Living longer in better health: Six shifts needed for healthy aging

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.

The aging world’s effects on the economy

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 2040

—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.

Some ‘superaged’ societies will see old-age dependency ratios increase substantially through 2040.

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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”).

The McKinsey Health Institute healthy aging framework is influenced by social and personal factors.

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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 a step change in healthy aging across the four dimensions of health (Exhibit 3).

Six shifts for healthy aging are needed.

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Shift 1: Invest in the promotion of healthy aging

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).

Neurological disorders, mental disorders, and substance-use disorders are correlated with less healthy aging.

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Investing in these preventative measures—across all four dimensions of health—can enable older people to enjoy a higher quality of life, increase social and economic contribution, and potentially reduce long-term healthcare costs. Investment should be complemented by research to identify future evidence-based 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 exists, gaining access to and integrating and linking these data sets remain 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.

Shift 3: Scale interventions proven to promote healthy aging

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.

  • Engaging initiatives that combat isolation and provide a sense of purpose, as seen in multiple programs with demonstrated outcomes, such as engaging the elderly to look after children,

    returning to school,

    and embracing innovative semiprofessional setups that engage older adults in new ways.

    Additionally, these interventions could potentially address challenges in other areas, such as by expanding the workforce or increasing the level of volunteering.
  • Programs and technology that promote independence and aging in place, as seen in Japan’s multigenerational affordable-housing complexes that integrate government-funded formal care

    or Singapore’s Senior Group Homes, which bring older people with mobility challenges together in a cluster of rental units.

    This could be technologically supported through minimally invasive methods, such as wearables or Vayyar’s radar technology, which detects even minor falls without cameras or wearables.

  • Humanistic approaches to care that promote a connection with direct carers and prioritize holistic care, as seen in newer approaches to residential care that incorporate person-centered care and the natural environment (such as the Eden Alternative

    or the Green House Project

    ), or in community care models, such as the Buurtzorg care model in which nurses in self-managing small teams take full responsibility for making “their” clients stronger and independent.

Shift 4: Accelerate innovation across the healthy aging ecosystem

Innovation should include, but also exceed far beyond, the traditional focus on life sciences. To drive innovation across the four dimensions of health as a society, society needs to foster and fund collaborations at the intersection of life sciences, digital, technology, and services. There is already substantial venture capital entering the field of aging, and some companies are starting to tailor their product and service to the older population (for example, remote assistance and fast medical consultation services).

Governments could further support these efforts by taking a whole-of-government approach to healthy aging, promoting the role of collaboration and support across all departments. It could also champion “focused research organizations” for topics that fall through the cracks as neither viable for private-sector investment nor large enough for government investment—for example, availability of comprehensive data sets

(see sidebar “Learning from successful interventions in other countries: South Korea’s impressive journey toward increasing the healthy life expectancy holds lessons for all”).

There are two areas that would benefit from greater, more ambitious innovation:

  • Improving dementia treatment and outcomes require a holistic approach of both pharmacological and non-pharmacological interventions. Globally, dementia is the sixth-greatest contributor to disability burden for people aged 55 and up—estimated to contribute 55.1 million DALYs in 2030

    and having led to an annual global cost of $1.3 trillion in 2020

    —highlighting the imperative to act. On pharmaceuticals, more global collaboration, such as data sharing and decisive financing, could drive R&D toward success. For example, a government-backed megafund could allow multiple avenues for dementia drug development to help overcome the traditionally high rates of R&D failure. This should be complemented by non-pharmacological interventions. It is well known from long-term large sample-size studies (for example, a study of more than 500,000 individuals in the UK Biobank) that exercise, particularly at a vigorous intensity, substantially decreases the risk of developing dementia.

    Physical activity—in all its forms, from household chores to walking, swimming, and running—especially early in life, has been connected to neuroprotective impact on cognitive function. As adults age, we should encourage continuing, or developing new, healthy habits and hobbies that have been linked to improved cognitive function, such as dancing

    and playing chess.

  • Closing the care workforce gap for aged care is a human challenge with a financial imperative. In the United States alone, the cost of informal caregiving for the elderly exceeds $500 billion annually.

    In Australia, more than 35,000 aged care workers are needed to fill the shortage.

    Countries are taking different approaches. For example, the Singaporean government is supporting institutions to raise salaries,

    and the Swiss Ministry of Health is testing a concept called “time bank,” in which people volunteer to look after the elderly who require assistance, with the number of hours spent on caring deposited into their individual social security accounts. In the Singaporean example, once volunteers reach the age at which they want support, then, according to the time deposit, a volunteer will look after them.

    No one single intervention, however, will likely be sufficient to address the massive shortfall in the care force and the pressures of affordability. But affordable, accessible care solutions will be needed to ensure dignity and independence in old age.

In the United States alone, the cost of informal caregiving for the elderly exceeds $500 billion annually.

Shift 5: Unleash the potential of all industries to enable healthy aging

Health is relevant across all sectors, and there is potential to develop products and improve infrastructure to support healthy aging. Non-health players could both develop products and services for the needs of older adults and provide inclusive infrastructure, especially in the workplace. Employers could offer eldercare funds, integrate older adults into the workforce (for example, by creating formal “second-career” pathways for older adults who have retired to reenter the workplace—such as Unilever’s U-Work program, first piloted in ten countries, which was so successful that Unilever began an internship program for those over age 60 in Argentina)

—and work to reduce age discrimination in the workplace. The most exciting interventions are likely to come from cross-sector collaborations—imagine receiving free rides on public transport for each completed short workout,

stage-appropriate nutrition nudges at the grocery store checkout, or smart-home technology that could identify and prevent physical or cognitive decline. These interventions can complement “age tech” innovations seen in traditional older adult medical-care settings, such as the Bocco Emo robot, which monitors older adults in nursing homes and engages patients in “conversation” while notifying staff that nursing care is required.

Additional potential examples of how sectors could support healthy aging through products, services, or infrastructure include the following:

  • The public sector could redesign its citizen support model to make services more accessible, such as designing around “stage” rather than age. For example, the Japanese government developed a policy guideline to implement an “age free” society that included measures across all dimensions of health.

    In addition, the public sector could provide leisure activities as a service to increase social connectivity, as seen in Canada’s arts organizations and community centers, which offer dance or writing activities.

  • Parts of the tech and gaming industry are designing more accessible, age-inclusive platforms for older adults to support physical, mental, and social engagement, including those with visual, mobility, or auditory impairments. For example, Xbox has designed an adaptive controller for players with reduced mobility and older adults,

    and several organizations provide accessible versions of phones and tablets.

Shift 6: Empower and motivate older adults to live to their full potential

Individuals have an important role to play in their own health. MHI believes that a combination of health education, public- and private-sector innovation, and the robust application of public policy will improve individuals’ ability to influence their own health outcomes. For the aging world, this will require several measures:

  • Education and widespread adoption of self-directed practices that enhance an individual’s role and responsibility in their healthy aging. This includes physical activity, healthy diets, social connections, and cognitive engagement—and it is important to adopt these habits as early as possible in life, ideally in childhood or early adulthood to reap the greatest gains later in life. To foster these activities, there should be sufficient support to maintain good vision (for example, financial support for cataract surgeries).
  • Ongoing community involvement by volunteering, working, or engaging in purposeful activity for as long as possible. In New York, the Department for the Aging is encouraging retirees from New York City government agencies to seek part-time, temporary work assignments that allow them to remain active and serve their community.

  • Inclusive public-sector infrastructure for an aging society to drive active participation over dependence. This includes, for example, focusing on stage, not age, in the distribution of social services, and providing an accessible, affordable, frequent, and safe public-transportation system that is designed for the needs of older participants (for example, increased volume of alarm sounds, larger-print signs).

A new era for healthy aging

At a time of rapid demographic change, it is vital to seize this opportunity to promote healthy aging and participation for older adults. Whether considering one’s own mortality, the aging of family members, or the greying of the workforce, it’s important to ask: How can people live longer in better health? MHI, in its focus on “adding years to life and life to years,” believes healthy aging is an imperative. People should expect and demand an extended health span in their older years and will need to decide on how to use this capacity.

Increasing years spent in good health is possible if all stakeholders embrace both the potential and the challenge. Together, MHI seeks to engage with leading organizations globally to catalyze practical action on the most pressing challenges facing the aging world today.

We know what is possible. Together, society can create a world where older adults and societies can expect a longer and higher quality of life.


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