Executive summary

The world continues to experience an unprecedented and sustained change in the age structure of the global population, driven by increasing levels of life expectancy and decreasing levels of fertility. People are living longer lives, and both the share and the number of older persons in the total population are growing rapidly. Globally, there were 727 million persons aged 65 years or over in 2020. Since women live longer than men, on average, they comprise the majority of older persons, especially at advanced ages. Over the next three decades, the number of older persons worldwide is projected to more than double, reaching over 1.5 billion in 2050. All regions will see an increase in the size of the older population between 2020 and 2050 Globally, the share of the population aged 65 years or over is expected to increase from 9.3 per cent in 2020 to around 16.0 per cent in 2050.

Population ageing is occurring alongside broader social and economic changes taking place throughout the world. Declines in fertility, changes in patterns of marriage, cohabitation and divorce, increased levels of education among younger generations, and continued rural-to-urban and international migration, in tandem with rapid economic development, are reshaping the context in which older persons live, including the size and composition of their households and their living arrangements. In Western European countries and the United States of America, intergenerational co-residence has declined dramatically, and most older persons now live either in single-person households or in households consisting of a couple only or a couple and their unmarried children. Despite the persistence of traditional family structures and cultural norms that favour multi-generational households, many countries of the less developed regions are experiencing a slow shift in family and household composition towards smaller families and household types. Family structures and household living arrangements can change quickly in response to major events or crises affecting family members and kin relations. For example, multi-generation households re-appeared in the United States of America and in some European countries in response to the economic crisis of 2008, while skip-generation families have become more common in sub-Saharan Africa as a means of caring for millions of children orphaned by the HIV/AIDS pandemic since the 1980s.

Throughout the world older women are more likely than older men to live alone. Older women are also more likely to live in skip-generation households or in extended-family households, whereas older men are more likely to live with a spouse only. Further, older men are more likely than older women to live with children under age 20, while older women are slightly more likely than older men to live with older children. These differences are explained to a large extent by the typical age difference between spouses and by the reproductive life spans of women and men. Since husbands are typically older than their wives, and since there is no male equivalent of menopause, men are more likely than women to co-reside with children under age 20 when they reach older ages.

Co-residence with adult children is a common mechanism of support for parents at older ages, which may be triggered by a decline in their physical or mental health and an increased need for personal care. In other cases, co-residence is a way for parents to support adult children who never left the parental home or have returned to cope with economic hardship or adverse life events. Yet another situation is an older person who moves into the household of an adult child to help care for grandchildren.

The living arrangements of older people are an important determinant of their economic well-being as well as their physical and psychosocial health and life satisfaction. Research has also found an association between mortality risks at older ages and an individual’s living arrangements. Older persons living alone or in institutions, for example, have higher overall mortality risks than those living with a spouse or other family members. The living arrangements of older persons can also have important macroeconomic implications by shaping the demand for housing, social services, energy, water and other resources.

Since early 2020, the world has been impacted by the rapid spread of COVID-19, which continues to expand globally. By the end of September 2020, over 33 million cases had been reported worldwide, with nearly 850,000 deaths attributed to the disease. Since COVID-19 is a new disease in humans, and since the pandemic is ongoing, available studies of its impact on older persons remain inconclusive. Nevertheless, a preliminary analysis of COVID-19 mortality rates at older ages has uncovered considerable variation across countries and points toward factors that may explain the observed differences. Among the factors affecting mortality from COVID-19 at older ages, the main determinant is the extent to which countries have been able to control the spread of the virus and mitigate the pandemic. In addition, frailty is a key factor since the risk of death from COVID-19 increases with both age and the presence of co-morbidities such as cardiovascular, pulmonary or kidney disease, as well as cancer and obesity. Living arrangements explain part of the observed international differences in age patterns of COVID-19 mortality, in particular for older persons whose living arrangements affect the risk of contracting COVID-19.

In this context, the living arrangements and mechanisms of family support for older persons have become increasingly important for policymakers, especially in countries at advanced stages of population ageing. Understanding the interconnections between the living arrangements of older persons and their health and well-being has particular relevance in light of the pledge made by Governments in the 2030 Agenda for Sustainable Development that no one will be left behind. In practice, this pledge implies that the Sustainable Development Goals (SDGs) must be achieved for all segments of society and at all ages, with a particular focus on the most vulnerable, including older persons.

How and with whom older people reside has important implications for the Goals related to ending poverty in all its forms everywhere (SDG 1), ensuring healthy lives and promoting well-being for all at all ages (SDG 3), and achieving gender equality and empowering all women and girls (SDG 5). Mitigating the impact of COVID-19 on the older population will require continued efforts by the international community to curb the spread of the virus and to put in place measures to protect the most vulnerable segments of the population — in particular, older persons with pre-existing conditions or who reside in institutions — from exposure to the disease.