Aging and the Left Behind: Puerto Rico and Its Unconventional Rapid Aging

Abstract

Puerto Rico is aging more rapidly than almost any country, with 2020 estimates placing its population share of adults older than 65 as being the 10 th highest in the world. Unlike most locales, Puerto Rico's aging is driven by both a) the culmination of long-running fertility and mortality trends, and b) high levels of outmigration of working-age adults, which contributes both directly (removal of young people) and indirectly (reduced births) to its pace of population aging. This article offers an overview of the main issues surrounding population aging in Puerto Rico. Policymakers and government leaders must plan for Puerto Rico's unconventional population aging, which will exacerbate traditional concerns about the sustainability of government services and long-term economic prospects. Additional concerns emerge related to reduced social support networks and their impact on caregiving dynamics and implications for health. Puerto Rico's unique history and political relationship with the United States presents challenges and benefits for its aging population. Research on aging in Puerto Rico and public health policies must adapt to the needs of the country's aging society.

How Social Determinants of Health of Individuals Living or Working in U.S. Department of Veterans Affairs Home-Based Long-Term Care Programs in Puerto Rico Influenced Recovery after Hurricane Maria

“…However, the question remains of what to do for those who are older or disabled who do not have strong social support networks, may not have adequate economic capital, and cannot draw on cultural capital. This is especially critical due to Puerto Rico’s rapidly aging population [ 8 ], which will continue to pose challenges as there exists both a lack of LTC infrastructure and a lack of caregivers.…”

“…These populations include older adults and people with disabilities who manage multiple chronic health conditions, many of whom receive home-based long-term care (LTC). The Puerto Rican population is also aging rapidly, with the number of residents aged 65 and older rising from 13% in 2010 to 22% in 2021 [ 7 , 8 , 9 ], leading to increases in demand for such care. Simultaneously, disasters, such as Hurricane Maria, are occurring with more regularity, ferocity, and unpredictability [ 10 , 11 ].…”

“…Social vulnerability and social justice research has also found these populations suffer more when disasters strike [ 13 ]. In recent years, Puerto Rico’s economy has been negatively affected by hundreds of thousands of mostly young people leaving the island amidst dismal fiscal policies implemented by Puerto Rico and the U.S. [ 8 , 14 ]. Economic research [ 15 ] has shown that countries with struggling economies are at a significantly higher risk of climate-related disasters, which can increase the likelihood of social vulnerability factors rising—including increased mortality and morbidity.…”

The neighborhood context and all-cause mortality among older adults in Puerto Rico

“…However, the outmigration of younger Puerto Ricans to the US mainland, has led to a significant reduction in the number of family members available to provide care for older adult family members. Moreover, with increasing numbers of Puerto Ricans migrating in search of economic and educational opportunities, we can expect a higher risk of social isolation and lower social participation among older adults, which may be detrimental to mental and physical health ( 3 ). Thus, we can expect that communities in Puerto Rico with a high proportion of older adults that live alone and have a high proportion of single-parent households may be associated with worse health and an increased risk of mortality.…”

“…The twenty-first century in the Commonwealth of Puerto Rico (hereafter, Puerto Rico)-an unincorporated United States (US) territory-is an era characterized by rapid population aging, reductions in social and economic resources, rampant disparities in access to adequate healthcare, and the ongoing reconstruction of the built environment post-Hurricanes Irma and María (1)(2)(3)(4)(5)(6). The constellation of these factors infers that many older Puerto Rican adults may lack access to resources, services, and contexts considered necessary for promoting healthy aging.…”