The age of healthy ageing

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CBAsmall 8Photo: Peter Kindersley/Centre for Ageing Better

It is a common assumption that ageing is controlled by the genes we inherit from our forefathers. Far from it. Geriatricians now estimate that, up to the age of 80 years, genes control only 20-30% of our ageing. It is how we have lived our lives that accounts for the rest.

This relatively recent knowledge has stimulated a massive expansion of research on healthy ageing. Diet, physical activity, social engagement and a host of other modifiable factors have been found to play a deciding role in what kind of old age we will have. Academic research is accompanied by shelves of popular books written by geriatricians, journalists and older writers. One of the key lessons of this literature is that it’s never too old to adopt a healthy lifestyle; and it’s never too young to start.

Critics of this school of thought argue that the emphasis on “ageing well” places too much responsibility on the individual: “ageing badly” means not only that you are suffering, but that it is your own fault. They also argue that it is potentially discriminatory against old-old people who may need support and social care. At the macro-level these ideas provide a good defence for the neoliberal state’s demolition of social welfare. In its extreme, the healthy ageing movement may seem unrealistic, in its blithe assumption that “we can all live into the future unbounded by old age”.

Age activist Ashton Applewhite points out that most of us will age into impairment, developing health conditions and frailties as we go along. Ageing well, she argues, means adapting to chronic illness and disability.

Notwithstanding these arguments, it is clear that interventions to improve the end years of life—to extend healthspan rather than lifespan – are both effective and increasingly important for individuals and society. For these to work at sufficient scale we need to lobby for, and build towards the kinds of societies that support healthy living for both the young and the old.

Photo: Centre for Ageing Better

If age is subjective, and ageing subject to lifestyle interventions, are there any limits to a human lifespan?

Medical advances and healthier lifestyles have seen the global number of centenarians increasing annually, with the oldest known person living to 122 years of age. However, most biogerontologsts agree that a human life is finite, and predict that the maximum human lifespan will be about 150 years.
The inevitability of ageing is driven by biological processes, many at cellular level. Mechanisms identified include DNA damage, accumulation of toxins and dead cells, changes in the gut microbiome and inflammation due to declining immune systems, to name a few.

In recent years there has been much progress in biological measures of ageing. Since 2011 epigenetic clocks have been developed to measure biological ageing using blood and tissue samples. When comparing this data with chronological age it is possible to predict life expectancy.

Much research is now devoted to understanding the influence of environmental factors on epigenetic clocks. Illness, unhealthy habits (smoking, alcohol), stress, abuse and mental health issues all show up in our epigenetic clock.

Understanding these processes may provide strategies to intervene in the ageing process. Some gerontologists believe that sooner or later there will be treatment, if not a cure, for ageing itself. Drugs such as metformin, rapamycin and resveratrol are currently being tested on animals with promising results. A growing number of Americans are already paying to have their bodies and/or brains cryonically preserved until such a cure is found.

As far as I can see, the prospect of a future with an infinitely growing human population is the stuff of science fiction. The real challenge of ageing on a personal and societal level is to compress the number of unhealthy years that come to the majority of us towards the end of life.
wordcloudFear of death aside, perhaps it is the low status and shabby treatment of older people that is feeding this longing for eternal life. Even in liberal societies, ageism is the last bastion of prejudice and permeates public discourse. Ageist expressions pass unnoticed in ordinary conversation—have you ever heard of a “sprightly teenager” or a “spry stockbroker”?  Phrases like “the silver Tsunami” and “the grey new world” headline stories on the demographic shift towards an older population, which is seen as a threat.

Ageism and agevists
The World Health Organization (WHO) describes ageism as the practice of categorising and dividing people “in ways that lead to harm, disadvantage and injustice and erode solidarity across generations.” It refers to the systematic discrimination against people just because they are older. WHO estimates that one in two people across the globe are ageist towards older people.

Ageism can take the form of actions, language, attitudes and unconscious bias and operates on three levels: institutional ageism, interpersonal and internalised ageism, all of which are harmful both to individuals and society.
Institutional ageism refers to ageism embedded in laws, rules, social norms, policies and practices. Examples here are discriminatory employment practices or unequal access to health care. A UK survey of over 50s found that 44% had experienced discrimination at work and the same percentage said they had experienced barriers to getting a new job.
Interpersonal ageism plays out in interactions between individuals and is very much shaped by wider social discourse. The Centre for Ageing Better analysed the language used across government and a range of nongovernmental organisations when addressing age, ageing and demographic change. They concluded that negative stereotypes and framing is pervasive across all sectors in the UK. These are often contradictory:

“We are at times invited to pity older people because of a misperception that older age groups are inherently physically and mentally less able than younger people, but at other times we are encouraged to be angry that older people enjoy greater political power, accumulated wealth and an apparently unfair share of public resources. The ultimate consequence of such negative and divisive framing is a society in which later life is seen as something to fear or dread, and older people are seen as a burden.”

Internalised or self-directed ageism is possibly the most damaging of all. When people internalise ageist messages, they modify their own thinking and behaviour, which limits their engagement in the world.  Negative thoughts about one’s own age can go very deep. A recent review of 13 studies concluded that the experience of ageism also has a negative effect on psychological well-being. This includes depression, stress and anxiety as well as reduced life satisfaction. As we have already seen, negative perceptions of age affect physical health and may accelerate the ageing process itself.

CBAsmall 2Photo: Centre for Ageing Better

Across the globe, older people are actively campaigning against ageism. "Ageivism" refers to an ideology that calls for social change and action on the protection and promotion of the rights of older. A new movement is on the rise, with organisations working together for a more age-friendly societies.

What is an age-friendly society? One with decent housing, healthcare and social support: a society where institutional ageism is banned, and a supportive public discourse promoted. In other words, an age-friendly society is one that is good for all age groups.

However, older people need additional support to live their best possible lives. Age UK describes age-friendly societies as places where is age not a barrier to living well and where the environment, activities and services specifically support older people. Ideally local people are engaged in deciding the priorities of these strategies.

In 2010 the WHO developed a framework for age-friendly cities that includes eight domains: healthcare; transport; housing; social participation; outdoor spaces and buildings; respect and social inclusion; civil participation and employment; and communication and information. A global network of like-minded cities and communities have committed to becoming more age-friendly and to facilitate the exchange of information, resources and best practices. Currently it includes 1,445 cities in 51 countries, covering 300 million people.

In 2010, Manchester was the first UK city to sign up to the framework, and by 2019 there were 34 age friendly communities across the UK. The approach reviews all policies and services and promotes age-friendly strategies. For example, campaigns have encouraged local businesses to provide seats for anyone who might need them, and local authorities to provide more public toilets. The engagement of older people is critical. For example, the London borough of Hackney has developed an Ageing Well strategy with the participation of older residents. As part of this initiative, the Hackney Older Citizens Committee has also been actively involved in raising the profile of older people and working with the council to make services more age friendly.

England has no overall strategy to prepare for the complex social and policy changes needed for its growing older population. A group of more than 70 campaigning organisations are calling for an Older People and Ageing Commissioner. This person will act as an independent champion for older people and ensure that policymaking across government considers the long-term needs of the ageing population. Wales and Ireland already have such commissioners who are active in protecting the rights of older people.

Other countries with growing older populations are leading the way with age-friendly policies. For example, Singapore has invested three billion Singapore dollars on a national plan that includes initiatives such as employment, education opportunities and healthcare. The Japanese government has established an insurance scheme that guarantees long term care. It pays for care plans that offer the elderly a choice of different care models, such as assisted-care facilities, home care and assistance with grocery shopping etc. Japan is also investing in new technologies, such as robots and other mechanical care aids as well as innovative research into regenerative and cell therapies.

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