The PHG Foundation is considering the ways in which the health system and wider society will need to adapt to make optimal use of emerging technologies through our My Healthy Future initiative. Through the lens of four different life stages, we have been exploring the challenges, opportunities and impacts these technologies may present in 20 years’ time.
All about ageing
We have a rapidly ageing population, and with estimates that nearly 1 in 4 people in the UK will be over the age of 65 by 2040, the final life stage we have been considering, that of ‘healthy ageing’, is more pertinent than ever before. Given this demographic transition and the strain that it puts on our health system (in common with other countries), it is essential that we consider what constitutes healthy ageing, and what individuals and society can do to ensure that older adults are maintaining their physical, social and mental health.
Having achieved significantly greater longevity in recent years through advances in modern medicine, the arguably harder task of optimising quality of life in later years has come under increasing scrutiny. The drive to live longer has been replaced by the drive to live ‘better’ (fuelled by the prevalence of chronic disease). The Office for National Statistics estimates UK life expectancy at 82.9 years for women and 79.2 years for men, however on average over 17 years of this is spent in poor health. It is hoped that new technologies could help to transform these final years of life.
What do we mean by ‘healthy ageing’?
Ageing is often viewed as a time of inevitable decline, a concept linked to notions of illness, frailty and isolation. As a counter to these negative connotations of older age, healthy ageing centres on holistic notions of well-being. Healthy ageing is not just about disease prevention and extending life; it is about creating the environments and opportunities that enable people to be and do what they value throughout their life into later years. As such, we need to reframe outcomes for healthy ageing beyond the essential basic activities of daily living, to explore the potential to gain new skills or be exposed to fresh opportunities. Being able to walk a certain distance or having a certain level of cardiovascular fitness is not so valuable in and of itself, but by the way in which it can broaden an individual’s horizons or enable them to continue with or enhance activities that are meaningful to them (e.g. walking the dog, volunteer work etc.)
Key features emerging from our research as relevant to ‘healthy ageing’ include:
Resilience
Being free of disease or infirmity is not an absolute requirement of healthy ageing. The same mechanisms that govern ageing also underpin age-related disease, making older people more susceptible to chronic conditions such as cardiovascular disease, hypertension and type II diabetes. Biological mechanisms that account for ageing progress and the impact of underlying lifestyle factors accumulate throughout an entire life time, inevitably leading to some degree of physical and cognitive decline. However, many older adults have one or more adverse health conditions or disabilities that, when well controlled, have little influence on their wellbeing. Therefore, whilst integrated technologies such as nonintrusive home sensors and novel biomarkers to aid prevention and early detection will be vital to healthy ageing, equally important will be monitoring/assistive technologies that help people to live independently, minimise adverse events and further deterioration. Recognising this, the concept of healthy ageing is inextricably linked to the notion of resilience – “the ability of individuals to ‘bounce back’ or maintain a high level of functioning despite these challenges”. A healthy ageing society is not one entirely without falls, dementia or multi-morbidity, but it is one where people are equipped with the knowledge, tools, and formal and informal support networks to cope with these challenges, and mitigate the effect on well-being.
The 100 year life?
Integral to modern conceptions of ageing are the opportunities created through the 100 year life; the theory that human longevity will prompt a societal restructuring, enabling individuals to live in accordance with their preferences, abilities and circumstances.
A child born in the UK today has more than a 50% chance of living to be over 100 years old. In light of this projection, the life structure that emerged in the 20th century – that of education, employment, then retirement – is less feasible when citizens are likely to live another 40 years following retirement age. A way around this is a multi-stage life, interspersed with learning, breaks and transitions into different professions. In one stage, the focus may be on accumulating financial assets, in another creating a better work-life balance that allows you to spend time with your grandchildren or pursue other hobbies or work that is not necessarily paid employment. It was suggested that these changes could in part be guided by personalised technologies that help support individuals to learn from their own ‘life story’ (i.e. what do I enjoy doing now and how can this be adapted for when I am older?) At its best, it offers people an opportunity to explore who they are, pursue multiple interests, and arrive at a way of living that accords with their personal values.
Proactive lifetime planning
It is envisaged that new technologies combined with a shift in public perceptions will enable these objectives to be realised. For example, even adults struggle to think about the future, but lifetime planning should ideally be encouraged from school age. The 100 year life encourages adaptation to changing circumstances, embracing variety and engaging with what is important to you at different stages of your life. With this in mind, technology developments should be harnessed to support the way we wish to live. Machine learning ‘life assistants’, ‘smart’ home monitoring tools, and digital scaffolding to enable continued access to personalised support following an adverse health event may help maintain independence and allow individuals to continue living in their own homes. Isolation and loneliness, alarmingly common amongst older people, could be reduced through digitally enabled care support networks and the promotion of community interaction.
The potential for many of us to live longer and heathier lives is undoubtedly there, but realising the vision will require not only innovative science and technology but also social dialogue and far-sighted policy development to ensure that we are able to make the most of these opportunities.