Living better for longer

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The decades-long increase in life expectancy we have experienced in the UK and other countries – which until recently increased by an average of five hours per day – can be considered a major success in the field of ageing. However, while people are living longer (improved lifespan), this has not uniformly resulted in living better for longer (improved healthspan). Socio-economic circumstances are also causing a variation of 20 years in healthspan between those from deprived and those from more privileged backgrounds.

Most of our resources and effort have understandably been focused on reducing disease and addressing age-related medical issues. There has been amazing innovation in terms of joint replacements and similar interventions that tackle issues associated with ageing – which are to be celebrated. We have telecare and telehealth technologies to address the risks associated with the increasing numbers experiencing falls and other adverse events. However, these mitigate the risk (or consequences), as opposed to minimising the creation of risk.

But research shows we can impact the rate of functional decline that is associated with increased risks and increased healthcare costs. We can address the wide variation in healthspan which is driven by the choices we can and do make. Why do we not hear that functional ageing can start as early as 42 and yet as late as 100+ depending on the choices we make? We often hear the phrase “what do you expect at your/my age?” oblivious to the evidence demonstrating a negative stereotype of ageing will result in you walking slower along with measurable cognitive decline just two years later.

Healthy ageing

There is an inevitability in losing functional abilities as we get chronologically older. What is not true is that most of these things happen at a specific chronological age. We have known for a long time that there are exceptions to how groups of people age, one example being the ‘Blue Zones’. Dan Buettner, the Blue Zones founder, identified five original blue zones – the places in the world with the healthiest, longest-living populations, including Okinawa, Japan; Sardinia, Italy; Nicoya, Costa Rica; Ikaria, Greece; and Loma Linda, California. 

While trying to create more blue zones is not a bad thing, all populations including the UK can make a significant difference right now by promoting the practical concept of ‘healthy ageing’. The World Health Organization describes healthy ageing as ‘the process of developing and maintaining the functional ability that enables wellbeing in older age. Functional ability is about having the capabilities that enable all people to be and do what they have reason to value.’

As a minimum, this includes what we describe as activities of daily living (daily tasks) – the things we all do regularly – in several cases, multiple times daily. We have also learned that having more better years doesn’t typically lead to a significant increase in life expectancy – providing improved healthspan rather than lifespan. We call this concept the compression of functional decline.The Australian government has been actively promoting this for a couple of years now.

Why are we not hearing the counter argument that it can and must be different if we are not to crush our NHS and Social Care organisations? According to the International Longevity Centre (ILC), If the UK’s target of five extra healthy years by 2035 had been met in 2019, it would be the world’s best performing country on the health span metric. However, the ILC adds: ‘But unless the UK ups its current spend on prevention from 4.8% of the overall health budget to 6%, this is an ambition that feels increasingly unlikely as the target date approaches.”

This is not simply a spending issue, but is exacerbated by the lack of any concerted effort to help people understand their role in how they age. There are a myriad of efforts from a wide range of organisations seeking to impact this – perhaps now is the time to coordinate and leverage this with the message: “We can live better for longer – but for society’s sake we need to encourage all of us to take personal ownership”.

Fitter and healthier

How have I personally responded to this? As part of my research into what people do that makes them age well, I discovered very good evidence showing runners aged extremely well (cyclists too). My family had tried to convince me to run again after giving it up in my teens as I “had bad knees” – but I wasn’t willing to take the drugs I was prescribed. But as the evidence of benefit was so overwhelming, in my late 50s I decided to take part in my local Parkrun, spending the rest of Saturday morning with ice packs on my knees – presumably (according to many around me) just one of those things that come with age.

So, my family packed me off to a good physio with a ‘knee speciality’. Just two weeks later, with muscles rebalanced, I was completing the Parkrun with no ice packs afterwards. I now run around 1,000 miles a year with the right warm up and cool down routine – and no knee pain – even completing my first marathon last year aged X. I’ve never been fitter and enjoy doing all the things I want to do.

There is a difference (if also an overlap) between treating health problems as we get older, and healthy ageing – which avoids many of those problems. Ever heard of the recommended 150 minutes of moderate to vigorous exercise each week? Based on data from high-quality studies involving up to 2.4 million people over 40 years, moderate and high levels of physical activity in the over-65s confers a 50% reduction in the risk of functional limitations or disability. That’s the personal benefit – the societal benefit? Perhaps nearly £4bn of reduced social care costs, and likely at least the same of healthcare costs.

Can we do this? Absolutely. Do most people know what and how? Absolutely not. Clearly public health bodies in local and central government have a responsibility here, but we should all reject the stereotypes, and encourage our media to help promote a positive image of healthy ageing.

Peter Gore is a retired professor of practice in healthy ageing and the CEO of an SME.