Rethink AgingReading time: about 20 3 minLiving longer in better health: Six shifts needed for healthy aging – Aging Shifts & Strategies* Understanding current aging Adults* Today, the vast majority of adults across the world can expect to live decades past retirement age. The number of older adults will more than double to an estimated 1.6 billion by mid-century, marking one of the most profound demographic shifts in human history. However, while global society should celebrate having, on average, an additional 20 years of life expectancy since 1960, it has not been as successful in extending the span of healthy life. A person on average will live ten more years in medium or poor health, impacting the ability to live life fully and leading to increases in care and dependency. These are real and profound challenges. The McKinsey Health Institute (MHI), however, believes this shift is too often framed in the negative, neglecting the opportunities presented as the shape of society transforms. We suggest expanding from the legacy framing of three phases of life—childhood, adulthood, and old age to encompass healthy aging. Instead, our analysis recognizes the reality that many people will live from two to three decades past their retirement age, where one could choose to be in school at 50 and choose to be employed at 80. Society should focus on capacity, not age, recognizing the potential for many to contribute as volunteers, advisers, community leaders, workers, board members, active family members, and innovators. MHI has identified action on six important shifts that could make it possible for governments, businesses across sectors, not-for-profit organizations, health and well-being stakeholders, and individuals to unlock improvements in healthy aging. These are as follows: - invest in the promotion of healthy aging
- improve measurements of health and get better data
- scale interventions proven to promote healthy aging
- accelerate innovation across the healthy aging ecosystem
- unleash the potential of all industries to enable healthy aging
- empower and motivate older adults to live to their full potential
In this article, MHI examines the effects of an aging population, the framework for holistic healthy aging, and actions that can be taken on the six shifts. By 2050, the absolute number of those older than 65 will more than double to 1.6 billion individuals, growing from 9.4 percent to 16.5 percent of the total population. While this reflects the benefits of additional life span, the magnitude of this growth is unprecedented, and will create challenges as care demands increase and dependency ratios shift. In 1950, for every person over the age of 65, there were 11.7 working-age people. Today, there are seven, and this is expected to shrink to 4.4 by 2040. Certain “superaged” societies, including Italy, Japan, and South Korea, will experience more dramatic shifts. Japan had a dozen working-age people for every older adult in 1950; today, there are roughly two working-age adults, and by 2040 that number may shrink to just above 1.5. All told, the world’s old-age dependency ratio will more than triple between 1950 and 2050. The urgency to act varies among countries, driven by the expected rate of change (Exhibit 1). Countries where populations are aging more slowly—for example, Ghana, which has a projected old-age dependency ratio of 8.4 by 204010—have a slightly longer runway to scale successful initiatives from superaged countries. Still, even for the countries where populations are aging more slowly, the proportion of people over 65 will almost double over the next decades. Image Removed
A healthier, more engaged generation of those over age 65 has the potential to contribute broadly around the world, whether it’s at a professional, personal, or community level. For example, in the United States, the 50-plus age group will contribute $12.6 trillion to the economy by 2030. In the United Kingdom, for example, it is estimated that a one-year extension of working life increases GDP by about one percent. This results in higher spending power and active leisure engagement, which spur new products and services tailored to the specific needs of this consumer group. Within the scope of this article, we focus on the potential of an aging world but also recognize the challenges ahead. For example, the need for greater levels of care will increase, driven by both increases in life expectancy and rates of neurodegenerative diseases, with more than 150 million people globally expected to suffer from dementia by 2050. Informal and formal caregivers and health systems will face increased strain, exacerbating the critical shortage of home health aides and personal caregivers. Similarly, the cost of healthcare globally will rise, from 8.6 percent today to a projected 9.4 percent of GDP by 2050. This economic impact could be magnified by potential reductions in global GDP due to years lost to disability, as well as premature death from age-related diseases. Given these challenges, MHI recognizes that we must examine healthy aging through a lens that encompasses all four dimensions of health: physical, mental, social, and spiritual. Understanding today’s older adults The four dimensions of health are shaped by social and personal influencing factors that support a holistic view of health (Exhibit 2). The importance of a more holistic approach to health has been demonstrated in practice. For example, the Okinawa Centenarian Study, a population-based study of 100-year-olds and other older adults in Okinawa, Japan, found that longevity and health reflected physical activity; a balanced, healthy, and calorie-restricted diet; a sense of belonging and rituals; a supportive social network (moai); and having a purpose to begin each day (ikigai) (see sidebar “Examples of individuals across the globe show that healthy aging is possible”). Image Removed
Examples of individuals across the globe show that healthy aging is possible This concept of health extending beyond physical attributes resonates with older adults. A recent MHI survey found that the majority of older adults think all four dimensions of health are important. Notably, perceived health and quality of life do not necessarily decline with age, underscoring the idea that individuals’ perception of personal health extends beyond the physical. While respondents over age 65 were more likely to have one or more health conditions, two-thirds reported good or very good perceived overall health. Another recent MHI survey focused on understanding generational differences found that 70 percent of baby boomers perceived their overall quality of life as high—eight percentage points higher than Gen Z respondents. The personal and social influencing factors can include how physical and cognitive fitness overlap. For example, numerous studies have shown a link between higher levels of physical activity and better brain health. This includes a 2019 meta-analysis concluding that physical activity, especially that of a moderate to vigorous intensity, had positive impacts on cognition and that physical activity even reduced the risk of developing cognitive disorders, including Alzheimer’s disease. When examining social and spiritual engagement, social scientists have identified social isolation and loneliness as an increasing problem, with rates of reported loneliness in older adults reaching 20 to 34 percent across China, Europe, Latin America, and the United States. According to the US Centers for Disease Control and Prevention, social isolation increases the risk of premature death—a risk that is similar to those seen with smoking, obesity, and physical inactivity. People living in high-income countries enjoy up to a 27-year difference in healthy life expectancy (HLE) at birth, compared with people born in low- and medium-income countries. However, within a country, the HLE can vary widely—for example, in England, people living in the least advantaged areas have a 19-year lower HLE than those in the most advantaged areas. Six shifts to support healthy aging globally MHI has identified six shifts that would be needed to see Summary This regards re-framing of society's view of aging to encompass healthy aging, as the number of adults over the age of 65 is set to double by mid-century. While the addition of an average of 20 years to life expectancy since 1960 is cause for celebration, most of those extra years are lived in poor health, leading to dependence and care needs. There is a possible shift that would not only improve the quality of life of older adults but would also increase social and economic contributions while potentially reducing long-term healthcare costs. The six shifts would include investing in the promotion of healthy aging, improving measurements of health and gathering better data, scaling interventions proven to promote healthy aging, reinventing healthcare delivery models, catalyzing a new social contract for aging, and unlocking productivity and engagement for the aging workforce. Image AddedChart from McKinsey & Co article. Click on the image for the complete article or below. Predictions & Opportunities Implementing these shifts could lead to a step change in healthy aging across the four dimensions of health (Exhibit 3). Image Removed
The burden of aging in older adults could be improved through preventative lifestyle interventions Globally, there is underinvestment in prevention of disease or impaired mobility. For example, European countries invest, on average, 2.8 percent of their health budget on prevention. While the path to healthy aging begins at adulthood, there is much that can be done for individuals in later years. More prevention efforts should be focused on conditions correlated to age, such as dementia and sensory impairments. Other prevention efforts could focus on how adults manage conditions such as depression throughout their lives, how older adults can continue to find purpose, social connections, and financial security, and strategies to encourage lifelong physical activity, even as mobility changes with age. Moreover, previous studies have indicated that prevention programs—both clinical (for example, hearing technology for those hard of hearing) and nonclinical (for example, focusing on improving housing, social connections, and fitness)—can improve the quality of life for older adults, which can reduce the need for medical care over time. Interestingly, only 20 percent of the modifiable contributors to an individual’s health are related to medical care, with nonclinical factors driving the other 80 percent (see sidebar “The burden of aging in older adults could be improved through preventative lifestyle interventions” (Exhibit 4). Image Removed
What if science could ‘target’ and potentially slow down the detrimental effects of aging? Investing in these preventative measures—across all four dimensions of health—can enable older people to enjoy , resulting in older people enjoying a higher quality of life, increase increasing social and economic contribution, and potentially reduce reducing long-term healthcare costs. Investment should be complemented by research to identify future evidence-based By investing in preventative measures, with real-world data-based trials for promising interventions, such as wearables, as well as “moonshot” interventions, such as targeting and treating aging itself (see sidebar “What if science could ‘target’ and potentially slow down the detrimental effects of aging?”). Shift 2: Improve measurements of health and get better data Even in high-income, technologically advanced countries, no standardized data set can illuminate older people’s diverse health capacity over time across the four dimensions of health, let alone their surrounding personal attributes, behaviors, and environmental factors. Although technologies to capture the various data exist, gaining access to and integrating and linking these data sets remains a major challenge. Additionally, these measurements are limited and do not always reflect an older adult’s priorities, whether it’s lifting a grandchild, driving long distances, or still being able to sew. The first step may be to define a standardized data catalog and measurements leveraging several existing examples. Governments may also consider sharing and integrating data sources across public institutions, healthcare, academia, businesses, and individuals to create high-quality, integrated longitudinal data spanning all four dimensions of health. Achieving this requires establishing a collaborative exchange of data that protects patient privacy, including strict data privacy measures and intellectual-property rights. This richness in data could enable a better understanding of the widely varying needs of older adults and passively track conditions specific to older adults (for example, cognitive performance over time), providing a solid evidence base for policies or personalized interventions. The long-term goal is to create data-driven measurements of holistic health, supported by standardized, integrated data. A recent study estimated that older adults’ disability-adjusted life years (DALYs) could be reduced by almost 30 percent, solely by applying proven interventions. These could include following a healthy diet; participating in physical activity; addressing social behaviors (such as smoking cessation); and ensuring access to vaccines, medicines for heart disease, diabetes and stroke prevention, and mental-health therapy. In the words of one doctor, “Exercise is the closest thing we have to an anti-aging pill.” Examples of scalable interventions can include the following: Boosting quality of life while managing age-related disease,as seen in the peer-reviewed NEXUS model for early-stage dementia, which suggests incorporating social and physical activities, stress reduction, cognitive exercise, support groups, and digital programs into in-home and facility-based eldercare. Similarly, access and use of technology could increase quality of life. Game-based therapy such as the Tovertafel system stimulates physical activity and is correlated with reduced sadness and increased social interaction in adults living with mid- to late-stage dementia. improving measurements of health and data, scaling proven interventions, innovating health systems, increasing access to care, and building cross-sector collaborations, it may be possible to address the challenges of an aging population and unlock the potential of healthy aging globally. The aging healthcare opportunity mirrors several CMS strategic pillars; expanding healthcare access, advancing continued equity, driving person-centered care innovation to tackle aging needs, and maintaining responsible stewardship of future programs. CMS policymakers, technologists, and leadership will need to consider how to address the challenges and opportunities presented by these trends. Here are a few opportunities: - Increased demand for services: As the aging population grows, there may be an increased demand for CMS services, including Medicare and Medicaid. This could place a strain on the agency's resources and require additional funding to meet the needs of beneficiaries and reduce the burden on the industry. This requires focused and dedicated CMS long-term planning to evaluate new systematic solutions and strategies.
- Shift towards home-based care: The shift towards home-based care could lead to a reduction in the number of beneficiaries who require institutional care. This could potentially result in cost savings for CMS and drive new planning, innovation and partnerships for care at home.
- Focus on preventive care: With a growing emphasis on preventive care, CMS may need to expand its coverage of preventive services, including screenings and wellness visits, to ensure that consumers receive the care they need to stay healthy.
- Increased use of technology: The use of technology in healthcare, such as telemedicine and remote patient monitoring, could increasingly help to improve access to care for consumers in rural or underserved areas. However, CMS will need to develop policies and guidelines to ensure that these technologies are used appropriately and safely.
- Greater emphasis on value-based care: As healthcare costs continue to rise, CMS may shift towards value-based care models that reward providers for delivering high-quality, cost-effective care. This could involve changes to reimbursement models and incentives for providers to improve patient outcomes and equity.
- Need for workforce development: As the healthcare landscape evolves, CMS may need to invest in workforce development to ensure that healthcare providers are prepared to meet the needs of an aging population. This could involve training programs for new and existing healthcare professionals, as well as support for innovative models of care delivery.
For the complete article: https://www.mckinsey.com/mhi/our-insights/living-longer-in-better-health-six-shifts-needed-for-healthy-aging
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| Howard Montgomery Howard is a practicing agnostic Human-Centered Design Thinking expert who thrives across the consumer experience continuum of products, services, digital, brand, strategy, and environments. He has led, collaborated and consulted with multiple Fortune 100 companies: Ford Motor, Unilever, BMW, The Home Depot, Steelcase, P&G and LG Electronics across diverse business sectors; building products, automotive, consumer, food and healthcare. He holds 48 International Patents and has been the recipient of over 25 international awards including IDEA Awards, iF Award and Good Design Award, and multiple publications of his work. He has taught at several schools in the USA and UK. He holds a bachelor’s degree with honors from Kingston University, London, UK and master’s degree from Cranbrook Academy of Art, Bloomfield Hills, USA, both in Design. |
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