International Workshop
Institute of Population andLabor Economics IPLE
Beijing, 23.-25. X. 2013

Well-being in Ageing Societies:
Perspectives from China,
Germany and Japan

Prof. Dr. Dres. h. c. Ursula Lehr
Bundesministerin a.D.
Institut für Gerontologie • Universität Heidelberg
Vorsitzende der BAGSO

Visions for the Ageing Societies© by Ursula Lehr • 2013

1. The demographic change
2. Well-being in Ageing Societies
3. Active Ageing - challenge andchance for individuals and societies

Visions for the Ageing Societies

in China, Japan and Germany:
more and more people are getting older and older (+)
It does not only count

how old one will be
but how one will get old© by Ursula Lehr • 2013

It is not only importantto add years to live
but also to add life to years.
Our life expectancy
is dependent from our life style –We have to do everything for a healthy ageing,
for well-being in ageing societies!

Visions for the Ageing Societies
Demographic trends

Population is growing older
Population change in
China:. 2000 1.275,1 Mio., median age 30,0 J. 20251.470,8 Mio., median age 39.0 J. 20501.462.1 Mio., median age 43,8 J

Germany•

2000

82,1 Mio., median age 40,1 J.

•

2025

78,8 Mio., median age 48,5 J.

•

2050

70,8 Mio., median age 51,4 J© by Ursula Lehr • 2013

Japan:
2000

127,0 Mio., median age 41,2 J

2025

123,8 Mio., median age 50,5 J

2050

109,2 Mio., median age 53,1 J
Quelle: UN (2002), World Population Ageing 1950-2050

Visions for the Ageing Societies

POPULATION AGEING
and URBANIZATION
are the global trends in the 21st century
In 2007 over half of the population lives in cities
2030 about 60% of the population will live in cities
Both trends are occurring at a faster rate
in developing countries© by Ursula Lehr • 2013

(Globas Age-friendly cities: WHO, 2007)

Visions for the Ageing Societies

Percentage of population
aged 65 and overin the year 2000

less than 10 %between 10 % and 19,9 %more than 20 %© by Ursula Lehr • 2013

in the year 2050

Visions for the Ageing Societies

The global population is growing,
but Europe, especially Germany,is expected to decrease dramatically;
and the population of Japan is decreasing, too-

Europe will become
the oldest continent in the world© by Ursula Lehr • 2013

due a continous rise in mean life expectancy
and a decreasing birth- rateDer
demografische
Wandeleine Herausforderung
Visions
for theAgeingSocieties
für Individuum und Gesellschaft(2000. 2025., 2050)
Mio.

6000
5428

alle Angaben in Millionen

4776

5000

4000

2000

3672

3000

2025
2000
2000
1358
727
683
603

1000

805
695
518

793

2050

438
384
314

30 40 47

ik

ze
O

m
da
or
N

Quelle: World Population Aging 1950-2050, herausgegeben von der UN, New York, 2002))

an

er

er
am
in
te
La

© by Ursula Lehr • 2011

ie
n

a

a
ik

ie
n
As

a
r ik
Af

Eu

ro

pa

0

Visions for the Ageing Societies

Percentage of people 60 years and older
42,3%
38,1%
35,1%
33,2%
29,5%

23,3%

23,2%

1975

20,4%

19,5%

1950

2000
14,6%

2025
11,7%

10,1%

2050
7,7%

7,5% 6,9%© by Ursula Lehr • 2013

China

GermanyJapan

Quelle: UN (2002), World Population Ageing 1950-2050

Visions for the Ageing Societies

Percentage of people 80 years
and older
15,4%

13,2%

10,4%
1950
1975
2000

7,4%
6,8%

2025
2050
3,8%

3,6%
2,2%

2,1%
0,9%
0,3% 0,6%© by Ursula Lehr • 2013

China

1,1%

1,0%
0,4%
GermanyJapan

Quelle: UN (2002), World Population Ageing 1950-2050

Visions for the Ageing Societies

Number of people 90 plusand 100 plus in Germanyüber 90 Jahreüber 100 Jahre
2100000

1047000
5013002000

2020

Quelle: UN (2002), World Population Ageing 1950-2050© by Ursula Lehr • 2013

114700

44000

10000

2050

Visions for the Ageing Societies

Number of citizens in Germany, whichcelebrated their 100. birthday (2012: 6255)

6255
5917
5660

5688

5480

5120
4836
4360
4122
3883

3883

3483
3098
2948
2756

2843

2515
2333
2164

bis 1990 alte Bundesländer, ab 1991
gesamte BRD

1959
1745

1827

1416

899

987

1076

1176

1249

535
158

261

2012

2011

2010

2009

2008

2007

2006

2005

2004

2003

2002

Gesamt

2001

2000

1999

Frauen1998

1997

Männer

1996

1995

1994

1993

1992

1991

1990

1989

1988

1987

1986

1985

1980

1975

1970

1965

© by Ursula Lehr • 2013

403

Quelle: Bundespräsidialamt

Visions for the Ageing Societies

Ageing has many faces:© by Ursula Lehr • 2013

There is the competent and wise senior,
who is able
to manage his own life

Visions for the Ageing Societies

Ageing has many faces:© by Ursula Lehr • 2013

There is the ill, helpless and dependent
senior, who needs help and support

There are many interindividual differences in the ageing
processes between people of the same chronological age.

Visions for the Ageing Societies

Percentage of competent, independent living (blue) ,ambulant care (green)
and living in Homes for the Aged (red)(Percentage of the population in Germany 80 years and older)
81,1

63,2

40
30,7

28,6

21,7
15

12,4
6,5

© by Ursula Lehr • 201380-85 years

85-90 yearsüber 90 years

Visions for the Ageing Societies

Unter 15 Jahre

15-60

60-65

65-70

70-75

Percentage of people who need carein different age-groups (2011)
0,6%

0,5%

1,8%

2,8%

4,8%

75-80

9,8%

20,5%

80-85

38,0%

© by Ursula Lehr • 2013

85-90

57,8%

über 90 Jahre

Insgesamt

3,1%Quelle: Statistisches
Bundesamt,
Pflegestatistik 2011

Visions for the Ageing Societies

More and more women in Germany don‘ nt have children

11%

21%
33%

1950 Geborene

1960 Geborene

1965 Geborene© by Ursula Lehr • 2013

(Schätzung)Visions for the Ageing Societies

80

One person 75 years and older
in relation to younger persons
in Germany

79
5
15

67
5
0-20

60

20-40

40-60

60-75

1.1
1,4
1,1
0,8

1,0
1,1
1,0
0,8

15
23
40

22

35
2,0
3,4
2,6
1,9

4
10
20

36

10
25

9,88

7,38

1,6
2,4
2,0
1,4

6,99

11

1,7
2,1
1,8
1,4

4,44

© by Ursula Lehr • 2013

0
1890

1925

1950

2010

2020

Quelle: Destatis 2009,
Schätzung aufgrund der 12. koordinierten Bevölkerungsvorausberechnung

2025

2040

3,9
3,92
2050

Visions for the Ageing Societies© by Ursula Lehr • 2013

1. The demographic change
2. Well-being in Ageing Societies
3. Active Ageing - challenge andchance for individuals and societies

Wellbeing in aging societies

The Global AgeWatch Index (2013) compiled by HelpAge
International and supported by the United Nations Fund forPopulation and Development ranks 91 countries based onfour domains – income security, health status, employment
and education, and enabling environments for an ageing© by Ursula Lehr • 2013

population.
“The global Age Watch Index is the first global index torank countries according to the social and economic
wellbeing of older people”

© by Ursula Lehr • 2013

Wellbeing in aging societies„Wellbeing“ is defined by„objective measures“
1. Income security
2. Health status
3. Employment and education
4. Enabling environment

Wellbeing in ageing societies
13 different indicators

1. Income security (4 indicators):( Pension income coverage, Poverty rate in old age, Relative welfareof oler people, GDP per capita )2. Health status (3 indictors):( Life expectancy at 60, Healthy life expectancy at 60, Psychologicalwellbeing)

3. Employment and education (2 indictors):(Employment of older people, Educational status of older people)© by Ursula Lehr • 2013

4. Enabling environment (4 indicators):(Social connections, Physical safety, Civic freedom, Access to public
transport)

Wellbeing in ageing societies© by Ursula Lehr • 2013

Global AgeWatch index of wellbeing of older
people (overall rank ofIncome
91 countries)
Health
Employment Environment
1. Sweden
2. Norway
3. Germany
4. The Netherlands
5. Canada
6. Switzerland
7. New Zealand
8. USA
9. Iceland
10. Japan
35. China

( 8,
7,
5,
5)
( 3, 13,
1, 22 )
( 9,
6,
6,
6)
( 4, 18, 11,1)( 26, 2,9,9)
( 28, 1, 12,4)( 43, 3,7, 13 )
( 36, 24, 2, 16 )( 15,
9, 18,
7)( 27,
5, 10, 19 )( 66, 51, 40, 24 )

Visions for the Ageing Societies

But, is this „wellbeing“?

© by Ursula Lehr • 2013

„older people in poorer countries often havebetter lives on average in several key respects
than those in somewhat richer ones“ (p.3 Global
Age watch Index)

Wellbeing in ageing societies© by Ursula Lehr • 2013

What means wellbeing, life-satisfaction, and which are their correlates?
There are many psychological studies, analyzed by ADAMS
1971 and THOMAE 1980 (p.288) . They found more than 60
correlates, including health (objectively assessed andperceived health), SES, income, degree of social
participation, perceived extension of life space, family
relationships, availability of transportation, close personal
relationships, opportunities to select goals and achieving
goals, sexual enjoyment, social activity and others.The„feeling of beeing needed“ has a high correlation to theperceived „quality of life“ in old age.
There is a very complex network of variables related towellbeing and life-satisfaction in old age. Subjective
measures, the perceived situation seems to be very
importantVisions for the Ageing Societies:© by Ursula Lehr • 2013

The degree of life satisfaction was very high, also in thegroup of centenarians (Rott,2013)
which had health problems and a reduced mobility andwere not rich. Most of them were happy, to be still alive.
Also BINKERT (Insa-Studie 2012) found in the agegroup 80+ the highest life satisfaction by 90% of thepeople, the lowest one of only 63% in the group of 5059 years old persons. The most unhappy persons were
found in the age group 30-39 years (18%), followed by
the 50-59 years old with 16%. (p.29)
Data of the „Deutsche Alterssurvey“ (2010) also show avery high degree of life satisfaction (51%, 58%, 65%)
and a high degree (42%, 37%, 33%) and a correlation
with educational level. So were dissatisfied 7% of
people with the lowest education, 5% with middle andonly 3% with higher education.

Visions for the Ageing Societies© by Ursula Lehr • 2013

1. The demographic change
2. Well-being in Ageing Societies
3. Active Ageing - challenge andchance for individuals and societies

Visions for the Ageing Societies:
Active Ageing
Population ageing : „the successful measures
are those which enable and increase older
people‘s participation in the labour maket and insocial and family activities. By these, and byadditional means of access to healthcare,security and lifelong learning, it is commonly
agreed that older people are empowered to live
independent, healthy and secure lives.“© by Ursula Lehr • 2013

(Active Ageing Index; European Center Vienna,
March 2013;(Germany has rank 9 from 27 European countries)

Visions for the Ageing Societies:
Active Ageing

Healthy aging is to be defined
not only by the absence of diseases
not only by psychophysical and psychosocial
wellbeing (WHO-Definiton)© by Ursula Lehr • 2013

Healthy aging includes the ability to copeadequately with stress, health-problems,
limitations and handicaps and to continue an
enjoying life –Visions for the Ageing Societies:
Active Ageing
Health and well-being do not decrease withincreasing age,

But you can find health only there,
where you are fighting for themevery day© by Ursula Lehr • 2013

(Viktor v. Weizsäcker)

Visions for the Ageing Societies:
Active Ageing

Prevention:© by Ursula Lehr • 2013

The importanceof physical,
mentaland social activities
well as healthy nutrition
must be made clear
from childhood on.
It is also necessary
to maintain a high degreeof physical, socialand mental activity
in men and women during the years ofadulthood.

Visions for the Ageing Societies:
Active Ageing
PHYSICAL ACTIVITY is a prerequisit for healthy
ageing.
Age-determined physical changes – such as© by Ursula Lehr • 2013

functional impairment of the organs, changes in
the motor-system and muscularsystem as well aschanges in the respiratory organs are similar to
the effect of lack of exercise.

The young physical inactive individual seems
to be oldJust as the old but active individual seems tobe young

Visions for the Ageing Societies:
Active Ageing
Mental ativity is a prerequisit of healthy ageing,
too.
Many studies have found , that mentally more active people,
individuals with a higher range of interests, a father reaching
future time perspective and a greater number of social
contacts reach old age with greater feelings of psychophysical wellbeing.

© by Ursula Lehr • 2013

Cognitive activity is essential for healthy
ageing.
Elderly persons must be given mental tasks; they must be
challenged to mental activity. Reduction in mental activity
can speed up the process of ageing.

Functions, which are not used, are decreasing

Visions for the Ageing Societies:
Active Ageing

Challenges for gerontologists, geriatricians,
medical doctors, psychologists and politicians
What can we do to ensure healthy aging?
To prevent illness and disability?
A healthy life- style already begins in childhood:- healthy nutrition,- physical and mental activity and fitness- the developing of a bright range of interests© by Ursula Lehr • 2013

- and to cope with stress situations.

Visions for the Ageing Societies:
Active Ageing
Ageing does not necessarily means a decline ofskills and abiliies;
the ageing process can be influenced by the person,by the life-style, but also

by promoting and age-friendly living
environment© by Ursula Lehr • 2013

Barrier-free buildings and streets, secureneighbourhoods enhance the mobility andindependence of elderly people, but also of
people of all age-groups.

Visions for the Ageing Societies:
Active Ageing© by Ursula Lehr • 2013

The Vienna- Conference (1982), the MadridConference (2002)
and the Leòn- Conference in 2007 on problemsof ageingalso discussed the image of the aged,
their competencies, potentials and humancapital, but also their problems
and the necessity to adapt the environment tothis growing group of the elderly.
The WHO has created amodel-programme of“age-friendly cities”.

© by Ursula Lehr • 2013

Visions for the Ageing Societies:
Active Ageing
With increasingly poor health theenvironment, ecological factors, gains more
influence.
Very often ecological variables(housing situation, rural or urban
environments, transportation system etc.)
will determine the degree of dependency.
Favourable ecological conditions extend thelife space, unfavourable may result in a
restriction and a loss of abilities and skills.
Often an adaptation of the home to thespecific needs of a person will contribute tomore independence of a handicappedelderlyIn order to realize active ageing, to prevent
frailness and care dependency, we need also a„preventive environment“On the one hand•barriers needs to be recognized andremoved,On the other hand© by Ursula Lehr • 2013•

the living environment needs to bearranged in a way that may motivate
psysical, mental and social activity

Cities also must provide the structure andservicesto support residents` well-being andproductivity
Older people are not a homogeneous group:
the individual diversity increases with age, determined by the biography,© by Ursula Lehr • 2013

the lifestyle and external social,environmental and economic factors.

Challenges for gerontologists and geriatricians
and politicians:
Teaching the people to do everything for a healthy, competent andactive ageing! Prevention und rehabilitation are very important!
To convince the responsible persons in the community for city
planning to realize this change, the ageing population; they haveto adjust the buildings, the traffic etc.to an aging society.

Also the branch of tourism has to realize the population
change. Tourists of to-morrow will be tourists of 70, 75, 80
years and older!

© by Ursula Lehr • 2013

To create an environment that is acceptable and human for allages, also for the elderly, is the challenge of our time. This also
needs to be emphasized more in research, teaching and every daypractice.

Visions for the Ageing Societies:
Active Ageing
Transportation is a key for influencing active ageing:
being able to move within the city
determines social and cultural participation
the construction of travel buses (high and narrow steps)
low floor buses are helpful for the aged, for familywith little children (Kinderwagen) and people withbicyclesbus-stations on the right place? Do they have seats(with armrest for getting up) in the waiting stations?
are bus-terminals and railway-stations easy to getin?
© by Ursula Lehr • 2013

the informations-system and theticket-self-service
the parking situation: enough space? Not too dark?

Visions for the Ageing Societies:
Active Ageing
It is necessary to enable the society to meet thedemographic change!
To change their attitude toward the aged,
to create a more positive image;- to change something in the environment(city-planning, traffic system,
to secure a greater mobility;)© by Ursula Lehr • 2013- architects and designers need to adjust
to an aging world.
Industry and factory have to realize the aging
society and change some of their products toguarantee elderly people an independent life andsocial participation.

Visions for the Ageing Societies:
Active Ageing

A policy for the aged,
however, should not be determined only by the question:„What can we do for the aged?“
It also should be asked:© by Ursula Lehr • 2013

„What can the aged do for thesociety? “Integration and participation of the elderly are a
prerequisite for the quality of life of the elderly, fortheir own health and productivity;– but it is helpful also for the society.

Visions for the Ageing Societies:
Active Ageing
To see the elderly as a resource
In our fast ageing world, older people are increasingly
playing an important role – by volunteering work,transmitting experience and knowledge, helping theirfamilies with caring responsibilities - or in paid work
These contributions can only be ensured if older persons
enjoy good health and if societies consider their needs.

© by Ursula Lehr • 2013

(WHO: Age friendly cities, 2007)

Visions for the Ageing Societies:
Active Ageing“The participation of older people enriches societies,
economically, culturally and spiritually.”© by Ursula Lehr • 2013

Health and productivity are closely connected. The lossof one may entail the loss of the other and so lead on
dependency, decline of mental, psychological andphysical abilities and incompetence – whereas
productivity, participation, responsibility and the feelingof being needed have a favourable effect on health… wehave to recognize that health and productivity areinteracting conditions.
The unproductive human is at higher risk of illness andeconomic dependency; and the sick person is limited in
productivity and is, therefore, at higher risk ofdependency” (Robert BUTLER,1981,p.12).

Visions for the Ageing Societies:
Active Ageing

A policy for senior citizens• maintaining and increasing thecompetence of the elderly in order toprevent dependency, to secure a healthy
aging with a high degree of quality oflife, to secure participation.

© by Ursula Lehr • 2013

• to promote the understanding between thegenerations, which requires theparticipation of all generations, partly byintegrating senior citizens in politics andpolitical decision-making

Visions for the Ageing Societies:
Active Ageing
A policy for senior citizens:

Extending and improving
rehabilitation measures in order tore-enable the elderly to lead an
independent life

© by Ursula Lehr • 2013

Finding a solution to the problems ofthe dependent and frail elderly, theproblems of housing conditions andthe problems of careingVisions for the Ageing Societies:
Active Ageing
Longevity - a challenge foractive and healthy aging• A policy for the elderly has to be more than just a policy
for pensions systems and a policy for care
• and has to include also other aspects:- to optimize development and education;- to force prevention, preventive behaviour,
healthy life-style – and rehabilitation- to create an age-friendly environment© by Ursula Lehr • 2013

- to create age-friendly products

Visions for the Ageing Societies:
Active Ageing© by Ursula Lehr • 2013

Politicians, City Councils andscientists of all disciplines andfaculties,
administrators and practionners,
have to discuss the question of
population change,
the question of an ageing society.
(how to get longevity combined with astate of psychophysical wellbeing, without
dependency)

Visions for the Ageing Societies:
Active Ageing
Old age, longevity, should not be seen as aproblem but as a chance and challenge – achallenge for everyone: for the aging individual,
for his/her family and for our society.

© by Ursula Lehr • 2013

We should not only ask for the problems anddeficits of aging and old age. We have to ask forthe resources, the new potentials of the aged,
also for the competencies and potentials of thevery old persons.

We have to see the aged of the 21st
century as human capital.

Visions for the Ageing Societies:
Active AgeingLet`s try to be optimistic!
The optimist
is a person who turns a
problem into a challengethat needs to be solved© by Ursula Lehr • 2013

The pessimist
is a person,who turns achallenge into a problem
which let him feel helpless© by Ursula Lehr • 2013

Visions for the Ageing Societies:
Active AgeingGerman Experiences in Programmes for the Elderly

National Association of Senior
Citizens‘ Organisations in Germany(= BAGSO)
More than 100 member organisations
Promotes the interests of around
13 million senior citizens in Germany
Campaigning to influence policy© by Ursula Lehr • 2013

Raising awareness of the importanceof senior citizens
Promoting their rights to participate
in society