Population of 65 years and over Deaths of 65 years and over

The Demographic and
Health Contexts of Current
and Future Care Needs of
Older Canadians
By Jacques Légaré
with the assistance
of Guillaume Lefrancois
Département de démographie
IRPP Conference
’’When I’m 64 …’’
Defining Care Giving Policy for an Aging Canada
Montréal, April 2-3, 2009
Outline
o
Introduction
o
What impacts on demand will the Baby
Boom generation have ?
o
Current and future homecare needs of
Canadian elderly
o
Current unmet needs for homecare
services: who is at risk among Canadian
elderly ?
Introduction
¡
Old age threshold
¡
Relative aging
¡
Morbidity among elderly
¡
For the future, compression or
expansion of morbidity ?
Old age threshold
« Vieux se dit d’un certain âge où, quand on (y)
est parvenu, on est caduc : les hommes sont
vieux à soixante ans, les chevaux à vingt. »
- Furetière, 1690
A new approach for old age
threshold
¡
Norman Ryder suggested to look instead at
years to live until death
l
¡
¡
¡
For example, if we decide that a human being becomes
old 10 years before its death, then the threshold will
be the age for which life expectancy will be 10 years.
If life expectancy at birth (e0) is 40, old age
threshold would be at age 65; when e0 is at 80,
as in many countries nowadays, old age
threshold should be at 75.
In many countries , it is really at age 75 that a
person becomes more vulnerable in terms of
health .
Accordingly, we should consider those 75+ as
elderly and those 85+ as oldest-old.
Relative aging
Proportions of elderly population, one with an old age threshold
at 65 years, and the other one with the old age threshold at « 10
years to live », Québec, 1951-2031
30
Men
Proportion ( %)
25
Population of elderly with an old
age threshold at 65 years
Women
20
15
Population of elderly with an old age
threshold « 10 years to live »
10
5
Calendar years
20
31
20
21
20
11
20
01
19
91
19
81
19
71
19
61
19
51
0
Sources: Statistics Canada, Canadian Census of 1951-2006.
Institut de la statistique du Québec, Perspectives démographiques du Québec de 2006-2031.
Morbidity among elderly
Life expectancy for all health status and without any activity
limitation, at age 65, by sex, Québec, 1982-2006
22
20
Years
18
Men
Women
Men without any activity limitation
Women without any activity limitation
16
14
12
19
82
19
83
19
84
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
10
Calendar years
Source: Institut national de santé publique du Québec, ISQ, et
Compression or expansion of morbidity ?
Trends in life expectancy for all health status and without any activity
limitation, at age 65, men, in some European countries, 1995-2003
22
Expected years to live
20
18
16
LE
AUT, BEL,
FIN, FRA,
DEU, IRL,
ITA, SPA
DFLE
GRC, NDL,
PRT, GBR
14
12
10
8
6
4
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Autriche
Belgique
Danmark
Finlande
France
Allemagne
Grèce
Irlande
Italie
Pays-Bas
Portugal
Espagne
Suède
Royaume-Uni
Source: Jean-Marie Robine, 2005
DNK,
SWE
Compression or expansion of morbidity ?
Trends in life expectancy for all health status and without any activity
limitation, at age 65, women, in some European countries, 1995-2003
22
20
LE
Expected years to live
18
16
AUT, BEL,
DNK, ITA,
ESP, SWE
14
12
FIN, FRA,
GBR
DFLE
10
8
DEU,
GRC, IRL,
NDL, PRT
6
4
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Autriche
Belgique
Danmark
Finlande
France
Allemagne
Grèce
Irlande
Italie
Pays-Bas
Portugal
Espagne
Suède
Royaume-Uni
Source: Jean-Marie Robine, 2005
What impacts on demand will the
Baby Boom generation have ?
The Baby Boom in some
occidental countries, 1940-1964
4,0
3,5
3,0
2,5
2,0
19
54
19
56
19
50
19
52
19
44
19
46
19
48
19
40
19
42
1,0
Calendar years
Sources: Dupâquier (1999) et données de l'ISQ
England
France
ROC
19
64
Germany
Italy
United States
Québec
1,5
19
58
19
60
19
62
Mean nomber of children per woman
4,5
An overview of disabled elderly,
75+, in Canada and in Europe
¡
¡
¡
People in institutions not included
For Europe , we refer to 9 countries,
participating members of FELICIE research
project (Belgium, Czech Republic, Finland,
France, Germany, Italy, Netherlands,
Portugal and England and Wales).
Impacts of health scenarios on projections
with implications for future health care
expenditures
Population increase between 2000/1 and 2030/1
of European and Canadian disabled elderly aged 75
years and over according to gender, by age groups
EUROPE
CANADA
134%
69%
85 +
85 +
199%
156%
Total
increase
(133%)
Total
increase
(72%)
106%
45%
75-84
75-84
140%
0%
50%
98%
100% 150% 200% 250%
men
0%
women
50%
100%
150%
200%
250%
Population increase between 2000/1 and 2030/1 of
European and Canadian disabled elderly aged 75
years and over according to different family
compositions
Canada
94%
Europe
Both sexes
25%
Both sexes
(133%)*
(72%)*
47%
137%
96%
88%
146%
157%
0%
50%
100%
150%
200%
0%
50%
100%
150%
*rate of increase of all categories
With partner and surviving children
With partner but no surviving children
With no partner and with surviving children
With no partner and no surviving children
200%
Population increase between 2000/1 and 2030/1 of
European and Canadian disabled elderly aged 85 years
and over according to different family compositions,
by gender
Women
CANADA
28%
85+
(134%)
158%
Women
EUROPE
7%
85+
(69%)
55%
99%
239%
211%
0%
100%
368%
200%
300%
400%
0%
Men
CANADA
129%
300%
400%
Men
EUROPE
85+
(156%)
108%
248%
66%
220%
247%
0%
200%
106%
85+
(199%)
229%
100%
100%
200%
300%
400%
With partner and surviving children
With no partner and with surviving children
0%
100%
200%
300%
400%
With partner but no surviving children
With no partner and no surviving children
Trends in total population (all health
status) and people in poor health,
aged 75+, Canada and Europe
Base scenario for Canada and constant scenario for FELICIE
countries
300
Standardized to 100 in
2001
Total Canadian population (all health status)
Canadian people in poor health
250
Total European population (all health status)
and people in poor health
200
150
100
2000
2005
2010
2015
Calendar years
Source : Légaré et Décarie, 2008
2020
2025
2030
Trends in total population (all health
status) and people in poor health,
aged 75+, Canada and Europe
Healthy Scenario
300
Standardized to 100 in 2001
Total Canadian population (all health status)
Canadian people in poor health
250
Total European population (all health status)
European people in poor health
200
150
100
2000
2005
2010
2015
Calendar years
Source : Légaré et Décarie, 2008
2020
2025
2030
Trends in people in poor health, aged 75+
according to their family network with
two health scenarios, Canada, 2001-2031
Source : Légaré et al. Horizons, 2007
Will future health expenditures go
hands in hands with the 65+ population
increase ?
Not necessarily!
Because among elderly, acute care costs
are more related to the time of their death
than their age
Than, the increases in the number of
deaths 65+ will be a better predictive
than the population 65+
Relative changes of population and
deaths of 65 years and over, Québec,
2001-2031
240
220
Index 100 in 2001
200
Population of 65 years and over
180
160
Deaths of 65 years and over
140
120
100
2001
2006
2011
2016
2021
2026
Calendar years
Source: Institut de la statistique du Québec (ISQ)
2031
Relative changes in the population and deaths of
the 65 years and over, according to two
mortality assumptions, Québec, 2001-2031
260
Population 65 years and over accordingly to ISQ
mortality
240
Base 100 en 2001
220
Deaths of 65 years and over accordingly to ISQ
mortality
200
180
Population 65 years and over
accordingly to bold scenario mortality
160
140
120
100
2001
Deaths of 65 years and over
accordingly to bold scenario mortality
2006
2011
2016
Année de calendrier
Source: Légaré et al., 2006
2021
2026
2031
Current and future homecare
needs of Canadian elderly
¡
¡
¡
¡
¡
The results in the next slides are coming from an undergoing
research project with my colleague Janice Keefe from Mount Saint
Vincent University, project founded by CIHR, the Alzheimer
Society of Canada and Health Canada.
Canadian elderly with a long term health problem, here for those
aged 65+, as many young papy and mamy boomers will need
assistance to keep their autonomy.
Calculated for all 4 activities (everyday housework, grocery
shopping, meal preparation and personal care) provided by each
source of assistance (formal, informal and mixed).
2001 Canada Community Health Survey (CCHS) & 2002 General
Social Survey (GSS) – logistic regression parameters for
characteristics of receivers/non receivers of assistance.
Projection technique: Dynamic projections up to 2031, using
Statistics Canada LifePaths micro simulation model.
Canadian population aged 65+
living in a private household
2031: n= 8 835 780
2006: n= 4 224 700
Need assistance
Do not need assistance
2031: n= 1 653 716
2006: n= 815 782
•The proportion of those needing assistance
remains constant over time at
19%
Canadian population aged 85+
living in a private household
2031: n= 1 017 881
2006: n= 493 625
Need assistance
Do not need assistance
2031: n= 476 874
2006: n= 236 466
•Here the proportion of those needing
assistance is much higher then for the 65+ at
around 47% and also stays constant over
time.
Canadian population aged 65+
living in a private household
2031: n= 8 835 780
2006: n= 4 224 700
109 %
Need assistance
2031: n= 1 653 716
103 %
2006: n= 815 782
Do not need assistance
Receive assistance
2031: n= 1 504 218 102 %
2006: n= 746 465
Do not receive assistance
Informal
2031: n= 624 326
2006: n= 334 950
Formal
2031: n= 569 582
86 %
2006: n= 257 071
Mixed
2031: n= 310 310
122 %
2006: n= 154 445
101 %
Population 65+ receiving
assistance, by sex and source,
Canada, 2006-2031
Variation 2006-2031
(%)
Elderly population aged 65+ receiving assistance
500000
+ 79 %
+ 111 %
400000
300000
+ 104 %
+ 101 %
200000
+ 142 %
100000
+ 90 %
0
2006
2011
2016
2021
2026
Men - Formal
Women - Formal
Men - Informal
Women - Informal
Men - Mixed
Women - Mixed
2031
Current unmet needs for homecare
services: who is at risk among
Canadian elderly ?
Elderly 65+ according to their
unmet needs for homecare
services, Canada, 2002
18%
82%
All met needs
At least one unmet needs
Source: Busque, Marc-Antoine, « Les laissés pour compte du virage ambulatoire: Analyse des besoins non
comblés de services à domicile chez les ainés canadiens », 2009, Université de Montréal, Mémoire de M.Sc.
en démographie
Prevalence of met and unmet needs of
the elderly 65+ and proportion of unmet
needs by age group, Canada, 2002
70
60
50
40
%
30
20
10
0
65-69
70-74
75-79
80-84
85+
age groups
unmet needs
met needs
proportion
Source: Busque, Marc-Antoine, « Les laissés pour compte du virage ambulatoire: Analyse des besoins non
comblés de services à domicile chez les ainés canadiens », 2009, Université de Montréal, Mémoire de M.Sc.
en démographie
Number of elderly 65+ according to
their met or unmet needs by age
group, Canada, 2002
250000
absolute numbers
200000
150000
100000
50000
85
+
80
-8
4
75
-7
9
70
-7
4
65
-6
9
0
age groups
unmet needs
met needs
Source: Busque, Marc-Antoine, « Les laissés pour compte du virage ambulatoire: Analyse des besoins non
comblés de services à domicile chez les ainés canadiens », 2009, Université de Montréal, Mémoire de M.Sc.
en démographie
Thank you!
« Politics is not an exact science as
many professors imagine, but an
art. »
Otto von Bismarck, chancellor of
Germany from 1871 to 1890 and
founder of the social security system
Number of births, Québec, Canada,
ROC, and United States, 19092001
140
Québec
Canada
ROC
United States
130
110
100
90
80
70
60
50
19
09
19
13
19
17
19
21
19
25
19
29
19
33
19
37
19
41
19
45
19
49
19
53
19
57
19
61
19
65
19
69
19
73
19
77
19
81
19
85
19
89
19
93
19
97
20
01
Births (Index = 100 in 1951)
120
Sources: Statistique Canada et National Center for Health Statistics.
Calendar years
Population 65+ receiving
assistance, by sex and source,
Canada, 2006-2031
Population
2006
2031
Variation
(%)
Formal
172 633
365 043
+ 111 %
Informal
Mixed
220 029
393 531
+ 79 %
117 854
240 934
+ 104 %
Formal
Informal
84 438
204 539
+ 142 %
114 920
230 795
+ 101 %
36 541
69 377
+ 90 %
746 465
1 504 218
+ 102 %
Source of
assistance
Mixed
Total population