The lost decade: how to live longer and healthier in old age

Some people experience a new lease of life in their 70s and 80s. Photo / 123rf

One of the most inspirational people I've encountered in recent years is an American woman who is, I believe, the oldest stewardess in the world.

Aged 84, Bette Nash has been flying for more than six decades: these days she serves customers on the American Airlines shuttle between Boston and Washington DC. She seemed surprised when I asked her for her secret.

"When I think about it now," she said slowly, "I think my goal in life is to keep moving."

Without knowing it, Bette turned out to have been following three of the tenets of the old-age lifestyle gurus: keep active, retain your sense of curiosity and connect with people. She doesn't go to the gym, and she admits to eating chocolate, but it's clear that the thrill of the job has never palled.

She reminisced about the time she flew with Jackie Kennedy, the former US first lady, in 1965. In those days, she said, the stewardesses wore white gloves and wrote the tickets by hand. The technology has changed since then, but "the people are the same", she said. "I thrive on people."

Is Bette Nash old? "I don't feel like I'm an old person," she told me. "My sister has Parkinson's and dementia and I look at her and think she's old, but she's younger than I am."

Bette is one of a new group of people, in their 70s and 80s, who are healthy and active, have much to offer and are living in what I call Extra Time - an extended middle age. In Illinois, researchers have found that septuagenarians who are still exercising after taking up running in the Seventies are now biologically 30 years younger than their chronological age - aerobic activity being a "miracle cure", according to the Academy of Medical Royal Colleges, due to its protective qualities against stroke, heart disease, some cancers and even dementia.

Healthy eating and exercise are both big factors in living longer. Photo / 123rf

We are now seeing stark and growing differences between groups in terms of both lifespan - the number of years we can expect to live - and healthspan, the number of years lived in good health. A shocking new report published last week by Sir Michael Marmot, the director of the UCL Institute of Health Equity, finds that this gap is getting bigger.

Life expectancy has stalled in England for the first time in 100 years, and gone into reverse for poorer women in deprived areas, including some of the so-called "red wall" constituencies in the North East that voted for Boris Johnson. A girl born in one of these deprived areas in 2017 will live on average three months less than one born in 2012; in that same time period, by contrast, a boy born in one of the richest areas is set to live on average three months longer.

There is now a gap of almost 12 years in the healthspan of the richest and poorest people. The UK is not alone. Growth in life expectancy has slowed in many rich countries since 2011, as the dramatic improvements achieved by the cessation of smoking started to fade.

However, of 16 countries in the Organisation for Economic Co-operation and Development (OECD), the UK, US and Iceland performed worst. Between 2011 and 2017, Estonia witnessed an annual improvement in life expectancy that was three times better than Britain's. What is going on?

The Marmot review places most of the blame on government austerity. Sir Michael has previously demonstrated that people who work in insecure jobs, and have little control over their lives, have high levels of cortisol, the stress hormone associated with coronary heart disease; and his new report points to factors including poor housing, low incomes, zero hours contracts, cuts to Sure Start centres and air pollution.

Yet the country-spanning nature of the issue seems to show that there are more factors at play.

Size matters

The report makes little mention of obesity, although it is associated with many of the chronic diseases that hit the poorest hardest, including type 2 diabetes and heart disease. The authors believe that obesity is a consequence of poverty, and it is certainly true that deprivation makes cheap junk food, cigarettes and alcohol harder to resist.

But that's no reason to lie supine in front of the junk food merchants. The life chances of the poorest children would be improved if the Government extended the sugar tax on fizzy drinks, which has led to a 28 per cent reduction in the average sugar content of those products, and banned junk food marketing.

People age better when they have strong social connections with other people. Photo / 123rf

More schools could adopt the "daily mile", invented by a Scottish head teacher to improve her pupil's health with a fun daily walk or jog, which requires no special equipment. Some GPs are already practising "social prescribing": trying to tackle underlying psychological issues, for instance by referring people to a dance class, rather than just handing out a pill, and this should be expanded.

Alone, but not lonely

Does loneliness play a role? We know that people age better - like Bette Nash - when they have strong social connections. Yet two weeks ago, a chilling report by the UK's Office for National Statistics suggested that "social capital" is declining dramatically. Communities are fracturing; neighbours have fewer positive interactions with one another; people are joining fewer clubs and societies and spending more time online, which does not bring the same level of interaction.

We urgently need to build new support networks - not least because we are running out of children. This year, the number of people aged over 65 in the world has outstripped those under five. This changing ratio of old to young means we cannot always rely on "family". In Denmark and Germany many older people live in co-housing developments, with people who share a common philosophy.

More of these schemes in Britain could augment brilliant initiatives such as HomeShare, which enables older people to rent out a room to a student. In Germany, grandparents are even "adopting" single parent families who are not blood relatives. We need more of these intergenerational schemes.

Right direction

Having a sense of purpose is also strongly correlated with better health. In Japanese culture, the concept of "ikigai", or "reason for being", plays an important role in Silver Centres, organisations that find part-time work for elderly people.

I have seen 90-year-olds using their calligraphy skills to write official certificates for companies; others clean parks or pack goods for local businesses. The chance to be useful and have a gossip is a lifeline. In England we are good at putting on coffee mornings, but perhaps need coffee mornings with a purpose.

There could be no starker indication of the North-South divide than the growing gaps in health and life expectancy. If the Government is serious about "levelling up", it must go beyond infrastructure to tackle health inequalities.

Bette Nash, and those like her, show that the 21st century offers huge opportunities to live longer, better lives; indeed Prof James Nazroo, at the University of Manchester, has found that it is only when they turn 80 that the richest third of Britons begins to experience the kinds of limitations, such as in walking, that people in the poorest third suffer from around 70.

Many of the better-off are making the most of Extra Time. But unless we spread that opportunity to everyone, our society will be the poorer for it.