From his wheelchair, Alberto Delgado Londoño gazes over the wall of a sunny courtyard, taking in the mountains that lie to the east of Bogotá, Colombia’s capital. At 74 years old, he resides in a newly established care facility for impoverished elderly individuals, which opened its doors at the end of last year.
Delgado Londoño was discovered by social workers while he was hospitalized, undergoing treatment for throat cancer and a head injury that resulted in partial paralysis. “I had nowhere else to go,” he explains. “My daughter is a single mother with two children and couldn’t accommodate me.”
He represents an increasing population of elderly residents in Bogotá who find themselves without support in their later years—approximately 1,100 seniors in the city are currently homeless, lacking familial assistance. In response to this vulnerable demographic, Bogotá launched a plan last year aimed at integrating its social services and healthcare systems.
“We must cultivate a society that prioritizes the care of its elderly,” asserts Gerson Bermont Galavis, the city’s health secretary. This initiative necessitates a transformation of the healthcare, social services, and employment sectors, which he believes calls for “a fundamentally different city.”
The population of Bogotá reached a peak of around 7.9 million this year, with projections indicating a decline beginning in 2027. Nearly 16% of its inhabitants are over the age of 60, a figure expected to rise to almost 20% by 2035, as reported by Bogotá’s Health Observatory.
Simultaneously, the old-age dependency ratio in Colombia is anticipated to double, increasing from 20.6% in 2025 to 42% by 2070, according to analyses from the nation’s central bank. This shift implies a diminishing number of taxpayers available to finance public pensions and support a healthcare system already burdened by a funding crisis.
As life expectancy increases and birth rates decline, the UN’s Economic Commission for Latin America and the Caribbean (ECLAC) highlights that “the aging process in the region is advancing more rapidly than in other parts of the world.” By 2050, the UN estimates that nearly 20% of the population will be over 65, compared to one in 11 in 2020. While Bogotá has not yet become the oldest city in the region, its abrupt drop in birth rates indicates it may soon find itself on par with other South American capitals such as Buenos Aires, Santiago, and Montevideo.
With a total fertility rate projected to be lower than that of Tokyo—at just 0.82 in 2025—Colombia’s national fertility rate has also seen a significant decline, plummeting to 1.6 children per woman in 2024 from 6.7 in 1960. This rate is far below the 2.1 required for population stability.
Juliana Jaramillo, an economist specializing in demographics at Colombia’s central bank, observes, “Parks are filled with dogs, with hardly any children in sight.” She adds, “However, it is quite challenging for a government to lower the costs associated with raising children. Instead of attempting to reverse this trend, adjustments must be made to accommodate the new reality.”
In light of these demographic shifts, the city is already adapting. Enrollment in nurseries across Bogotá fell by 13% from 2019 to 2023, marking the most significant decline in the country, and 287 schools, primarily private institutions, closed in the capital between 2019 and 2024.
“We are witnessing a city that is aging rapidly, and our response has been insufficient,” states Dr. Manuel González, who is instrumental in shaping Bogotá’s health policies. He notes that longer life spans often lead to unhealthy and isolated experiences for many individuals, highlighting that “we are spending a decade of our lives in poor health.”
While boosting birth rates presents challenges, the city is concentrating on enhancing “healthy life” expectancy and shifting public perceptions regarding aging.
A key element of this reimagining is San Juan de Dios, a century-old hospital complex located in Bogotá’s historic center, near the country’s top institutions for oncology, dermatology, and neonatal care. Although it closed in 2001 due to financial issues, the constitutional court later recognized it as a national heritage site, mandating the restoration of its 24 buildings. Currently, renovations are underway for eleven of them.
The 16-hectare (40-acre) site will feature facilities for youth and mental health, as well as residential care for older adults, health and research institutions, rewilded gardens, and a cultural center, with restoration costs estimated at approximately 4 trillion pesos (£940 million).
“This is envisioned as a miniature city,” explains González, “but the operational model from a century ago no longer meets our needs.”
He believes that San Juan de Dios should serve as an intergenerational healthcare model, catering to individuals from birth through old age. In March, a new Centre for Thought and Innovation on Ageing was inaugurated in the complex’s former laundry, aimed at advising Bogotá and the surrounding area on preventive care, chronic illness management, and disability support. A training center is also available for caregivers to acquire essential skills, such as catheter management and patient transfers.
Paola Camelo Urrego from the University of the Andes remarks, “In Latin American countries like Colombia, caregiving has traditionally been a household responsibility, predominantly undertaken by women.” In Bogotá, women spend nearly five hours daily on unpaid caregiving, and multigenerational households are becoming less frequent, resulting in fewer family members available to assist with dependents.
In 2020, Bogotá’s former mayor Claudia López established “care blocks” where caregivers can temporarily leave a child or elderly family member. This network of 20 community centers also promotes healthier, more independent living. For instance, in one center, a lively group of seniors over 65 learns to navigate WhatsApp, followed by lessons in English or motorcycle repair.
These centers have helped elevate the status of caregivers, according to Camelo Urrego, though they have not altered the distribution of caregiving responsibilities. “Women return home to find that nothing has changed,” she concludes.
