Piotr Szukalski
D epartm ent o f D em o g ra p h y
Institute o f E co n o m etric s and S tatistics, U n iv ersity o f L odz
THE CHANGING DEMOGRAPHIC PATTERNS AND THE SOCIAL
CONDITIONS OF THE HEALTH STATUS OF THE ELDERLY
A b s tr a c t
The health status - meant as the W HO definition - o f the elderly is affected by changes in the dem ographic patterns. Lowering fertility, declining freąuency o f marriages and the growing num ber o f divorces decrease the probability o f finding care on the side o f the family after one's reaching a ripe old age. Ali this enforces changes in the care system for the elderly. The traditional - basing on family bonds - model is being superseded by institutional - financed from public means - forms. In the case o f Poland the changes in the care system - especially the care for people requiring it all the tim e - resulting from dem ographic conditions are even more important as the Polish society is bound to be subject to acceleration o f the ageing processes in the first half o f the 21-st century.
W h ile sp e ak in g a b o u t the h ealth status o f the eld erly o n e m ust not o m it factors d e te rm in in g this state. F rom now on let us take the W H O d efin itio n o f health which co m p rises such fac to rs as fram e o f m ind, social and phy sical co n d itio n s. In the p ap er I w o u ld like to a n sw e r the q u estio n ab o u t the role o f the past. p resen t and futurę c h a n g es in the d em o g ra p h ic pattern s. A s already k n ow n. d u rin g the p ro cess of m o d e rn isatio n the P olish so ciety o f the 20-th cen tu ry w as su b je ct to an accelerated - as co m p a re d to m ore c iv ilised co u n tries - d e m o g ra p h ic tran sitio n . T h e most ch a ra c te ristic fea tu re o f this p ro ce ss w as tran sitio n from re la tiv e ly high to relatively Iow m o rta lity and fertility. A s it is c o m m o n ly k n ow n the large n u m b e rs o f old p eople w h o em erg e d d u rin g sev eral d o zen years resu lted fro m this d e m o g ra p h ic transition: this a b so lu te in crease is a c o n seq u e n ce o f the lo w erin g m o rta lity w hich makes peo p le rea ch a ripe o ld age w h erea s the rela tiv e in crease is ca u se d by sm a lle r num bers o f the n ew ly born - that is by the lo w er fertility.
F u rth e r on w e w o u ld like to h ig h lig h t the m ost im p o rtan t p o ssib le effe c ts o f the ch a n g es in the d em o g ra p h ic p attern s upon the w elfare o f the eld erly - the effe c ts of so ca lle d the se co n d and the third d e m o g ra p h ic transition.
A ssu m in g that the fam ily fav o u rab ly affe c ts the h ealth statu s irre sp e ctiv e o f one’s age (alth o u g h there is som e ev id en c e that it m ight be the p ro p e r h ealth itself that u n d erlies o n e ’s d ec isio n to start fam ily [9]) w e are g o in g to reflec t the ev o lu tio n which the P o lish fam ily is b o u n d to face as w ell as the p o ssib le c o n se q u e n c e s o f this evolution upon the h ealth sta tu s o f the elderly. F av o u rab le e ffe c ts o f living in the
fam ily m ig h t be o b se rv e d th ro u g h co m p arin g the stru ctu res o f p eo p le ag ed 50 and o v e r w ith re sp e c t to the p o p u la tio n s o f the living (data from the rep rese n tativ e ce n su s o f 1995) an d o f the d ead (d ata o f 1996) (see: table 1). W e assu m e in d irectly that the m o rta lity o f the eld erly is the best in d ic ato r p o ssib le to m e asu re th e ir health status.
Table 1. The structure of the elderly by m arital status (the living - 1995, the deceased - 1996)
M arital Males Females
Age status the living the dead the living the dead
50-59 years single 6.0 12.3 4.0 7.9 old m arried 86.7 69.8 74.0 62.9 widowed 2.8 6.0 15.9 20.1 divorces 4.5 11.9 6.1 9.1 60 year single 3.3 4.2 5.3 8.5 and over m arried 80.9 67.8 41.2 19.8 widowed 13.2 24.4 50.5 6 8 .6 divorced 2.6 3.6 3.0 3.1
Source: Own calculations on the basis o f the Demograpliic Yearbook o f 1997. CSO. Warsów
B o th in the ca se o f m en and w o m en th eir m arital sta tu s in flu e n ces the m ortality . M a rrie d p eo p le are ch a racterise d by low er m o rtality w h ich m ight be ac co u n te d fo r b oth e m o tio n a l (life jo y , assista n ce in ev ery d ay life) and b e h a v io u ral fac to rs (re g u la r w ay o f living, risk av e rsio n - e.g. lo w er co n su m p tio n o f alco h o l and to b a cc o ) as w ell as fo r e c o n o m ic fac to rs (re tu rn s to scalę o w in g to w o rk d iv e rsific a tio n w ith in the fam ily h o u seh o ld ). In this c o n tex t there sh o u ld be som e w o rrie s a b o u t the fact o f m a rria g e ev a sio n and the g ro w in g n u m b e r o f d iv o rce s in P oland. In fu tu rę su ch p h e n o m e n a can lead to an in crease in the n u m b e r o f the lonely w h ich m ig h t a g g ra v ate the rela tiv e w elfare. A d d itio n ally . in the case o f fem a les to be sin g le o r to be d iv o rce d en tails startin g a jo b w h ich in fu tu rę so m e tim es re su lts in som e o cc u p a tio n a l ailm en ts. T o b elittle the p rese n t te n d en cy to w ard s c o n tra c tin g m a rria g es and th eir durab ility , it sh o u ld be ad d e d that w e m ight m erely fac e so m e te rm ch a n g e s in sta rtin g the fam ily ra th e r than the d im in ish in g w illin g n ess to c o n tra c t m arriag es.
B e arin g in m in d all the p ro b lem s fac in g the h ealth and p en sio n system s it seem s o b v io u s th a t it is the fam ily o f the o ld p erso n that sh o u ld be in m ore ch a rg e o f ca rin g fo r them . It is n o t a b o u t all the fo rm s o f care b u t first o f all a b o u t p ro p h y lax is a n d the care fo r the c h ro n ic ally d isab led . A s far as p ro p h y lax is is c o n c e rn e d a case in p o in t m ig h t b e p ro p erly d esig n ed fu rn itu re and o th e r fu rn ish in g s to e n a b le the in v alid to fu n c tio n on th e ir o w n (e.g. to ilet h an d les and a rran g e m en t o f ev e ry d ay o b je cts fix ed in su ch a w ay to av o id u n n ec essary b en d in g w h ich h o w ev e r, very often
entails red e co ratin g all the p lace o f d w ellin g [5]). In the ca se o f the c h ro n ic ally disabled w hat m a tte rs is - d e p e n d in g on the situ atio n - en su rin g all day o r at least part tim e care.
W hile sp e ak in g a b o u t the d u ties o f the old m an's fam ily and o th e r form s o f aid with resp e ct to the elderly, w e did not m ean th e ir sp o u se s as the a v e rag e age difference b etw e en p artn e rs to the m a rria g e is o nly 2-3 years. T h e sp o u se is thus old them selves an d is not alw ays able to giv e a help in g hand. It is then the o ld m an's offspring that sh o u ld take ca re o f the old. F u rth e r on w e are g o in g to d isc u ss the changes in fertility p attern s and th eir co n seq u e n ces. A s already m en tio n ed . the post- transition d e m o g ra p h ic State is ch a racterise d by Iow fertility w h ich is reflec te d by the fertility in d ic ato r sh o w in g how m any ch ild ren are born by one w om an. In P oland this indicator has b een d ec lin in g fo r m any years and in 1996 it w as 1.58. T o assure the sim ple g en e ratio n su b stitu tio n it sh o u ld be 2.15. In som e u rb a n re g io n s the indicator h ardly ex c e e d e d one (in L odz V o iv o d sh ip - 1.233, in W arsaw - 1.283, in Katowice - 1.332). S uch a situ atio n m ean s that - u n d er the trad itio n ally p rev a ilin g family p attern 2 + 2 - there m ust also be co u p les w ho d ecid e not to h av e ch ild ren at all, couples ca lle d d in k ie s (do u b le incom e, no kids). B oth sp o u se s in such m arriag es are o cc u p atio n ally activ e and m ake effic ie n t use o f c o n tra ce p tiv e s. A s a resu lt w e should e x p e ct the n u m b e r o f ch ild le ss fam ilies to g ro w w h ich m ight ad d itio n a lly burden the p rese n t system o f h ealth care. A t the sam e tim e the in c re asin g p o p u larity of one-child fam ilies has it that a fte r rea ch in g o ld age a sin g le and c h ild le ss perso n will not have any su p p o rt on the side o f the relativ es. P arents o f an o nly ch ild m ight experience a sim ila r situ atio n if th eir ch ild u n d erg o es an ac cid en t o r d ec id e s to leave their parents' p lace o f living. T o u n d ersta n d this q u estio n b e tte r let us take F ra n ce as an exam ple, w h ere in 1970 10% o f peo p le aged 60 and o v e r did have n eith er offspring nor sib lin g s. T h e ev o lu tio n o f fertility is likely to copy the situ atio n from previous c e n tu ries - it is e stim a ted that in the 18th cen tu ry F ra n ce ca 25% peo p le aged 60-85 did not have any rela tiv e s in d irec t line [6], A t the end o f the 7 0 ’s 10% of old peo p le in P o lan d did not o ffsp rin g , eith e r [11],
F orm s and fre q u en c y o f aid g iv en by the fam ily to the o ld d e p e n d on a lot o f factors. Let us m en tio n tw o o f such factors: o ccu p atio n al a c tiv itie s and the p lace o f residence o f the o ld m an's rela tiv e s. A s far as o cc u p atio n al a c tiv itie s are co n c e rn e d they are likely to a ffec t not the fre q u en c y o f aid but its form s. T h e ex a m p le o f the USA show s that the g ro w in g p articip a tio n o f fem ales in the la b o u r m arket, w hich took place in the 7 0 ’s, resu lted in an in creased d em an d fo r p riv ate h ealth and nursing se rv ic es w hich as a resu lt c o n trib u ted to the em erg en c e o f a d y n am ica lly developing se cto r o f the eco n o m y [8],
T he o th e r o f the a b o v e -m en tio n ed fac to rs - the p lace o f re sid e n ce o f the old m ans rela tiv e s - d eterm in e s the tim e and the fre q u en c y o f the care. In this ca se - assuming that sp a ce v ic in ity m ak es c o n tac ts e a sie r - it is w o rth y to g et ac q u ain ted with the fo recast reg a rd in g h o u se h o ld s elab o rate d by the C S O [B o le sła w sk i, 1997], The forecast en v isa g e s that in the years 1996-2020 the n u m b e r o f h o u se h o ld s w ill grow by 27.8% w h erea s the p o p u la tio n - by o nly 5.4% . It m e an s that the av e rag e
n u m b e r o f h o u se h o ld m em b ers w ill d ro p from 3.064 to 2.5 3 9 p erso n s and the n u m b e r o f ad u lts - fro m 2.2 2 0 to 1.937. T h ese q u an tita tiv e ch a n g es w ill resu lt from an in c re asin g sh are o f sm ali, o n e o r tw o -p erso n h o u se h o ld s w h ich is g o in g to be a c o n se q u e n c e o f the fo llo w in g d em o g ra p h ic patterns: co n tra ctin g m a rria g es at m ore m atu rę age, c o n sc io u s living in celibacy, the in creasin g n u m b e r o f k n o w in g ly ch ild le ss c o u p les, an ti-m o rtal actio n s p ro tra ctin g life expectancy.
In the end w e c o n c lu d e th at in the co u rse o f agein g p ro ce sses the n u m b e r o f o ld p eo p le ru n n in g o n e-p e rso n h o u se h o ld s is goin g to grow .
O n e co n se q u e n c e o f the lo n g e r life ex p e ctan c y o f fem ales is th a t there w ill be a lot o f o n e -w o m a n - e sp ec ially o n e-w id o w - h o u seh o ld s. T h e fo re ca st seem s to su b stan tia te the th e sis that the o ld are b o u n d to be m ore sp atially d istan t fro m th e ir fam ilies, a lth o u g h the h o u sin g m ight allev iate this situation. W h e th e r spatial d istan c e m e an s living in so litu d e d ep e n d s m uch m ore on o th e r facto rs. O f such facto rs let us touch on in te r-g e n eratio n flo w s that d eterm in e the d irec tio n and the am o u n t o f the in te r-g e n e ra tio n su p p o rt g iven w ith in one fam ily. A c c o rd in g to som e re se a rc h e rs w e w itn e ss co n sid erab le o v ere stim a tio n o f the role o f the fam ily and fam ily bonds.
T h is p ro c e ss sta rted as early as in the 17th cen tu ry w hen o u r a n c e sto rs began g ettin g in te reste d in th e ir clo sest rela tiv e s rath e r than in th eir w h o le social e n v iro n m e n t [1]. T h is ten d en c y is g ettin g C onsolidated n ow adays, w h ich is fav o u red by the tran sitio n o f the h o u se h o ld from p ro d u ctio n to c o n su m p tio n unit [3]. E arn in g s g ain ed in d e v e lo p e d co u n trie s let peo p le p o sse ss su b stan tia l m e an s ev en a fte r sa tisfy in g th e ir b asie needs. T h o se m eans can be spent on g o o d s and se rv ic es, the m ain p u rp o se o f w h ich is to en jo y fam ily m em b ers and c o n so lid a te the fam ily. T h e fam ily o f tod ay is c h a ra c te rise d by the an x iety to satisfy th ree feelin g s: ro m an tic love that u n d e rlie s ea ch m arriag e; p aren tal love a sso cia te d w ith m a ternity; d o m e stic ity w h ere fam ily b o n d s are stro n g er than ex tern al b o n d s [3].
W h ile sp e ak in g a b o u t in te r-g e n eratio n flo w s it sh o u ld be stated that they are not sy m m etric as they u su ally flo w in to the young, alth o u g h this situ atio n rev e rse s at a ce rta in age. T h e fin an c ial flo w s are clearly u n fav o u rab le fo r the old w h erea s the b alan c e o f se rv ic es is m ore eq u iv ale n t. T h is is so b ec au se - d esp ite Iow real in c o m es o f the old - p en sio n s are still re la tiv e ly high (if co m p ared to w ag es and salaries) w h ich is ad d itio n a lly ac co m p a n ie d by Iow co n su m p tio n ex p e c ta tio n s o f the old. A s a resu lt, the o ld are ab le to tran sfe r som e p art o f th eir incom e to th e ir ch ild ren and g ra n d c h ild re n . T h is refers e sp ec ially to the b asie g o o d b ein g d w ellin g -p lac e.
T h e se co n d p art o f the in te rg en era tio n al flow s form n o n -m aterial serv ices. In this ca se the o ld im p ro v e th eir b alan c e in the co u rse o f age. W hile g ettin g o ld e r they are less su itab le to h elp th eir d e sce n d an ts w ith such w o rk as lo o k in g a fte r g ra n d c h ild re n , g o in g sh o p p in g , etc. O n the contrary, they th e m se lv es need m ore aid and th e ir fam ilies m u st get e n g a g ed m ore in ca rin g fo r them . W hile c o m m e n tin g on the in te rg e n e ra tio n a l flo w s I am far fro m statin g that the o ld are ab u sed by the yo u n g id lers - th e ir o ffsp rin g o r g ran d c h ild ren . F rom the po in t o f view o f the old
helping their d e sc e n d a n ts is o n e w ay o f co n firm in g th eir utility so it sh o u ld be rath e r viewed as a p sy ch o th erap y .
The p ro lo n g in g life e x p e ctan c y in P o lan d w ill lead to co n sid e ra b le in crease in the nu m b er o f old p eo p le the d e sce n d an ts o f w h o se are b o u n d to be o ld and unable to fu n ctio n on th e ir ow n, too. A t p rese n t in P o lan d there are ca 800 th o u san d people aged 80 an d o v e r and o v e r 300 th o u sa n d p eo p le aged 85 an d o v er w ho cali for perm anent care (ac c o rd in g to A m eric an g ero n to lo g ists ea ch p erso n ag ed 80 and over requires p e rm a n e n t care) and w h o se ch ild ren are u sually 5 0 -6 0 y ears old. T he futurę g ro w th in the n u m b e r o f the eld erly is g o in g to en tail som e o th e r unprecedented p ro b lem s reg a rd in g h ealth care. B e arin g in m ind the fact that peo p le aged 60 or so are u su a lly p h y sically fit w e can e x p e ct them to get e n g a g e d m ore in caring for ripe o ld people.
T he p rese n t d e m o g ra p h ic te n d en c ies not o nly ad v e rsely affe c t the p ro b ab ility that the old m an w ill fin d som e g u ard ia n s am o n g th e ir d e sce n d an ts but they also limit kinship n etw o rk s so that in fu tu rę w e m ight face the w orld in w hich lots o f people w ill be on th e ir o w n - w ith o u t sib lin g s, c o u sin s o r ev en fu rth e r fam ily - all those w ho m ig h t be in te reste d in th eir lot [3], T h is is g o in g to in c re ase the importance o f the in stitu tio n s sp e cia lise d in ca rin g fo r the elderly. T h e sp read o f females' o cc u p atio n al a c tiv itie s is g o in g to act in the sam e d irec tio n as so m e p art o f women e n g a g ed in w o rk is sure to m ake use o f sp e cia listic in stitu tio n s ag a in st payment.
In the en d I w o u ld like to p resen t a fo re ca st reg a rd in g the fu tu rę n u m b e r o f the elderly p eo p le in P olan d . D ata on ch a n g es in the n u m b e r o f o ld p eo p le by five- year p erio d s can be fo u n d in a fo re ca st elab o rate d by the U N O P o p u latio n Departm ent. T h e fo re c a st has a long tim e h o rizo n - up to the y ea r 20 5 0 (see: table 2). The fo re c a st w as b ased up o n the ag e in g m eth o d and sho u ld be re g a rd e d as highly pro b ab le.
Table 2. The elderly (in thousands) in Poland in the years 2000-2050 according to the UN estimates (moderate variant)
Age Years 2000 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050 60-64 1701 1481 2205 2668 2688 2210 2054 2409 2777 2954 2600 65-69 1602 1514 1325 1986 2415 2446 2021 1886 2222 2574 2747 70-74 1345 1339 1275 1126 1697 2077 2117 1758 1651 1958 2278 75-79 908 1012 1016 977 868 1319 1626 1670 1401 1328 1589 80+ 712 835 964 1046 1080 1052 1290 1602 1825 1830 1817 60+ 6268 6181 6785 7803 8748 9104 9108 9325 9876 10644 11031
Source: The Sex and Age Distribution o f the World Populations, The 1996 Revision. New York UN, 1997 p. 673.
In the w h o le p erio d u n d e r co n sid eratio n the n u m b e r o f the eld erly p eo p le in P o lan d is g ro w in g . In som e fiv e-y ea r p erio d s this g ro w th is slow , in som e o th e rs - m uch faster. O n ly b etw e en 2000 and 2005 th eir n u m b e r w ill d ec lin e w h ich resu lts fro m the w ar b ab y d e p re ssio n . T h e m ost c o n sp icu o u s fea tu re is th e ir rela tiv e in c re ase in the su c ce ssiv e ag e g roups. T h e 60 -6 4 age gro u p inc re ase s by 5 2 .8 % , the 7 5 -7 9 - by 7 4 .7 % and the 80 and o v er - by 155.2% . In fu tu rę w e w ill face a co n stan t in c re ase in the p o p u la tio n o f elderly, and esp ec ially - o f very o ld people. A ll this m eans that in the se v eral d o zen years to com e the p o p u la tio n o f o ld p eo p le w ill g ro w b y 3/4 an d the d e m an d fo r m edical care w ill g ro w ev en m ore - o w in g to the stru ctu re o f the p o p u la tio n . It sh o u ld be noticed that it is w o m en that are g o in g to m ake up the lio n 's sh are o f p eo p le ad v a n ce d in years. T h eir q u an tita tiv e su p rem a cy is g ettin g m ore v isib le in the su c ce ssiv e age groups. T h is fact affe c ts to m uch ex ten t the system o f h ealth care as w o m en m uch m ore o ften than m en visit d o cto rs, are h o sp italised , stay in san ato ria, p u rch a se m ed icin es and are d ep e n d e n t on the fam ily.
F o r fin an c ial rea so n s and fro m the p o in t o f view o f the e ffic ie n c y o f the health system it is im p o rta n t to state w hat w ill be the share o f o ld p eo p le in the total p o p u la tio n o f P olan d . P ro p er d ata is rep o rted in table 3.
Table 3. Old people in Poland in the years 2000-2010 (per 1000)
Age Years 2000 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050 60-64 43 37 55 67 67 55 51 60 69 74 65 65-69 41 38 33 49 60 61 50 47 55 64 69 70-74 34 34 32 28 42 51 53 44 41 49 57 75-79 23 25 25 24 21 32 40 41 35 33 40 80+ 18 21 24 26 27 26 32 40 45 46 45 60+ 161 158 172 196 219 227 228 233 248 267 277
Source: Own calculations on the basis o f the United Nations estimates [ UN, 1997, p. 673] W ith in the 5 0 y ears to co m e w e e x p e ct - unless there is d rastic d eterio ratio n in m o rta lity rates - a co n sid e ra b le in c re ase in the sh ares o f o ld p eo p le in the total p o p u la tio n o f P o lan d . A t the b eg in n in g o f the 21-st ce n tu ry ev ery sixth perso n w ill be m ore than 60 y ears o ld w h erea s in the m iddle o f the next ce n tu ry ev ery fo urth p erso n w ill fali in to this group. In the first d ec ad e o f the 21 -st c e n tu ry there w ill be o nly slig h t c h a n g es in this resp e ct but later on they are g o in g to take m o m en tu m . Ju d g in g by the p re se n t fav o u ra b le te n d en c ies in m o rta lity o b se rv e d fo r sev eral years, one m ay claim that the p rese n ted fo re c a st u n d ere stim a te s the actual n u m b e r o f old p eo p le to live in P o lan d in the 21 -st century. In such a situ atio n it is o f m uch im p o rta n ce to co m p a re the life e x p e ctan c ies o f o ld peo p le in P o lan d and o th e r d e v e lo p e d E u ro p e an co u n tries. A c c o rd in g to the d ata o f 1996 an a v e rag e 60 year- o ld P olish m an is to live an o th er 15.93 years w h erea s that 65 years o f age - 12.93. T h e resp e c tiv e n u m b e rs fo r w o m en are 20.52 and 15.53 years. In 1997 the
respective n u m b ers w ere: m ales: 16.13 and 13.13, fem ales: 20.8 0 and 16.79. P ro p er data regarding som e o th e r c o u n tries are rep o rte d in table 4.
The av e rag e life ex p e ctan c y o f p eo p le on the verg e o f o ld age is by 2-2.5 years shorter in P oland than in o th e r d ev e lo p e d E u ro p e an co u n tries. T h e p ara m ete rs observed in the o th e r co u n trie s sho u ld be v iew ed as P olan d 's fu tu rę values. A s fa r as the life ex p e ctan c ies are co n c ern ed the tim e d istan c e b etw e en P oland and the o th e r countries is a q u a rte r o f a century. B asing on the d ata re p o rted o n e m ay claim that the public h ealth ca re system w ill not be able to satisfy all the n ee d s d e m a n d e d by the old.
Table 4. Life expectancy of people aged 60 and 65 in some European countries in the years 1960-1990
60 years of age 65 years of age
Country 1960 1970 1980 1990 1960 1970 1980 1990 Males United Kingdom 15.0 15.2 15.9 17.6 11.9 12.0 12.6 14.1 France 15.6 16.2 17.3 19.0 12.5 13.0 14.0 15.6 Italy 16.7 16.7 16.8 18.6 13.4 13.3 13.3 15.1 Norway 18.0 17.3 17.7 18.3 14.5 13.8 14.3 14.6 Females United Kingdom 18.9 19.8 20.4 21.7 15.1 16.0 16.6 17.8 France 19.5 20.8 22.4 24.2 15.6 16.8 18.2 19.9 Italy 19.3 20.2 21.2 23.0 15.3 16.2 17.1 18.8 Norway 20.2 21.0 22.2 22.7 16.1 16.8 18.0 18.6
Source: Wiszniewski] A., Demograficzieskij potencjał Rossji, „Woprosy Ekonomiki". 1998. nr 3 p. 120
It sh o u ld be stressed th at u n d er m any years o f n eg lig en c e ac co m p a n ie d by underinvestm ent an d n o n ch a la n t attitu d e to w ard s this issue on the side o f a u th o rities the situ atio n seem s u n lik e ly to get b e tte r b efo re the seco n d d ec ad e o f the 21-st century w hen p eo p le b o rn d u rin g the p o st-w ar b aby b o o m p erio d are g o in g to en te r their p en sio n ab le age. T h e m ore w ill have to be req u ired then on the side o f old people's fam ilies. O n e m ay ev en su p p o se that it is also the p u b lic se c to r that w ill find it a d v isab le to tra n sfe r as m any care d u tie s as p o ssib le to the o ld peo p le's fam ilies a fte r h av in g m ade them ac q u ain ted w ith m eth o d s o f trea tin g p eo p le advanced in years. O ne m ay also su p p o se that the p riv ate se c to r o f m edical and nursing se rv ic es w ill ex p a n d , too, fo llo w in g h ig h e r living sta n d ard s o f the P olish family.
T h e fam ily o f to d ay fac es a lot o f p ro b lem s that did not use to ex ist b efo re o r e x iste d on a m uch sm a lle r scalę only. O ne o f such p ro b lem s is the care fo r the elderly. T h e p ro tra c tin g life ex p e ctan c y reflec te d by the rec tu n g u liz atio n o f the life ex p e c ta n c y cu rv e has it th at - assu m in g stab ility o f the p ro b ab ility o f d ea th s - ca 82% o f the n ew ly bo rn w ill live to be 60, 65% o f them w ill rea ch 70 and 37% - the age o f 80. T h e scalę o f the ag e in g p ro ce sses nec essitie s c o m b in in g v ario u s fo rm s o f care fo r the eld erly . O ne o f them is in h eren tly related to the fam ily w h ich w as trad itio n ally re g a rd e d as the m ain stay o f the o ld age. It w as o w n ch ild ren that used to be p erc eiv e d as the b est assu ra n ce ag a in st o ld age. V iew in g the p rese n t situ atio n th ro u g h this m u lti-cen tu ry ax io m let us h ope that the c u rren t te n d en c ies in fertility and co n tra c tin g m a rria g es are o nly tem p o rary problem s.
R eferences
[1] Aries P., Historia dzieciństwa. Dziecko i rodzina w dawnych czasach (The H istory o f Childhood. The Child and the Fam ily in Form er Times), Marabut, Gdańsk. 1995. [2] Bolesławski L., Prognoza gospodarstw domowych 1996-2020 (.4 Forecast o f
H ouseholds 1996-2020), Studia i analizy statystyczne (Statistica! Studies and Analyses), GUS, W arsaw, 1997.
[3] Boutilier R., Targeting Families: Marketing to and through the New Family. American Demographics Books, Ithaca 1993.
[4] Burguiere A., Klapisch-Zuber Ch., Segalen M.. Zonabend F., The Family: What Next, in: Burguiere A., Klapisch-Zuber Ch., Segalen M., Zonabend F. (eds.), A History o f the Family, vol. II, The Belknap Press, Cambridge, Mass. 1996.
[5] Coni N., Davison W., W ebster S., Starzenie się (The Ageing Process). PWN. W arsaw 1994.
[6] Ekert-Jaffe O., La familie est-elle un bon assureur, "Problemes Econom iques", 1997. No 2.537.
[7] Golini A., Vivio R., Strategies for the Provision of Social and Health Care Services for the Elderly, w: Lopez A., Caselli G. (eds), Health and M ortality among Elderly Populations, Oxford, Clarendon Press 1996.
[8] M ergenhagen P., Targeting Transitions: Marketing to Consumers during Life Changes, American Demographics Books, Ithaca 1995.
[9] Podogrodzka M., Zróżnicowanie um ieralności według stanu cywilnego (Differentiation o f M ortality by M arital Status), "Studia Demograficzne" (D em ographic Studies).
1992, No 3 (109).
[101 Rocznik Demograficzny 1997 (D emographic Yearbook 1997), GUS. W arsaw 1997. [11] Susułowska M., Psychologia starzenia się i starości (Psycltology o f the Ageing
Process and o f the Old Age), PWN, W arsaw 1989.
[12] Trwanie życia i umieralność według przyczyn w 1996 roku (Life Expectancy and M ortality by Causes in 1996), GUS, W arsaw 1997.
[13] The Sex and Age Distribution of the W orld Populations, The 1996 Revision. New York UN, 1997.
[14] W iszniewskij A., Demograficzieskij potencjał Rossji, „W oprosy Ekonom iki”, 1998, nr 3.
