Who wants to live to 100?

June 28, 2018 by Paul Higgs, The Conversation
A lonely life. Credit: Robert Kneschke/Shutterstock.com

While the ageing of society has become one of the givens in today's world, less is made of the lived experience of the very elderly in society. And although there is some suggestion that the much trumpeted steady expansion of the human lifespan has begun to slow down, the numbers of very old people continue to grow. Despite this, debates about the resourcing of universal health and social care tend not to examine the costs associated with extreme ageing. Yet the problem of chronic conditions and multiple morbidity is greatest among octagenerians and nonagenarians.

Very old age, if commented upon, is presented as if it were a kind of extreme sports competition. Centenarians are celebrated simply for reaching 100. Nonagenarians hit the news when they run a mile, climb a mountain or pilot a plane. Otherwise, silence reigns. Yet the focus of most is on aged 80 and over – a group for whom care is needed because health cures have failed them. The morbidities and infirmities that beset the extremely aged are not so much ignored as abandoned to the efforts of medical services and social care.

At UCL, we are trying to throw some light on this darker side of ageing. There are of course a number of ways that such "hyper-ageing" can be approached and understood. One view celebrates the fact that the more and more people can expect to live for 100 years or more. Another sees it as an apocalyptic disaster, as agedness "swamps" the resources of society needed to maintain itself. Yet another view juggles between the successes of more years of healthy active life and the failings of more years of living with disability and infirmity.

Changing patterns of disease

Across the world, the burden of disease has been receding. But this is more the case for illnesses affecting younger people and those that are likely to lead to death, rather than disablement. By contrast, conditions that are degenerative and disabling more often than causing death remain largely unchanged.

Rates of osteo-arthritis, for example, which disables but does not kill you, have been rising over the last 25 years (from 213·4 cases per 100,000 in 1990 to 232·1 cases per 100,000 in 2016). Rates for Alzheimer's disease, which disables more than it causes death, have also grown but in a less pronounced manner, (rising from 460·9 cases per 100,000 in 1990 to 470·6 cases per 100,000 in 2016).

Although some affecting older people, such as chronic , which kills and disables you, have been falling (from 1666·8 cases per 100,000 in 1990 to 945·3 cases per 100,000 in 2016), the really large falls in prevalence have been in conditions affecting the young, such as of diarrhoea and related common infectious diseases, which have dropped remarkably, from 8951·2 in 1990 to 3275·6 in 2016.

In Denmark, one of the few national surveys of nonagenerians was conducted around the turn of this century. The researchers found that the majority contacted had some disability and that women were more often affected than men. The same researchers also observed that "about 10% of the octogenarians and more than 55% of the centenarians live in nursing homes, while dependency rises from approximately 30% to 70%, and the prevalence of dementia rises from approximately 7% to 50%".

In the UK, one study of 85-year-olds found a median number of five diseases per person, with more than half suffering from hearing impairment, just over half from osteoarthritis, and just under half suffering from . Just under a quarter had some form of cancer. Less than 5% told the researchers that their health was poor: most said it was good.

The silent issue

This last point emphasises how extreme ageing presents issues that easily go unremarked upon. Its problems are largely confined within the individual household or in long-term care institutions. Wider society scarcely acknowledges these problems and most of those on the receiving end, whether carers or people being cared for, are simply too overwhelmed to do much about them.

Although not closed off to the public, the nursing home remains more present in the imagination than in most people's everyday experience. The social networks of the frail elderly, whether living at home or in a nursing home, tend to be so much smaller than those of the rest of the population. Most people over 80 live alone. They often have only a few people to talk with. Meantime, stories of abuse, or TV footage of the inside of the nursing home paint a grim picture to all who watch, read or hear them.

These isolation and neglect of these spaces help preserve the distance between an "us" who are, if we are ageing, ageing well clear of such scenarios, and a "them", who are not. To be old and frail is not an identity to be acclaimed and the old and frail are generally unable or unwilling to represent themselves as such.

For many of these people, life can be difficult. Estimates suggest that chronic pain "in people aged 85 years or older is common", affecting the majority of people from this age group. Aged lives of quiet desperation are sadly not rare, nor are most lived in the heroic terms of the marathon-running nonagenarian that hits the news.

In drawing attention to this, we are not attempting to promote further victimhood. What we hope to achieve is to cast a little light upon the darker side of our ageing and of our ageing societies. Old age should not be sought out just for the sake of it.

Explore further: Research finds a little exercise does a lot of good for ageing muscles

Related Stories

Research finds a little exercise does a lot of good for ageing muscles

May 24, 2018
Getting old doesn't necessarily mean getting weak and frail – just a little bit of exercise can help maintain muscle mass and strength, Otago research has revealed.

Number of older people with four or more diseases will double by 2035, say researchers

January 23, 2018
A study published today in Age and Ageing, the scientific journal of the British Geriatrics Society, reports that the number of older people diagnosed with four or more diseases will double between 2015 and 2035. A third ...

Living with dementia, feeling lonely and isolated? MARIO the robot can help

May 14, 2018
Dementia is a major cause of disability and dependency among older people worldwide, with about 50 million people suffering from it and nearly 10 million new cases every year, according to a fact sheet by the World Health ...

Higher risk of dementia among frail older adults

November 16, 2017
The risk of developing dementia is around 3.5 times higher in frail older adults than in their non-frail peers, according to a new study from UCL.

Aging population in England and Wales with care needs set to grow by 25% within a decade 

May 24, 2017
The number of people aged over 65 years needing care could reach 2.8 million by 2025 in England and Wales – an increase of 25 percent from 2015 (equivalent to an additional 560000 people) over a decade, according to a study ...

More than 15,000 frail elderly New Zealanders are lonely

December 14, 2017
More than 15,000 frail elderly identified as being lonely according to a world-first study of 72,000 older New Zealanders. That equates to one in five older people.

Recommended for you

Sugar content of most supermarket yogurts well above recommended threshold

September 18, 2018
A comprehensive survey of ingredients in yogurts highlights high sugar levels in many—particularly organic yogurts and those marketed towards children.

Research confronts 'yucky' attitudes about genetically engineered foods

September 18, 2018
Is a non-browning apple less "natural" than non-fat milk? In one case, people have injected something into apple DNA to prevent it from turning brown after it's cut. In the other, people used technology to remove something ...

Your teen is underestimating the health risks of vaping

September 17, 2018
Teens today are more reluctant to smoke cigarettes than their counterparts nearly three decades ago, according to a study released this summer. But parents should hold their collective sigh of relief. The study, carried out ...

Thinking beyond yourself can make you more open to healthy lifestyle choices

September 17, 2018
Public health messages often tell people things they don't want to hear: Smokers should stop smoking. Sedentary people need to get moving. Trade your pizza and hot dogs for a salad with lean protein.

Shifting focus from life extension to 'healthspan' extension

September 17, 2018
Clinicians, scientists and public health professionals should proudly "declare victory" in their efforts to extend the human lifespan to its very limits, according to University of Illinois at Chicago epidemiologist S. Jay ...

Survey finds 2M US teens are vaping marijuana

September 17, 2018
A school-based survey shows nearly 1 in 11 U.S. students have used marijuana in electronic cigarettes, heightening health concerns about the new popularity of vaping among teens.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.