Ageism: Understanding Its Origins and Impacts

Ageism: Where It Comes From and What It Does
Copyright © 2022 by Alan S. Gutterman. Information about the author and permitted uses of this Work
appears at the end of this Work.
1
Alan S. Gutterman
_______________
According to the United Nations, the number of older-age adults across the world has almost quintupled in
the last 65 years and by 2050 1 in 6 people in the world will be over the age of 65, up from 1 in 11 in 2019.
Among the main drivers of the exponential growth in the older population in developed countries have
been increases in the quality of life and life expectancy accompanied by decreases in infant mortality and
birth rates, advances in combatting chronic diseases of middle age and beyond (i.e., cardiovascular
problems and cancer) and early successes in what is expected to be a revolution in addressing diseases and
conditions typically associated with old age using a variety of tools including better nutrition, medical care,
education, technology, sanitation and socio-economic support. Crucially, greater life expectancy in
wealthier countries has been accompanied by a “compression in morbidity”, which refers to the health-
related quality of life before death, and researchers are claiming that people “will be healthier for even
longer”. This aging of the population opens up opportunities, but also presents challenges to governments,
society and older persons themselves. The World Health Organization has called for engagement around
four action areas: “change how we think, feel and act towards age and ageing; ensure that communities
foster older people’s abilities; deliver person-centered integrated care and services that respond to older
people’s needs; and provide access to long-term care for older people who need it”. In order for these
efforts to be successful, it is essential to have a better understanding of aging, how it is measured and
experienced by older persons in their day-to-day lives and how deeply engrained personal and institutional
ageism in society creates barriers to progress that harm everyone, not just those persons who are on the
receiving end of discrimination and stereotyping.
_______________
According to statistics compiled and published by the United Nations Development
Programme, the number of older-age adults across the world has almost quintupled in the
last 65 years, with the above average growth occurring in Latin America and the
Caribbean, Africa and Asia.1
As of 2015, the number of older adults above 60 years of
age was 906 million worldwide, representing 12.3% of the world population; however,
there were significant variations among geographic regions with respect to the share of
older-age adults: over 20% in Europe (23.86%) and North America (20.74%), but just
over 5% in Africa (5.39%). Asia, with its 514 million older-age adults, had the largest
proportion of the worldwide population (57%). According to the United Nations (“UN”),
by 2050 1 in 6 people in the world will be over the age of 65, up from 1 in 11 in 2019.2
1
G. Cruz-Martinez and G. Cerev, “Global AgeWatch Index and Insights” in D. Gu and M. Dupre (Editors),
Encyclopedia of Gerentology and Population Aging (Springer, 2020), 2-3 (citing World population
prospects: the 2017 revision. Percentage of total population by broad age groups (United Nations
Development Programme, 2017)).
2
World Population Prospects 2019 Highlights (New York: United Nations Department of Economic and
Social Affairs Population Division, 2019).

2
Source: Gateway to Global Aging Data (a platform for population survey data on aging around the world)
The UN has noted that population aging is a global phenomenon, with virtually every
country in the world experiencing growth in the size and proportion of older persons in
their population, and all countries will be passing through an extraordinary longevity
revolution in which the chance of surviving to age 65 rises from less than 50%—as was
the case in Sweden in the 1890s—to more than 90% as of 2019 in countries with the
highest life expectancy.3
The UN reported that the proportion of adult life spent beyond
age 65 has increased from less than a fifth in the 1960s to a quarter or more in most
developed countries as of 2019, a change that is having a profound impact on society as
older persons continuing to a growing and influential demographic group. And, in many
ways, we are just at the beginning of a new phase for human society. In 1914 the
probability that someone born that year would live to 100 was about 1%; however,
projections from the Human Mortality Database (University of California, Berkeley) and
the Max Planck Institute for Demographic Research in Germany indicated that reaching
centenarian status will no longer be a rarity, and in fact will be the norm, in 2107, a
continuation of a dramatic shift in longevity that has been occurring since the middle of
the 19th
century.4
Among the main drivers of the exponential growth in the older population in developed
countries have been increases in the quality of life and life expectancy accompanied by
decreases in infant mortality and birth rates, advances in combatting chronic diseases of
middle age and beyond (i.e., cardiovascular problems and cancer) and early successes in
what is expected to be a revolution in addressing diseases and conditions typically
associated with old age using a variety of tools including better nutrition, medical care,
education, technology, sanitation and socio-economic support.5
Crucially, greater life
3
Id.
4
L. Gratton and A. Scott, The 100-Year Life: Living and Working in an Age of Longevity (London:
Bloomsbury, 2016), 25.
5
Id. at 25-29. See also E. Stallard, “Demographic issues in longevity risk analysis”, Journal of Risk
Insurance, 73(4) (2006), 575.

3
expectancy in wealthier countries has been accompanied by a “compression in
morbidity”, which refers to the health-related quality of life before death, and researchers
are claiming that people “will be healthier for even longer”.6
Developing countries, often
thought to be immune from the challenges of aging due to their relatively higher
birthrates and steady supply of younger workers, are also expected to see significant and
rapid increases in the percentage of their elderly population due to the same combination
of falling infant mortality and birth rates; however, it is not clear whether those countries
will have the resources to maintain the wellbeing of older persons in their midst in the
same way as wealthier countries.7
In the US, the rate of population growth is slow; however, it is expected that the
population will grow by nearly 79 million people in the next four decades and cross the
400 million mark in 2058, with net international migration projected to become the large
driver of population growth starting in 2030 due to falling fertility rates and the rising
number of deaths in an aging population.8
Notably, the share of Americans in the 65-
and-older group is expected to nearly double in size during that period, growing from 49
million in 2016 (15% of the total population) to 95 million (23% of the total population)
in 2060, and the population 85 years and older will grow by nearly 200% by 2060 to
reach 19 million. Several factors are converging to accelerate what has been referred to
as the “greying of America” including the aging of the large group of “baby boomers”
into older adulthood, improvements in health care that have promoted longevity and
rising life expectancy and slowing growth in the population under age 18 (by 2034, older
adults are expected to outnumber children for the first time in US history). Projections
also show that while older women will continue to outnumber older men, the gap will be
narrowing in the coming years, and that the US will be shifting from a youth-dependent
population to an old-aged dependent population.9
6
Id. at 35 (citing J. Fries, “Ageing, Natural Death and the Compression of Morbidity”, New England
Journal of Medicine, 303(3) (July 1980), 130).
7
A. Kanter, “The United Nations Convention on the Rights of Persons with Disabilities and its
implications for the rights of elderly people under international law”, Georgia State University Law
Review, 25 (2009), 527, 528 (citing G. Pison, Population and Societies (French National Institute of
Demographic Studies, July/August 2009 (while it took the US over 70 years to double its over 65
population, the elderly populations in developing countries such as Iran, Syria, Tunisia and Vietnam were
expected to double in 20 years or less)).
8
The data and discussion in this paragraph is adapted from J. Vespa, L. Medina and D. Armstrong
“Demographic Turning Points for the United Sates: Population Projections for 2020 to 2060”, Current
Population Reports P225-1144 (Washington DC: US Census Bureau, 2020). Racial and ethnic
characteristics of the general population are also expected to shift significantly by 2060 from the situation
in 2016: Non-Hispanic White (decrease from 61.3% to 44.3%); Black or African American (increase from
13.3% to 15%; Asian (increase from 5.7% to 9.1%) and Hispanic (increase from 17.8% to 27.5%).
9
The youth dependency ratio, which equals (population under age 18/population aged 18 to 64) times 100,
is expected to decline slightly from 37 in 2020 to 35 in 2060 (the ratio peaked at 65 in 1960), while the old
age dependency ratio, which equals (population aged 65 and older/population aged 18 to 64) times 100, is
expected to increase significantly from 28 in 2020 to 41 in 2060. Notably, the total dependency ratio,
which is calculated by adding both the youth and old age dependency ratios, will increase from 64 in 2020
to 76 in 2060, creating new issues for policymakers allocating financial and social resources among
dependent groups. Id. at 6 (citing G. Reznik, D. Shoffner and D. Weaver, “Coping With the Demographic
Challenge: Fewer Children and Living Longer”, Social Security Bulletin 66(4) (Washington DC: Social
Security Administration, 2005/2006)).

4
In its July 2017 Issues Brief on Ageing, Older Persons and the 2030 Agenda for
Sustainable Development prepared with the support of HelpAge International and AARP,
the UNDP cataloged a number of challenges that the aging of the population present to
governments, society and older persons themselves10
:
 Many countries are struggling to provide adequate social protection for older persons
and adapt their public health systems to cope with the rising incidence and prevalence
of non-communicable diseases, which requires a shift to meet the surging demands
for age-appropriate care for older persons (e.g., long-term care outside of the
household, services and technologies for prevention, detection and treatment of
diseases)
 Poverty is a major threat to the wellbeing of older persons, many of whom must cope
with income insecurity, malnutrition, poor health and lack of access to clean water,
sanitation and adequate housing, and the pensions provided to older persons unable to
continue generating income through their own work are often not sufficient to meet
their basic needs for various reasons including informality of labor markets and a lack
resources for adequate public and private investment in pension programs
 Older persons are especially affected by displacement caused by conflict and natural
hazards due to reduced physical ability and limited mobility and are often ignored in
humanitarian interventions
 Persistent prejudice and discrimination towards older persons at individual and
institutional levels erodes the multiple basic human rights of older persons including
their rights to autonomy, participation, access to education and training, health and
social care, security and decent employment
 Aging also aggravates the challenges that many older persons face as a result of being
part of other disadvantaged groups (i.e., discrimination on the basis of gender, sexual
orientation, race, ethnicity, caste, disability, religion or socioeconomic status)
 Older women and men are vulnerable to physical, emotional and/or financial abuse
including violence and neglect from their own family members and the extent of such
abuse is likely underreported due to shortcomings in the collection and analysis of
data on persons in older age groups
10
Ageing, Older Persons and the 2030 Agenda for Sustainable Development (New York: United Nations
Development Programme, July 2017), 14-15.

5
Source: UN Decade of Healthy Ageing (who.int)
The world is responding to these challenges in a number of different ways including the
ambitious “UN Decade of Healthy Ageing 2021-2030”, which was endorsed by the both
the World Health Assembly and the UN General Assembly in 2020. The Decade is based
on acknowledging that humans are now living longer than any time in history and
recognizing that the steps taken to increase longevity are of little value unless they are
accompanied by “adding more life to years” through “healthy ageing … [which] is ‘the
process of developing and maintaining the functional ability that enables wellbeing in
older age’”.11
Elements of functional ability include ability to meet one’s basic needs;
ability to learn, grow and make decisions; mobility; ability to build and maintain
relationships; and ability to contribute.12
In order to realize the Decade’s goals with
respect to the development and optimization of the functional abilities of older persons,
deference and respect must be given to their intrinsic capacities and investments must be
made to monitor healthy aging across the life course support older peoples’ positive
interactions in the environments in which they live such that they are able to thrive.
In its 2020 baseline report with respect to the goals of the Decade, the World Health
Organization (“WHO”) stressed that at least 142 million older persons worldwide were
unable to meet their basic needs and called for engagement around four action areas to
optimize the functional abilities of older persons: “change how we think, feel and act
towards age and ageing; ensure that communities foster older people’s abilities; deliver
person-centered integrated care and services that respond to older people’s needs; and
provide access to long-term care for older people who need it”.13
Specific goals for each
of these areas include14
:
11
Decade of healthy ageing: baseline report (Geneva: World Health Organization, 2020), xi.
12
Id.
13
Id.
14
UN Decade of Healthy Ageing (who.int)

6
 Combatting Ageism: Challenging and eliminating negative attitudes towards older
people that take various forms including stereotyping (how we think), prejudice (how
we feel) and discrimination (how we act) towards people on the basis of their age
 Communities: Creating age-friendly physical, social and economic environments for
older persons by removing physical and social barriers and implementing policies,
systems, services, products and technologies that address the social determinants of
healthy ageing and enable people, even when they lose capacity, to continue to do the
things they value
 Integrated Care: Creating and maintaining non-discriminatory access to good-quality
essential health services that include preventive care; promotion of good health;
curative, rehabilitative, palliative and end-of-life care; safe, affordable, effective,
good-quality essential medicines and vaccines; dental care and health and assistive
technologies, while ensuring that use of these services does not cause the user
financial hardship
 Long-term Care: Provide care to address declines in physical and mental capacity
associated with aging that can limit older people’s ability to care for themselves and
to participate in society including access to good-quality long-term care to provide
those in need of support and assistance with rehabilitation, assistive technologies and
supportive, inclusive environments so they can enjoy basic human rights and live
with dignity
The report also called out key enablers of the efforts that would be required in each of the
aforementioned action areas including “meaningful engagement with older people,
families, caregivers and others; building capacity for integrated action across sectors;
linking stakeholders to share experience and learn from others; and strengthening data,
research and innovation to accelerate implementation”.15
While societal norms and
assumptions will need to change in order for “healthy ageing” to thrive, the role for
governments is crucial and will require a shift in their traditional attention to issues of
retirement toward “creating a regulatory and legislative framework that gives people
choices over how they create the multiple stages of their life” that will become the
implicit feature of the experience of those who will be alive much longer than their
ancestors.16
Reference should be made to the detailed Plan of Action for the Decade and
an online platform has been established to connect and convene stakeholders involved in
promoting the four action areas at the country level and provide support on finding and
sharing relevant knowledge.17
_______________
The Longevity Economy
15
Decade of healthy ageing: baseline report (Geneva: World Health Organization, 2020), xi.
16
L. Gratton and A. Scott, The 100-Year Life: Living and Working in an Age of Longevity (London:
Bloomsbury, 2016), 18 (noting the health and income inequality will likely be the biggest challenges for
governments, both in their own countries and globally in the form of ongoing gaps between the wealthiest
nations and developing countries).
17
See UN Decade of Healthy Ageing Plan of Action and Decade of Healthy Ageing - The Platform.

7
One of the most misunderstood and underreported aspects of the aging of the population is the significant
contributions that people aged 50 and older make to the economy and the benefits that those provide to
everyone in society. AARP conducted a series of data analyses on various types of contributions that
Americans 50 and over, numbering about 117 million as of 2018, made to economic and unpaid activities
and found them to be worth over $9 trillion in 2018 ($8.3 trillion in economic activities and an estimated
$745 billion in unpaid benefits, altogether representing about 40% of the US Gross Domestic Product
(“GDP”)) and projected to continue growing through 2050. AARP noted that contributions from older
persons ranged from working, paying taxes and supporting the job market to giving time and money to
charitable causes and also included invaluable support to family and friends as caregivers. Some
perspective for the size of these contributions came from AARP pointing out that if the US population of
persons 50 and older was its own country, its GDP would place it third in the world, behind only the US
and China. AARP highlighted the following insights from its research as being especially important to
know and understand:
 Economic contributions from older adults will grow over time, benefitting people of all ages and
generations. By 2030, when the first millennials are about to turn 50, the contribution of the 50+ age
group to the economic will have increased to $12.6 trillion from $8.3 trillion as of 2018, and when the
members of Generation Z begin to turn 50 in 2050 the contribution of the 50+ age group to the US
economy will have exploded to $26.8 trillion (more than three times the amount in 2018). Businesses
should take note that consumers in the 50+ group were responsible for 56 cents of every dollar spent in
the US on goods and services in 2018 and that this amount is expected to increase to 61 cents by 2050.
 Societal contributions from older adults strengthen communities across the country. AARP
estimated that the value of volunteering activities and caregiving support provided by members of the
50+ age group in 2018 was $745 billion and that they also made significant societal contributions in
the form of charitable contributions ($97 billion), expenditures on education services (including for
their children and grandchildren) ($135 billion) and contributions to educational institutions ($4
billion).
 The 50-plus age demographic has a major impact on taxes. While ageism often takes the form of
complaints that older persons drain public resources through the payments made to them for social
security and other elements of the country’s social safety net without making corresponding
contributions, the reality is that the 50+ population continues to be a significant contributor to federal
($1.4 trillion in 2018) and state and local ($650 billion in 2018) taxes through direct payments and the
ripple effect of all of their economic activities. Moreover, AARP anticipates that tax contributions will
grow by four times by 2050.
 The 50-plus age group will be a critical driver of job sustainability in the US through 2050. The
50+ population supported 88.6 million jobs in the US in 2018 including jobs they held or created,
directly or indirectly (44% of total employment), and AARP projected that this number would increase
to 101.7 in 2050.
 However, age discrimination against Americans age 50-plus cost the US economy $850 billion in
2018. AARP studied the economic impact of age discrimination against persons 50 and older in the
US and found that their potential economic contribution could increase by $3.9 trillion in a no-age bias
economy, which would mean a contribution of $30.7 trillion to GDP by 2050.
 In addition, if working family caregivers had more access to supportive policies, the economy
would benefit as well. The 50+ population includes a significant percentage of the persons who serve
as caregivers for family members and many of them also struggle to maintain their jobs in order to earn
the money necessary to support themselves and those that depend on them. AARP found that if family
caregivers ages 50-plus had access to support in the workplace, the potential economic contribution
could increase by $1.7 trillion (5.5%) in 2030 and by $4.1 trillion (6.6%) in 2050.
Source: The Longevity Economy® Outlook: How people age 50 and older are fueling economic growth,
stimulating jobs, and creating opportunities for all (aarp.org). AARP used data from various sources
including the Centers for Disease Control and Prevention, the Bureau of Economic Analysis, Bureau of
Labor Statistics and The Economist Intelligence Unit’s macroeconomic forecasts.
_______________

8
Understanding Aging
In order to understand the issues surrounding ageism and the steps that must be taken in
order to address and remediate them, it is important to investigate the complex question
of just what “aging” is. In fact, the concept of “old age” is multidimensional, which
includes chronological (based on a birthdate), biological (related to human body ability),
psychological (concerned with psycho-emotional functioning) and social age (related to
social roles such as grandparents).18
The WHO explained that at the biological level,
aging results from the impact of the accumulation of a wide variety of molecular and
cellular damage over time which leads to a gradual decrease in physical and mental
capacity, a growing risk of disease, and ultimately, death.19
According to the WHO,
aging increases the likelihood of experiencing one or more common health conditions
including hearing loss, cataracts and refractive errors, back and neck pain and
osteoarthritis, chronic obstructive pulmonary disease, diabetes, depression, and dementia,
and also brings the onset of complex health states referred to as “geriatric syndromes”
that do not fall into discrete disease categories (e.g., frailty, urinary incontinence, falls,
delirium and pressure ulcers). However, the WHO emphasized that it is important to
remember that “[t]here is no ‘typical’ older person” and that “these changes are neither
linear nor consistent, and they are only loosely associated with a person’s age in years”,
thus explaining why there are some 70 year-olds who can be clearly observed enjoying
extremely good health and functioning with physical and mental capacities that are not
much different than much younger people while other persons of the same age have
grown frail and require significant help from others.20
The nature and pace of biological changes depends on factors such as a person’s physical
and social environment, personal characteristics and the extent to which he or she
develops and maintains healthy behaviors (e.g., a balanced diet, regular physical activity
and refraining from tobacco use). The WHO also pointed out that biological changes are
just a part of the story of aging, and that older persons are likely to face a range of
challenging life transitions including retirement, relocation and the death of friend and
partners, each of which create profound emotional losses that need to be addressed with
appropriate support and strategies for recovery, adaptation and psychosocial growth.
18
Ageing, Older Persons and the 2030 Agenda for Sustainable Development (New York: United Nations
Development Programme, July 2017), 21 (footnote 1).
19
The discussion in this paragraph is adapted from Ageing and Health (World Health Organization,
February 5, 2018).
20
Specifically, the WHO explained as follows: “There is no ‘typical’ older person. Some 80 year-olds have
physical and mental capacities similar to many 20 year-olds. Other people experience significant declines
in physical and mental capacities at much younger ages. A comprehensive public health response must
address this wide range of older people’s experiences and needs.” Id. See also Strengthening Older
People’s Rights: Towards a UN Convention, 5 and Why it’s time for a convention on the rights of older
people (HelpAge International, 2009), 2 (both noting that older people are not a homogenous group (e.g.,
older men and women age differently and people in their 60s may lead very different lives to those in their
80s and 90s) and the discrimination that they experience is often multi-dimensional, based not only on age
but on other factors, such as gender, ethnic origin, where they live, disability, poverty, sexuality or literacy
levels).

9
Another consideration was highlighted by the Alberta Civil Liberties Research Centre,
which has noted some of the difficulties and shortcoming with defining and applying the
term “elderly” in terms of chronological age given recent trends of higher life expectancy
and increased longevity and pointed out that in some sub-communities, such as
Aboriginals and people with disabilities, a lower baseline year might be more appropriate
given the shorter average life expectancies and poorer overall health among members of
those groups.21
The UN Committee on Economic, Social and Cultural Rights (“CESCR”) noted that the
terminology used to describe older persons varies considerably, even in international
documents and includes: "older persons", "the aged", "the elderly", "the third age", "the
ageing" and, to denote persons more than 80 years of age, "the fourth age". The CESCR
opted for the use of "older persons" (as has the author of this work22
), the term employed
in General Assembly resolutions 47/5 and 48/98, and noted that when the term “older
persons” is used in UN statistical services, it refers to persons aged 60 and above, and the
European Union’s statistical service considered “older persons” to mean persons aged 65
and above, since 65 is the most common age of retirement.23
However, while it is
convenient to refer to some milestone of chronological age for definitional purposes, the
CESCR emphasized that its chosen descriptive term, “older persons”, covers a group that
is “as heterogeneous and varied as the rest of the population and their situation depends
on a country’s economic and social situation, on demographic, environmental, cultural
and employment factors and, at the individual level, on the family situation, the level of
education, the urban or rural environment, and the occupation of workers and retirees”.24
The CESCR noted that while there are older persons who are in good health and whose
financial situation is acceptable, there are also many others “who do not have adequate
21
Access to Justice and Canadian Elders (Alberta Civil Liberties Research Centre).
22
The use of the descriptive term “older persons” by the author of this work also reflects the findings of
surveys of persons over a certain age that they find terms such as “elderly,” “aged,” and “old,” to be
disrespectful and supportive of an inaccurate stereotype of frailty. See M. Falconer and D. O’Neill, “Out
with “the old,” elderly, and aged”, BMJ, 334 (7588) (February 10, 2007), 316.
23
UN Committee on Economic, Social and Cultural Rights: The Economic, Social, and Cultural Rights of
Older Persons: General Comment 6, UN Doc. E/C.12/1995/16/Rev. 1 (August 12, 1995), Paragraph 9. See
also World Population Aging 2019 Highlights (New York: United Nations Department of Economic and
Social Affairs Population Division, 2019) (noting that that traditional measures and indicators of population
ageing used by the UN and researchers have been mostly or entirely based on people’s chronological age,
defining older persons as those aged 60 or 65 years or over, thus providing a simple clear and easily
replicable way to measure and track various indicators of population aging).
24
Older Persons: General Comment 6, UN Doc. E/C.12/1995/16/Rev. 1 (August 12, 1995), Paragraph 16.
The UN Development Programme has acknowledged the diversity among persons in the group
chronologically-defined as “60 years or over” with respect to their needs, capabilities, lifestyles,
experiences and preferences and that fact that the conditions faced by any one person will be shaped not
only by their age but also gender, health, income, education, ethnicity and other factors. Ageing, Older
Persons and the 2030 Agenda for Sustainable Development (New York: United Nations Development
Programme, July 2017), 21 (footnote 1).

10
means of support, even in developed countries, and who feature prominently among the
most vulnerable, marginal and unprotected groups”.25
Reliance and emphasis on chronological age for policy decisions and assumptions
regarding older persons has also been critiqued by the UN Refugee Agency, which has
pointed out that “families and communities often use other socio-cultural referents to
define age, including family status (grandparents), physical appearance, or age-related
health conditions” and groups of people, such as refugees and internally displaced
persons, are often subjected to the psychological and psychosocial toll of traumatic
experiences which, combined with poor nutrition and exposure to disease, cause them
to “age” faster than settled populations and make them vulnerable to many of the
challenges associated with old age well before they reach their 60th
birthday.26
The
Office of the UN High Commissioner for Human Rights (“OHCHR”) has argued that
“[t]he quality of life and the societal role of a person aged 60, 70 or 80 years may differ
substantially from the representations underlying various legal and social notions such as
mandatory retirement age”, that “age alone cannot be used as a proxy for illness, risk or
dependency”.27
The OHCHR reminded that while “age-specific vulnerabilities and
fragility can be the result of physical and mental conditions, or impairments resulting
from ageing”, they can also “just as likely … result from the obstacles encountered due to
societal perception and the interaction of an individual with his or her environment …
[and] … a life with dignity in old age may well be more determined by the measures and
policies in place to ensure individuals the exercise and enjoyment of all human rights
than by their chronological age”.28
Measuring Aging
In its 2019 report on world population aging, the UN explained that traditional measures
and indicators of population ageing used by the UN and researchers have been mostly or
entirely based on people’s chronological age, defining older persons as those aged 60 or
65 years or over, thus providing a simple clear and easily replicable way to measure and
track various indicators of population aging.29
For example, it has been common practice
to use the percentage of older persons, defined using the selected age threshold, in the
25
Older Persons: General Comment 6, UN Doc. E/C.12/1995/16/Rev. 1 (August 12, 1995), Paragraph 17
(noting also that “[i]n times of recession and of restructuring of the economy, older persons are particularly
at risk”).
26
See UNHCR Emergency Handbook.
27
See also Paragraphs 8 and 9 of the Report of the UN High Commissioner for Human Rights on Human
Rights Situation of Older Persons (E/2012/51),
28
Id.
29
World Population Aging 2019 Highlights (New York: United Nations Department of Economic and
Social Affairs Population Division, 2019). See UN Committee on Economic, Social and Cultural Rights:
The Economic, Social, and Cultural Rights of Older Persons: General Comment 6, UN Doc.
E/C.12/1995/16/Rev. 1 (August 12, 1995), Paragraph 9 (noting that when the term “older persons” is used
in UN statistical services, it refers to persons aged 60 and above, and the European Union’s statistical
service considers “older persons” to mean persons aged 65 and above, since 65 is the most common age of
retirement).

11
general population as the main indicator to analyze population aging. The UN noted,
however, that there has been increasing recognition that the mortality risks, health status,
type and level of activity, productivity and other socioeconomic characteristics of older
persons have changed significantly in many parts of the world over the last century, and,
in particular, in the last few decades, and that new alternative concepts and measures of
aging were necessary.
The UN described three types of measures of population aging that are now being used
when examining and discussing the dynamic demographic shifts associated with
increased longevity. The first measure was the old-age dependency ratio (“OADR”),
which is defined as the number of old-age dependents (i.e., persons aged 65 years or
over) per 100 persons of working age (i.e., aged 18 to 64 years). The OADR has been
popular due to its simplicity in measuring and monitoring changes in the implied
economic dependency associated with a growing share of the population at older ages,
and declining fertility and increased longevity have both contributed to an increase in the
relative size of older age groups as the proportion of younger age groups has declined.
For example, data from the US Census Bureau indicated that the OADR was 29 as of
2020, up from 21 just ten years earlier, and is expected to increase significantly to 41 in
2060.30
However, the OADR has been criticized for failing to take into account that
older persons are quite diverse with respect to economic activity, including labor force
participation and functional capacity, and that not all persons in the traditional working
ages (i.e., 18 to 64 years) are active in the labor force and, in fact, some of them are also
economically dependent.31
The second measure was the prospective old age dependency ratio (“POADR”), which
redefines population aging based on remaining life expectancy, in most cases using 15
years as the measure, instead of basing it on the number of years already lived, thus
taking into account the increases in life expectancy that have been occurring over the last
few decades and which are expected to continue to occur in the future. POADR is
calculated as the number of persons over the age closest to the a remaining life
expectancy of 15 years relative to the number of persons in the population who are
between the age of 20 and that age. According to the UN, trends in the POADR suggest
that there are slower increases, and even declines, in dependency in many countries with
substantial older populations than what has been projected in traditional models based on
the OADR.32
In other words, while the population is aging, the process is slower and
more measured than what has previously been thought and more consideration should be
given to those characteristics of older persons that support their autonomy and their
30
J. Vespa, L. Medina and D. Armstrong “Demographic Turning Points for the United Sates: Population
Projections for 2020 to 2060”, Current Population Reports P225-1144 (Washington DC: US Census
Bureau, 2020).
31
World Population Aging 2019 Highlights (New York: United Nations Department of Economic and
Social Affairs Population Division, 2019), 11-13.
32
Id. at 13-15 (citing W. Sanderson and S. Scherbov, “Average remaining lifetimes can increase as human
populations age”, Nature, 435 No. 7043 (2005), 811; and W. Sanderson and S. Scherbov, “A new
perspective on population aging”, Demographic Research, 16(2) (2007), 27).

12
ability to make positive contributions to society as opposed to simply being a drain on
finite resources.
The third measure, which can be derived in different ways, attempts to take into account
economic factors such as production and consumption of resources and focuses on
calculating the resource needs (i.e., consumption) of older persons relative to the
resources (i.e., income from labor) produced by all workers irrespective of their ages.33
For example, the economic old-age dependency ratio (“EOADR”) is defined as the
effective number of consumers aged 65 years or over divided by the effective number of
workers at all ages, and takes into account the resources that older persons have available
for consumption as they reach old age and the options available to them and society to
achieve and maintain a specific level of consumption (e.g., participating in the labor force
in order to earn income, drawing on income from assets accumulated over the course of
their lifetimes and/or relying on economic transfers from their families and/or public old
age support systems).34
The UN noted that it was projected that population aging would
lead to a global increase from 20 effective older consumers per 100 effective workers in
2019 to 33 by 2050 and also reported that as of 2019 the highest EOADRs could be
found in Europe, North America and Australia and New Zealand due to the high
consumption at older ages relative to younger ages in those areas and the increasing share
of older persons in the population in those areas.35
Measures of aging such as the EOADR focus the discussion on several different and
important factors relating to the impact of older persons on society. The discussion
above suggests that older persons can choose from among several different strategies to
fund their consumption of resources in the later years; however, the availability of those
strategies depends on each individual’s specific circumstances and choices made by those
in charge of public policy with respect to support for the aging. For example, the costs
associated with accessing certain types of consumption necessary to maintain a basic
standard of living and wellbeing, such as health care, must be considered, as must any
physical or mental conditions that may limit the ability of a specific individual to attempt
to supplement his or her economic resources by working. The ability of an older person
to draw on income from assets accumulated over their lifetimes depends on their family
history and their experience in the workplace, which in turn is influenced by access to
education and other types of support. The availability of “public transfers”, such as
Social Security, to fund consumption in older age varies from country to country,
although it is clearly an important source of support in even the richest nations.
33
Id. at 15-18.
34
The UN explained the foundations for understanding “economic old-age dependency” as follows:
“Individuals go through extended period of dependency at the beginning and end of their life: children and
older persons consume more resources than they produce through their own labor. Conversely, working-
age adults produce more than they consume. The relative size of these age groups, as well as the extent of
their dependency, determines the support needed from the working-age population.” Id. at 15. With
regard to the “effective number” of consumers and producers, see A. Mason, Demographic Transition
and Demographic Dividends in Developed and Developing Countries (New York: United Nations,
2007).
35
Id. at 16.

13
The UN has noted that population aging will put increased financial pressure on old-age
support systems, regardless of how aging is measure, and that countries will need to
“establish social protection programs that can be sustained over the long term to prevent
poverty, reduce inequality and promote social inclusion among older persons”.36
However, the costs associated with these programs should not be framed as burdens to be
borne by younger persons in the workforce, but rather should be implemented as an
integral part of a larger collection of public policies that promote accumulation of
personal resources prior to reach older age (thus reducing the economic strain on society
caused by an expensive system of public transfers) and empower older persons to
continue to make important contributions to society. For example, the UN called on
governments to “support continuing and lifelong education and health care for all;
encourage savings behavior and healthy lifestyles throughout the life course; promote
employment among women, older persons and others traditionally excluded from the
labor force, including through a gradual increase in the official retirement age; and
support family-friendly policies to facilitate work-life balance and increased gender
equality in both public and private life”.37
Economists have also suggested that societies can create advantageous “demographic
dividends” through careful planning for the ultimate aging of their populations. The
traditional understanding of a demographic dividend focuses on a period, which usually
extends for two to three decades, when young working people represent the greatest
proportion of the population in relation to dependent groups such as children and older
persons who have left the workforce. During this period, spending on the dependent
groups is reduced and the “excess” income from the large working group can be
reinvested to support dynamic economic growth (i.e., a “dividend” for society due to the
demographic profile during that period).38
However, there are other potential dividends
that can be pursued based on the understanding that the large group of younger workers
will eventually age and will need to find new roles in society. A second dividend can be
realized through programs that promote savings and accumulation of assets by people
during their working years so that they can support themselves in the future, rather than
looking to public transfers that prevent investment in other social programs. In addition,
these assets can be invested and contribute to increases in national income that can be
used to fuel sustainable development.39
Governments can contribute this second dividend
by supporting public health and other programs that make it easier for people to remain
productive members of the workforce if they choose and derive the highest economic
benefits from their work. A potential third dividend comes from investing in policies and
programs to unleash the social capital that older adults can offer, tapping into a group that
includes some of the best educated, healthiest and wealthiest people in the history of the
36
Id. at 2.
37
Id.
38
For a basic introduction to the concept of “demographic dividend”, see R. Lee and A. Mason, “What is
Demographic Dividend?”, Finance and Development, 43(3) (2006).
39
M. Guruprasad, Economics for Everyone –Demographic Dividend.

14
world.40
Linda Fried of Columbia University has been a leading proponent of this third
demographic dividend, explaining41
:
“A core principal of this third demographic dividend is that we should not
squander talents and capabilities of any group, and that building for
intergenerational synergies and cohesion will strengthen each generation as
well as the nation that builds them. This includes creating roles that improve
the launching of the younger generations, in ways that older adults would find
meaningful and impactful and that could significantly amplify the ability of
youth - our future - to thrive. … A demographic triumph in Stage 3 means
investing in the old to help the young -- and our whole society -- to succeed,
and designing institutions that create roles, responsibilities, meaning and
purpose for older age. … Achieving the third demographic dividend should be
a model for the world. It represents an annuity that every child could hope to
inherit, and a legacy every older adult might like to leave.”
Older Persons’ Indices
Spanier and Doron explained that composite indicators or indices—which are indices of
individual indicators—that compare country performance have been increasingly
recognized as a useful to inform domestic policymakers on the country’s trends and
possible policy-gaps with respect to a wide range of issues including economic progress
and performance, technology acquisition and diffusion, human development, gender-
rights development, child development, promotion of human rights and democracy,
environmental sustainability, food insecurity, health care and freedom of the press.42
Policymakers can use these indices to establish policy priorities, benchmark performance
against other countries, monitor the progress of specific programs and communicate goals
and achievement to relevant stakeholders. They noted that the explosion of the number
of older persons as a proportion of the world’s population signals a dramatic and historic
demographic transformation that will challenge policymakers and demands new tools,
such as indices, that provide the material information required to make the best decisions
for older persons and the communities in which they live and work. Two commonly used
international indices relating to the wellbeing of older persons are the Global AgeWatch
Index and the Active Aging Index, and Spanier and Doron themselves have called for
adoption of an International Older Persons’ Human Right Index that measures the status
of the rules concerning the human rights of older persons.43
Global AgeWatch Index
40
Id.
41
L. Fried, “The Third Demographic Dividend and the Global Challenge of Longer Lives”,
HuffPost (August 24, 2014).
42
B. Spanier and I. Doron, “From Well-Being to Rights: Creating an International Older Persons’ Human
Rights Index (IOPHRI)”, The Elder Law Journal, 24(2) (2016), 101.
43
Id.

15
The Global AgeWatch Index was developed by a partnership between HelpAge
International and Professor Asghar Zaidi to measure the quality of life of older people,
spotlight successes and shortcomings of country responses to population aging and
stimulate demand for and supply of age-disaggregated data.44
The Global AgeWatch
Index is multidimensional and takes into account priority areas identified by the 2012 UN
Population Fund and HelpAge report, Ageing in the Twenty-First Century: A Celebration
and a Challenge and the Madrid International Plan of Action on Ageing.45
According to
HelpAge International, the four dimensions of the Global AgeWatch Index cover “the
most crucial aspects of [the] wellbeing, experience and opportunities” of older-age
people. The dimensions touch on a number of areas thought to be necessary for the
economic and social wellbeing of older persons and include the following46
:
 Income security, measured by pension income coverage, the poverty rate in old age,
the relative welfare of older people and gross national income per capita
 Health status, measured by life expectancy at 60, healthy life expectancy at 60 and
psychological wellbeing
 Capability, measured by employment of older people and educational status of older
people
 Enabling environment, measured by social connections, physical safety, civic
freedom and access to public transport
In their commentary on the Global AgeWatch Index, Cruz-Martinez and Cerev explained
the rationale for some of the choices made in designing the dimensions and selecting the
specific indicators, noting that “[t]he income dimension highlights the importance of
adequate income for sustaining wellbeing in later life” and pointing out that over 70% of
the world’s population is not adequately covered by social protection, that almost half of
the older adults over pensionable age to not receive a pension and for those that do
receive a pension the benefit levels are inadequate. They pointed out that the health
status domain highlighted the importance of accessing quality health and care services,
the capability domain indicators were intended to be proxies for engagement in the
workforce and valuing the human capital of older persons and enabling environment
indicators were selected by older adults themselves to reflect the social and physical
factors that are importance for them to realize their potential and “be and do what they
desire and value”.47
44
A. Mihnovits and A. Zaidi, Global AgeWatch Index 2015: Methodology update (London: HelpAge
International, 2015). See also About Global AgeWatch Insights (Global AgeWatch Index 2015).
45
G. Cruz-Martinez and G. Cerev, “Global AgeWatch Index and Insights” in D. Gu and M. Dupre
(Editors), Encyclopedia of Gerentology and Population Aging (Springer, 2020), 3.
46
G. Cruz-Martinez and G. Cerev, “Global AgeWatch Index and Insights” in D. Gu and M. Dupre
(Editors), Encyclopedia of Gerentology and Population Aging (Springer, 2020), 4-5 (based on Global
AgeWatch Index 2015: Insight report (London: HelpAge International, 2015). Weights were assigned to
each of the indicators for each dimension (e.g., weights for the three indicators making the health status
dimension were 40% for life expectancy, 40% for healthy life expectance and 20% for psychological
wellbeing.
47
Id. (comments on coverage by social protection and pension availability based on International Labour
Organization, Social protection for older persons: Key policy trends and statistics (Geneva: International
Labour Office, 2014)).

16
The Index was published annually from 2013 to 2015 (starting with 91 countries in 2013
and expanding to 96 countries by 2015) and drew on data from a mix of mostly open
sources such as the World Bank, World Health Organization, International Labour
Organization, Eurostat and Organisation for Economic Co-operation and Development.48
Accordingly to the Global Rankings Table for the 2015 Index, Switzerland ranked first
and Afghanistan was last, the top 7 countries and 18 of the top 20 were located in
Western Europe, North America and Australasia, 10 of the 20 countries at the bottom of
the rankings were located in Africa and the rankings were generally in line with the
income levels in the various countries.49
The Index became a useful advocacy tool and
was redesigned in 2017 by HelpAge International and AARP to become the Global
AgeWatch Insights, the first edition of which was published in December 2018 and
focused on the inequities of health systems worldwide and the lack of quality data about
aging and health in low- and middle-income countries.50
Active Ageing Index
“Active Aging” has been described as the process of optimizing opportunities for health,
participation and security in order to enhance quality of life as people age.51
Active aging
is a response to the social phenomenon of ageism and its prejudices, stereotypes and
discriminatory behavior and evidence that “the process of ageing and those who belong
to the older population have long been defined as a threat to social values and interests”.52
Active aging had been embraced by the UN and the WHO and become part of current
mainstream social policy framework within social gerontology.53
The Active Ageing
Index (“AAI”) is an analytical tool developed in 2012 by the European Centre for
Social Welfare Policy and Research in Vienna in close collaboration with, and advice
from, the European Commission's Directorate General for Employment Social Affairs
and Inclusion (“DG EMPL”) and the United Nations Economic Commission for Europe
(“UNECE”) that aims to help policy makers in developing policies for active and
healthy ageing that ensure, as people grow older, that they can continue contributing to
the economy and society and be able to look after themselves for as long as
possible.54
The AAI was developed in the context of the European Year for Active
Ageing and Solidarity between Generations 2012 and in furtherance of the Guiding
48
Id. at 5-6.
49
See Global rankings table | Global AgeWatch Index 2015.
50
Global AgeWatch Insights: The right to health for older people, the right to be counted (HelpAge
International and AARP, 2018) (noting that barriers to the right of older persons to health included age
discrimination, monetary poverty, costs of health services, low health literacy, and lack of institutional
outreach to the older-age population in isolated communities).
51
I. Doron, “Re-thinking Old Age: Time for Ageivism”, Human Rights Defender, 27 (2018), 33.
52
E. Pike, “Physical Activity and Narratives of Successful Ageing” in E. Tulle and C. Phoenix (Editors),
Physical Activity and Sport in Later Life (London: Palgrave Palgrave Macmillan, London, 2015), 21
(citing C. Critcher, Moral Panics and the Media (Buckingham, UK: Open University Press, 2003).
53
I. Doron, “Re-thinking Old Age: Time for Ageivism”, Human Rights Defender, 27 (2018), 33. See
Active Ageing: A Policy Framework (Geneva: World Health Organization, 2002).
54
The summary of the Active Ageing Index in this section is adapted from European Commission and UN
Economic Commission for Europe, Introducing the Active Ageing Index: Policy Brief (April 2013).

17
Principles on Active Ageing and Intergenerational Solidarity adopted in 2012, the AAI
was constructed based on the following definition of “active ageing”:
"Active ageing refers to the situation where people continue to participate in the
formal labour market, as well as engage in other unpaid productive activities
(such as care provision to family members and volunteering), and live healthy,
independent and secure lives as they age."
The AAI is constructed from four different domains (employment; participation in
society; independent, health and secure living; and capacity and enabling environment for
active aging), each of which represents a different aspect to active and health ageing, and
attempts to incorporate both the actual experiences of active ageing and the capacity for
active ageing as determined by individual characteristics and environmental factors. A
number of individual indicators, 22 in all across all four domains, contribute to the AAI,
and the indicators are weighted individually and then combined within the four domains
to create domain specific indices (the overall AAI for a country is the weighted average
of the four domain specific indexes).55
The indicators are as follows:
 Employment: Employment rate 55-59; employment rate 60-64; employment rate 65-
69; and employment rate 70-74
 Participation in Society: Voluntary activities; care to children and/or grandchildren;
care to older adults; and political participation
 Independent, Health and Secure Living: Physical exercise; access to health and dental
care; independent living; financial security (three indicators including relative median
income; no poverty risk; and no severe material deprivation); physical safety; and
lifelong learning
 Capacity and Enabling Environment for Active Aging: Remaining life expectancy at
age 55; share of healthy life expectancy at age 55; mental wellbeing; use of ICT;
social connectedness; and educational attainment
The first three domains focus on various aspects of older persons’ actual experiences of
active aging and the last domain is concerned with capabilities to actively age.
The results of the AAI are presented as a ranking of the EU countries based on the scores
achieved in the overall AAI and in domain-specific indices, and the ranking of the
countries may differ across domains. Theoretically, the maximum AAI score is 100;
however, the scores of even the highest rating countries cluster around 40, which means
that all of the countries have an extensive amount of work to do in order to tap into their
full “active aging potential”. Results for the latest available year show that the overall
2018 AAI ranged between 27.7 and 47.2 points (EU average: 35.7) across all of the EU
55
For a detailed overview of how the AAI was constructed including the specific selection criteria for
choosing the AAI domains and indicators, the methodology applied for standardizing the indicators, the
weighting method and detailed information on the indicators (i.e., definitions and data sources), see
Methodology paper: Active Ageing Index 2012 (European Centre for Social Welfare Policy and Research)
and Active Ageing Index 2012: Concept, Methodology and Final Results.

18
countries, and in the eight years separating 2008 and 2016, the overall AAI score
increased from 32.1 to 35.7 points for the EU average. AAI results aggregated by gender
are also presented and, not surprisingly, gender-specific country rankings are different.
The social participation domain is the only one in which on average women perform men
and for the other domains the AAI scores are lower for women than for men, particularly
in the employment domain. Overall, AAI performance tends to correlate strongly with
other measures of economic and social performance.56
As mentioned above, three of the domains in the AAI—employment, participation in
society and independent living—are based in large part on the Guiding Principles for
Active Ageing and Solidarity between Generations, which are intended to serve as a
checklist for national authorities and other stakeholders on steps that can and should be
taken to promote active aging. Accordingly, countries can refer to the following
recommendations in the Guiding Principles when developing policies to address
shortcomings identified in AAI scores for those domains57
:
Employment
 Continuing vocational education and training: Offer women and men of all ages
access to, and participation in, education, training and skills development allowing
them (re-)entry into and to fully participate in the labour market in quality jobs.
 Healthy working conditions: Promote working conditions and work environments
that maintain workers' health and well-being, thereby ensuring workers’ life-long
employability.
 Age management strategies: Adapt careers and working conditions to the changing
needs of workers as they age, thereby avoiding early retirement.
 Employment services for older workers: Provide counselling, placement,
reintegration support to older workers who wish to remain on the labor market.
 Prevent age discrimination: Ensure equal rights for older workers in the labor
market, refraining from using age as a decisive criterion for assessing whether a
worker is fit for a certain job or not; prevent negative age-related stereotypes and
discriminatory attitudes towards older workers at the work place; highlight the
contribution older workers make.
 Employment-friendly tax / benefit systems: Review tax and benefit systems to
ensure that work pays for older workers, while ensuring an adequate level of
benefits.
 Transfer of experience: Capitalize on older workers' knowledge and skills through
mentoring and age-diverse teams.
 Reconciliation of work and care: Adapt working conditions and offer leave
arrangements suitable for women and men, allowing them as informal carers to
remain in employment or return to the labor market.
56
2018 Active Ageing Index Analytical Report October 2019 (Geneva, UN Economic Commission for
Europe, 2019).
57
Guiding Principles on Active Ageing and Solidarity between Generations (2012).

19
Participation in society
 Income security: Put in place systems that provide adequate incomes in old age
preserving the financial autonomy of older people and enabling them to live in
dignity.
 Social inclusion: Fight social exclusion and isolation of older people by offering
them equal opportunities to participate in society through cultural, political and social
activities.
 Senior volunteering: Create a better environment for volunteer activities of older
people and remove existing obstacles so that older people can contribute to society by
making use of their competences, skills and experience.
 Life-long learning: Provide older people with learning opportunities, notably in
areas such as information and communication technologies (ICT), self-care and
personal finance, empowering them to participate actively in society and to take
charge of their own life.
 Participation in decision making: keep older women and men involved in decision
making, particularly in the areas that directly affect them.
 Support for informal careers: Make professional support and training available to
informal careers; ensure respite care and adequate social protection to prevent social
exclusion of careers.
Independent living
 Health promotion and disease prevention: Take measures to maximize healthy life
years for women and men and reduce the risk of dependency through the
implementation of health promotion and disease prevention. Provide opportunities for
physical and mental activity adapted to the capacities of older people.
 Adapted housing and services: Adapt housing and provide services that allow older
people with health impairments to live with the highest possible degree of autonomy.
 Accessible and affordable transport: Adapt transport systems to make them
accessible, affordable, safe and secure for older people, allowing them to stay
autonomous and participate actively in society.
 Age-friendly environments and goods and services: Adapt local environments as
well as goods and services so that they are suitable for people of all ages (design-for-
all approach), in particular by making use of new technologies, including eHealth;
prevent age discrimination in the access to goods and services.
 Maximizing autonomy in long-term care: For people in need of help/care, ensure
that their autonomy and participation are augmented, preserved or restored to the
greatest possible extent and that they are treated with dignity and compassion.
While the AAI was originally developed for use among the EU countries, the UNECE
and the DG EMPL have developed guidelines to adjust the flexible methodology of the
AAI to various policy-related and scientific purposes, including calculations at national
level in non-EU countries and at subnational level. The guidelines provide information on
selection of appropriate data sources and variables for calculation of the AAI indicators
so that the index preserves its core concept, structure and its functionality, and ways of

20
adapting the original methodology.58
Others have suggested ways to enhance the utility
and applicability of the AAI by integrating indicators that are aligned with the key
priorities of the Madrid International Plan of Action on Ageing (“MIPAA”) as a means
for monitoring MIPAA implementation. For example, the AAI indicator of independent
living could be expanded to incorporate MIPAA indicators such as housing and the living
environment, sanitation, lighting, mobile services and transportation services; the AAI
indicator of physical safety could incorporate MIPAA indicators for neglect, abuse and
violence prevalence; and gaps in the AAI could be filled by adding MIPAA indicators
such as training of care providers and health professionals and geriatric-driven health care
services.59
While widely used and discussed, active aging has also been criticized on several grounds
(e.g., overemphasis on independence, self-reliance, consumerism and individual
responsibility, all traits of capitalistic and individualistic ideologies, at the expense of
ignoring values of interdependence, reciprocity, cooperation and filial piety, and
overemphasis on capitalistic values of economic activity and contribution without giving
due regard for the value and importance of spiritual, familial and other “non-productive”
activities).60
In Doron’s view, the critiques were based on the belief that the use of
terminology such as “active aging” obscured attention to “the diverse subjective and
personal experiences of older persons with regard to their aging bodies”.61
He proposed
extending active ageing through “ageivism”, which he described as “an ideology which
encompasses a set of ideas and ideals regarding older persons as a distinct social group”
and “calls for the liberation of older persons from existing oppression and discrimination
which is embedded in ageism”.62
International Older Persons’ Human Rights Index
Spanier and Doron argued that policymakers, business leaders, and members of the
general public, needed better information based on material facts in order to make
effective decisions about creating laws and regulations and designing programs to protect
and promote the rights of the continuously growing group of older persons around the
world.63
They noted that while a range of composite indicators (i.e., indices or index) had
been developed by statistical offices and national or international organizations to present
58
Active Ageing Index (AAI) in Non-EU Countries and at Subnational Level (Economic Commission for
Europe and the European Commission’s Directorate General for Employment, Social Affairs and Inclusion,
August 2018).
59
J. Parry, J. Um and A. Zaidi, “Monitoring active ageing in the Asia-Pacific region: Recommendations for
future implementation of the MIPAA”, International Journal on Ageing in Developing Countries, 2(2)
(2018), 82.
60
I. Doron, “Re-thinking Old Age: Time for Ageivism”, Human Rights Defender, 27 (2018), 34 (citing
with respect to criticisms, C. Phillipson, Reconstructing old age: New agendas in social theory and practice
(London: Sage, 1998) and C. Phoenix and B. Grant, “Expanding the agenda for research on the physically
active ageing body”, Journal of Aging and Physical Activity, 17 (2009), 362.
61
Id.
62
Id.
63
Rights Index (IOPHRI)”, The Elder Law Journal, 24(2) (2016), 101.

21
and compare information from multiple countries on topics such as the environment,
economy, science, health, education and human rights, relatively little had been done to
create and implement an international index that focused specifically on laws, regulations
and other policies and practices concerning the human rights of older persons. In their
view, such an index would be an essential and valuable addition to the indexes described
above that have focused on their wellbeing and facilitation of active or healthy aging.
Spanier and Doron proposed the International Older Persons’ Human Rights Index
(“IOPHRI”) to “identify and evaluate good national practices regarding normative
protection and promotion of the rights of older persons, including measures to prevent
discrimination, neglect, abuse, and violence”.64
The IOPHRI is based on a multi-
dimensional model of elder law that was first presented by Doron for use in Israel and
then expanded for use in an international context.65
According to Spanier and Doron, the
model, which as five dimensions, was unique in that it offered a “holistic picture of the
legal system’s responses to the needs of older persons” through its ability “to describe the
needs and interests of the older person population and, at the same time, to address legal
issues that are unique for this social group”.66
Spanier and Doron described each of the
dimensions as follows67
:
 The Legal Principles Dimension: Includes the core principles and values that apply to
a wide range of events within the society (i.e., the constitutional, statutory, and
common law rules and principles that the legal system uses to respond to a broad
range of societal concerns), such as the principles of prohibiting all forms of
discrimination and guaranteeing all persons equal treatment under the law and respect
and protection for their fundamental human rights. One issue is the extent to which
age and older people are explicitly mentioned in laws and principles.
 The Protective Dimension: Includes laws and legal systems that are designed to
provide special protection for older adults taking into account the goals of providing
security and responding to the special needs of older persons, with examples being
social security legislation and laws and regulations intended to prevent abuse and
neglect of older persons.
 The Familial and Informal Supportive Dimension: Includes laws intended to support
the formal and informal networks that support older persons and their needs, such as
laws focused on enabling older adults to receive informal, community-based care and
laws to provide support for caregivers (e.g., paid leaves of absence for caregiving,
part-time work and availability of paid sick days).
64
Id. at 126.
65
See I. Doron, “A Multi-Dimensional Model of Elder Law: An Israeli Example”, 28 Ageing International,
242 (2003), 245 and I. Doron, “A Multi-Dimensional Model of Elder Law” in I. Doron (Editor), Theories
on Law and Ageing: The Jurisprudence of Elder Law (Berlin: Springer, 2009), 59.
66
Rights Index (IOPHRI)”, The Elder Law Journal, 24(2) (2016), 101, 126-127.
67
Adapted from the description of the five dimensions in B. Spanier and I. Doron, “From Well-Being to
Rights: Creating an International Older Persons’ Human Rights Index (IOPHRI)”, The Elder Law Journal,
24(2) (2016), 101, 127-128.

22
 The Preventive Dimension: Includes laws and other means for providing older
persons with the legal tools they need in order to plan for their futures on their own
including economic planning, the ability to plan for future incapacity (e.g.,
instruments, such as advance directives, setting out the older person’s preferred
course of medical treatment when a terminal condition occurs) and laws enabling
older persons to exercise control over their lives and avoid future loss of control by
being placed under guardianship against their will and/or without informed consent.
 The Empowerment Dimension: Includes laws and legal structures designed to help
older persons realize their rights and implement them, such as laws the provide social
security benefits based on age and laws and practices that directly assist older persons
in accessing the rights that are afforded to them under other types of laws (i.e.,
“access to justice”).
When designing the IOPHRI, Spanier and Doron included all five of the dimensions
described above, but narrowed the inquiry down to two elements or indicators in each
dimension in order to facilitate easier comparisons between countries68
:
Legal Principles
 In the Constitution, within the text concerning the right to equality and the prohibition
of discrimination, is there a specific mention of "age" or "older persons"?
 Is there an explicit legal prohibition of discrimination against workers on the basis of
"age" (e.g., a law of equal work opportunities)?
Protective
 Is there financial protection for older persons within the social security legislation
(i.e. old age pension)?
 Is there specific law for protecting older persons from "abuse"?
Familial and Informal Supportive
 Is there a specific law that recognizes and provides for rights of family members who
are caregivers of older persons?
 Is there obligation by law for close family members to take care of their elder
relatives?
Preventive
68
Id. at 130-141 (including a detailed illustration of how the model might be applied to generate an overall
index score for a specific country). Answers to each of the questions are given equal weighting based on a
four levels of weight scales: “0” - no right for this kind to older persons; “1” – right exists with significant
or formal limitations; “2” – right exists with informal or minor limitations; and “3” – right exists.

23
 Is there a law that enables older persons to decide in advance by who and what
medical decisions will be made on their behalf once they are found legally incapable
of making such decisions?
 Is there a possibility for older persons to prepare a will?
Empowerment
 Is there a specific law solely regarding older persons' rights?
 Is there a legal right for older persons to receive legal assistance or representation?
What is Ageism?
According to the World Health Organization (“WHO”)69
:
“Ageism refers to the stereotypes (how we think), prejudice (how we feel) and
discrimination (how we act) directed towards people on the basis of their age. It
can be institutional, interpersonal or self-directed. Institutional ageism refers to
69
Global report on ageism (Geneva: World Health Organization, 2021), xvi.

24
the laws, rules, social norms, policies and practices of institutions that unfairly
restrict opportunities and systematically disadvantage individuals because of their
age. Interpersonal ageism arises in interactions between two or more individuals,
while self-directed ageism occurs when ageism is internalized and turned against
oneself … Ageism often intersects and interacts with other forms of stereotypes,
prejudice and discrimination, including ableism, sexism and racism. Multiple
intersecting forms of bias compound disadvantage and make the effects of ageism
on individuals’ health and well-being even worse.”
The WHO, like many others, has noted that ageism starts in childhood (i.e., children pick
up cues from their environment about stereotypes and prejudices in the culture in which
they are living and gradually internalize them into their own beliefs) and is reinforced
over time unless steps to intervene are taken. The WHO identified various determinants
of ageism: factors that increase the risk of perpetrating ageism against older people
including being younger, male, anxious about death and less educated; factors that reduce
the risk of perpetrating ageism including having certain personality traits, such as
empathy, and encouraging more intergenerational contacts; and factors that increase the
risk of being a target for ageist stereotyping and discrimination include being older, being
dependent on others for care, having a lower healthy life expectancy in the country and
working in certain professions or occupational sectors (i.e. technology or hospitality).70
According to the WHO, the global incidence of ageism is stunning--one in two people are
ageist against older persons—and ageism permeates actions and outcomes in a wide
range of institutions and sectors of society including the provision of health and social
care, the workplace, the media and the legal system.71
Age is one of three dimensions—race and gender are the other two—that people
automatically use to categorize others when they first see or meet them.72
However,
while racism and prejudice based on gender had been extensively studied in the years
leading up to the beginning of the 21st
century, relatively little work had been done on
exploring prejudice based on age.73
Ageism shares certain common characteristics with
other “isms” in society, such as sexism and racism; however, Woolf and others have
pointed to several important differences that need to be considered when trying to
understand how ageism works. First, while gender and race remain constant throughout a
person’s lifetime, age classification changes as a person moves from childhood to young
adult to middle age and then to older age. Second, everyone, assuming that they survive
long enough, will eventually be vulnerable to the negative impacts of ageism, which can
70
Id.
71
Id. at xvii.
72
Researchers refer to these dimensions as “primitive” or “automatic” categories. See, e.g., D. Hamilton
and J. Sherman, “Stereotypes”, in R. Wyer and T. Srull (Eds.), Handbook of Social Cognition (Hillsdale,
NJ: Erlbaum, 1994), Volume 2, 1–68. See also M. Brewer and L. Lui, “The primacy of age and sex in the
structure of person categories”, Social Cognition 7:7 (1989), 262 (arguing that age-based social
categorizations are automatic or made too quickly, generally in under a second, without thought or
deliberation).
73
T. Nelson, (Editor), Ageism: Stereotyping and prejudice against older adults (Cambridge, MA: MIT
Press, 2002). See also L. Ayalon and C. Tesch-Romer (Editors), Contemporary Perspectives on Ageism
(Springer Open, 2018).

25
cause them to act in an ageist manner with respect to others and often towards
themselves.74
Another unique thing about ageism, when compared to negative stereotyping of other
groups based on immediately apparent characteristics such as race or gender, is that older
adults do not become old until they reach a specific threshold established by society, such
as turning 65 or retiring from the workplace, and thus they have not had the
“opportunities”, such as they are, that members of the other groups have had to develop
coping mechanisms for dealing with the negative stereotyping that they are suddenly
confronted with. Coping is made even more difficult by the fact that persons who reach
the status of “old” bring with them their own stereotypes that have been acquired over the
years since they were very young and are often shocked to realize that these perceptions,
generally negative, apply to themselves. The result is a self-internalization process that
makes the aging process even more difficult and painful.75
As Milner et al. explained:
“Age-based stereotypes are often internalized in childhood, long before the information is
personally relevant, so they are accepted without critical examination. Termed ‘pre-
mature cognitive commitment’, this mindless coding leads people to accept beliefs
unconditionally. Later, when people perceive themselves to be ageing, the coding acts as
a self-induced prime, causing them to act in ways consistent with this coding and creating
a self-fulfilling prophecy.”76
Researchers have found that younger adults who hold more-
negative age stereotypes and engage in actions that are discriminatory against older
persons also put themselves at risk for adverse health outcomes as they age and become
older persons themselves.77
74
A. Traxler, Let's get gerontologized: Developing a sensitivity to aging. the multi-purpose senior center
concept: A training manual for practitioners working with the aging (Springfield, IL: Illinois Department of
Aging, 1980) (as described in L. Woolf, Ageism). Traxler defined ageism as "any attitude, action, or
institutional structure which subordinates a person or group because of age or any assignment of roles in
society purely on the basis of age". Id at 4. See also B. Blaine, “Understanding Age Stereotypes and
Ageism” in B. Blaine, Understanding the Psychology of Diversity (2nd
Edition) (Thousand Oaks CA: Sage
Publications Inc., 2002), 178-179 (describing research showing that old age stereotypes and negative age-
related attitudes are just as prevalent, if not higher in certain instances, in older adults compared to younger
adults (e.g., M. Hummert et al., “Using the Implicit Association Test to Measure Age Differences in
Implicit Social Cognitions”, Psychology and Aging, 17(3) (2002), 482), meaning that elderly persons
sometimes seem to be stereotyping themselves with their negative perceptions of their own-age peers).
75
B. Blaine, “Understanding Age Stereotypes and Ageism” in B. Blaine, Understanding the Psychology of
Diversity (2nd
Edition) (Thousand Oaks CA: Sage Publications Inc., 2002), 175, 182 (citing B. Levy,
“Stereotype Embodiment: A Psychosocial Approach to Aging”, Current Directions in Psychological
Science, 18(6) (2009)).
76
C. Milner, K. Van Norman and J. Milner, The Media’s Portrayal of Aging (changingthewayweage.com)
(citing T. Nelson (Editor), Ageism, Stereotyping and Prejudice against older persons (Cambridge MA: MIT
Press, 2002)). See also N. Dahmen and R. Cozma (Editors), Media Takes: On Aging (New York and
Sacramento CA: International Longevity Center-USA and Leading Age California, 2009) (“Many
Americans start developing stereotypes about older people during childhood, reinforce them through
adulthood, and enter old age with attitudes toward their own age group as unfavorable as younger person’s
attitudes.”) and T. Nelson (Editor), Ageism: Stereotyping and Prejudice Against Older Persons (Cambridge
MA: MIT Press, 2002), 84-86 (Table 4.1: Studies Examining Children’s Age Attitudes).
77
B. Levy, M. Slade, E-S. Chang, S. Kannoth and S-Y. Wang, “Ageism Amplifies Cost and Prevalence of
Health Conditions”, The Gerentologist, 60(1) (February 2020), 174 (noting, for example, that studies have
found that young adults holding more-negative age stereotypes were twice as likely to experience

26
The term “ageism” was first used in the late 1960s to describe the process of systematic
stereotyping of people because they are old. The term “individual ageism” includes the
impact of culture-based negative age stereotypes and negative self-perceptions of aging
on the health of older persons, while the term “structural ageism” refers to the explicit or
implicit policies, practices or procedures of societal institutions that discriminate against
older persons (including age-based actions of individuals who are part of those
institutions, such as hospital staff members).78
Robert Butler, who was the first director
of the National Institute of Aging, and the person who coined the term, later argued that
ageism in practice is no different than other societal “isms” such as racism and sexism
and that it “allows other generations to see older people as different from themselves;
thus they subtly cease to identify with their elders as human beings”.79
According to the
WHO80
:
“Ageism is the stereotyping, prejudice, and discrimination against people on the
basis of their age. Ageism is widespread and an insidious practice which has
harmful effects on the health of older adults. For older people, ageism is an
everyday challenge. Overlooked for employment, restricted from social services
and stereotyped in the media, ageism marginalises and excludes older people in
their communities. Ageism is everywhere, yet it is the most socially
“normalized” of any prejudice, and is not widely countered – like racism or
sexism. These attitudes lead to the marginalisation of older people within our
communities and have negative impacts on their health and well-being.”
Defining ageism has been problematic and there are a wide range of definitions that
include various types of components. For example, a relatively simple approach is to
define ageism as “prejudice against older persons” or the “association of negative traits
with the aged”. Levy and Banaji described ageism as a difference in one’s feelings,
beliefs or behaviors based on another person’s chronological age.81
Others have included
two parts in their definitions of ageism, such as “stereotyping and prejudice”, “negative
attitudes and behaviors toward the elderly” or “prejudice and discrimination against older
people”. A three-part definition of “ageism” includes multiple components of attitudes
regarding aging and older persons: an affective component such as feelings that one has
cardiovascular events up to 40 years later than their young adult peers holding more-positive age
stereotypes, after adjusting for relevant covariates including family history of cardiovascular disease).
78
E-S. Chang, S. Kannoth, S. Levy, S-Y. Wang, J.E. Lee and B.R. Levy, “Global reach of ageism on older
persons’ health: A systematic review”, PLoS ONE 15(1) (2020) (citing R. Butler, “Dispelling agesim: The
cross-cutting intervention”, Annals of the American Academy of Political and Social Science, 503 (1989),
138; and R. Butler, “Ageism”, Generations 29(3) (2005), 840).
79
R. Butler, Why Survive? Being Old in America (New York: Harper & Row, 1975).
80
https://www.who.int/ageing/ageism/en/ The WHO has been particularly concerned about “elder abuse”,
which it has defined as “a single, or repeated act, or lack of appropriate actions, occurring within any
relationship where there is an expectation of trust which causes harm or distress to an older person” and has
noted can occur in different ways including physical, psychological/emotional, sexual and financial.
Ageing and Life Course: Elder Abuse (Geneva: World Health Organization, 2009).
81
B. Levy and M. Banaji, “Implicit ageism” in T. Nelson (Editor), Ageism, Stereotyping and prejudice
against older persons (Cambridge: The MIT Press, 2002), 49.

27
toward older individuals; a cognitive component such as beliefs or stereotypes about
older people; and a behavioral component such as discrimination against older people.
Definitions also distinguish between personal and institutional discrimination and/or
recognize that attitudes toward older persons can be negative or positive.82
Society uses
various names for the social categories assigned to older persons including old people,
elders, seniors, senior citizens and the elderly, and the very act of categorization provides
support for ageist feelings and beliefs and the behaviors that can be identified in the
social interactions in which older persons are involved.83
North and Fiske noted that ageism research tended “to lump ‘older people’ together as
one group, as do policy matters that conceptualize everyone over 65 as ‘senior’” and
went on to argue that such an approach “is problematic primarily because it often fails to
represent accurately a rapidly growing, diverse, and health older population”.84
They
suggested that it was valuable and appropriate to recognize a distinction between the still-
active “young-old” and the potentially more impaired “old-old” when conducting
research on ageism and developing and implementing policy decisions that impact the
lives and wellbeing of older persons. They noted that “subtyping” of older persons has
its roots in the 1970s writings of Neugarten, who described the “young-old” group of that
era as being between the ages of 55 to 75 and having some degree of affluence, health,
education, political activeness and freedom from traditional familial responsibilities.
Contrasted to this group was an “old-old” group who were less active than the members
of the young-old group and predominantly retired.85
Notably, Neugarten took an
optimistic view of the opportunities available to the young-old, calling on them to engage
in self-enhancement and participate in their communities as “agents of social change to
create an age-irrelevant society”.86
North and Fiske suggested that Neugarten’s young-
old group resembled the baby boomer generation that emerged decades later in terms of
health, wealth, influence and potential for re-defining “old age”; however, they noted that
while “the notion of aging may be changing, social policies lag behind” (e.g., the official
designation of “senior citizen” still refers to persons over 65 (or sometimes younger).87
According to North and Fiske, ageism theory and research activities have been fixated on
causes pertaining to the old-old and many of those theories, such as ageism being
associated with younger people’s anxieties about death, are not credibly applicable to the
82
Adapted from E. Palmore’s book review of T. Nelson (Editor), Ageism: Stereotyping and Prejudice
Against Older Persons (Cambridge MA: MIT Press, 2002) in The Gerontologist 43(3) (2003), 418.
Palmore also highlights and briefly describes a number of social-psychological concepts that have been
applied to ageism including “baby talk”, “compassionate ageism”, “elder speak”, “implicit (or unconscious)
ageism”, “learned helplessness”, “negative halo effects” and “social role perspective”. Id. at 419.
83
B. Blaine, “Understanding Age Stereotypes and Ageism” in B. Blaine, Understanding the Psychology of
Diversity (2nd
Edition) (Thousand Oaks CA: Sage Publications Inc., 2002), 175, 176.
84
M. North and S. Fiske, “Subtyping Ageism: Policy Issues in Succession and Consumption”, Social Issues
and Policy Review, 7(1) (2013), 36.
85
B.L. Neugarten, “Age groups in American society and the rise of the young-old”, The Annals of the
American Academy of Political and Social Science, 415(1) (1974), 187.
86
Id.
87
M. North and S. Fiske, “Subtyping Ageism: Policy Issues in Succession and Consumption”, Social Issues
and Policy Review, 7(1) (2013), 36, 38-39.

28
healthier young-old who do not appear anywhere near death.88
The active young-old also
do not conform to stereotypical perceptions of older persons as being non-competitive
and low status.89
North and Fiske called for more attention to be paid to incorporating
the diversity among older persons in terms of appearance, attitudes and health into
economic and social policy initiatives and studying and addressing ageism that targets
different segments of the older population. For example, they argued that firms should
tailor their hiring practices to the abilities of individuals, rather than stereotyping them on
the basis of age, and that further research should be continued in order to demonstrate
that age-related cognitive decline has been greatly exaggerated and that young-old
employees can be extremely valuable.90
As for older persons that fall within the old-old
category, North and Fiske pointed out that much of the societal tension centers around the
fear among younger generations that programs for older persons, such as Medicare and
Social Security, deplete scarce resources and the belief among the young that the old-old
are non-reciprocating and take more than they give back.91
Their suggested response was
for policymakers to focus their creating energy on developing new kinds of societal roles
for the old-old that utilize their considerable life-acquired skills, promote a sense of
agency and purpose and are cost effective.92
The landscape for research and policy relating to ageism was nicely summarized by
Margues et al.93
:
“Ageism is a multifaceted concept including three distinct dimensions: a cognitive
(e.g., stereotypes), an affective (e.g., prejudice) and a behavioural dimension (e.g.,
discrimination). Ageism can operate both consciously (explicitly) and
unconsciously (implicitly), and it can be expressed at three different levels: micro-
level (individual), meso-level (social networks) and macro-level (institutional and
cultural). Furthermore, ageism has two distinct targets: On the one hand, ageism
can be directed at other individuals—“other-directed ageism”—such as when we
think that other older people are slow or wise. On the other hand, ageism can be
directed towards oneself—“self-directed ageism” (e.g., I have negative feelings
regarding my own aging).”
Regardless of how ageism is defined and described, it has become highly prevalent and
widespread across many cultures. Data from 57 countries collected through the World
Values Survey in 2014 indicating that 60% of the respondents reported that older people
did not receive the respect that they deserve, and other studies have indicated that the
88
Id. at 39-40.
89
Id. at 41 (citing S. Fiske, A. Cuddy, P. Click and J. Xu, “A model of (often mixed) stereotype content:
Competence and warmth respectively follow from perceived status and competition”, Journal of
Personality and Social Psychology, 82 (2002), 878).
90
Id. at 46 (citing L. Brooke and P. Taylor, “Older workers and employment: Managing age relations”,
Ageing and Society, 25(3) (2005), 415).
91
Id. at 48.
92
Id. at 49.
93
S. Margues et al., “Determinants of Ageism against Older Adults: A Systematic Review”, International
Journal of Environmental Research and Public Health, 17 (2020), 2560).

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