Socio-economic changes and progress in medical technology and public health have accelerated demographic transition in many countries around the world. First mortality rates declined, then there were fertility reductions and finally the parallel increase in life expectancy. Thailand has experienced one of the fastest demographic transitions on record and its population structure is transforming from a young to an older population. The number of elderly Thai people increased from 1.7 million in 1970 to 7.5 million by 2010 (or from 4.9% to 11.8% of the total population).
The number and proportion of the population that is elderly is expected to continue to increase. The Institute for Population and Social Research (IPSR) has estimated that, in the coming 10 to 15 years, the elderly population will increase to 11.0 – 12.9 million or to 16.8%-19.8% of the total Thai population. Research into the dynamics of ageing is an area of considerable interest to IPSR. More data on ageing can help Thai society prepare for the physical and psycho-emotional needs of an elderly population as well as inform socio-economic planning. Advances in medicine and public health have produced an elderly population that is in better health than previous generations with an expectation of more years of productive life.
In 2010, IPSR proposed that Thailand change the definition of elderly from those age 60 years or older to 65 years and older. This change would more accurately reflect the remaining life expectancy of the middle-age Thai population today. Changing the definition of “elderly” in this way would decrease the number of elderly persons from 7.5 million to 5.1 million. Such a change in population classification could have unforeseen impacts on the younger generation however and these impacts need to be studied. For example, increased life expectancy has implications for the increased need for savings and economising by working age groups. Similarly, redefining the elderly age group has implications for government welfare services and budget for the elderly subsidy, pensions, social security, and health insurance that would initially decrease as the threshold age for being classified as “elderly” is increased. Tax collection might be expected to rise due to the increase in the active labour force with an increased retirement age. These and other factors and consequences need to be studied to inform policy and planning for an older society in the future including policies on savings, pensions and quality of elderly care.
A natural part of ageing is the degradation of the body and physiology. Thus, the elderly are at greater risk of health problems than most other age groups in the population. Many of the conditions which affect the elderly are chronic, based on the irreversible decline in healthiness of bodily organs. These conditions include hypertension, cerebro-vascular diseases, diabetes, joint ailments, osteoporosis, orthopedic problems and dementia. These conditions generally produce some level of disability in the elderly and limit their ability to perform daily tasks unassisted. As the population ages, the prevalence of these disabilities can be expected to increase and this will require more assistance from others in society to the elderly, depending on the severity of the disability of each individual.
At present, social welfare services provided to the elderly by the Thai government and various organisations do not have wide enough coverage or depth. Accessing the elderly is problematic for those still economically active in the informal sector. Also, there is limited budget and staff to tend to the needs of the elderly. Informal care systems are more prominent these days, including care by family members and those close to the elderly. The burden on the care providers, the value of youth as providers for the elderly and elderly expectations of support from children and grandchildren are evolving along with the socio-economic changes. These phenomena also have consequences for family relationships and emotions of care providers and the elderly themselves. There is a need to systematically monitor these developments.
IPSR has launched a project for monitoring population, economic, socio-cultural and long-term care issues as they affect the Thai elderly population. This project looks at demographic, health science, sociological, economic and communication dimensions of ageing with the view that the elderly are a store of socio-cultural capital of the nation and need to be valued for their potential both by themselves and by society in general. The elderly are a treasury of traditional wisdom and provide a cultural link for passing on the heritage of a nation to the next generation.
Projections of the increase in the population aged 65 years and above need to take into consideration the prevalence of disabilities, living arrangements and the socio-economic status of the elderly who are vulnerable and lack essential guarantees. At the same time there are healthy, able and economically active elderly. The Disability Free Life Expectancy (DFLE), Active Ageing Index and the Morbidity Free Rate are indicators to inform national planning in preparation of care services for the elderly such as long-term care and response by relevant individuals, community groups and government agencies. There will need to be more precise definitions of the special service needs of elderly, their health insurance and the economic safety net.
The following graphic depicts the conceptual framework of research into the elderly at IPSR.
Conceptual Framework for Research Cluster 2