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After Covid, a demographic crisis awaits

An 82-year old patient patient at Headley Court, Surrey, (Photo by Victoria Jones-WPA Pool/Getty Images)

June 13, 2020 - 6:58am

A bleak but timely long read this week at Kosciuszko Review by biomedical analyst Tom Tyler who examines the global implications of our ageing demographics through the lens of Covid-19. The virus has, he argues, revealed both the looming demographic crisis and also the acute vulnerability of ageing populations to a pandemic:

In Italy, for example, 22% of the population are over the age of 65, among the highest proportions in the world. And as of the publication of this article, coronavirus deaths from this age cohort represent over 85% of the total. This pattern is very much repeated throughout Europe. In Sweden for example, a nation often hailed for its highly developed medical infrastructure and welfare state, more than 90% of the country’s dead have been over the age of 70. 
- Tom Tyler, Kosciuszko Review

Care homes, Tyler shows, are relatively recent innovations that have sprung up to deal with changing demographics, serving some 400,000 elderly people in the UK and employing 1.47 million care workers. These workers are typically women, often immigrants, and perform gruelling work in often-poor conditions for low pay. As turnover is high in the sector, care homes turn to overseas workforces for staff, intensifying toxic debates about immigration. Meanwhile, the countries from which migrant workers are recruited themselves face the same demographic time-bomb — only without the resources to ‘pull’ migrant workers from elsewhere to plug their own care gaps:

Moldova is by many measures the poorest state in Europe and is currently undergoing one of the worst demographic declines in the world, the severity of which is so great that the country’s politicians have begun to frame it in existential terms. The bitter irony of Moldova’s fate is that part of its emigration-induced worker shortage includes the thousands of women who have left to Italy to work as “badanti” – carers for the elderly. 
- Tom Tyler, Kosciuszko Review

And even as countries compete to displace their demographic problem onto other, poorer countries that face the same challenges, Tyler argues that housing the elderly together for care is a model acutely vulnerable to pandemics. If you cluster large numbers of frail elderly people in close proximity, with the same people caring for all of them, it only takes one infected carer for a disease to reach every resident in the care home. And we can be confident that Covid-19 won’t be the last pandemic.

What prospects are there, then, of averting another Covid-19 care home catastrophe, or of a more drawn-out collapse of the model under demographic or economic pressures? Though medical advances may eventually be able to help future generations sustain independent living into old age, Tyler suggests we shouldn’t bank on it — not for several decades at least, by which time we’ll be well into the crisis.

Other solutions focus more on societal changes that will challenge prevailing ideas about how we organise ourselves. It’s too early to tell whether pronatalist policies in countries such as Hungary will be enough to reverse that country’s demographic decline, but it’s difficult to imagine such a policy arriving in Britain without fierce liberal opposition. Likewise, multi-generational living may offer some support — but it’s difficult when very little of the housing stock is built for such arrangements.

The likely near-future, meanwhile, is a bleak mix of ever more expensive care homes, marginalised elderly people, rapidly-spreading infections, care responsibilities falling once more on families and local communities — and what the Japanese call ‘kokodushi’: in Tyler’s words, ‘old people dying alone in their apartments and remaining undiscovered for weeks, months, occasionally years.’


Mary Harrington is a contributing editor at UnHerd.

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D Glover
D Glover
4 years ago

‘pronatalist policies in countries such as Hungary will be enough to reverse that country’s demographic decline, but it’s difficult to imagine such a policy arriving in Britain without fierce liberal opposition.’

There’s a more fundamental reason in the UK’s case. We import half our food. If a ‘pronatalist’ policy made our population grow even faster than it does now, where would the food come from? Housing? Water? Energy?

I’m 65, my mother died in a care home in her 90’s. I think we have to accept that death comes in old age. Insulating old people from contagion is not possible, never was in the past, and might not even be desirable.

Importing carers to look after the aged is a Ponzi scheme, because carers get old, too.

Tim Rowe
Tim Rowe
4 years ago

This is a difficult problem. As a designer of hospitals and other healthcare facilities for pretty much the whole of my working life I have seen at first hand the desperately poor standard of care for our elderly.

Although a designer of these facilities I am of the opinion that the building itself is of little importance when compared to the quality of care staff. Again it would seem to me that “qualification” of care staff is less important than a truly caring nature sympathetic to the needs and feelings of the people being cared for.

My father was 87 when he died having been incapacitated physically regarding walking from a hip injury, fortunately my Mum could care for him until the very end when he was in a care home for his last few months of life. He was to the end, able to do the Telegraph crossword. My Mum is now 97, in a few days, and still lives independently and walks into town, a distance of probably a mile. I have retired, got stung in the banking crash and sail an old boat in the Med during the summer months. I am athletic and active and touch wood, will continue this lifestyle until I am into my 90’s. My Mum came out to the boat and took the helm in her 91st year. She has expressed the idea to come and sail again. Long may it continue.

andy thompson
andy thompson
4 years ago
Reply to  Tim Rowe

Good luck to you sir and to your mother too. Hope she manages to take the helm again real soon!

Malcolm Ripley
Malcolm Ripley
4 years ago

The problem is that this Covid pandemic is nothing unusual. Every year between 17000 to 45000 people die from seasonal respiratory viral infections and most of them are the elderly. We can even predict exactly when it will occur and every year we do precisely NOTHING.

Both the medical establishment and politicians need to hang their collective heads in shame at this appalling situation. Ironically enough had they had a process in place that they “switch on” at the end of September that very same process could have been “switched on” at the beginning of February and would have saved tens of thousands of lives. Not only that there would have been no need for ridiculously bad models from someone whose track record is very bad on this subject. There would also be no need for illogical quarantining of 96% of the population who are unaffected!

How do people think that elderly woman in the above photo is feeling surrounded by people whose faces she cannot see? An utterly appalling situation

Jeffrey Shaw
Jeffrey Shaw
4 years ago

“And we can be confident that Covid-19 won’t be the last pandemic.”
Indeed – the current charade was successful, well beyond the visions of those who perpetrated it. This was primarily due to their underestimation of the gleeful compliance the public exercised in the face of government pronouncements that eliminated their freedom. At this point they don’t seriously need to produce a virus – they only need to announce its existence and then roll out the daily “death” figures, which will promptly be reproduced in the disinformation infrastructure, which is also at their command.

D Glover
D Glover
4 years ago
Reply to  Jeffrey Shaw

And why would they do that? The government don’t benefit from trashing the economy. This UK government haven’t covered themselves in credit. So, why would they be faking this?

Jeffrey Shaw
Jeffrey Shaw
4 years ago
Reply to  D Glover

A. You are speaking of the elected government, which is not in charge.
B. It is properly – the Government”doesn’t” benefit. But in reality they do – they gain additional power over others and they get to exercise greater authority. This is the calling of almost everyone drawn to governance – “service” is not part of the equation.

D Glover
D Glover
4 years ago
Reply to  Jeffrey Shaw

‘The Government doesn’t’ only works if it is singular.
Then you must write ‘But in reality it does’

Silke David
Silke David
4 years ago
Reply to  D Glover

I wonder why they are faking it, too. Did Amazon promise to pay their correct taxes?
Every day the ONS publishes daily Lab confirmed positive tests. If you look closer, the actual number of people tested positive is a fraction of this number. They never explain in their press briefings that people in hospital can get tested several times a day, or these numbers include people who already tested positive but are included in research. We also know that death certificates have been amended to include Covid even when they were negative or were never tested.
Why, why why. Sadly no-one why power and contacts in government asks these questions and the public are like the 3 monkeys. So the conspiracy theory, like in Killing Eve, that there are some powerfully people deciding the fate of the world, almost seems realistic.

Lee Johnson
Lee Johnson
4 years ago
Reply to  Jeffrey Shaw

Why do you bother reading any articles or news ?

Jeffrey Shaw
Jeffrey Shaw
4 years ago
Reply to  Lee Johnson

Because the spread of the lies and distortions are everywhere. Do you believe the modern story of archeology being taught at universities around the world, in the face of contrary evidence? Do you think substantially pharmaceutical medicine was all that was practiced 100 years ago? Are you aware of the substantial differences?

Lee Johnson
Lee Johnson
4 years ago
Reply to  Jeffrey Shaw

I’m not even aware of your prose. Sorry.

Scott Carson
Scott Carson
4 years ago
Reply to  Jeffrey Shaw

I thought I was a cynical paranoiac, until I read this.

So, thanks for that. 👍

Jeffrey Shaw
Jeffrey Shaw
4 years ago
Reply to  Scott Carson

Those of us who comprehend these realities really ARE “in this together.”

conall boyle
conall boyle
4 years ago

Why is it a demographic crisis when a country decides that its population is already too big? Reducing the number of people on this planet, especially the high consumers, is the only realistic option to avoid ecological catastrophe.

So why isn’t demographic decline as in Italy or Japan seen as a sign of virtue? Why MUST such countries rush to re-fill and expand the numbers? A greener, less frantic more spacious land is surely a human bonus?

Don’t worry about the 400,000 OAPs in care homes, needing 1.5 million imported carers. The ‘demographic transition’ from declining population would reduce both numbers, and the fewer octo- and nono-generians will be fitter and able to look after them selves too. Already in Japan robotic and AI solutions are being found.

It’s high time to celebrate and adapt to declining populations, and enjoying the benefits of less crowding. Saving the planet should be a joy not a curse.

D Glover
D Glover
4 years ago
Reply to  conall boyle

Follow the money. A rising population makes powerful interests richer.
Sell more houses; food; cars; etc.

Lee Johnson
Lee Johnson
4 years ago

Are old people simply a problem ? If they are simply a problem who is living a worthwhile life and who is not ? Does it matter ?