Heath and Aging

Why Population Aging Matters: A Global Perspective

Trend 6: Changing Family Structure

As people live longer and have fewer children, family structures are transformed. This has important implications in terms of providing care to older people.

Most older people today have children, and many have grandchildren and siblings. However, in countries with very low birth rates, future generations will have few if any siblings. As a result of this trend and the global trend toward having fewer children, people will have less familial care and support as they age.

As life expectancy increases in most nations, so do the odds of different generations within a family coexisting. In more developed countries, this has manifested itself as the “beanpole family,” a vertical extension of family structure characterized by an increase in the number of living generations within a lineage and a decrease in the number of people within each generation. As mortality rates continue to improve, more people in their 50s and 60s likely will have surviving parents, aunts, and uncles. Consequently, more children will know their grandparents and even their great-grandparents, especially their great-grandmothers. There is no historical precedent for a majority of middle-aged and older adults having living parents.

While the picture of the nuclear or extended family that stays together through life is still the norm in most nations, it is changing in many countries around the world. Among baby boom generations in the West, the family unit may take a variety of shapes. This reflects higher rates of divorce, remarriage, blended and step-family relations, and adults who have never married or are voluntarily childless. Further, many couples and single mothers delay childbearing until their 30s and 40s, households increasingly have both adults working, and more children are being raised in single-parent households.

People currently divorced constitute a small proportion of older populations. This will soon change in many countries as younger populations with higher rates of divorce and separation age. In the United States, for example, 9 percent of the 65-and-over population is divorced or separated compared to 17 percent of people age 55 to 64 and 18 percent of people age 45 to 54. This trend has gender-specific implications: Nonmarried women are less likely than nonmarried men to have accumulated assets and pension wealth for use in older age, and older men are less likely to form and maintain supportive social networks.

Childlessness is another important factor that will affect caregiving but has received relatively scant attention. In modern societies, around 20 percent of women do not give birth. Rising percentages of childless women are seen in Europe and North America and, increasingly, in Latin America and Southeast Asia as well. Research among European adults age 18 to 39 shows that, in some countries, more than one-third either intend to remain childless or are uncertain about remaining childless. Given the variation in family structure worldwide, it will be increasingly important to distinguish between the various reasons for childlessness—voluntary, involuntary coerced, involuntary natural, or loss of children due to HIV/AIDS. Each has different implications for care arrangements as middle-aged women reach older age.

Older people’s living arrangements reflect their need for family, community, or institutional support. Living arrangements also indicate sociocultural preferences—for example, some choose to live in nuclear households while others prefer extended families. The number, and often the percentage, of older people living alone is rising in most countries. In some European countries, more than 40 percent of women age 65 and older live alone. Even in societies with strong traditions of older parents living with children, such as in Japan, traditional living arrangements are becoming less common (Figure 9). In the past, living alone in older age often was equated with social isolation or family abandonment. However, research in many cultural settings shows that older people, even those living alone, prefer to be in their own homes and communities. This preference is reinforced by greater longevity, expanded social benefits, increased home ownership, elder-friendly housing, and an emphasis in many nations on community care.

While multigeneration households are dwindling in the more developed world, two- and three-generation households are still the norm in most less developed countries. Despite the apparent robustness of such living arrangements for older people, concerns are emerging. For example, unmarried women or widows without children can have little support and nowhere to live if extended family will not take them in. Further, changes in household structures occurring in the face of large numbers of AIDS deaths in parts of Africa and Asia may leave many orphans living with and supported by grandparents. There also are broader concerns related to young adult migration to urban areas, levels of intrafamily remittances, and return migration of adults after extended periods of employment in other countries.

Long-term care for older people has become a key issue in the West and also in many less developed, middle-income nations. Such care involves a range of support mechanisms such as home nursing, community care and assisted living, residential care, and long-stay hospitals. While the cost of long-term care is a burden to families and society, there are other concerns as well. For example, the staffing needs of caring for aging populations have increased the migration of health workers from lower income to higher income nations. Clearly, it is not premature to talk about the globalization of support for older persons.

YEAR Living in an Institution or with non-relatives Living alone Living with spouse only Living with married child or other relative(s)
1960 1.3% 4.3% 7.0% 86.8%
1970 2.4% 5.8% 11.6% 78.7%
1980 3.7% 8.8% 18.1% 69.8%
1990 4.4% 10.9% 24.1% 60.5%
2000 4.9% 13.8% 30.9% 50.5%

Source: National Institute of Population and Social Security Research. Population Statistics of Japan 2003. Available at: http://www.ipss.go.jp/index-e.html. Accessed January 18, 2007.

Publication Date: September 2011
Page Last Updated: October 7, 2011