Older Adults and the Health Transition in Agincourt, Rural South Africa: New Understanding, Growing Complexity

The population living in less developed regions of the world is growing rapidly, with the fastest growth projected for Africa. With declining mortality and fertility, the age structures of developing countries have aged. Subject to the same mortality and fertility declines, the percentage of people over age 50 will continue to rise, with large increases in the numbers of older people (Heligman, Chen, and Babkol, 1993). United Nations projections for South Africa indicate that the percentage of the population over age 60 will more than double from 6 percent in 1999 to 14 percent in 2050, estimates that are lower than those computed for less developed regions as a whole (United Nations, 1999). While mortality levels are projected to decrease, the absolute number of deaths in the less developed regions will increase, with a shift to an older age distribution. As the population structure ages, so the age structure of deaths changes to one in which the greatest proportion of deaths is at the oldest ages. This is due to the fact that a greater proportion of the population has reached older ages as well as the lower probability of dying at younger ages. Such change in population age structure shifts the mortality profile from one dominated by the infectious diseases more common in children, toward one dominated by the noncommunicable diseases that affect older adults and the elderly. Despite the relatively young distribution of African mortality compared with other less developed regions, the number of deaths in Africa has increased more at the older ages; this reflects both