How should policymakers respond to the new challenges and opportunities of ageing in Scotland

“How should
policymakers respond
to the new challenges
and opportunities of
ageing in Scotland”
David Sinclair, International Longevity
Centre – UK @ilcuk @sinclairda

The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.

ILC-UK Planning Tomorrow, Today
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think tank
evidence based
policy focussed
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independent
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experts
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Who do we work with?


Our focus is broad


Summary
Life expectancy continues to grow
4 reasons to worry
Opportunities
6 final trends
Policy priorities for Scotland?


Life expectancy is increasing
In the UK, life expectancy at birth is
expected to increase by 7 years for
men and 6.7 years for women
between 2010 and 2060.
Within the EU, life expectancy at
birth is expected to increase by 7.9
years for men and 6.5 years for
women between 2010 and 2060.


And we might be underestimating
• The IMF warns that, based on past
underestimations, it is possible that
current global longevity projections
could be underestimated.
• If longevity projections are being
underestimated, this could add
between 1.5% to 2% of GDP to the
annual costs of pensions in countries
with advanced economies by 2050


Impact of the global economic downturn
EU GDP growth is expected to be 1.4% per year
between 2010 and 2060 compared to 2.5% for the 10
years 1997-2006.
More difficult for the state to pay for longevity:
Employment and productivity falling; falling tax intake;
more difficult to meet debt obligations; difficulties in
funding public pension systems
And for the individual: Unemployment, reductions in
wages, or reductions in hours worked, make it more
difficult to save adequately for retirement; Falls in
value of pension pots; Price inflation has been high.

Why should we worry?
4 reasons to worry
– Oldest old
– The cost of ageing
– Isolation and exclusion
– The squeezed middle aged
But opportunities
– Prevention (Vaccination nutrition pa)
– Housing
– Working longer
– Health developments and new technology

Challenge 1: Oldest old
Growth in the number of oldest old


How many centenarians are there?
 There are currently
11,800 people in the UK
who are currently at least
100 (DWP)
 There are fewer than 100
people who are aged
more than 110. (DWP)
 In 1911 there were just
100 Centenarians living in
England & Wales
 Growth 7% p/a

Life is not easy for the oldest old
 Three quarters of the oldest old suffer
from limiting longstanding illnesses,
and one out of three perceive
themselves as being in poor health.
 “almost 50% of men and women aged
80-84 report severe limitations in
activities” (IFS, 2010)
 Sixty per-cent of over 90s report
difficulties shopping for groceries, and
35% report difficulties managing
money.

http://www.flickr.com/photos
/pondspider/4170990903/size
s/m/in/photostream/


Health of the oldest old
 A very high proportion of centenarians
use drugs
 Some evidence of longer hospital stays
 23% of those aged 85 and over had levels
of clinical depressive symptoms 60% of
interviewees aged over 90 had had a fall
and that of these, 4 in five were unable to
get up after at least one fall
 Dementia between 50% and 100%
 98% of centenarians and near
centenarians consulted a GP

Poverty is a very real challenge
 The oldest old (aged 85 and
over) are, as a group, at
greater risk of poverty than
younger older people (aged
65-85). Up to 10% of the
oldest old have total net
wealth of £3,000 or less.


The oldest old remain the most excluded
 Almost 38% of
those aged 85 or
older faced some
kind of social
exclusion, an
encouraging
decline of 10%
from the 2002
levels


OAP recovering after getting trapped in bath
for 5 days


Challenge 2:
Cost of ageing
In the UK: age-related
spending is projected to
rise from an annual cost of
21.3% to 26.3% of GDP
between 2016/17 and
2061/62, a rise of 5% of
GDP (equivalent to a rise
of around £79bn in
today’s money).


Trends in healthcare
As a result of a growing older
population, increasing longevity and a
greater coverage of public health care
within the EU the pressure on public
health care funding is likely to continue
growing. Public health spending in the
EU currently accounts for 14.6% of total
government spending, around 7.1% of
GDP.

Healthcare costs
• In the UK: spending on health care is projected to see the
largest rise of all elements of age-related spending, rising
from an annual cost of 6.8% to 9.1% of GDP between
2016/17 and 2061/62, a rise of 2.3% of GDP (equivalent to
a rise of around £36bn in today’s money).
• In the EU: spending on health care is projected to rise from
an annual cost of 7.1% to 8.3% of GDP between 2010 and
2060, a rise of 1.1% of GDP.
• Globally: it is difficult to project the costs of health care
because of the lack of data from developing countries. But
evidence of growing numbers with long term conditions.

Spending on health care will see the
greatest increase of all age-related
spending over the next 50 years

Projected health care
spending as a
proportion of GDP


Long term care costs
• In the UK: spending on long term
care is projected to rise between
2016/17 and 2061/62 from an
annual cost of 1.1% to 2% of
GDP, a rise of 0.9% of GDP59
(equivalent to a rise of around
£14bn in today’s money).
• EU spending on long term care is
projected to rise from an annual
cost of 1.8% to 3.4% of GDP
between 2010 and 2060

Pension costs
• UK spending on public pensions (state
pension, pensioner benefits and public
service pensions) is projected to rise
from an annual cost of 8.9% to 10.8% of
GDP between 2016/17 and 2061/62
(equivalent to a rise of £33bn in
today’s money). These assumptions do
not include consideration of the impact
of a single-tier pension.


Challenge 3: Isolation and Exclusion
Increasingly living alone - isolation
50 per cent of the
1960s cohort will be
living alone at age 75
compared with 37 per
cent for the 19161920 cohort and 41
per cent of the 1940s
cohort

(Evandrou &
Falkingham, 2000).


Living together is good for us
 Those who moved from living alone to living
as part of a couple (with no children)
exhibited a 68% fall in the odds of becoming
multiply excluded between 2002 and 2008
compared to those who stayed living alone;
 Those who moved from being resident in a
couple household to living alone were over
three times more likely to become multiply
excluded. For this age group (50+),
becoming a widow is one of the most
common reasons for starting to live alone.

http://www.flickr.co
m/photos/anabadili/
2963913137/sizes/m
/in/photostream/

Exclusion from Cultural Activities


Exclusion from Local Amenities


Exclusion from Decent Housing and
Public Transport


Challenge 4: The squeezed middle age
People in their fifties increasingly
excluded from society
The number of people aged 50 plus
being socially excluded from decent
housing, public transport and local
amenities has risen sharply
Over one in six people in their fifties
(18%) were socially excluded in two
of more areas of their life – up from
13 per cent in 2002.


Britons ageing quicker than their parents


Will the baby boomers demand change?
“They have fewer ties to family
responsibilities... With their homes paid for
their major housing concern is for property
taxes and repairs... Being essentially free
from obligation, they may spend their income
and assets as they wish. Here is a potential
market, therefore for those marketers who
wish to appeal to it. It is a new market,
almost unrecognised which must be
developed with care as it depends upon the
changing role of older persons in our society
and the realisation that they are more free
than their predecessors in the past century.”

Will the baby boomers demand change?
“They have fewer ties to family
responsibilities... With their homes paid for
their major housing concern is for property
taxes and repairs... Being essentially free
from obligation, they may spend their income
and assets as they wish. Here is a potential
market, therefore for those marketers who
wish to appeal to it. It is a new market,
almost unrecognised which must be
developed with care as it depends upon the
changing role of older persons in our society
and the realisation that they are more free
than their predecessors in the past century.”

Dodge,
1962


Convenient myth of the elderly hedonist
The elderly have had a recent makeover, as appears in the 70-is-the-new-50 cliche….The
impression is one of elderly hedonists – more people in their 60s are getting divorced
and starting a new life; line-dancing, gymnastics and dating agencies, going from holiday
to holiday; concessions, free passes and cheap tickets. The OAP of yesterday has been
transformed into the swinger who refuses to acknowledge ageing.
In other words, the high-profile, fun-loving elderly consumer has become the contemporary
emblem of old age. This is profoundly reassuring for the rest of us, and it conveniently
dissimulates the image of those who live on into their ninth and 10th decade, consigned to
the low-watt penumbra of the nursing home, or worse, the invisible "shut-ins", as they are
sometimes called, those too timid to go out, who have lost confidence on the uneven
pavements and dizzying shopping crowds; those afflicted by the mysterious paranoias of
old age, trembling each time the doorbell rings and frightened of the unexpected
telephone call; people whose days are marked by boredom and its twin, loneliness; the
companionless meal, the ticking clock and the sound of the electricity meter in the
stillness, while the winter dark presses against the windows by 4pm, the only company the
school photograph of grandchildren with their cheeky smiles and lost milk teeth smiling
against the blue background of a painted summer sky.
Jeremy Seabrook http://www.guardian.co.uk/commentisfree/2010/jan/12/elderly-care-michaelparkinson

Some Opportunities


Dependency is not inevitable
Dependency is not inevitable
and a ”considerable
proportion of the
centenarians maintain a
good level of auto sufficiency
for the basic performance of

http://www.flickr.com/photos/driever/5525684658/siz
es/m/in/photostream/

the everyday life”. (Antonini
et al, 2008)

Some of the oldest old become more active


A move to prevention is vital
 Prevention of ill health
 Physical Activity
 Smoking and alcohol consumption
 Nutrition
 Immunisation
(NUDGE, COMPEL OR EDUCATE?)


Getting housing right
1. Extra care housing is a
home for life
2. Extra care translates
into fewer falls
3. Extra care is
associated with a lower
uptake of inpatient
hospital beds


And how can we make new housing and
communities aspirational?


Dependency ratios are increasing (by 2060)

From around
four workingage people to
around two
working-age
people for
every person
aged 65 (UK)

Working longer – a solution?
The longer that people spend in work, the longer
they have to save for retirement and the shorter their
retirement will be, relative to their working life.
A later average age of exit can also increase the
number of people in work, relative to the number who
are retired, making it easier to fund pensions,
benefits and health and care costs from current
taxes.

We are working longer
 Labour market participation at
older ages (ages 55 to 64) is
expected to increase within the
EU from around 50% to around
67% between 2010 and 2060.
 The average age of exit is also
projected to increase from
around 62 to around 64 within
the EU and from around 64 to
around 65 within the UK
between 2010 and 2060.

Technology limited by imagination


Fantastic developments in health
I think there’ll be a
cure for cancer one
day. That we never
thought we’d see…
and Alzheimer’s.
I would wish for a pill
to cure everything…


A significant association between internet use
and perceived control in one’s life
Uses the internet
Yes
No

Total

Strongly agree
Moderately agree

551 (39.6%) 840 (60.4%)
1515 (51.6%) 1420 (48.4%)

1391
2935

Slightly agree

1545 (59.4%) 1058 (40.6%)

2603

Slightly disagree
Moderately
disagree

636 (68.2%)
593 (77.3%)

296 (31.8%)
174 (22.7%)

932
767

Strongly disagree

268 (71.8%)

105 (28.2%)

373

Chi-Sq= 422.074, df = 5, P=<0.000

Table 1. Feels what happens in life is often determined by factors beyond control

A strong association between the measure of
internet use and measures of loneliness
Uses the internet
Yes

No

Total

Hardly ever or
never

3764 (60.2%) 2489 (39.8%)

6253

Some of the time

1091(51.3%)

1037 (48.7%)

2128

Often

272 (37.4%)

456 (62.6%)

728

Chi-Sq= 166.556, df = 2, P=<0.000
Table 5. How often respondent feels lonely


People who reported not using the internet were
more likely to say that they ‘often’ felt isolated
Uses the internet
Yes

No

Total

Hardly ever or
never

3683 (59.5%) 2503 (40.5%)

6186

Some of the time

1242 (52.6%) 1118 (47.4%)

2360

Often

198 (37.4%)

529

331 (62.6%)

Chi-Sq= 115.871, df = 2, P=<0.000
Table 6. How often respondent feels isolated from others

We must recognise and maximise the
contribution of age
• Labour market participation
at older ages is on the rise.
• Carers of all ages contribute
the equivalent of £119
billion every year in the UK.
• Older consumers (aged 65
and over) spend on
average, around £100bn
per year.
• Older people volunteer.

6 other challenges to think about
 Urbanisation: In the developing world the share of
older persons residing in urban areas will rise from
about 56 million in 1998 to over 908 million by
2050
 The care workforce (role for older people?)
 Challenges of migration
 Climate change/environmental change
 Dementia
 Affluenza (Debt/Obesity)
 A growing culture of “othering” (fear of crime)


Priorities for Scottish policymakers?
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Prevention of ill health (public health)
Get housing right
Using technology to improve service delivery
Focus on the poorest
Create jobs for older and younger people
Be proactive on isolation and loneliness (transport)
Tackle the “Glasgow city” effect. Respond to the
fairness challenge of increasing State Pension
Age?


A question for you
What is the one thing you would do to make
Scotland the best place in the world to grow old?


Many thanks

David Sinclair
Assistant Director, Policy & Communications
International Longevity Centre
Davidsinclair@ilcuk.org.uk
02073400440
Twitter: @ilcuk and @sinclairda

How should policymakers respond to the new challenges and opportunities of ageing in Scotland

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How should policymakers respond to the new challenges and opportunities of ageing in Scotland