Fact file: Misconceptions on ageing and health
Some of the most important barriers to developing good public policy on ageing are pervasive misconceptions, negative attitudes and assumptions about older people. Although there is substantial evidence about the many contributions that older people make to their societies, they are frequently stereotyped as dependent, frail, out of touch, or a burden. These ageist attitudes limit older people’s freedom to live the lives they choose and our capacity to capitalise on the great human capacity that older people represent.
1. There is no typical older person
Older age is characterised by great diversity. Some 80-year-olds have levels of physical and mental capacity that compare favourably with 20-year-olds. Others of the same age may require extensive care and support for basic activities like dressing and eating. Policy should be framed to improve the functional ability of all older people, whether they are robust, care dependent or in between.
2. Diversity in older age is not random
A large proportion of the diversity in capacity and circumstance observed in older age is the result of the cumulative impact of advantage and disadvantage across people’s lives. The physical and social environments in which we live are powerful influences on Healthy Ageing. Yet the relationships we have with our environments are shaped by factors such as the family we were born into, our sex, our ethnicity, and financial resources.
As a result, older people with the greatest health-related needs often have the least economic and social resources available to meet them. Policy must avoid reinforcing the health inequities that underlie much of this diversity.
3. Only a small proportion of older people are care dependent
Only a small proportion of older people are dependent on others for care. In fact, older people make many contributions to their families and societies. Research in the United Kingdom of Great Britain and Northern Ireland in 2011 estimated that, the contributions older people made through taxation, consumer spending and other economically valuable activities were worth nearly GBP 40 billion more than expenditure on them through pensions, welfare and health care combined.
This is set to rise to GBP 77 billion by 2030. Although less evidence is available from low- and middle-income countries, the contribution of older people in these settings is also significant. In Kenya, for example, the average age of smallholder farmers is 60 years, making them critical for ensuring food security. Policy should avoid stereotypical views that lead to discrimination against individuals and groups simply on the basis of age.
4. Population ageing will increase health-care costs but not by as much as expected.
Although older age is generally associated with an increased need for health care, the link with health service utilization is weak. For example, despite the high burden of disease in low-income settings, older people tend to use health services less often than younger adults. In high-income countries, there is growing evidence that at around age 70, health-care expenditure per person falls significantly, with long-term care filling the gap.
One way of controlling unnecessary health-care costs is therefore to invest in long-term care systems. Enabling people to live long and healthy lives may also ease pressures on the inflation of health-care costs since some health care costs actually fall in advanced old age.
5. 70 is not yet the new 60
There is little evidence that older people today are experiencing life in better health than was the case for their parents or their grandparents.
An analysis by WHO in 2014 of large longitudinal studies conducted in high-income countries suggested that although the prevalence of severe disability (defined as a situation when help is required from another person to carry out basic activities such as eating and washing) may be declining slightly, no significant change in less severe disability has been observed during the past 30 years. Investing in Healthy Ageing is crucial for countries to benefit from population ageing.
6. Good health in older age is not just the absence of disease
Most people over the age of 70 experience a number of health conditions at the same time, but continue to be able to do the things that are important to them. The combination of a person’s physical and mental capacities (known as intrinsic capacity) is a better predictor of their health and wellbeing than the presence or absence of disease.
Services that are integrated and focus on improving older people’s intrinsic capacity have better outcomes and are likely to be no more expensive than services that focus on any specific disease.
7. Families are important but alone cannot provide the care many older people need
While families will always play a central role in long-term care, changing demography and social norms mean it is impossible for families alone to meet the needs of care dependent older people. Long-term care is about more than meeting basic needs – it is about preserving older persons’ rights (including to health), fundamental freedoms and human dignity.
This means caregivers require adequate training and support. Responsibility for long-term care should be shared between families, governments and other sectors in order to ensure access to quality health care and avoid financial hardship to both older people and their caregivers.
8. Expenditure on older populations is an investment, not a cost
Rather than framing the expenditures on older populations simply as a cost, they are better considered as investments. These investments can yield significant dividends, both in the health and well-being of older people and for society as a whole through increased participation, consumption and social cohesion.
Policies should be framed in ways that enhance the abilities of older people to do the things they value and to make these contributions, rather than looking to simply reduce social expenditures.
9. It’s not all about genes
While Healthy Ageing starts at birth with our genetic inheritance, only approximately 25% of the diversity in longevity is explained by genetic factors. The other 75% is largely the result of the cumulative impact of our interactions with our physical and social environments, which shape behaviours and exposures across the life course.
Many of the opportunities and barriers we face are strongly influenced by personal characteristics, such as our sex and ethnicity, as well as our occupation, level of education, and wealth. Policies should address these person-environment interactions across the life course.
10. Mandatory retirement ages do not help create jobs for youth
Policies enforcing mandatory retirement ages do not help create jobs for youth, but they reduce older workers’ ability to contribute. They also reduce an organization’s opportunities to benefit from the capabilities of older workers. Age has not been shown to be a reliable indicator for judging workers’ potential productivity or employability.
Moreover, surveys in the United States, for example, have found that the majority of people approaching traditional retirement age do not actually want to retire. Despite this, many countries or industries still have mandatory retirement ages. These discriminatory practices should be abolished.