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First published by HarperCollinsPublishers 2019

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Text © Camilla Cavendish 2019

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Source ISBN: 9780008295158

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Version 2020-01-28

Contents

Cover

Title Page

Copyright

Dedication

Introduction

The New World of Extra Time

1 The Death of Birth

Demography tips the balance of power

2 Younger Than You Thought

The stages of life are changing

3 Just Do It

If exercise and diet was a pill, we’d all be taking it

4 No Desire to Retire

Don’t give up the day job

5 New Neurons

Old brains can learn new tricks – and they must, to keep in shape

6 In the Genes

Immortality isn’t here yet, but anti-ageing drugs are on the way

7 Out of the Ghetto

Everyone needs a neighbourhood

8 Health Revolution

Robots care for you, humans care about you

9 Finding Ikigai

Purpose Is Vital

10 Generation Hexed

We need a new social contract

Epilogue

A Different, Better World

Endnotes

Further Reading

Acknowledgements

List of Searchable Terms

About the Publisher

Dedication

In memory of Richard Cavendish,

1930–2016

Introduction
The New World of Extra Time

IN 2018, A DUTCHMAN began a court battle to make himself legally 20 years younger. Emile Ratelband, 69, told a court in Arnhem in the Netherlands that he did not feel ‘comfortable’ with his official chronological age, which did not reflect his emotional state – and was preventing him from finding work, or love online. He wanted to change his date of birth from 11 March 1949 to 11 March 1969.

Doctors had told him that his body was that of a 45-year-old, Ratelband argued. ‘When I’m 69,’ he said, ‘I am limited. If I’m 49, I can take up more work. When I’m on Tinder and it says I’m 69, I’m outdated.’ His friends had urged him to lie, he claimed, but ‘if you lie, you have to remember everything you say’.

Ratelband compared his quest to be identified as younger with that of people who wish to be identified as transgender – implying that age should be fluid. He said his parents were dead, so could not be upset by his desire to turn back the clock. He even offered to waive his right to a pension.

Ratelband, a ‘positivity coach’, is a provocateur who enjoys attention. The court turned him down, ruling that an age change would have ‘undesirable implications’ for legal rights, such as the right to vote. But this seemingly frivolous case actually illustrates something profound: we are on the cusp of an entirely new period in our history, which is coming at us fast.

This is the advent of Extra Time.

If you are in your fifties or sixties today, you have a very good chance of living into your nineties. If you play your cards right and have luck on your side, many of those years could be healthy and productive. Our chronological age is becoming decoupled from our biological capabilities.

In football, ‘extra time’ is the period when there’s everything still to play for. That will be true for many of us. Droves of people are ‘unretiring’ and going back to work. Advances in biology and neuroscience will help us stay younger longer. But our institutions, and our societies, have not caught up. Ratelband’s looks, his physical strength, his ambitions are out of kilter with what we traditionally associate with being 69. He feels compelled to go to the extreme lengths of changing his birth date. Why can’t we, instead, just change our view of what it means to be 69?

The Fierce Urgency of 100

In 1917, King George V of England sent the first ever telegram to a centenarian. It was handwritten, and delivered by bicycle. In 2017, Queen Elizabeth II sent out thousands of 100th birthday cards, with a team of seven employed to administer them all.¹

The era of Extra Time will see a growing number of centenarians. The Office for National Statistics estimates that one in three babies born in Britain today will live to 100. Some scientists even think we could live to 150 (as we will see in Chapter 6).

This should be a fairy tale. Instead, there are widespread fears that we are sitting on a ‘demographic time bomb’, with droves of elderly people about to bankrupt governments and hurt GDP. If people get less creative as they age, and stop work around 60, economies could slump and younger generations could face crippling taxes.

But it doesn’t have to be that way. More and more people, like Emile Ratelband, have no desire to retire. Fears about the declining ratio of workers to pensioners rest on the official definition of ‘working age’, as 15–64. But David Hockney became the world’s foremost iPad painter at 76; Tina Turner made the cover of Vogue at 73; Yuichiro Miura climbed Everest aged 80. Warren Buffett is still investing in his eighties and David Attenborough is making hit TV series in his nineties. Behind them stride loads of ordinary people who see Extra Time as an opportunity, who are starting businesses and are highly productive. They can defuse the time bomb.

Will they be fit enough? When a football match goes into Extra Time, there’s a premium on fitness. Here, the omens are pretty good. Today’s seventy-somethings are sprightlier than ever before, and the incidence of dementia is falling. There is work to do, though, on health inequalities. Increases in life expectancy have slowed in the UK,² where the average life expectancy at birth is now 82 for women and nudging 80 for men. In America, life expectancy at birth has dropped for three years in a row,³ partly because of the opioid epidemic. Both countries face a battle against obesity – and poverty (see here and here).⁴

Globally, demographers think these dips in life expectancy are probably blips. The twenty-first century will be defined by people living longer, in societies which are growing older much faster than we have fully realised. But are they ageing faster? Only if you cling to out-of-date notions of what it means to be 50, 65 or 80.

Islands of Extra Time

On the Pacific island of Okinawa, there is no word for retirement. The longest-living women in the world are still caring for great-grandchildren when they hit their 100s. Okinawans are rarely lonely, because they are supported by a network of friends, the ‘moai’, who are committed to share both good times and bad. The typical Okinawan house doesn’t have much furniture: people tend to eat sitting on the floor, so they are getting up and down many times a day. They also have a strong sense of ‘ikigai’, roughly translated as ‘reason for being’. My Japanese friends tell me that you find your ikigai at the place where your values intersect with what you enjoy doing, and what you are good at.

Okinawa is one of the Blue Zones, the parts of the world identified by researcher Dan Buettner, where people have low rates of chronic disease and live exceptionally long lives. While it’s not possible to distil a single magic ingredient, common to all Blue Zones are plant-based diets with very little processed food, strong friendships and a sense of purpose, lots of sleep and strenuous physical activity.

We can’t all live on islands, getting up with the sun and tilling the soil. But the Blue Zones do suggest that what we think of as ‘normal’ may be a very poor version of what our natural selves could be. And that is incredibly positive.

Why I Wrote This Book

I started writing this book in 2016, after my beloved father died. He had dreaded getting ‘old’, so much so that it whittled down his life much too early. I remember his gloom on his fiftieth birthday. As we sat together on his favourite cliff in Cornwall, watching the waves break below, he said he felt that everything was ‘over’. I was a child, and 50 was older than I could imagine. But I did notice, from that point on, that my father started to think of himself in a different way. He would say ‘Oh, I’m too old for that’ with a sigh. After my mother left him, he refused to get a cat, although he adored them, on the basis that it might outlive him and be left homeless. He was 58 when he got divorced, and missed our two cats, Arthur and Merlin, most terribly (they went with my mother in the divorce, along with a hotly contested dining table). He ended up living, in largely excellent health, to 86. And he lived all that time without cats, who could have kept him company.

After he died, I couldn’t stop thinking about the way age can become a barrier.

My mother lied about her age until she was 72, because she was terrified she would lose her job as a secretary, and default on the mortgage she took out after the divorce. This created a huge burden of deception. She never dared join the company pension scheme for fear of being found out. She also hated the feeling that, as her looks dwindled, she was becoming invisible. She refused to let my children call her ‘Granny’, or refer to her in any way as a grandmother, which made things awkward between them.

In conventional terms, my parents were ‘old’ – almost 40 – by the time they conceived me. They’d met at Oxford University in the 1950s, she a glamorous American who’d grown up in Greenwich, Connecticut, he the bookish son of an English vicar. Their world was an intellectual, bohemian one of artists and academics for whom work was passion, savings in the bank negligible and ‘retirement’ anathema. My father dictated his final article for History Today magazine from a bed in Charing Cross Hospital. My mother was campaigning to help a friend get his job back when she had her final heart attack.

My thoughts about my parents chimed with my growing professional awareness of our fatalism about older people. As a journalist, and through my work for the Department of Health, I have met many compassionate nursing and care staff struggling against tick-box cultures and low pay.⁵ When I sat on the board of our national hospital and care-home regulator,⁶ it was clear that patients were being warehoused in post-war silos. As head of the Number 10 Policy Unit, I worked to introduce the sugar tax and other measures to combat obesity, a condition which is making people old before their time, but is portrayed as a ‘choice’. And I felt that media excitement about living to 100 jarred with a lack of ambition about what that should mean.

I have written this book to challenge our notions of ageing, and find out what different countries are doing to build a new world for Extra Time. I have been privileged to meet many wonderful pioneers, who I think of as ‘rebels against fate’, who are refusing to dress demurely, stop work or be carted off to care homes.

The rebels against fate intuitively understand that something fundamental has changed. They are all saying, in different ways, that age should not define us. My goal in this book is to spread their message, to persuade you to contemplate your own future before it’s too late, and to try to change the pattern of thinking in our societies about what we mean by ‘old’. Because it sure as hell isn’t 50, whatever my father thought. Yet much of the data about the ‘old’ still starts at 50 – when some of us will be only halfway through our lives.

This book is not a rose-tinted rhapsody. I don’t predict that we will all be skipping our way cheerfully to 120. In fact, I’ve written it partly as a warning.

Living longer is not a blessing, in my view, unless it is living better for longer. Neither of my parents had any desire to live to 100. What they cared about was living as full a life as possible, and then hopefully checking out as fast as possible.

One of the most shocking things I have confirmed, in researching this book, is just how drastically the futures of the rich and poor, the highly educated and the less educated are diverging. Only Japan has begun to effectively address the health problems which mean that some people are what the Japanese call ‘Young-Old’ at 80, while others are ‘Old-Old’ at 65. For me, this is one of the biggest ethical challenges of our time. If we don’t fix it, the rich, the educated and the lucky may still be thriving at 90 – but they will be living in societies which cannot afford to look after those who are less fortunate. We must prevent that from happening: since one measure of a civilised society is how it treats its elderly.

A Different, Better World

This book spans many aspects of a huge topic. I have tried to break it down into ten lessons, each of which reflects what I have learned from experts, academics and policymakers, but also from those on the frontline. I’ve interviewed biologists who are challenging the very notion that ageing is inevitable; neuroscientists who are finding ways to stave off brain decline; and social entrepreneurs who are working to bring the generations together, rather than letting them drift apart.

I begin by surveying the demographic trends, longer lives and plummeting birth rates, which pose a profound and unexpected challenge to our species. Voluntary childlessness was always presumed to be evolutionarily impossible. But birth rates are falling so fast that some countries will soon shrink. China is growing old before it gets rich. If America stays vibrant, this could alter the geopolitical balance of power.

Almost without noticing, we have created an entirely new stage of life – an extended middle age. I look at this new stage in Chapter 2, and at how the media, and governments, send the wrong signals. I look at alternative ways to compute healthy lifespan, and at the widening gap between the rich and educated, and the less fortunate. In Chapter 3 I explore what true biological ageing might look like, without junk food and sedentary lifestyles, and argue that obesity is making some people old before their time. I am not advocating any particular product or medicine in this book, but I do suggest that the evidence for aerobic exercise, and against sugar, is compelling.

Some Silicon Valley billionaires are on a quest to find immortality. Their research is fascinating. Especially intriguing are the ‘super-centenarians’, whose risk of dying levels off after the age of 105. But my chief interest is in improving life, not prolonging it. In Chapter 5 I describe developments in neuroscience which show that we are never too old to learn. I look at what kinds of brain training might help keep us sharp, and at the ‘cognitive reserve’ which may be protective against Alzheimer’s. In Chapter 6 I hunt down pills which claim to have anti-ageing properties, harnessing genes and proteins in our bodies. These discoveries raise what may sound like an odd question: should we treat ageing as a disease? But in another decade it may seem eccentric to treat one illness at a time, rather than to use the underlying circuits in our bodies to ward off many different conditions.

That doesn’t mean we won’t get ill. In Chapter 8 I meet cold but useful robots in Japan, and warm inspiring nurses in Holland, and I argue for more compassionate health and care systems based on a blend of technology and humanity.

The challenge for CEOs is considerable. The multi-generational workforce is on the way, but it will not be straightforward to manage. Even though jobs are being automated, retiring babyboomers are creating skill shortages. We need a fourth stage of education, to match the fourth industrial revolution. Luckily, pioneers are shrugging off the notion that retirement is good for you, and are starting successful businesses (Chapter 4). Others are creating the kinds of neighbourhoods we will all need, to look after each other (Chapter 7). Still others are harnessing the energy and altruism of older people to do good, whether that is grandmothers in Zimbabwe or hospital volunteers in England (Chapter 9).

Longer lives, and shrinking numbers of young people, are putting pressure on the social contract. How will our societies look after the old, without bankrupting the young? In Chapter 8 I propose a new settlement for funding social care, drawing on the examples of Germany and Japan. In Chapter 10 I argue that the new divide is not simply between young and old, but between the skilled and the less skilled, at all ages.

One of the greatest blocks to progress is our own prejudice. We need to transform our attitudes, and realise it’s not old age that’s getting longer, it’s middle age. The challenge is urgent. The world is becoming an older one, faster than anyone anticipated. That’s not only because we are living longer, it’s also because of what I call the ‘Death of Birth’, as described in the next chapter.

1
The Death of Birth
Demography tips the balance of power

BY 2020, FOR THE first time in history, there will be more people on the planet over 65 than under 5.¹ More grandparents than grandchildren.

Two trends are driving this ageing of the world. First, we are living longer. In the twentieth century, average life expectancy increased by 30 years in most developed countries, because of better nutrition and sanitation, and medical advances. Men currently live longest in Switzerland, with an average life expectancy at birth of 82; women live longest in Japan, to about 87. Australia, Israel, Canada, South Korea and most Western European countries are close behind. The gap between men and women is narrowing, because men who once led rackety lives (drinking and smoking) are cleaning up their act.

The second reason is that the world’s women are turning away from motherhood. In 1964 the average woman had just over 5 children; in 2015 she had only 2.5.²

There are now 83 countries, home to nearly half the world’s population, with fertility rates below the ‘replacement rate’ – roughly 2.1 births per woman – needed to maintain the population. Australia, New Zealand, Brazil, Chile and almost every country in Europe now has fertility below that level. South Africa and India are moving rapidly towards replacement rate, with birth rates of 2.5 and 2.3 respectively.³

The changes will alter the shape of countries. Japan’s population is already shrinking. By the middle of this century Italy, Poland, South Korea and Russia will be dwindling too.⁴ And these shifts could redraw the geopolitical balance of power: between countries on an ageing, shrinking trajectory – notably China – and countries which are sustained by younger, immigrant populations – currently the US.

Africa will provide the young of the future. The populations of 26 African countries are expected to double between 2017 and 2050, adding another 1.3 billion people to that continent.⁵

Fewer humans should be good news for the environment, once global population peaks (some time after 2070, though estimates range from 9 to 11 billion).⁶ But the impact on humans can already be glimpsed. Visit Japan’s Akita Prefecture, where over a third of residents are over 65 and the main growth industry is funeral parlours.⁷ Or go to Rudong in eastern China, where half the schools have closed in the past 15 years as the younger generation moves away.

Demography is changing not only the landscape, but the very meaning of family. What networks will we rely on, as children become scarce?

The Chinese government has passed an ‘Elderly Rights Law’, threatening to fine children who don’t visit parents often enough.⁸ But the children are fighting back. ‘What is considered “often”?’ complained one poster on Weibo, the Chinese Twitter.⁹ ‘It’s fine that no one is paying for us to visit our parents, but is there someone who can give us time off to do it?’ asked another, refusing to buy into traditional notions of family.

The best way to visualise what is happening is through the population pyramids used by demographers. In 1950, if you laid out the population of any nation with each age group represented by a bar, the youngest at the bottom and the oldest at the top, it looked like a pyramid, with the young outnumbering the old. That has been the shape throughout recorded history, as this chart for Japan shows:

Since then, falling birth rates and longer lifespans have changed the picture dramatically. Japan, the world’s oldest society, has one of the lowest birth rates in the world: 1.4 births per woman. Fifty years ago, life expectancy in Japan was about 72 years. Now it is 84. In 2015, over a quarter of the population was over 65, turning the pyramid into a barrel:

Between now and 2050, longer lifespans will continue to alter the pyramids’ shape. The fastest growing group in the world population will be those aged over 80. In Japan, the pyramid will stretch up and outwards, to look more like a flowerpot:

One former health minister has predicted that ‘the Japanese race will become extinct’. The first question is why? Why have millions of individuals simultaneously changed their minds about having children?

Japan: ‘Herbivore Men’ and Career Women

‘Men here don’t want a woman who’s cleverer than them,’ says Keiko, a Japanese executive in her early forties, who is wearing a smart suit and demure heels when we meet in the lobby of the Tokyo Hilton. ‘They worry you might be demanding, that you might be demanding in bed too. And I just think, why bother? Why bother with a guy who’s more interested in his Xbox?’

Something strange is going on in Japan, which now has the world’s highest proportion of old people. In 2013, it was claimed, more nappies were sold for elderly, incontinent people than for babies.¹⁰ That ugly benchmark proclaims the raw truth: babies have gone out of fashion.

The roots of this shift, in a society which has traditionally prized family above everything, lie in a feminist revolution: women are shaking off the traditions of dutiful service to husband and household, and challenging men to adapt. ‘I wouldn’t mind a child, if I’m honest,’ said a Japanese student I met in London. ‘But I’m not sure I’d want to put up with a husband.’

‘It’s hard,’ says one Japanese woman in her late thirties, who speaks perfect English and has married a New Zealander. ‘Many of my friends are really serious about their careers. It’s their chance and they’re not going to bother with a man who can’t bring home the bacon.’

As women become more ambitious for themselves, they talk disparagingly about what they call ‘herbivore men’ (soˉshoku-kei danshi), a term coined in 2006 by the Nikkei columnist Maki Fukasawa. The herbivore man doesn’t know how to ask a woman out on a date. He’s intimidated by women. And, the implication is, he’s not even that interested. A survey in the Japan Times found 20 per cent of men in their late twenties reported having little or no interest in sex – some citing crippling long working hours.¹¹

It’s not clear to what extent the stereotype is true. There are still plenty of Love Hotels, the Japanese hotels which were created for salarymen to grab some respite. And the number of children produced by married couples is still hovering around replacement rate. But far more people are staying single. As arranged marriages disappear, hundreds of thousands of men whose mothers would once have found them a bride are struggling to adapt. One in four 50-year-old Japanese men has never been married.¹² Since this is a country which still feels uncomfortable having children out of wedlock, that’s bad for birth.

Having children is also a costly business. In surveys, 20- and thirty-something men and women¹³ say lack of money is a serious obstacle to getting married. Couples increasingly need two incomes. But it’s hard to combine a career with motherhood in a culture where people stay at their desks late.

Cost is not the whole story. Many women have been liberated from the need to find a husband to support them, as employers have become more open-minded about hiring. This partly stems, ironically, from the realisation that Japan must utilise all its talents if its economy is to prosper as the population shrinks. As all the curves on the graph turn downwards, experts are now looking desperately for solutions.

‘We must increase immigration, or we will see our nation vanish,’ says Dr Jun Saito, a leading economist at the UCLA Japan Center in Tokyo. Dr Saito believes that Japan must import more foreign workers even if it manages to increase the number of women and older people in the work force. ‘Even if we raised the fertility rate to 2.1 tomorrow,’ he tells me, ‘an option that is difficult to achieve, the population would not stabilize until 60 to 70 years later.’

Japanese reluctance to admit immigrants is legendary. Fewer than 2 per cent of the country’s workforce is foreign. Although the government recently created new visas for low-skilled foreign workers in industries like construction and care, and has broken a taboo by letting those workers bring their families immediately, rather than after five years, the numbers are a trickle. Only 18 foreign workers have qualified for the care-worker visa, partly because the exams are in Japanese.

‘The worst scenario in my mind,’ Dr Saito confides, ‘is that even if we open up the country, nobody comes.’

China: Growing Old Before It Gets Rich

They call it the grey wall of China. By 2100, China’s elderly population will dwarf that of any other country except India. It’ll be so large, wags joke, that you’ll be able to see it from outer space. At the park around Beijing’s Temple of Heaven, in the cool of early morning, hundreds of older people are playing cards, doing tai-chi or exercising. A group of about 50, mainly women, dance to lilting music. They move gracefully, quietly, in a choreographed routine, on the paths between the trees.

It’s an uplifting, harmonious scene. The women place their feet confidently, and with precision. But it’s hard to feel so confident of the future. Most of the people in this park are retired. China’s working-age population has been in decline since 2012¹⁴ and is set to fall by almost a quarter by 2050. The demographer Nicholas Eberstadt, of the American Enterprise Institute, has predicted that this will drag down China’s GDP growth rate. By mid-century, China’s population could look much more like Japan’s – but without Japan’s affluence.

The birth rate was falling even before the government introduced the One-Child Policy in 1978. Now, China is awash with only children. Many find themselves having to support two parents and four grandparents – known as ‘the 4–2–1’ problem. There is the added, disturbing glut of bachelors because so many families preferred sons to daughters. These ‘guang gun’ (bare branches) will struggle to find brides.

Sensing the danger, the Communist Party dropped the One-Child Policy in 2015. But it is probably too late. Few eligible families have applied to have a second child. Many don’t feel they can afford it, because so many have moved to cities where the cost of living is high. Seven in ten Chinese mothers work, with little time for an extra child.

Marriage is becoming less attractive. On TV dating shows like If You Are the One, successful Chinese women criticise potential suitors for being ugly or poor. More women than men now attend Chinese universities, and many are defying the jibes about unmarried women being ‘shengnu’, or ‘leftover’. A survey by the Chinese dating website Baihe.com has found 75 per cent of women saying that any husband should earn twice as much as them.

The Chinese Academy of Social Sciences predicts that the Chinese population will peak at 1.44 billion in 2029 before entering ‘unstoppable’ decline.¹⁵ By 2065, it says, the population will have shrunk to the levels of the mid-1990s.

What could this mean for China as a military power? Mark L. Haas, a political scientist at Duquesne University, Pittsburgh, Pennsylvania, has suggested that China could be forced to make ‘geriatric peace’ with other nations, as it becomes too burdened by its elderly to maintain military spending. That is not certain: China may not feel beholden to spend as much as a democracy on older citizens, and it can use technology to raise productivity. But it is too big to be able to level the playing field by importing enough immigrants.

Instead, the government has started offering five-year multiple-entry visas to tempt its diaspora back home – something South Africa and India are also doing.¹⁶ It is also contemplating raising the retirement age, which is 60 for men and 55 for women.¹⁷

Will they be fit enough? China faces an increasing burden of chronic disease approaching Western levels. Junk food and stress have accompanied rapid urbanisation and the country has not yet broken the smoking habit. Under Mao, China’s population was surprisingly healthy: it saw the world’s most sustained increase in life expectancy, from 35 in 1949 to 65 in 1980.¹⁸ That healthy, working-age population helped to drive its unprecedented economic growth.¹⁹ But now, China is growing old with neither Japan’s wealth nor its health, at a time when many of its jobs still require physical, manual labour. And its rival, America, is on a different path.

China v America

America has long been a demographic exception, with a higher birth rate than most other rich countries. China’s population is currently around four times the size of America’s. But that gap will have halved²⁰ by the end of this century, unless America slams the door shut on immigrants.

The chart below gives a glimpse into the geopolitics of the next few decades. It shows China’s working-age population dropping, along with Europe’s, while America’s remains stable:

Before the financial crisis, the American population was sustaining itself, with a birth rate of 2.12.²¹ This is partly because it has higher levels of immigration, and because immigrants tend to have larger families. In the US, 23 per cent of births are to foreign-born women,²² while only 13 per cent of the population is comprised of immigrants.²³

American women also become mothers earlier than in any other OECD country: at an average age of 26, compared with 28 in the UK, and 31 in Italy. Only 14 per cent of US women remain childless, compared to 18 per cent in the UK and 23 per cent in Germany.²⁴

There is a dark side. America has been lagging behind other rich countries in life expectancy, partly because its high rates of obesity mean it has failed to combat deaths from stroke. But now, US life expectancy at birth has dropped for three years in a row, the first drop since the AIDS/HIV epidemic, partly because of what the Princeton professors Case and Deaton have dubbed ‘deaths of despair’²⁵ – from suicide, alcohol and opioids.²⁶ Poverty and inequality pose real challenges.

In 2017, America also hit a 40-year low in its fertility rate, of 1.76.²⁷ What is not clear is whether this is a post-crisis blip or a new direction. The fertility rate of Mexicans in America dropped by a third between 2006 and 2013, partly because of the financial squeeze – and it hasn’t yet recovered. If migrants are to keep working their magic on fertility, they need to keep coming, because second- and third-generation immigrants tend to adopt the cultures of the host country and have fewer babies. Any president who builds a wall could therefore get more than he bargained for: because population is shaping up to be a powerful geopolitical weapon.

India: Educating Rhia

Today’s Indian couples say their ideal family size is two children, according to a poll by The Economist.²⁸ That’s smaller than the ideal family cited by Brits and Americans. Fifty years since the biologist Paul Erhlich predicted mass famine in his book The Population Bomb, India’s youthful population is growing slowly. The average woman now has just 2.3 children – fewer if she is Sikh, Jain or Christian, slightly more if she is Hindu and a bit more again if she is Muslim.

India did not need a One-Child Policy to reach this point. Although government has nudged people to have smaller families in various ways, India is a good advert for the principle that educating girls reduces the number of children they have. Especially if you accept that education comes in many forms. Birth rates have fallen where cable TV has arrived in rural areas, bringing Bollywood soap operas featuring independent childless women and chic urban mothers with small families.²⁹ Audiences name their babies after the characters, become less tolerant of domestic violence and use contraception. India is not alone: telenovelas have had a similar effect in Brazil.³⁰

While India still wrestles with poverty and illiteracy, it seems that urbanisation, growing prosperity, public health and most of all education are powerful contraceptives.

Singapore: City Living

‘Having kids was important to our parents,’ one thirty-something civil servant in Singapore explained to researcher Joel Kotkin, who conducted extensive interviews with young professionals. ‘But now we tend to have a cost and benefit analysis about family. The cost is tangible, but the benefits are not.’³¹

Such chilling pragmatism resonates in many parts of Asia, especially those where property prices are high. It is no accident that Singapore, Tokyo, Hong Kong, Shanghai and Beijing, some of the world’s most expensive cities, have some of the lowest birth rates. The Singapore government’s ‘Marriage and Parenthood Package’ offers substantial bonuses to couples who have children. But it’s not working too well. Many ambitious youngsters seem more focused on their careers: a third of graduates aged 30 to 34 years old are single in Singapore, and the birth rate is 1.2.³²

These modern workers don’t seem to worry that no one will look after them in old age. Across Asia, the traditional model of close-knit families is breaking down. Social networks are increasingly made up of friends, not relatives: reinforcing the notion that childlessness is normal.

Europe: Waiting for Mr Right?

‘Capitalism + atheism + feminism = sterility = migration,’ tweeted Julian Assange, founder of WikiLeaks and fugitive from justice, in 2017. ‘EU birthrate = 1.6,’ he went on. ‘Replacement = 2.1. Merkel, May, Macron, Gentiloni [the leaders of Germany, Britain, France and Italy at the time] all childless.’

This was a neat summary of Europe’s plight. And nowhere does it apply more strongly than in Italy, which most of us still associate with large Catholic families. The country of ‘amore’ now has the lowest birth rate in Europe. This is partly a consequence of youth unemployment. The long, grim recession since the financial crash of 2008 has seen many Italians travel abroad to find jobs, and others fearing they can’t afford children.

The average Italian woman would still like two or more children.³³ But she doesn’t have her first child until 31 – older than anywhere else in the EU.³⁴ One reason may be that two-thirds of Italian men under 35 are still living with their parents, in contrast to most young women.³⁵ Politicians have dubbed these Mama’s boys ‘bamboccioni’ (‘big babies’) who won’t grow up. Political commentator Antonio Politi has claimed that women are being deterred from raising families by men who are neither fulfilling their roles as breadwinners, nor stepping up to fatherhood.

Attempts to warn women not to leave it too late have backfired spectacularly. When Italy’s health minister Beatrice Lorenzin organised a national Fertility Day, with talks up and down the country, she was met with outraged counter-demonstrations. Women marched through the streets carrying placards reading ‘siamo in attesa’:³⁶ a play on the Italian for ‘we’re expecting’, which also translates as ‘we’re waiting’. Waiting for jobs, waiting for affordable childcare, and waiting for equality. Many Italian women still lose their jobs when they get pregnant; one in four is sacked within a year of having her first child.³⁷ Romance is not entirely dead, but the birth rate is in trouble when women need to work but don’t have equality.

Germany has similarly high rates of childlessness to Italy. But in Europe’s prosperous heart, this has less to do with money worries. ‘In the days of “Kinder, Küche, Kirche” [“Children, Kitchen, Church”] it was natural to have children,’ I’m told by Dr Jan Kessler, a paediatrician in Munich. ‘But that’s old-fashioned to a generation which wants to keep its options open. They want to study; they want a good career; it’s never really a good time to have a child.’

Women are enjoying success, and don’t always want to deal with old-fashioned views of motherhood. ‘No one minds me having a career,’ one married academic told me. ‘But I would get a lot of flak if I left a child in a crèche.’ Some German women fear being labelled as Rabenmütter, ‘raven mothers’, if they dare to combine work and motherhood. This appalling image, of ravens as carrion-eaters who neglect their young, seems to weigh heavily on some women, who are in any case not certain whether they want children.

The German government gives generous parental leave and has massively expanded day care. It now spends almost three times as much on benefits to families as it spends on defence.³⁸ (The UK spends about 1.3 times more.³⁹) The reforms were led by Ursula von der Leyen, a government minister and mother of seven, who subsidised paternity leave and declared that men should be responsible for half of the childcare. And the birth rate has nudged up a little, with the help of immigrants. To keep pace, the Federal Statistical Office has estimated that the country would need half a million immigrants every year until 2040. That seems unlikely, given the backlash which followed Angela Merkel’s opening the borders to around a million refugees in 2015.

The birth rate is higher in Britain, where part-time working and maternity benefits are routine. That’s partly because of high levels of immigration: 28 per cent of live births in the UK are to foreign-born women,⁴⁰ though foreign-born people make up about 14 per cent of the population.

We are also breeding a nation of only children. Almost half of British families now contain only one child. It’s not clear how much of that is deliberate. In polls, Brits say their ideal family is just over two children, but the birth rate is 1.76.

Sarah Davies, a teacher, was in her mid-thirties when she plucked up the courage to ask her long-term boyfriend to settle down. He dumped her. Now, she wonders if she’s left it too late. ‘No one will fancy me if I look desperate,’ she says gloomily, staring at a dating site. Ms Davies is not one of those mythical creatures regularly accused by the UK press of ignorantly frittering away their fertility. She’s been muffling the ticking of her biological clock for years, fearing men are on a different timetable. ‘They’ve got no incentive,’ she reflects. ‘If I was a man, I’d probably focus on my career too, and not want to be hamstrung by a baby till I’d made it.’ A lack of suitable partners may explain recent increases in the numbers of single women seeking IVF, and why birth rates for women over 40 are at their highest level since 1949.⁴¹ That seems more likely than the idea that highly capable career women, who stick to every other timetable, somehow ‘forgot’ to have kids.

Is Life Expectancy Stalling?

Galloping increases in life expectancy have recently slowed dramatically in the UK, and to a lesser extent in Germany, Sweden and the Netherlands. This has surprised actuaries. Some blame it on government cuts to public services, although those were not uniform in those countries.⁴² Others believe it has more to do with a slowdown in the incredible progress we have made against heart attacks and stroke.

Life expectancy at birth grew substantially during the twentieth century, because we were reducing deaths among infants and children: but life expectancy from the age of 65 barely budged. Between 1970 and 2011, however, older people saw a dramatic change: life expectancy at 65 increased 20 times as fast as in the previous century. The main reason? A massive drop in deaths from heart attack and stroke, driven by people giving up cigarettes.

Since 2011, progress has slowed. ‘It’s possible we have gone back to the time before 2000, when life expectancy improvement was more gradual,’ says Gordon Aitken, insurance analyst at RBC Capital Markets. ‘From 2000 to 2010, we saw the wealthier getting healthier. But it’s hard to keep reducing deaths from cardiovascular diseases at the same rate. And obesity and diabetes are on the rise.’

There is no consensus on how the change affects different socio-economic groups. One data set suggests that the ‘Comfortable’ are unaffected, and that the losses are among the ‘Hard-Pressed’. Another suggests that all groups are seeing a slowdown in improvement.⁴³

While these differences are of enormous importance to insurers, because they affect annuity payouts, they are less crucial for the rest of us. Mr Aitken explains that the chance of dying in 2018, for example, didn’t increase from the previous year. What has happened is that the forecasts for growth were too optimistic. A 65-year-old man in the UK is now expected to live to 86.5, while a 65-year-old woman is expected to reach 88.4.

Sub-Saharan Africa: The Young of the Future

Sub-Saharan Africa finds itself in a demographic bind of a different sort. Its population is expected to quadruple to 4 billion people by 2100,⁴⁴ with Nigeria overtaking America as the world’s third most populous country. There is much excitement at the prospect of youth burgeoning as the old world shrinks. Tanzanian President John Magufuli has claimed he sees no need for birth control, insisting a high fertility rate will boost his country’s economy.⁴⁵

Sadly, he may be mistaken. The great leaps forward made by the Asian Tiger economies came from the so-called ‘demographic dividend’: of rapid growth in working-age populations, enabling those countries to grow fast and invest, followed by sharp subsequent falls in the birth rate which boosted the skills base, because parents with fewer children could invest more in educating each one.

Sub-Saharan Africa is on a different path, of continuing population growth with no demographic dividend in sight. Its per capita income is growing slowly, and its many willing hands may not be able to find work, if they remain at low skill levels. Add to that the likely strains on the environment and infrastructure, and Mr Magufuli may come to change his mind.

The Paradox of Living Longer, But Not Being Fertile for Longer

Falling birth rates must be good news for a planet whose natural resources have been stretched to the limit by humans. And they reflect a welcome next step in the liberation of women. Almost everywhere outside sub-Saharan Africa, women are throwing off the shackles of their traditional roles. Lower infant mortality has made it safer to have smaller families. The hold of religion is waning. More women are pursuing careers. At the same time, job insecurity and the high cost of living, especially in cities where the jobs are, has left many couples fearing they can’t afford children.

Some worried governments have resorted to bribery. The Polish Ministry of Health put out a terrible video, encouraging the population to ‘multiply like rabbits’.⁴⁶ Norway, Sweden, Denmark, France, Germany and Russia pay ‘baby bonuses’. Some of these schemes have had limited success: France and Sweden have the highest birth rates in Europe. But not all women want to be treated like prize cows. A Danish government video, urging women to ‘Do It for Denmark’, missed the point: that many women don’t want children, and others can’t find a good father.

It may be that the post-war baby boom was unusual. Today’s combination of greater career opportunities for women, and increased financial pressures, may be returning us to an era when people did not get married, or have children, until they felt they could afford it. Some may leave it too late as a result. Others will feel liberated from the tyrannical view that there is something wrong with you if you’re childless.

In Extra Time people study longer, leave home later and may not be settled or solvent until their mid-thirties: when they may hit the hard deadline of the biological clock. That mismatch will leave some couples very disappointed.

For the foreseeable future, it looks as though we will be stuck with male fertility declining from about 45, and female fertility from around 30. In most other respects, though, we remain younger for longer.

2
Younger Than You Thought
The stages of life are changing

MY 19-YEAR-OLD GODDAUGHTER IS looking over my shoulder as I write. Will she be reading this again in 2150, when she will be 150? That is the subject of a $1 billion bet made by two American experts on ageing.

Steven Austad, chair of biology at the University of Alabama at Birmingham, has predicted that there will be a 150-year-old human by the year 2150, based on the many breakthroughs which are slowing ageing in mice (see Chapter 6). His friend Jay Olshansky, public health professor at the University of Illinois, disagrees. He thinks the brain will be an insuperable barrier. ‘We can replace hips, hearts and so on, but we can’t replace the brain,’ he has said.¹

The two men made the bet in 2000. They each put $150 into an investment fund, and signed a contract certifying that the winner’s heirs will cash it out in 2150. They later doubled their initial investment, and now expect the jackpot to be around $1 billion. If Austad is right, someone alive today will still be around to see who wins the bet.

While we wait to see whether lifespans jump to 150, some other changes have already crept up on us. At 19, my goddaughter ought to be emerging from adolescence into adulthood. But she’s just started university, is racking up debt and expects to be living with her parents for years to come. So many people are now in this situation, some experts argue that the stage of adolescence should last until 24. That’s the average age at which children now move out of the family home in the UK, France, Germany and Australia.

The Australian professor Susan Sawyer has argued that adolescence should be extended in both directions: starting at 10,² to reflect the fact that puberty is now starting at that tender age in some girls, and lasting until 24. Extended parental involvement through this later period can be highly beneficial, the psychologist Laurence Steinberg has argued, because we now know that the brain continues to mature into the twenties.

If adolescence now lasts for 14 years, what happens to the subsequent stages of life? They are also lengthening. We saw in the last chapter that people are having children later. Beyond that, mature independent adulthood is lasting longer too.

It’s Not Old Age That’s Getting Longer, It’s Middle Age

Last winter, a doctor friend of mine was in charge of the influenza vaccinations for the over-65s at his local clinic. A crowd of grey-haired strangers walked in. They’d never come to see him before, because there was nothing wrong with them.

These people are part of a growing group who are defying all the labels. They don’t see themselves as old, don’t act old and won’t buy products marketed at the old either.

In England, the proportion of over-65s with any kind of impairment has been falling for two decades.³ In America, three-quarters of people under 75 have no problems with hearing or vision, no difficulty walking, and no form of cognitive impairment.⁴ These are fully fledged citizens with plenty left to offer, not retirees on their way out. Step up a generation, to those aged between 75 and 84, and half still have none of those disabilities.

That doesn’t mean that older people don’t forget their keys, or lose concentration. But it does mean that some of our fears are overdone. In surveys, most people say they think that everyone will get dementia (or Alzheimer’s, a form of dementia) if they live long enough.⁵ But only one in six people over 80 have dementia:⁶ many never get it. And in Denmark, Sweden,⁷ the UK and US, the risk of getting dementia is a fifth lower than it was 20 years ago.⁸ In 2000, the average age for receiving a diagnosis of dementia in the US was 80.7; by 2012, it had crept up to 82.4, even though doctors had got better at spotting it.⁹

Experts are not sure why the incidence of dementia is dropping but the Framingham Heart Study, which has tracked 5,000 people over 60, suggests that rates of dementia have mirrored improvements in heart health.¹⁰ In the UK, dementia rates have fallen faster for men than for women, which may be because men previously smoked more. There will still be news headlines about dementia being on the rise but what’s growing is the total number of older people, not our own individual risk.

The ‘Young-Old’: The New Kids on the Block

The Japanese, whose society is now the oldest on the planet, caught up with the reality of Extra Time long ago. The group who are still hale and hearty and rushing around after grandchildren they call the ‘Young-Old’. Those who are frail and in need of support they call ‘Old-Old’.

‘The Young-Old are very active and healthy and productive – totally different from 30 years ago,’ says Professor Takao Suzuki, Professor of Gerontology at Tokyo’s J F Oberlin University. ‘Walking speeds are much faster, for example. The World Health Organization defines “old” as 65, but as gerontologists and geriatricians, our main concern is with the Old-Old, who are very different from a health standpoint.’

Sketching energetically on his whiteboard, Professor Suzuki is, endearingly but disconcertingly, wearing a thin black cowboy tie over his pristine white shirt. He draws a matrix showing the Young-Old starting at 60, and Old-Old from 75 – but says the start date of becoming Old-Old can be much later than that. Professor Suzuki attributes Japan’s uniquely long-life expectancy to good medical care, prosperity and improved nutrition after the Second World War, when people could afford to eat far more protein, mostly fish. Consumption of carbohydrates, fat and sugar has barely changed, he says, as fast food outlets are still relatively few. Unlike Western experts, he worries more about under-nourished widows than obesity. (Some widows were not eligible for their husband’s full pension, he says, and have trouble getting to the shops to buy groceries.)

The Oldest Stewardess in the World

Bette Nash, 82, is telling me about the time she flew with Jackie Kennedy. It was 1965, and the glamorous wife of the former US president walked onto the flight where Bette was a stewardess. ‘We used to have to wear white gloves. I was pulling them on with my back turned and I heard this voice asking, was this flight going to Washington? She was real sweet, never asked for any attention.’

The plane, Bette remembers, was a Constellation – very different to the Airbus she flies now. For Bette Nash is still working. She is probably the oldest stewardess in the world. American Airlines, her employer, recently threw a party to celebrate her 60th anniversary. Regular passengers on the Washington, DC–Boston shuttle bought her gifts.

Bette says she has no intention of retiring: ‘I thrive on people.’ She talks fast and exudes energy: ‘If I’m ever off for a few days and think about stopping, as soon as I get my uniform back on and drive to the airport, it’s great. It’s the people who work for the airline and it’s the customers. I know their little needs. I know the commuter who likes his tomato juice plain in the winter and on ice in the summer. I feel so comfortable going to work.’

Technology has changed in the past 60 years – Bette doesn’t have to handwrite the tickets any more – but people haven’t changed. ‘It’s being kind to people, and them being kind to you. A little love and kindness is what everyone needs.’

The job is physically tiring, but Bette makes few concessions: ‘If I have free time I don’t sit down, I walk the cabin and talk to people. I do have a nap in the afternoon – I’ll admit that – but younger people get tired too.’ She gets up early in the morning and prepares a meal for her son before driving the hour to the airport. On the way home, she says, she does feel more tired. ‘Before, I might have gone to the store on the way home, and done other things; now I might just get gas.’

What is her secret? She pauses. ‘When I think about it now, I think my goal in life is to keep moving,’ she chuckles. She may sit down to watch TV, but never for long. ‘There’s always something to do.’ She doesn’t follow an exercise regime, and admits to eating chocolate, but laughs: ‘I can still suck in my tummy.’ Almost without knowing it, she seems to have been following three of the tenets of the old-age lifestyle gurus: keep active, retain your sense of purpose and connect with people.

Is Bette Nash old? She thinks for a moment. ‘I don’t feel like I’m an old person. I have a handicapped son, I don’t have the chance to feel old; his needs are so great. My sister has Parkinson’s and dementia and I look at her and I think she’s old, but she’s younger than I am.’

Bette is not ‘old’ in the way we used to think of it. But her younger sister is. And this is where the debate gets confused. The stereotypes don’t fit any more. What we are witnessing is the decoupling of biological age from chronological age.

New Stages Require New Signals

When Otto von Bismarck, the German chancellor, created what was arguably the world’s first state pension in 1889, he set the pension age at 70. Few would ever draw it, since the average German lived to around 45.

Today, life expectancy in Germany is 81. But Germany’s pension age is 65¹¹ and the average German gives up work at 62. Right across Europe, retirement ages are not keeping pace with life expectancy. In the UK, men leave the labour force earlier than they did in 1950.¹²

If current trends continue, some of us living in Europe, parts of Asia and North America could spend a quarter of our lives retired. That is crazy.

Lord Adair Turner chaired the independent UK Pensions Commission which recommended in 2005 that the British government should raise the pension age to 66 by 2030, and to 68 by 2050. He now thinks this wasn’t sufficiently far-sighted. The UK government now intends to raise the pension age to 67 by 2028, but he thinks ‘this won’t be nearly enough. In 1950, average male life expectancy at 65 was 12 years. By the time we were looking at it, in 2003, it was 20 years. Life expectancy at 65 could be another 35 years by the time we reach mid-century. We should have started increasing the pension age years before.’

Actuaries, he says, simply didn’t realise how fast life expectancy was growing: ‘There was a dominant hypothesis about a limit to life. They kept producing curves showing life expectancy growing, but then tailing off. Eventually we said there’s no reason to tail off.’ Why did they get it so wrong? ‘Smoking. The tobacco companies were mass murderers,’ says Turner – and no one thought their power would wane.

Pensions are one of many signals which influence how we see older people – and ourselves. These signals need updating.

What it means to be 65 has changed utterly. In the 1950s, a 65-year-old woman in Britain could expect to live a further 14 years.¹³ Today, according to the UK’s Office for National Statistics, the average 65-year-old woman can look forward a further 23.4 years.¹⁴

Yet 65 is now the age at which many institutions impose a concept of old age upon their citizens. It’s the moment when Germans, Swedes, Canadians, Australians and Brits can officially retire, and Americans become eligible for full Medicare (federal health insurance). It’s a tipping point for financial advisers, who will often start switching your pension portfolio into bonds when you hit your 50s. And ‘65+’ is often the maximum age bracket cited in questionnaires, with no other boxes to tick – as if it’s the beginning of the end.

In London, everyone gets a free bus pass when they turn 60. It’s called an Older Person’s Bus Pass – something which causes a great deal of blushing among the many still-vibrant commuters who could perfectly well afford to pay their own fare. In the US it is entirely normal to call people ‘Seniors’, and to offer them Senior discounts, for a period of what could, these days, end up being 30 years. Yet much of that period will be spent as Young-Old, not Old-Old.

What if, instead of defining people by how many birthdays they’ve enjoyed, we define them by how many years they have left? Obviously, that’s hypothetical. None of us can know individually when we will meet our end. But we do know the average. And if we apply that average, things look different.

If we defined old age as having 15 years or less left to live, we wouldn’t call many baby boomers ‘old’ until they hit 74. Up to that point they’d be middle-aged. This is a crude measure. Not everyone will be in good health at 74: some will need support. But it’s still a useful thought experiment, which has been carried out by a group of demographers at the International Institute for Applied Systems Analysis in Vienna.

The Austrians wanted to challenge the use of 65 as the onset of old age in Europe.¹⁵ First, they ran the numbers for remaining life expectancy. Next, they drew up a list of characteristics which we usually associate with being ‘old’, such as reduced mental agility and dependency on others. On this basis, across four different countries – Norway, Japan, Lithuania and the US – they concluded most baby boomers remain middle-aged until their mid-seventies.

The insight that chronological age is a poor way to classify who is ‘old’ came originally from the Canadian-American demographer Norman Ryder, who realised in the 1970s that expected lifespan is a better indicator than age of our need for state support: which is, after all, what the state is interested in.

‘If you don’t consider people old just because they reached age 65, but instead take into account how long they have left to live, then the faster the increase in life expectancy, the less ageing is actually going on,’ explains demographer Sergei Scherbov, leader of the Vienna study. ‘Two hundred years ago, a 60-year-old would have been a very old person,’ he tells me. ‘Someone who is 60 years old today, I would argue, is middle-aged.’

Scherbov is now working with the UN to redesign traditional measures of ageing, using what he calls ‘characteristic-equivalent ages’. In 2015, for example, the average Japanese woman of 65 could expect to live another 24 years. But the average woman in Nigeria had to be much younger – 46 – to get 24 more years life expectancy. To be equitable, their pensions would need to start at different ages.

Evolving lifespans should make governments careful about what signals they send, to encourage people to save enough. ‘You don’t need to tell a 25-year-old when their retirement should be,’ says Lord Turner. ‘If you tell them there is a fixed retirement age, you are not telling them that things are uncertain. It would be better to tell them, look right now you’re in a pension scheme which retires at 65, but that may change with life expectancy.’ Lord Turner has suggested making the pension more generous from 70, and means-testing other benefits before that age.¹⁶

Our Stereotypes Are Out of Date

Institutional signals of this kind are one reason why we have not caught up with the reality of Extra Time. Another is the media. We journalists are deeply confused about age.

In 2018, The Times gave a double-page spread to a French lady called Mylène Desclaux,¹⁷ who had published a book about how to be sexy at 50. The breathless article advised women never to give a birthday party after 49, to avoid wearing reading glasses which might give the game away and to change their first name if it sounded too dated. In other words, lie. At 50! What would she suggest women do at 70, I wondered?

If 50 is old to some journalists, 65 is beyond the pale. Sub-editors love to bung ‘pensioner’ into headlines, making the subject an object of pity no matter what the story. ‘Plucky Pensioner Patrols Crime-ridden Streets Armed Only with Torch’ was a recent headline in Cape Town, South Africa. ‘Plucky Pensioner Chases Bag Thieves’ was another in England’s Swindon Advertiser, about a 69-year-old who sprinted after a wallet thief. The implication, as usual, was that anyone brave and fit enough to do this at 69 was extraordinary. In fact, the multitude of stories entitled ‘plucky pensioner’, from all over the world, suggests to me that courage, energy and strength are not uncommon among people who are, in fact, in extended middle age.

The media also has a strange tendency to move from the active to the passive when describing the elderly. ‘She had a fall’, we report of a grandmother, rather than ‘she fell down’. We would never say that of George Clooney. So why do we demean older people in this way? Unconsciously, our language turns people into sub-humans, lesser beings. My mother used to loathe being called ‘dear’ by strangers: she felt she’d fallen into some void, some category of oldness which robbed her of her identity.

I’ve fallen into the same trap myself, by focusing on age when it was irrelevant. When I interviewed Margaret Atwood, bestselling Canadian novelist and author of The Handmaid’s Tale,¹⁸ I asked her how she felt about having 1.6 million followers on Twitter at the age of 77. Atwood, who is one of my heroines, shot back sharply: ‘It’s 1.75 million!’ I felt ashamed. She went on to say, ‘A lot of them are robots. You know they are robots when they send you a message saying, “I miss your great big dick”.’ That was her graceful way of telling me to stop being so bloody patronising. What was I thinking?

‘There is a casualness of ageism,’ says Professor Martin Green, CEO of Care England. ‘People say things they would never say if the word “old” was replaced by “gay” or “black”. They say silly old people, shouldn’t be driving. But 19-year-olds are worse drivers than 80-year-olds.’

‘Everybody ghettoises the old,’ says the broadcaster Joan Bakewell. ‘But the old is us.’ Bakewell, 85, is a poster girl for ageing well. She looks fabulous and has lost none of her sharpness. But when she presented the TV programme Life at 100 in 2017, she had to keep challenging the production team for referring to older viewers as ‘they’. ‘There shouldn’t be that distinction,’ she says. ‘We are all in this together.’

Language matters. Baroness Sally Greengross, a formidable campaigner for older people, told me about a friend in her eighties who went to hospital and was admitted to the ‘geriatric’ ward. ‘But I’m not geriatric!’ she protested furiously, as they wheeled her away down the corridor. ‘Take me somewhere else!’

Women are thought to suffer ageism earlier, and more consistently, than men.¹⁹ That’s partly because we care more about how women look. The multi-billion-pound cosmetic industry, with its claim to reverse ageing, may be doing more harm than good. Personally, I see nothing wrong with trying to avoid wrinkles. But advertising does feed off the idea that we are in a constant battle against ‘old’. If anti-ageing is becoming synonymous with being anti-old people, we have a problem.

Becca Levy, Associate Professor of Epidemiology and Psychology at the Yale School of Public Health, has found that individuals’ own health is influenced by their perceptions of what ageing is like. Her team followed several hundred Americans over 50 for 20 years, and found that those who held more positive views of ageing lived an astonishing 7.5 years longer than their peers.²⁰

Negativity is rife. Broadcasters, galleries and museums spend hours worrying about how to reach more youthful audiences – despite the fact that older people have more time and money, and are growing in number. We value youth, tech and energy over wisdom and maturity, or so it seems.

The extreme youth of Silicon Valley plays into all of this. In 2014, the median age of Facebook employees was 29; at Amazon and Google it was 30. Facebook founder Mark Zuckerberg famously quipped, ‘Young people are just smarter.’ Many of us unthinkingly bought his line – just as we’ve bought some other lines from Facebook.

The Value of Experience

Chesley ‘Sully’ Sullenberger was 58 when he safely landed US Airways Flight 1549 in New York’s Hudson River after both engines were disabled by a flock of geese, saving everyone on board. The plane juddered across the Manhattan skyline and plunged safely into the icy water between the narrow banks. It was an extraordinary feat, which was turned into a Hollywood movie – Sully (2016) – by Clint Eastwood.

‘One way of looking at this,’ Sully reflected afterwards, ‘might be that for 42 years, I’ve been making small, regular deposits in this bank of experience, education and training. And on January 15, the balance was sufficient so that I could make a very large withdrawal.’

That wonderfully modest, laconic statement sums up the value of cumulative expertise. I’m not claiming that every 58-year-old is a hero-in-the-making – and I’ve seen good ideas from young people being ignored because they are not considered mature enough – but I do feel that we live in a world more interested in ‘digital skills’ than judgement, which only comes with experience. Personally, I don’t want to be flown by a novice pilot any more than I want to be operated on by a surgeon still in training. I want the guy who’s done the same procedure a thousand times.

Some economists believe that ageing workforces are behind the decline in Western productivity. But what if part of the problem is that baby boomers are retiring in droves, taking with them valuable experience and institutional memory?

‘I am of the old school,’ said English barrister Jerry Hayes, 64, describing how he intervened to save an innocent young man from being jailed for rape.²¹ Hayes was supposed to be prosecuting the man, but his 40 years of experience at the English Bar made ‘alarm bells ring’ when he took over the case at the eleventh hour and asked a police officer whether there were any mobile-phone messages from the man’s accuser. The officer insisted he hadn’t bothered to show the messages to the defence as there was nothing in them, but Hayes stood his ground and demanded the evidence. 40,000 messages were then handed over, which showed that the so-called ‘victim’ had been pestering the man continually for sex. The case collapsed and a terrible miscarriage of justice was avoided – but only because of the intuition, experience and sheer bloody-mindedness of a man with a white beard who believed that getting justice was more important than nailing up another successful prosecution.

How Much Extra Time Might You Get?

To get an idea of your life expectancy, type a few facts about yourself into an online pension calculator. Let’s say you tell it you are a healthy white Englishman, born in 1958. The calculator will give you a life expectancy of 90.

That may come as a shock. Most of us massively underestimate how long we have to live. We tend to think ‘when did Granny die?’ rather than realising that we have gained Extra Time. People in their fifties and sixties underestimate their chances of survival to age 75 by 20 per cent according to the UK Institute for Fiscal Studies. Widows and widowers are especially pessimistic.

None of us likes to think about death. But if we fear it’s around the corner when it isn’t, there’s a risk we may start to feel ‘old’ too soon. We won’t save enough, plan our career far enough ahead, or, frankly, feel positive enough about our future.

Of course, averages don’t tell us much about our own individual prospects. Our longevity can be boosted by all sorts of things: our income, fitness, even whether we are married or not (married people live longer). But the single most powerful predictor of how long each of us will live turns out to be our level of education. The more time you spent in education in early life, the more Extra Time you are likely to have at the end. And the better your chances of spending that Extra Time in good health.

The figures are surprising. In 2008, white American men with one or more degrees were expected to live up to 14 years longer than black American men who didn’t finish high school.²² In OECD countries, the gap between men with those education levels is around 7 years.²³

Education is a stronger predictor of lifespan than wealth. Well-educated Cuba, though dirt poor, has higher life expectancies than America. Oil-rich but poorly educated Equatorial Guinea, on the other hand, has low average life expectancies. So stark are these differences, one expert has suggested that governments should invest more in schools than in hospitals.²⁴

The Geography of Life Chances

I’m standing outside the Abbey Road Studios in London’s St John’s Wood. This is where The Beatles recorded some of their greatest hits and the traffic has stopped as four French tourists attempt to re-create the Fab Four’s famous Abbey Road album cover, by walking across the black-and-white zebra crossing. I cycle past here regularly, and I know that every tourist imagines they were the first to have the idea. A taxi driver gives me a weary look.

From Abbey Road, a prosperous area in the Borough of Westminster with red-brick mansion blocks and detached houses, I’m cycling south to meet a friend for coffee. I’m going to do a route I take often, along backstreets. What I didn’t know, until recently, was that this route spans 10 years of life expectancy.²⁵

At Abbey Road, female life expectancy at birth is around 87 years and 85 for men. I cycle south, towards Lord’s cricket ground, into Church Street ward. Here, female life expectancy has dropped to 81 years and it’s 80 for men. I make a right turn towards St Mary’s Hospital, Paddington, where I was born, and cut along the canal to Westbourne Park tube station, where I’m meeting my friend. By now, female life expectancy has dropped to 77 years and to 75 for men. In a 15-minute trip, life expectancy has changed by a decade. A baby girl who is born and who lives her life in Abbey Road can expect to live, on average, 10 years longer than one born just 1.5 miles away.

You can find similar gaps in many Western regions. Raj Chetty of Stanford University has found a 15-year gap in lifespan between the poorest and richest Americans. But he has also found that absolute income seems to matter less than where you live. The poorest live five years longer in New York and Los Angeles than they do in Tulsa and Detroit. In those areas, Chetty’s work suggests that smoking, drinking, stress and obesity have more impact on lifespan than income inequality or unemployment, although of course the two are linked.

Are You Heading for a Nursing Home, or the Beach?

‘In the end,’ as Abraham Lincoln said, ‘it is not the years in your life that count. It is the life in your years.’ In surveys, people say repeatedly that they don’t want to live to 100 if that means spending their last years in some ghostly half-life of senescence.

In the twentieth century, when most of us died from infectious diseases, increases in life expectancy generally implied an improvement in health for everybody. In the twenty-first century, that link has broken. Longevity is bringing some people more years of good health, but others more years of frailty.

There are two reasons for this. First, medical advances mean that things which used to kill us, like heart attacks and stroke, are less often fatal. We can keep people alive, stumbling gratefully on, some in good shape, others less so. Second, there has been an explosion in chronic conditions, like type 2 diabetes, high blood pressure, dementia and respiratory disease, which are often linked to smoking, drinking and lack of physical activity.

Differences in those behaviours are one reason why people living in the South East of England, for example, are likely to enjoy eight more years of life free from disability than those who live in the North East, according to the Newcastle epidemiologist Carol Jagger.²⁶

To get a handle on all of this, statisticians have started to track not only life expectancy but ‘healthy life expectancy’, defined as the years spent in ‘very good’ or ‘good’ health, and ‘disability-free life expectancy’: the years spent without any limiting condition. The methodology is not terribly robust as it’s all based on surveys people fill in, reporting how they feel. The categories are broad too: being in ‘poor health’ could mean that you suffer from arthritis and can’t walk as far as you used to, or that you have early stage dementia. There’s an urgent need for better data. But even so, the patterns are striking.

From as young as 40, some less-educated people report having a ‘functional limitation’ in walking, driving, or some other aspect of daily life. By the age of 60, graduates are in significantly better health than non-graduates. At 85, over half of graduates are still living happily, with no functional limitation.²⁷ We will see in Chapter 5 that some highly educated people also seem to have ‘cognitive reserve’, which can be protective against Alzheimer’s.

It is not clear exactly why education is so vital. Some experts argue that education is formative. It may make us better at planning, and exercising self-control, which may feed into healthier lifestyle choices. It also affects the kind of jobs we do. Lower-skilled jobs can be physically taxing, emotionally stressful and – it turns out – bad for health.

The legendary Whitehall II Study of British civil servants,²⁸ led by the epidemiologist Sir Michael Marmot in the early 2000s, found that staff doing the lowest skilled jobs, like messengers and doorkeepers, had a mortality rate three times higher than permanent secretaries and top managers. They also had far higher levels of cortisol, the stress hormone associated with coronary heart disease.²⁹ Marmot’s findings may seem counter-intuitive, but they make sense. Senior executives may work longer hours and face gruelling decisions, but support staff have lower social status, far less control over their working environment and probably a longer commute.

Life has never been fair. But as we live longer, less-educated and poorer people are becoming ‘Old-Old’ earlier than richer and more educated ones, and the gap is widening.³⁰ Professor James Nazroo, at the University of Manchester, has found that when they turn 80, the richest third of Britons is only just beginning to experience the limitations that people in the poorest third have been suffering from 70.

Narrowing that gap, providing people with more equal life chances, must surely be one of the most important social justice missions of our times. The rich and well educated already know some of the secrets to making the most of Extra Time – and there are more in this book. But unless we spread that knowledge to everyone, we will all be the poorer.

One country is leading the way. The Japanese government has set itself an explicit aim of ‘extending Healthy Life Expectancy more than the increase of Average Life Expectancy’ through its Health Japan 21 initiative.³¹ Ministers are working to actively combat what they call ‘lifestyle-related diseases’ with detailed targets for everything from salt intake to blood pressure levels, to the number of steps people take every day. Different provinces run programmes encouraging people to stay fit, reduce their smoking and drinking, and to take care of themselves.

These schemes are getting traction. The average Japanese man gained an entire extra year of healthy life between 2013 and 2016 (women gained six months).³² This was a win for Extra Time, since life expectancy at birth rose by nine months for men and six months for women in the same period.³³

These schemes build on the strong Japanese tradition of self-reliance. Many Japanese people I have interviewed do not want to be a burden to their children as they age, nor do they expect the state to do everything. They are willing to try and ditch bad habits. If other countries emulate this approach, tackling behaviour throughout the life course, not just at the beginning or the end, we might close the gap.

You’re Only as Old as You Feel

Spring Chicken, a British start-up which sells home gadgets to the elderly, conducted a survey which asked: ‘What age do you feel – on the outside, and on the inside?’³⁴ Most people between 50 and 90 reported feeling a few years younger than their actual age on the outside, but considerably younger on the inside. The older the respondents, the bigger the gap. Eighty-year-olds in the survey reported that they felt about 50 years old on the inside. Are they delusional, or might they just be on to something?

‘People will say things like, “I still feel 30, it’s just my knees are letting me down,”’ says Anna James, who founded the business after a fruitless and frustrating search for gadgets to help her father, who is 74 and has Parkinson’s. Her father now works in her business and tests out products, yet even he refuses to see himself as needing help. In 2017, James realised her father was getting to the point where he was going to need an electric wheelchair, but he wouldn’t consider it. ‘You’ve got to battle with the psyche,’ she says. So she asked him to test out electric wheelchairs and write a blog about his favourite model. Eventually, the time came. ‘Could I borrow that wheelchair for a few weeks?’ he asked. ‘He took it on a cruise with my mother,’ she says, ‘and ended up selling one to another guest on board!’ This was a man who was still young and dynamic inside – and able to make a sale.

Reasons to Be Cheerful

Extra Time has given us an entirely new stage of life: the stage of the ‘Young-Old’. We need to catch up with this new reality, stop lumping everyone from 60 to 100 together, and accept that it is normal to be vibrant and capable in your seventies. Media editors should take a look at how they portray ‘pensioners’, and question whether they are falling for a narrow narrative about youth. Governments must raise retirement ages in line with life expectancy and make this explicit: as part of signalling that the average lifespan has changed. And all of us need to challenge our own attitudes. Prejudices we build up against the ‘old’ will only hurt us when we reach that stage ourselves.

One vital question is what proportion of the over-60s will be ‘Young-Old’, thriving and capable like stewardess Bette Nash, and how many will be ‘Old-Old’, needing care, like her sister. On the answer to that question rests the future of our economies and the cohesion of our societies. If there are too many ‘Old-Old’, our welfare states and healthcare systems will be overloaded and younger generations will bear the burden. But if we can help people to stay healthy and productive, if we can abolish prejudice, we could see a new era of extended middle age, with most people staying vital almost to the end.

Later in this book I describe breakthroughs in genetics and neuroscience which may transform the youthspan, elongating our ‘Young-Old’ period and limiting the ‘Old-Old’. But we don’t have to wait for those. We already hold two of the keys in our hands to improving our Extra Time: diet and exercise.

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