Extra Time: 10 Lessons for an Ageing Society - How to Live Longer and Live Better

Since 2011, progress has slowed. ‘It’s possible we have gone back to the time before 2000, when life expectancy improvement was more gradual,’ says Gordon Aitken, insurance analyst at RBC Capital Markets. ‘From 2000 to 2010, we saw the wealthier getting healthier. But it’s hard to keep reducing deaths from cardiovascular diseases at the same rate. And obesity and diabetes are on the rise.’

There is no consensus on how the change affects different socio-economic groups. One data set suggests that the ‘Comfortable’ are unaffected, and that the losses are among the ‘Hard-Pressed’. Another suggests that all groups are seeing a slowdown in improvement.

While these differences are of enormous importance to insurers, because they affect annuity payouts, they are less crucial for the rest of us. Mr Aitken explains that the chance of dying in 2018, for example, didn’t increase from the previous year. What has happened is that the forecasts for growth were too optimistic. A 65-year-old man in the UK is now expected to live to 86.5, while a 65-year-old woman is expected to reach 88.4.

Sub-Saharan Africa: The Young of the Future

Sub-Saharan Africa finds itself in a demographic bind of a different sort. Its population is expected to quadruple to 4 billion people by 2100,

with Nigeria overtaking America as the world’s third most populous country. There is much excitement at the prospect of youth burgeoning as the old world shrinks. Tanzanian President John Magufuli has claimed he sees no need for birth control, insisting a high fertility rate will boost his country’s economy.

Sadly, he may be mistaken. The great leaps forward made by the Asian Tiger economies came from the so-called ‘demographic dividend’: of rapid growth in working-age populations, enabling those countries to grow fast and invest, followed by sharp subsequent falls in the birth rate which boosted the skills base, because parents with fewer children could invest more in educating each one.

Sub-Saharan Africa is on a different path, of continuing population growth with no demographic dividend in sight. Its per capita income is growing slowly, and its many willing hands may not be able to find work, if they remain at low skill levels. Add to that the likely strains on the environment and infrastructure, and Mr Magufuli may come to change his mind.

The Paradox of Living Longer, But Not Being Fertile for Longer

Falling birth rates must be good news for a planet whose natural resources have been stretched to the limit by humans. And they reflect a welcome next step in the liberation of women. Almost everywhere outside sub-Saharan Africa, women are throwing off the shackles of their traditional roles. Lower infant mortality has made it safer to have smaller families. The hold of religion is waning. More women are pursuing careers. At the same time, job insecurity and the high cost of living, especially in cities where the jobs are, has left many couples fearing they can’t afford children.

Some worried governments have resorted to bribery. The Polish Ministry of Health put out a terrible video, encouraging the population to ‘multiply like rabbits’.

Norway, Sweden, Denmark, France, Germany and Russia pay ‘baby bonuses’. Some of these schemes have had limited success: France and Sweden have the highest birth rates in Europe. But not all women want to be treated like prize cows. A Danish government video, urging women to ‘Do It for Denmark’, missed the point: that many women don’t want children, and others can’t find a good father.

It may be that the post-war baby boom was unusual. Today’s combination of greater career opportunities for women, and increased financial pressures, may be returning us to an era when people did not get married, or have children, until they felt they could afford it. Some may leave it too late as a result. Others will feel liberated from the tyrannical view that there is something wrong with you if you’re childless.

In Extra Time people study longer, leave home later and may not be settled or solvent until their mid-thirties: when they may hit the hard deadline of the biological clock. That mismatch will leave some couples very disappointed.

For the foreseeable future, it looks as though we will be stuck with male fertility declining from about 45, and female fertility from around 30. In most other respects, though, we remain younger for longer.

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Younger Than You Thought (#ulink_e6a5b4d4-122b-54eb-8365-cf8467f72143)

The stages of life are changing (#ulink_e6a5b4d4-122b-54eb-8365-cf8467f72143)

MY 19-YEAR-OLD GODDAUGHTER IS looking over my shoulder as I write. Will she be reading this again in 2150, when she will be 150? That is the subject of a $1 billion bet made by two American experts on ageing.

Steven Austad, chair of biology at the University of Alabama at Birmingham, has predicted that there will be a 150-year-old human by the year 2150, based on the many breakthroughs which are slowing ageing in mice (see Chapter 6). His friend Jay Olshansky, public health professor at the University of Illinois, disagrees. He thinks the brain will be an insuperable barrier. ‘We can replace hips, hearts and so on, but we can’t replace the brain,’ he has said.

The two men made the bet in 2000. They each put $150 into an investment fund, and signed a contract certifying that the winner’s heirs will cash it out in 2150. They later doubled their initial investment, and now expect the jackpot to be around $1 billion. If Austad is right, someone alive today will still be around to see who wins the bet.

While we wait to see whether lifespans jump to 150, some other changes have already crept up on us. At 19, my goddaughter ought to be emerging from adolescence into adulthood. But she’s just started university, is racking up debt and expects to be living with her parents for years to come. So many people are now in this situation, some experts argue that the stage of adolescence should last until 24. That’s the average age at which children now move out of the family home in the UK, France, Germany and Australia.

The Australian professor Susan Sawyer has argued that adolescence should be extended in both directions: starting at 10,

to reflect the fact that puberty is now starting at that tender age in some girls, and lasting until 24. Extended parental involvement through this later period can be highly beneficial, the psychologist Laurence Steinberg has argued, because we now know that the brain continues to mature into the twenties.

If adolescence now lasts for 14 years, what happens to the subsequent stages of life? They are also lengthening. We saw in the last chapter that people are having children later. Beyond that, mature independent adulthood is lasting longer too.

It’s Not Old Age That’s Getting Longer, It’s Middle Age

Last winter, a doctor friend of mine was in charge of the influenza vaccinations for the over-65s at his local clinic. A crowd of grey-haired strangers walked in. They’d never come to see him before, because there was nothing wrong with them.

These people are part of a growing group who are defying all the labels. They don’t see themselves as old, don’t act old and won’t buy products marketed at the old either.

In England, the proportion of over-65s with any kind of impairment has been falling for two decades.

In America, three-quarters of people under 75 have no problems with hearing or vision, no difficulty walking, and no form of cognitive impairment.

These are fully fledged citizens with plenty left to offer, not retirees on their way out. Step up a generation, to those aged between 75 and 84, and half still have none of those disabilities.

That doesn’t mean that older people don’t forget their keys, or lose concentration. But it does mean that some of our fears are overdone. In surveys, most people say they think that everyone will get dementia (or Alzheimer’s, a form of dementia) if they live long enough.

But only one in six people over 80 have dementia:

many never get it. And in Denmark, Sweden,

the UK and US, the risk of getting dementia is a fifth lower than it was 20 years ago.

In 2000, the average age for receiving a diagnosis of dementia in the US was 80.7; by 2012, it had crept up to 82.4, even though doctors had got better at spotting it.

Experts are not sure why the incidence of dementia is dropping but the Framingham Heart Study, which has tracked 5,000 people over 60, suggests that rates of dementia have mirrored improvements in heart health.

In the UK, dementia rates have fallen faster for men than for women, which may be because men previously smoked more. There will still be news headlines about dementia being on the rise but what’s growing is the total number of older people, not our own individual risk.

The ‘Young-Old’: The New Kids on the Block

The Japanese, whose society is now the oldest on the planet, caught up with the reality of Extra Time long ago. The group who are still hale and hearty and rushing around after grandchildren they call the ‘Young-Old’. Those who are frail and in need of support they call ‘Old-Old’.

‘The Young-Old are very active and healthy and productive – totally different from 30 years ago,’ says Professor Takao Suzuki, Professor of Gerontology at Tokyo’s J F Oberlin University. ‘Walking speeds are much faster, for example. The World Health Organization defines “old” as 65, but as gerontologists and geriatricians, our main concern is with the Old-Old, who are very different from a health standpoint.’

Sketching energetically on his whiteboard, Professor Suzuki is, endearingly but disconcertingly, wearing a thin black cowboy tie over his pristine white shirt. He draws a matrix showing the Young-Old starting at 60, and Old-Old from 75 – but says the start date of becoming Old-Old can be much later than that. Professor Suzuki attributes Japan’s uniquely long-life expectancy to good medical care, prosperity and improved nutrition after the Second World War, when people could afford to eat far more protein, mostly fish. Consumption of carbohydrates, fat and sugar has barely changed, he says, as fast food outlets are still relatively few. Unlike Western experts, he worries more about under-nourished widows than obesity. (Some widows were not eligible for their husband’s full pension, he says, and have trouble getting to the shops to buy groceries.)

The Oldest Stewardess in the World

Bette Nash, 82, is telling me about the time she flew with Jackie Kennedy. It was 1965, and the glamorous wife of the former US president walked onto the flight where Bette was a stewardess. ‘We used to have to wear white gloves. I was pulling them on with my back turned and I heard this voice asking, was this flight going to Washington? She was real sweet, never asked for any attention.’

The plane, Bette remembers, was a Constellation – very different to the Airbus she flies now. For Bette Nash is still working. She is probably the oldest stewardess in the world. American Airlines, her employer, recently threw a party to celebrate her 60th anniversary. Regular passengers on the Washington, DC–Boston shuttle bought her gifts.

Bette says she has no intention of retiring: ‘I thrive on people.’ She talks fast and exudes energy: ‘If I’m ever off for a few days and think about stopping, as soon as I get my uniform back on and drive to the airport, it’s great. It’s the people who work for the airline and it’s the customers. I know their little needs. I know the commuter who likes his tomato juice plain in the winter and on ice in the summer. I feel so comfortable going to work.’

Technology has changed in the past 60 years – Bette doesn’t have to handwrite the tickets any more – but people haven’t changed. ‘It’s being kind to people, and them being kind to you. A little love and kindness is what everyone needs.’

The job is physically tiring, but Bette makes few concessions: ‘If I have free time I don’t sit down, I walk the cabin and talk to people. I do have a nap in the afternoon – I’ll admit that – but younger people get tired too.’ She gets up early in the morning and prepares a meal for her son before driving the hour to the airport. On the way home, she says, she does feel more tired. ‘Before, I might have gone to the store on the way home, and done other things; now I might just get gas.’

What is her secret? She pauses. ‘When I think about it now, I think my goal in life is to keep moving,’ she chuckles. She may sit down to watch TV, but never for long. ‘There’s always something to do.’ She doesn’t follow an exercise regime, and admits to eating chocolate, but laughs: ‘I can still suck in my tummy.’ Almost without knowing it, she seems to have been following three of the tenets of the old-age lifestyle gurus: keep active, retain your sense of purpose and connect with people.

Is Bette Nash old? She thinks for a moment. ‘I don’t feel like I’m an old person. I have a handicapped son, I don’t have the chance to feel old; his needs are so great. My sister has Parkinson’s and dementia and I look at her and I think she’s old, but she’s younger than I am.’