Healthy Ageing Trends in England

With more and more people living longer, a crucial issue is are we ageing better? Using the fascinating English Longitudinal Study of Ageing (ELSA), I analyzed frailty trends in England between 2002-18 in a paper with Jonathan Old that has recently been published in the Journal of the Economics of Ageing (link here).

The frailty index approach we adopt has been widely used in health and economic research. It is an index based on individual replies to a number of questions about health and functional abilities. The more health problems you have or the more limitations in daily activities the higher the frailty score. Using ELSA and its sample of more than 17,000 people aged over 50 years we can track how frailty tends to develop at an individual level, how it varies by socioeconomic circumstances and whether it has changed over time.?

Similar to findings using frailty indices in the US and EU, we find that frailty rates deteriorate at around 3% per annum at an individual level. That 3% is a small number when the frailty index is low in your 50s but becomes larger as frailty reaches higher levels in your 80s. Ageing is of course also characterised by considerable diversity across?individuals.?In England, the healthiest 90-year-olds (top 10%) have less than half the frailties of the frailest (bottom 10%) 50-year- olds. Similarly, the top 10% of 70-year-olds have a frailty index less than the average 50-year-old.?

The good news is that there are distinct signs in England that frailty levels have been improving across cohorts. Based on our estimates we find that a 75 year old in 2018 had the same health status as a 70 year old in 2002. It is not all good news though. There are striking differences in frailty levels dependent upon socioeconomic status. Those with more wealth and education have markedly lower levels of frailty at older ages for a long time compared to others. They also have seen the most marked improvements in frailty, with those with lower income and education levels seeing relatively little change. There is also evidence that the rate of improvement across cohorts has been slowing in most recent years.

Digging more into the data reveals a number of issues. The first is that the sharp regional variations in frailty by age that are observed in England are the product of differences in worst outcomes rather than in typical outcomes (in other words, within group not across group issues). The second is that whilst there have been improvements in a number of the components that make up the frailty index there hasn’t been any change in the underlying incidence of disease.?

A theme of all my work on longevity is around the rising importance of ageing well given the increasing probability we all now face of becoming old. These results emphasise that how we age is malleable – you can see how that is reflected across socio-economic groups, regions and over time. If governments want to raise average?healthy life expectancy these results suggest that tackling the worst health outcomes is the place to begin and likely to have a big effect on the average. It also points to the continued need for research into understanding the ageing process itself if we want to reduce the incidence of age-related diseases and ensure that in future years that more of life is spent in good health. The good news is we can influence how we age and in general in England over the past two decades we have been ageing better albeit at very unequal rates. But further progress certainly can’t be taken for granted given the signs of a slowdown and ensuring that the future old are healthier than the current generation has to be a key aim for our health system.

The paper has a lot more detail for those who are interested (link here) but for a shorter version with a few key charts I hope the below is helpful: