“There is only one alternative to ageing. There are many alternatives to ageing well.” Dr Alexandre Kalache*
We are all living several years longer, disability-free, according to new data released by the Australian Institute of Health and Welfare (AIHW) this week.
The latest collection of findings reports that between 1998 and 2012, male life expectancy at birth rose from 75.9 years to 79.9 years—a gain of 4 extra years. For females it rose from 81.5 years to 84.3 years—an extra 2.8 years.
While life expectancy gains always sound good, extended years of poor health and disability can take the gloss off the gains.
But the additional good news is that disability-free life expectancy has also increased for the same period. For males, disability-free life expectancy at birth rose by 4.4 years while for females it rose by 2.4 years.
The report’s author, Dr Xing-yan Wen, of the Disability and Ageing Unit at the AIHW, said the gains in the number of expected years living free of disability were related to a combination of both increasing longevity and decreases in the rates of prevalence of disability.
Increased independence
According to the report, men who were 65 in 2012 could expect to live another 8.7 years without disability and a further 10.4 years with some form of disability. Of those 10.4 years of ‘some form of disability’, men could expect 3.7 of them to involve a ‘severe or profound core activity limitation’ —that is, sometimes or always needing personal help with activities of self-care, mobility or communication.
Mixed news for women. Women who were 65 in 2012 could expect to live 9.5 years without disability – a year more than their male counterparts – and a further 12.5 years with some form of disability. In their case, women can expect 5.8 of those years with a disability to involve ‘a severe or profound core activity limitation’.
So, while women can still expect to live longer than men, gender gaps in life expectancy and years living free of disability are narrowing across all age groups.
Between 1998 and 2012, the gap between males and females for years free of disability approximately halved, from 4.1 years to 2.1 years.
The bottom line is that most of us want to live as long as we can, as well as we can, avoiding ill-health and disability for as long as possible.
Use of aged care services
Living longer without disability is important, not just for our own quality of life, but because it has significant implications for Australia’s health, aged care and disability support systems. The proportion of the population in older groups will continue to rise steeply through to the middle of the century with the ageing of the post war baby boomers, placing increasing pressure on these systems.
Another recent AIHW report – looking at prevalence of use of aged care services prior to death among people 65 and older in 2010-11- found that, overall, 80 per cent had used aged care in the eight years before death.
Perhaps unsurprisingly, the older you were at death, the more likely you were to have been using aged care services. People who died aged 85 and older were much more likely to have used aged care before death than those who died at younger ages (91 per cent versus 57 per cent of people aged 65-74 at death).
Three-fifths were current clients of aged care programs when they died.
Almost half (47 per cent) began using aged care more than four years before death but in all age groups, there was increased take-up of care in the last 6 months of life.
Again it is probably not surprising that this ‘last six months’ trend was much more marked for people who died relatively younger – aged 65 to 74.
Compression of morbidity, then, is the goal of living disease and illness-free for as long as possible. And the idea is that it is not only good for us ourselves, but it’s good for society.
‘Keep yourself nice’
The bottom line is that most of us want to live as long as we can, as well as we can, avoiding ill-health and disability for as long as possible.
Population health experts talk about a concept called ‘compression of morbidity’ to describe one of the goals of healthy ageing and longevity. Morbidity is the presence or rate of illness or disease in a population and its impact, including the ‘burden’ that it causes. Compression refers to the concept of pushing all the morbidity of one’s life into as small a time period as possible.
Compression of morbidity, then, is the goal of living disease and illness-free for as long as possible. And the idea is that it is not only good for us ourselves, but it’s good for society.
Former director of the World Health Organisation’s global Ageing and Life Course Programme and instigator of WHO’s Active Ageing Policy Framework and the global movement on Age-Friendly Cities among many other enduring initiatives, Sixty-nine year old Dr Alexandre Kalache*, is a leading proponent of this goal.
Dr Kalache says ageing has been one of the most important societal achievements of the 20th century, with 30 years added to life expectancy worldwide.
“Now we need to make sure that we capitalise on those years by making them as active as possible, for the sake of the individual and society,” he says.
“Baby boomers are leading the way, showing younger people that getting old is the best thing that can happen to them. There is only one alternative to ageing. There are many alternatives to ageing well.”
* About Dr Alexandre Kalache: Following his medical training in Brazil and then his MSc and PhD in the United Kingdom, Dr Kalache held research and teaching positions at both the Universities of Oxford and London for almost twenty years. During this time he founded the Epidemiology of Ageing Unit at the London School of Hygiene and Tropical Medicine (1983) and created the first European Masters degree in Health Promotion (1991).
From 1995-2008 he directed the World Health Organisation’s global Ageing and Life Course Programme from the Geneva headquarters. During his thirteen years at WHO he launched the Active Ageing Policy Framework and the Global Network of Age-Friendly Cities among many other enduring initiatives. In 2012 Alexandre Kalache took up the Presidency of the International Longevity Centre-Brazil in his home city of Rio de Janeiro. ILC-Brazil is an autonomous think tank which is part of an international consortium of fourteen such centres. Concurrently, Dr Kalache serves as Global Ambassador of HelpAge International, Senior Advisor at the New York Academy of Medicine and sits on a multitude of boards ranging from the World Economic Forum to the Gulbenkian Foundation. He acts as worldwide adviser on ageing issues to national, state and municipal governments, civil society organisations and the private sector.
