"Successfully" Aging "Alone?": Unequal Global Opportunities and Rising Risks in Family-Based Models of Care Cross-Nationally.

Abstract

Background and objectives: For the first time in human history, older adults will outnumber children and a substantial and growing proportion will live alone and lack one or more nuclear family ties. Such unprecedented shifts require a reevaluation of existing models of "successful aging," particularly in terms of long-term care policies.

Research design and methods: This paper draws on country-level data from multiple publicly available sources (e.g., World Bank, Organization for Economic Cooperation and Development, Our World in Data, and the World Values Survey) to examine cross-national patterns of development, health, demography, resources and policies, and cultural values in low-, middle-, and high-income countries.

Results: Although there exists substantial heterogeneity across countries, country-level patterns illustrate the economic privilege of living alone and the dominance of "successful aging" opportunities in high-income countries. Cultural values about family reflect standard patterns of economic development, yet friendship emerges as a particularly consistent global value. At the country-level, living alone and health are associated with higher-income countries with lower within-country inequality.

Discussion and implications: Aging "alone" is a risk factor in some contexts, yet a marker of privilege in others. Models of "successful aging" are largely unobtainable in lower-income countries or high-inequality countries, and therefore require a thorough incorporation of global realities or final abandonment in favor of more nuanced structural perspectives. Long-term care policies that assume the presence of family will yield increasing risk over time across all global contexts and represent a key vulnerability in the future of healthy aging policy.