Sri LankaAddressing the Needs of an Aging Population

Demographic Trends and Informal Support

Presenter:K.A.P. Siddhisena

Department of DemographyUniversity of Colombo

September 9, 2008

An overview of first two chapters

• Chapter 1: Demographic trends, the profile of old people, and the emerging issues:

• This chapter probes :

1. In the world context, the status of Population Ageing in SriLanka

2. Demographic trends and demographic factors that explain the aging of Sri Lanka’s population: two main drives of falling fertility and increasing longevity.

3. Socio-demographic Profile of the old people: social characteristics and reviewing their socio-economic conditions.

In the world context, the Population Ageing in Sri Lanka

• Population Ageing is a global phenomenon, but it looms particularly large for Sri Lanka: not only in its population among the oldest in the non-developed world, but Sri Lanka is continuously experiencing one of the fastest ageing populations in the world.

• The proportion of the Sri Lanka population aged 60 and above in 2000 was 9.2%, which exceeded the average of all regions in the world except OECD counties, Eastern Europe and the Former Soviet Union.

Figure 1.1: Demographic aging, Sri Lanka and world regional averages (percentage of population over 60 years old, 2000-2050)

Sri Lanka

Asia

OECD

Latin Americaand CaribbeanEastern Europeand former SUMiddle East andNorth AfricaSub-SaharanAfrica

Demographic trends and factors affecting Population Ageing

• The main driver of the slowing momentum of population growth hasbeen rapid fertility decline since the 1950s.

• Increasing life expectancy is the next most important driver of Sri Lanka’s population aging: lower mortality prolongs the survival of older persons. The proportion of oldest – old is 12% which is highest in south-Asia.

• The increase in the numbers of old people and reductions in the youngest age groups will change Sri Lanka’s age structure from the pyramidal structure typical of most developing countries to a flat pillar shape similar to that evolving in the most developed countries today

Figure 1.5: Share of the old people age groups, Sri Lanka 2001-2100

5 .37 .3

9 .4 1 0 .61 2 .2

1 3 .7 1 3 .3 1 3 .9 1 3 .1 1 2 .0 1 2 .22 .9

3 .5

5 .2

7 .0

8 .2

9 .8 1 1 .3 1 1 .3 1 2 .11 1 .7 1 0 .8

1 .0

1 .3

1 .8

2 .8

4 .0

5 .0

6 .57 .9 8 .6

9 .6 9 .8

0

5

1 0

1 5

2 0

2 5

3 0

3 5

4 0

2 0 0 0 2 0 1 0 2 0 2 0 2 0 3 0 2 0 4 0 2 0 5 0 2 0 6 0 2 0 7 0 2 0 8 0 2 0 9 0 2 1 0 0Y e a rs

Perc

enta

ge o

f pop

ulat

ion

(%)

6 0 -6 9 7 0 -7 9 + 8 0

Figure 1.7: Trends in dependency ratios, Sri Lanka 2001-2101

29%26%

37%

63%

50%

16%

93%

76%

54%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2001 2011 2021 2031 2041 2051 2061 2071 2081 2091 2101

Perc

enta

ge o

f pop

ulat

ion

Child dependency

Old age dependency

Total dependency

contd

• Forecasting the Future Fertility Trend• The future fertility trend is the most difficult to forecast. • There are reasons to anticipate that fertility in Sri Lanka may follow a

similar trajectory to East Asian countries, such as Korea and Japan.

Socio-economic characteristics of old people• Gender composition and marital status. Among old people, there is a

large share of women and widows.

Figure 1.9: Numbers of old people by sex and age, 2006

53%

53%

58%

56%

58%

59%69%

-

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

60-64 65-69 70-74 75-79 80-84 85-89 90+

Age groups (year

Male FemaleS i 3

Residence. As in most developing countries co-residence rates are high in Sri Lanka. Almost 80 percent of old people live with their children, and many rely on their children for financial and other support. Only 6 percent of elderly live alone.

Poverty profile. Poverty does not affect old people disproportionately more than the population as a whole, but the incidence of poverty among the very old is large, and it affects more old women than men.

Health profile. Overall health indicators for Sri Lanka’s population are better than for almost all low and low-middle-income countries The failure to improve older adult mortality has been due primarily to increasing mortality in older adults from non-communicable disease, particularly ischemic heart disease (IHD), strokes and diabetes.

In comparison to other countries in the region, fewer Sri Lankans over 60 years of age participate in the labor force (but participation rates of old persons in Sri Lanka exceed those in developed countries).

Emerging issues

• Will rapid aging and modernization put a strain on the traditional family support to old people?

• Sri Lanka provides the most comprehensive social security system in South Asia, but will this system be ready to support an increased elderly population?

• Sri Lanka also provides universal health care to its population, but how to adapt this system to caring for an increasingly old population?

• Sri Lanka also provides universal health care to its population, but how to adapt this system to caring for an increasingly old population?

Chapter 2: Informal support systems

• This chapter provides insights into five sections:

1. The living arrangements of old people:The levels and determinants of co-residence and the preferences

2. The types of intergenerational transfers in kind support- caring for the elderly.

3. The role of old people in the family- respect and authority4. Future expectation of support 5. Formal support arrangements

Living arrangements

• The majority of Sri Lankan elderly live with their children—only 6 percent live alone.

• About 77 percent of elderly live with their children in either of two arrangements: with their spouse and children (40 percent) or only with their children (37 percent).

Figure 2.1: Living arrangement of old people by age, gender, and education (a) By age

0

10

20

30

40

50

60

70

living alone spouse only spouse &children

children spouse &others

other livingarrangement

60-69

70-79

80+

b) By gender

0

10

20

30

40

50

60

70

living alone spouse only spouse &children

children spouse &others

other livingarrangement

male

female

Contd.

• Living arrangements in Sri Lanka are not likely to have changed much from the past.

• Will Sri Lankan elderly continue to co-reside with their children if they are able to afford living separately?

Contd.

Figure 2.5: Opinions from old people and adult children on the best living arrangement for the old people

0102030405060708090

Withspouse

With son Withdaughter

Withchildren

Other

Old peopleAdult children

Intergenerational transfers (cash and in-kind)

• About half of all Sri Lankan elderly receive cash assistance as the primary source of income.

• About 75% receives food and in kind-transfers, while slightly less than a third report receiving household help from their children.

Cash Transfers

• Sri Lankan elderly receive cash support from a variety of sources, both public and private. According to World Bank 2006 Sri Lanka Aging Survey, the elderly report receiving cash transfers over the past month ranging from about Rs. 2,000 (US$20) to Rs. 9,999 (US$98).

Contd.

• Women are more likely than men to receive monetary transfers from their children.

• Transfers appear to be targeted to the neediest and those with more children.

• In-Kind Support• The main in kind support provided to the elderly in Sri

Lanka is food, clothing or other material goods from family members, followed by household help.

• Emotional support is the least common assistance provided to the elderly.

Caring for the ElderlyADL support indicators

Percent By age of older parent By gender of older parent

60-69 70-79 80+ Male Female

Receive any ADL support

Yes 20.2 13.4 21.1 45.7 17.4 22.4

No 79.8 86.6 78.9 54.3 82.6 77.6

Providers of ADL support

Children 13.0 8.0 14.5 29.1 11.0 14.7

Spouse 4.2 4.8 3.8 2.5 8.1 0.9

Son/daughter-in-law 5.2 2.2 5.3 17.5 2.3 7.5

Grandchildren 2.3 0.9 1.8 10.7 1.4 3.2

Siblings 0.6 0.7 0.8 0.0 0.5 0.8

Other relatives 0.6 0.4 0.7 0.8 0.4 0.7

Reciprocity

Table 2.5: Percent of old people providing transfers to adult children within previous 12 months,by age

Type of transfer Percent providing 60-69 70-79 80+

Money 6.7 6.7 5.5 5.2

Housework help 17.8 18.9 18.5 11.0

Food or material goods 8.1 11.5 5.9 0.9

Child care 45.9 46.1 50.5 29.3

Source: World Bank 2006 Sri Lanka Aging Survey. Note: Sample is old people with at least one child by birth.

C.Respect and authority within household and society

Table 2.6: Level of participation in family decision making process

Expenditures Elder

Spouse

Son/ daughter/ daughter-in-law/ grand child

Not applicable

Food eaten at home 37.5 21.5 39.0 0.9

Your clothes 41.9 10.8 44.8 1.6

Expensive purchases for the household (i.e., refrigerator or TV) 15.3 6.5 45.9 29.2

Money for monthly savings 19.4 6.0 28.8 42.2

Source: World Bank 2006 Sri Lanka Aging Survey.

D. Expectations of future support

Independent Children Others (Total number in sample)

Report of adult children

Total (n=609) 0.1 99.9 0.0 609

Report of old person

Total (n=2413) 2.6 95.6 1.9 2413

Gender

Males 3.7 94.6 1.7 1063

Females 1.6 96.4 2.0 1350

Educational level

No education 1.9 94.9 3.3 352

1-12 years 2.2 96.3 1.5 1914

12+years 8.7 88.3 3.0 147

Table 2.7: Attitudes of old people and adult children on who should be primarily responsible for taking care of parents during old age

Source: World Bank 2006 Sri Lanka Aging Survey.

E. Formal care for the Elderly

• Old people regard institutionalization as a last resort.• Local NGOs are the primary providers of institutional care.• There is little data on the level and sources of funding of elders’

homes. • Day centers, an alternative to institutionalization of the better-

abled elderly, are few.• Attempts to introduce trained volunteers has met with little

success.• According to available data there are no institutions providing

specialized, long-term 24 hour or intermediate care

Policy Recommendations

• Most Sri Lankans live with their children in old age, but that the family support system is showing some signs of being strained.

• These strains will likely increase as the population ages and the number of elderly per working member increases.

• Strengthening of incentives for families to continue to provide support to the elderly.

• The government should also explore ways to increase capacity of nursing homes for old people.

• Elderly living alone (mainly widowed women) warrant specific policy attention.

• Improving the health of the elderly.