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Global Health and Aging
Familial support and caregiving among
generations typically run in both directions.
Older people often provide care for a variety
of others (spouses, older parents, children,
grandchildren, and nonfamily members), while
families, and especially adult children, are the
primary source of support and care for their
older relatives. Most older people today have
children, and many have grandchildren and
living siblings. However, in countries with very
low birth rates, future generations will have few
if any siblings. The global trend toward having
fewer children assures that there will be less
potential care and support for older people from
their families in the future.
As life expectancy increases in most nations, so
do the odds that several generations are alive at
the same time. In more developed countries, this
is manifested as a “beanpole family,” a vertical
extension of family structure characterized
by more but smaller generations. As mortality
rates continue to improve, more people in their
50s and 60s are likely to have surviving parents,
aunts, and uncles. Consequently, more children
will know their grandparents and even their
great-grandparents, especially their great-
grandmothers. There is no historical precedent
for a majority of middle-aged and older adults
having living parents.
However, while the number of surviving
generations in a family may have increased,
today these generations are more likely to live
separately. In many countries, the shape of
economic security; rising rates of migration,
divorce, and remarriage; and blended and
stepfamily relations. In addition, more adults
are choosing not to marry or have children at
all. In parts of sub-Saharan Africa, the skipped-
generation family household—in which an
older person or couple resides with at least one
grandchild but no middle-generation family
members—has become increasingly common
because of high mortality from HIV/AIDS.
In Zambia, for example, 30 percent of older
women head such households. In developed
countries, couples and single mothers often
delay childbearing until their 30s and 40s,
households increasingly have both adults
working, and more children are being raised in
single-parent households.
The number, and often the percentage, of older
people living alone is rising in most countries.
In some European countries, more than 40
percent of women aged 65 or older live alone.
Even in societies with strong traditions of older
parents living with children, such as in Japan,
traditional living arrangements are becoming
less common (Figure 14).
In the past, living alone in older age often
was equated with social isolation or family
abandonment. However, research in many
cultural settings shows that older people prefer
to be in their own homes and communities,
even if that means living alone. This preference
is reinforced by greater longevity, expanded
friendly housing, and an emphasis in many
nations on community care.
The ultimate impact of these changing family
patterns on health is unknown. Older people
sharing goods that might be available in a larger
family, and the risk of falling into poverty in
older age may increase as family size falls. On
the other hand, older people are also a resource
for younger generations, and their absence may
create an additional burden for younger family
members.
Changing Role of the Family