A healthy old age: realistic or futile goal?

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Abstract
Distinguishing age from ill health Setting aside ageism, some of the other fears about the increasing older population have their origins in the well established relationship between advanced age and dependency. This raises the important question of whether the overall health of the rising older population is improving or deteriorating.2 The issue centres on the average age at onset of disability in relation to the average age at death. If potential exists to postpone the onset of disability this would result in a healthier older population, who would benefit from a shorter period of dependency before death. The alternative argument proposes that improvements in life expectancy have not resulted from better overall health but from the protracted survival of chronically ill and disabled people. In this scenario individuals face the unappealing prospect of an extended period of dependency in the years before death. This has been mooted as an argument against health promotion in old age, which some believe will simply increase the number of years spent in chronic disability. However, evidence is beginning to emerge that, certainly for well educated, affluent older people, morbidity is already being compressed and that healthy ageing may be achievable for some. A landmark observational study from the University of Pennsylvania followed graduates from their early 40s to their mid 70s.3 The study focused on the three potentially modifiable risk factors of cigarette smoking, body mass index, and exercise patterns. Those with high health risks from these factors in their mid-60s had both an earlier onset of disability and a greater level of cumulative disability, as well as more disability in the final year of life. In contrast, the age at onset of disability was postponed by more than five years in the low risk group. In this study, adopting low risk habits in later life was associated with not only an increase in lifespan but also an increase in healthspan. View larger version: In this window In a new window Growing proportions of older people are a world wide phenomenon. Data from US Census Bureau The promise of healthy ageing resurfaced in recent longitudinal data on disability from the United States showing that its older population is less disabled and less ill than predicted.4 This unexpected finding may be due to a range of factors which include cohort effects, medical interventions, and healthier lifestyles. Lost fitness can be regained with regular physical activity Acknowledgments This is an edited version of a presentation at the Millennium Festival of Medicine in London, 6-10 November 2000.