Are the extra years we have all gained, healthy years? Some argue that there is an increasing period at the end of life of ill health. Others do not see it. Is it all about the measurement and the sample?

Government statistics include both life expectancy and healthy ageing. The World Health Organization defines healthy ageing as

“the process of developing and maintaining the functional ability that enables well-being in older age.”

What is worrying me now is the apparent disagreement over current trends. All agree that we are living longer. They agree the healthcare costs increase because of that expansion. Science learns to treat diseases that were once thought untreatable. They disagree as to whether that “unhealthy” stage at the end of life is increasing or decreasing.

Measuring Healthy Ageing

Governments measure “Healthy Life Expectancy” and “Disability Free Life Expectancy”. These combine measures of life expectancy with assessments of health provided by individuals. They are based on survey data. They measure an individuals’ perception. How do they feel about their health and how that affects their life. This raises a whole set of issues when trying to interpret the data.

An individual’s assessment will depend on the environment in which they live. Living happily in the community in one’s own home may lead to positive measures. Move the same individual to an institution and they may feel differently. Living in an affluent area or a deprived area may change the results.

The Impact of Environment

A recent study in Australia tried to unpick some of the environmental issues. Many published statistics use cross sectional data. The sample draws people of different ages from the population and compares them. Instead, this was a longitudinal study. It followed the same people throughout their lifetime. Perhaps because of this the results were different. They measured the period of “ill health” at the end of life. Was it expanding or compressing over time. Did younger generations live longer? Did their period of ill health increase or decrease.

The results are encouraging. Younger cohorts were living longer. In the vast majority of instances the period of ill health was also decreasing. They had “compression” in most of the demographic subgroups that they looked at and with most measures. They measured things like “activities of daily living”. This is a well know scale and looks at one’s ability to live a normal life or whether ill health was getting in the way.

There were differences amongst groups. Some showed no change in healthspan rather than a decrease. There was a tendency for women to suffer more than men. Those with lower education and living in rented accommodation do benefit less. Environment did impact this group.

One measure showed these trends more. This was related to whether people had chronic illnesses. This may have skewed the results. There is evidence all over the world that chronic illnesses increase as we live longer. However measures of health ageing do not go down. Modern medicine makes it possible to live with them.

Health is Socially Defined

I was on a call with other substackers interested in ageing. They reminded me of the work of Ellen Langer at Harvard. She argues that health is socially defined. In her podcasts she uses two key examples. The first is an old study of 80-year-old men. They were taken to spend a week “living in the past”. In fact in a carefully constructed environment. It mimicked their world when they were young. Their rooms were decorated with 1950’s memorabilia. The television was black and white and showed period programmes. The radio and the music were from the 1950s.

The men were split into two groups. One was asked to use the week to reminisce about their youth. The second were asked to live the experience. To speak in the present tense and talk as if they were back in the period. The researchers took multiple measures of ageing. From cognitive tests to physical grip strength. They even took “before and after” photographs. The results were that both groups got “younger”. The group that lived the experience especially. Their illnesses faded away. Their arthritis was no longer noticed. They stood up straighter. They were more adventurous.

The second example concerned the teams that clean rooms in hotels. They were asked how much exercise they took. Most said “none”. Half of the sample were then “educated”. The parallels with the effort of making up seven rooms a day and going to the gym were explained. The similarity in movements between work and gym exercises were drawn. It was explained that just because they did not go to a gym did not mean that they were not exercising. The results confirmed that health is not a fixed concept. Comparison with a control group showed clearly the impact. Those who understood that their work was exercise lost weight. Their blood pressure dropped. They built muscles. Nothing else changed, they were working no harder. It was all in their mind.

Samples and Measures

We know that people living in deprevation have a shorter life span. It does not matter whether it is in a poor area of a rich country or a poorer country. We know that those people will get chronic diseases at a younger age. It would be expected that their healthspan would be shorter. When talking about healthy ageing we need to understand the sample.

We know that attitude to ageing can influence lifespan. It seems that health can be socially defined. Those same attitudes may reduce the period of ill health at the end of life. What questions we use will have an impact.