The worst bit of old age is not being extended. It’s being delayed.

Elderly woman in kitchen

You’ve heard it a million times: in developed nations, populations are ageing.

But what does that mean? At the extremes, it could mean either of two quite different things. It could mean a host of frail elderly people stuck in nursing homes for 20 years, or it could mean a bunch of 80-year-olds who act like the 60-year-olds of years gone by – getting on, but essentially still vital and functioning.

The nursing-home alternative is, I suspect, the option that most people think about when they hear of “our ageing population”.

The good news is that the 80-is-the-new-60 alternative seems to be the way things are actually heading. As life expectancy rose in the US up to 2008, researchers saw a reduction in “end-of-life morbidity”. This is that lousy period at the end of many people’s lives where they find themselves unable to take care of themselves, do their normal daily tasks like cleaning up the kitchen, and generally stay independent.

This cheery phenomenon, called “compression of morbidity”, has only been established in the past few years, because data on healthy life expectancy has been hard to get. And it hasn’t really yet impacted the public discussion on population ageing.

But eventually it will.

At a public policy level, it gives support to the Rudd Government’s 2009 decision to raise the pension age to 67 by 2023, and probably also to the Coalition’s unimplemented plan to raise it to 70 by 2035 (Australian pension age summary here). It will also start impacting estimates of things like the amount of nursing home care and other support that our elderly will need over the next 50 years.

Meanwhile, at a personal level … well, if you currently plan to be old someday, this should make you very happy indeed.

In the US, two-thirds of the compression of morbidity has been driven by two big changes. Firstly, more people have been surviving heart disease in good shape. This matters, because cardiovascular conditions are one factor in whether you are able to stay healthy and independent in old age. (Two other factors are arthritis and dementia.) Second – and this was new to me – treatment of vision problems is getting better.

I lay this out in more detail in my latest column for The CEO Magazine. But if you want details of how this is playing out in the US, try Understanding the Improvement in Disability Free Life Expectancy In the U.S. Elderly Population. Its main point:

[H]ealthy life increased measurably in the US between 1992 and 2008. Years of healthy life expectancy at age 65 increased by 1.8 years over that time period, while disabled life expectancy fell by 0.5 years.

This and other CEO Magazine columns are here; follow me on Twitter @shorewalker1.

About David Walker

David Walker runs publishing consultancy Shorewalker DMS (shorewalker.net) and is commissioning editor of Acuity magazine. David has previously edited the award-winning INTHEBLACK business magazine, been chief operating officer of online publisher WorkDay Media, held policy and communications roles at the Committee for Economic Development of Australia and the Business Council of Australia, and run the website for online finance start-up eChoice. He has written professionally on economics, business and public policy since 1987 and spent three years in the Canberra Press Gallery for News Limited and The Age.
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15 Responses to The worst bit of old age is not being extended. It’s being delayed.

  1. Moz of Yarramulla says:

    I think it’s awesome news. I hope to enjoy another, longer, active retirement in a few years time (I semi-retired for much of my 30’s). Different interests now, but still way more “hobby” activities than I can fit in around work and other necessity-of-life stuff.

    My parents are currently doing their “70 is the new 50, oh but we’re retired” thing, wandering round drinking, golfing and obsessing over grandchildren. On that note, grandchildren still seem to arrive about the time people retire. Interesting how the life expectancy changes seem to be matched by child-bearing age changes.

    Hopefully by the time I get into the “compressed morbidity” stage there will be more options available than there are now.

    The big change I’ve seen is my parents attitude towards torturing people rather than death. Being around their parents as they made the transition from independent to dead seems to have made a real impact on how they feel about that process, in a way that they can’t intellectualise despite being seemingly thoughtful people. I’m somewhat surprised (pleasantly!) that after having many arguments and eventually feeling forced into effectively divorcing them (via signing an enduring power of attorney to a friend) because my parents were adamant that if I was seriously injured they would do everything in their power to make my pain as intense as possible for as long as possible.

    Especially for my mother, watching her mother go through cycles of near-death from gangrene, bits chopped off, perk up, more gangrene… after a few rounds it became clear that she wasn’t having any fun. But for some reason my mother was extremely cautious about letting me near her mother during that period. I think she knew what her mother had asked me to do. But a few years later she seems to have decided that she wants that option for herself. Yes, actually, she is a boomer. What made you think that?

    I devoutly hope never to be forced into that position myself (the prolonged agony one, I have no problem helping people die any more than I have helping them live. It’s about consent and the right to self-determination).

  2. derrida derider says:

    All true for the US. But the US really is different – its life expectancy at old age has not risen as fast as others’, for example, and it has long poured massive resources into medical interventions for the last year of life (driven by the economics of its peculiar healthcare system, and at the expense of care in earlier years). Australian and European evidence of morbidity compression is much more equivocal.

    Still, it is good to point out that alarmist predictions of the effects of population aging implicitly assume morbidity expansion – and there is even less evidence of that anywhere.

    • David Walker says:

      Thanks DD. Do you have some references to published papers on the Australian and European data?

      • David Walker says:

        DD, just to clarify, the request for references is a genuine one; I’m not disputing your statement. Indeed, I believe that “the US really is different” is an increasingly important principle. I haven’t myself found good local data, but it would be great to have some.

    • DD
      It also seems a bit at odds with all the stories in the media along the lines of ,more and more ,ever younger ,people with things like morbid obesity and type two diabetes , no ?

      • derrida derider says:
        • Thanks, so all the reports re diabetes and obesity related problems are….?

        • derrida derider says:

          Yep, bulldust. At least so far.

        • conrad says:

          No it’s not bulldust at all — see some abs stats: here . If you went back further in time, that pattern would continue. There are two obvious reasons why there is less effect than the media hype.

          One is that being somewhat overweight isn’t associated with bad health outcomes — in fact this group lives a little longer than people of normal weight in some studies (although I doubt the extra weight is causal — but basically the range in which health outcomes are similar is quite broad).

          The second is that we haven’t seen a lot of the long term effect of obesity. Basically, a lot of today’s older generation who are now obese were not when they were young, and so the long term effects are going to be less. This includes less obvious ones, like cognitive decline in old age, where the causal association is now pretty well established. If you are 60 now, for example, you were extremely unlikely to have been obese when you were twenty (i.e., the mid 70s). Alternatively, looking at the linked data, if the 15% of obese 20 year olds in 2012 don’t get into shape over their life, they will have spent decades doing slow damage to themselves by the time they are 60. But this is really a much more recent thing which has propagated through the system yet, and hence is less obvious.

        • DD Conrad

          It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us, we were all going direct to Heaven, we were all going direct the other way – in short, the period was so far like the present period, that some of its noisiest authorities insisted on its being received, for good or for evil, in the superlative degree of comparison only.

    • Conrad says:

      I don’t think the different trajectories in the US and here make that much difference. This is because the differences are still relatively minor, and lot of the difference in differences has been caused by low SES groups in the US going backwards, and those groups are not getting good care at the end of life anyway. While that’s not a very happy situation for them, it does mean public policy doesn’t need to change much (unless of course someone wants to give them decent free health and other end of life care, but that of course is another story).

  3. Phil Clark says:

    I always find it an odd cunundrum that we have all the resources and technology to live in a global utopia but collectively move down the path of adversarial free market competition that dictates the standard of living for so many. Of course this is a “dreamers” naive view of the world unbound by the stark reality of human nature but I can’t help feeling our world will be forced to change one way or the other. Additionally I have never fully understood why we look upon our elders as a burden. Having worked within the Age Care industry in Australia I see a selfish generation discarding the past into institutions while they fill there lives with meaningless information as the wait for a treasure of memories to pass away. As for longevity, well it’s nice to know I’ll have a few more years to look forward too regardless of the economics of being old.

  4. Nicholas Gruen says:

    Reminds me of a cute joke where a little girl says to her grandad “I hope you live until you’re 100 years and 3 months old”.

    Thank you says grandad. But why the 3 months.

    “Because I don’t want you to die suddenly”.

  5. paul frijters says:

    yes, good news indeed, and of course it is even better in most other Western countries because the US has notoriously low health outcomes despite notoriously high health costs.
    The obesity issue remains highly relevant to health policy if only because of the large cost externality. Last time I looked, an obese person costs his/her neighbours 3000 dollars per year in additional public health costs. The fact that the obese don’t die younger in that sense just means the externality goes on for longer. The cognitive decline issue Conrad mentions might well make this externality bigger over time.

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