Planning for the future: Be positive about ageing and you will live longer

One of the best reads I have had recently is summarised in this short YouTube clip (youtu.be/A74CKWkp6B4), which may be more palatable than the full report for most busy people. The Perennials: The Future of Ageing is the product of ongoing surveys with older people in over 20 countries around the world, and surveillance of leading ageing research and demography.¹

As our ageing population flourishes into being half of consultations over the working life of those GPs just starting out, let’s reflect on what difference attitudes make.

If you ask the 16 to 24-year-olds, they will say age 61 is old; if you ask a 50-year-old, they will say around 75; and if you ask a 75-year-old, they will say 80s. It’s always older than you are.

Around the world, how old is old differs as well. In Spain, you are old at age 74, and in Saudi Arabia, you are just 55. I asked the emeritus professor of geriatric medicine David Richmond when he was 92, and he said, “I think I have made it to the target group that we want to study.”

For clinicians, being old is realised with the complexity of medical conditions and balancing of pills, creams and investigations, working out the combination of support needed to maintain independent living, filling in the insurance claims for travel (whenever that can begin again) and negotiating the complex family issues. Societies and older people themselves have different views than the GP.

We are in for a difficult time, and all of us will need to think about our older members of society

The negativity about older people comes from societal and media portrayal of older people being frail, ill, dependent, having low social status, contributing little to the economy and being a drain on health services.

Older people get 1.5 per cent of parts in TV shows and movies, and when you look at dialogue, older men get 5 per cent of speaking parts and women 3 per cent – no wonder they are invisible. Most advertising has people aged under 40 in it, but most money is spent by those aged over 40.

People with a negative view of ageing have greater difficulty planning for the future, can struggle with relationships and are more likely to have depression and loneliness. At least 20 per cent of older populations are affected by loneliness or isolation.

COVID-19 has made this worse for some and better for others. With children worrying about older parents, contacts may have been more frequent during lockdowns, and when the lockdowns lifted and people went back to work, older relatives went down the priority list again.

We are in for a difficult time, and all of us will need to think about our older members of society, include them and listen out for them.

Socioeconomic status makes a difference to ageing, and longevity is affected by the postcode lottery like a lot of things.

As you travel south in Auckland from the North Shore, life expectancy decreases (Stats NZ data 2017–2019; stats.govt.nz). For men, life expectancy at birth on the North Shore is 83+, and in south Auckland, it is as low as 75. Women living on the North Shore have a life expectancy of 87+, compared with 79 for some areas of south Auckland. This is shocking in our safe, first-world, developed society!

Age discrimination adds to racial discrimination, and regional differences add to the ethnic disparity of at least seven years lower life expectancy for Māori.

There is, of course, another view. Interviews with older people who were “ill”, by our standard (complex multimorbidity), showed they were not focused on their health, manage daily activities despite health issues, and focus on family, wellbeing and plans for society.

The reality is that older people are happier – the least happy section of the population is those aged 40–64 (the busy years). Older people are more connected, and those who are contributing to their families and society are more content. Older people are considered wise, and many younger people now value older people’s contributions, especially as older people stay in the workforce for longer.

Older people also make active relationship choices, with the divorce rate in the 60s climbing over the last decades – perhaps people see the next 30 years as needing to be different from the last 30.

With this comes an increase in sexually transmitted infections for those aged 50–70 and beyond. An 85-year-old acquaintance contracted hepatitis B from a new partner a few years ago, so be alert to this. At least 40 per cent of those between age 65 and 85 are sexually active (higher if they have a partner), and approximately half of those aged over 65 say they are not getting enough sex.

Don’t forget there is a person under there, even when they have dementia with delusions, live in a nursing home, have COVID-19, take their time to get up on the examination table, or don’t recognise you in your personal protective equipment.

Enjoy the wisdom of older patients, and encourage them to continue contributing to their families, whānau and communities. Intergenerational contact, engagement and activities help dissipate ageism. Any ways you can encourage that in your practice, and in the way you live, will be good for older people.

Those who have positive attitudes about ageing, during mid and late life, live an average of seven years longer. So, my last word, for your own good, is to be positive about ageing and you will live longer.

Ngaire Kerse is a professor of general practice and primary health care, and the Joyce Cook Chair in Ageing Well, University of Auckland