Are we ageing less quickly? Are we remaining healthier for longer? In two previous Newsletters I have looked at this issue. In Newsletter # 027 “Life Extends with Good Years” I looked at physical changes. In Newsletter #030 “Join the Dots” at cognitive ability. As part of the Longevity Week I listened to a presentation by Prof. Andrew Scott of the London Business School on this topic. His presentation confirms many of the other findings but adds new insights.
As we grow older we become more frail as we lose our health. Frailty is made up of many different things. It includes mobility. Can we get up from a chair? Pick up something from the floor? Extend our arms or walk 100 yards? It includes our everyday living. Can we shop? Use the telephone and even go to the toilet? It includes our mental state. Are we depressed? Unhappy and not enjoying life? Have we suffered from a chronic disease? A stoke? Diabetes? Dementia? Finally it includes our cognitive ability. Practical things like remembering the date, the day of the week or even the month?
If all these were combined into an index how would it move with age? Probably in some kind of increasing curve. Frailty will build up slowly and then speed up. The question posed by Professor Scott was whether it mattered when you were born. Are people born 70 years ago moving up the same curve as those born fifty years ago? If healthy ageing is real then the answer would be no. Those born later would be on a “better” curve. The onset of frailty would have started at a later age and might grow at a slower rate.
The English Longitudinal Study of Ageing (ELSA)
ELSA is survey based on a sample of the English population over 50. It is a longitudinal survey so the same individuals are surveyed every two years. The results can be looked at within individual, to look for trends. Professor Scott and his co- researcher looked at nine “waves” of the survey between 2002 and 2018. The survey is huge and they were able to track all the dimensions of frailty for over seventeen thousand individuals. This enabled them to extend their analysis. They built a “frailty” index covering five dimensions of ageing. These were: Mobility; Activities of Daily Living ;Depression; Medical Conditions Suffered and Cognitive Ability. All were taken from a self-reported questionnaire. They represent how people felt. How you feel is more likely to affect behaviour.
Healthy Ageing Is Improving for Some of Us in Some Areas.
The overall index shows the pattern we would hope for. The curve of frailty versus age shifts. Depending on when we were born, our frailty at any given age changes. Someone born in 1930 reaches a given frailty level at (say) sixty. Someone born forty years later is on a different curve. They will not reach that frailty level until close to 80. In fact being born one year later leads to roughly 6 months improvement in the onset of frailty. Those forty years would represent a 19.6 year improvement.
In Newsletter #027 the results are very similar. It described data collected from surveys by the UK Office of National Statistics. They asked people about the onset of medical conditions severe enough to restrict their everyday living. In the twenty years between 1997 and 2017 the onset was pushed back 13 years.
The size of the ELSA sample means that they could look separately at the different components within the overall index. They are behaving differently. The “medical conditions suffered” do not seem to have any effect. Even the curves of depression are not moving much. By comparison, the “mobility only” index is shifting about eight to nine months a year. So too are those for "Everyday Activity" and "Cognitive Ability". These are a huge shifts. Lifestyle, diet, environment and medicine are having a massive effect.
Who you are and where you live is known to affect your life expectancy. The large sample meant they could look at the impact of demographics. We already knew that the gap between the most deprived 10% of the UK and the most “prosperous” is nearly a decade of life expectancy. It turns out that this is mirrored in the frailty improvements. The South does better than the North.
The rate of improvement in healthy ageing is highest for those with the most education and wealth. The improvements in frailty over time are 25% higher for those with tertiary education compared to those that left school at 16. Those in the top third of wealth are improving 10% more than those in the bottom third. This means an improvement of seven months a year for the wealthiest. There is little improvement visible in the more deprived groups.
A Cautionary Point.
The improvement in life expectancy over the last century was one on mankind’s greatest achievements. The changes in lifestyle, living environments and medicine combined to create something magical. But we have not been able to continue the rate of improvement. Indeed in some countries we are losing ground. Most notably in the US. Life expectancy there is now declining. It is under the combined attack of alkaloid addiction and obesity.
It appears that the same effect may be taking place with frailty. The rate of improvement in healthy ageing is slowing. Scott analysed the data from the early and later years. The “ moving of the curves” is slowing down. The improvement in healthy ageing is slowing. To fix this, a paradigm shift of Government policy on health will be needed. Governments have to rethink the meaning of a "health service". They must stop thinking of treating people who are already ill. They have to move to prevention.
Beware the stereotypes
We are “getting older” at a very different age to our parents. Our memories of what our parents could do at a given age are a very poor indicator of what we can do at that age. They are a very poor basis on which to build a stereotype of a given age. Even a friend who is only ten years older is on a very different ageing curve. Better not to look for clues but to live the life you want to live. If someone tells you that you are too old to do something, send them this Newsletter!