There is one certainty in life: as life is a terminal sexually transmitted disease, we will all die.

Old age can be grim and tortuous as chronic disease disables, physically and mentally, and isolation increases as peers die and 'nearest and dearest' toil under the pressures of caring.

Could it be that this traditional picture of old age masks a reality in which the old will live longer and better quality lives and then fall off their 'perches' swiftly and neatly?

The current popular belief is that there is a 'crisis' in funding the NHS and social care arising from the 'greying' of the population. National statistics show there are increasing numbers of people over retirement age and that the number of 'expensive' elderly over 85 years is set to increase sharply in the next 25 years.

The crisis-mongers argue that the economics of the Western world cannot afford to fund the consequences of increasing numbers of elderly people in their societies. This is nonsense.

Instead of regarding these demographic changes as a crisis, they should be regarded as a triumph: people are living longer. Ah, bleat the woe-mongers, these extended lives are of poor quality, with many survivors having increasing levels of disability which will break the welfare state.

Wrong again, perhaps? Slowly evidence is emerging, initially from the US but now also from the demography of EU member states, that the health of elderly people is improving and that many can look forward increasingly to good health.

A citizen retiring today has experienced a youth of war and rationing (with good nutrition) followed by a working life in the welfare state and increasing affluence.

It is likely that such people are healthier than a new retiree 20 years ago who experienced a youth of war and industrial recession, followed by a working life of unemployment risks and another world war. The retiree of 2009 will be a product of the welfare state and post-war affluence. The increasing affluence of successive cohorts of retirees is likely to ensure a healthier old age.

This assertion is being subjected to increasing analysis by demographers.

An analysis of US data has concluded that the rate of chronic disability among the elderly is declining at an increasing rate.

It seems that a 1.5 per cent reduction in chronic disability of elderly people is possible.

What other demographic events appear to be taking place and are being ignored by policy-makers in their clouds of gloom? Another familiar bleat of woe concerns rising divorce rates and the creation of more single householders with problems of isolation which may induce psychological and physical strain and decline.

But let's be careful with the comparator: with what are we comparing current trends? A hundred years ago a large proportion of the population was in domestic service, did not marry and experienced a lonely old age. Marriage rates have risen in the 20th century and perhaps this outweighs the problems created by increasing divorce rates. No doubt the 'drains folk' in local planning can tell you more about the implications of this for your local services.

Another demographic trend is the narrowing of the gender gap. For many decades women have, on average, survived six to eight years longer than men. But recently, women, despite discrimination and 'glass ceilings', have experienced increasing levels of employment, associated with greater affluence and stressed behaviours which impair health.

While people are living longer, the equalisation of gender lifestyles is narrowing the survival difference between men and women: for example, the gender survival difference in Sweden has narrowed from six to four years.

So what? One effect of this is that fewer will become widowed. This means that more couples may survive to care for each other. The informal care sector is a subject of little analysis.

Typically, spouses are the first line of such support, often managing partners with horrendous disability and with little support from state services, whose bias is often towards the single regardless of comparative need.

The second line of informal care is children and other relatives (especially daughters-in-law) and after that voluntary agencies have a role. If gender mortality differences wane, what will be the impact on the formal and informal sectors? When dependency accelerates and the elderly gravitate to residential homes, the impact can be considerable. The effect of such care on women may be greater than that on men. Typically, women in the labour force return home to cook and do household tasks while the man 'rests'; again there is evidence of changes between successive cohorts.

Such women and their compatriots who have never worked but carried out household tasks routinely but with increasing difficulty find themselves bereft of a role when they go into care. The shock and decline can be sharp.

For the man transferred to residential care, the 'shock' of change is minimal as support is switched from spouse to a professional making his coffee.

Seeing the 'greying' of the population as a crisis is in part a product of ignorance and a failure to analyse demographic trends.

This advocacy needs to be conditioned by recognition of demographic trends and by focusing on the delivery of services which are of proven cost effectiveness.

The time of graceful old age may be upon us and its challenges, in terms of politics, economics and social care, should be tackled systematically, rather than with the generation of confusing 'crises' and the inadequacy of much public health planning.


1 Singer B, Manton K. The effects of health changes on projection of health service needs for the elderly population of the United States.

Proceedings of the National Academy of Science USA 1998; 95: 15618-22.