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ROK ASEAN Home Care Pilot Project
October 2003 - March 2006

Impact Evaluation Home Care Project Tegal Alur, West Jakarta
February 2006




The National Workshop on
Health Care Needs of Older Persons was
Organized by RI Ministry of Health
Jakarta, 22 - 24 August 2005.
in collaboration with
Yayasan Emong Lansia, funded by UN ESCAP




 For the most part, when older people lose their ability to do things on their own, it doesn't happen just because they have aged. More likely, it is because they have become inactive. Older inactive adults lose ground in four areas that are important for staying healthy and independent: endurance, strength, balance, and flexibility.

Fortunately, research suggests that you can maintain or at least partly
restore these four areas through exercise -- or through everyday physical
activities (walking briskly or gardening, for example) that accomplish some
of the same goals as exercise. What may seem like very small changes
resulting from exercise and physical activity can have a big impact.

Excercise: A Guide from the National Institute on Aging

Target Heart Rate

Source: National Institute on Aging








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Books on Health










Ageing in the Twenty-First Century:
A Celebration and A Challenge

UNFPA-Report (PDF)


Executive summary

Population ageing is one of the most
significant trends of the 21st century.

It has important and far-reaching implications for all aspects
of society. Around the world, two persons celebrate their
sixtieth birthday every second – an annual total of almost
58 million sixtieth birthdays. With one in nine persons in
the world aged 60 years or over, projected to increase to
one in five by 2050, population ageing is a phenomenon
that can no longer be ignored.

Ageing in the Twenty-First Century: A Celebration and
A Challenge analyses the current situation of older persons
and reviews progress in policies and actions taken by
governments and other stakeholders since the Second
World Assembly on Ageing in implementing the Madrid
International Plan of Action on Ageing to respond to the
opportunities and challenges of an ageing world.
older persons.

It provides many inspiring examples of innovative programmes that successfully address ageing issues and the concerns of

The report identifies gaps and provides recommendations
for the way forward to ensure a society for all ages in which
both young and old are given the opportunity to contribute
to development and share in its benefits.

A unique feature of the report is a focus on the voices of
older persons themselves, captured through consultations
with older men and women around the world

The report, which is the product of a collaboration of over
twenty United Nations entities and major international
organizations working in the area of population ageing,
shows that important progress has been made by many
countries in adopting new policies, strategies, plans and
laws on ageing, but that much more needs to be done
to fully implement the Madrid Plan and fulfil the potential
of our ageing world.


Population ageing

Population ageing is happening in all regions and in countries
at various levels of development. '

It is progressing fastest in
developing countries, including in those that also have a
large population of young people.

Of the current 15 countries with more than 10 million older persons, seven of these are developing countries.

Ageing is a triumph of development. Increasing longevity
is one of humanity’s greatest achievements.

People live longer because of improved nutrition, sanitation, medical advances, health care, education and economic well-being. Life expectancy at birth is over 80 now in 33 countries;
just five years ago, only 19 countries had reached this.

Many of those reading this report will live into their 80s,
90s, and even 100s.

At present, only Japan has an older population of more than 30 per cent; by 2050, 64 countries are expected to join Japan with an older population of more than 30 per cent.

The opportunities that this demographic
shift presents are as endless as the contributions that a
socially and economically active, secure and healthy ageing
population can bring to society.

Population ageing also presents social, economic and cultural challenges to individuals, families, societies and the global
community. As United Nations Secretary-General Ban
Ki-moon points out in the Preface to the report, “the social
and economic implications of this phenomenon are profound,
extending far beyond the individual older person and the
immediate family, touching broader society and the global
community in unprecedented ways”.

It is how we choose to address the challenges and maximize the opportunities of a growing older population that will determine whether society will reap the benefits of the “longevity dividend”.
With the number and proportion of older persons growing
faster than any other age group, and in an increasing range
of countries, there are concerns about the capacities of
societies to address the challenges associated with this
demographic shift.

To face the challenges and also take advantage of the
opportunities resulting from population ageing, this
report calls for new approaches to the way that societies,
workforces, and social and intergenerational relations are
These must be sustained by a strong political
commitment and a solid data and knowledge base that
ensure an effective integration of global ageing within the
larger processes of development.

People everywhere must age with dignity and security, enjoying life through the full realization of all human rights and fundamental freedoms. Looking at both challenges and opportunities is the best recipe for success in an ageing world.


The ageing transformation
A population is classified as ageing when older people
become a proportionately larger share of the total

Declining fertility rates and increasing survival at
older ages have led to population ageing.

Life expectancy at birth has risen substantially across the world.
In 2010-2015, life expectancy is 78 years in developed countries and 68 years in developing regions.

By 2045-2050, newborns can expect to live to 83 years in developed regions and 74 years in developing regions.

In 1950, there were 205 million persons aged 60 years or
over in the world. By 2012, the number of older persons
increased to almost 810 million.

It is projected to reach 1 billion in less than ten years and double by 2050, reaching 2 billion.

There are marked differences between regions.
For example, in 2012, 6 per cent of the population in Africa
was 60 years and over, compared with 10 per cent in
Latin America and the Caribbean, 11 per cent in Asia,
15 per cent in Oceania, 19 per cent in Northern America,
and 22 per cent in Europe.

By 2050, it is expected that 10 per cent of the population in
Africa will be 60 years and over, compared with 24 per cent in Asia, 24 per cent in Oceania, 25 per cent in Latin America and
the Caribbean, 27 per cent in Northern America, and 34 percent
in Europe

Globally, women form the majority of older persons.
Today, for every 100 women aged 60 or over worldwide,
there are just 84 men. For every 100 women aged 80 or over,
there are only 61 men.

Men and women experience old age
differently. Gender relations structure the entire lifecourse,
influencing access to resources and opportunities, with an
impact that is both ongoing and cumulative.

In many situations, older women are usually more vulnerable
to discrimination, including poor access to jobs and healthcare,
subjection to abuse, denial of the right to own and inherit
property, and lack of basic minimum income and social
security. But older men, particularly after retirement, may
also become vulnerable due to their weaker social support
networks and can also be subject to abuse, particularly
financial abuse. These differences have important
implications for public policy and programme planning

The older generation is not a homogenous group for which
one-size-fits-all policies are sufficient. It is important not to
standardize older people as a single category but to
recognize that the older population is just as diverse as any
other age group, in terms of, for example, age, sex, ethnicity,
education, income and health.

Each group of older persons,
such as those who are poor, women, men, oldest old,
indigenous, illiterate, urban or rural, has particular needs
and interests that must be addressed specifically through
tailored programmes and intervention models.


The Second World Assembly on Ageing

The Second World Assembly on Ageing, convened in
Madrid, Spain in 2002, to address the challenges of rapid
population ageing, adopted the Madrid International Plan
of Action on Ageing which focused on mainstreaming older
persons in development, advancing health and well-being
into old age, and ensuring enabling and supportive

The Madrid Plan calls for changes in attitudes, policies
and practices to ensure that older persons are not viewed
simply as welfare beneficiaries but as active participants in
the development process whose rights must be respected.

Ageing in the Twenty-First Century: A Celebration and
A Challenge is a contribution to the ten-year review and
appraisal of progress towards implementation of the
Madrid Plan.

A key finding of this report is the incredible productivity
and contributions of those aged 60 and over, as caregivers,
voters, volunteers, entrepreneurs and more.

The report shows that, with the right measures in place to secure health care, regular income, social networks and legal protection,
there is a longevity dividend to be reaped worldwide by
current and future generations.

The report makes the case for national and local governments,
international organizations, communities, and civil society
to fully commit to a concerted global effort to realign 21st
century society to fit the realities of 21st century demographics

It points out that concrete, cost-effective advances will come
from ensuring that age investment begins at birth.



Income security

Among the most urgent concerns of older persons worldwide
is income security. This, together with health, is most frequently
mentioned by older persons themselves.

These issues are also among the greatest challenges for governments faced with ageing populations.

The global economic crisis has exacerbated the financial pressure to ensure both economic security and access to
health care in old age.

Investments in pension systems are seen as one of the most
important ways to ensure economic independence and
reduce poverty in old age.

Sustainability of these systems is of particular concern, particularly in developed countries, while social protection and old-age pension coverage remain a challenge for developing countries, where a large proportion of the labour force is found
in the informal sector.

Social protection floors must be implemented in order to
guarantee income security and access to essential health
and social services for all older persons and provide a safety
net that contributes to the postponement of disability and
prevention of impoverishment in old age.

There is no solid evidence that population ageing per se has undermined economic development or that countries do not have sufficient resources to ensure pensions and health care
for an older population.

Nevertheless, globally, only one third of countries have comprehensive social protection schemes, most of which only cover those in formal employment, or less than half of the economically active population worldwide.

While pensions, and particularly social pensions, are an important end in themselves, since they make a big difference
in the well-being of older persons, they have also
been shown to benefit entire families. In times of crisis,
pensions can constitute the main source of household
income, and often enable young people and their families
to cope with the shortage or loss of employment


Access to quality health care

In order to realize their right to enjoy the highest attainable
standard of physical and mental health, older persons
must have access to age-friendly and affordable health-care
information and services that meet their needs.

This includes preventive, curative and long-term care.
A lifecourse perspective should include health promotion and
disease prevention activities that focus on maintaining
independence, preventing and delaying disease and
disability, and providing treatment.

Policies are needed to
promote healthy lifestyles, assistive technology, medical
research and rehabilitative care.

Training of caregivers and health professionals is essential to
ensure that those who work with older persons have access
to information and basic training in the care of older people.

Better support must be provided to all caregivers, including
family members, community-based carers, particularly for
long-term care for frail older persons, and older people who
care for others.

The report points out that good health must lie at the core
of society’s response to population ageing.

Ensuring that people, while living longer lives, live healthier lives will result in greater opportunities and lower costs to older persons, their families and society


Enabling environments

An age-friendly physical environment that promotes the
development and use of innovative technologies that
encourage active ageing is especially important as people
grow older and experience diminished mobility and visual
and hearing impairments.

Affordable housing and easily accessible transportation that encourage ageing in place are essential to maintain independence, facilitate social contacts and permit older
persons to remain active members of society.

More must be done to expose, investigate and prevent
discrimination, abuse and violence against older persons,
especially women who are more vulnerable.

There has been some progress in promoting the human rights
of older persons, notably discussions centring on the
development of international human rights instruments
that specifically address older persons.


The way forward

In many parts of the world, families have the main
responsibility for the care and financial support of older
dependants. The resulting costs can be extreme for workingage
generations, often affecting their savings capacity,
employability and productivity. However, private transfers
from family can no longer automatically be considered as
the only source of income for older family members.

The report shows how living arrangements of older people
are changing in tune with changes in societies. Family sizes
are decreasing and intergenerational support systems will
continue to be exposed to important changes, particularly
in the years to come.

here are significant numbers of “skipped-generation” households consisting of children and older people, especially in rural areas, as a result of rural-tourban migration of “middle-generation” adults.

Consultations with older persons around the world point to many cases in which older persons provide assistance to adult children and grandchildren, not only with childcare and housework, but
also with substantial financial contributions to the family.

The report stresses the need to address current societal
inequalities by ensuring equal access of all segments of the
population to education, employment, health care and basic
social services that will enable people to live decently in the
present and save for the future. It calls for strong investments
in human capital by improving the education and employment
prospects of the current generation of young people

Population ageing presents challenges for governments and
society, but need not be seen as a crisis. It can and should
be planned for in order to transform these challenges into

This report lays out a compelling rationale for
investments that ensure a good quality of life when people
age and suggests positive solutions, which are feasible even
for poorer countries.

The voices of older persons who took part in consultations
for this report reiterate a need for income security, flexible
employment opportunities, access to affordable health care
and medicines, age-friendly housing and transportation,
and elimination of discrimination, violence and abuse
targeted at older people. Again and again, older persons
point out that they want to remain active and respected
members of society.

The report challenges the international community to do
much more on ageing in the development sphere. There is
a clear rationale for explicit development goals on ageing
underpinned by capacity development, budgets and policies
along with improved research and analysis on ageing based
on timely and good quality data.

As countries prepare to chart a course beyond 2015, population ageing and policy responses to the concerns of older people must be at the heart of the process. In a rapidly ageing world, explicit development goals related to the older population, notably
absent in the current Millennium Development Goals
framework, must be considered



Ten priority actions to maximize the
opportunity of ageing populations



Recognize the inevitability of population ageing and the need to adequately prepare all stakeholders (governments, civil society, private sector, communities, and families) for the growing numbers of older persons. This should be done by enhancing understanding, strengthening national and local
capacities, and developing the political, economic and social reforms needed to adapt societies to an ageing world.


Ensure that all older persons can live with dignity and security, enjoying access to essential health and social services and a minimum income through the implementation of national social protection floors and other social investments that extend the autonomy and independence of older people, prevent impoverishment in old age and contribute to a more healthy ageing. These actions should
be based on a long-term vision, and supported by a strong political commitment and a secured budget that prevents negative impacts in time of crisis or governmental changes


Support communities and families to develop support systems which ensure that frail older persons receive the long-term care they need and promote active and healthy ageing at the local level to facilitate ageing in place.


Invest in young people today by promoting healthy habits, and ensuring education and employment opportunities, access to health services, and social security coverage for all workers as the best investment to improve the lives of future generations of older persons. Flexible employment,
lifelong learning and retraining opportunities should be promoted to facilitate the integration in the labour market of current generations of older persons


Support international and national efforts to develop comparative research on ageing, and ensure that genderand culture-sensitive data and evidence from this research are available to inform policymaking


Mainstream ageing into all gender policies and gender into ageing policies, taking into account the specific requirements of older women and men.


Ensure inclusion of ageing and the needs of older persons in all national development policies and programmes.


Ensure inclusion of ageing and the needs of older persons in national humanitarian response, climate change mitigation and adaptation plans, and disaster management and preparedness programmes


Ensure that ageing issues are adequately reflected in the post-2015 development agenda, including through the development of specific goals and indicators


Develop a new rights-based culture of ageing and a change of mindset and societal attitudes towards ageing and older persons, from welfare recipients to active, contributing members of society. This requires, among others, working towards the development of international human rights instruments
and their translation into national laws and regulations and affirmative measures that challenge age discrimination and recognize older people as autonomous subjects.



2008 World Population Data Sheet

World Population Highlights - Key Findings

Webcast 2008 World Population Datasheet

World Mortality 2007

Population Aging and Economic Growth

Wall Chart World Mortality 2007

Aging Population

World Population Ageing 2007




World Population Prospects: The 2008 Revision

United Nations Population Division

The results of the 2008 Revision incorporate the findings of the most recent national population
censuses and of numerous specialized population surveys carried out around the world. The 2008
Revision provides the demographic data and indicators to assess trends at the global, regional and
national levels and to calculate many other key indicators commonly used by the United Nations system.

Read Press Release with Key Findings March 9, 2009

World Population to exceed 9 Billuon by 2050
Developing Countries to add 2.3 Billion Inhabitants with 1.1 Billion Aged over 60
and 1.2 Billion of Working Age


Read Selected Tables
Population of the World, Major Development Groups and Major Areas 1950, 1975, 2009 and 2050 according to different variants


View Data Online (United Nations Population Division)
World population Prospects: The 2008 Revision Population Database



Key findings with regard to population ageing:
Slow population growth brought about by reductions in fertility leads to population ageing, that is, it produces populations where the proportion of older persons increases while that of younger persons decreases. In the more developed regions, 22 per cent of population is already aged 60 years or over and that proportion is projected to reach 33 per cent in 2050. In developed countries as a whole, the number of older persons has already surpassed the number of children (persons under age 15), and by 2050 the number of older persons in developed countries will be more than twice the number of children.
Population ageing is less advanced in developing countries. Nevertheless, the populations of a majority of them are poised to enter a period of rapid population ageing. In developing countries as a whole, just 9 per cent of the population is today aged 60 years or over but that proportion will more than double by 2050, reaching 20 per cent that year.
Globally, the number of persons aged 60 or over is expected almost to triple, increasing from 739 million in 2009 to 2 billion by 2050. Furthermore, already 65 per cent of the world's older persons live in the less developed regions and by 2050, 79 per cent will do so.
In ageing populations, the numbers of persons with older ages grow faster the higher the age range considered. Thus, whereas the number of persons aged 60 or over is expected to triple, that of persons aged 80 or over (the oldest-old) is projected to increase four-fold, to reach 395 million in 2050. Today, just about half of the oldest-old live in developing countries but that share is expected to reach 69 per cent in 2050.
Although the population of all countries is expected to age over the foreseeable future, the population will remain relatively young in countries where fertility is still high, many of which are experiencing very rapid population growth. High population growth rates prevail in many developing countries, most of which are least developed. Between 2010 and 2050, the populations of 31 countries, the majority of which are least developed, will double or more. Among them, the populations of Afghanistan, Burkina Faso, Niger, Somalia, Timor-Leste and Uganda are projected to increase by 150 per cent or more.

In sharp contrast, the populations of 45 countries or areas are expected to decrease between 2010 and 2050. These countries include Belarus, Bosnia-Herzegovina, Bulgaria, Croatia, Cuba, Georgia, Germany, Hungary, Japan, Latvia, Lithuania, Moldova, Poland, the Republic of Korea, Romania, the Russian Federation and Ukraine, all of which are expected to see their populations decline by at least 10 per cent by 2050.


Preparing for an Aging World

The world's population is aging at an accelerated rate. Declining fertility rates combined with steady improvements in life expectancy over the latter half of the 20th century have produced dramatic growth in the world's elderly population. People aged 65 and over now comprise a greater share of the world's population than ever before, and this proportion will increase during the 21st century. This trend has immense implications for many countries around the globe because of its potential to overburden existing social institutions for the elderly. One popular view envisions global aging as a looming catastrophe, as populations top-heavy with frail, retired elderly drain pension and social security funds, overwhelm health care systems, and rely for support on a dwindling working-age population.

Preparing for an Aging World: The Case for Cross-National Research (Washington, D.C.: National Academy Press, 2001), a panel of experts convened by the National Research Council (NRC), part of the National Academy of Sciences, examines the issues surrounding global aging and their implications for policy and research. The report rejects alarmist as well as complacent views of global aging. Though aging trends raise difficult issues, the report concludes there is no crisis. Aging is gradual and its consequences tend to appear gradually and predictably. Thus policymakers have time to deal with these issues before they become acute problems. Furthermore, because aging is at different stages around the world, there are opportunities for nations to learn from each other's experiences. Taking advantage of these opportunities will require cross-national planning and coordination of research and data collection.


Population aging refers to an increase in the percentage of elderly people (65 and older). The number of elderly increased more than threefold since 1950, from approximately 130 million (about 4 percent of global population) to 419 million (6.9 percent) in 2000. The number of elderly is now increasing by 8 million per year; by 2030, this increase will reach 24 million per year. The most rapid acceleration in aging will occur after 2010, when the large post­World War II baby boom cohorts begin to reach age 65.

The elderly population itself is also growing older. The "oldest old" (80 and older) population is the fastest-growing group among the elderly. Levels of illness and disability among this group far exceed those for other age groups, and thus the needs of this group are likely to increase substantially in the 21st century.

In 2000, Italy was the world's "oldest" nation, with more than 18 percent of its population aged 65 and over (compared with 8 percent in 1950). Also with notably high levels (above 17 percent) were Sweden, Belgium, Greece, and Japan.

Among the world's regions, Europe has the highest proportion of population aged 65 and over and should remain the global leader in this category well into the 21st century. However, other regions of the world will begin to age much more rapidly in coming decades: The percentage of those aged 65 and older in Asia, Latin America and the Caribbean, and the Near East/North Africa will more than triple by 2050 (see figure on next page).


These shifts in global age structure highlight several areas in which policymakers need a clearer understanding of aging's effects and the impacts of alternative policies. These areas include the following:


Work, Retirement, and Pensions

Global Aging, 2000 - 2050 Percentage of Elderly by Region Table

Global Aging, 2000 - 2050:
Percentage of Elderly by Region

One of the most dramatic developments of the past 40 years has been declining labor force participation among older people in many parts of the world. Public pension plans in some countries have created incentives for older workers to retire, thus exacerbating the financial problems posed by aging populations. There has also been a shift in many countries from pay-as-you-go retirement programs to fully funded ones, as well as a shift toward private programs. It is important to disentangle incentives for leaving the workforce, as well as to ensure a closer alignment between public and private pension programs. For many developing nations that are now designing pension programs that have public as well as private components, there are opportunities to learn from more-developed nations' experiences.

Private Wealth and Income Security

The need for income security during retirement--now an increasingly lengthy and important segment of life for many--is an important concern in developed societies. Providing income security has raised two critical policy challenges: (1) ensuring that individuals have sufficient income during retirement to avoid a sharp decline in living standards and (2) ensuring that elderly people are sheltered from financial risks. Policymakers need better data on the econoTransfer Systems

The well-being of older persons often depends on intricate systems of pecuniary and non-pecuniary transfers associated with individual savings, family behavior, and, as in the case of many social security systems, transfers from current workers to retired persons. Although considerable progress has been made in understanding these transfer systems, gaps in our understanding remain. Particularly in need of study are interrelationships across systems and a clearer picture of how changes in one system (such as public pensions) affect others. For instance, do publicly funded programs crowd out private-sector or family-based transfers?


The health of elderly populations is a critical issue and influences outcomes in all of the other policy areas affected by aging. Evidence shows that disability is declining across countries, which would suggest that more elderly people are leading longer and healthier lives. While all countries must address the changing health needs of older citizens, the diversity of national health care systems points to the value of comparable cross-national data on health care quality and outcomes, which to date have largely been lacking.


Overarching the financial and health status of older populations is the issue of their well-being and quality of life--not simply in later years but from birth to death. Our understanding of this issue would benefit from measures of subjective well-being that are sensitive to changes in well-being during major life transitions, such as retirement.mic behavior of elderly populations, such as whether they continue to save or begin to "dissave."


To address these gaps, the NRC panel recommended that nations coordinate data collection and research in order to leverage resources and benefit from nations' collective experience. Specifically, the panel identified several activities for pursuing an effective research agenda on aging:

  • Develop multidisciplinary research designs to produce data on aging populations that can most effectively inform policy choices.

  • Conduct longitudinal research to illuminate the long-term interrelationships among work, health, economic status, and family structure.

  • Establish mechanisms that will help to harmonize and standardize data collected in different countries.

  • Emphasize the critical importance of cross-national research, organized as a cooperative venture that will enhance the ability of policymakers to evaluate institutional and programmatic features of aging policy.

  • Consolidate information from multiple sources to generate linked databases.

  • Create unhindered access to relevant data for the widest possible community of scientists.


    The report emphasizes that the full effects of global aging are still decades away. Therefore nations have time to develop and use research tools to guide future policies. However, considerable lead time will be required to collect and interpret the kinds of data scientists need to understand the ramifications of aging. Nations need to act promptly to develop strategies for generating policy- relevant information to guide policymaking and to avoid the potential for a global "aging" crisis.

    RB-5058 (2001)

    RAND policy briefs summarize research that has been more fully documented elsewhere. Unlike most RAND policy briefs, this brief describes work conducted outside RAND, in this case by the National Research Council (NRC), and documented in Preparing for an Aging World: The Case for Cross-National Research, ISBN: 0-309-07421-5 (pb). Copies of the NRC report are available from the National Academy Press, 2101 Constitution Avenue, N.W., Washington, DC 20418, or at The NRC study was funded by the Behavioral and Social Research Program of the National Institute on Aging. If you would like a copy of a CD-ROM that contains the full text of the NRC report Preparing for an Aging World: The Case for Cross-National Research, as well as 11 other reports that the NRC has prepared for the National Institute on Aging, please contact the Behavioral and Social Sciences Program, National Institute on Aging, 7201 Wisconsin Avenue, Room 533, Bethesda, MD 20892.

    As part of its mission to synthesize and disseminate important population-related research, RAND's Population Matters program produced this policy brief in consultation with the NRC. Population Matters is sponsored by the William and Flora Hewlett Foundation, the David and Lucile Packard Foundation, the Rockefeller Foundation, and the United Nations Population Fund. Population Matters publications and other project information are available at This research brief is also available in printed form.

    RAND publications are available from RAND Distribution Services (Telephone: 310-451-7002, or toll free 877-584-8642; Fax: 310-451-6915; E-mail: [email protected]; or the Web:

    RAND® is a registered trademark. RAND is a nonprofit institution that helps improve policy and decisionmaking through research and analysis; its publications do not necessarily reflect the opinions or policies of its research sponsors.

    Source: Rand Corp