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Proc Natl Acad Sci U S A. 2018 Sep 11;115(37):9169-9174. doi: 10.1073/pnas.1806260115. Epub 2018 Aug 28.

Multidimensional comparison of countries' adaptation to societal aging.

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Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549.
Schaffer Center for Health Policy, University of Southern California, Los Angeles, CA 90089.
Schaffer Center for Health Policy, Sol Price School of Public Policy, University of Southern California, Los Angeles, CA 90089.
Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY 10032


As long-term changes in life expectancy and fertility drive the emergence of aging societies across the globe, individual countries vary widely in the development of age-relevant policies and programs. While failure to adapt to the demographic transformation carries not only important financial risks but also social risks, most efforts to gauge countries' preparedness focus on economic indicators. Using data from the Organization for Economic Cooperation and Development (OECD) and other sources, we developed a multidimensional Aging Society Index that assesses the status of older populations across five specific domains, including productivity and engagement, well-being, equity, economic and physical security, and intergenerational cohesion. For 18 OECD countries, the results demonstrate substantial diversity in countries' progress in adapting to aging. For any given domain, there are wide differences across countries, and within most countries, there is substantial variation across domains. Overall, Norway and Sweden rank first in adaptation to aging, followed by the United States, The Netherlands, and Japan. Central and eastern European countries rank at the bottom, with huge untapped potential for successful aging. The United States ranks best in productivity and engagement, in the top half for cohesion, and in the middle in well-being, but it ranks third from the bottom in equity. Only well-being and security showed significant between-domain correlation (r = 0.59, P = 0.011), strengthening the case for a multidimensional index. Examination of heterogeneity within and across domains of the index can be used to assess the need for, and effectiveness of, various programs and policies and facilitate successful adaptation to the demographic transition.


aging; international; society

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