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Ageing may mean several different things. I thought I’d write a short memo to describe what it means when someone says that societies are demographically ageing.

1. Declining fertility

As opposed to what may seem obvious, babies are an essential driver of ageing, or more precisely, the absence of babies. When people have fewer children the balance of age groups in the population changes and the proportion of children diminishes. As a result, the average age of people tends to increase.
Declining fertility is the main driver of the demographic concept called the demographic transition. However, according to this theory, infant mortality rate declines before fertility rates, which leads to an increasing number of children during the time of the transition.

2. Decreasing mortality rates

Despite having very low birth rates in Europe, we still speak of the ageing of Europe. This demographic evolution is associated with the second main factor for ageing, i.e. decreasing mortality rates. People start dying later than before. Instead of dying at all ages due to a number of varying causes, especially infectious diseases, people pass away at more advanced ages, usually caused by chronic diseases, such as heart or respiratory conditions. This evolution of the causes of death from infectious diseases to chronic diseases is usually referred to as the epidemiological transition. The ageing of Western Europe is essentially due to the decreasing mortality in old and very old people. The groups referred to as the “oldest old” (85+) and the centenarians (100+) are the fastest growing age groups.

Note that debates in France notably around the fear of exploding costs of ageing are associated with the ageing of the baby-boomers (those born between 1945 and 1965) rather than ageing in general. This phase is temporary due to the unusually high birth rates combined with unusually high children survival rate during this period. The impact of this demographic bump will progressively fade away throughout the century and Western countries may even become slightly younger at one point. Society will nevertheless have to bear the costs of this populous generation. Other things being equal, Western societies will remain “old societies” where people have few children and nearly all live for a very long time.

In sum we are transferring from two demographically sustainable systems: in the first one, many children are conceived but few live to old age, while in the second one, few children are born but nearly all live to old age. In Western Europe, the transition is nearly complete. The question relative to whether the current number of people on the planet assuming a decent standard of living is sustainable is a completely different question that is unrelated to ageing. To me, and to many others, the advanced ageing of Western Societies is one our greatest achievements that should be protected.

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As a child and later growing up, you don’t really see people ageing. It is only once they have passed that you suddenly and painfully realise that these family monuments were not eternal. As far as I can remember, my great aunt Charlotte was always old. Her death, a few weeks ago touched me very much in a number of ways and I would like to tell you some aspects of her story. Mainly I want to share her end-of-life because it is to me an example of a beautiful death. By beautiful, I don’t mean happy or painless: far from me the idea of depicting death as a promenade. Death is one of the most important moments of life and there is beauty in it.

Charlotte was born in 1918 in Vallet, a small city in Western France, where much of the economy was – and still is – turned towards the production of white wine. She was a child of this generation when men went to war and often did not come back. I am not completely sure this is the reason why she remained a single woman. She lived her whole life in her parents’ house and despite being childless she took care of the numerous children both her sisters had. She worked as a secretary and was a main figure of the town. She lived a life of generosity but independence as well, especially in her later years.

As she was growing older and frailer, her nieces and nephews grew worried of her capacity to live by herself in this big house staircases and so on. Yet, discussions of institionalisation were systematically cut short: no way, Tante Charlotte would never move to a nursing home. I remember my father repeating that if ‘we did put her in a home, it would kill her.’ Little did he know how true this would turn out to be. She loved her garden, the birds inhabiting it and the peace of her home. So, her wish was respected and progressively, care was organised around her, with lately a calendar organising the regular visits of all her nieces and nephews to make sure she had recurrent company. Lately, her vision had decreased to the point where she couldn’t really watch her favourite programmes on TV. In the later months, she had incomprehensively started to destroy documents. She would shred papers into pieces and throw them in the toilet. It was as if she wanted to destroy evidence. As if she knew time was up.

A week before her death, she unexpectedly emitted the wish to move into a nursing home due to pain from a sciatica. Despite being caught by surprise, arrangements had been made and she was able to move in the very same day. Who would have thought that in less than twelve hours she would collapse? In the morning of her second day at the nursing home, she suffered a severe stroke. At this point, the decision was made not to hospitalise her considering her advanced age, the severity of the situation but also in consideration of the quality of life she would have if she sustained the stroke. The extremely painful and traumatising decision was made to let her go. Once enough time has gone by I will write a post on this unimaginably difficult moment but now is not the time. In the six days that followed her stroke, family visited constantly and shared last moments with her. This was the moment for the generation following her, now in their fifties and sixties to share thoughts and memories despite uncertainty about her ability to hear or understand. She died in the early hours of her seventh day at the nursing home.

As I could not physically unite with my family at this time, I went a few weeks later with my mother in her now empty house. My mother told me that when she prepared the funeral, she found her calendar where Tante Charlotte had crossed in advance all the days that she lived in the nursing home, leaving the following days blank. She had the habit of crossing days once they were over, but this time, it was as if she knew in advance the course of the events and that she wouldn’t be there to cross those last days. We sat in her summertime green garden and talked about how painfully beautiful Charlotte’s end-of-life had been.

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