Changing perceptions of health and ageing

A longer life is an incredibly valuable resource. It provides the opportunity for rethinking not just what older age might be, but how our whole lives might unfold.

Yet the extent of the opportunities that arise from increasing longevity will depend heavily on one key factor: health. If people are experiencing these extra years of life in good health, their ability to do the things they value will be little different from that of a younger person. If these added years are dominated by declines in physical and mental capacity, the implications for older people and for society are much more negative.

Unfortunately, although it is often assumed that increasing longevity is being accompanied by an extended period of good health, there is little evidence to suggest that older people today are experiencing better health than their parents did at the same age.

However, poor health does not need to dominate older age. Most of the health problems that confront older people are associated with chronic conditions, particularly noncommunicable diseases. Many of these can be prevented or delayed by engaging in healthy behaviours.

Other health problems can be effectively managed, particularly if they are detected early enough. And even for people with declined capacity, supportive environments can ensure that they live lives of dignity and continued personal growth. Yet, the world is very far from these ideals.

One of the challenges in developing a comprehensive response to population ageing is that many common perceptions and assumptions about older people are based on outdated stereotypes. This limits the way we conceptualise problems, the questions we ask and our capacity to seize innovative opportunities.

After all, what do we currently know about ageing and health?

There is no typical older person

Older populations are characterised by great diversity. For example, some 80-year-olds have levels of physical and mental capacity comparable to those of many 20-year-olds. Policies must be framed in ways that enable as many people as possible to achieve these positive trajectories of ageing. And they must serve to breakdown the many barriers that limit the ongoing social participation and contributions of older people. But many people will experience significant declines in capacity at much younger ages. For example, some people in their 60s may require help from others to undertake even basic activities. A comprehensive public-health response to population ageing must address their needs too.

Although some of the diversity seen in older age reflects our genetic inheritance, most arises from the physical and social environments we inhabit. These include our home, neighbourhood and community, and these can affect health directly, or through barriers or incentives that influence our opportunities, decisions and behaviour.

But the relationship we have with our environments varies according to many personal characteristics, including the family we were born into, our sex and our ethnicity. The influences of environments are often fundamentally skewed by these characteristics, leading to inequalities in health, and where these are unfair and avoidable, to health inequities. Indeed, a significant proportion of the vast diversity of capacity and circumstance that we see in older age is likely to be underpinned by the cumulative impact of these health inequities across the life course.

Older age does not imply dependence

Although there is no typical older person, society often views older people in stereotypical ways that can lead to discrimination against individuals or groups simply on the basis of their age. This has been labelled ageism, and this may now be an even more pervasive form of discrimination than sexism or racism. One widespread ageist stereotype of older people is that they are dependent or a burden.

Age-based assumptions of dependence ignore the many contributions that older people make to the economy. For example, research in the United Kingdom in 2011 estimated that, after setting the costs of pensions, welfare and healthcare against contributions made through taxation, consumer spending and other economically valuable activities, older people made a net contribution to society of nearly £40 billion, which will rise to £77 billion by 2030.

Population ageing will increase healthcare costs – but not by as much as expected

Another commonly held assumption is that the growing needs of ageing populations will lead to unsustainable increases in healthcare costs. In reality, the picture is far less clear.

Although older age is generally associated with increased health-related needs, the association with both healthcare utilisation and expenditure is variable.

Indeed, no matter how old we are, the period of life associated with the greatest healthcare costs is the last year or two of life. But this relationship, too, varies significantly among countries. For example, around 10% of all healthcare expenditures in Australia and the Netherlands and around 22% in the United States of America are incurred in caring for people during their last year of life. The increased costs associated with the last years of life also appear to be lower in the oldest age groups compared to the younger age groups.

Guided by this evidence, the overarching message is optimistic: with the right policies and services in place, population ageing can be viewed as a rich new opportunity for both individuals and societies.

Happy new year and good health for all Algarve Resident readers from the Hospital Particular do Algarve Health Group.