Credit, Getty Images
Who will care for the elderly in the future? The question is at the heart of one of the most profound transformations in Brazil's recent history.
In the coming decades, the country will have more and more people living longer, while at the same time registering fewer births, smaller families and an increasingly smaller proportion of workers to support pensions and public services.
Brazil is aging at a speed that today's developed countries took more than a century to experience. And the challenge goes far beyond Social Security: it also involves adapting health systems, cities, care services and the job market itself to an increasingly older population.
This is the diagnosis of economists, population researchers and longevity scholars interviewed by BBC News Brasil.
"Aging is the main demographic characteristic of Brazil in the 21st century", says demographer José Eustáquio Diniz Alves.
"The population aged 60 or over represented less than 10% at the beginning of the 21st century and projections indicate that it should reach 40% by the end of the century. It is a very big change", he says.
For experts, the impacts of this transformation will be felt in practically all areas of society, from public accounts to the job market, from health services to the organization of care for the elderly population.
"We need to start discussing who will take care of the elderly in the coming decades", says doctor Martha Oliveira, former director of the National Supplementary Health Agency (ANS) and current CEO of Grupo Laços, aimed at the 60+ public.
End of Most read
"European countries like the United Kingdom and the Netherlands had more time and money to prepare for this challenge", he points out.
"Soon we will have more than 30% of our population over 60 years old, but without health facilities, sidewalks, transportation or socialization. None of this is ready."
Analysts emphasize, however, that the scenario is not inevitably negative: policies aimed at increasing productivity, inclusion in the job market and taking advantage of the economic potential of the elderly can mitigate the impacts.
The size of the challenge
Data from population projections from the Brazilian Institute of Geography and Statistics (IBGE) show that Brazilians aged 60 or over already represent 15.6% of the population, almost double the 8.7% recorded in 2000.
The forecast is that, in 2070, this share should reach 37.8% of Brazilians, equivalent to around 75 million people, or slightly more than the total number of inhabitants in the United Kingdom today.
The average age of the population, which was 28.3 years in 2000 and reached 35.5 years in 2023, is expected to reach 48.4 years in 2070.
But aging itself is not the most worrying fact, according to experts. The biggest challenge is the falling fertility rate and the shrinking active population.
According to the same IBGE projection, the country's total population is expected to start falling from 2042 onwards, after reaching its peak in 2041.
The average number of children per woman is also falling: it went from 2.32 in 2000 to 1.55 in the 2022 Census, below the population replacement level of approximately 2.1 children per woman.
The IBGE also projects that the rate will reach 1.44 in 2041, before a small recovery in the following years.
To get an idea of what this means, just look at the past: in 1950, Brazil had an average of 6.21 children per woman. For each woman, there are almost 5 fewer children compared to 70 years ago — or a drop of approximately 75% in the fertility rate.
Watch news from Brazil and the world on the BBC World Service
Download here
End of app promotion
This process is not exclusive to Brazil. Around the world, several countries are experiencing similar demographic changes or even at more accelerated and advanced levels.
The global fertility rate, for example, was 2.2 children per woman in 2024, according to the World Bank, compared to approximately 5 in the 1960s.
According to the World Health Organization (WHO), between 2015 and 2050, the proportion of the world population aged 60 and over will almost double, from 12% to 22%.
And the speed of aging is not faster because the demographic transition is at very different stages, depending on the region. Africa still has high fertility, while Europe and parts of Asia face very low levels, for example.
Still, experts draw attention to the speed at which the Brazilian population is aging.
Martha Oliveira observes that one of the best indicators for comparing countries in this regard is the time needed for the population aged 65 and over to double, from 7% to 14% of the total.
A country like Italy, for example, took around 60 years to make this transition. In Brazil, this process should only last 21 years.
"European countries have had more than a century to adapt their health, pension and social assistance systems to population aging. Brazil will only have a few decades to make similar adjustments, in a context of lower average income and deep social inequalities", summarizes Oliveira.
According to her, this requires urgent planning to ensure that increased longevity is accompanied by quality of life and autonomy.
The warning also appears in a report released by Moody's Ratings, one of the largest global credit risk rating agencies, in September.
The document classifies Brazil among the countries that "will have to bear the costs of population aging with income levels much lower than those observed in advanced economies that went through this process before them."
In Moody's assessment, this reduces the time available to adapt pensions, health, labor market and care systems, while increasing pressure on public accounts and economic growth.
Economic impacts
The changing relationship between people who work and people who depend on the State's social protection is at the heart of the economic challenge posed by aging, experts say.
With fewer young people entering the job market and more elderly people living for longer periods after retirement, the number of taxpayers is growing at a slower pace than the number of retirees.
In the pay-as-you-go pension system used in Brazil, contributions from active workers are used to pay the benefits of retirees and pensioners, without the formation of an individual fund for each insured person.
For all these reasons, demographic changes are already worrying the government's economic team.
In projections included in the 2027 Budget Guidelines Law (LDO) project, sent to Congress in April, the government estimates that the aging of the population will cause a significant deterioration in Social Security accounts in the coming decades.
According to official calculations, the deficit of the National Social Security Institute (INSS), currently equivalent to 2.49% of the Gross Domestic Product (GDP, sum of all goods and services produced in the country), is expected to reach 10.41% of GDP by the end of the century. In nominal values, the projection is that the deficit will quadruple, from R$338 billion in 2026 to R$28.44 trillion in 2100.
The projection already takes into account the Social Security reform carried out in 2019, in the first year of former president Jair Bolsonaro's term.
The government estimates that, in 2060, for every person over 60, there will be 1.6 people aged between 16 and 59.
This ratio, says the LDO, is "substantially lower than the current one, which is 4.6, indicating a progressive impairment of the social security support base."
Given these numbers, experts estimate that the Social Security reform approved in 2019 will hardly be the last.
Although it has reduced some of the pressure on public accounts by raising the minimum retirement age and tightening rules for granting benefits, new challenges will emerge in the coming decades.
Credit, Rafa Neddermeyer/Agência Brasil
"Social Security has to adapt to the new demographic dynamics", says José Eustáquio Diniz Alves.
"But a reform cannot disproportionately penalize the poorest population and needs to resolve fiscal issues to allow for an improvement in well-being as a whole, including that of new generations."
The debate also needs to include ways to increase revenue and increase the economy's productivity, the demographer also points out.
"It's not enough to just look at expenses. We also need to think about the country's ability to generate wealth and revenue to support an aging population."
The concern also appears in the Moody's Ratings report, which points out that the pressures of aging begin long before the total population declines.
Therefore, the agency assesses that economic growth in the coming decades will increasingly depend on countries' ability to increase productivity. In other words, produce more with fewer workers.
This involves investments in education, professional training, technological innovation, automation and artificial intelligence. Countries that manage to increase productivity will be able to offset part of the losses resulting from demographic change.
Madhavi Bokil, executive director of Credit Strategy and Standards at Moody's Ratings, also notes that, in the case of Brazil and other developing countries, the challenge is worsened by economic growth that has already been slowing down in recent years.
"The aging of the population exacerbates the challenges of growth and, essentially, reaching the living standards of advanced economies", he states.
"That's really the problem: an aging population impacts growth, fiscal pressures and fiscal flexibility."
Health and society
But the challenge does not stop there, with more obstacles in the field of health and the organization of life in society. That's because living longer doesn't necessarily mean living better, experts say.
Today, more than 80% of Brazilians over 60 years of age depend on the Unified Health System (SUS), according to the Longitudinal Study of the Health of Brazilian Elderly (Elsi-Brazil) carried out by the Oswaldo Cruz Foundation (Fiocruz), in partnership with the Federal University of Minas Gerais (UFMG).
And, according to Martha Oliveira, Brazil still has a healthcare system designed to respond to acute illnesses, when the main challenge of aging is the continuous care of chronic conditions, such as hypertension, diabetes, dementia, osteoporosis and cardiovascular diseases.
"The country still thinks about health in a very reactive way. We need to migrate to a model focused on prevention, maintenance of functionality and autonomy", he states.
The specialist also draws attention to a topic that is rarely discussed: long-term care.
As the number of people over 80 years of age grows, the number of elderly people who need some degree of assistance with daily activities, such as eating, hygiene or mobility, increases.
Today, a large part of assistance to dependent elderly people falls on family members, especially women, in a context of increasingly smaller families and fewer children available to assume this role.
Data from IBGE's Continuous National Household Sample Survey (Pnad Contínua) showed that the number of family members dedicated to caring for individuals aged 60 or over jumped from 3.7 million in 2016 to 5.1 million in 2019. At the same time, the number of people caring for children up to 5 years old decreased.
Another Pnad survey also points out that the demand for paid elderly caregivers has already increased by 15% between 2019 and 2023, reaching around 840,000 professionals three years ago.
According to the General Register of Employed and Unemployed Persons (CAGED), there was a 547% growth between 2012 and 2022 in the formalization of the profession, despite many caregivers still working informally.
Martha Oliveira also highlights that the so-called "aging health" is not just about hospital care or medication, it also involves ensuring a dignified life and citizenship.
"We're talking about a good sidewalk, accessible transportation, dealing with the problem of loneliness among the elderly," says the doctor.
"Aging health policy cannot just be about health as we know it, but an integrated policy, which must involve several government ministries", he summarizes. "But Brazil hasn't stopped doing that yet."
Another challenge is combating ageism, the form of discrimination based on age.
A survey by the Voto 70+ movement, which brought together more than 18 thousand demonstrations from Brazilians aged 70 or over, showed that ageism and the rights of the elderly population appear as the participants' second biggest concern, behind only social inequality.
The survey identified that health, housing, retirement and respect are among the topics most mentioned by interviewees.
"This generation has a lot to say about the future of the country and wants to participate in decisions that affect not only their lives, but also those of future generations", says Cléa Klouri, coordinator of the movement.
How to finance aging?
The increase in social security and health expenses is practically inevitable because it arises from an already contracted demographic reality. But who will pay the bill?
"Aging will happen. The question is how to finance this process", says José Eustáquio Diniz Alves.
One of the alternatives discussed is precisely to carry out pension reforms, gradually raising the retirement age, in line with the increase in life expectancy.
Another option adopted by some countries to face the economic effects of aging is encouraging immigration, which has been growing especially in Europe and Asia.
Moody's Ratings warns, however, that this path may only be temporary.
"Immigration can give countries more time to attract foreign workers, but it cannot reverse population aging on a global scale," says the company's report.
But a front considered fundamental by experts is encouraging older people to remain economically active for longer.
For Cléa Klouri, coordinator of the Voto 70+ movement, the public debate often treats the elderly only as beneficiaries of social policies, ignoring their ability to continue contributing economically and participating in public life.
In her assessment, the country has not yet adapted to the reality of a generation that lives longer, remains active for longer and wants to continue influencing the direction of society.
Today, in Brazil, almost 8.8 million people aged 60 or over continue to work. According to the research and data intelligence institute Nexus, in the last ten years, the number of elderly people in the job market has increased by 53%.
For demographer José Eustáquio Diniz Alves, the traditional and rigid view that the elderly should just retire and "do nothing" is outdated.
"We need to take advantage of the productive potential of the elderly population, who may, for example, be retired from a job, but have another job and continue contributing to Social Security", he says.
However, for the elderly to remain active, Alves highlights that education must be continuous throughout their lives, allowing this population to learn how to deal with new technologies, such as cell phones and artificial intelligence.
"The rigid logic that there is time to study, time to work and time to retire no longer works", he argues.
Credit, Joédson Alves/Agência Brasil
At the same time, aging creates new consumer markets, interviewees point out.
The so-called "longevity economy" encompasses everything from health and care services to tourism, adapted housing, financial products and technologies aimed at the older population.
"Longevity should not just be seen as a problem. It creates important economic opportunities if the country knows how to take advantage of the potential of this population", says Martha Oliveira, CEO of Grupo Laços.
According to Moody's Ratings, sectors such as health services, long-term care, adapted housing and financial products aimed at retirement tend to benefit structurally from the aging of the population.
The agency also points out that the shortage of workers resulting from the drop in fertility could accelerate investments in technology, automation and artificial intelligence.
Countries and companies that successfully adopt these solutions are likely to mitigate part of the workforce loss caused by aging, the report says.
"In this sense, labor shortages are fundamentally a supply-side challenge, and technology represents one of the most effective responses to address it," says the credit rating agency.
'A window of opportunity'
Despite the warnings, experts reject the idea that aging is necessarily a sentence of economic decline.
Countries such as Japan, South Korea and Taiwan faced similar processes and managed to sustain high levels of development through productivity gains, investment in technology and increased population participation in the labor market.
Japan itself is cited by Moody's Ratings as an example of adaptation. The country combined automation, increased female participation in the labor market and extension of working life to mitigate part of the effects of the reduction in the active population.
For Martha Oliveira, former director of ANS, one of the main international lessons is the need to abandon a model excessively centered on hospitals and start investing in prevention and continuous health monitoring.
The expert cites initiatives in countries such as the United Kingdom, the Netherlands and the United States that seek to transfer part of the care to the home environment through remote monitoring, telemedicine and monitoring technologies.
"They are trying to integrate care even more and looking at aging from the beginning, trying to bring technology and the idea of the home as a place of care to the center of the discussion," he said.
In José Eustáquio Diniz Alves' assessment, Brazil still has a "window of opportunity" to act.
According to him, the country can transform longevity into an economic asset if it manages to keep elderly people healthy, productive and integrated into society for longer.
"We have examples today of countries that didn't get rich before getting older, but are getting richer as they get older," he says. "If we adapt to the new reality, there is still time."
What can we expect from the new government?
In a televised speech last Sunday (08/11), President Luiz Inácio Lula da Silva (PT) promised to expand the National Care Policy for the elderly population in his next term.
"The Brazilian population is aging and there is an urgent need to improve public policies so that they are capable of promoting quality of life and dignity for the elderly population," he stated.
The program was established in 2024 to guarantee assistance to people who need help with daily activities and offer more support to families and professionals responsible for their care.
But the model still faces obstacles in getting off the ground, experts say. The adhesion of states and municipalities is voluntary, there are no budgetary resources specifically linked to the policy and there is a lack of services to assist people who need help with daily activities, they point out.
"Aging has been a very rapid change in Brazil, which has not yet been properly considered by either public or private initiatives", says Cléa Klouri, coordinator of the Voto 70+ movement. "Longevity is there, but it is often still overlooked, without any major political project aimed at this public."
According to Klouri, perhaps the big exception are services aimed at the most fragile elderly, such as ILPI (Long-Term Institutions for the Elderly), homes financed by the public system for people aged 60 or over who require long-term care.
“We need to look at more active longevity,” he says.
Credit, Reuters
Na área da Previdência, o governo reeleito do presidente Lula apostou, em seu plano de governo, na manutenção da política de valorização do salário mínimo, que beneficia diretamente aposentados e pensionistas que recebem o piso previdenciário, além de beneficiários do Benefício de Prestação Continuada (BPC).
A proposta, porém, é alvo de críticas de economistas pelo impacto nas contas públicas.
Como aposentadorias, pensões e o BPC vinculados ao piso também acompanham seus reajustes, aumentos acima da inflação elevam as despesas previdenciárias e assistenciais.
Segundo dados publicados pela Folha de S.Paulo, cerca de 70% dos beneficiários do INSS recebem o equivalente ao piso nacional.
"Definitivamente não é sustentável a longo prazo. "Hoje o salário mínimo tem um valor relativo à mediana de salários razoavelmente elevada, de modo que seus efeitos sobre pobreza e desigualdade são limitados, enquanto o efeito sobre as contas públicas é significativo", afirmou Daniel Duque, pesquisador de Economia Aplicada da FGV/IBRE, à BBC Brasil.
Guilherme Klein, professor de Economia da Universidade Federal do Rio de Janeiro (UFRJ) e pesquisador do Centro de Pesquisa em Macroeconomia das Desigualdades (Made) da USP, defende, contudo, que a política de reajustes acima da inflação trouxe inúmeros benefícios sociais e econômicos.
E que o teto de 2,5% para o ganho real do salário mínimo, adotado durante o terceiro mandato de Lula, reduz as preocupações com sua sustentabilidade fiscal.
"Nos anos 2000, grande parte da queda da desigualdade que a gente teve foi por um efeito do aumento do salário mínimo. Então, do ponto de vista social e econômico mesmo, é muito importante", afirma.
Mas ele reconhece que o cenário econômico atual é diferente daquele da metade dos anos 2000 e que é possível discutir mudanças na forma como o piso é vinculado a benefícios previdenciários e assistenciais.
"É possível que a gente, em algum momento, discuta, por exemplo, uma vinculação que não seja 100% entre o salário mínimo e a Previdência, ou o salário mínimo e o BPC. Eu acho que tem outras coisas que são muito mais importantes, talvez, de serem mantidas", afirma Klein, em referência aos pisos constitucionais de saúde e educação, cuja redução também foi sugerida por Flávio Bolsonaro (PL).
O programa com o qual Lula foi reelito no mês passado também prevê melhorar o atendimento do INSS, combater fraudes contra idosos e ampliar oportunidades de qualificação e permanência no mercado de trabalho para pessoas mais velhas.
Na saúde, uma das principais iniciativas anunciadas em 2026 é o Programa de Atenção Domiciliar à Pessoa Idosa (PADI Brasil), que prevê ampliar o atendimento multiprofissional do SUS na casa de idosos com limitações funcionais.
O governo anunciou investimentos de aproximadamente R$ 500 milhões até 2027 para a iniciativa, com o objetivo de facilitar o acesso a cuidados de saúde e reduzir a necessidade de internações e deslocamentos.
Outra frente é a ampliação da rede de assistência e prevenção. O governo propõe fortalecer programas como o Farmácia Popular e ampliar os Centros-Dia e os espaços de convivência para idosos.
*Gráficos por Laís Alegretti, da equipe de jornalismo visual da BBC News Brasil
Descubra mais
Assista
Fim de Assista
