LSE IQ Episoe 24
How Can We Age Better?

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Welcome to LSE IQ, a podcast from the London School of Economics and political science, where we ask leading social scientists and other experts to answer an intelligent question about economics, politics or society. 

We are all getting older, not just as individuals but as societies; particularly in the developed world. The middle-income and developing countries are following on quickly behind us. In 1950, there were 14 million people over the age of 80 globally; in 2080, that number is expected to be 700 million. In Britain, a child born today will live for more than 90 years, and more than 30% will reach a hundred. Indeed, Michael Murphy, professor of demography LSE, has said that perhaps the greatest achievement of humanity over the last century is the doubling of the amount of years a child could expect to live from birth. 

Given the extended life spans many of us will live, in this episode of LSE IQ Sue Windibank asks: how can we age better?  

KATE: This is the common house, and everybody- we have 11 units here of townhouses, and everybody owns- they own their own town house, and then they own a portion of the common house. The common house heads two bedrooms and two bathrooms. 

SUE WINDIBANK: So you can have guests come in and stay?

KATE: Yes; if it's somebody that we know, like a family member or a good friend…

KATE: My name is Kate. Last October - I don't know how it happened, but last October I turned 70 - and I was living in Ohio, and seven years ago I packed my Toyota Corolla and drove cross-country to Santa Cruz. I really did not know about co-housing; I kind of heard about it, but I didn't know anything about it and certainly had never seen a co-housing place. I was looking for a place to live and heard about this, and so I decided to come and check it out. 

SUE WINDIBANK: Kate leaves in the New Brighton co-housing community in Northern California. Co-housing communities are intentional communities created and run by their residents. Although we are admittedly near Santa Cruz, with its hippie past and counter-cultural vibe, co-housing is different to a commune. Residents have their own private homes with all the regular amenities, but there is typically a common house where residents eat together a couple of times a week or month, and meet together to manage community activities; including the upkeep of shared spaces, which they mostly do themselves. 

SUE WINDIBANK: So what are some of the benefits of living in this kind of arrangement?  

KATE: Well, it’s an efficient way to live. We share washer and dryer, tools, meals - even our problems or stories, we might confide in somebody - but I think of it as sharing our lives. I've always been a do-it-yourself kind of person; I mean, when our children were small, we did a parent participating nursery school, and I always like to have my hands on things. So I figured with co-housing, that would be kind of along the lines of my personality; also I'm out here with no family, and so I figured that this would be as close to family as I could get. 

SUE WINDIBANK: So what is it like to live here?  

KATE: I feel like it's an old-fashioned sense of neighbourhood, through our participation for the operation of the community. We have a courtyard in the middle, and then we have three buildings around it; and the common house is on the fourth side. So we're really- we're on a busy street, but we're very self- contained; there's no cars in the community. The children can just walk over to each other's houses. 

SUE WINDIBANK: Kate leaves in a multi-generational community and enjoys it that way, but this kind of housing is also being adopted by communities of exclusively older people seeking to enjoy some of its benefits. Kath Scanlon , an assistant professorial research fellow at LSE, explains.  

KATH SCANLON: Well, really the idea of older people's co-housing started in Denmark, and there are lots of established communities in Denmark. I would say they're not as much about providing support for vulnerable older people; they're about older people who want to take control of what their life is going to look like in later years, and they decide that they want to live in a really sociable - and a place with people with like interests and so on - so they'll come together in this community. Some of them are for older people; only some of them will accommodate young people too. 

Probably the best-known one is older - in this country at least - is Older Woman's Co-Housing - the acronym is OUCH - and they're in Barnet, in North London. This is a scheme that opened up recently; it's only been occupied for about three years. It's a very beautiful design, it's won a lot of architectural awards; it's on a triangular site that's surrounded by houses, so it's tucked away and all the homes that are in it look inwards onto their communal garden and space. Now this particular scheme is only for women, and it's only for women- I think the minimum age is 55, but the women who live there are mostly older than that. It took a very long time to come to fruition; the members of the group started meeting now, I think, 18 years ago; so it was a very, very long gestation, and what that meant is that the people in this group - the people who are now living in this scheme - know each other really well. I think that has been one of the fundamental elements of their success, is that they know each other and they trust each other.

SUE WINDIBANK: And you're planning to do some research in this area, aren't you? What are you planning to look at?  

KATH SCANLON: One of the benefits that has been claimed for cohousing - and especially for cohousing for older people - is that it's a way to cut down loneliness and isolation amongst older people. Now we know that's a huge problem everywhere in Western societies; and not only is it a problem in terms of just, loneliness is bad and nobody enjoys being lonely, but it also can lead to all kinds of knock- on effects on mental health and on physical health. So what's often claimed is that living in this kind of intentional community - such as a co housing scheme - means that people are less lonely, that they're more socially active - that they're more physically active, probably - and that should have knock-on benefits for their health, for their longevity, for their engagement in society. Lots of people who've looked at this from a kind of qualitative point of view have said this is great, because it has all these benefits for the people who live here - and benefits for society at large, because health care costs are less and so on - but it's never been empirically studied with evidence to prove this is the case. So we are hoping to be able to look at this over a five-year period and find that evidence; is there actually evidence that living this way has benefits for mental and physical health, and can we quantify those benefits?

SUE WINDIBANK: Given the ageing demographic in this country and many other Western countries, could this ever be anything but a niche solution to some of the issues like loneliness and depression/isolation in later life?

KATH SCANLON: if you're talking specifically about co housing, I think realistically, this is not going to be a mass housing solution for millions of people it. Quite apart from the benefits for older people, there are a lot of practical difficulties with getting these schemes off the ground. It requires enormous dedication and huge amounts of time to do it successfully in the British system, as evidenced by how long it took for the OUCH scheme to get off the ground. Nevertheless, it is a kind of testbed for this kind of solution, where you intentionally bring together people who are not blood relatives - or the kinds of people who would normally live in this kind of group setting; like, say, university students in a halls of residence or something like that. You have this- almost a natural experiment - does forming this kind of community benefit people? - and if we find that it does, then there are other ways of doing it. It doesn't have to be cohousing; there are other kinds of things that we could look at, that could bring these benefits to more people.  

SUE WINDIBANK: Of course, another important issue is that co housing isn't for everyone. Back in California, I asked Kate what kind of person might enjoy living in this kind of community. 

KATE: Well, I think somebody who's a do-it-yourself person; somebody who likes other people. We had somebody living here who was an introvert, and moved in hoping that it would bring her out; and it didn’t, and she moved out. Takes a lot of patience to live here, because everybody does things different ways; and you have to understand other people. You know, I think anytime that you live with other people, everybody has personalities and backgrounds; and you have to just put up with how other people live sometimes. To me, that makes it interesting too. 

SUE WINDIBANK: But beyond the cohousing environment itself, the Kath Scanlon thinks these communities might have lessons that could be applied in other settings. 

KATH SCANLON: Yes, we could apply this in other settings like other residential settings for older people. Well, there's a whole spectrum of housing for older people; from retirement villages for active seniors, to nursing homes and care homes for people who really can't look after themselves. The more care is provided, the less autonomy the residents have, which is not surprising; but that lack of agency and that lack of involvement - about making decisions about things that affect them - is a very strong contrast to a cohousing community where the people who live there decide everything; there isn't any outside management, they are the people who run the place. So we're expecting that we’ll find that they feel happier, and more fulfilled and more involved; and maybe that could be transferred to how these other kinds of settings for older people are run, to give the people who live there really more of an active role in running their own communities.

SUE WINDIBANK: Underscoring how important connectedness is in later life is some research by Thijs Van Den Broek , assistant professor at the Erasmus School of Health Policy and Management in Rotterdam and formerly of LSE.  

SUE WINDIBANK: So you've done some research on depression in later life; what did you actually look at? 

THIJS VAN DEN BROEK: So my colleague 1h and I, we looked at differences in later life depression between Eastern European countries and Western European countries, and what we found was that older people in Eastern Europe tend to have more depressive symptoms than older people in Western Europe.

SUE WINDIBANK: What are the predictors of depression in older age? 

THIJS VAN DEN BROEK: Well, there are many. There's a strong socio-economic gradient; lower educated people tend to have more depressive symptoms in later life than higher- educated people. Also, there are lots of important family factors; childless persons tend to have more depressive symptoms than parents, and also the later- life mental health of people who live with a partner or a spouse tends to be better than those who live alone.

SUE WINDIBANK: So did having children protect people from being more depressed in later life?

THIJS VAN DEN BROEK: Yes, our finding suggests that having children is indeed protective against depression and also feelings of loneliness. The extent to which this is the case is larger in Eastern Europe than in Western Europe; this is also in line with what we expected, because given the erosion of government support for all the people in Eastern Europe, this has actually made their dependence on their own children stronger.

SUE WINDIBANK: In the UK social care is under threat. Is this something that we should be concerned of in the context of ageing?

THIJS VAN DEN BROEK: Well, our research suggests that the extent to which the welfare state actually reduces the extent to which people are dependent on their family for their welfare. Actually, what is associated with the extent to which we find cross-national differences in the links between childlessness and later life depression; so such potential cutbacks might result in larger mental health inequalities in later life, I believe so.

SUE WINDIBANK: Do you think people should be more consciously aware of building community and social capital around them, given the findings of your research?

THIJS VAN DEN BROEK: Well, let me go a little bit beyond my own research when answering this question. I think the answer is yes; loneliness is a big problem for all the people - and mainly for people in very old days, I have to say - and it's associated with mortality and morbidity. So it's increasingly also seen as a public health issue; investing in your social embeddedness would be something to strive for.  

SUE WINDIBANK: Japan is of course at the forefront of the global ageing phenomenon. In 2006, it became the world's first 'super-aged society’, with over 21% of the country's population being over the age of 65. Hiroko Akiyama, professor at the Institute of gerontology at the University of Tokyo, explains what these trends look like today. 

SUE WINDIBANK: So what kind of demographic changes are you seeing in Japan? 

HIROKO AKIYAMA: We are the front-runner of a super society. Already, 28% of that population is aged 65 and older; and by 2030, about one-third of the population will be 65 and older and 20% of the population will be 75 and older, so it's rapidly ageing. And at the same time we are living longer - the life expectancy is 81 years for men and 87 years for women - so we're living longer, but also we are living healthier compared to the previous generations. 

SUE WINDIBANK: People in Japan are actually ageing better than 20 years ago. aren't they? Could you say something about that? 

HIROKO AKIYAMA: Well, Idt that we have secret recipe for long life. So many factors for longevity include, of course, the health and the educational attainment; and financial well-being and social class, and lifestyle choice such as a nutrition, exercise and smoking. So this is for any country; it's kind of an integration of this wide range of factors into the ageing process. I think that Japan's longevity is the result of the integration.

KATE: Some of Professor Akiyama's research looks at retrofitting normal communities, so older people have a better quality of life and find it easier to remain in their own homes for as long as possible. The project is looking at two towns: one, (INAUDIBLE), not far outside Tokyo; and another, (INAUDIBLE), is a more rural community in the west of Japan's main island, Honshu.

HIROKO AKIYAMA: The current communities in Japan, who were built when the population was much younger - so the Japanese population is shaped like a pyramid, so there are many, many children, and only 5% are older people - but now as I mentioned, almost 1/3 of the population is 65 and older. So the current infrastructure; we had an infrastructure like housing and transportation system, and also soft infrastructure such as the education system or employment system, or health and long-term care system. I think we have to look at the current system and rebuild a (INAUDIBLE) infrastructure; six or seven years ago, we started kind of a social experiment to redesign just [an] ordinary community to be [a] community which meet the needs of [a] highly aged society. We started in two (INAUDIBLE) - one in just what we are trying to do is to redesign the community where people of all age shall live for [a] hundred years, staying healthy and active and connected and

SUE WINDIBANK: So what kind of practical changes are you looking at?

HIROKO AKIYAMA: There are many other issues we have to deal with; for example, one is our transportation system, because very soon, 20% of the population will be 75 and older. Many people (INAUDIBLE) experience at driving a car, so we are trying to create the alternative transportation system; and another project is looking creating opportunities for seniors [so they] can participate and work, so actually we are creating many workplaces in the community. And another project; Japan’s education system is very front-loaded, I think they really focus on people under 25 years old. So another project is focused on [a] lifelong learning system, so people can have opportunity to learn for through lifelong.

Another very big project is, of course, health and long-term care; we are trying to create a home-based health and long-term care systems, so a team of different professionals deliver health, medical and also long-term care services to the home. This is really tremendous reform of the long-term care system.

SUE WINDIBANK: These measures are, of course, focused on dealing with people's frailties in later life; but Professor Alan Walker, professor of Social Policy and Social Gerontology at the University of Sheffield, is interested in reframing the way we think about ageing.

SUE WINDIBANK: So you talk about ageing as a lifelong process; what do you mean by that?

ALAN WALKER: Well, I think a general misconception - but also among many social policy analysts - is that when we speak of ageing, we actually mean the period from 60 or 65 to death. I think that is the fundamental misconception of what ageing actually is, because we begin ageing in the womb and it takes place from birth to death. A major problem I think for society, is that we've neglected the fact that what happens to us in later life is largely caused by what we do in early life and midlife.

SUE WINDIBANK: And some of your research actually showed that we have a great deal of personal control over how we age, doesn't it?

ALAN WALKER: Well, I would say that if we think about the ageing process, there is nothing that is under the complete control of individuals - I think it's an individual and societal responsibility - but there is a huge misconception, widely held, that there's a gene for ageing, and actually we can't do anything about it. It's all predetermined; and no matter what we do - whether we smoke, drink, are relatively inactive - it doesn't matter at all, because the great reaper in the sky is going to determine when we die or when we age. That is absolute nonsense. The fact is, there is no gene for ageing; and when you look very closely at what determines how we age, and basically what biologists are concerned with in the ageing process is functional ability - what we can do - and actually that's what most people associate with ageing. So when we talk about being old, it's being not able to get around - not able to do the things that we used to do as younger people - but how that is determined is largely by what are called environmental factors, and not genetic ones. That means behaviour, lifestyle; it means air pollution, it means diet; it means deprivation; so all of those factors account for about four-fifths of the ageing process, and genetics, when it boils down to it, account for only one fit.

SUE WINDIBANK: So why do policymakers focus on old age, rather than ageing?

ALAN WALKER: I think that the neglect of ageing by policy makers is attributable to a number of factors; and frankly, most policy makers have very short time horizons, and for some of them ageing is just too long a period to focus on. It's much easier to contemplate later life and old age; and the problem there is that if they do that, they're always reacting to what has already taken place. You know, they're responding like an emergency service to increasing obesity, or increasing frailty or multimorbidity; they're not intervening at an earlier stage of the life cycle to try to prevent those things. So that that would save money for the Exchequer, but it also would improve the quality of life of older people immeasurably. Then the other big barrier to policy action is the idea of prevention; because if we take a lifecourse approach to ageing, the fundamental fact that we're trying to get across is that we have to prevent those things that we call the inevitable features of later life - those chronic conditions; coronary heart disease, diabetes and so on, we have to prevent them - yet in Britain, and in fact most developed societies, the huge amount of health resources are devoted to acute care and emergency care, not to preventative care or preventative medicine. And that's like trying to turn around a huge oil tanker at sea; it will take a massive amount of effort, and the policymakers do not seem to be interested in embarking upon that huge effort.

SUE WINDIBANK: What would a whole life core strategy look like?

ALAN WALKER: Well, if we wanted to implement social policy for the life course - which was aimed at preventing, as far as possible, all of those chronic conditions associated with later life - I think we would need to start at the very earliest point. Of course, with foetal health, ensuring the very best maternal care for women - particularly because inequality shows itself in cumulative waves across the life course - particularly ensuring that those who are most deprived get the best possible care. Then in childhood, we have to ensure that children have the very, very solid foundation on which to grow the rest of their lives. They have to be taught, for example, about the importance of activity and good diets; they have to be taught that they're likely to live to be a hundred years old, and if you're going to live that long you have to look after your bodies as well as you can. We need then midlife policies; particularly at the workplace, because many jobs create the conditions which lead to disability in later life. They wear people's bodies down; they cause excess tension and stress, which is also a major factor in needing to chronic conditions in later life. And then I would say also, we need a remedial policy for those people who reach old age, but they haven't undertaken all of those preventive activities; and society hasn't acted to try to enable them - empower them, if you like - to be more active and to take better care of their bodies of their life courses. So then we need remedial action; we need prosthetics, we need changes in the environment to enable people who are frail or have chronic conditions to become included in society, and not excluded. So you see, what I'm talking about is a complete life course approach; and it needs to be a radical life course approach.

SUE WINDIBANK: I think I've read some of your writing, where you've described longevity as potentially an asset socially and economically. What do you mean by that?

ALAN WALKER: I think that most policymakers across the Western world regard the ageing population as a problem; and in particular they regard it as an economic problem, and that's basically the starting point for most political discussions of later life. I think that is fundamentally wrong; and it's a road to nowhere, because the populations are ageing and there is no alternative to population ageing. We can track the ageing of Western society back to the 1840s, and it's been linear; so there isn't an inexorable increase in longevity. As societies, we need to respond to that; and I think one of the ways we do that is say, ‘Well, in what ways can we turn what’s seen as a burden, negative terms, into something much more positive?’ And the positive is this; that because we have an ageing society - we have an ageing workforce - and particularly in those countries where immigration is a big political issue, there is no alternative but to make better use of their ageing workforce. Employers are not doing that, not at all; and they have in the past of course relied on rejuvenation - getting more young people in - but ageing means there are fewer young people. So in a nutshell, the future productivity of countries like Britain rests heavily on how we utilise the skills and experience of an ageing workforce; yet in most workplaces, people get trained only at the early stage of their careers, and then basically they're left to fend for themselves. So we need a life course approach to education and training; lifelong education, lifelong training. 

Then there's the other side of the ageing process; and that is those people who have frailty or have difficulty, they need to be helped. There are all sorts of possibilities for new technologies to assist people with frailty, to assist their carers, to take better care of them and to do so remotely. So I think there are lots of possibilities for increased productivity and increased economic growth in the ageing of the population.

SUE WINDIBANK: This brings us onto the contentious topic of working into later life, and the increasing state pension age in the UK and other countries. In the UK under current law, the state pension age is due to increase to 68 between 2044 and 2046. Following a recent review, the government has announced plans to bring this timetable forward, with the state pension age increasing to 68, between 2037 and 2039. Here's Alan Walker:

ALAN WALKER: Well, I think there's a simple fix to the ageing of the population that most policymakers have tended to grab on to; and that is, we can cut the cost of pensions by simply increasing pension ages. Across all European countries - and in fact, most of the Western world - policymakers decided that is their quick fix; and the problem with that quick fix is not that people are living longer, therefore, they potentially have the capacity to work longer. The big problem is inequality. There are some people who have the capacity to work longer, and there are many of those people who want to work longer. So for example, there are more than a million men in the British labour market are over pension age, and most of those are there because they want to be there; they want to continue working, don't want to give up. Okay, there may be some push factors involved such as low income; but I think for a large proportion of them, there's voluntary, additional work. But then the other side of the coin is those people who have worked in jobs intermittently with long periods of unemployment, or have been in arduous labour; and they are simply not able to work longer. So if you push the bar up, you make the lives of those people who cannot compete, cannot work, so much harder; and all of the research evidence shows that psychological distress is increased when you increase pension age among those people, who simply cannot respond to the increase in pension age.

SUE WINDIBANK: In Japan the retirement age is relatively young, although Prime Minister Shinzō Abe has said he wants to raise it beyond 65 and allow people to defer their pensions beyond 70. I asked Hiroko Akiyama about this.

SUE WINDIBANK: So now I think many companies in Japan retire people at 60, and there's an option to carry on working …’til 65; is that sustainable?

HIROKO AKIYAMA: No, I don't think so; because already we experience a shortage of a labour force, because fertility is very low, quite low. It's really not sustainable, and we have to come up some strategy to people (INAUDIBLE) who are seniors who contribute to the labour force. As I mentioned we are living longer, but also we stay healthier in old age; so from the beginning, about 80% of Japanese seniors are healthy until mid-70 - and actually we can expand that age to age 80 - so (INAUDIBLE) ‘we like to see’, 80% of the Japanese seniors are functionally healthy, and also 70% of the Japanese seniors are willing to work. They actually prefer being part of the contributor to the society, rather than just (INAUDIBLE) ‘disabled’ pensions.

SUE WINDIBANK: We all age and become frail differently; perhaps if you're a professor, your health might be slightly different than if you have a very manual job. Is there a danger that increasing retirement ages will leave some people in poverty in later life?

HIROKO AKIYAMA: Well, in my view, it would not be wise to raise the retirement age; I think that we need more flexible work arrangements, because (INAUDIBLE) people mean after 60 or 65 - like, the second half of the marathon race, it's really - I mean, people are diverse in terms of physical and cognitive abilities; and also the time they have free. Because some people might be taking care of their parents or spouse, or taking care of grandchildren; and so some people work through time, but some people, their time is more limited. So I think we have to come up with a more flexible work arrangement, so everyone can work within the capacity they have. So raising retirement age is not wise, first of all, I think in terms of productivity and safety.

SUE WINDIBANK: I asked our interviewees to sum up how they thought we could age better, either as individuals or as a society. Here's Thijs Van Den Broek:

THIJS VAN DEN BROEK: Well, there are probably many answers to this question; but something that I would like to point to is the reduction of barriers to upward social mobility, because we know research shows that people who grow up in a family of lower socioeconomic status tend to also have, even in later life, poorer mental health. But this is largely due to the fact that they end up having lower education, lower socioeconomic position in adulthood themselves; so if we would manage to enable these people to climb up the socio-economic ladder, then this also might come with substantial later life mental health benefits for them.

SUE WINDIBANK: Alan Walker focuses on an area that most of us have some control over: 

ALAN WALKER: If we want to age better as a society, I would say the one thing we can do is to ensure that we remain active across our lifecourses. Now that doesn't mean extreme activity; I’m talking about mild to moderately active. If we do that, then everyone is going to have, on average, a more healthy later life.

SUE WINDIBANK: Great; I'm going to be doing an extra lap around the park at lunchtime then!

ALAN WALKER: Are you are a park lover?.

SUE WINDIBANK: I’m a park walker!

SUE WINDIBANK: Here's professor Hiroko Akiyama:

HIROKO AKIYAMA: I would say, keep socially engaged.

SUE WINDIBANK: And this is something that Kath Scanlon concurs with:

SUE WINDIBANK: How can we age better?

KATH SCANLON: By staying active; by maintaining a wide group of friends of all ages, not just amongst our own age group - I say as an incipient older person; I hope to someday become an older person, and indeed an extremely, extremely old person - and I think the way to do that is by remaining active, remaining intellectually engaged with whatever it is that interests you; and really staying out in the world, rather than retiring to the comfort of BBC Four and Netflix.

SUE WINDIBANK: In the New Brighton Cohousing Community in Santa Cruz County, it's dinnertime.

KATE: There's a big thing here; I don't know about in England, but there's a big thing about seniors being lonely, not having the socialisation. And that's something that here, everybody is very social; at a minimum we get together twice a week for dinner, but also just walking across the courtyard we'll run into people, and you know, chat. I think it's very hard to be lonely here, unless you don't leave your door.

SUE WINDIBANK: How do we age better? Tell us what you think using the hashtag #lseiq. A big thank you to Kate and the New Brighton Cohousing Community, who graciously allowed me to look around and invited me to stay and enjoy dinner with them. 


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