Live longer, live healthier

The United Nations has declared this to be the decade of healthy ageing, shifting its approach from not only treating and preventing disease, but also to focusing on a range of contributing factors to health and wellbeing.

Since the mid-20th century, life expectancy across the globe has increased.

There is no doubt that people are now living longer – but the question is, how much of these longer lives are we living independent and illness-free?

In the UK, both men and women are expected to reach close to 80 years of age, which is almost a decade longer than was expected 50 years ago.

Although life expectancy itself has steadily been increasing, there has been little progress in improving healthy life expectancy – or years lived in good health.

With that in mind, experts from Manchester Met say it is time to think not just about quantity of years, but also quality – helping more people live well into old age and importantly, with the ability to still live their lives to the fullest.

So how can quality of life be extended? Experts say everything from a combination of societal changes and public health interventions are needed – right down to enabling people to be more active into older age.

An increasingly unhealthy population

“There is a lot of focus on living longer, and perhaps not as much focus on living healthier for longer,” said Rachel Cooper, Professor of Musculoskeletal Epidemiology at Manchester Met’s Institute of Sport.

“We should be ensuring we not only reach old age, but that we continue to live independently and maintain a good quality of life into old age as well.”

Bill Ollier, Professor in Epidemiology at the University agrees that people are not necessarily living healthy lives for longer, and much of this is due to the increasing prevalence of long-term health conditions.

In fact, he says that in the UK we are currently facing a national health crisis, with more and more people suffering from obesity, diabetes, and other chronic illnesses each year – all of which have a significant impact on quality of life.

Prof Ollier said: “Life expectancy has been steadily increasing for some time – though this did stall in the years even before the COVID-19 pandemic – but the gap between length of life and quality of life has not been closing at all – if anything that gap is only widening.

“What has caused this? Well, what we currently have is a multitude of chronically ill people – a population that is increasingly unhealthy for a range of reasons.

“Often these people have multiple conditions that need ongoing treatment for years and even decades, and because of that they have a decreasing quality of life.”

Prof Ollier explained that there are many complex reasons for this decrease, including sedentary behaviour, poor nutrition, smoking and alcohol consumption, as well as stress from the ever more hectic lives we live, and things like exposure to air pollution.

He said: “Essentially, all of these factors are making the health of our population more fragile, and this has very clearly been demonstrated by the devastating impacts of the COVID-19 pandemic, where if you look at the death rates, they are staggeringly higher in people with existing long-term conditions.

“If you look at diabetes or respiratory conditions like chronic obstructive pulmonary disease, or cardiovascular disease, or people who have obesity, death rates from COVID-19 are much higher in those people.

“We must also look at our legitimately failing public health and disease prevention infrastructure.”

Postcode lottery medicine

Experts say that where chronic longterm conditions are reducing the number of years people are living in good health, there are also certain groups who are more likely to suffer from these conditions – showing the stark health inequalities between different groups within society.

“Something that is also very evident is that a lot of the risk factors that impact health as we get older are  socioeconomically patterned,” said Prof Cooper.

“What this means is, it is often those from more disadvantaged backgrounds that are not only living shorter lives, but that are living more of their shorter lives in poor health and with lack of independence.”

Prof Ollier refers to the differences in health across society as ‘postcode lottery medicine’, saying that public health data proves that levels of deprivation relate directly to the prevalence of certain illnesses.

He said: “Where you live has a direct correlation to not only how long you might live, but also how long you will live illness free.

“This clearly goes back to those risk factors – things like smoking, drinking and stress – which people living in more deprived areas are more likely to do and experience.

“We know that there is a North-South divide in terms of life expectancy, but even within cities there are huge differences. Let’s take London for example, there are areas and pockets within London where there is great deprivation and that strongly correlates with poorer life chances, shorter life expectancy and a shorter health expectancy.”

Health should not just be the absence of disease, but the satisfaction of all human needs.

In fact, data shows that people living in the most deprived areas of the country spend nearly a third of their lives in poor health, in comparison to only around a sixth for those living in the most affluent areas.

Everything from being less able to afford nutritious food, to being more predisposed to smoking and drinking is impacting the health of those living in less prosperous areas.

Prof Cooper explained: “Take a risk factor such as smoking. Thanks to public health interventions the prevalence of smoking, and hence its health impacts, have declined.

“But when we look at the socioeconomic patterning of smoking there is a striking difference between groups, with those from more disadvantaged areas more likely to smoke and therefore more likely to see its negative impact on their health.”

Prof Ollier added: “It’s easy to assume that if people are not as wealthy, they are more likely to be malnourished – but it is actually the opposite.

“When you have very little money, the food you can more easily afford to buy is more likely to be high in calorie and low in nutrients, which is why more often than not, obesity mirrors deprivation.”

Increasing someone’s chances of ageing well

Eat better, exercise more, stop smoking, drink less – increasing your chances of living a longer and healthier life might sound simple. But experts say that changing someone’s behaviour to age well is not just a case of telling people to do better – particularly those who face additional challenges due to their socioeconomic position.

Prof Cooper explained: “Some of the key, impactful behaviours associated with healthy ageing include physical activity and not being sedentary.

“We know this and have evidence this works, but the challenge is knowing how to use this information and best implement interventions.

“So, it’s not as simple as telling someone, ‘You need to be more physically active’ and putting that onus on them.

“You need to have the resources and environment where this is possible, and this is where we see massive differences in different groups in being able to take this action.”

Prof Cooper explained that if you live in a greener part of the country with nice accessible places to exercise outdoors – or if you have money and time to go to gyms and fitness classes – then you’re more likely to be physically active than someone who might be living in an inner-city area with no access to facilities or resources for these.

“So, you can see that support needs to be given at a society level as well as on an individual level,” she said.

Prof Ollier also argues that tackling this national health crisis will take big changes across the whole of society, with everyone having a responsibility to put health on their agenda.

He said: “We must define health differently. Health should not just be the absence of disease, but

the satisfaction of all human needs.

“That could mean having a satisfactory roof over your head, having access to satisfactory means of nutrition, having a satisfactory education that explains the basis of staying healthy.

“We should also be focusing on delivering interventions to prevent ill health – so interventions before we become sick.

“At the moment, we only really interact with the health services – so our GPs or the hospital – after we are already sick. It’s almost always a reactive process, not proactive.

“The focus of staying well and disease prevention should also be at the centre of every aspect of life – including within government. So, whether it is business, the treasury, transport, urban planning, education, social care or recreation – they all need to have health on their agenda.

“What I mean by this is, they all need to consider potential impacts of what they are doing on the health of the population and also how it can play its part to improve health.”

How can we master ageing well?

But what about those individuals who seem to have mastered the art of ageing well?

Hans Degens, Professor of Muscle Physiology at Manchester Met’s Institute of Sport, says that we may find some of the answers to the question of ‘how do we live healthier (and fitter) for longer?’ by looking at those who are doing it – master athletes.

In last year’s Tokyo Olympic Games, Oksana Chusovitina made history as she became the oldest ever woman to compete in Olympics gymnastics, at the age of 46 years.

And she isn’t the only sports person who has managed to maintain peak physical fitness beyond what are considered her prime years.

But what can this tell us about ageing well?

Prof Degens explained: “Our research has proved that as we get older our muscles become weaker and slower and as a result, we lose some of our ability to perform daily activities.

“But one of the big questions I have asked during my career is ‘to what extent is the impact on our muscles related to becoming less and less active?’

“Because the older you get – and we see this in all kinds of species, not just humans – the less and less active you become.”

Competing into older age, master athletes have managed to find a way to maintain a high physical performance and appear sometimes physiologically as much as 30 years younger than their calendar age suggests.

Prof Degens said: “Master athletes stay highly active into old age.

“Our research has shown that their performance remains high, even as they age. However, even though they are still performing at a higher level than the average person, as they get older they still experience the same kind of decline in physical factors as anyone else.

“So they still lose as much muscle mass, strength and fitness as the average person would.”

But thankfully its not all bad news, as Prof Degens believes that by learning from these individuals and training more and being more physically active, while we cannot stop the ageing process, we can still improve our health and fitness at any age.

He explained: “This will help us extend our quality of life and continue to undertake everyday activities for many years.”

Experts say walking at pace, climbing the stairs regularly, and adding weight when undertaking everyday activities can all help build endurance and slow the signs of ageing on our muscles.

Prof Degens added: “Now anyone can do this, regardless of your socioeconomic background, regardless of the age you are starting at.

“As long as you aren’t so far down the line that you are no longer mobile, there are measures everyone can take to improve health factors, maintain independence and extend quality of life.”