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Sheffield University’s Professor of Social Policy and Social Gerontology challenges the assumption that population ageing inevitably means ever increasing health and social care costs, and argues for a radical new approach to tackle ageing and chronic disease throughout our lives so we can live healthier as well as longer:
The recent ONS announcement that centenarians are now the fastest growing age group in the UK evoked predictable headlines about the ‘burden’ of old age.
It is time to call a halt to collective hand-wringing about the growing numbers of older people and the false assumption that this inevitably means ever increasing health and social care costs. Instead we need urgently to bring into focus the ageing process itself, which is life long and not confined only to old age.
This radical shift in emphasis should prompt conversations about how the chronic conditions associated with later life, the principal drivers of demand for health and social care, can be prevented or, at least, postponed. In place of demographic despair this new approach offers the potential for savings for reinvestment and, more importantly, substantial improvements in well-being and quality of life for millions of people.
The conclusion of the wealth of recent scientific research is that, while ageing is inevitable, it is also malleable. In other words, the precise course that ageing takes is not predetermined but rather subject to a variety of influences. Not only is there no ‘ageing gene’ which governs how we age but genetics play only a minor role.
How we age, or even if we reach old age, are importantly shaped by the social, political and economic environments into which we are born and within which we develop and live our lives.
Poor housing, lack of access to clean air and green spaces, precarious and stressful employment, limited availability of fresh food, and the over-supply of health-damaging substances including alcohol, tobacco and high calorific foods are well-known risk factors for the main chronic conditions that are associated overwhelmingly with older age – coronary heart disease (CHD), stroke, diabetes, cancer – which either result in premature death or disability requiring long-term care.
These poor living conditions can result in exposure to pathogens and stressful events, deprivation of positive social connections and health-damaging practices, all of which increase the risk of chronic conditions in later life and the resulting functional limitations.
Tobacco use, poor diets, lack of physical exercise and excess alcohol consumption are all associated with the main causes of functional limitations in later life – adult obesity and smoking are the two biggest global drivers of chronic conditions and premature death. Inactivity results in a loss of fitness – strength, stamina, suppleness and skill. Variable exposure to these potentially avoidable risk factors helps to explain the UK’s large inequalities in life expectancy and healthy life expectancy – where two people of the same age may have sharply contrasting capabilities and resulting life qualities.
Research on frailty in later life found that older people (65+) who were wealthy and lived in affluent neighbourhoods had half the amount of frailty compared with those who were poor and living in deprived neighbourhoods. At the other end of the life course Public Health England figures show 11.7 per cent of children aged 11 were obese last year among the richest 5 per cent but, among the poorest 5 per cent, 26 percent were obese.
The prioritisation of ageing requires a longer term strategic approach. Our favoured term for this strategy is ‘active ageing’ but the title is far less important than the substance. The two essential ingredients are: a life course focus and an explicit intention to prevent both chronic conditions and their grossly unequal distribution. In practice this strategy would entail specific actions at different stages of the life course to promote knowledge about ageing and the actions that can ensure increases in healthy life expectancy.
A life course orientation to the promotion of healthy life expectancy would entail specific measures geared to its different stages, including childhood, working and later life. Also, because of the very wide inequalities in health expectancies we will need to disproportionately invest in approaches that effectively address the needs of deprived areas and groups, including culturally sensitive interventions for people of black and minority ethnic origin.
One measure that transcends all age groups is the promotion of physical exercise: the evidence on its beneficial effects in preventing chronic physical and mental conditions is now so robust that a large scale national programme is warranted.
Exercise improves fitness and, with it, functional ability and resilience. Even small amounts of regular physical activity have a positive health effect. Moreover improved fitness has a beneficial impact on cognitive ability, not only in midlife but into old age as well. Indeed exercise may reverse a decline in functional capacity and fitness that has already occurred and, therefore, be of benefit to those who already have chronic conditions and even those with multiple conditions.
The striking characteristic of these active ageing measures is the combination of big potential impact and low cost. Ageing is malleable, chronic conditions can be prevented. Health and social policy makers have a responsibility to try harder.