Ministry of Science,

Technology and Innovation

Danish Research Agency
The Ageing Society 2030
Report by the Steering Group for the strategic foresight
on the ageing society 2030
The Danish Council for Strategic Research

The ageing society 2030
Report by the Steering Group
for strategic foresight on
the ageing society 2030
The Danish Council for
Strategic Research, March 2006
ISBN 87-90201-86-8
(online version)
Published by:
The Danish Research Agency
Artillerivej 88
DK-2300 Copenhagen S
Denmark
Phone: (+45) 3544 6200
Fax: (+45) 3544 6201
E-mail: forsk@forsk.dk
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The Ageing Society 2030
Report by the Steering Group for the strategic
foresight on the ageing society 2030
The Danish Council for Strategic Research 2006
Content Table
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Foreword 3
1. Introduction 7
2. The ageing society 9
3. Vision: the age-integrated society 13
4. Healthy ageing 17
4.1 Research topics 25
5. The age-integrated labour market 27
5.1 Research topics 32
6. Cohesion in society 33
6.1 Research topics 41
7. Summary 43
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I may not be as strong as I think, the old man said.
But I know many tricks and I have resolution.
E. Hemingway, The Old Man and the Sea
This is the report by the Steering Group for strategic foresight on
the ageing society 2030.
The report is a result of a study initiated by the Minister for
Science, Technology and Innovation in consultation with the
Danish Council for Strategic Research in December 2004.
The premise for the study was the anticipated growth in the
number of people over the age of 60-65, resulting from the pre-
vious trend in the birth rate, the continued relatively low rate of
fertility and the anticipated increase in average life expectancy.
These factors are inducing the emergence of an ageing society,
which presents both challenges and opportunities.
The purpose of the Steering Groups project was to establish a
basis for implementing research activities that actively address
the challenges and opportunities of an ageing society. Such a
project naturally consists in making a number of choices for
inclusion and exclusion. The Steering Group has opted to start
from the premise of a vision of the development of an age-inte-
grated society in which individuals roles in society are not
determined by their chronological age, but rather by their
physical and psychological functional ability. There is thus a
consciously selected normative basis underlying the
deliberations. In the progression towards the ageing society, the
workforce, with its present legislation, regulations, agreements
and practice of access to and retirement from the labour market,
will become smaller and smaller. At the same time, the increase
in average life expectancy will mean that the individual will
spend an increasingly greater proportion of his/her adult life
outside the labour market. In financial, social and human terms
this does not make sense. Societys structures have not kept up
with the increase in life expectancy and the improvement of
Foreword

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functional abilities. These therefore need to be adapted, so that
ageing and society can go hand in hand towards an age-integrated
society.
As a consequence, research should not focus simply on ageing in
the sense of research into the elderly. There should be greater
focus on the preconditions for creating an age-integrated society:
the determinants for an active and healthy life, functional ability
in its broadest sense, the technological opportunities for
maintaining functional ability for as long as possible, the
organisation of the labour market and of companies, and social
cohesion in terms of culture, society, gender and ethnicity and
across the generations.
For many of these areas, as the report indicates, there will be
abundant potential for interaction between research environments,
companies, organisations and public-sector stakeholders. This
will prepare the ground for multidisciplinary interaction with an
international perspective generally and an EU perspective more
specifically. Ultimately, one can envisage how Danish society
might become an exporter not only of products that assist in
maintaining functional ability, but also and far more
promisingly a major exporter of a vision of society: the
age-integrated society. In this context, Denmark has a solid
foundation by virtue of its positions of strength in register-based
research, organisation of care for the elderly, the Danish welfare
model in general and the Danish labour market model in
particular. It is precisely these factors which provide Denmark
with a sound position within European and international research.
Demographic changes will come to play a major role in the
development of society in general and in political decisions in
particular. Companies, organisations, politicians etc, will
constantly need to focus on the change processes resulting
from the shift towards the age-integrated society. Policies
on retirement, health, employment, taxation, the family,
immigration, research and education must be adapted to the new
demographic conditions. The labour market and conditions of
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employment must be adapted to match up to these new
challenges. Actors on the commodities markets must be aware
of the potential there is in an ageing society borne by new
generations of elderly and active consumers. Technological
innovation must be based extensively on the fact that society is
undergoing an ageing process and that technology, which,
through dynamic interaction, both influences and is influenced
by society, can contribute to the ageing society becoming not a
problem but an opportunity to be embraced.
Along with this implied emphasis on the demographic change
processes, it is also important for the Steering Group to mention
that, beyond the thematic and specific proposals for research,
there may be good reasons to further strengthen Danish research
in demographics in general, including register-based research,
and to ensure the emergence of a general public appreciation
that society is progressing towards a different structure. It is
important to build up a body of knowledge for the decisions that
will lead Denmark in the direction of the age-integrated society,
but it is equally essential that the actors and the populace
understands that we are heading towards a different society. This
is not a consequence of the problems of financing the welfare
society. It is a consequence of the increase in life expectancy and
the improvement in functional abilities. Only if we all understand
where we are headed will it be possible for politicians and the
heads of companies and organisations to make the decisions that
will gradually eliminate the significance of chronological age and
replace it with a whole-life perspective which anticipates the
age-integrated society. This calls for dialogue between the general
public and the decision-makers.
Jrn Henrik Petersen
Professor, dr. phil. & lic. oecon.
Centre for Welfare State Research/Department of Political
Science and Public Management,
University of Southern Denmark,
Steering Group Chairman
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Ageing populations will be a challenge for all the OECD
countries in the coming years. Those countries and businesses
that are best able to tackle these challenges stand to achieve
social, economic and skills-related advantages. The issue thus has
a wide popular and political interest, since it encompasses a
number of critical social dilemmas which call for solutions and
offer opportunities.
The Minister for Science, Technology and Innovation, in
consultation with the Danish Council for Strategic Research,
has implemented a strategic foresight project focusing on the
challenges, opportunities and threats in the ageing society of
the future.
The Strategic Foresight on the ageing society 2030 is one in a
series of foresight projects initiated by the Minister for Science,
Technology and Innovation. The projects are being carried out
under the joint rubric of Technological Foresight. This foresight is
also a pilot project for the Danish Council for Strategic Research
in its future work on strategic early warning. As a systematic
attempt to look into the future, a foresight consists of dialogues
on and analyses of development prospects in terms of science,
technology, economy and society. A foresight can:
Propose for debate a number of different futures
Provide a basis for targeting new areas
Provide a basis for prioritising resources today in order to
realise the future we want tomorrow
Increase the interaction between research, businesses,
organisations and public authorities.
To manage the Strategic Foresight on the ageing society 2030,
the Danish Council for Strategic Research appointed a steering
group comprising individuals with specialised skills, who, from a
variety of professional viewpoints, have contributed insight and
knowledge on the challenges, opportunities and threats in the
ageing society of the future.
1. Introduction

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The Steering Groups members:
Professor Jrn Henrik Petersen, dr. phil., lic. oecon.,
University of Southern Denmark, Chairman
Associate Professor Kirsten Avlund, dr. med., PhD,
University of Copenhagen
Karen Munk, PhD, University of Aarhus, coordinator
Professor Birgit Jger, PhD, Roskilde University
Henning Kirk, dr. med., author
Head of Division, Associate Professor Bernard Jeune, M.D.,
University of Southern Denmark
Villy J. Rasmussen, management consultant, external lecturer
Professor Brian Clark, PhD, DSc., University of Aarhus
The point of departure for the Steering Groups work was prima-
rily a series of background reports prepared by the groups indivi-
dual members on the basis of their specialist backgrounds, and
the Danish and international literature. With these and a vision of
the development of an age-integrated society as the basis, the
guiding principle for the choice of strategically informed research
themes and topics was whether they could contribute to the reali-
sation of the vision.
New Insight A/S and The Danish Research Agency provided con-
sultancy and secretarial support to the Steering Group.
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The concept of the ageing society reflects:
A trend in society of longer life expectancy and a birth-rate
falling or remaining low, leading to a change in the composition
of the population, with an increasing number of older persons
relative to both the number of children and young people and the
number of people of working age.
As the figure above shows, in the period up to 2030, the trend in
Danish age distribution will result in an expected fall of approx.
119,000 young people under 20 years of age and a fall in the
number of people of working age in the age-group 20-65 of
approx. 189,000, while the number of older persons, over 65
years of age, increases by some 353,000.
2. The Ageing Society
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This section is based on the following reports: Petersen, Jrn Henrik:
3. Det demografiske grundlag bag det aldrende samfund [The demo-
graphic basis of the ageing society]; Jeune, Bernard/Kirk, Henning: 1.
Det aldrende samfund [The ageing society].
Source: Own calculations based on the Danish Welfare Commissions population projection
Age distribution in Denmark in 2000 and 2030
Age 20 Age 65
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This change in the populations age distribution will lead to a
considerable reduction in the workforce.
In addition to that, the dependency ratio is increasing appreciably.
Whereas today there are 3.6 people in the working-age range of
20 to 64 to finance provision for each person under 20 or over 65
years of age, in the year 2030, there will be only 2.5 people.
This consequence follows, even though fertility in Denmark is
relatively high compared with other countries.
As shown in the above figure, the Danish Welfare Commission
anticipates a reduction in the workforce of approx. 350,000
people up to 2040. The dependency ratio grows, as the figure on
page 11 shows, by around 30 per cent in the same period, after
which it falls before rising again. This is a striking intimation
that, on a cautious assumption, Danish society is heading towards
a status as an ageing society. This progression reflects the
trend in the number of births in the 20th century, a falling birth
rate and increased average life expectancy. The average life
expectancy is expected to continue rising, and, on not unrealistic
assumptions, the dependency ratio might conceivably grow more
than projected by the Welfare Commission.
Trends in the Danish workforce, 1960-2040
Source: Danish Welfare Commission: Future Welfare Our choices, December 2005
projected workforce workforce
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Even small shifts in average life expectancy will have significant
consequences for the populations future size, the dependency
ratio size and hence public expenditure.
The ageing process does not stop in 2030. Analyses of the long-
term trend (1901-2081) show that, except for the increase in the
birth rate which followed in the wake of the world wars, in the
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century there was no particular increase in the birth rate,
while the number of people over 65, for their part, roughly
quadrupled. This number is expected to peak around 2040, when
there will be approx. 400,000 more older persons than now, while
the number of children will be lower. At the same time, there is
considerable growth in the number of people over 80 years of
age. The long-term picture is of a society with a permanently
higher proportion of the population in the older age groups.
Looking at the ageing society simply on the basis of the
shifts linked to chronological age, the trend based on existing
traditions, norms and images of ageing gives rise to many
concerns about a shortage of labour, a growing dependency
burden, increased social and health costs, etc.
The demographic dependency ratio according
to the Danish Welfare Commissions population projection
Dependency ratio Dependency ratio
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In this progression towards the age-integrated society, a change in
perspective will be essential, so that age shifts are seen more as
challenges and opportunities. It is precisely this that the Steering
Group has chosen to summarise in its vision of the age-integra-
ted society.
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It is a mistake to consider the ageing of society as an intrinsic
problem. On the contrary, the increasing average life expectancy
is a triumph of civilisation that is to be welcomed.
Even if societys ageing, seen in isolation, is not a problem, this
poses a new and considerable challenge for modern society. A
consistent point in the foresight project has been that society has
increasingly been structured around chronological age and that
this social construction limits the positive opportunities offered
by an ageing society. The Steering Groups vision is therefore that
Danish society should progress towards an age-integrated society,
the organisation of which in 2030 will be founded on functional
abilities and not on chronological age.
In that age-integrated society, age barriers are removed and in all
social structures - education, work, leisure, families, etc. - there
are opportunities for all, regardless of chronological age.
Children, young people, adults, older persons and the elderly
are all integrated members of society with roles determined by
their respective functional abilities. The Steering Group would,
however, also like to emphasise strongly that the age barriers in
terms of children and young people are to no small degree in the
nature of protective measures. The task is primarily to eliminate
age barriers in adult life.
Even though the concept of the age-integrated society, as
described in one of the background reports, is rooted in
international literature, in the Steering Groups opinion, the
concept itself merits a research initiative.
3. Vision: the age-integrated society
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This section is based on the following reports: Jeune, Bernard/ Kirk,
Henning: 1. Det aldrende samfund [The ageing society]; Petersen, Jrn
Henrik: 2. Det alderskonstruerede vs. det aldersintegrerede samfund
- en vision [The age-constructed versus the age-integrated society
- a vision].
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The concept of the age-integrated society
The object is to identify the essential elements of the
age-integrated society and to shed light on some of the issues
that arise when the concepts of ageing and society are linked:
More precise identification of the concept of the
age-integrated society and its characteristics.
Studies of the transition period from a society which is
structured around chronological age, to a society which rests
on the whole-life perspective of the age-integrated society.
The significance of the altered family structure (the vertical
family) for the functioning of the ageing society.
The images of older persons, stereotypes, values, attitudes
and creation of norms in and around the ageing society.
General surveys of the good life in late life, including
expectations instilled in younger generations.
The significance of ageing for revitalising civil society,
including the role of older persons as care-providers.
Factors determining roles when age criteria are no longer
decisive.
The transition to an age-integrated society is not without its
problems. For example, the democratic balance shifts to the
benefit of the older segment of the population, which may sow
the seeds of intergenerational tension.
Similarly, the populations social groupings in terms of gender
and ethnic origin will offer a different basis for exploiting the
opportunities of the age-integrated society. This is of crucial
significance to ensure cohesion in the ageing society, and a
number of preconditions are therefore linked to the aspiration to
realise the vision of an age-integrated society in 2030.
The Steering Group focused in particular on three main areas,
each of which call for an interdisciplinary research effort
characterised by the interaction between research and practice,
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comprising both private and public-sector actors at a centralised
and decentralised level. These three main areas are:
Healthy ageing with good functional ability and better
utilisation of new technological facilities
The objective is to ensure that everyone has the opportunity
to age healthily. This assumes that the risk of loss of
functionality is proactively limited as much as possible, and
that the facilities for compensating the individual for loss of
functionality are used in such a way that his or her personal
integrity and autonomy are guaranteed.
This topic is discussed in section 4.
An age-integrated labour market with better opportunities
for late careers, life-long learning and flexible continuance in
employment
The objective is to counteract the negative effects of ageing
on the development of the workforce and to counteract
exclusion from active participation in society by creating
opportunities for all to achieve flexible continuance on the
labour market.
This topic is discussed in section 5.
Promoting social cohesion across generations, genders
and ethnicity
The objective is to counteract the negative effects of social,
gender-related and ethnically determined differences in the
ageing process at the individual level and ensure that the
values and norms behind the unwritten social contract
between the generations are adhered to, so that the potential
risk of intergenerational tension is reduced.
This topic is discussed in section 6.
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Healthy ageing - with good functional ability and
better utilisation of new technological facilities
The realisation of the age-integrated society is contingent on the
creation of conditions for healthy ageing, i.e. that the number of
good years of life is increased and the number of poor years of
life is reduced, regardless of how much average life expectancy
rises in future. It is essential to start from the basis that increased
life expectancy appears to be followed by more good years of life
without loss of functional ability. The number of years of life
with long-term illness will, however, also be increased, because
more people will survive chronic illnesses. It must be expected
that, in future, they will receive even better treatment, and there-
fore, to a greater extent than now, will be able to retain their
functionality ability.
A growing proportion of the coming older generations will be
better educated, enjoy better living conditions and a better
lifestyle than preceding older generations. They will have been
children in the post-war period, when children were vaccinated
and infectious illnesses could be treated using antibiotics. They
will have been adults in recent decades, when mortality from
cardiovascular diseases halved because of better prevention and
treatment. They will have been in work in a period when the
working environment was appreciably improved. They will
therefore be generations who have not had their immune system
4. Healthy ageing
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This section is based on the following reports: Avlund, Kirsten/ Jeune,
Bernard/ Kirk, Henning: 4. Sundhed og funktionsevne i det aldrende
samfund r 2030 [Health and functional ability in the ageing society in
the year 2030]; Clark, Brian: 6. Biologisk aldring [Biological ageing];
Jger, Birgit: 5. Teknologisk uafhngighed i det aldrende samfund
2030 [Technological independence in the ageing society 2030]; Munk,
Karen: 8. Alder, aldring og psykisk funktionsevne og udvikling [Age,
ageing and mental functional ability and development].
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run down following serious infections, who have less
arteriosclerosis and who are less physically run down than
preceding generations.
Not least, the higher level of education of the coming older
generations will mean a higher level of cognitive function and
therefore the potential for better psychological ageing.
In addition to this is the fact that there is a close connection
between healthy physical and psychological ageing, in that both
better physical function and a better lifestyle have a positive
influence on cognitive function. It may therefore be expected
that the levels of both physical and cognitive function in future
older generations will be higher in 2030 than now. This
presumes, however, that chronic illnesses, including dementia
and depression, will be better treated or can even be prevented
or deferred until later in life.
The preconditions for healthy ageing, both physical and mental,
begin at birth and are created throughout the course of life. Good
conditions in childhood and early establishment of a healthy
lifestyle, a good education and a sound working environment,
maintaining a healthy lifestyle in adult life and the prevention of
risk throughout life are factors which are all critical for healthy
ageing.
There are therefore grounds for concern over a number of recent
trends which have a negative influence on these preconditions.
This applies to the continued maintenance of the social legacy
and social inequality, in terms of childhood, education, lifestyle,
working environment and health in adult life, which in some
areas is actually deteriorating. In spite of a falling proportion of
smokers, the proportion of heavy smokers is rising. In spite of a
rising proportion of people following the recommendations for
physical activity, inactivity is rising among those who are already
physically inactive. In spite of a generally falling energy intake
and less fat intake, the intake of carbohydrates is rising,
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especially through a greater intake of sugary drinks. In spite of a
tendency to slimmer bodies in sections of the population, the
proportion of the overweight and obese is increasing cause for
concern. In spite of an overall decline in the annual number of
hours worked, the proportion of people who are stressed at work
is rising.
Combined and severally, these factors may contribute to an
increasing incidence of chronic illness, in spite of all the
generally positive tendencies which should otherwise have the
contrary outcome. If these health-related consequences are to be
avoided, dedicated preventive efforts will be required in all the
areas mentioned.
In spite of better conditions, the coming older generations will
not be a homogenous group of healthy older persons. Despite
more healthy older persons in future, there will also be many
with chronic illnesses and impaired functional abilities, some of
whom will make use of integrated home and institutional care.
There can be no doubt that older persons in poor health will
receive better medical treatment in the future and will therefore
live longer with their illness. But one of the major questions for
the ageing society in the year 2030 is whether, through preventive
measures, it will also be possible to postpone chronic illnesses to
a later age.
New challenges for research
It is a challenge for future research to produce new knowledge
that may be applied in new measures to promote healthy ageing,
i.e. to ensure good years of life for as long as possible. This
presumes that sickness and loss of functional ability can be
postponed until the last phase of life. This can only occur if
there is progress across the board, i.e. in prevention, in the
development of new types of treatment and in rehabilitation
measures. It should be emphasised that new technological
solutions in the age-integrated society need to be designed in
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such a way that good years of life are increased while yet
preserving personal integrity and self-determination.
Prevention and rehabilitation
It is essential to understand the diverse and divergent factors that
affect healthy ageing. The current trend in the increase in average
life expectancy is not due to the sudden introduction of radical
technological solutions, but to a combination of a series of
constant small improvements in living conditions, and health
promotion, prevention, treatment and care.
Several factors contribute to preventing illness and the loss of
functional ability. These include smoking cessation, physical
activity, healthy eating habits, stress reduction, better illness
behaviour, early diagnosis, better treatment and rehabilitation
regardless of age, replacement of age criteria with functional
criteria, patient education, positive images of older persons, and
the support of social networks. Proper patient care processes
involving self-monitoring and self-treatment will also contribute
to the prevention of the loss of functional ability from a range
of chronic illnesses. The development of new rehabilitation
measures for the most widespread and serious geriatric diseases
and the development of new types of integrated home and
institutional care will be the primary tasks for the future enlarged
municipalities.
Potential new forms of medical treatment
Beyond a targeted preventive effort, the realisation of healthy
ageing is contingent on the development of new treatments based
on advanced scientific research. It is important to arrive at a
better scientific understanding of the fundamental mechanisms of
biological ageing, of the determinants for a long, active life and
of the risk factors that determine the onset and severity of
chronic illnesses.
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A primary task for future diagnosis and treatment will be to
identify the early signs of chronic illness and loss of functional
ability. New instruments for early diagnosis will constantly be
developed, involving a number of biomarkers in new population
screenings. New preventive treatment regimes, employing both
new medicines and changes in behaviour during illness, will be
increasingly prevalent. Knowledge of the individual patients
genetic profile will be incorporated into future individualised
drug treatments. Telemedical monitoring devices will be used in
more and more areas. Functional criteria will increasingly replace
age criteria when deciding on treatment, even in very advanced
age.
At the same time, there is much discussion as to whether some of
the most important illnesses might be more or less eradicated
over the next 25 years. There is also discussion as to whether
there will be a radical breakthrough in the development of gene
therapy and regenerative medicine, based on the results of stem
cell research. In many technology foresights, it is anticipated that
gene therapy and regenerative medicine will be used in an
increasing number of diseases before 2030, but there is no
certainty as to which areas this is likely to happen in. The
development of new forms of treatment is complex and requires
a convergence in knowledge and technology between
biotechnology, IT and nanotechnology. The admission of gene
therapy and regenerative medicine into the treatment of
widespread chronic disease by the year 2030 will require a
genuine paradigm shift.
New forms of treatment, deriving from advances in
biotechnology, IT and nanotechnology, may potentially be able to
replace expensive conventional treatments, and significantly
reduce the side effects of drugs in a range of serious diseases.
But there are also new risks associated with the use of these
technologies. The health risks associated with nanotechnology
are as yet undetermined. There are certain reservations over the
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widespread genetic profiling of large population groups. This is
therefore a complex challenge that will be taken up worldwide in
the future. It will be in the Danish interest to possess scientific
environments in the elite class in a range of selected areas
The health system and IT
The development of the Danish health system will be
increasingly based on the use of IT. It may be expected that there
will be a fusion of IT with biotechnology, which will, to a large
extent, make substantial sections of the health service partially
independent of time and place, and which may also improve
communication and coordination between the different functions
in the health sector. This will, furthermore, allow for increased
responsibility for ones own health, self-monitoring and
self-treatment to a much higher degree than is currently the case.
This active involvement of the population, regardless of age and
functional ability, is expected to become an integrated part of the
health system of the future.
The relationship between the patient and the health service will
be significantly altered, so that hospitals are likely to be used
most for cases where there is a need for especially complicated
diagnosis and treatment. All other contacts with the health
service will consist of a combination of contacts with general
practice, mobile hospitals, and telemedical monitoring,
rehabilitation contacts with local health centres, and virtual
consultations with different sections of the health service
combined with self-monitoring and dialogue via groups of
patients and their relatives on the web.
Everyday technology
It is a key for the vision of the age-integrated society that if and
when citizens experience either a major or a minor loss of
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functional ability, they remain self-reliant and not dependent on
assistance, so that they can remain in their own homes for as long
as possible. This imposes demands on the design and technical
solutions of everyday technology, aids and appliances, and the
layout of homes. In these areas, developments within IT,
communications technology and biotechnology will be critical
for the development of the age-integrated society, but they will
also create new problems.
These technological developments will turn up in everyday
technology right from IT everywhere through to flexible
housing and new types of products and service provision. It will
be possible to monitor automatically and constantly a wide range
of indicators of significance for an individuals well-being and
hence rapidly intercept acute problems that require rapid
intervention. This new everyday technology will be capable of
being used to adjust the individuals lifestyle in a healthy
direction much more precisely than today - both by offering the
person ongoing advice about food, exercise and relaxing, and by
dosing drug treatment, so that it matches the individual profile.
Self-monitoring, self-treatment and self-care will not take place
within a social vacuum. Today there are already many new types
of social networks, organisations and self-help groups which have
sprung up on the Internet. This gives citizens opportunities for
engaging in a new interaction that will underpin their interest in
taking on greater responsibility for their own health. The
development of everyday technology in the home will also
provide opportunities for better communication and coordination
with nursing care. But this development will also put increasing
demands on developing the citizens competencies, so that they
can master use of the new technology; cf. above on patient
education.
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Design of housing and clothing
When they get older, most people would like to live their lives as
they are used to, even in the case of lost functional ability. They
therefore want to remain living in their familiar home and to have
the option of fitting it out with the necessary extra equipment so
as to be able to manage at home. In the future, therefore, there
will be increasing demand for flexible housing. The trends in new
building are already moving in the direction of intelligent
housing, more space per occupant and modifications adapted to
an ageing population, e.g. toilets, washbasins, bath and kitchen
designed for mobility impaired people. This trend will continue
to be an important feature in the age-integrated society.
Attractive and functional clothing designed with particular regard
for older persons with chronic disease may increase well-being
and self-esteem. Intelligent textiles and smart clothing,
featuring new properties (e.g. soiling and odour repellent) and
incorporating IT and communications solutions directly in the
garment, already now form the basis for the development of new
fashions. Even though some companies in Denmark are already
leaders in this area, an argument can be made for a special
research effort in this traditional Danish business area, so that
the new opportunities may be exploited even further.
There are similar trends emerging in areas such as food,
education, leisure, culture, transport, financial services, personal
wellness services, home care, professional social organisations,
which have potential for the evolution of new products and
services that can capitalise on the opportunities in the ageing
society. The exploitation by Danish companies of these future
market potentials is contingent on targeted research.
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Dilemmas and ethical problems
In step with technological advances within both the health sector
and everyday technology, there will be a need for keener ethical
monitoring. The need to balance expectations and risks, before
making decisions about major research programmes, will grow.
There are therefore grounds for anticipating that the system of
scientific ethics committees and similar bodies consisting of a
broad selection of bioethicists and laypersons will acquire greater
significance.
They should be able to address issues such as:
The collection and use of sensitive genetic data based on
the analysis of individuals.
Criteria for what the concepts of good years of life and
quality of life embody.
The potential challenge in the use of technology to personal
integrity.
The consequences of medical ageism involving negligence
in instituting health-related measures in cases where the
symptoms of disease are perceived as old-age phenomena.
The consequences of biomedicalisation involving
pathologisation and the treatment of signs of ageing which
are not symptoms of disease.
The dilemmas of a long life and the options for rejecting
life-prolonging treatment on an informed basis.
4.1 Research topics
There are many different challenges to meet if the vision of
healthy ageing in an age-integrated society is to be realised. This
presumes first and foremost more knowledge of the fundamental
biological and psychological ageing mechanisms, knowledge of
the determinants for the population's health behaviour and for an
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active and long life, and knowledge of the interaction between
technology and the health system. The Steering Group finds the
following research topics to be of strategic significance:
The determinants for an active and healthy life, i.e. for good
extra years of life without loss of functional ability and
without long-term illness.
Identification of critical phases of life, stressful events and
risk factors, which in a whole-life perspective are of
significance for the development of chronic illness and early
loss of functional ability.
Health behaviour, lifestyle, social networks and other
preventive initiatives as determinants for the age-related onset
and severity of diseases, and for cognitive function over the
course of life.
The development of early functional markers for biological
and psychological ageing and for surviving without loss of
functional ability.
Biological and clinical research of age-related functions and
diseases as a basis for new forms of treatment.
Individual and institutional causes and ethical implications of
medical ageism and biomedicalisation.
Inequality and polarisation in health behaviour, health,
functional ability and life expectancy determined by social,
gender-related and ethnic factors.
Continuous intervention studies of practice for improving
rehabilitation and integrated home and institutional care.
Maintenance and development of technological competence
over the entire course of life.
Opportunities and consequences of technology-based health
measures (pervasive health care), including the commercial
opportunities for Danish companies.
The opportunities and consequences of the extended use of
IT and robotics in the health service and everyday life.
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5. The age-integrated labour market
4
An age-integrated labour market with better
opportunities for late careers, life-long learning
and flexible continuance in employment
The age-integrated society depends on everyone having the
possibility to remain in work, regardless of age, their functional
ability permitting. There are however a number of institutional
and social conditions that make this difficult because they do not
take account of our greater longevity.
The future labour market
Ageing has a huge impact on the labour market. First and
foremost, the workforce is becoming smaller and older on
average. At the same time, the number of people outside the
workforce will rise. It will therefore be necessary to make use
of all existing labour force resources. Companies and public
service production need qualified labour and the financing
of the welfare society depends on having many people in
employment. Furthermore, for many, old and young alike, there
is a strong individual desire to be able to remain in work with
more flexible opportunities for opting in and out depending on
their life situation at the time.
Ageing also has an effect on the composition of the workforce
in terms of formal education, non-formal skills and ethnicity.
These consequences are often overlooked but they are of great
significance for the labour market in the ageing society.
This development will be marked by a general rise in the
workforces formal level of education in step with the departure
4
This section is based on the following reports: Petersen, Jrn Henrik:
10. Pensionsalderens historik og dens betydning for tilbagetrkningen
[History of the pensionable age and its significance for retirement];
Rasmussen, Villy J.: 7. Seniorpolitik og de ldres arbejdsressourcer
[Seniors policy and the occupational resources of older persons].
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of the older workforce with less comprehensive formal education
and the arrival of young persons with better educational
qualifications. Nonetheless, there are already a number of
extrapolations and expectations of future mismatch problems,
and a further intensifying of competition for qualified labour is
anticipated, not least between the public and private sectors.
It is necessary for society to be able to make flexible use of all
labour resources. There are therefore good grounds for a
scientific investigation into what it is that will enable older
persons in the future to remain, and to want to remain, longer on
the labour market.
Motives for continuing on or retiring from the labour market
Existing research shows that there are many different factors
which determine whether older persons want to stay on or retire
from the labour market. These motives broadly fall into four cate-
gories:
1 Individually determined (e.g. gender, health, education).
2 Financially determined (e.g. retirement schemes and income).
3 Connection to the labour market (e.g. type of position,
seniority).
4 Job-related conditions (e.g. company culture, flexible
working hours).
Existing research has focused only to a lesser extent on the job-
related conditions. However, individual surveys indicate that
favourable employment conditions delay the age of retirement.
There are therefore grounds for a greater interest in research in
job-related conditions.
Seniors skills
It is important for older persons to maintain the relevant skills.
It is accordingly a problem for the development of their skills in
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an ageing society that training and professional development are
gradually downgraded with age. Older employees generally
manifest an interest in continued professional and personal
development. The reality is, however, that the scope of further
education declines with age, although less so for the most highly
educated. There is thus a tendency towards polarisation in this
area, both between the young and the old and amongst older
persons themselves. It is essentially to counter this tendency that
the intentions behind lifelong learning are given a concrete
application-oriented content.
In analyses of the difference between older and younger
employees, the older persons are assessed as being stronger
in terms of sense of responsibility, faith in intuition,
stress-resistance, stability and experience, but are in a slightly
weaker position with regard to innovation and adaptability
outside their field of knowledge and expertise. It is worth
emphasising that a regular change of job and ongoing
qualification serves to encourage open-mindedness, innovativity
and adaptability, while avoiding the routine trap.
It is also key to view seniors skills as relevant to future demand
for qualified labour, especially for the solution of especially
complex tasks. Many seniors have the ability and the mental
energy for thinking long-term, which is why they are particularly
suited and motivated to act as mentors for junior employees.
Seniors have an understanding that there are many
considerations, perspectives and interests involved in the
workplace (diversity) and, through greater independence from
social norms, they are often more creative and better
problem-solvers than juniors. Furthermore, seniors have built up
a great store of patterns of insight and experience as well as an
ability to recognise patterns in new knowledge and combine them
with what they have already assimilated. Within their fields of
knowledge and skills, seniors are very effective problem-solvers
and fully capable of adapting to new tasks.
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The staff policy of the future
Changes in pension terms and incentives through public
retirement schemes are a necessary, but not a sufficient,
condition for persuading more older persons to remain longer on
the labour market. In parallel with the changes in public-sector
schemes with consequences for retirement patterns, a strategic
seniors policy for companies should be developed, with a focus
on job-related factors which motivate older persons to remain in
work, either as wage-earners or self-employed. The management
of seniors should be a central factor in future staff policy. Efforts
by management to utilise and retain older persons and to develop
seniors competencies and processes in order to facilitate a
flexible late-life career for all types of employees represent a
neglected area of research. But it is an important field to shed
light on, if the intentions concerning an age-integrated labour
market are to be realised.
To improve older persons qualifications for remaining in work, it
is imperative to prevent and reduce familiar and future working
environment problems. The Steering Group is aware that the
Danish National Institute of Occupational Health has initiated a
project on future working environment problems, but in the
Steering Groups assessment, measures relating to the future
working environment based on a vision of an age-integrated
society require further studies.
Prejudices and stereotyping as an aspect of staff policy
concerning age and skills must be eliminated. A progressive and
development-oriented staff policy, based on changing roles and
individuality, is only slowly gaining a foothold on the labour
market. A development from a perspective in which a new
division of labour between old and young employees is
established requires that the stigmatisation of age is replaced by a
new emphasis on the skills possessed by seniors. Our knowledge
of how prejudices and stereotypes concerning age can be
removed is extremely limited.
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Other requirements from the labour market
In relation to the vision of an age-integrated society, there are a
number of institutional issues that are key.
The whole-life perspective, together with the labour markets
tradition for flexibility and security, will be decisive for the
organisation of working life. One can imagine a working life
comprising several job phases, several periods of education,
breaks for raising children and phases of part-time work.
Combined, these will increase the opportunities for the
individual to be in a position to continue in working life. It
will be the task of the educational institutions, organisations
and, not least, the public sector to provide the necessary
framework.
It will be decisive for stability in the labour market and in
society to embrace inclusiveness for all, regardless of formal
educational qualifications, gender and ethnic background.
Not taking account of the risk of polarisation may reinforce
inequality and thus threaten the cohesion of the ageing
society.
There is a strong need for deliberation on how education
should be incorporated as a social institution into the ageing
society, and, in this context, it is not just activities within the
formal education system that are under consideration. It
concerns, in the broadest sense, knowledge as an integrated
component of the dynamics of ageing, and knowledge
understood as theoretical insight, practical and productive
skills (tacit, implicit, somatic knowledge), and ethical
wisdom, when knowledge is applied in concrete situations.
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5.1 Research topics
If the vision of an age-integrated society is to be realised, it is
contingent on changes in the functioning of the labour market.
The Steering Group finds the following research topics to be of
strategic significance:
The significance of formal age limits for early retirement
from or flexible continuance on the labour market.
The creation of norms for retirement from and flexible
continuance on the labour market, including older persons
attitude to life-long learning.
The wage structures significance for realising the
opportunities for flexible continuance on the labour market.
Age-specific work skills, including seniors skills.
Making the value of employees to companies visible.
Initiatives for promoting flexibility and adaptability linked to
the ageing society.
Special seniors duties seen in the light of the development
potential of mature life.
The relationship between running down and preceding
working environment.
Analyses of late-life career patterns among wage-earners or
the self-employed.
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Cohesion in society - across generations, genders
and ethnicity
Cohesion in society - across generations, genders and ethnicity
The vision of an age-integrated society faces a major challenge in
terms of encouraging social cohesion across generations, genders
and ethnicity in step with the ageing of society. Ageing creates
risks of a wide range of potential tensions primarily between the
generations. These tensions will manifest themselves not least in
the political process.
It is natural to assume that the ageing of the population and the
concomitant ageing of the electorate will make its mark on the
political processes which are critical to the future development of
the welfare state.
Increased ratio of the elderly and economic sustainability
A growth in the dependency/elderly ratio as a step in the societal
ageing process entails one of three things:
A rising tax rate.
A falling compensation factor.
A combination of rising tax rate and falling compensation
factor.
But a fourth strategy may also be invoked, which aims at growth
in employment, as underlined by the Danish Welfare
Commission, among others.
6. Cohesion in society i samfundet
5
5
This section is based on the following report: Petersen, Jrn Henrik: 9.
Aldring og politisk beslutningsproces [The elderly and the political
decision-making process].
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It is this context that underlies the debate on ageings societal
consequences.
Rising tax is a reflection of the costs of an ageing population
being imposed on the children and grandchildren of the elderly.
Falling compensation burdens the elderly themselves, while the
combination shares the costs, as it were. In all events, the
problem of distribution between the generations is both a current
and a future one.
When there are more to provide for and fewer to provide, the
issue of financing must arise as a problem. For this reason,
questions concerning especially pensions, work and retirement,
health and care have come into focus in the political debate. This
is reflected in the countless reports and political discussions from
the UN, OECD, EU and international think-tanks worldwide.
Discussions in recent years have focused primarily on fiscal
sustainability in general and the sustainability of the existing
system of provision in particular as a result of increased
dependency/elderly ratios. In both cases, the question revolves
around the extent to which the familiar tax structure can, in the
future, ensure coverage of the costs that need to be defrayed
when the composition of the population changes. Here in
Denmark, the most recent contribution to this debate has come
from the Welfare Commission. The argumentation and debate
ensuing from that will not be reiterated here.
Political sustainability
It is a generally accepted fact in the welfare state literature that
both politics and the politically created institutions play an
independent role. Beyond economic sustainability, one may
therefore talk about political sustainability, which relates to the
question as to whether in future there will be a political majority
in support of a given spending or pensions structure.
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An ageing electorate will increase the political influence of those
in particular who benefit from the pensions system. The tendency
will thus be for the ageing process to increase the tax/
contribution rate because politicians will be increasingly
dependent on older voters, who will back the pensions policy.
In parallel with its contribution to levelling out the individuals
variations in income over the course of life and to the
redistribution between the well-off and less well-off, the pensions
system also affects individuals savings, job choice and retire-
ment decisions. In this context, it is important to stress that
growth in the tax/contribution rate will be able to be greatly redu-
ced if rises in actual ages of retirement can be achieved. In
concrete terms, this means that the considerations discussed in
the section on the labour market and on flexible continuance in
employment will, for many older persons, become a critical
political issue in the future.
Many of the current discussions about the pensions systems,
retirement from working life and health and care systems gloss
over the fact that, at their deepest level, they are about the
relationship between the young elderly, their children and their
grandchildren.
The existing structure of the Danish pensions system has
consequences for the relationship between generations in the
future.
Denmark has a three-pillared pensions system:
The state pension, covering all citizens, and which includes
significant redistributive elements.
ATP, based on previous savings, and - as a supplementary and
important provision - the individualised savings-based labour
market pensions, and last the special pension (currently
suspended).
Privately organised savings schemes with old age in mind.
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This pillar structure can lead to tension between the collective
and the individual. To the same extent that labour-market
pensions appear attractive to large sections of the populations,
scepticism may develop over the here-and-now financing of the
state pension. In financial terms there will be a tendency for the
system - not least for the young - to appear less attractive,
without this necessarily having any political consequences. It
may, however, give rise to tensions between the generations.
From the perspective of 2030, there are therefore grounds for
maintaining awareness of how this structural tension may
manifest itself in a change in voting behaviour.
The unwritten contract between the generations
Ageing has unavoidable consequences for the unwritten contract
between the generations. This will be influenced by the ageing of
the electorate and by a number of distribution policy tensions
between the generations.
From the perspective of 2030, there is good reason to believe that
future political behaviour will be marked by changes in the
values and resources of an electorate characterised by different
generational interests.
The generations are certainly linked together, partly through
blood ties, which presumably carries a certain responsibility in
terms of the unwritten contract, and partly through the role
reversal which occurs over the course of life. Today it is you who
is affected, tomorrow me. On the other hand, this extended,
vertical family structure may perhaps weaken this perceived
responsibility. And it is likely that, in the wake of the
individualisation process now in progress, the individual will feel
personally less responsible. The welfare state dynamic is pulling
in the direction of a system-invested responsibility.
The contracts political durability is self-evident if the generations
reproduce themselves over time, so that there is always a
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numerically equivalent (or greater) generation to take its turn in
honouring the contract. But the contracts friction-free progress
may be threatened when demographic conditions mean that the
equilibrium between the generations is shattered, as will be the
case in the coming 25 years as a result of the previous decline in
the fertility rate and increase in average life expectancy.
It is important to ensure a balance between the areas paid for by
the public purse. If the balance tips too much to the advantage of
the elderly, tensions may arise. An equilibrium has to be ensured
between the level of service and the level of costs aimed at the
different service areas (the generations differ in the service areas,
e.g. school versus nursing care). On the whole, with this
demographic change in mind, it will be important to direct
long-range focus at the choice between cash benefit and service
provision.
In the party-political youth organisations, there is a tendency to
gradually call into question the existing political and economic
generational contract. However, this has not yet made significant
inroads in the political conduct of young and young adult voters.
One can conversely see a tendency among the established parties
in Western Europe for an increasing aversion to altering too
radically the welfare provision where this is particularly to the
benefit of the elderly, e.g. early retirement pensions. This may
increase the risk of future intergenerational tensions.
Wide support for fundamental values
Historically, support for fundamental values in Denmark in terms
of the elderly, health and retirement is however very stable across
ages, genders and social groups.
Surveys of the support for democracy and attitudes to the welfare
state from the Danish Democracy and Power Study, World Value
Survey and the EU, among others, show that Denmark has a
well-functioning democracy and that social capital (an indicator
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of the social cohesion in society), in spite of quite considerable
changes in social structures over the last 30 years, has been and
remains relatively robust. In contrast to the trend in, for example,
the UK and the USA, where a worrying attrition of the social
capital has been observed, the same appears not yet to be the case
in Denmark.
As measured in a large number of questionnaire-based surveys
over many years, there is quite considerable stability in the
populations fundamental preferences when it comes to support
for solidarity in society, as is generally manifest in the welfare
states distribution policy. All adult generations see solidarity with
older persons as a moral obligation, perhaps because old age is a
fate that awaits us all.
All in all there is thus a historic basis for an assessment of the
significance of ageing for future voter behaviour, which points in
the direction of quite substantial stability.
This however is not to say that this may not change. There may,
for example, be changes in value orientation from a generational
perspective. Concerted grey politics backed by lobby interests
may emerge to influence future legislation, while new gender-
specific political interests may weaken the basis for the almost
automatic support for the welfare societys collective obligations.
Value orientation from a generational perspective
We currently know but little about the development of the
populations value orientation from a generational perspective.
Will the values that a generation had in its youth also characterise
it later in life, or will there be changes? This is a classic
sociological question, about which disagreement persists. There
is much to suggest that it is the prevailing values of a given
historical period, combined with key events in the individuals
life, which, together with ageing and generational affinity,
establish the basis for the choice of lifestyle and way of life, and
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through that determine behaviour. Added to this are the
observations of innumerable studies of the significance of social
group affinities and, of course, gender and ethnic differences. A
change in value orientation may influence voter behaviour. There
are thus good arguments for creating a better body of knowledge
about the development of the populations value orientation from
a generational perspective.
Grey politics and lobbyism
Even though the Danish Democracy and Power study and other
like it surveyed the power and influence on the parliamentary
process of business and interest organisations, there was no
explicit focus on what might be referred to as the emergence of
grey politics, i.e. politics shaped by interest organisations and
lobbyists with special interest in issues affecting older persons
and health.
Accordingly, we do not know much about how these
organisations will influence the political process within policies
on the elderly in the future. The US Congress has for decades had
a standing committee on ageing and conditions for the elderly,
and, insofar as experiences from this offer an idea of the effect of
lobbying, there are clear tendencies towards a professionalisation
of special interests viewpoints in nearly all areas. Seen on the
basis of a vision of an age-integrated society, where it is a matter
of preserving a certain balance between generational interests,
there are therefore good reasons for the lobby influence of
professional special interests being made the object of scientific
study.
Gender differences
A third specific area in which our current knowledge is limited is
the consequences of gender playing a large and growing role in
politics. It has long been documented that there are significant
gender differences in values and political behaviour. Womens
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values have increasingly influenced welfare policy in recent
decades. Despite a still large gender inequality in political
representation, there are reasons for anticipating that women will
increasingly set the agenda in the future. We do not know how
this will affect the overall political process, but, on the basis of
more sporadic impressions, there is reason to assume that, for
example, diversity and intergenerational considerations and a
more critical attitude to new technology, for example, in the
health area will come to play a greater role.
Furthermore, in terms of ageing it is a fact that women live
longer, but save less for their pensions (because of less
favourable employment conditions) and may therefore become
poorer than men as (single) older persons. This will give the
ageing of society a special gender dimension. Even though
the gender dimension is not yet a notable theme in political life,
examples such as the creation of an actual womens party in
Sweden and a very conscious prioritisation of a womens policy
in Norway, which engages in positive discrimination, suggest a
possible development where women will act in relation to all
political prioritisations on the basis of (broad) gender interests.
Ethnicity
There is comprehensive research concerning integration, but
attention has not been given to the effects of ageing and its
possible significance for the political process. While immigrant
groups comprised just fewer than 9 per cent of the population in
2006, in 2030 this will be a full 14 per cent. In 2030, immigrants
will also comprise a young group, constituting 8.5 per cent of
the over-65 age group.
It is probable, and especially if the integration process does not
become significantly more effective, that this may result in
political mobilisation among the ethnic minorities. The question
is whether the ethnic minorities will seek to protect specifically
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ethnic interests, or whether they will embrace a more classical
Danish political pattern.
One important condition with regard to ageing will be the future
trend among ethnic minorities in attitudes to the duties of civil
society. Among many ethnic minorities, there is traditionally an
expectation that women in particular will take responsibility for
the care needs of the family, including of the elderly. Among the
ethnic minorities, there is a need to follow the development of
womens wishes in general and in this context specifically.
It is also desirable to ascertain the risk of a segment of the elderly
from the ethnic minorities in 20-25 years time being relatively
poor and threatened with exclusion from society. Many of them
will not have had employment of an extent and of a kind that
they will have private savings and pensions.
6.1 Research topics
The Steering Group has found that there are very many areas in
which we lack specific knowledge if we are to counter possible
generational tensions and strengthen cohesion in the ageing
society. This is especially the case if we are to realise the vision
of an age-integrated society. The Steering Group finds the
following research topics to be of strategic significance:
The concept of social cohesion in an ageing and in an
age-integrated society.
The concept of social capital in an ageing and in an
age-integrated society.
The electorates ageing and consequences for political
processes and potential political outcomes.
Coordination of the concepts of political and economic
sustainability.
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Studies of the populations preferences concerning
prioritisation between the major cash transfer incomes and
services (health, care, education) as core provisions in the
age-integrated society.
Potential risks for intergenerational tensions.
The implementation of the unwritten social contract in an
age-integrated society.
The future older persons financial situation, including the
elderly of other ethnic origins.
Age functioning simultaneously as an inclusion and an
exclusion mechanism. The welfare state and the over 65s
(the policy on the elderly from a whole-life perspective).
Studies of the professionalised elderly groups influence on
the political processes.
Studies of gender differences and ethnicity in interaction with
cohesion in an age-integrated society.
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Compared with other countries, Denmark is relatively well placed
when one considers the challenges the ageing society entails both
from a 2030 perspective and in the longer term. The fertility rate
is relatively high and the anticipated dependency ratio is lower
than in many other countries.
The key challenge is to think long-term in order to counter the
problems that society will face and to exploit the opportunities
that exist in creating a socially, innovatively, economically and
politically sustainable ageing society with healthy ageing for all.
The Steering Group notes that the social structures have managed
only to a limited extent to adapt to the positive changes in
average life expectancy. One might talk of a socio-structural
delay which has meant that the social structure is not organised
with the upper age bands more marked robustness and better
functional ability in mind.
The foresight is therefore founded on a vision for the future
ageing society of 2030 in which the concept of chronological
age is replaced by a whole-life perspective based on functional
ability. The Steering Group has chosen to call this a vision for
the age-integrated society.
Making this vision a reality is dependant on a number of other
objectives being realised in the period up to 2030. The Steering
Group has sought especially to point to the following factors:
It is desirable to ensure the preconditions for healthy ageing
for all citizens regardless of age, gender and ethnicity, i.e. a
development in which the number of good years of life is
increased and the number of poor years of life is reduced
- regardless of average life expectancy.
7. Summary

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There is a need to create agreement on prioritisation in future
medical research, in which prevention, treatment, recovery
and improvement are seen as a whole. This has to be done
with due consideration for the opportunities for managing the
future growth in expenditure in the health and care sectors.
Technological solutions must be produced which support
the ageing societys citizens, so that they can retain good
functional ability for as long as possible without losing
personal integrity and autonomy.
Practical conditions must be created for flexible continuance
in the labour market regardless of age.
It is crucial to avoid the development of tensions between the
generations. This presumes that democratic decisions are not
taken unilaterally for the benefit of the elderly age groups,
even though they are becoming a large and growing segment
of the electorate. A basis must be created for a democratic
debate on the values and norms which should be normative
for life in the age-integrated welfare state.
It is essential to create frameworks and conditions which will
permit Danish companies to exploit the positive global
market potential, which the growing and ever more affluent
elderly groups will represent in the period leading up to 2030.
The research institutions, companies and public-sector actors
at a centralised and decentralised level must develop
opportunities for a system export, which will arise out of
the emergence of the age-integrated society.
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