Living longer: a bonus or a burden?

Carolyn Moynihan
October 15, 2015
Reproduced with Permission

This century faces many uncertainties, among them the exact trajectory of climate change, the consequences of automation, and whether people, or anything, can live on Mars. But one thing is quite clear: it will be a century when the world grows older.

A new report from the World Health Organisation informs us that, "Today, for the first time in history most people can expect to live into their 60s and beyond." The number of people in this age group is set to double by 2050. In developing and middle income countries fewer young people are dying; in high-income countries the old are living even longer.

This is good news for the former, and a challenge for the latter. Whether added years are a blessing for the elderly and a bonus for society, or a burden for both, will depend on whether we understand what makes for health and happiness in old age - and actively foster those things.

To arrive at old age in good health, surrounded by family and friends, able to contribute the wisdom of experience to younger generations and to rely on their support and care when frailty finally sets in - this is a blessing indeed, and many people no doubt experience it.

But many others do not, and there is no guarantee that prospects for the elderly in general will improve. Physical health, family connectedness and mental health are three areas highlighted by WHO and two other recent pieces of research that can make the difference.

Physical health: we are not in great shape

The WHO report, Ageing and Health , notes that, contrary to what we might assume, older people today are not necessarily experiencing better health than their parents, thanks in large part to chronic conditions like diabetes and heart disease. These can be prevented by healthier lifestyles, and even in very advanced years, physical activity and good nutrition can have powerful benefits for health and wellbeing, it points out.

For those who do have health problems or become frail and dependent supportive environments and long-term care can ensure they have a dignified life, says WHO.

"Yet unhealthy behaviours remain prevalent among older people, health systems are poorly aligned with the needs of the older populations they now serve, in many parts of the world it is unsafe and impractical for an older person to leave their home, caregivers are often untrained, and at least 1 in 10 older people is a victim of some form of elder abuse (Chapter 3)."

What's needed, says the UN body, is "a comprehensive public health response" and yet, despite more than a decade of awareness, such a response is not evident. A framework for it is what the 260 pages of Ageing and Health aims to provide.

The unconnected: "elder orphans"

But poor or indifferent physical health is not the only handicap that older people may face.

Recently a New York geriatrician flagged another problem in the ageing West: the growing number of "elder orphans" -- people over 65 who are ageing alone and unsupported, with no known family member or designated surrogate to act on their behalf. Dr Maria Torroella Carney has undertaken research which indicates that nearly 1 in 4 Americans over age 65 are currently in this category, or at risk of entering it.

Dr. Carney and her team highlighted the case of "HB," a 76-year-old man living alone who arrived at a New York hospital after a failed suicide attempt, and who needed a multi-disciplinary approach to his pain and suffering. With his only existing family across the country in California, HB's case was complicated and prolonged by delirium, unclear decision-making capacity and lack of social support. He was discharged to a nursing facility for likely eventual long-term placement.

"It seems that, with increasing longevity and the trend toward having fewer children and families being fragmented, that this risk of aging alone is increasing," Dr Carney told a Canadian television channel . There is no structure in place to address this largely hidden problem and society needs to develop one, she says.

Single adults of fifty-plus need to work on their own plan: "Who will be that decision-maker for you if you are unable to make decisions? Get a health care proxy; find an advocate, create a strategy for yourself."

Mental health: saved by religion

The thought of facing old age alone and in poor health is a depressing one, and depression can undermine both physical and mental health. (Poor physical health can also feed depression, of course.) A study based on the European SHARE project comparing 10 countries in Northern, Southern, and Western Europe indicated a prevalence of depression among older adults ranging from 18 percent in Denmark to 37 percent in Spain.

In Spain and Italy fewer adults over 60 are employed, more have financial difficulties and fewer say their health is very good compared with their age peers in Northern and Western European countries. These things could contribute to depression. But the Southern Europeans also tend to be less involved in sports and social clubs and voluntary work - things that are associated with better mental health.

On the plus side, Italians and Spaniards are more likely to live with other people, presumably their family - perhaps a reason for not joining outside groups - and are a little more likely to belong to a church or other religious organisation.

Researchers from the Erasmus MC Medical Centre in Rotterdam and the London School of Economics studied the effects of these different forms of social engagement on the mental health of Europeans over 50 and reached a surprising (to them) conclusion: joining a religious organisation is more beneficial than charity work, sport, education or political activity in improving mental health. In fact, membership in political and community organisations had a detrimental effect over time.

Interviews with 9000 people over a period of four years provided the data for the study, showing any change of activity and experience of depressive symptoms. LSE epidemiologist Dr Mauricio Avendano said the only activity associated with sustained happiness was attending a church, synagogue or mosque.

"The church appears to play a very important social role in keeping depression at bay and also as a coping mechanism during periods of illness in later life. It is not clear to us how much this is about religion per se, or whether it may be about the sense of belonging and not being socially isolated," he said.

By contrast, joining political and community organisations only provides short-term benefits in terms of mental health and seems to lead to an increase in depressive symptoms longer term.

"Participants receive a higher sense of reward when they first join an organisation but if it involves a lot of effort and they don't get much in return, the benefits may wear off after some time," Dr Avendano explained. Similarly, the study did not find any short-term benefits from sports and participation in other social activities.

The researchers cannot say for sure that religious participation causes reduced depression and suggest further study. If a causal relationship is proven, however, it means, say the researchers, "that policies encouraging or enabling older persons to maintain their affiliations with religious communities … may result in reduced levels of depressive symptoms among older persons."

So here is what the doctor should order: Have a healthy diet, exercise and don't smoke. Foster family bonds. And go to church. Those three things would go a long way to making older age a bonus rather than a burden.