Population ageing is accelerating in Latin America and the Caribbean (LAC). While the region remains younger than OECD countries on average, it is ageing at a faster pace as fertility declines and survival at older ages improves. United Nations projections indicate that the share of people aged 65 and over will rise rapidly across LAC over the coming decades, increasing the old-age dependency ratio and the demand for health and long-term care services. The speed of this demographic transition matters for policy. Countries ageing faster have less time to adapt financing, service delivery and workforce capacity, particularly for long-term care (LTC) and chronic disease management. This makes early investment in age‑friendly health systems and community-based care models critical to prevent avoidable hospital use and unmet care needs as dependency rises (Bloom, Canning and Fink, 2010[1]).
By 2050, the share of people aged 65 and over is projected to almost double in the LAC31 average, rising from 9.3% in 2023 to 18.1% (Figure 9.1, left panel). Even then, LAC will remain younger than the OECD average, where the share is projected to reach 26.4% in 2050 (from 18.5% in 2023). Ageing will be most advanced in Cuba (around 30.2% aged 65+ in 2050), Chile (26.7%) and Costa Rica (25.3%), while Haiti, Guatemala and Bolivia are projected to remain below 10%. In several countries that are still relatively young today (for example Belize and Honduras), the share aged 65+ increases rapidly in proportional terms but remains comparatively low in 2050 because it starts from a small base and fertility remains higher than in the fastest-ageing countries. As women live longer than men, the older population will increasingly be feminised, with implications for income security, care needs and living arrangements (Bilal et al., 2019[2]).
Growth will be even faster at the oldest ages. The share of people aged 80 and over in the LAC31 average is projected to rise from 1.8% in 2023 to 4.9% in 2050 while the OECD average is also set to increase substantially, from 4.9% to 9.6%. (Figure 9.1, right panel). Several countries are projected to see this share at least triple, with some Caribbean countries, such as Antigua and Barbuda, approaching 8% by 2050. This will increase demand for long-term care, complex chronic care in primary care, better care co-ordination, and rehabilitation and reablement services to prevent or delay dependency and support ageing in place (OECD, 2025[3]). However, ageing will vary within countries, often progressing faster in urban areas and potentially widening socio-economic disparities. Strengthening health systems and age-friendly environments can help ensure that longer lives do not necessarily translate into greater dependency (Beard et al., 2016[4]).
In parallel, as the share of older adults increases, the relative size of the working-age population declines – tightening fiscal and workforce constraints during the transition. The ratio of working-age adults to people aged 65 and over in LAC31 is projected to fall from about 7.2 in 2023 to 3.6 in 2050 (Figure 9.2), implying roughly half as many potential workers per older person. In OECD, the same ratio is projected to decrease from 3.6 in 2023 to 2.4 in 2050. The outlook is particularly challenging in Cuba (1.9 in 2050), Chile (2.3), Costa Rica (2.5) and Barbados (2.5), where the scope to finance age‑related spending from a relatively large working-age base will diminish substantially.
Although non-LAC OECD countries are currently at a more advanced stage of population ageing, the speed of the transition in LAC makes early and integrated policy planning especially urgent. Health systems will need to adapt rapidly to evolving population needs, while reforms in pension systems, labour markets and health financing – particularly for long-term care (see section “Long-term care” in this chapter) – will be essential to safeguard financial sustainability (Álvarez, 2020[5]).
