Demography

The good news about getting old

The largest ever study of the health of people aged 85+ dispels the gloomy predictions surrounding the elderly, says its chief architect Carol Jagger.
An elderly man exercises in the \'pensioners playground\' in Hyde Park, London./ Credits: Reuters
Allianz knowledge on demography: Carol Jagger, Professor of Epidemiology of Ageing Carol Jagger, AXA Professor of Epidemiology of Ageing, Newcastle University: "There is a lot of research on frailty. This is a more positive view. It is about how healthy our 85-year-olds are, what care they need, and how that changes over time." Nine out of ten say they are mostly happy, three out of four claim to have good health, and about four out of five rate their quality of life as good or excellent. Contrary to conventional wisdom, very old people seem to think that they are doing all right.

These optimistic voices are those of people aged 85 in the Newcastle area of northeast England, participants in the Newcastle 85+ Study, the most comprehensive effort yet to understand the aging process.

The study’s results challenge the negativity surrounding the “burden” of aging, in particular the emergence of the over-85s as the fastest growing sector populations in the UK and other developed nations, often presented as a kind of demographic doomsday for healthcare and public finances.

“The picture of doom and gloom is not actually the case,” says Professor Carol Jagger, AXA Professor of Epidemiology of Ageing at Newcastle University, who oversees the design and analysis of the Newcastle 85+ Study. “Yes, there is a lot of disease but there are still a lot of people functioning well both mentally and physically.”

Creating a healthy aging index

The project involved 850 people in the Newcastle area of northeast England, from all social groups, who in 2006, when aged 85, either underwent health assessments or had their medical records reviewed, or both. About 10 percent of them were living in care homes at the time.

The baseline health assessment included a blood test and timed participants doing physical activities like getting up from a chair and going to do a task. Researchers asked participants about daily activities like washing, getting dressed, housework, and getting around, quizzing them on their levels of independence, wellbeing, happiness and loneliness.

In addition, they were tested for cognitive ability, including a computerised test which helped measure reaction times. All these tests were repeated after 18 months, after 36 months and finally a shorter interview was undertaken after five years in 2011.

“The ultimate goal is to produce a healthy aging index,” explains Jagger. “There is a lot of research on frailty. This is a more positive view. It is about how healthy our 85-year-olds are, what care they need, and how that changes over time. We wanted to look at the whole spectrum of health—biological, functional, clinical, and social.”

Consequences of comorbidity

First the bad news: nobody had zero diseases. On average, men had four diseases and women had five. Known as comorbidity, this prevalence of multiple diseases challenges established medical practice, says Jagger. “It has implications for general practitioners who like to deal with one problem per consultation, and also for management of multiple medications.”

Instead of consulting specialists in particular diseases separately, these people may be better served by panels of experts that coordinate treatment for multiple conditions. While in the short term this might eat up healthcare resources, a joined-up approach could prove more efficient at preventing complications.

If the current disease trends prevail, the research indicates, there will be an increase in those requiring 24-hour care of about 82 percent in England and Wales. That would imply a further 630,000 care home places by 2030.

This pattern of aging, comorbidity and consequent healthcare demand will be repeated across the developed world. “We have to find out what the determinants are of disability progression so we can hopefully slow that down, which will mean that fewer people require 24-hour care,” says Jagger.

Reasons to be cheerful


At the same time, however, the picture emerging from Newcastle is that the impact of these diseases is not as debilitating as perceived.

Ninety-one percent of participants reported that they were happy most of the time, over three quarters reported good health for their age, and four out of five required little care. Of the 17 activities of daily living that the study measured over 20 percent of participants said they had no difficulty with any of them. In addition, 70 percent of participants had normal cognitive function, with a surprisingly high number scoring full marks in the test (which includes tasks like counting backwards from 100 in 7s).

Is it possible that the participants are over-estimating their abilities, or putting on a brave face? Jagger insists that the questionnaires are robust, and consistent with independent observations and objective testing.
Interestingly, there were large variations between men and women, with 58 percent of men described as independent compared with just 31 percent of women. This was not unexpected, she says, and is known widely as the “disability survival paradox”.

“Women live longer but have a greater proportion of their lives with disability. They tend to have more disabling diseases while men have more fatal diseases. For example, women have more arthritis while men have more cardiovascular disease,” she explains. Why this happens nobody yet knows, although the 85+ Study is preparing numerous research papers on how specific diseases develop.

Come grow old with me

There is a paradox at the heart of the Newcastle 85+ Study—widespread disease without corresponding levels of disability.

“The big question is: what do you consider to be successful aging?” Jagger suggests. “The WHO defines health as a state of complete mental and physical and social wellbeing and not merely the absence of disease or infirmity. But that implies the absence of disease is necessary for health. So when we talk about healthy aging do we really mean with no disease, because then we would say that none of our 85-year-olds are aging healthily whereas I think quite a few of them are.”

And it is not just health institutions and the wider public that need to have a rethink. The elderly themselves should consider their options.

“A lot of older people think that staying in their own house is keeping control but it’s not,” says Jagger. “Often the house is totally inappropriate and when you get too ill someone else has to make that decision. Being in control is when you are doing the planning.” This means providing the elderly with more accurate information about how their chronic conditions are likely to progress, one of the key goals of the Newcastle 85+ Study.

“I know there will come a time when I need to move closer to my daughter but I will do that when I am still active and can create a network,” Jagger explains. “My mother did the same and moved to be near me at 82. I like to think, as the Robert Browning poem says, ‘Come grow old with me! The best is yet to be.’”


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