Redistribution of this population occurs es- sentially as a result of areal differentials in mortality and mi- gration. Where the elderly reside will obviously play a key role in determining where services will have to be delivered and what needs must be satisfied, but equally important is that, to the extent these processes operate in a selective manner, we can expect that areas with different redistribution experiences are likely to have elderly populations with different needs. Unfor- tunately, little is known about areal differentials in mortality and migration and the factors that affect them, especially for some very important types of areas such as metropolitan areas. For our purposes here, however, and probably of greater impor- tance is the fact that even less is known about the population compositional differentials among areas that are being created by redistribution. To this point, we have focused almost exclusively on how a knowledge of demographic trends can further our understand

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46 WILLIAM J. SEROW AND DAVID F. SLY TABI~E 1 Size of the Older Population by Age and Sex, 1940-1980 1980 1970 1960 Totals Totals Age Group Male Female by Age Male Female by Age Male 45~9 5,388,249 5,701,506 11,089,755 5,851,334 6,264,605 12,115,939 5,357,925 50-54 5,620,670 6,089,362 11,710,032 5,347,916 5,756,102 11,104,018 4,734,829 55-59 5,481,863 6,133,391 11,615,254 4,765,821 5,207,207 9,973,028 4,127,245 60-64 4,669,892 5,417,729 10,087,621 4,026,972 4,589,812 8,616,784 3,409,319 65-69 3,902,955 4,879,526 8,782,481 3,122,084 3,869,541 6,991,625 2,931,088 70-74 2,85S,547 3,944,577 6,798,124 2,315,000 3,128,831 5,443,831 2,185,216 75-79 1,847,661 2,946,061 4,793,722 1,560,661 2,274,173 3,834,834 1,359,424 80-84 1,019,227 1,915,806 2,935,033 875,584 1,408,727 2,284,311 665,093 85-89 477,185 1,043,107 1,520,202 362,063 656,084 1,018,147 255,776 90+ 204,340 515,525 719,865 180,316 312,438 492,754 106,500 Total of all age groups 110,053,161 116,492,644 226,545,805 98,912,192 104,299,734 203,211,926 88,331,494 Total persons aged 55 + 20,456,670 26,795,632 47,252,302 17,208,501 21,446,813 38,655,314 15,039,661 Total persons aged 65 + 10,304,915 15,244,512 25,549,427 8,415,708 11,649,794 20,065,502 7,503,097 Total persons aged 75 + 3,548,413 6,420,409 9,968,822 2,978,624 4,651,422 7,630,046 2,386,793 Total persons aged 85 + 681,525 1,558,542 2,240,067 542,379 968,522 1,510,901 362,276 Percentage of total population 55 + 20.9 19.0 65 + 11.3 9.9 75 + 4.4 3.7 85 + 1.0 0.7 Percentage Change 1970-1980 1960-1970 1950-1960 1940-1950 55 + 22.2 . 20.3 25.4 30.7 65 + 27.3 21.2 34.8 36.2 SOURCES: U.S. Bureau of the Census, 1943 (Table 1), 1953 (Table 94), 1964 (Table 156), 1972 (Table 50), and 1983 (Table 40). ing and our ability to predict the demand for needs among the elderly. It is equally important to realize that a knowledge of demographic trends will also help us to better understand and predict the extent to which we will be able to supply these needs and the kinds of trade-offs that may be necessary in order to do so. Some of the subpopulation factors mentioned in the preced- ing paragraphs may influence supply-side considerations, but the more important factors in this sense will emerge from con- sidering the elderly in relation to the total population. For ex- ample, fairly good evidence suggests that as federal monies for the elderly have increased, dollars for the youngest segment of the population have decreased. Similarly, the viability of the

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DEMOGRAPHY OF CURRENT AND FUTURE COHORTS 47 1950 1940 Totals Totals Totals Female by Age Male Female by Age Male Female by Age 5,521,560 10,879,485 4,545,606 4,556,172 4,871,125 9,605,954 4,142,277 4,153,303 4,302,620 8,429,865 3,639,761 3,612,763 3,733,133 7,142,452 3,047,212 3,027,151 3,326,822 6,257,910 2,431,035 2,582,455 2,553,716 4,738,932 1,633,382 1,785,826 1,694,135 3,053,559 992,645 1,157,730 914,834 1,579,927 500,345 624,225 392,805 648,581 177,760 251,845 174,171 280,671 56,670 91,175 9,101,778 4,209,269 8,290,580 3,752,750 7,252,524 3,011,364 6,074,363 2,397,816 5,013,490 1,896,088 3,419,028 1,270,967 2,150,375 723,680 1,124,570 359,011 429,605 121,455 147,845 34,919 4,045,956 8,255,225 3,504,096 7,256,846 2,832,501 5,843,865 2,330,524 4,728,340 1,910,569 3,806,657 1,298,565 2,569,532 780,302 1,503,982 415,380 774,391 155,557 277,012 52,821 87,740 90,991,681 179,323,175 74,833,239 75,864,122 150,697,361 66,061,592 65,607,683 131,669,275 17,092,236 32,131,897 9,056,483 16,559,580 3,175,945 5,562,738 12,478,810 13,133,170 5,791,837 6,493,256 1,727,420 2,124,975 25,611,980 9,815,300 12,285,093 4,406,120 3,852,395 1,239,065 9,776,219 19,591,519 4,613,194 9,019,314 1,404,060 2,643,125 566,976 929,252 234,430 343,020 577,450 156,374 208,378 364,752 18.5 17.0 14.9 9.2 8.1 6.8 3.1 2.6 2.0 0.5 0.4 0.3 current Social Security program is directly tied to the availabi- lity of workers and the ratio of workers to retirees. This discussion, although general, should make it clear that demographic trends play a key role in shaping the social and built environment and can have an important influence on dem- ographic trends. In the pages that follow, we will trace the evo- lution of the elderly population in the United States, giving particular attention to the emergence of the "oldest old" as a significant subpopulation and the "new aged" as a group that has emerged from different social and built environments. Both of these groups will pose new and different challenges to policy- makers responsible for guiding the emergence of a social and built environment to meet their needs.

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48 WILLIAM J. SEROW AND DAVID F. SLY THE EVOLUTION OF THE OLDER U.S. POPULATION By now, nearly everyone is aware, at least in a general way, of the rapid growth that has occurred in the nation's older popula- tion (Siegel and Davidson, 1984; Population Reference Bureau, 19751. The data in Table 1 allow us to detail some of the high- lights of the recent changes in the size of this subpopulation. Perhaps one of the most important points to be made from these data is that both the size and the pace of change in size are strongly influenced by the age criterion employed to define the "older population." In the discussion that follows, we focus on the ages 56 and older and 65 and older because for most pur- poses these two ranges represent the lower and upper ages within which most persons have defined the older population. In 1940 there were just over 20 million persons who were 55 years of age or older; just over 9 million of these were 65 or older. The number of persons above these ages has increased steadily during each successive decade and roughly doubled dur- ing each of the 30-year intervals within the 40-year period; that is, there were nearly twice as many older persons in 1970 as in 1940, and there were twice as many in 1980 as at midcentury. Indeed, by 1980 the number of persons aged 55 and older had passed the 47.25 million mark, and the number of persons aged 65 and older exceeded 25.5 million. These recent figures repre- sent a 141 percent increase in the number of persons 55 and older during the 40-year period and a 183 percent increase in the number of persons 65 and older. To put the magnitude of these increases into proper perspective, we need only consider by way of contrast that the nation's total population increased by 72 percent (from around 132 million to 227 million) while the population under the age of 15 increased by just 55 percent (from about 33 million to 51 million persons). Although the increase in the older population seems quite substantial, particularly when compared with the increase in the total population and its youngest dependent sector, the most substantial increases have actually occurred within the oldest age groups of the old. For example, the number of persons aged 75 and older was more than 275 percent higher in 1980 than in 1940. Yet even this increase seems small compared with the

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DEMOGRAPHY OF CURRENT AND FUTURE COHORTS 49 increase in the number of persons SS and older, which went from 0.36 million in 1940 to over 2.2 million in 1980 an increase of nearly 515 percent and 10 times greater than the increase occur- ring within the group of individuals under the age of 15. Components of Change The number of elderly in the population can change from one decade to the next as a result of three basic processes. One of these processes, the aging of younger cohorts, is similar to fer- tility in the general population in the sense that it is the basic mechanism through which people are added to the ranks of the elderly. Mortality, on the other hand, is the basic mechanism by which people leave the population. Migration can make either a TABLE 2 Components of Change (in millions) for the Population Aged 65 and Older, 1940-1980 Components 1970-1980 1960-1970 1950-1960 1940-1950 Population at end of decade 25,549 20,066 16,560 12,285 Population at beginning of decade 20,066 16,560 12,285 9,019 Net increase 5,483 3,506 4,275 3,266 Gains-persons reaching 65 17,455 14,242 12,396 9,776 Losses Death to 65+ 12,265 11,027 8,623 6,713 Deaths to initial population 10,096 9,007 6,921 5,167 Deaths to remaining population 2,169 2,020 1,702 1,546 Gross change 29,720 25,269 20,619 16,489 Percentage of changes Rate of gross gain 87.0 86.0 100.1 108.4 Rate of gross loss 61.1 66.6 70.2 74.4 Rate of net gain 25.9 19.4 29.9 34.0 Total death rate 32.7 35.7 34.9 35.7 MRIP 65+ 50.3 54.4 56.3 57.3 MRPR 65 12.4 14.1 13.7 15.8 NOTE: MRIP 65 + = Mortality rate for initial population 65 and over. MRPR 65 = Mortality rate for persons reaching 65. SOURCE: Adapted from Siegel and Davidson, 1984.

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50 WILLIAM J. SEROW AND DAVID F. SLY positive or negative contribution to the growth of the elderly population. In Table 2 we present data that show the changes over decades in the number of persons aged 65 and older, along with estimates of the contribution of the components of change. In making these estimates, we have relied on basic census sur- vival techniques, and we have made no effort to take account of migration or of the varying degrees of coverage or accuracy of reporting age between censuses. Although we want to empha- size that these estimates do contain errors, we are also confident that they are sufficient to capture the general trends in the components. Between 1940 and 1950 the number of persons 65 and older increased by nearly 3.3 million from an initial population of just over 9 million. Achieving this net gain required the addition of nearly 10 percent more people to the 65-and-older group than were already part of it at the beginning of the decade because nearly 60 percent of the persons 65 and older in 1940 died during the decade, as did about 16 percent of those persons who aged to 65 and older during the decade. In other words, nearly 75 deaths occurred over the decade to persons who were 65 and older or who aged into this group for each 100 persons who were already this age at the beginning of the decade. By the next decade (1950-1960) the number of deaths had declined to around 70 per 100 people at the beginning of the decade. Most of the improvement in this figure resulted from a decline in the deaths of persons reaching age 65 or older during the decade rather than a decline in deaths to persons already 65 at the start of the decade. At the same time, there was a sub- stantial increase (3.5 million) in the number of persons who aged into the elderly group during this decade from the number who had done so during the previous decade. Thus, the resulting net increase in the number of persons aged 65 or older during the period can be thought of as resulting primarily from persons "aging in" and from a decline in the number of deaths in the group. Had the trends of the 1950s continued, the elderly population would probably have begun to "young" eventually. That is, the average age of the elderly would have begun to decrease. This did not happen, however, and a number of changes in trends were initiated during the 1960s that reversed the potential di

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DEMOGRAPHY OF CURRENT AND FUTURE COHORTS ~1 rection of the l950s. First, the death rate of persons reaching age 65 and older stabilized and was at nearly the same level during this decade as it had been during the previous decade. Second, the death rate for persons 65 and older began to decline rather substantially. Finally, this was the first decade during which the number of persons aging into the elderly population was considerably smaller than the number of elderly at the beginning of the decade. In this sense, it is important to note that the latter was not a function of a decline in the number of persons aging into the elderly population; this figure actually increased by nearly 2 million over the number aging in during the previous decade. Rather, the smaller number was a function of the increased chances of survival for those aging in during earlier decades and the increasing size of the cohorts supplying these individuals. During the 1970s the trends that had emerged in the 1960s continued, and the result was the largest interdecade net in- crease in the number of elderly over the period being considered. The cohorts aging in were some 2.2 million persons larger than the cohorts that had aged in during the 1960s; they constituted roughly the same proportion (87 percent) of the population aged 65 and older at the beginning of the decade as was true of those aging in and those 65 and older during the 1960s. Whereas the mortality rate for those persons aging in was nearly stable be- tween the 1950s and the 1960s, there was once again a substan- tial reduction between the 1960s and the 1970s. Even this reduc- tion (1.7 deaths per 100 persons), however, was small compared with the reduction of 4.1 deaths per 100 population that occurred for persons who were 65 and older at the beginning of the decade. Age Composition of the Elderly Population Thus, over the whole period under consideration (1940-1950 to 1970-1980), the number of persons reaching age 65 and older during the last decade was some 78 percent larger than during the first, the mortality rate for persons 65 and older at the start of each decade decreased by more than 12 percent, and the mortality rate for those reaching age 65 and older during the decade decreased by over 21 percent. The percentage of the total population in this group increased steadily from just 6.S percent

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52 WILLIAM J. SEROWAND DAVID F. SLY in 1940 to 11.3 percent in 1980; the comparable change for the population aged 55 and older was from 14.9 percent to 20.9 percent. The data presented earlier documenting the growth of the elderly population, and in particular those data dealing with the components of change, strongly suggest that there have been significant changes in the composition of this population. What is interesting in this sense is that many of these changes are not as dramatic as some people have believed whereas others are more dramatic than is usually thought. A clear example of the former can be seen in Table 3. Many people still believe that the average age of the elderly population has increased dramat . ~ ~ ~ ~ . ~ ~ ~ 1 _ _ 1 ~ 1 Lie ~ ~ ~ ~ a_ ~ ~ ~ at +1-~ ~ ah ~ ically over the past tew clecactes, DUE Inese data snow ant Ills mean age for persons 55 and older increased over the past five decades by just 2 years to 67.7 in 1980. Over the same period, the population aged 65 and older aged by 1.7 years to 74.4. These averages, however, are strongly influenced not merely by the decreases in death rates discussed earlier, but also by the sharp increases that have occurred in the size of the cohorts entering the elderly ages between each decade; in other words, TABLE 3 Age Composition (percentage) of the Population Aged 55 and Older and of the Population Aged 65 and Older, 1940-1980 Age 1980 1970196019501940 Population groups aged 55 and older 55-59 24.7 25.8 28.7 28.3 30.0 60-64 21.3 22.3 21.5 23.7 24.1 65-69 18.6 18.1 18.8 19.6 19.4 70-74 14.4 14.1 14.3 13.3 13.1 75-79 10.1 9.9 9.2 8.4 7.7 80-84 6.2 5.9 4.8 4.4 3.9 85-89 3.2 2.6 1.9 1.7 1.4 90+ 1.5 1.3 .8 .6 .4 Mean 67.7 67.2 64.6 66.1 65.7 Population groups aged 65 and older 65-69 34.4 34.8 37.8 40.8 42.2 70-74 26.6 27.1 28.6 27.8 28.5 75-79 18.8 19.1 18.4 17.5 16.7 80-84 11.5 11.4 9.5 9.1 8.6 85-89 5.9 5.1 3.9 3.5 3.1 90+ 2.8 2.5 1.8 1.3 .9 Mean 74.4 74.1 73.4 73.0 72.7 SOURCE: Derived from Table 1.

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92 WILLIAM J. SEROW AND DAVID F. SLY associated with greater levels of chronic conditions and greater use of health care facilities and providers. As noted earlier, much of the underlying cause of the contin- ued aging of the older population lies in declining mortality. One of the critical issues that will arise in conjunction with this aging and that is of particular relevance to the social and built environment is the question of Tong-term care needs. Ries (1985) recently prepared projections of total population and nursing home residents, by age, for the year 2003 under conditions of constant and declining mortality (Table 211. Even in the un- likely event that there would be no changes in mortality be- tween the years covered by this study (1978-2003), Ries projects that the number of nursing home residents will increase by nearly 60 percent, from 1.2 million to 1.9 million. If, however, age- and sex-specific mortality continues to decrease, as it did during the period from 1966 to 1976, then the number of nursing home residents would rise by more than 100 percent to 2.6 million. THE FUTURE OLDER POPULATION In the first three sections of this paper, we examined (1) the basic demographic structure of the older population and how this structure has changed from 1940 to 1980; (2) the dramatic effects that reductions in mortality at the older ages have had on the growth of the elderly population and its changing age and sex composition; and (3) the emergence of the new old, illustrating how cohorts entering the other end of the elderly age distribution (its new births) would influence its composition and structure. Now, we want to draw from each of the three previous sections and consider what we can expect in the future. To some extent, these issues have already been touched on. The mortality sched- uTes discussed earlier portend that new cohorts entering the older ages will live under considerably Tower risks of death until much later in life. The data we presented on education, earn- ings, labor force participation, and family size suggest the poten- tial for a more heterogeneous life-style among the elderly in the future. What is important to realize is that we can identify such trends, but we cannot necessarily extrapolate them to the future

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94 WILLIAM J. SEROW AND DAVID F. SLY and know what to expect. For example, future cohorts that enter the older ages may be more healthy than past cohorts and more able to provide for themselves, but if they live longer, their savings and income may actually become less adequate than those of many elderly today. Indeed, it is even possible that their better physical condition and their expectations of a different life-styTe may lead them to dispose of savings at a greater rate at the very time that they are expected to live longer. Nevertheless, an understanding of future trends in the growth and structure of the elderly population is necessary if we are even to assess the alternative futures. The projections most fre- quently used for planning and policy purposes are the Series 14 middle-mortaTity/middle-fertility projections of the Bureau of the Census. These projections, which roughly assume a continuation of current fertility trends, forecast that life expectancy at birth will increase to 76.7 years by the year 2000 and continue to increase gradually to 81 years by 2080. The corresponding fig- ures for men are 72.9 years in 2000 and 76.7 years in 2080; for women, the expectancy is 80.5 years in 2000 and 85.2 years in 2080 (U.S. Bureau of the Census, 1984b). The projections (Table 22) also indicate that the total popula- tion of the country will increase to nearly 250 million in 1990 and 268 million by the turn of the century. By the year 2020, there would be some 296 million people in the country. The proportion of persons aged 55 and older will not change radically from its 1980 level (21 percent) through the turn of the century, even though the absolute number of persons 55 and older will have increased from 47 million in 1980 to nearly 59 million in the year 2000. Over the next 20 years, however, as the first of the baby boom cohorts enters the 55-and-older age group, both the proportion and number of older persons will rise sharply. The percentage of the total population that is 55 and older will pass 26 percent by the year 2010, and it will approach 31 percent by the year 2020 when the number of persons aged 55 and older will be nearly 92 million. Of particular significance in this growth is the increasing size of the cohorts entering these ages. Note, for example, that between 1990 and 2020, the two cohorts making up the ages 55-64 double in size. The population aged 65 and older wit! follow roughly the same path in the sense that its absolute numbers will continue to increase but its proportion of the total population will increase

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96 WILLIAM J. SEROW AND DAVID F. SLY only moderately. The larger increase in the proportion of the population aged 65 and older will lag 10 years behind the larger increases in the 55-and-older population; thus, they will not begin to appear until the year 2020. Nevertheless, according to the projections, the population aged 65 and older will increase from its 1980 level of 26 million to 39 million in the year 2010; it will grow to 51 million by 2020. In other words, nearly one- half of the expected growth in the population aged 55 and older between 1980 and 2020 will occur in the single decade from 2010 to 2020, during which the size of the 65-and-older population will increase by some 12 million persons. The projected reductions in mortality will ensure the contin- ued growth of the old old (aged 85 and older) population. Its numbers will increase from their 1980 level of 2.2 million to nearly 7.1 million by the year 2020. By that time, they will constitute nearly 2.5 percent of the total population. Although the projections described in the preceding para- graphs are those that are most frequently cited, this does not mean that the picture they portray will materialize. In fact, it is important to note that a major shortcoming of the Census Bureau middle-range projections in the past has been their un- derestimates of reductions in mortality. In the two sets of projec- tions released prior to those discussed above, the mortality error accounted for over 40 percent of the 6-year aggregate error, and in the projections made since 1960, ~ percent too many deaths were predicted by only the sixth year of the projection period. Clearly then, previous Census Bureau projections have erred in a manner that most strongly affects the older ages. What can we expect if this type of error is similarly reflected in the cur- rent middle-range projections? To help answer this question, Table 23 presents data for an alternative set of projections that assumes a life expectancy at birth in the year 2000 that is 2 years greater than in the previ- ously discussed set and a life expectancy that will rise to 85.9 years in the year 2080. These assumptions result in total population increases (over the middle-level projections) that range from nearly 360,000 in 1990 to more than 5.4 million by the year 2020. What is even more important for our purposes, however, is that the majority of these gains would occur in the population aged 55 and older. For example, by the year 2000, about 1.3 million of the total

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98 WILLIAM J. SEROW AND DAVID F. SLY increase of 1.6 million (or about 81 percent) occurs in the popu- lation aged 55 and older. By the year 2020, nearly 4.7 million of the total increase of 5.4 million (or about 86 percent) occurs in the population aged 55 and older. If we make these comparisons on the basis of the population aged 65 and older, we can see that the majority of deaths saved would actually be concentrated in this age range. That is, with the Tow-mortality projections, there would be 1.1 million more persons aged 65 and older than there would be for the middle-level projections by the year 2000, and nearly 4 million more by the year 2020. As the data imply, these alternative sets of projections produce substantially different age compositions of the elderly over time. The proportion of the 65-and-older population aged 65-74 (which was 61 percent in 1980) will drop to about 57 percent in 1990 by both sets of projections, and it will continue to decline over the next two decades. According to the middle-level projections, it will increase again to 58 percent by the year 2020; yet according to the low-mortaTity projections, it will reach only 55 percent by this time. The reasons for this pattern center around the differ- ent sizes of the newly entering cohorts and the extent to which their fluctuations in size will be offset by the enhanced survival chances of those already in the older ages. These factors can be highlighted by looking at the other end of the elderly age distri- bution. The proportion of persons aged 85 and older will increase with both sets of projections for each of the first three decades of the projection period, reaching 17 percent for the middle-level projections and 19 percent for the low-mortaTity-level projec- tions. By the end of the projection period (the year 2020), the respective shares of the 65-and-older population that will be aged 85 and older are 14 percent and 16 percent, but it should be noted that with the Tow-mortality projections, we are estimat- ing an increase of nearly 2 million more persons aged 85 and older than with the middIe-level projections. Although it is clearly impossible to state definitively that the Tow-mortaTity projection ultimately will prove closer to. reality than the middle-level alternative, the weight of recent experi- ence certainly favors this conclusion. Such an outcome will clearly have profound effects on the social and built environ- ment, both as it relates to the needs of the older population and as it tempers the overall quality of life for the entire population. The limitations of both space and time preclude a detailed

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DEMOGRAPHY OF CURRENT AND FUTURE COHORTS 99 elaboration of the entire realm of such effects. We prefer to consider the issue we deem to be potentially of the greatest import, namely, the need for Tong-term care. Probably the most striking difference between the two sets of population projec- tions shown in Tables 22 and 23 is the difference in the size of the very old population that is, the population aged 85 or older. We have already noted the much greater probability that this segment of the population resides in a nursing home or similar facility. At this writing, it is far from certain whether reductions in mortality will increase or decrease the level of morbidity and the presence of chronic, potentially disabling conditions among the older population (Feldman, 1985; Fries, 1985; Schneider, 19851. Of course, the worst-case scenario would be that increases in life expectancy at the older ages would result in additional years of life characterized by affliction with such conditions. Thus, we would argue that the demand for congregate living facilities and Tong-term care facilities would rise as a result of a diminution in mortality. Furthermore, we could extend the ar- gument to note that considerably greater resources will be re- quired to construct such facilities, to train more personnel to staff them, and to pay the costs of their operation. Given the present role of the public sector, through Medicaid, of bearing a large proportion of these latter costs (in addition to the costs of increased short-term hospitalization and medical treatment through Medicare), we could easily arrive at some rather sobering conclusions regarding the impact of reductions in mortality on the social and built environment, not only for aged individuals and their families but also for society at large. Even if the age-specific proportions of older persons residing in long-term care facilities do not increase, the number of persons so residing must inexorably rise with the increase in the size of the population at risk. Any increases in the size of the 85-and- older population, such as that arising from reduced mortality, will increase the number who will ultimately require such a living arrangement. And any increases in the demand for such care will lead to increases in the demand for the resources to underwrite these costs. Such resources presumably will continue to come from the aged individuals themselves, from their families, and from soci- ety as a whole, embodied in the public sector. As we have previ- ously noted, there is some reason to believe that future genera

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100 WILLIAM J. SEROW AND DAVID F. SLY tions of the elderly, especially women, will command more resources than is true of present generations. Yet these re- sources cannot be regarded as infinite and, indeed, will have to be stretched over a Tong life span. These individuals will have fewer surviving children on whom to rely for financial and other support, and, as life expectancy rises, the children of the oldest old will more and more be counted among the youngest (and even among the intermediate) old. The children of the oldest old will themselves be concerned with providing for their own im- pending care needs and may be unable to provide both financial and personal support to their oldest old parents. One might argue that it is the proper role of society to provide the neces- sary resources, but the allocation of additional scarce resources for these purposes means that fewer resources are available for other needs, that additional resources will have to be transferred from the private to the public sector, or that continued borrowing by the public sector wi]Ll ensue. Thus, under this worst-case scenario, the social and built environment would deteriorate for all parties. Few persons Took forward to spending their last years in an institutionalized setting. Unless policies are altered to permit societal funding for home-based care, however, this prospect be- comes increasingly likely. The children of the potentially insti- tutionalized will be fewer in number, relatively, and it is possible that they will be unable to provide home-based care even if it were affordable. If society as a whole chooses to underwrite the resource costs of such care, it may have to face the choice of doing without resources for other socially defined purposes, sub- jecting itself to greater taxation (and, therefore, to less disposa- ble income), or witnessing the continued growth of the nation's budgetary deficit, which will ultimately destroy the health of the nation's economy. REFERENCES Coale, A. J. 1964. "How a Population Ages or Grows Younger." In R. Freedmen (ed.), Population: The Vital Revolution, New York: Doubleday & Company. Cowgill, D. O. 1974. "The Aging of Populations and Societies." Annals of the Ameri can Academy of Political and Social Science 415:1-18. Feldman, J. 1985. "Demography of Aging." Paper presented at the annual meeting of the Gerontological Society of America, New Orleans.

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DEMOGRAPHY OF CURRENT AND FUTURE COHORTS 101 Fries, J. 1985. "Evidence for Compression of Morbidity." Paper presented at the annual meeting of the Gerontological Society of America, New Orleans. Grove, R., and A. Hetzel. 1968. Vital Statistics Rates in the United States, 1940- 1960. Hyattsville, Md.: National Center for Health Statistics, Table 48. Hermalin, A. 1966. The effect of changes in mortality rates on population growth and age distribution in the United States. Milbank Memorial Fund Quarterly 44: 451-69. Heuser, R. 1976. Fertility Tables for Birth Cohorts by Color: United States, 1917- 1973. Hyattsville, Md.: National Center for Health Statistics. Keyfitz, N. 1968. "Changing Vital Rates and Age Distribution." Population Studies 22:235-251. Lopez, A., and K. Hanada. 1982. "Mortality Patterns and Trends Among the Elderly in Developed Countries." World Health Statistics Quarterly 35:203-224. Manton, K. 1982. "Changing Concepts of Morbidity and Mortality in the Elderly Population." Milbank Memorial Fund Quarterly 60:183-244. Myers, G. C. 1985a. "Aging and Worldwide Population Change." In Handbook of Aging and the Social Sciences, R. Binstock and E. Shanus, eds., New York: Van Nostrand Reinhold. Myers, G. C. 1985b. "Demographic and Socio-Economic Aspects of Population Ag- ing." In Population Aging Paris: CICRED. National Center for Health Statistics (and predecessor agencies). 1940-1980. Vital Statistics of the United States National Center for Health Statistics. 1975. U.S. Decennial Life Tables for 1969- 1971. Hyattsville, Md.: National Center for Health Statistics. National Center for Health Statistics. 1985. U.S. Decennial Life Tables for 1979- 1981. Hyattsville, Md.: National Center for Health Statistics. Pearl, R. 1940. "The Aging of Populations." Journal of the American Statistical Association 209:277-297. Population Reference Bureau. 1975. "The Elderly in America." Population Bulletin 30(3) Ries, P. 1985. "Health Characteristics According to Family and Personal Income." Data from the National Health Survey, Series 10, No. 147. Hyattsville, Md.: Na- tional Center for Health Statistics. Rosenwaike, I. 1985. "Implications for Aging and Diseases of Aging." Paper pre- sented at the annual meeting of the Gerontological Society of America, New Orleans. Schneider, E. 1985. "Implications for Aging and Diseases of Aging." Paper presented at the annual meeting of the Gerontological Society of America, New Orleans. Siegel, J. S. 1980. "On the Demography of Aging." Demography 17:345-364. Siegel, J. S., and M. Davidson. 1984. "Demographic and Socioeconomic Aspects of Aging." Current Population Reports, Series P-23, No. 138. Washington, D.C.: U.S. Government Printing Office. U.S. Bureau of the Census. 1943. Sixteenth Census of the United States: Population. Volume IV: Characteristics by Age, Part 1, U.S. Summary. Washington, D.C.: U.S. Government Printing Office, Tables 1, 6, 10, 18, 24, 26. U.S. Bureau of the Census. 1953. Census of Population: 1950. Volume II: Character- istics of the Population. Part 1, U.S. Summary, Chapter C. Washington, D.C.: Government Printing Office, Tables 94, 102, 107, 116, 139, 145, 156. U.S. Bureau of the Census. 1964. Census of Population: 1960. Volume I: Character- istics of the Population. Part 1, U.S. Summary, Chapter D. Detailed Characteris

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102 WILLIAM J. SEROWAND DAVID F. SLY tics. Washington, D.C.: U.S. Government Printing Office, Tables 156, 173, 176, 181, 194, 219, 232, 233. U.S. Bureau of the Census. 1972. Census of Population: 1970. Volume I: Character- istics of the Population. Part 1, U.S. Summary, Chapter B. General Population Characteristics. Washington, D.C.: U.S. Government Printing Office, Tables 50, 56, 57. U.S. Bureau of the Census. 1973. Census of Population: 1970. Volume I: Character- istics of the Population. Part 1, U.S. Summary, Chapter D. Detailed Characteris- tics. Washington, D.C.: U.S. Government Printing Office, Tables 199, 203, 204, 215, 245. U.S. Bureau of the Census. 1983. Census of Population: 1980. Volume I: Character- istics of the Population. Part 1, U.S. Summary, Chapter B. General Population Characteristics. Washington, D.C.: U.S. Government Printing Office, Tables 40, 50. U.S. Bureau of the Census. 1984a. Census of Population: 1980. Volume I: Character- istics of the Population. Part 1, U.S. Summary, Chapter D. Detailed Characteris- tics. Washington, D.C.: U.S. Government Printing Office, Tables 262, 264, 265, 272, 293. U.S. Bureau of the Census. 1984b. "Projections of the Population of the United States by Age, Sex and Race; 1983 to 2080." Current Population Reports, Series P- 25, no. 952. Washington, D.C.: U.S. Government Printing Office.