Background
Statistics South Africa (Stats SA) has a mandate to provide statistical information in South Africa and conducts
household surveys, population censuses and use of administrative records to achieve this. With the establishment
of a Health Statistics component within the organisation, Stats SA also provides information on health statistics in
the country. While there is currently no dedicated survey on health issues conducted by Stats SA, the organisation
is able to collect some information through other surveys such as the General Household Survey (GHS) and the
Living Conditions Survey (LCS), as well as through the use of data on deaths from the South African civil
registration system that is processed at Stats SA.
On an annual basis, a theme is selected to produce a thematic health report, based on available data at Stats SA.
This report focuses on the health of older persons in South Africa, highlighting their morbidity and mortality patterns
based on recent information obtained from the 2013 GHS and the 2013 Mortality and causes of death data. It
follows up on two key publications with detailed information on older persons published by Stats SA in 2013: (i)
Social profile of South Africa, 2002–2012 (Report 03-19-00) and (ii) Census 2011: Profile of older persons in South
Africa (Report No. 03-01-60). Both reports used the age range of 60 years and older to define ‘older persons’ and
the same age range is used in this report. This is also in line with the recommendation made by the World Health
Organization (2009).
Globally, the number of older people is expected to rise above the number of children by 2045 (Joubert &
Bradshaw 2006). There are 50 million people who are 60 years and above, accounting for 5% in sub-Saharan
Africa. South Africa is one of the most rapidly ageing countries in Africa and the population is projected to continue
ageing over the next two decades despite the impact of the AIDS epidemic (Joubert & Bradshaw 2006). The 2011
South African population census showed that the number of older persons in the country increased from 2,8 million
in 1996 to 4,1 million in 2011 (7,1% in 1996 to 8,0% in 2011). According to the revised 2013 mid-year population
estimates, the total population of South Africa was 53 157 490 and older persons accounted for 4 394 295 people,
representing 8,3% of the total population in South Africa (Statistics South Africa, 2013). The number of older
persons is expected to continue to increase and it is estimated that there will be approximately 7 million older
persons in South Africa by 2030 (Statistics South Africa, 2013).
This increase in numbers and proportions of older persons has implications for the planning of social and health
services in South Africa (Joubert & Bradshaw 2006). Chronic and degenerative diseases represent a major cause
of morbidity and mortality among older people in both developed and developing countries (Medical Research
Council, 2005). Developing countries are at different stages of the epidemiological transition, which is the change in
causes of death from infectious diseases to chronic diseases (Medical Research Council, 2005). In Africa, deaths
from non-communicable diseases are expected to rise above deaths due to nutritional diseases, maternal and
prenatal diseases combined (International Longevity Centre, 2011). There is a scarcity of information about the
health status and causes of mortality in the older population, as well as use and satisfaction of health services by
older persons (Joubert & Bradshaw 2006).
For the period 2010–2014, the Government of South Africa agreed on 12 key outcomes as the key indicators for its
programme of action. This included a vision of “A long and healthy life for all South Africans”. (Department of
Health, 2011). In addition, the Department of Health identified four outputs against which to be measured and these
included increasing life expectancy and combating HIV and AIDS, and tuberculosis. Information in this report will
play an important role in assisting the Government of South Africa when establishing progress made towards
achieving its vision of “A long and healthy life for all South Africans”, with a specific focus on the needs of older
persons. For many decades, older persons remained a vulnerable group in many societies. International and country
commitments were made to create age-friendly societies that attend to the health and socio-economic needs of
older persons. The commitments are reflected in the recent spell of international guidelines and country-specific
older person legislations and policies. The Madrid Plan calls for the recognition of the contribution of older
persons and the promotion of their rights, and emphasises the role of government in providing and ensuring access
to basic social services (United Nations, 2002).
The rights of older persons are enshrined in the Universal Declaration of Human Rights. According to section 25 of
the Declaration, “everyone has the right to a standard of living adequate for the health and well-being of himself
and of his family, including food, clothing, housing and medical care and necessary social services, and the right to
security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in
circumstances beyond his control” (United Nations, 1948).
The South African older person legislations and policies reflect key guidelines embedded in the Madrid Plan. The
commitment from the government to develop the lives of the older persons is reflected in the establishment of
relevant structures and bodies. The South African Older Persons Policy adopted in 2006 (Act No. 13 of 2006)
provides a framework for providing for the needs of older persons. These include the establishment of the
Directorate of Care and Services within the Department of Social Development. The government recognises that
older persons are indeed a vulnerable group, due to their health and socio-economic circumstances. The
vulnerability of older persons in South Africa is largely determined by pre-1994 policies and inequalities.
The Constitution of the Republic of South Africa, 1996 (Act No. 108 of 1996) declares that every South African
(including older persons) has the right to dignity and to have that dignity respected and protected (Republic of
South Africa, 1996). The Older Persons Act, 2006 (Act No. 13 of 2006) makes provision for fulfilling these rights by
alleviating the difficulty or plight of older persons in South Africa through setting up a framework for their
empowerment and protection. The Older Persons Act promotes and maintains the rights, status, wellbeing, and
safety and security of older persons through maintenance and promotion of the status, wellbeing, safety and
security of older persons, protection of their rights, helping them stay in their homes in the community for as long as
possible, regulate services and residential facilities for older persons, and to combat abuse of older persons.
The Older Persons Act, 2006 stipulates that older persons require social security in the form of an old-age pension
as a support mechanism. It has been noted that old-age pensions play a crucial role in supplementing household
income and in some instances it is the only source of income for some households (Statistics South Africa, 2012).
The National Development Plan 2030 emphasises the importance of the social security systems in an attempt to
redress the high levels of poverty and inequality experienced in South Africa (Statistics South Africa, 2011).
1.2 Objectives of this report
The main purpose of this report is to provide detailed information on the morbidity and mortality profile of older
persons in South Africa. The report draws on secondary data from the GHS and the Mortality and causes of death
data to provide detailed information on the health status of this special group.
This report is part of an annual regular series of thematic health reports produced by Statistics South Africa and the
objectives of this report are as follows:
? To provide information on coverage of medical aid among older persons, their health and disability status
and self-reported illnesses;
? To present patterns on chronic conditions among older persons and the use of medication; and
? To highlight patterns of mortality among older persons focussing on the underlying causes of death.
It is envisaged that this report will be used to inform planning initiatives that are aimed at the improvement of the
geriatric services within the health sector in South Africa. Furthermore, information from this report can be used to
identify challenges faced by older persons in their health needs.
Statistics South Africa 3
Patterns of morbidity and mortality among older persons in South Africa, 2013
1.3 Organisation and presentation of this report
This report is divided into nine chapters: Chapter 1 provides an introduction to the report. The second chapter
outlines the sources of data and methods used to analyse the data. Background characteristics and distribution of
older persons are presented in Chapter 3. The fourth chapter covers information on perceived health status and
healthcare-seeking behaviour focussing on medical aid coverage and consultations with health workers. The fifth
chapter presents information on recent self-reported illnesses. Chronic conditions and use of medication are
discussed in Chapter 6 while issues on disability and use of assistive devices are in Chapter 7. Patterns of mortality
and causes of death are provided in Chapter 8. The last chapter, Chapter 9, presents the summary and concluding
remarks.