With population ageing occurring in many countries, are rises in life expectancy resulting in increases in good quality years of life?
This is the million dollar question but it is hard to give a definite answer. Most data on trends in life and healthy life expectancy use surveys that do not include people in care homes which can skew results at older ages. Our study did include these but the answer isn’t clear cut because it depends on how you measure ‘quality’ or ‘health’.
What factors did you used to determine whether years lived were classed as “healthy”?
We used three basic measures of health: cognitive impairment as defined by the Mini-Mental State Examination score, disability defined by difficulty with daily activities, and self-rated health.
How was severe disability defined and differentiated from disability?
Our measure allowed us to separate people who had difficulty with what we call instrumental activities of daily living such as shopping or doing the laundry, from basic personal care activities like dressing or bathing or getting in and out of a chair or bed.
The basic personal care activities are lost later than the instrumental activities and so we define severe disability if a person has difficulty or cannot do the personal care activities.
Were you surprised by your research findings?
I was not too surprised at the findings that we are living fewer years with cognitive impairment as we had already shown that the prevalence of dementia had reduced over the twenty years.
However I was surprised at the magnitude of the increase in years spent with disability at age 65, an increase of 2.5 years with mild disability and just over half a year with severe disability for women.
How did the UK findings compare to other countries across Europe?
It is difficult to compare because of the different ways health and disability are defined. Similar trends to ours for self-rated health have been seen in Belgium and Denmark and expansion of mild disability has been seen in Spain and France.
Is better medical management likely to have contributed to the increases in years lived healthily?
Better vascular control has probably contributed to the reduction in years with cognitive impairment but increases in education levels have contributed as well.
Establishing whether better medical management has contributed to changes in self rated health are tricky because this type of question (‘Would you say that for someone your age your health in general is- excellent, good, fair or poor?’) is affected by changing expectations of health.
What improvements do you think should be made by policy makers to improve healthy ageing?
We need to understand the reasons for the increase in mild disability which we couldn’t do in the type of analysis we did for this paper.
It might well be linked to increases in obesity and so the messages about better diets and keeping physically active should be maintained. But we also need to understand why some people don’t take up these messages and how we can help older people maintain independence for longer.
In some European countries you see older people strolling around in the evenings, in Tokyo I’ve seen some very old couples exercising by walking around their neighbourhood and in China its common to see older people in groups doing Tai Chi.
So some of the exercising for health I think is cultural. But perhaps we need safer streets and parks in some places and maybe community champions who can advise and encourage better lifestyles.
What do you think the future holds for the field of ageing research?
Well it will obviously continue to be a growth area! Given that the very old, those aged 85 and over, are the fastest growing section of our population, we need to understand better how to optimally treat them.
Very old people rarely get into clinical trials and so we don’t know fully how many drugs work in this age group or how they interact with other drugs, as many of this age group will be taking multiple medicines.
Another thing we need to be aware of is that cohorts differ in their lifetime experiences – those turning 65 now have had the benefit of the NHS all their lives as well as better education and job chances than their parents and less sedentary lifestyles than their children. All of these factors affect how we age and how we cope with the ageing process.
Where can readers find more information?
Our full paper is available online.
I have recently undertaken a review of trends in life and health expectancy for the Government Office for Science Foresight Ageing project.
About Professor Carol Jagger
Carol Jagger is the AXA Professor of Epidemiology of Ageing at the Institute of Health and Society, Newcastle University and Deputy Director of the Newcastle University Institute for Ageing.
She has worked in the field of ageing for about 30 years, is the leading UK researcher on healthy life expectancy and is currently a Chartered Scientist, Honorary Fellow of the Institute and Faculty of Actuaries and a Fellow of the Gerontological Society of America.