When we talk about aging in our society, we often focus on statistics that show the number of people aged 65 and older is growing. However, the group of individuals aged 65 and older is a very large category, and it can look very different depending on demographic factors such as age, as well as medical and functional characteristics. Neglecting this reality and assuming homogeneity or static numerical age within the 65-plus population results in a failure to anticipate and adequately prepare for the future.

Here's an example of an elephant in the room that can be easily overlooked if one assumes that people aged 65 and over are relatively homogeneous. Mrs. "A," an 87-year-old woman with mild cognitive impairment, osteoporosis, hypertension, and chronic kidney disease, arrived at the clinic ahead of her scheduled appointment. Over the past year, her overall physical functioning had been deteriorating, and she faced increasing difficulty leaving her house. This was further complicated by a vertebral compression fracture she had sustained six months prior, which immobilized her for extended periods. Following the loss of her husband, Mrs. "A" lived alone and was no longer able to manage basic household chores as she could a year ago. Consequently, her daughter, who resided nearby, assumed responsibility for most of these tasks. Recognizing the need for additional support, Mrs. "A" applied for long-term care insurance to alleviate the caregiving burden. Subsequently, she visited the doctor's office earlier than scheduled to obtain a medical certificate as part of her application process.

The story of Mrs. "A" illustrates the significance of long-term care insurance in assisting individuals whose overall life functioning declines due to illness and aging. This insurance service offers support by facilitating access to a range of services, including in-home care, daycare centers, or convalescent hospitals, tailored to the level of care required. By aggregating the number of individuals deemed eligible for long-term elder care insurance, we can gain insights into the broader demand for elder care within our society.

When considering the average age at which long-term elder care insurance becomes necessary for Koreans, it is important to acknowledge individual variations. While signs of old age, such as slowed walking and a bent back, tend to emerge around the age of 72, and frailty becomes more pronounced around 77, the specific age at which care needs arise can differ among individuals. By examining the statistics from the National Health Insurance Service's long-term care classification system and the resident population by city and district over the past 13 years, it is evident that the number of individuals authorized for long-term care insurance for the elderly closely aligns with the population aged 85 and over.

Since the introduction of long-term care insurance for the elderly in 2008, there have been many reports that considered the sustainability of the program. However, many of these studies have made conservative (low) projections of the growth in demand for long-term care insurance. Unfortunately, these reports have either incorrectly assumed that the initial age pattern of long-term care utilization will be maintained, or that future national care needs will follow the overall population change of those aged 65 and over. However, while the 65-plus population has grown relatively modestly, the 85-plus population has grown dramatically. These macro changes have driven national care needs to grow faster than experts predicted five or 10 years ago.

If we make policies based on existing reports that failed to take this into account  -- for example, If we don't recognize this huge movement called demographic change, where the number of convalescent hospital admissions is growing at a faster rate than the growth of the population over 65 --, we'll blame the hospitals for creating for-profit demand where there is none. Note that convalescent hospital stays are not covered by long-term care insurance. However, most people, who need to be admitted to a convalescent hospital, have a level of frailty that requires long-term care insurance coverage.

Furthermore, the country has not adequately prepared for the anticipated surge in the oldest-old population over the next 20 years. Since the creation of the cognitive support tier in 2018, the number of people authorized for long-term care insurance has been converging on 110 percent of the 85-year-old population until recently. If we assume that this convergence will be maintained for the foreseeable future, the number of people authorized for long-term care insurance is expected to increase from 950,000 in 2021 (860,000 people aged 85 and over) to 2.97 million in 2041 (2.7 million people aged 85 and over).

It takes 507,000 caregivers and 34,000 social workers to care for 950,000 seniors. If we do the math, we'll need at least 1.5 million caregivers in 2041. But there's one thing this calculation doesn't take into account. The people who will need care in 20 years are baby boomers with one or two children. Today, in their 80s, their children take the lead in providing care, with long-term care insurance in-home services playing a supporting role. The baby boomers of 20 years from now will have fewer or no children to fill that role, so the concept of three to four hours of in-home care per day will likely need to be modified in 20 years, resulting in a much larger number of caregivers.

The burden of this care explosion will be borne by a smaller number of younger generations. Compared to the national pension fund depleting issue, which deals with the relatively slow-growing 65-plus population, the impact of the care burden for older people will be more dramatic. Considering that the working-age population (15-64 years old) is expected to fall from 37 million in 2021 to 27 million in 2041, it is difficult to imagine that the current structure of long-term care services will be maintained in 20 years. Using similar assumptions, an analysis by Professor Kim Yong-ha of Soon Chun Hyang University estimates that the required premium rate for the long-term care insurance system for the elderly, which was 0.68 percent in 2020, will need to increase 9.4 times to 6.4 percent by 2065.

The future demographics of the aging population are here to stay, and there's nothing we can do about it. However, the number "65" has prevented our society from facing the elephant in the room: frailty and care. Once we can see the elephant, we can discuss what we need to do to delay aging, slow the progression of frailty, and prevent lack of care. But for now, we all seem to be comfortably blindfolded.

Jung Hee-won, a geriatric physician at Asan Medical Center, graduated from Seoul National University College of Medicine and trained at Seoul National University Hospital. During his med-school days, while practicing the horn, he realized the importance of muscle maintenance and became interested in sarcopenia. His main research interests include frailty, sarcopenia and establishing age-friendly health systems for acute hospitals. This column was originally published in Chosun Ilbo in Korean on May 24. --Ed.