Across the nation, birth and fertility rates are down, and they have been falling since the 2008 recession. For decades, they were high enough to maintain a stable population, but they have now fallen below that threshold. On top of that, baby boomers are quickly approaching (or have reached) retirement age.

Data from the Population Division of the U.S. Census Bureau compiled in 2011 indicate that 14.9 percent of Iowa residents are over the age of 65, the seventh highest in the nation. Twenty percent of Iowans are between the ages of 50 and 64. Birthrates in Iowa are also below the national average, putting the state in a more dire position than the rest of the United States.

The Daily Iowan Editorial Board has concluded that the state of Iowa must encourage married couples to have more children, retain younger residents, and incentivize those entering medical professions.

Ingrid Wensel, the executive director of the Heritage Agency, which serves elderly residents in Johnson County among others in eastern Iowa, said the state is not ready to meet the coming demand in health care. Much of her nursing staff, she said, is around age 50, and several facilities are struggling to expand their staff size due to a lack of trained caregivers.

Even though most long-term care is handled in the home, Wensel said, those caring for elderly patients are often spouses who are also fairly old and have their own health problems.

“[The growing elderly population] overburdens the under-resourced long-term care system, and there are not enough facilities to care for them,” she said.

A report from the U.S. Department of Agriculture estimated that it would cost about $300,000 to raise one child from birth to age 17. That’s enough to make even people who like kids think twice about starting a family, especially when one adds debt that young people generally accumulate, such as student loans, credit-card bills, and a multitude of other burdens. It’s no wonder that couples are waiting longer and longer to have children and are therefore having fewer.

A 2012 Pew Research Center report found that immigrants, once a reliable source of population growth, have experienced the greatest decline in birthrates over the past 20 years. The solution cannot continue to be “just import more people.”

The economic consequences of an increasingly elderly population, according to the World Economic and Social Survey, would likely decrease both sustained economic growth and the labor supply for higher-income nations such as the United States. It said massive numbers of immigrants would be necessary to offset a smaller labor force caused by an older population.

The severity is underscored by declining populations as well as a higher concentration of the elderly in rural Iowa. A study by the Department of Agriculture found that more than 700 counties across the nation lost 10 percent or more of their population from 1988 to 2008. The study said this is largely because young people often leave for college, the military, or to see the world. Because most Iowa counties are sparsely populated, this does not bode well for their future.

Gov. Terry Branstad communications director Tim Albrecht said the state is trying to attract and retain young people with more available jobs. In urban areas, where the population is exploding, this seems to be working, but once again, as falling populations indicate, rural Iowa appears to be left behind again.

Not only is rural Iowa in dire need of more young people, the state’s medical facilities are poorly prepared for the coming increase in elderly patients.

The state of Iowa is horribly unprepared for the effects of the falling birthrate and growing number of senior citizens, and it must act soon before the problem spirals out of control.