Fewer hands to help.
In 2010 there were more than seven Americans aged 45 to 64 for every American aged 80 and over. On projections made in 2013, there will be about four by 2030 and fewer than three by 2050.
This year the first baby boomers, born in 1946, turn 80. That birthday matters more than their sixty-fifth did. Researchers at the AARP Public Policy Institute describe 80 and over as “the high-risk years”, the age at which disability stops being the exception. In 2010, 70.5% of Americans aged 80 and over had some kind of disability, against 19.7% of people aged 45 to 54.1
The same researchers asked a simple question: for each person over 80, how many people are there in the usual caregiving years of 45 to 64? In 2010 the answer was more than seven. Their projections, published in 2013, put it at four by 2030 and fewer than three by 2050.1 More people who need a hand getting up, and fewer people to offer one.
Potential family caregivers per person aged 80 and over
People aged 45 to 64 for each American aged 80 and over. 2020 onwards are projections made in 2013.
Source: Redfoot, Feinberg and Houser, AARP Public Policy Institute (2013), Appendix B and text
Peak 65
The wave behind those numbers has already arrived. According to the Census Bureau's latest estimates, the US population aged 65 and older rose by 3.1% in a single year, to 61.2 million in 2024, and grew by 13.0% between 2020 and 2024. Older adults made up 18.0% of the country, up from 12.4% in 2004.2 Over the same four years the number of children fell by 1.7%, and by 2024 older adults outnumbered children in 11 states and in almost 45% of counties.2
The flow is now at its height. The Alliance for Lifetime Income's Retirement Income Institute estimates that more than 4.1 million Americans will turn 65 each year through 2027, a stretch it calls Peak 65, or about 11,200 a day.3
But 65 is not where most people start to need help. The group to watch is the oldest old. The Administration for Community Living projects that Americans aged 85 and older will more than double, from 6.5 million in 2022 to 13.7 million in 2040, while the 65-plus population as a whole reaches about 78.3 million.4 We looked at what makes growing older at home hard for this group in an earlier piece.
The care gap
Between 2010 and 2030, the AARP team projected, the population aged 80 and over would grow by 79%. The population aged 45 to 64, the people most likely to step in, would grow by 1%. In the 2030s the gap keeps widening: the over-80s were projected to grow by a further 44%, the 45 to 64 group by 10%.1
The ratio is a blunt instrument. Not every 50-year-old is a carer, and many carers are spouses in their seventies or grandchildren in their twenties. But it captures something families already feel: the people who would once have been around to help are fewer, and busier.
The same report projected that the share of frail older Americans with no children at all would rise from 14 to 18% between 2010 and 2030, and that 16 states would see their caregiver ratio fall by half or more over those two decades. Yet 68% of Americans said they expected to be able to rely on their families for long-term care.1 What that reliance already costs families, in time, money and health, is the subject of The other patient.
Paid help has to grow too
When family cannot cover it, the alternative is paid care at home, and that workforce would have to grow quickly. Home health and personal care aides held about 4.7 million jobs in the US in 2025. The Bureau of Labor Statistics projects that number to grow by 18% by 2035, much faster than the average for all occupations, with about 760,500 openings a year.5
Many of those openings are not new jobs at all. They come from the need to replace aides who move to other occupations or leave the labour force, in work with a median annual wage of $35,800 in May 2025.5 The bureau's reason for the growth is plain: aides “will be in high demand to care for the rising number of older people”, and long-term care is shifting away from facilities towards homes and communities.5 We set out the size of the wider direct care gap in The biggest market nobody is building for.
Europe is further along
Europe is on the same path, a few steps ahead. Eurostat's latest projections put the EU's old-age dependency ratio, the number of people aged 65 and over relative to those aged 15 to 64, at 34.4% in 2025, rising to 61.9% by 2100. In 2025 there was roughly one older person for every three people of working age. By 2100, Eurostat projects, there may be up to two.6
The steepest part of that climb comes first: Eurostat expects the ratio to rise rapidly until 2050 as the baby boomers and the generations after them retire, then more slowly. The number of Europeans aged 65 and over is projected to grow from 99.0 million at the start of 2025 to 133.8 million in 2100, the only main age group projected to grow considerably while the EU's population as a whole shrinks.6
What fewer hands means
None of this is a forecast about strangers. The Americans who will be 85 in 2040 are 71 today. Their children are now in their forties and fifties. The arithmetic leaves three ways forward: more paid carers, more family time, or more of daily life that older people can manage by themselves.
The first two are already stretched. The third depends on what happens at home: whether someone can get up from a chair, walk to the kitchen and back, and get through a day without needing another person in the room. That is why we work on mobility at home. Whether a powered exoskeleton can help with any of it is a question only studies with older adults can answer.
These figures describe the need. They are not results or claims about Veema.
Sources
- Redfoot, Feinberg and Houser, AARP Public Policy Institute (2013): The Aging of the Baby Boom and the Growing Care Gap (Insight on the Issues 85): caregiver support ratio (people 45 to 64 per person 80+) 6.6 in 1990, 7.2 in 2010, 6.1 in 2020, 4.1 in 2030, 2.9 in 2050; 80+ population +79% vs 45 to 64 +1% (2010 to 2030), +44% vs +10% (2030s); disability 70.5% at 80+ vs 19.7% at 45 to 54 (2010); childless frail older people 14% to 18%; 16 states with declines of 50% or more; 68% expect to rely on family; oldest boomers turn 80 in 2026; "high-risk years of 80-plus".
- US Census Bureau, Vintage 2024 Population Estimates (2025): Population 65+ up 3.1% to 61.2 million in 2024; +13.0% from 2020 to 2024; share 12.4% in 2004 to 18.0% in 2024; children down 1.7% since 2020; older adults outnumber children in 11 states and almost 45% of counties (1,411).
- Alliance for Lifetime Income, Retirement Income Institute, Peak 65 release (2024): More than 4.1 million Americans will turn 65 each year through 2027 (about 11,200 a day).
- Administration for Community Living, 2023 Profile of Older Americans (2024): 85+ population projected to more than double from 6.5 million in 2022 to 13.7 million in 2040; about 78.3 million people 65+ by 2040.
- US Bureau of Labor Statistics, Occupational Outlook Handbook: Home Health and Personal Care Aides (2025 to 2035 projections): About 4.7 million jobs in 2025; projected 18% growth 2025 to 2035, much faster than average; about 760,500 openings a year; many openings from replacing workers who transfer or leave the labour force; median annual wage $35,800 (May 2025); demand quote; shift from facility-based care to homes and communities.
- Eurostat, Population projections in the EU, Statistics Explained (2026): EUROPOP2025: old-age dependency ratio (15 to 64 base) 34.4% in 2025 to 61.9% in 2100; roughly 1 older person per 3 of working age in 2025, up to 2 by 2100; rises rapidly until 2050; 65+ population 99.0 million (start of 2025) to 133.8 million (2100), the only main age group projected to grow considerably as the EU population declines.
