From his wheelchair, Alberto Delgado Londoño can see over the wall of the sunlit courtyard towards the mountains east of Bogotá, Colombia’s capital. The 74-year-old lives in a care home for destitute elderly people, which opened at the end of last year. Social workers found him in hospital, where he was being treated for throat cancer and a head injury that left him partly paralysed.
To reach this vulnerable group, Bogotá unveiled a plan last year to integrate its social care and health systems. This means overhauling healthcare, social care and employment, requiring “a totally different city”, he says. The capital’s population peaked this year at about 7.9 million; it is forecast to start shrinking from 2027.
Nearly 16% of its residents are aged over 60, with the number projected to reach nearly 20% by 2035, according to Bogotá’s Health Observatory. Meanwhile, the old-age dependency ratio across Colombia is projected to double from 20.6% in 2025 to 42% by 2070, according to modelling by the country’s central bank. That means fewer taxpayers to foot the bill for public pensions and support a healthcare system already under strain from a national funding crisis.
As people live longer and birthrates fall, the UN’s Economic Commission for Latin America and the Caribbean (Eclac) notes that “the ageing process in the region is occurring faster than in other regions of the world”. By 2050, the UN projects that nearly one in five people will be over the age of 65, up from one in 11 in 2020. Bogotá is not yet the oldest city in the region, but the sudden slump in its birthrate suggests it could soon match other South American capitals, such as Buenos Aires, Santiago and Montevideo.
Bogotá’s total fertility rate – the average number of children a woman is likely to have over her lifetime – is lower than Tokyo’s, at 0.82 in 2025. Nationally, the rate has also fallen sharply – down to 1.6 children for every woman in 2024, from 6.7 in 1960. It is far below the replacement rate of 2.1 required to maintain a stable population.
Nursery enrolment in Bogotá fell by 13% between 2019 and 2023, the steepest drop in the country, and 287 schools, mostly private, closed in the capital between 2019 and 2024. Increased longevity means more people enduring unhealthy and lonely lives, he says. At the heart of this attempt to rethink ageing is San Juan de Dios, a 100-year-old hospital complex in Bogotá’s historic centre, close to Colombia’s leading institutes for oncology, dermatology and neonatal care.
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