In Our Time - Ageing

Episode Date: January 28, 1999

Melvyn Bragg and guests discuss ageing. In 1900, 1% of the world’s population were over 65. In the 1990s nearly 8% are. By the year 2020, nearly 1/5th of the world’s population will be over 65 - the figure rises to 25% in the UK. We are now living longer than at any time in our history. How much do economic factors, rather than biological factors, determine what ageing really means and our attitude to it? And what are the ethical, economic and biological implications of living longer?Tom Kirkwood, is an expert on the science of ageing and he brings to bear a close study of how the ageing process is being arrested and speculates on the very great age some of us could and will reach. He has said: “Today’s older people are the vanguard of an extraordinary revolution in longevity that is radically changing the structure of society and altering our perceptions of life and death. The price for this success - and make no mistake it is a success - is that we now face the challenge of ageing.”Alan Walker is an expert in the sociology of ageing and he takes in the whole context, especially the economic dimension. With Professor Alan Walker, social gerontologist, advisor to the UN’s programme on Ageing and has chaired the European Commission’s observatory on Ageing and Older People; Professor Tom Kirkwood, Britain’s first professor of Biological Gerontology, University of Manchester and President of the British Society for Research into Ageing.

Thanks for downloading the In Our Time podcast. For more details about In Our Time and for our terms of use, please go to BBC.co.com.uk, forward slash radio 4. I hope you enjoy the program. Hello, today I'm joined by Britain's first professor of biological gerontology, Tom Kirkwood from Manchester University, and Alan Walker, Professor of Social Policy at the University of Sheffield, to discuss and explore one of the great revolutions of our century,

that of old age. In 1900, 1% of the world's population, was over 65 in the 1990s, nearly 8% are. By the year 2020, nearly one-fifth of the world's population will be over 65 and the percentage will be higher in Europe. We're now living longer than at any time in our history. How much do economic factors rather than biological factors determining what aging really means and our attitude to it and what are the ethical, economic and biological implications of living longer? Professor Alan Walker is a leading social gerontologist, together with his academic work and numerous publications,

he's directly involved in influencing social policy. He's advisor to the UN's program on aging, and he's chaired the European Commission's Observatory on Aging and Older People. Professor Tom Kirkwood is an expert on the science of aging, as well as being Britain's first professor of biological gerontology at the University of Manchester. He's president of the British Society of a Research into Aging. Today he publishes Time of Our Lives,

a book which overturns the notion that aging is either necessary or inevitable. In it, he says, quote, today's older people are the vanguard of an extraordinary revolution in longevity that is radically changing the structure of society and altering our perceptions of life and death. The price for this success, and make no mistake, it is a success, is that we now face the challenge of aging. Well, first of all, let's establish why this aging has occurred. Most people, everybody will listen to this program, we will know that diseases have been conquered, transplants are available to some people. We eat better if we have the money and the options.

We know about exercise. We know about non-smoking. So all that has helped enormously. Is there anything significantly more than that? No, I think it's the collection of all of these things. It's the improvement in public health, particularly. It's the development of antibiotics of vaccines that have reduced the death rate,

particularly from infectious diseases in the early years of life, coupled with the general improvement in housing, in nutrition, in medical care. This has contributed to people living really to their biological potential, something that they couldn't do 100 years ago. And of course what this means is that whereas life used to be cut short, it's now, you know, sort of terminated by the ageing process, by an increase in a whole number of degenerative conditions,

the frailty that comes with old age. You make the quite provocative statement that ageing is neither inevitable or necessary. Now could you just develop that a little, please? These really come from the biology of aging, from looking at how aging processes affect organisms. I think it's very important that as we look to a new world in which people are living longer, that we get rid of some of the prejudices that we've had about the aging process. Such as? Well, there's a common view that aging is inevitable as a consequence of biological wear and tear,

that we simply have to run down with time. And this has led us to a very fatalistic way of looking at the aging process. I think it's important to recognize that systems, biological systems, do not intrinsically have to run down with time. And for example, there are some species that simply don't age. And look to what that tells us about the aging process. I'm not saying that human aging is inevitable. I mean, we will have aging with us for a very long time to come. But the fact that living systems can combat this intrinsic tendency to accumulate faults and things that go wrong with time is very important.

And I think this is part of looking to a future in which people are going to be living longer and longer. So aging is not inevitable. And you bring up your somer theory. Can you say that briefly with two sorts of cells, the germ cells and the somer cells. Germ cells can live for a very, very long time. Somer cells are those which degenerate. But you say if they did not degenerate, then we could live even longer. Yes, absolutely.

The real key to understanding ageing is this distinction between, the germ cells that in a sense have to be immortal because it's the germ cells that keep the genes going from generation to generation. And the rest of the body is what we call the soma. The theory is, I call it the disposable soma theory, and it's really a theory of sort of sex, death and economics, if you like. And it recognises that in the evolutionary past,

and this also applies to other species than humans, that life tends to be cut short not by the wearing out of the body, but by accidents in the environment. And what this tells us is that the soma does not need to invest in a great deal of maintenance and repair. Sooner or later it's going to be killed by some sort of external accident, and all that you really need from an evolutionary, from a Darwinian point of view, is enough investment in the maintenance of the cells of the somer that you can keep going in good shape through your natural expectation of life in the wild.

So it's not inevitable that things were out, and it is possible, perhaps, to interfere with the soma to an extent that we will live much, much, much longer. And you think there's also no such thing as a death gene. There's no such thing as something inside you, which means that you inevitably drop dead, aged, let me say, 59 of or something or other. Yes, absolutely. This is really the reason for the other statement that ageing is not necessary. That, again, one of the preconceptions that we tend to have about the aging process is that aging is a necessary way of, preventing, for example, the population from overcrowding the planet, and that perhaps we've evolved some kind of active death program that turns on in later life and kills us. But again,

science tells us that this just doesn't make sense, that organisms in the wild don't, as a rule, die of old age. They die while they're young. There's no need for such a program to evolve, and there's no evidence at all that there are genes for aging. In fact, we're programmed not for death at the end of our lives. We're programmed for survival. And most of the most of the world, and Most of the genetic factors that play a part in determining how long we live are things that do work to maintain and repair the body and keep us going for a long time. But they're just not perfect mechanisms and they're not perfect because they're expensive. So your study of biology, before I turn to Ellen Walker, leads you to believe that science will enable us not only to live much, much longer, but could enable us to live very, very much longer.

And also in the lengthened period of living, be much fitter. We don't have to live as people, as as it were, the old-fashioned idea of aged, bedridden people. We could live much longer as fitter people. That's what science is pointing to. Science points to the fact that the aging process is malleable, that we can change the rate at which aging occurs, that we can, if we look after the somatic cells and tissues of our bodies, that we can reach old age in much better shape than has happened in times past.

I think we're not going to see sort of a sudden increase in human life. for example, from the current life expectancy between 75 and 80, jumping suddenly to 150 years, the increases that we're going to see in the next century will be much more modest than that. But I think one of the things that science must really focus on is not so much extending lifespan in terms of the number of years lived as extending health span so as to push back the ages at which the degenerative diseases of old age tend to strike. I think most of us would be very happy if it was possible to delay the onset of conditions like Alzheimer's disease and osteoporosis so that we could remain with the lifespan we have at the moment but enjoy a much healthier old age.

Well, we're given science a good run. Alan Walker, do you think it's simply down to science that we're living longer? Well, I think that what we've been talking about so far is advanced old age. What we know is that the illnesses are, you know, in the jargon, compressed towards the very end of life. And I think that's, you know, that's important and significant. But really the meaning of age is not determined by biology at all. It's determined by social and economic policies. So, for example, in this country and the rest of Western Europe, since the 1950s, long-evity has been increased by around 10 years.

Over that same period, the age at which people, leave employment has declined by 10 years. So the social and economic meaning of old age is determined by the employment process, the production process, and what the rest of society understands by older people are those that are excluded from the labour market. They are retired and regarded as being non-productive. I think that is the critical issue. What matters for most people is not really how long they will live and whether their lifespan will be extended by. five, 10 or 20 years. But under what conditions will they survive in social and economic terms? Will they have sufficient resources to live on? Will their health be reasonable? And I have in my office a cartoon pinned on the wall and there are two old men swathed in blankets in an old people's home and one saying to the other, imagine we gave up smoking for this. You know, the issue is what are the social and economic conditions of old age? And over the whole course of this century, what society defines as being old has been primarily determined by the needs of employment. So if you go back to the turn of the century, you find that people would work until they could work no longer.

And then they would survive maybe two or three years. What happened from 1908, but particularly in the post-war period with the beverage reforms, is that we introduce pension systems which defined people as old at the, ages in this country of 60 for women and 65 for men, and then employers took those pension ages as the cut-off point of employment. And that has been the clear defining point of old age, not advanced old age as determined by biology. So when people perceive older people in society, when they regard them, it's past the ages of 60 or 65, that they think of them as being old. I think one of the problems of modern societies is that as long everty has increased, the age at which people are being regarded as old has been declining. And this is a really serious

problem because many employers regard employees as being too old at the age of 50. Do you see any conflict between economic productivity and biological productivity? No, I think that there is a danger of emphasizing too much. the biological front, the critical issues are really economic and social. There are questions here about, you know, how resources are distributed in society. Do we emphasize, for example, research on increasing longevity, or do we emphasize research that will improve the quality of life of those people who live in old age? And you can say that's an unreal or unfair distinction, but the fact is research resources are limited. And at some point, we have to be a real, you

to make a choice about where the priority should lie. So if you ask me to choose within the two, I would want to put more emphasis on looking at ways of improving the social and economic life of older people now, rather than some more speculative

research about how the lifespan might be extended. But you see conflict in the sense that Tom Kirkwood's science enabling people to live longer and physically better lives longer might come into conflict with social and economic, not only policies, but capacities to look after or to employ in the

widest sense such people. I think this is one of the great challenges for Western societies, and it's usually spoken about in very outrageous language about the burden of dependency, and those kind of terms that you rightly dismissed in your introduction. I think that there is an easy answer to this and it's to do with economic activity. I explained already that what's been happening is that people have been leaving the labour market earlier. They've been encouraged to do that by policy makers, eager to overcome unemployment among younger people. What we have to do is turn that around and in a period where people are living longer, it's reasonable to expect that they might work longer, but we need a whole range of social and economic policies to enable

that. It's really a cultural revolution to persuade employers that someone is not too old, but old at the age of 50. I mean, we are an age discriminatory society, particularly in the labour market. Do you think that the social advances that have been made in the last 30 years are comparable to the biological, scientific advances that Tom Kirkwood was talking about? No, I don't. I think that very much age discrimination is embedded in the society.

I don't think that policymakers have taken the lead in trying to turn around public attitudes. It is gradually happening now, for example, with codes of practice being introduced in employment to persuade employers that people in their 50s are not too old and they have skills and experience that might be utilised. We need new forms of training to keep people in touch with developments in technology over the whole of their working lives. There is really a need for a radical change

to catch up with what has been happening in biology. I think I'd like to challenge this suggestion that, you know, sort of biology and the social approach are at odds in any sense with each other. They certainly shouldn't be competing for funding. What we need to see in the whole area is the development of a much more positive attitude, supporting research across the whole spectrum. But also I think it's worth noting that the changes that we've seen this century

are changes that come not as direct consequences of research on the science of aging. This is a comparatively new science. These actually come from social developments. The fact that people are living longer is not because scientists have discovered ways of altering the aging process. Now that people are living longer, we need to harness science to be able to ensure that those gains

that have come from social benefits are years of good quality life. And I think this is where the science of aging can help us enormously because it reinforces very strongly everything that you said, Alan, about needing to challenge preconceptions about old people.

It tells us that, you know, the body is not programmed to die at a particular point in time. In fact, the aging process can be altered. It can be altered by how we feed ourselves by lifestyle. So actually we're working to the same agenda. You talk very positively, Tom Kirkland, though,

and I call this aging a success, and many people would agree with you. On the other hand, one of the facts about aging is a great and steep increase in diseases to do with dementia, and that is going to increase, and the cures for that still seem a very long way away if they're ever going to arrive. So in that sense, it isn't all roses, is it?

No, it's not all roses. And I think, you know, we all know that ultimately, you know, sort of aging means an increase in the likelihood of developing diseases like dementia and all of the other degenerative conditions that really limit our opportunities for life. So, yes, you know, we need to recognize that aging is, you know, an unwelcome process. We can do a lot, though, to approach old age in a much more constructive way. Lifestyle choices that we make early in life can have a see. significant impact in keeping us independent and even delaying the onset of conditions like that. Well, those are lifestyle choices. Well, they don't have to be expensive.

It depends what you mean by expensive. People in great poverty don't have much choice about they don't have lifestyle choices, do they? Well, I think if with the right approaches to, you know, basically how one looks after one's body, one can make lifestyle choices even within a very constrained budget. completely your basic point, which is that wealth does give you many more opportunities to extend your life. And one of the clearest things that comes from studies around the country is that people in the better off areas tend on the whole to live longer. But I do think that

there are messages in terms of health education, in terms of lifestyle choices. For example, you know, the taking of exercise. We can all do that. It doesn't cost anything to walk. The buying of fresh fruit and vegetables. Again, you know, obviously the more money you have, the more opportunity you have to do that. But it is possible to eat on a relatively low budget, reasonably healthy foods. These are the sorts of things that can make a difference. Can I ask, Alan Walker, this idea of not aging, really.

We're talking about aging, but sort of talk about not aging. Most research is being done in America. This is by no means an anti-American remark which is followed. To the contrary, I mean, a lot of very good and helpful work is doing there. But it is a society which one of the things it does is, it seeks happiness, is that it seeks a sort of perfection. Are we off on that particular track? And is that a track that's attainable, or is it going to lead us into the frustration of having people living longer and longer with less and less ability to live the lives they want to lead?

I think that's really the crux of the problem, as Tom has been indicating to answer to your question. Some groups in society are able to age healthily and can change. choose to exit from employment at, you know, below the age of retirement and lead very comfortable lives. And those are a minority. We don't know one or two percent of the world population, aren't we? Well, in world population, certainly. And even in Western societies, we're talking about a tiny fraction. So actually, for the vast majority, the real issues are under what social and economic conditions.

And that's why I think we do as a society have some real choices to be made about how we allocate resources. And, you know, I would say it's reasonable in an aging society that older people should secure more of the resources, and that should be unquestioned. It seems a basic matter of social justice. But what's happening currently

in most Western societies is that resources for older people are being restricted. Therefore, the capacity that they have to lead comfortable even lives that are beyond poverty is being constrained. So poverty is

still a severe problem in all Western societies, particularly in the UK. And it means that really people don't have the choice to choose healthy lifestyles, to eat properly, to give up smoking, whatever, because their choices are constrained by their socio-economic conditions. And it's that that needs addressing. And I think there are, you know, there are a lot of very low-level, low-tech things that can be done to make people's lives more bearable and sustainable, to improve quality of life in old age, rather than the emphasis on high tech or on hard science. There's some very basic support systems that would relieve the problems faced by many older people who cannot get around, can't do their shopping.

And most of those services are inadequate. So I think we'd spend a little amount of money to do a great deal in this field. It is a moral imperative that we do, that society adopts a very affirmative attitude towards the increases in life expectancy that we have at the moment across the entire spectrum. So this relates to the science, it relates also to the development of social interventions. Yes, but it does raise problems which you say are exaggerated, Alan Walker, but they're very present in a lot of people's minds as to how to make this provision.

Say you've got the chance to make this provision, and not a lot of people have. We're talking about, again, a tiny percentage of the world population and a small percentage of the European population, Alan Walker. say you retire at the age of 65 and you're now going to live to 95 or 60 and 30 years. Well, 30 years ago, in my recollection, you, I mean, I sound like Queen Victoria. 30 years ago, you could buy a house in London for you can't buy a chicken shed for that now. And that's just where you live. You could buy a decent house in London in 1969 in the San Joseub, London, for around the 5 or 6,000 quid mark.

It's inconceivable that I'll ever happen. you tell people in their 20s now, they've very right not to believe you. You're talking about the same houses going for two, three hundred thousand. So how can anybody make provision against that? If that is the economic reality we come from, which is just so much of reality in some ways as biological reality. Well, how do you face up to that? Well, you express it absolutely perfectly,

and I think that, you know, the important thing is that politicians, policymakers, don't approach this question in the context of alarm and despondency. They see it in a positive way, but they take the kind of measures that are required to enable that conundrum to be answered. And it can be answered. And it can be answered. I mean, a great number of people listening to this programme would like to know, me first. You see, what's happened? I started by explaining that old age is in effect being defined by retirement and pension systems. So what we must do in an age when longivity is increasing rapidly is to reconstruct the life course. And that is exactly what you're arguing for. You know, we cannot live any longer with this notion that there is a set retirement age.

Even if people have redefined it themselves by leaving the labour market earlier, we have to, in a sense, move to a new world where that notion of retirement is reconstructed. The notion of life after retirement is reconstructed. So we might envisage people who are combining part retirement and part employment. To a much more advanced age, to 75 at least, I would argue currently. So it's possible economically for people to survive into old age and at the same time to earn income and at the same time to answer the critical policy question about how do you pay for pensions and health care.

And these are really fundamental issues. But if we carry in our head, and in particular on the policymaker's prescriptions, the old model of work and retirement, we will never survive this revolution in longevity. We must redefine the life course. How would both of you tackle that? You'd say to the present government or the present opinion formers, look, this is what you should do. What would you say, Tom Kirkwood?

I think we need absolutely to challenge the terrible oppression of ageing. that exists throughout society, and this affects the policymakers. It also affects us as individuals. And we tend to be rather sort of defeatist, I think, many of us, as we look towards old age. There's a great deal that we can do. Again, I would say without spending a lot of money in terms of seizing opportunities for developing active interests as we come towards retirement, for continuing education, for rising to the challenge of coping with new technology,

for going out and using the many, many opportunities for productive activity during a time when we may not be in mainstream employment and possibly even earning some extra money through these kinds of activities that will help us to do the kinds of things that we'd really want to do. Well, I think you've come to the most important thing last to tell you the truth.

I think earning extra money is going to be essential to top up any sort of, if the economy goes in the next 30 years, it's when the last 30 years, that is going to be an essential. Alan Walker. Well, I think the clear fact is we're in, in transition. This is a revolution that's taking place in longevity, and we haven't adjusted to it. That's a very simple fact. Those institutions of society, like retirement, like pensions, employment,

and even policymakers have not adjusted to this new reality. So on the one hand, you find teachers who are being encouraged to leave in their 50s, that's clearly crazy if they're skilled and, you know, have the wisdom and knowledge. On the other hand, there are some employers who, because there are fewer younger people. In an ageing population, if there are more older people, there are a few younger people. Because there are fewer younger people coming up to the labour market, there are some employers in Europe at least who are saying, hang on, we need to keep some of those skills and experience that older people have, whereas in the 50s, 60s and 70s we would be encouraging them to leave. Now they're saying, let's keep them in employment because we need

their skills and we need them to train the younger generation. So I think the seeds of an alternative are currently being sound. And it's also true that in various European countries, the older part of the population is developing political clout, putting senators in, putting deputies in various parliaments and so. Can I end with a final question?

We've talked basically about the rich world in this conversation. People are also aging, living longer in the poor world, if we could just be blunt about it. Now, that is a different order of

problems do you see briefly and what is going on there that should be addressed? In the developing societies, there is ageing taking place too, though they differ enormously, very, very difficult to summarize briefly, the kind of problems they're encountering. You know, from one hand, you've got a country like China that is seeing very rapid aging because of some of the social and economic policies introduced there, whereas some sub-Saharan African countries, the aging is taking place at a different pace. but the fact is that the majority of older people in the world living developing societies. So it is an issue for those countries as well as the advanced world.

And if we think we have problems, where there is no basic infrastructure of pensions and social security, there are very severe problems indeed. Yes, it is very dramatic that this is a process which is affecting the entire globe. I started writing my book during a period when I was staying in northern Ghana and it was very dramatic there that in a society which is very traditionally structured according to the oldest being the most respected, the ones that hold power that the demographic change is beginning to undermine these traditional structures to a very great extent. The old were revered as wise when there were few of them.

Absolutely. And it was a system that worked very well when only a very few people would come to be very old. But now that many more people are living to be old, it's putting tremendous strain on these traditional structures, and these societies face enormous challenge. Can I think of the many as wise? That's probably the real problem. Or one of the problems. Well, thank you both

very much. Professor Alan Walker, Professor Thomas Kirkwood, and thank you for listening. We hope you've enjoyed this Radio 4 podcast. You can find hundreds of other programmes about history, science and philosophy at BBC.com.com.com.com.