Old Age and Health Articles

Too Many Drugs

• More than one in four elderly patients was given potentially hazardous medication during 2007. That is the conclusion of a study by Ute Amann and her co-authors in the current issue of the Deutsches Arzteblatt International.
  
  Giving certain medical drug substances to over-65-year-olds can increase the risk of undesired drug effects, and for this reason experts describe them as "potentially inappropriate medications" (PIMs).
  
  This study used information from a large database to attempt to estimate the risk of PIM for older people according to age, sex, and drug substance. The researchers used the data of 447 592 men and 356 808 women aged 65 or over to assess how often PIMs were prescribed per patient.
  
  Women had more PIM prescriptions than men. The potentially hazardous drugs that were most often prescribed were amitriptyline, acetyldigoxin, tetrazepam, and oxazepam. Overall, 8.8% of all patients in the database received four or more prescriptions for the same or an equivalent drug during the study period.
  
  

Aging of eyes is blamed for range of health woes

The gradual yellowing of the lens and the narrowing of the pupil that occur with age disturb the body’s circadian rhythm, contributing to a range of health problems, these studies suggest. As the eyes age, less and less sunlight gets through the lens to reach key cells in the retina that regulate the body’s circadian rhythm, its internal clock.

Photoreceptive cells in the retina absorb sunlight and transmit messages to a part of the brain called the suprachiasmatic nucleus (SCN), which governs the internal clock. The SCN adjusts the body to the environment by initiating the release of the hormone melatonin in the evening and cortisol in the morning.

Melatonin is thought to have many health-promoting functions, and studies have shown that people with low melatonin secretion, a marker for a dysfunctional SCN, have a higher incidence of many illnesses, including cancer, diabetes and heart disease.

Scientists believe that with age, people should make an effort to expose themselves to bright sunlight or bright indoor lighting when they cannot get outdoors. Older adults are at particular risk, because they spend more time indoors.

Move Away From Full Time Care Homes

Faced with soaring health care costs and shrinking Medicare and Medicaid financing, nursing home operators are closing some facilities and embracing an emerging model of care that allows many elderly patients to remain in their homes and still receive the medical and social services available in institutions.

The rapid expansion of this new type of care comes at a time when health care experts argue that for many aged patients, the nursing home model is no longer financially viable or medically justified.

In the newer model, a team of doctors, social workers, physical and occupational therapists and other specialists provides managed care for individual patients at home, at adult day-care centers and in visits to specialists. Studies suggest that it can be less expensive than traditional nursing homes while providing better medical outcomes.

The number of such programs has expanded rapidly, growing from 42 programs in 22 states in 2007 to 84 in 29 states today. In New York City, a program run by a division of CenterLight Health System, formerly known as the Beth Abraham Family of Health Services, has over 2,500 participants at 12 sites in the metropolitan area.

"It used to be that if you needed some kind of long-term care, the only way you could get that service was in a nursing home, with 24-hour nursing care," said Jason A. Helgerson, the Medicaid director for New York State. "That meant we were institutionalizing service for people, many of whom didn't need 24-hour nursing care. If a person can get a service like home health care or Meals on Wheels, they can stay in an apartment and thrive in that environment, and it's a lower cost to taxpayers."

The recent influx of adult day-care centers and other managed care plans for the frail elderly is being driven by financial constraints as President Obama and Congressional leaders seek hundreds of billions of dollars in savings in Medicare and Medicaid. Nursing homes, which tend to rely heavily on Medicare and Medicaid dollars, are facing enormous financial pressure - Mr. Obama's proposed budget includes a $56 billion Medicare cut over 10 years achieved by restricting payments to nursing homes and other long-term care providers.

Nationally, the number of nursing homes has declined by nearly 350 in the past six years, according to the American Health Care Association. In New York, the number of nursing homes declined to 634 this January from 649 in October 2007, and the number of beds to 116,514 from 119,691.

Over the next three years, New York State plans to shift 70,000 to 80,000 people who need more than 120 days of Medicaid-reimbursed long-term care services and are not in nursing homes into managed care models, Mr. Helgerson said.

The move away from nursing homes was highlighted on Thursday when Cardinal Timothy M. Dolan announced that the Archdiocese of New York, one of the state’s largest providers of nursing home care, is selling two of its seven nursing homes and opening or planning to open seven new adult day-care centers over the next three years.

"Seniors and others who have chronic health needs should not have to give up their homes and independence just to get the medical care and other attention they need to live safely and comfortably," Cardinal Dolan said in a statement before he opened a 250-patient program at Saint Vincent de Paul Catholic Healthcare Center in the South Bronx.

These new adult day-care centers, known around the nation by the acronym PACE - Program of All-Inclusive Care for the Elderly - provide almost all the services a nursing home might, including periodic examinations by doctors and nurses, daytime social activities like sing-alongs and lectures, physical and occupational therapy and two or three daily meals. All the participants are considered eligible for nursing homes because they cannot perform two or more essential activities on their own like bathing, dressing and going to the toilet. But they get to sleep in their own beds at night, often with a home health care aide or relative nearby.

The nonprofit groups that operate them receive a fixed monthly fee for each participant and manage their entire care, including visits to specialists, hospitalizations, home care and even placement in a nursing home. Because Medicare and Medicaid pay set fees instead of paying for specific procedures, center operators are motivated to provide preventive care to avoid costly hospitalizations or nursing home care.

Some elderly people, however, spurn PACE programs because under managed care, they would have to switch their physicians to those at the PACE center or in its network.

Most elderly people want to live out their lives at home, a desire evident in interviews in the PACE center the archdiocese opened in 2009 in Harlem, which has a staff of three doctors and is visited regularly by a dentist, a podiatrist and a psychiatrist.

Edna Blandon, 74, a diabetic weakened on her left side by a stroke who relies on a wheelchair, is transported by specialized van to the Harlem PACE center three days a week and appreciates that it provides not only a home care attendant but sends a nurse every two weeks to change pills in her pillbox and load a 14-day supply of insulin into syringes that she will inject.

"My spirits would drop if I went to a nursing home," she said. "I love the fact that I can go home at night. There's no place like home. I can sit down, look at the TV and go to bed when I want."

James Harper, 70, a retired bank employee who spent 10 months at the archdiocese's Kateri Residence, a nursing home on the Upper West Side, after a stroke paralyzed his right side, enjoys yoga breathing classes and discussions about black history. Yet he gets to spend nights and weekends with his wife, Albertene, and daughter, Traci, both of whom work during the day and are not around to care for him.

"This way I'm around people," he said.

Dr. Fredrick T. Sherman, the Harlem PACE medical director, said that a 2009 study showed that PACE programs reduce lengths of stays in hospitals and delay assignments to nursing homes.

The archdiocese, whose new centers will serve a total of 1,500 people, receives an average of $4,000 a month from Medicaid for each participant and $3,300 from Medicare. By comparison, said Scott LaRue, the chief executive of ArchCare, the archdiocesan health care network, a month of nursing home care can cost the government $9,000.

Ultimately, the archdiocese hopes that half of its elderly clients will be served in community settings rather than in nursing homes, which currently serve about 90 percent of the archdiocese's clients. For-profit companies have not yet moved into the managed care market, in part because of uncertainties about reimbursement formulas and the risks of taking on a nursing home population.

The PACE population tends to be younger than that at nursing homes, which raises the question of whether many PACE clients would really need nursing homes without PACE. Dr. Sherman replies to such skepticism by saying that his clients "need that level of service - the question is where they're going to get it."

Without PACE, he said, "they're going to end up in nursing homes."

Dementia In Australia

Dementia is the single biggest age-related disease facing Australians, with 1600 new cases diagnosed every week, and it is predicted its prevalence will double over the next 20 years, according to a new report.

There are 280,000 Australians currently living with dementia with the number set to reach 400,000 within 10 years.

The report, commissioned by the Department of Health and Ageing, finds that Australia's aged care system is effectively broken when it comes to caring for people living with dementia. It describes the national network as ''complicated, inflexible and largely unable to meet their [people with dementia] needs''.

The Minister for Mental Health and Ageing, Mark Butler, said the report - which was based on the feedback of more than 1000 older Australians, their families and carers who attended 16 specially convened consultations nationwide - made for sober reading.''It is clear from the feedback received through the conversations that the issues that continue to beset the provision of care for people with dementia have not been given the prominence they deserve in the debate about the quality of aged care,'' he said.''The overwhelming view of older Australians is that the aged care system is simply not meeting the needs of dementia sufferers and their families. For many older Australians, 'dementia-specific care' is matched by the reality of locked wards."Families want to keep loved ones living with dementia at home for as long as possible but the current system does not provide adequate support and assistance to enable people to remain at home.''

The report found that, specifically, community care packages were inadequate and inflexible and that the system was beset by long waiting times, lack of transparency in administration costs and clogged by bureaucratic roadblocks."It is also clear from the consultations that older Australians and their families want staff appropriately trained in all aspects of dementia, and paid accordingly,'' Mr Butler said."As Australians, we enjoy one of the longest life expectancies in the world but we need to make sure that those extra years are years of quality.''

The National Aged Care Alliance - an overarching body of 28 organisations representing consumers, providers and aged care workers - said a complete overhaul of the aged care system was urgently needed, adding their claim was backed by the Productivity Commission, which had made the same recommendation more than eight months ago.Alzheimer's Australia chief executive Glenn Rees said that even after more than a decade in the job, he was shocked by some of the stories that emerged during the consultation process."There is a dramatic contrast between the experiences of the people with dementia and family carers who benefited from timely diagnosis and referral to services, and the overwhelming majority of those who were traumatised by poor diagnosis, lack of information and care services that had next to no understanding of dementia," Mr Rees said."People with dementia and their carers don't know where to turn to receive services and support.''

Mr Rees said Alzheimer's Australia was lobbying for an immediate injection in the federal budget of $500 million for dementia services."It is clear that aged-care reform that does not give priority to dementia will fail,'' he said. "And it is time the health system took dementia seriously as a chronic disease within a public health framework."Sadly it is clear too that it is not just a question of more funding and services but a lack of knowledge and respect for people with dementia in the way they are treated."Failure to act now will lead only to increased burdens and costs for both the nation and individuals, with the highest price for these failures paid by the families of those with this cruel disease, who struggle to care for their loved ones.''

Australian Nursing Federation federal secretary Lee Thomas said that workforce considerations were a critical sticking point for improving aged care services."Respondents to the Alzheimer's Australia consultation call for better paid, better trained and higher levels of aged care staff. This is a critical element of reform if we are to create a system which gives older people the opportunity to age well – with dignity, choice and quality services," she said.

Aged and Community Services Australia president Rob Hankins said the report outlined the need for more community-based care, higher-quality residential care, better access to respite and an improvement in services for people from different backgrounds."There are systemic problems with aged care in this country and we can't afford to just keep patching up the system and hope it will resolve itself," Mr Hankins said."Comprehensive reform is the only way forward and the Government must show the leadership to commit to it once and for all in the Budget this May."

Dutch Dementiaville

Dementia is a stark reminder of how, as Philip Larkin said, “our flesh/ Surrounds us with its own decisions”. Brain processes we may not even have heard of, and certainly could not understand, eat into our ability to think and our capacity to grasp who and what and why.

Until we lose our agency altogether, we act in ways that hitherto would have horrified us. Our memories are pruned and the rich connectedness of the “I” is pulled apart. The future shrinks along with the past and we are confined to an eternal present in which (to quote Larkin again) we sit “through days of thin continuous dreaming”, trying, with what remains of our self, to make sense of a world that has become warped into a permanent and often terrifying question mark.

Little wonder then that it is difficult to look unflinchingly at this condition, in which we see mirrored our most radical vulnerability, or even to think clearly about how we should respond to, support, manage, care for and protect those who suffer from it and whose ranks we may well ourselves join. So when we hear of a purpose-built village in the Netherlands, populated almost entirely by people with dementia, we may have rather confused reactions. In Hogeweg, which was opened in 2009, 152 residents live in groups of six in houses that have been designed to correspond to a variety of Dutch lifestyles, from rustic to Indonesian, so that they look like home. The domestic spaces are customised to match the memories, culture, interests and hobbies of the residents, which is important since, when factual and other explicit memories are lost, the material environment is an even more crucial prop for orientation.

Residents are free to do largely as they wish — to dress when and how they like, to eat whatever they fancy, to walk out into the streets, rain or shine, to enter each other’s houses, to participate in cultural activities, even to go shopping without their wallets and return with dozens of cans of food they do not want or need. One key to reconciling this remarkable freedom with ensuring safety is the lavish provision of carers — four to each resident — available day and night to bring people home and ensure that they do not neglect or hurt themselves, even to return food to the supermarket.

The Hogeweg experiment, which has attracted European-wide attention, sounds imaginative and deeply humane. The description of the atmosphere as “serene” is not implausible and a great improvement on the anguished indignity and frustration that often characterises the life of residents in even the best-run and respectful institutions, where the focus is primarily on provision of basic care and any ambition to establish a truly therapeutic community is constrained by risk assessments, often made more cautious by staff shortages.

Daily life in some institutions consists of dozing in chairs in front of incomprehensible television screens, and/or being subjected to unchosen music, punctuated by futile attempts to go home that may be rewarded by an increase in sedation. The contrast with Hogeweg, where residents take themselves to the hairdresser, have a drink and do their shopping, all under the careful but unobtrusive guidance of care staff — could not be greater.

Even so, some have found rather chilling the very idea of the village, even if it does replicate the amenities of everyday life and offers the residents the possibility of self-expression that may lead to striking improvements in their condition. The sequestration of people with dementia may seem a cognitive apartheid; or waken memories of earlier rejected approaches to chronic illness — colonies for people with epilepsy, asylums for the mentally ill hidden in the depths of the countryside, remote isolation hospitals for infectious diseases and other “total institutions”.

To be transferred to a place where you are surrounded by other people who do not understand you or acknowledge you, just as you do not comprehend or acknowledge them, might seem to reinforce the sense that dementia is taking you to a world with no outside. And there is the deception practised on patients by treating behaviour that is nothing of the kind as normal and then discreetly heading off its consequences. In some cases, the deceit is quite elaborate, with better-off residents encouraged to believe that the carers are their servants, the delusion being reinforced by expensive décor. An analogy with The Truman Show, the film in which people unwittingly live in a 24-hour reality televison show, has been invoked.

These reservations are compelling only if we underestimate the extent to which dementia remorselessly unscrambles every aspect of ourselves. To a person with the drastically shrunken life-space of advanced Alzheimer’s disease, a conventional care home is much more of a ghetto than Hogeweg, particularly as the latter’s world, free of the locks, doors and proscriptions of most institutions, keeps its walls hidden. And the village is not cut off from the outside world. Visiting by friends, acquaintances and loved ones is open. The key to the enterprise is a sustained attempt to empathise with the experience of the residents, motivated by a profound respect that sees people with dementia as being as singular beneath their general symptoms as they were when they were cognitively intact.

And, ah yes, resources. At £50,000 per person per year, this publicly funded facility is not cheap. In the light of Andrew Lansley’s plans for the NHS, which will divert more taxpayers’ money into the pockets of health entrepreneurs, similar developments in the UK may seem utopian. We should, however, see Hogeweg as a benchmark against which what is typically on offer for people with dementia should be judged; and we should not allow the malign forces currently circling the NHS to allow us to lose sight of what is possible or to despair of realising it.

Because I know where I would like to be cared for — somewhere like Hogeweg where I would not be a mere instance of a disease, but still a person. But please, please don’t call my new home town “Dementiaville”.

Longevity and Personality

Researchers at Albert Einstein College of Medicine and Ferkauf Graduate School of Psychology of Yeshiva University have found that personality traits like being outgoing, optimistic, easygoing, and enjoying laughter as well as staying engaged in activities may be part of the longevity genes mix.

Up until now, research has focused on genetic variations that offer a physiological advantage such as high levels of HDL (“good”) cholesterol.

The findings come from Einstein’s Longevity Genes Project, which includes over 500 Ashkenazi Jews over the age of 95 and 700 of their offspring. Ashkenazi (Eastern European) Jews were selected because they are genetically homogeneous, making it easier to spot genetic differences within the study population.

Previous studies have indicated that personality arises from underlying genetic mechanisms that may directly affect health. The present study of 243 of the centenarians (average age 97.6 years, 75 percent women) was aimed at detecting genetically-based personality characteristics by developing a brief measure (the Personality Outlook Profile Scale, or POPS) of personality in centenarians.

“When I started working with centenarians, I thought we’d find that they survived so long in part because they were mean and ornery,” said Nir Barzilai, M.D., the Ingeborg and Ira Leon Rennert Chair of Aging Research, director of Einstein’s Institute for Aging Research and co-corresponding author of the study.

“But when we assessed the personalities of these 243 centenarians, we found qualities that clearly reflect a positive attitude towards life. Most were outgoing, optimistic and easygoing. They considered laughter an important part of life and had a large social network. They expressed emotions openly rather than bottling them up.”

In addition, the centenarians had lower scores for displaying neurotic personality and higher scores for being conscientious compared with a representative sample of the U.S. population.

“Some evidence indicates that personality can change between the ages of 70 and 100, so we don’t know whether our centenarians have maintained their personality traits across their entire lifespans,” continued Dr. Barzilai. “Nevertheless, our findings suggest that centenarians share particular personality traits and that genetically-based aspects of personality may play an important role in achieving both good health and exceptional longevity.”

The Myths

Professor Tom Kirkwood has demolished a string of misconceptions about the aging process with a groundbreaking study into the health of more than 1,000 older people in the 85-plus generation.

His study, the largest of its kind ever undertaken, has proved revealing on several fronts:

Life expectancy is increasing by about two years every decade.
People in the 85-plus range are generally much happier, and more independent, than is generally realized. Remarkably, 80% of a group carefully selected by the Kirkwood team — a fair sample of the UK population of this age — need little care. Around the same number rate their quality of life either good or excellent.
On the downside, 20% need either regular daily help or critical 24-hour care.
While the most recent analysis showed that the number of people in the UK aged over 80 to be at 2.6 million, by 2030 the figure is likely to jump to 4.8 million — and one in five will need regular care. Kirkwood’s team, at the world-leading Biomedical Research Centre in Aging at Newcastle University, estimates that this will lead to an 82% increase in the demand for places in care homes, with an additional 630,000 older people needing accommodation.

Kirkwood’s project is comprehensively tracking the activities, and well-being, of people once considered very old. Known as the Newcastle 85+ Study, it began in 2006 when more than 1,000 85-year-olds, from Newcastle upon Tyne and North Tyneside, were carefully selected from all social classes and backgrounds through GP practices.

Kirkwood explains: “What we now know is that the genetic factors that influence your longevity are not genes that measure out the passage of time; the reason we age and die is because, as we live our lives, our bodies accumulate a great variety of small faults in the cells, and the molecules that make up the cells in our body — so aging is driven by this accumulation of faults. The genes that influence longevity are those that influence how well the body copes with damage, how aggressive our repair mechanisms are; they’re genes that regulate the house-keeping and maintenance and repair.”

Official longevity forecasts have proved wide off the mark. Until relatively recently, he recalls, all the best brains in the world were forecasting that life expectancy would stall. “UN forecasts of 1980 predicted it was going to bump into a ceiling and stop increasing next week, but it didn’t happen; [it] carried on increasing pretty much as before.”

Why? “Something profound had changed … we were reducing the deaths in the early and middle years of life; we were reducing deaths around people who were very old — 80 and over — and those rates are [now] less than half what they were in 1951, the year I was born. This presents a really important challenge: to understand what life is like for the growing numbers of older people. We really want to understand something about the factors that influence the personal trajectory of health into old age.”

Of course, this has huge implications for the cost of caring. Revealingly, in tracking 17 activities of daily living among survey participants, researchers found that men fared better than women; a third managed all 17 without help, compared with a sixth of women. Although women live, on average, five to six years longer than men, the study has found that their disabilities become greater with age.

Middle Age Is Unusual

As a 42-year-old man born in England, I can expect to live for about another 38 years. In other words, I can no longer claim to be young. I am, without doubt, middle-aged.

To some people that is a depressing realization. We are used to dismissing our fifth and sixth decades as a negative chapter in our lives, perhaps even a cause for crisis. But recent scientific findings have shown just how important middle age is for every one of us, and how crucial it has been to the success of our species. Middle age is not just about wrinkles and worry. It is not about getting old. It is an ancient, pivotal episode in the human life span, preprogrammed into us by natural selection, an exceptional characteristic of an exceptional species.

Compared with other animals, humans have a very unusual pattern to our lives. We take a very long time to grow up, we are long-lived, and most of us stop reproducing halfway through our life span. A few other species have some elements of this pattern, but only humans have distorted the course of their lives in such a dramatic way. Most of that distortion is caused by the evolution of middle age, which adds two decades that most other animals simply do not get.

An important clue that middle age isn’t just the start of a downward spiral is that it does not bear the hallmarks of general, passive decline. Most body systems deteriorate very little during this stage of life. Those that do, deteriorate in ways that are very distinctive, are rarely seen in other species and are often abrupt.

For example, our ability to focus on nearby objects declines in a predictable way: Farsightedness is rare at 35 but universal at 50. Skin elasticity also decreases reliably and often surprisingly abruptly in early middle age. Patterns of fat deposition change in predictable, stereotyped ways. Other systems, notably cognition, barely change.

Each of these changes can be explained in evolutionary terms. In general, it makes sense to invest in the repair and maintenance only of body systems that deliver an immediate fitness benefit — that is, those that help to propagate your genes. As people get older, they no longer need spectacular visual acuity or mate-attracting, unblemished skin. Yet they do need their brains, and that is why we still invest heavily in them during middle age.

As for fat — that wonderfully efficient energy store that saved the lives of many of our hard-pressed ancestors — its role changes when we are no longer gearing up to produce offspring, especially in women. As the years pass, less fat is stored in depots ready to meet the demands of reproduction — the breasts, hips and thighs — or under the skin, where it gives a smooth, youthful appearance. Once our babymaking days are over, fat is stored in larger quantities and also stored more centrally, where it is easiest to carry about. That way, if times get tough we can use it for our own survival, thus freeing up food for our younger relatives.

These changes strongly suggest that middle age is a controlled and preprogrammed process not of decline but of development.

A crowning achievement

When we think of human development, we usually think of the growth of a fetus or the maturation of a child into an adult. Yet the tightly choreographed transition into middle age is a later but equally important stage in which we are each recast into yet another novel form.

That form is one of the most remarkable of all: a resilient, healthy, energy-efficient and productive phase of life that has laid the foundations for our species’s success. Indeed, the multiple roles of middle-aged people in human societies are so complex and intertwined, it could be argued that they are the most impressive living things yet produced by natural selection.

The claim that middle age evolved faces one obvious objection. For any trait to evolve, natural selection has to act on it generation after generation. Yet we often think of prehistoric life as nasty, brutish and short. Surely too few of our ancestors lived beyond age 40 to allow features of modern-day middle age, such as the deposition of a spare tire around the middle, to have been selected for.

This is a misconception. Although average life expectancy may sometimes have been very low, this does not mean that humans rarely reached the age of 40 during the past 100,000 years. Average life expectancy at birth can be a misleading measure; if infant mortality is high, then the average is skewed dramatically downward, even if people who survive to adulthood have a good chance of living a long, healthy life.

The evidence from skeletal remains suggests that our ancestors frequently lived well into middle age and beyond. Certainly many modern hunter-gatherers live well beyond 40.

The probable existence of lots of prehistoric middle-aged people means that natural selection had plenty to work on. Those with beneficial traits would have been more successful at nurturing their children to reproductive age and helping provide for their grandchildren, and hence would have passed on those traits to their descendants. As a result, modern middle age is the result of millennia of natural selection.

Lifelong learning

But why did it evolve as it did? In prehistory, and still today, human survival is entirely dependent on skilled gathering of rare, valuable resources. Humans cooperate, plan and innovate so they can extract what they need from their environment, be that roots to eat, hides to wear or rare metals to coat smartphone touch screens. We lead an energy-intensive, communication-driven, information-rich way of life, and it was the evolution of middle age that supported this.

For example, hunter-gatherer societies often have complex and difficult techniques for finding and processing food that take a long time to learn. There is evidence that many hunter-gatherers take decades to learn their craft and that their resource-acquiring abilities may not peak until they are older than 40.

Gathering sufficient calories is crucial for the success of a human community, especially since young humans take so long to grow up. Indeed, for the early years of life they devour calories without contributing many to the group themselves. Research suggests that a human child requires resources to be provided by multiple adults, almost certainly more than two young parents. For example, a recent study of two groups of South American hunter-gatherers suggested that each couple required the help of an additional 1.3 non-reproducing adults to provide for their children. Thus, middle-aged people may be seen as an essential human innovation, an elite caste of skilled, experienced super-providers on which the rest of us depend.

Culture conveyers

The other key role of middle age is the propagation of information. All animals inherit a great deal of information in their genes; some also learn more as they grow up. Humans have taken this second form of information transfer to a new level. We are born knowing and being able to do almost nothing. Each of us depends on a continuous infusion of skills, knowledge and customs, collectively known as culture, if we are to survive. And the main route by which culture is transferred is by middle-aged people showing and telling their children — as well as the young adults with whom they hunt and gather — what to do.

These two roles of middle-aged humans — as super-providers and master culture-conveyers — continue today. In offices, on construction sites and on sports fields around the world, we see middle-aged people advising and guiding younger adults and sometimes even ordering them about. Middle-aged people can do more, they earn more and, in short, they run the world.

This has left its mark on the human brain. As might be expected of people propagating complex skills, middle-aged people exhibit no dramatic cognitive deterioration. Changes do occur in our thinking abilities, but they are subtle. For example, response speeds slow down over the course of adulthood. However, speed isn’t everything, and it is still debated whether other abilities deteriorate at all.

To carry out their roles in society, middle-aged people need not necessarily think better than younger adults, but they may have to think differently. Indeed, functional brain imaging studies suggest that they sometimes use different brain regions than young people when performing the same tasks, raising the possibility that the nature of thought itself changes as we get older.

An elite club

A central and related feature of middle age is the many healthy years we enjoy after we have stopped reproducing. Female humans are especially unusual animals because they become infertile halfway through their lives, but male humans often also effectively “self-sterilize” by remaining with their post-menopausal partners. Almost no other species does this.

The possible benefits of menopause are not immediately obvious: After all, natural selection favors individuals who rear the most offspring. Yet there are other, rare examples of reproductive cessation in the animal kingdom that may provide some clues. Orcas also undergo menopause, and it is striking how much their lives mirror ours. They are long-lived, slow to develop, intelligent and vocally communicative. They invent and apply a complex array of techniques for communal food acquisition, and they are extremely widespread.

Thus, humans can be seen as members of an elite club of species in which adulthood has become so long and complicated that it can no longer all be given over to breeding. Just like farsightedness and inelastic skin, menopause now appears to be a coordinated, controlled process. It liberates women and their partners from the unremitting demands of producing children and gives them time to do what middle-aged people do best: live long and pamper.

What kind of old age will you have?

Many of us look forward to spending retirement expanding our world — traveling, trying what we never had time to do, taking classes that give us new knowledge and skills. These activities are not only desirable in themselves, they help us to live longer and healthier lives.

But they are not within everyone’s reach. Absent money and a sense of possibilities, retirement can become more time to fill with television. “We see people without money, who had very hard lives, who are not aware of their own potential,” said Maureen Kellen-Taylor, the chief operating officer of EngAGE ,a program in the Los Angeles area that provides arts and other classes for some 5,000 people — the vast majority of them low-income — living in senior apartment communities. “They just had to get through life, taking care of things, and the idea of following a dream was not on their radar screens.”

That’s why the Burbank Senior Artists Colony is remarkable. Opened in 2005, it is a mix of market-rate and low-income apartments. The building looks like an upscale hotel but is built for the arts, with studios, a video editing room, a theater and classrooms.

Residents may arrive with no previous artistic experience or skill as an artist — but artists they become. The theater group that Sally Connors participates in is working with a troupe in London, via Skype, to write and perform a soap opera. Walter Hurlburt shows his oil paintings — for sale — at the colony’s periodic art exhibitions. Residents work with students from a nearby alternative high school to do improv theater, make claymation films and art from recycled items. Suzanne Knode wrote a short movie, “Bandida,” about an elderly woman who takes the bus to rob a convenience store. Then the residents filmed it — and Ira Glass’s “This American Life” television show filmed them — and submitted the film to the Sundance Film Festival. “A pistol, a plan, and sensible shoes,” says the poster.

The Burbank colony is the showpiece of EngAGE, an organization started in 1997 by Tim Carpenter. He was working for a health care company that built primary care centers for senior citizens when he met John Huskey, a Los Angeles developer of affordable housing.

Carpenter and Huskey began to talk about how to combine what each of them was doing. They had originally contemplated establishing acute-care health centers in senior apartment buildings, but now had a different idea. “We live in a society that’s very acute-care based — we wait till someone’s sick,” Carpenter said. “We decided to try to get people to take on healthy behaviors without having to go to the doctor.”

Carpenter, who had a background in the arts, started in one of the complexes built by Huskey’s company, Meta Housing, in Duarte in 1997, by teaching writing himself. The program soon expanded to more buildings. In 2005, the Burbank colony opened — the first one in which EngAGE had a say in the design.

EngAGE now brings arts training, wellness programs like an annual Senior Olympics, and computer and other classes to 27 senior apartment buildings in the Los Angeles area, and will add another eight over the next year, including two — in North Hollywood and Long Beach — that, like Burbank, will be designed for the arts. The NoHo Senior Artists Colony will open in October with a 77-seat professional theater in the lobby. Burbank and the Piedmont Senior Apartments in North Hollywood have a mix of market rate and subsidized apartments, but the other 25 are all for low-income seniors. Most of the residents are living on less than $15,000 a year. They pay $400 to $800 a month for a one- or two-bedroom apartment.

Basil Alexander at an EngAGE annual senior Olympics, a multi-generational event that allows seniors to participate in competitions in wellness and the arts.

The classes are demanding — no one is gluing macaroni to paper plates — and the teachers are pros, either laid-off schoolteachers or artists. The dance teacher at the Portofino Villas site in Pomona, for example, is Trina Parks, a dancer and actress who was the first seriously lethal and first African-American Bond girl — she played Thumper in “Diamonds Are Forever.”

Carpenter calls this approach the opposite of the assisted-living model. Assisted living centers provide whatever medical care is needed. They usually have a great dining hall. There are buses to the mall and trips to see plays. “These are things that don’t help people that much,” Carpenter said.

Everyone knows that staying physically fit is important to remaining healthy in later years. And we know that mental fitness is also crucial.

But certain strategies are better than others. “Doing Sudoku helps the part of the brain that does Sudoku,” said Michael C. Patterson, who used to run the Staying Sharp program at AARP and now is a principal in MindRAMP, a company that advises institutions working with senior citizens on promoting brain health in aging. “You need to exercise the full brain.”

And it has to be a serious exercise, Patterson says. “Part of the process is you set a goal for yourself, and did you achieve it?” he said. “Making potholders is not going to do the trick.”

Creativity in aging is Patterson’s business, of course, but the idea is amply supported by research. (The National Center for Creative Aging is a good place to start.) One of the best all-around exercises for older adults is doing theater. The researchers Helga and Tony Noice (she is a psychologist, he is an actor) gave nine 90-minute classes to a group of adults. Some did theater training, some trained in visual arts and another group did nothing. After four weeks, the differences in cognitive function were astonishing. The theater trainees scored nearly a 60 percent increase in problem-solving ability (with visual arts, that ability declined) and the gain was sustained. The Noices believe that theater is especially good for the brain because it requires engagement on many levels — emotional, physical and intellectual.

Not inconsequential: theater is fun and social, so people stick with it. Some of the visual arts students dropped out, but none of the actors did. “When you really get involved in a creative project, it’s physical exercise, mental stimulation, socializing, your stress goes down and it’s enjoyable — something you will do,” said Patterson.

A study done at the University of Southern California found that more respondents in EngAGE programs reported that their health had improved in the past year, while in a control group, more people reported that their health had worsened. A study carried out by Century Housing, one of the top lenders to EngAGE’s communities, put a dollar figure on the gains. In the program, it found, 25 percent fewer people than in comparable groups needed expensive interventions such as nursing care. The savings came to about $9,000 per year per resident.

EngAGE gets its money in part through fund-raising, but two-thirds of its income comes as payments from the senior complexes where it works. These buildings, in turn, stay afloat mainly through federal tax credits for low-income housing, said Huskey. The program is highly competitive, and projects are more likely to win tax credits if they have a local financial contribution — for example, from the Los Angeles Community Redevelopment Agency, or from banks, which by law must invest in their communities, including in low-income areas.

EngAGE is an important selling point for these groups, Huskey said. “They would much rather have a project that has a better story of how it’s affecting people’s lives. They want to do well by doing good.” Huskey said his company was approaching Charlotte, N.C., Austin, Tex., and Minneapolis about starting senior artist colonies in those cities. “What started out as self-serving desire to get a 15-minute head start on my competitors has become a great thing,” Huskey said.

Sally Connors thinks so. She and her husband had five good years after his lung cancer diagnosis, and they used them to travel. After he died, Connors, a junior high science teacher, thought she would spend her time reading, walking and doing genealogical research. “I wouldn’t be going out and doing things,” she said. “I would be very bored.”

But she had a daughter in Burbank, and one day they drove by the colony. “Why don’t you live there, Mom?” her daughter said.

“I’m not an artist,” Connors replied.

“But you could be,” her daughter said.

That was five years ago. Since then, she has taken every single class EngAGE offers in the colony. She’s been in every theater performance. She had dreamed as a teenager of singing with a band — now she sang “Sentimental Journey” and “Blue Moon” with a band at a Fourth of July celebration. She wrote a two-minute screenplay, cast it, directed it, produced it and showed it as part of a film festival in the building. She’s part of the theater group working with their British counterparts, and mentors high school kids. She’s studied drawing and acrylic, watercolor and oil painting.

At 78, she does yoga twice a week and works out with a personal trainer. “I would be a lot older than I am right now if I hadn’t found this,” she said. “Definitely older mentally. I have a friend I don’t call anymore. For her everything is wrong — I can’t do this because I’m too old. That would have been me."

“All those years I spent thinking: ‘If I only knew then what I know now,’” said Suzanne Knode, who counts “Bandida” — her first writing ever, at 63 — as the start of a new life. “But I said, ‘Wait a minute. I know now what I know now. And I’m still alive.”

10 of Science Fiction’s Most Depressing Futuristic Retirement Scenarios

The UN's Department of Economic and Social Affairs estimates that, by the year 2100, life expectancy in developed countries will hover around 97 years and around 106 years by 2300. But will the quality of life for the elderly and retired increase with that increased lifespan? While many science fiction stories promise rejuvenation procedures and freshly grown bodies waiting to download your personality, there are some tales in which our venerable elders (and sometimes not-so-elders) are dehumanized — sometimes in uncomfortably close exaggerations of the modern day.

Living the same hour over and over again: In Charles Yu's How to Live Safely in a Science Fictional Universe, you can hide from the world by living out of time. Time machine technician Charles Yu does it by hiding himself in a pocket universe while his retired mother hides from her unhappy memories inside a one-hour time loop. Instead of hanging out in a nursing home, where your dementia constantly reboots your memory, you can just relive the same hour over and over again. Charles' mother chooses an hour of prepping and eating family dinner with simulacra of her son and vanished husband, It might sound appealing on the surface, but you always sort of know that it's not real and that your family hasn't come to visit you in a rather long time.

Being murdered by your younger self: That's the basic setup for the upcoming time-travel flick Looper (you can read our very excited first impressions here). You hang out, spend a few years killing time-traveling criminals for a mob outfit, then close your loop by killing your future self. Then you hang out on a beach in France for the next three decades before you're sent back in time to get killed. This one's a bit different from the other examples, since your death is related to future mob politics rather than old age, but it must be frustrating to know that your death is coming up and you have only your past self to blame.

Living out your days in Virtual Florida: Futurama is always good for a more extreme version of our own depressing reality, and instead of sending its elderly into physical nursing homes, retirees get sent to the Near-Death Star. There they are used as batteries (because it turned out that The Matrix was totally correct and everyone who doubted it was utterly short-sighted) and plugged into a virtual reality retirement community. All that processing power, and all the elderly get to do is eat virtual oatmeal, play virtual bingo, and wait around for the kids to call.

Living for eternity as a disembodied head: Futurama actually has multiple dismal dumping grounds for human beings (and that's before we get around to what becomes of disabled robots). Granted, many of the heads in jars are likely clones implanted with the memories of their original personages, but unless they're playing president of Earth (like Richard Nixon) or dating Bender (like Lucy Liu), most immortal heads live up on a shelf in the Head Museum, offering occasional advice to people who still have bodies and wishing for death.

Being murdered by your government: This is a pretty common scifi scenario for the elderly, especially the elderly who live in fascist societies (often disguised as false utopias). Sometimes, the dying part is a bittersweet occasion; in Ally Condie's Matched, your death day is a party attended by your family and you die with the taste of cake on your lips. Other times, you're mislead about what's going to happen; in Lois Lowry's The Giver, you think you're headed off into the wilderness (which, granted, has a bit of a "being sent off on an iceberg" feel to begin with), only to die on the end of a needle. Often, it's a question of economics — the society decides that the elderly are of no use, so why not make more resources for other people? (In V for Vendetta, thugs murder nursing home residents simply to open up more beds.) Soylent Green goes one step further, convincing the elderly to seek euthenasia so that the government can process their bodies into food for the populace.

Being murdered for mass entertainment: In the cross-country Death Race 2000, the elderly are worth 100 points (and elderly women an additional 10 points above that), making them the most desirable targets for the depraved Death Race drivers. In fact, hospitals use the drivers as an excuse to get rid of their elderly patients. But the driver known as Frankenstein decides that maybe the folks with little regard for human life and death are the ones best suited to die.

Living out your golden years in a state of quasi-undeath: Ian R. MacLeod's short story "Recrossing the Styx" envisions a future in which people can indefinitely extend their lives through organ transplants, memory uploads, and titanium joints to the point where you could no longer consider them alive. These walking corpses hang out on the same cruises ships where their rejuvenation procedures are performed, a series of floating undead nursing homes. The trick to making this sort of retirement work for you is to die young and leave a good-looking walking corpse.

Being used as a mad scientist's test subject: The scientists running the nursing home in Margaret Peterson Haddix's novel Turnabout use the mental fog of extremely elderly patients to elicit their consent to participate in a dangerous drug test. In The X-Files episode "Emily," one nursing home implants alien-human hybrid embryos into elderly women, having them carry the resulting fetuses to term while they sleep. For a more mystical example, another X-Files episode, "Excelsis Dei," sees an orderly giving nursing home patients mushrooms that both treat Alzheimer's and grant patients the ability to see ghosts.

Extending your life via suspended animation: There are lots of stories in which the dead can be revived for brief periods of time (Will McIntosh's wonderfully chilling short story "Bridesicle" comes to mind). In the Judge Dredd installment "The Forever Crimes," we encounter the not-quite-final resting place of the super-rich, where the sick and elderly exist in a grim, morque-like facility exist in suspended animation. They can be woken up for brief periods of time, but that forces them to suspend a little bit of their remaining lifetime. And sadly, you'll probably find yourself woken up for bad news, like the death of a loved one.

Going into storage: Most people in Richard K. Morgan's Altered Carbon do experience old age — in fact, thanks to the resleeving process, they often experience it twice. But while science has found a way to put you in a new body, it hasn't found a way to make the aging process more pleasant. After two full lifetimes, most folks who aren't rich enough for frequent resleevings put their memories and personalities in storage, opting for only occasional and temporary resleeving.

The Gray Tsunami

On a bright February morning under a blank desert sky, three experts in world population get into a van in Tempe, Arizona, and drive back to the future. From the campus of Arizona State University on the edge of Phoenix, the three head northwest along Grand Avenue, following old U.S. Route 60 out of the city. On either side, what used to be cotton fields and cattle feedlots, and before that catclaw bushes and cactus scrub, has turned into suburban sprawl. The Phoenix metropolitan area, a.k.a. the Valley of the Sun, has grown more quickly than any other urban area in the United States, following an influx over the past decade of Hispanic migrants and white retirees. Due largely to the latter, the Northwest Valley of Phoenix is one of the fastest-aging population centers of the country.

The day starts cool, even cold. Frost disrupts the tee times on the bright green golf courses dotting the Northwest Valley. Arizona’s median age is 34, but at the point where Grand Avenue crosses the dry bed of the New River, palm trees sprout from the sidewalks and the median age jumps to 75. Silver-haired drivers on souped-up golf carts nose into the traffic, one maneuvering fearlessly in front of the university van. Screened by a low white wall, rows of nearly identical single-level houses nestle on tidy, concentric streets. A big hospital overlooks the development like a lifeguard scanning a beach. Welcome to Sun City, Arizona, population 38,000, the once and future retirement mecca, where the whole world seems to be headed.

At Del Webb Boulevard—Del E. Webb was the visionary developer who built Sun City—the van turns and parks in front of the community’s historical museum. The three academics get out. They are Michael Birt, 58, a gerontologist and director of the university’s Center for Sustainable Health; Jennifer Glick, 42, a sociologist and demographer at the ASU Center for Population Dynamics; and Haruna Fukui, 32, a Japanese graduate student working on her Ph.D. in sociology with Glick as her adviser.

They were asked to discuss global population trends, including growth, fertility, and the impacts of immigration. But especially they planned to address the overarching trend of aging, which some researchers are calling “the gray tsunami” because it threatens to inundate the world’s health-care systems and sweep away today’s social, political, and economic norms. To make the discussion more pointed, it would take place during a field trip to Sun City, the prototypical American retirement community, now entering old age itself. None of the three has been here before, and they are curious to see it.

Population growth, not aging, has drawn the lion’s share of public attention, so the panel speaks to that topic first. There was consternation in the media when the Population Division of the United Nations announced that Earth had gained its 7 billionth person in 2011. By 2050 there could be 3 billion more of us, according to the agency’s most pessimistic projection. But Glick, the demographer, says, “Let’s not make a big deal about that number. The focus should be on the rate of growth and on the eventual turnabout.” Although billions of people are still in the pipeline, global population growth is slowing so rapidly that a decline in the population later this century seems unavoidable.

Demographers habitually take the long view, because subtle changes in population trends may take 50 years or more to register statistically. In 1960, the year Del Webb sold the first homes in Sun City, demographers believed that Earth’s population was out of control. “We thought it would explode,” Glick says. The sense of gloom was captured in 1968 by Paul Ehrlich’s best-selling book, The Population Bomb, which predicted widespread famine and mass mortality. Instead, an annual population gain of 2 percent has been cut in half and continues to head down. “That’s because fertility has declined, which writers of the time didn’t anticipate,” Glick adds.

The slowdown in growth has been offset somewhat by rising longevity. “People are living longer, 20 and 30 years longer, across the globe,” observes Birt, the gerontologist. Greater longevity causes a society to age unless births surge in compensation. In fact, the U.N. called attention to the aging phenomenon in developed nations as early as 1956.


Aging Boom / Fertility Bust


Del Webb was no demographer, but in the late 1950s he saw an opportunity in America’s budding crop of elderly. Promoting the then-novel idea of “active retirement,” Webb was a very active 60-year-old himself. Tall and lean, a vigorous golfer and baseball fan, he was a millionaire contractor with a common touch. The people who flocked to see his Sun City demonstration homes—100,000 showed up over New Year’s weekend in 1960—had had their fill of hard times. These were people who had lived through an economic depression and a world war. The advertisements for Sun City depicted a golden way of life in a place where they could retire and relax, where they would not be frail or sick.

Some of those ads now hang in the Sun City Historical Museum, which occupies one of the first homes to be built here, next to the first golf course. Two vintage golf carts, labeled Him and Her, stand side by side in the carport. Inside, the modest fixtures and furniture of a typical 1960s retired couple are on display. The original cinder-block structure consisted of five rooms totaling just 858 square feet; an addition was put on the back later. The small eat-in kitchen features a boxy electric range and fridge. The sink in the pink-tiled bathroom is very low and the toilet is minuscule, hardly suitable for today’s amplified Americans. The three academics smile as they look into the bathroom. “There are no handrails, nothing to grab onto,” Glick says.

Sun City’s radical idea—to restrict home ownership to people 55 and older—effectively excluded families and children from the development. But recently the policy was updated. Now only one owner has to be over 55, this to accommodate residents with younger spouses. Getting back in the van and touring the quiet, curving streets, with their neat plantings and pink-tinted gravel, the ASU group sees no pregnant women or kids, no young people whatsoever. Sun City has a fertility rate of zero.

The fertility rate is the number of children an average female will produce in her lifetime. The panelists note that the rate is currently plunging in almost all countries around the world. True, it has not occurred in sub-Saharan Africa, not yet. But for those who specialize in the long view, fertility collapse and accelerated aging have supplanted overpopulation as the most salient demographic trend.

“Take Taiwan,” says Birt. “Its fertility rate has gone from about 7 in 1950 to less than 1 today. This trend applies to any country on the development escalator. It’s inevitable.” As a country develops, initially its death rate declines because of a rising standard of living and better medical care. Next, almost automatically, fertility goes down. “Japan got on the escalator first, and the emerging countries, like Brazil, will get there,” Birt continues. “The religion of the country is irrelevant. It’s happening now in Iran. It’s happening in Catholic countries that oppose birth control, like Italy and Spain. In Mexico the fertility rate is under 3, approaching replacement level.”

The replacement rate is the number of children that the average woman must produce in order to replace herself and her mate. Demographers normally define the replacement rate as 2.1 children, the 0.1 increment allowing for infant mortality. It is a pivotal number, indicating that a population is stable, not expanding, and very likely to shrink. Among the 222 countries and territories in the world, two-thirds now have fertility rates below 3, while one-third have slipped under 2 and have begun to contract. Japan, the poster child for extreme trends in aging and fertility, is projected to lose a third of its population in the next 50 years. The most populous nation, China, has a fertility rate of 1.5. Though China’s strict one-child-per-couple decree obviously has holes, the policy is having the desired result. India, the second most populous nation, has brought down its growth to 2.6 children per woman. The United States stands at the cusp of population decline because American females are having an average of only 2.06 children apiece.

In those figures lies the turnabout in world population that Glick predicts, and also its senescence, because when people are taken off the population escalator—at the front end, by not being born—those already on it become more conspicuous as they near the top. There is no stopping the process. “That’s why we say demography is destiny,” Glick remarks. “There’s only one exit: death.”

Birt describes a favorite graphic of his, derived from a 2007 United Nations publication. He calls it “Solving for X” because of the problem it raises for the world’s health-care systems. Two lines are crossing, the percentage of people over 65 and the percentage under 5. Back in 1950, children predominated in the world; in 2050 the seniors will be on top. “The percent over 65 and under 5 are trading places,” Birt says. “We’re almost at the X spot.” The forecast date for global X to occur is 2017, but each country will arrive at the transition at a different time. “Japan blasted through its intersection years ago,” he notes.

Was there a single factor to account for this world-shaking reversal? “Yes,” Glick says. “You start educating girls.”

Birt agrees. “You start educating women, and they delay marriage and have fewer children,” he says. “It’s all due to not having children in societies that let women loose.” He turns to Fukui, who so far has not spoken. “Fukui-san, you’re 32 and not married. That would be inconceivable in Japan 30 years ago.” Actually, he does not know for sure that Fukui is unmarried, but he does know Japan, having studied and worked there earlier in his career. With a Ph.D. in Japanese studies, he speaks and reads the language fluently. His calling her “Fukui-san” is akin to saying “Miss Fukui.”


The Immigration 
Engine


Fukui speaks near-perfect American English, even incorporating a questioning inflection at the end of her sentences. Since becoming a graduate student in Arizona, she goes home to Japan only four weeks a year. She does not object to Birt’s appraisal of her, because it is true. Politely, Fukui turns the conversation to koreika shakai, or “aging society,” a term that has become grimly familiar in her country. Japan has the highest median age in the world, a shade under 45 years, and is in a quiet panic about how to take care of its graying, shrinking population.

For a decade, Fukui recounts, stories have been reported of elderly children tending their frail, sick parents, and lately there are reports of seniors dying alone in Tokyo housing projects, some by their own hand, “without notice, and found days, sometimes months, later.” Although planners saw the gray tsunami coming when it was still far off, they did not do much to prepare for it, she says. She remembers an elementary school that was built in her hometown when she was young. The new school was fitted with wheelchair ramps and movable partitions so it could be converted to a senior center when the flow of children dried up.

In her postgraduate research, Fukui is studying senior citizen facilities in Phoenix. Sun City perplexes her; she calls it “an extreme example of self-separation.” In contrast, Japan mingles its youngest and oldest citizens, placing schools next to senior centers, for example. “We respect the elderly,” Fukui says. “Having them around during your childhood is an asset. So society tends to promote that.”

If the United States is deficient in Confucian respect for the aged, it has an asset that Japan lacks. Immigration alters a country’s population much more rapidly than other factors. Like human hydraulic fluid, immigration pressures the demographic machinery of the world, and the world whines and wheezes in response. Japan’s reaction—to restrict foreigners and maintain its ethnic purity—has resulted in a different kind of self-separation. The Japanese are concerned that immigrants will not “fit in,” Fukui says. But the needs of its burgeoning elderly have forced the government to relent and let in caregivers from Indonesia and the Philippines. Over the next 40 years, according to United Nations estimates, the majority of the world’s immigrants will head to the United States. “We have higher fertility because we’re an immigrant-receiving country,” Glick says. Bearing children at higher rates than their hosts and taking lower-paying jobs in hospitals and nursing homes, the new arrivals have the potential to alleviate two problems at once, those of rapid aging and a shortage of caregivers. “In the Anglo world,” Glick continues, “the over-65 portion is increasing, but the child population we have is dynamic. So I think there will be enough labor to provide care” for the elderly, she says.

The Phoenix sprawl foreshadows the fractured demography to come. Although Phoenix and the state at large are 30 percent Hispanic, that proportion drops to 0.9 percent inside the walls of Sun City and other Arizona retirement enclaves—where residents tend to be white, often from the Midwest. Eight of 10 Arizonans who are 65 and older are white, and their numbers are expected to double in 10 years. Meanwhile, 60 percent of the state’s Hispanic residents are younger than 24. Already the majority of elementary schoolchildren are Hispanic. By 2030 half the state’s residents will be either under the age of 18 or over 65, an unprecedented gulf dividing groups by both age and ethnicity. It would be hard to concoct a better recipe for social heartburn. In her sociological research Glick has documented the stresses on Hispanic and Asian immigrants in Phoenix, which intensified during the recession of the past four years. “When you have an economic crisis like we’ve had recently, it’s easy to target a powerless group like immigrants,” she says. What is happening in Arizona is a microcosm of global strains, as younger, darker countries confront aging, richer ones.

A New Old World 
Looms


 But here it is just another relaxed day on the bowling greens in Sun City. Cars move in a dreamy line along Del Webb Boulevard. The ASU van turns into a shopping plaza and parks in front of Fry’s Supermarket. Getting into a space took a bit longer than it might have because the other drivers in the lot are, shall we say, erratic. All the same, nobody honks. Sun City cuts everyone a lot of slack.

Sun City is an anachronism, the three researchers agree, and the pool of potential residents is bound to shrink. “It isn’t emblematic any more. This is what the baby boomers’ parents were retiring to,” says Glick.

The boomers who are starting to retire today will live one, two, three decades longer than Del Webb’s pioneers. They will definitely need handrails in their houses, if only because, according to surveys, they will want to stay in their homes as long as possible. “Aging in place” is the new mantra in gerontology, Birt says. The trend has reached Sun City and what is now its third generation of residents. Originally the community was a wintertime escape for aging “snowbirds”; today most residents stay in their houses year-round, braving the summertime heat.

As independent as they may strive to be, the baby boomers will not escape chronic illness and the other ravages of old age. Birt has a version of his Solving for X graphic that shows the disease burden on the graying world population. While infectious diseases and illnesses related to poverty are declining, noncommunicable conditions like cancer, heart disease, diabetes, and Alzheimer’s continue to increase. Del Webb’s own health history illustrates the change. In his twenties he nearly died of typhoid, a major infectious killer of the early 20th century. Advised by a doctor to move to a warm, dry climate, he chose Phoenix. Webb died when he was 75 of lung cancer, a modern lifestyle disease caused mainly by smoking and largely affecting older people.

Scary statistics about the coming tidal wave of debilitated seniors are almost ridiculously easy to generate. Among Americans over 80—who represent the fastest-growing segment of the U.S. population—half have a neurodegenerative disorder. The 5 million who are currently afflicted by Alzheimer’s disease will grow to as many as 16 million by 2030. Again, the Phoenix area will spearhead the trend. Already more nursing homes are located in the Northwest Valley than anywhere else in the country. Behind its palm trees and golf courses, Sun City is destined to become a Potemkin village of invalids unless it opens its doors to a younger and more diverse population.

Among Americans over 80—the fastest-growing segment of the U.S. population—half have a neurodegenerative disorder.

Part of Birt’s job at ASU’s Center for Sustainable Health is to brainstorm solutions to the gray tsunami. He puts his faith in technology, envisioning that in lieu of human attendants, medical devices in highly wired households will keep an eye on seniors, reminding them about their medications and monitoring their vital signs, even as they sleep. “Even weighing someone in a doctor’s office takes time,” Birt says. “If you had all these measurements coming in—the patients weighed at night, in their beds, and you’d track how well they’re sleeping at the same time—their care would be more effective.” Not surprisingly, the Japanese lead the world in developing robots and other automated solutions to the caregiving crisis.

The trio is having coffee at a small table in the supermarket. Elderly shoppers glide about with their carts, wheels squeaking on the polished floor. Wi-Fi is available in the store, but judging by one question - "Is that a laptop?" a shopper asks, pointing to a computer on the table - the present generation of retirees may not be ready for digitized medical care.

Sun City has spawned plump successors: Sun City West, Sun City Grand, and Sun City Festival, each development pushing farther out into the desert and offering greater amenities to a more upscale class of retirees. But many boomers have not saved enough money to retire and will probably have to keep working well past 65; others, tapping on their smartphones beside their swimming pools, may prefer to keep working anyway. “After all,” Glick comments, “retirement is a 20th-century phenomenon. Before then, nobody retired. Two hundred years from now they might be asking, ‘What? Retired?’ ”

The shared vision of retiring to white, middle-class Sun City is defunct. Our current Social Security system depends on a steady stream of young, healthy workers to support it. Immigrant workers will need to come in to aid the elderly, and then they will become elderly themselves. Similar trends will play out in other countries, each on its own timescale and in accordance with its unique culture and circumstance. Culture is flavoring, but still, demography is destiny, as the panelists contend.

If and when a more diverse population moves in to Sun City, something of value will be lost. As Birt suggests, there is a special serenity in a place where no one gets mad at bad driving or confused shopping. The challenge for America as it ages, he says, is for “younger people and older people to be tolerant of the other. Sun City is an environment that is patient with the limitations of elderly adults. I noticed it. I felt it. The U.S. is such an impatient culture…but it is accepting and attractive here. You can see why they stay.”

Jeff Wheelwright is the author of The Wandering Gene and the Indian Princess: Race, Religion, and DNA .

Simple Pension Solution

Rising longevity in recent decades is a resounding success story. But public policy has struggled to keep up. The bean-counters are getting nervous. Growth in the number of people claiming the state pension is outpacing that of the workforce of taxpayers who fund it, creating a big headache for the public finances.

Reform is inevitable and the coalition rightly aims to address the looming problem. Its mid-term review last week hinted at plans to put in place “a new mechanism to ensure that the state pension age reflects future changes in life expectancy”. The details are yet to be fleshed out, but if the pension age were to rise in step with life expectancy the working age population should brace itself for a big shock.

On current plans most readers of this article will have to wait until they are 67 before they can claim their state pension. If they’re lucky. We’ve not seen the last of the rising state pension age: in fact we’ve barely begun. The age threshold would have to go up by almost one year in every five, on recent trends, just to balance the books. Today’s young adults might become eligible only at the age of 77. While the government’s proposed solution may sort out the public finances, it will be politically painful and highly inequitable. It is time to abolish the state pension age and think more radically about 21st-century retirement.

How costly is rising longevity? Government analysis suggests that a one-year rise in average life expectancy for the population of 2030 would cost the taxpayer about £7bn in annual pension payments in today’s money, leaving aside any change to the pension age. That’s roughly equivalent to the budget of the entire Ministry of Justice or more than 1p on all income tax rates — just to keep the public finances in balance each time life expectancy rises by a year. Clearly something must be done to keep costs in check.

Raising the state pension age in line with life expectancy is a clumsy solution. Increasing longevity isn’t just a fiscal problem, it is also raising questions about fairness. The uniform age threshold is already highly regressive and raising it will make it more so.

Better-off people typically enjoy far longer retirements than the less wealthy. The post-65 life expectancy of a healthy male manual worker in the early 2000s was 14.1 years, while a similar professional could look forward to an 18.3-year retirement. This difference in life expectancy means the planned £140-a-week state pension will lead to the richest members of society getting over £30,000 more in retirement benefits than their lower-paid countrymen.

What’s more, recent evidence suggests that mortality rates are improving faster for the more affluent members of society, compounding the inequity. A higher uniform pension age in this context is going to hand only a greater proportion of pension spending to those who need it least, while cutting the entitlement of the lower paid. This is hardly fair, not least because well-paid professionals are likely to have a greater capacity and desire to work longer in their cosy office than is, say, a Gorbals metal-basher. Nor does it make much economic sense to encourage productive workers into retirement.

The uniform state pension age should therefore not be long for this world. The next reform must encourage people to work longer, increase individuals’ control over their lives and get the public finances off the hook for ever-rising longevity. But it must do so equitably.

There is a simple way of achieving these goals. Rather than paying everyone a fixed income from an arbitrarily chosen age — too early for some, too late for others — government should instead give citizens an equal lump sum at the age of 60, leaving them to choose when to take it to an annuity provider to convert into a monthly pension income. Let’s call it the “state pension pot”.

Those who choose to work longer would be rewarded with a higher income from their annuitised state pension pot upon retirement. The new arrangement would be much fairer, since annuity providers would reflect the lower life expectancy of lower-paid citizens in a higher annual retirement income.

Crucially, as life expectancy rises, citizens would get the message that they need to work longer as the available annuity rates at a given age decline. The change would therefore obviate the need for a recurring political row about whether a shrinking number of taxpayers should be squeezed yet further to fund longer retirements.

The government is right to grasp the longevity nettle. But in doing so it must extend personal choice and responsibility and avoid exacerbating the current inequities. The one-size-fits-all state pension age is a relic of the last century. Perhaps the state pension pot is something that politicians of all hues could sign up to.

Velvet

It's no surprise that soft materials are more pleasing to the touch than rough ones, but a recent study found that they can actually improve the cognitive and emotional skills of older adults. In the research, published in the October 2012 issue of Geriatrics and Gerontology International, participants were divided into three groups, each of which completed twice-weekly activities that involved working with either a piece of velvet, canvas or Velcro. After 10 weeks, participants in the velvet group had increased verbal fluency and emotional competence and decreased negative emotions, whereas those in the Velcro group had the opposite results. (There was no change in the canvas group.)

This study is the first ever to look at how touching different materials affects well-being, so the researchers do not yet know how the phenomenon works, but they hypothesize that the association between soft materials and positive memories may be to thank.

Cost of Dementia Care

Dementia’s financial impact on the U.S. economy in 2010 was around $109 billion, reported researchers in the New England Journal of Medicine on Wednesday. That figure largely consists of the costs of nursing-home care and home-based care, and it will likely double by 2040 as the population ages, according to the study.

That financial burden becomes even heavier if informal care, such as care provided by family members at home, is included. With those figures, the study found that the total cost of dementia in 2010 was between $157 billion and $215 billion.

This makes dementia one of the most costly diseases to society, the researchers write. As Stephen Hall reported for MIT Technology Review in October 2012 (see “The Dementia Plague”), the growing dementia problem could bankrupt the healthcare system if scientists are uanble to find a way to treat or delay dementing diseases.

Video Games Keep You Sharp

Wanna help grandma keep her mind sharp? Consider throwing out her crossword puzzles and giving her a joystick. Because a study finds that elderly people who played a video game for at least 10 hours gained three years of protection from cognitive decline. Gamers also became quicker at processing information. The research is in the journal PLoS ONE. [Fredric D. Wolinsky et al., A Randomized Controlled Trial of Cognitive Training Using a Visual Speed of Processing Intervention in Middle Aged and Older Adults]

Almost 700 subjects were divided into two groups: those between the ages of fifty and sixty-four and people aged sixty-five and older. Members from each age group were asked to either work on a crossword puzzle or play a video game called Road Tour, which involves matching fleeting images of car types and road signs.

In both age groups, those who played the video game showed improvements on executive function—which includes memory, attention, problem solving skills and perception—when tested a year later.

Some of the gamers were given four additional hours of training with the game. And their cognitive improvement lasted an additional year. So video games might help ward off cognitive decline. Just don’t play Road Tour while actually driving.

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In the late 1970s a Harvard psychologist named ­Ellen Langer found a way to turn back time. In a series of remarkable experiments she showed how allowing old people to make quite simple choices and gain control over their lives could end up lengthening them.

The most startling Langer experiment involved role play. In 1979 a group of old people were ­accommodated in a retreat that immersed them in the world of 1959. And incredibly their biological age, as measured by things such as joint flexibility, reduced. Because they weren’t thinking of themselves as old, they became, effectively, younger.

Either of these Langer effects — that produced by giving people choices and that produced by role playing as younger people — might explain the findings of an innovative and potentially ­important new study carried out at the University of California.

According to a paper published in Nature, playing a car-racing video game can improve cognitive performance in older adults. The game was specially designed to force choices between driving the car and attending to road signs. The authors say that it offers support to those who believe that it is possible to improve brain fitness by training.

Of course there is an alternative theory, which can be offered with tongue only slightly in cheek. That is that video game playing is good for you and that, far from worrying about it, parents should be encouraging their children to spend more time with their Xbox. Put down the books, crack open Mario Karts.

It has been noted that the IQ of young people is greater than that of their elders. a long-term trend that is known as the Flynn Effect. This may not be happening despite children slouching in front of video games. It may be happening because they are slouched in front of video games. Just a theory.

Staying Active

The 64-year-old woman who swam 110 miles proves the power of grit and determination above youth and strength When Paul McCartney composed When I’m Sixty-Four back in the late 1960s, you were expected to be physically and mentally knackered by the time you’d reached that age. At best you might just summon the energy to knit a sweater by the fireside. This week Diana Nyad, aged 64, nailed that cliché when she became the first person to swim the 110 miles from Cuba to the US without a shark cage, taking almost 53 hours.

Nyad had first tried the swim at the age of 28, back in 1978, but gave up after 76 miles. Two subsequent bids also failed. So why did she succeed this time, in her seventh decade? The clue is in how, having staggered on to Florida beach after 53 hours’ non-stop swimming, she declared: “We should never ever give up; you are never too old to chase your dreams.”

Nyad is a prime example of something medical science has steadily begun to realise: when it comes to endurance, age really can be just a number. What counts is attitude, action and resilience.

It is not only in swimming that older people are proving themselves to be endurance stars. A 2011 study of masters athletes — the name given to older competitors — at the Hawaii Ironman Triathlon (a 2.4-mile swim, a 112-mile bike ride and a full 26.2-mile marathon run) found that the top male finishers aged from 60 to 64 were only a few minutes slower than the top 30 to 34-year-olds.

The older triathletes represent “a fascinating model of exceptionally successful ageing”, concluded investigators in the journal, Medicine & Science in Sports & Exercise .

This isn’t due to something new being slipped into their Horlicks. Nor has the physiology of older people changed in itself. What’s new is a change in older people’s attitudes. They are reinventing a dictum often cited by the car-maker, Henry Ford: “Whether you think you can, or you think you can’t — you’re right.”

This sleek new breed of grey panther is proving, for example, that the long-held belief that you lose muscle strength as you age is nothing more than a destructive self-fulfilling prophesy.

Research on sedentary seniors has indeed shown that between the age of 40 and 50, we can lose more than 8 per cent of our muscle mass. The atrophy can increase to more than 15 per cent each decade after we hit 75.

But it does not have to be that way. Research last year in the journal, Physician and Sportsmedicine , for example, examined the muscles of 40 amateur masters athletes aged from 40 to 81 who trained four or five times a week.

The size of the older people’s muscles in their thighs simply did not decline with age, the study found. The lead researcher, Andrew Wroblewski of the University of Pittsburgh, concluded that: “This contradicts the common observation that muscle mass and strength decline as a function of ageing alone. Instead, these declines may signal the effect of chronic disuse rather than muscle ageing.”

Some muscles can even endure better with age. The journal, Ergonomics has reported how tests of shoulder and body muscles in people aged 55-65 could actually generate more power in endurance tasks and were slower to tire out than the same muscles in people aged 18-25. This compensated for any relative loss of muscle strength that the older people showed.

The benefits of being a sprightly 60-plus are not only physical. The boomers’ positive attitude not only helps their fitness — their fitness helps to strengthen their mental attitude.

Getting on your running pumps in later life encourages you to focus on what you can actually achieve, rather than what society claims you can no longer manage. So says Josefin Eman a Swedish investigator who interviewed 22 athletically active older men and women for last December’s Journal of Aging Studies.

Eman concluded that, “Men and women who continue to practise competitive sports into old age make sense of the process of growing old by focusing primarily on their physical abilities”. This, she added, “helps them to challenge the usual thinking about old age and the process of growing old”.

Of course, you can’t carry on like this forever. There must be a cut-off point. But where?

Conventional wisdom says that our muscle power begins a slow but steady decline from about 35 and then continues until we are 70. After that, things start to head south at an alarming rate.

Don’t try telling that to Dr Charles Eugster, though. The London-born 93-year-old started rowing competitively at the age of 60 and became a World Masters Rowing gold medallist. Subsequently he became an international decathlete and a national fitness champion in Switzerland, where he now lives.

He carried on rowing until he was 82, when he believed he should call it a day. Three years later, he had a crisis. “I looked at myself in the mirror one day, and saw an old man,” he says.

“It was pure vanity, really,” he has explained. “I looked a mess and I was having a late-life crisis. My body was degenerating. I thought: who knows about muscles? So when I was 87, I joined a bodybuilding club.”

Eugster lost 26lb, gained a six-pack and built bulging biceps that he proudly keeps exercising to this day. Eugster insists his regime has not only slowed the effects of ageing, but has actually reversed them. “This is keeping me alive,” he says.

You don’t have to go as far as Eugster, though. We can all adopt habits of thinking that help to put us on the path to becoming endurance elders.

These habits have been studied by Dr Kate Bennett, a reader in psychology at the University of Liverpool’s Institute of Psychology, Health and Society, whose work focuses on mental resilience in older age. Bennett has examined resilience in terms of how some people do better than others when they have faced serious challenges in life.

“Having future plans and maintaining a strong sense of purpose in life is important,” she explains. “Diana Nyad’s ambition to swim that stretch of water was a main driving force in her life. But it doesn’t have to be so dramatic, some older people have simpler but just as important goals, such as seeing their grandchildren going to university.”

Having the resilience to endure does not mean being a stand-alone tough. Quite the opposite, in fact, as Bennett has found. “Resilient people tend to have gathered support around them: they maintain good relationships with family, friends and their wider community.

“They also tend to think that life is intrinsically worthwhile. Again, this positive attitude does not have to be linked to anything ground-shaking.”

On top of this comes a habit of seeing the world positively. “Being generally optimistic helps, believing that you can do the things that you want to do,” she adds.

You don’t have to become a masters triathlete, either, to gain the benefits of exercise in later life. A mere ten-minute workout session, conducted twice a week for three months boosted muscle strength by a third in a group of middle-aged sedentary men, says research in the Journal of Behavioral Medicine . The weight-training sessions also boosted their lung capacity by more then 10 per cent.

The usual convention when encouraging anyone to start exercising from middle-age onwards is to insert a caution along the lines of: “Consult your family doctor before starting any strenuous regime.”

According to experts in the American Journal of Sports Medicine , however, this could not be more wrong. “The greatest threat to the health of the ageing athlete is not the ageing process itself but rather inactivity,” says Dr Darrell Menard, the lead researcher, himself a former nationally ranked elite runner.

“There is less risk in activity than in continuous inactivity. It is more advisable to pass a careful physical examination if one intends to be sedentary, in order to establish whether one’s state of health is good enough to stand the inactivity.”

Supercentenarians

The two oldest men in the world died recently. Jiroemon Kimura, a 116-year-old, died in June in Japan after becoming the oldest man yet recorded. His successor Salustiano Sanchez, aged 112 and born in Spain, died last week in New York State. That leaves just two men in the world known to be over 110, compared with 58 women (19 of whom are Japanese, 20 American). By contrast there are now half a million people over 100, and the number is growing at 7 per cent a year.

For all the continuing improvements in average life expectancy, the maximum age of human beings seems to be stuck. It’s still very difficult even for women to get to 110 and the number of people who reach 115 seems if anything to be falling. According to Professor Stephen Coles, of the Gerontology Research Group at University of California, Los Angeles, your probability of dying each year shoots up to 50 per cent once you reach 110 and 70 per cent at 115.

Female “supercentenarians” — as 110-plus people are called — are a long way off breaking the record for long life. The record, 122, was set by Jeanne-Louise Calment in 1997, and the oldest living person in the world, Misao Okawa, 115 years and 199 days as of today, would have to live another seven years to overtake that: meaning Ms Calment’s record will stand for at least 23 years. Ms Okawa is the only person over 115 alive today, whereas in 1997 there were four.

Japan has more supercentenarians per head of population than other countries, but not as many as thought a few years ago. After an investigation in 2010, about 300 very old people, claiming monthly pensions through their children, were found to be either missing entirely or dead in their beds for decades. These phantoms included several over 110.

The lack of any increase in people living past 110 is surprising. Demographers are so used to rising average longevity all that they might expect to see more of us pushing the boundaries of extreme old age as well. Instead there is an enormous increase in 100-year-olds and not much change in 110-year-olds.

The smidgin of good news for the pension industry, therefore, is that it seems that human lifespan comes with some sort of a sell-by date. In this respect we are not like some creatures — tortoises, sharks, trees — that would apparently go on for ever but for accidents and illnesses.

Professor Coles has done 11 autopsies on supercentenarians and finds that most die of congestive heart failure secondary to “systemic TTR amyloidosis”, a thickening of the blood. The rest tend to inhale food particles and get pneumonia. It is not really clear why women live longer than men; probably something to do with their having a different cocktail of steroid hormones.

Next time you hear some techno-optimist say that the first person to live to 250, or even 1,000, may already have been born, remind them of these numbers. The only way to get a person past the “Calment limit” of (say) 125 will be some sort of genetic engineering. This might prove to be, if not easy, at least fairly routine — in technical terms. Fiddling with just a few genes in worms, fruit flies and mice has enabled scientists to extend their lifespan, sometimes up to sevenfold. One recent study in Lausanne found a 50 per cent reduction in the activity of just three genes on Chromosome 2 increased mouse lifespan by about 250 days, and kept them healthy longer.

Ethically, however, such a step in human beings is unthinkable, since it would mean altering the genes of an unborn child without asking his or her permission. It is hard to imagine any government allowing such an experiment, with a high probability of unexpected consequences, let alone anybody finding a team of scientists prepared to do it. Plus, ethics aside, it is not easy to see where the demand for such a drastic and expensive step would come from. Who would actually want their next child to live past 125, let alone badly enough to go through with it?

All those people who eat wheat germ or special yoghurt or vitamin supplements in the hope of living for ever are probably wasting their time. So too are those who practise “caloric restriction” on the ground that mice live much longer if nearly starved. Such gaunt folk might get to 100 instead of 90, but they are not going to get to 120 by such means.

Exercise, too, is nice, but it’s not going to help at extreme old age. People who walk fast at 75 are more likely to live beyond 85 than those who walk slowly, but cause and effect goes the wrong way: being likely to live longer makes you a faster walker rather than vice versa.

It’s still possible there might be a pharmaceutical way of extending lifespan. The genes that need altering to get flies and worms to live longer are all part of a nutrient-signalling pathway, and a drug that affects this pathway has been shown to extend lifespan in flies. It’s called rapamycin, after Rapa Nui (Easter Island) where it was first found in soil bacteria. Rapamycin’s molecular targets are similar in people and flies, so it might work in people too. It is already used as an anti-cancer agent.

But the latest news is not encouraging, because rapamycin’s side-effects are unattractive: impaired wound healing, insulin insensitivity, impaired immunity, cataracts and testicular degeneration. Dr Linda Partridge, of the Max Planck Institute for the Biology of Ageing in Cologne, says that separating these side-effects from the benefits, and working out when people have to start taking the drug to get any benefit, is the current focus of work on mice. In the meantime, those of us who were born before the last decade of the 20th century can mostly forget about seeing the 22nd century: there are now just seven people born in the 19th century known to be still alive. We may live much longer on average than our grandparents, but there’s not much chance of breaking records. Just as well when you think about the implications for pensions, healthcare costs and intergenerational equity.

Save More Tomorrow

Sometimes even the most valuable economic insights just don’t seem to travel. It is 12 years since a couple of American economists came up with a paper with profound implications for countries with ageing populations and unmanageable future pensions bills — such as Britain. So far we’ve chosen to ignore them.

The hand-wringing over our failure to save enough for old age has been going on for decades. Only this week HSBC came up with yet another gloomy study showing the paucity of pension saving. Sad to say, it’s hard not to stifle a yawn. We know that.

The more interesting question is whether we have the tools to do anything about it. The academics, Richard Thaler and Shlomo Benartzi, said yes. Use behavioural economics and harness the power of loss aversion and inertia, they said.

Instead of trying to hector, lecture and frighten people into making bigger pension contributions, offer them a less immediately painful choice. US employers that gave staff the option of committing now to make bigger contributions out of future pay rises were met with stunning results.

Seventy-eight per cent of employees offered the plan, known as Save More Tomorrow (SMT), opted in. Almost all of them (98 per cent) stayed in the programme over the course of at least two pay rises. Eighty per cent stayed for at least three. Most remarkable, the average saving rates for participants increased from 3.8 per cent of pay to 11.6 per cent over 28 months. That’s an extraordinary rise in thrift.

In the UK we’re already starting to see the power of inertia in early results from the auto-enrolment reforms, whereby low and moderate earners are automatically enrolled in workplace schemes and have contributions deducted from their pay packets.

Employees can opt out, but only after they have first been enrolled. The idea is that most wouldn’t bother, especially when told they would miss out on matching contributions from their employers. It’s so far proving much more powerful than even the most fanatical proponents of “nudge” economics would have predicted.

Anecdotally, only about 9 per cent to 10 per cent of employees are opting out, which is far lower than expected. McDonald’s, the burger chain, has reported an opt-out rate of just 2 per cent for its 10,500 hourly-paid UK workers.

Another theme is also emerging from the early auto-enrolment guinea pigs. This is that the young are proving the stickiest. Opt-outs among twentysomethings are as low as 3 per cent, while for fiftysomethings, more like 15 per cent are opting out.

It is very early days for this enormous experiment in social engineering. The big test will come in 2017, when the minimum contributions of this first cohort of employers and employees is, by law, ratcheted up. Suddenly deductions will jump from 1 per cent of pay to 3 per cent. Will this be the moment when the frogs jump out of the boiling water? That is clearly a possibility.

The interesting feature of the SMT approach in the US is that by committing to make additional deductions only out of future pay rises, the employees make no immediate sacrifice, and they barely notice the hit when it comes, because they still enjoy a part of the pay rise. Their take-home pay packets never shrink, while their retirement savings take off.

Many US employers now offer their staff SMT options. But few if any UK employers do, as far as I can ascertain. It’s not clear why. It may be that HR managers have just been too distracted by auto-enrolment. It may be the pay freezes of recent years: SMT doesn’t work unless staff are awarded real-terms pay rises. It may be the absence of paternalism in many firms.

Yet the evidence suggests that SMT-style programmes might be powerful in defusing the pensions time bomb. No business leader or minister could survive without at least a smattering of macroeconomics. Maybe it’s time they brushed up on their behavioural economics, too

It's Worse Than You Think

It was her stoicism that made her so compelling. When the home-ridden 83-year-old Sally Lubanov went on the Today programme this week, she politely explained that she didn’t want to whinge or whine. She could cope with the fact that her carers hadn’t given her a bath in three years, her toenails were never cut, her sheets rarely changed and no one ever visited her at the weekend. She understood that her helpers didn’t have the time to take her shopping or even spend more than a couple of minutes with her once they had taken off their coats, put on their apron and gloves and filled out the forms. But she said it would be “heaven” if just once she could sit down and share a hot meal with one of them.

“Grow old with me, the best is yet to be”, wrote Robert Browning, but that’s not true in Britain now. This isn’t about finding a few stray hairs on your chin or dozing off in front of the fire; it’s about feeling achy, arthritic, brittle and fragile, gradually losing your hearing and sight or maybe your memory and being forced for the first time since childhood to rely on the help of others. The war generation find this particularly difficult; they have been hard-working and resilient. They don’t want to go into a home but many find themselves needing Shaun or Sian from the care agency to turn up and straighten out their lives a few times a week.

More than 1.8 million people in Britain now need care for their final years. Most can no longer wash their floors or even their faces. Some need help to brush the crumbs from their chins or go to the bathroom. Others are waiting for a cup of tea and some food. Most are terrified of tumbling when they are alone. Many can’t recognise the rotating cast walking through the door. Yet according to Leonard Cheshire Disability, two thirds of councils use 15-minute visits for the disabled and elderly, meaning that by the time the carers have phoned to tell their company they have arrived, completed the paperwork and checked their medication, it’s time to go.

It’s hard to blame the carers. I talked to Jeanette in West London who went into the profession when she left college last year. “So many remind me of my nan and grandad,” she says. “But I can’t make eye contact. I am terrified they’ll want to talk and I’ll get behind my schedule. So I make the bed, maybe take them to the toilet, fill out the forms and give their hand a squeeze as I go. It’s usually the only human contact they have all week.” She’s not doing it for the money, which is ten pence more than the minimum wage, but because “my nan died last year and she really spoilt me. I hate to think of old people alone with no one to help with the cooking or washing. We treat our dogs better here. At least they get taken for walks.”

Lorna, a carer in the West country, also gets 10p above the minimum wage, has to pay for her own car and petrol and is not paid while she is driving between appointments. “I’m always late. It’s impossible to feed, bathe, dress and medicate each person in the few minutes I am allocated. We’re not allowed to give them a wet shave or a blow dry or clip their nails but occasionally I crack, get up very early and bring along my rollers. Most of my patients have dementia, so they need time and reassurance.”

But there is nothing more she can do. She is already working six days a week, 12 hours a day. They sometimes cling to me when I leave. It’s heart-rending to have to wrench myself away. Their loneliness is unbearable.” What about the families? Surely children should be looking after their parents? Lorna doesn’t criticise them. “I work all hours and barely have time to see my mum in Manchester. It’s the same for my friends. We have children, careers and crises of our own.”

It’s going to get worse. Few people come from large families any more; half of women now only have one child and one in five don’t have any.

The Government needs to act. It is not enough for Norman Lamb, the Care Minister, to say that it is “completely inappropriate” for carers to spend so little time over each appointment. He must do something — but we already spend £14 billion on adult social care. Even turning all 15-minute appointments into half hour slots would cost half a billion.

A century ago only 5 per cent of the population was over 65; now it’s 18 per cent. The number of people over 85 will double in the next decade. A fifth of us will reach 100 with gnarled veins on our hands and worn out hips. We will be too frail to use our bus-passes and may have abandoned our triwalkers. We are likely to be relying on the kindness of others to clean our dentures and pull up our socks. But there is not going to be enough money to look after us all.

It’s up to us. We have to start planning for our old age. We spend billions of pounds on potions, lotions, dye, pills and cosmetic procedures to stay young, but we refuse to contemplate our final years. We seem to think that, like Bill Nighy, we will all dance off on to our cruises or end our days at the Best Exotic Marigold Hotel in India. But we should be more like our Northern European cousins. In the Netherlands, Germany and Scandinavia they have sheltered housing for the elderly. Groups of like-minded people plan their retirement together, usually in towns near parks where their children and grandchildren can easily visit. They often share a helper, laundry services and sometimes catering.

The Government, which has been fixated on young families, has recently issued new planning guidance asking local authorities to make specific provision of land for the elderly with bungalows, retirement villages and serviced apartment blocks in order to free up more housing for the young and accommodate the old. It’s the most sensible way forward.

So get together with friends and book your place now. You can lean on each other’s crutches in your twilight years. As Longfellow wrote: “For age is opportunity no less than youth itself, though in another dress.”

Exercise

EVEN people in their nineties can benefit from strength and endurance training usually reserved for elite athletes, according to a study.

The research into the athletic capacity of the very elderly comes as a new breed of endurance athletes in their seventies and eighties are reporting that they can not only run faster than they did in their twenties, but can improve performance year after year in defiance of the ageing process. Last year, the London marathon had 237 runners aged over 70, and 12 in their eighties.

In the latest study, published in the journal Age, researchers from the University of Navarra in Spain worked with 24 people aged between 91 and 96 over a 12-week period. One group of 11 were trained for two days a week with “multicomponent” exercises for strength and to improve balance. They were encouraged to try to walk faster, stand on one leg or count backwards from 100 while doing various exercises.

The 13 others did 30 minutes of “mobility” exercises — the sort of gentle stretching encouraged in nursing homes.

At the end of the experiment, the first group showed a significant improvement in walking speed; hip and knee flexibility; improvement in hand strength and ability to do verbal and arithmetical tasks.

In a separate, as yet unpublished study by the same researchers, 18 previously inactive people suffering mild dementia, with an average age of 88, demonstrated significant mental and physical improvements after exercise.

“We have shown this kind of exercise is entirely safe to do, and improves strength, power and muscle mass as well as mental function,” said Mikel Izquierdo-Redin, professor of physiotherapy at the university, who is leading the project.

Izquierdo is visiting Britain later this year to give lectures to senior academics interested in testing resistance and endurance training programmes on elderly people here.

Retired people make up 17% of the population, and Britain is lagging behind in recognising the benefits of exercise for them. The first set of government exercise guidelines for the over-65s was published only in 2011. That document spoke of “some health benefits” from two sessions a week of strength training for elderly people, but warned that many in the age group could be too unfit to take on much activity.

“These guidelines were the first official mention of strength training for elderly people,” said Richard Ferguson, a senior lecturer in exercise physiology at Loughborough University, who contributed to the government document. “There is not enough funding for this kind of research here. We can’t prevent age-related decline, but we can slow it down, and strength is as important as cardiovascular health and aerobic exercise.”

However, there is disagreement about what can be achieved. Jonathan Folland, reader in human performance, also at Loughborough, thinks few people will improve their athletic prowess beyond the age of 60. “It’s really hard, though not impossible,” he says.

Britain’s small but growing group of aged athletes is proving him wrong. Charles Eugster, 94, a retired dentist from Kensington in west London, who took up serious exercise when he began to gain weight in his eighties, has cut his training to three two-hour sessions a week, but says his performance in parkour and rowing, has still improved.

“I started to get better at it when I was 89,” he said. “It is as though something in my body has changed in a positive way. I don’t get colds any more either.”

The British Triathlon Federation, which now has almost 100 members over 70, against 44 in 2011, has just given a special award to Brian Forster, an 82-year-old retired chemist from Ashton Hayes, Cheshire, who won a world title for his age group last year by taking 90 seconds off his 2012 duathlon — running and cycling — performance time.

Forster, who trains three times a week, became an athlete having survived a stroke five years ago. “I feel like I have been given a second chance,” he said. “I’m going to continue running until I can’t go any more.”

Daphne Belt, 74, an antiques dealer from Littlehampton, West Sussex, who took up running when she was 50, and has taken part in several triathlons, said: “There is no question I’m faster now than I was when I was young.”

So far, none of them is a match for the Indian-born farmer Fauja Singh, 102, who retired from marathon races only last year. He still runs and walks 10 miles a day.

Cuddle Chair

That sitting device you see above, Time reports, is a $419 "tranquility chair" currently on display at the Home Care and Rehabilitation Exhibition in Tokyo (where else?). The obvious first impressions upon seeing it are that it is (a) creepy; and (b) expensive. But it is also a useful illustration of an emerging, emotionally charged debate.

In short, countries like Japan that are facing so-called elder-booms are developing technology, including robots, that will help assist nursing-home employees and others care for old people. The megacute robot PARO is one example: One of its functions is to soothe the elderly in settings where there isn't a human available. This notion of artificially soothing naturally makes some people uncomfortable, especially given that many of the elderly people for whom such technology is designed may suffer from senility and not fully understand that they are not petting or interacting with another living creature.

Sherry Turkle, an MIT professor who studies human-computer interaction, is one of the foremost critics of these sorts of technologies. "It's not just that older people are supposed to be talking. Younger people are supposed to be listening," Turkle told Live Science in 2013. "We are showing very little interest in what our elders have to say. We are building the machines that will literally let their stories fall on deaf ears." Her broader argument, in short, is that to delegate the task of elder care to machines is to mortgage certain important human values.

The counterargument to this: Yes, in a perfect world every old person would have a living, breathing human there to comfort them, but that's not the world we live in now and, given demographic patterns, definitely won't be the world we live in in, say, 2130. In the real world, the choice is whether old people will sit in nursing facilities alone or with a toy or robot that helps bring them some comfort and happiness — in other words, it's no choice at all.

The counter-counterargument to this: well, okay. But if we go down the robot path, aren't we going to quickly not even try to ensure that old people are treated with dignity and have healthy interactions with younger people? Won't there be a cruel and swift outsourcing of a role that's been an important part of human culture and key to our empathic makeup forever?

And so on and so on. It's a debate that will only heat up, and it's composed of some rather wrenching questions that lack easy answers. Wherever we stand on the broader issues, though, we can all agree: There's a pretty good chance that chair comes to life at night and murders people.

Caring For The Dying

Atul Gawande: Aim for a good life, not a good death

Why are you interested in mortality?

Medicine is grappling with what is ultimately an unsolvable problem. I never felt I had good answers for people who were facing death; when do we push ahead with treatments and when do we not? It wasn't until I connected with experts working in palliative care that I began to gain a sense of how you can unravel these problems. At the centre of the issue is the difference between the medical priorities of health, safety and survival, and an individual's priorities for well-being.

Has medicine got its priorities wrong?

We make trade-offs every single day. For my patients in nursing homes, often their biggest struggle is with things being taken away from them, in the name of health, that they care deeply about. You'll see people with Alzheimer's who want nothing more than a cookie, but are given only pureed food because they might choke. We do these things in the name of health, but there's a larger idea about what makes life worth living that we're not serving. That comes to bear most obviously at the end of life.

Why have we come to see the end of life as primarily a medical problem?

I think the big change has been the family. My grandfather lived in a village in India and died at the age of 108. He spent the last decade of his life needing substantial help to live, but it didn't require him to be in an old age home. It worked because he was surrounded by family who would take care of him – but that only worked because young women were more or less enslaved to the task.

The success and growth of our economies have come from giving young people the freedom to choose the work they want and where they want to live. Pensions have been important in giving older people the financial independence to live without family; the problem comes when you can no longer take care of yourself. We've decided that this is a medical problem, but the medical focus is on health and safety – not on what people might see as their most important priorities.

You have written that the medicalisation of death is "an experiment that is failing". Why?

We see failure on multiple levels. One is the sheer amount of suffering endured by people in institutions such as old age homes or intensive care units. On another level, you are admitted into these institutions and no one knows who you are; no one recognises the arc of your life and the things that have been important along the way. The most important thing about you is that you are diabetic, and you have some problems walking and swallowing – that's who you are.

But there are other approaches. For instance, one major study in cancer patients found that people who receive early palliative care choose less chemotherapy, spend less time in hospital, and start hospice care earlier. And the result? They have less suffering, lower cost, and they live 25 per cent longer on average. This suggests we've just been making bad decisions.

Is death a subject that doctors feel comfortable discussing with patients?

Generally, we're very confident about our ability to manage these situations. I'm very good at telling people: "You've got a bad situation. We could do an operation and there's a 50 per cent chance that you won't make it through, but if you don't have the operation there's a 100 per cent chance that you won't make it through."

But we're not good at helping people tell us what trade-offs they are and aren't willing to make. Choosing that 50 per cent chance is absolutely the right thing to do if you are pursuing goals that are in line with a person's priorities. But if survival means she'll be cognitively impaired, never return to her house, have to be fed through a feeding tube and endure pain and suffering – when the most important thing to her is being with her family, being mentally aware, or completing some work she's focused on – suddenly a different choice might be better.

Have you ever offered treatment you knew probably wouldn't work and could make someone's life worse?

Absolutely. In my new book, Being Mortal, I describe a 34-year-old woman who was diagnosed with metastatic lung cancer during her first pregnancy, and then turned out to have thyroid cancer too. I found myself offering surgery for her thyroid cancer, when the reality was the lung cancer would kill her long before the thyroid cancer caused problems. The difficulty and anxiety of trying to come to sensible decisions and acknowledge what's in the room – that here's a problem we aren't going to be able to control, just manage – can leave you offering fantasies of the future.

Has researching the book changed the way you interact with dying patients?

The core change has been to shift from saying: "Here are the pros and cons, what do you want to do", to asking: "What is your understanding of your condition; what are your goals and fears; what trade-offs are you willing to make?"

Recently a friend came to me whose best friend has been diagnosed with advanced brain cancer and needs increasing amounts of help with each passing week. His doctors aren't acknowledging this person crumbling in front of them. They're rightly trying the first rounds of chemotherapy and radiotherapy, but in the meantime nobody knows what could happen next, and no one is asking: "How shall we help him cope, and what would he actually want if time becomes short?"

So what advice did you offer your friend?

That there's a powerful conversation to be had around what well-being means to that person. Ask those questions, hear his answers, use them to make plans, and then understand that they will change and you will have to ask the questions again in a few weeks. His friend may not yet be at a point where he can discuss any more than one of those questions, but it would be a lot more than they've got to go on now.

Do you support the idea of assisted dying?

I think there's often a misplaced goal. The goal shouldn't be to have a good death, but to have as good a life as possible, all the way to the end. I support having the capacity to do something for people with unbearable suffering, but it troubles me that we have focused on assisted dying without having figured out assisted living very well.

Have you thought much about how you'd like to spend your own twilight years?

Right now, I'd say that if my body went I would still want to be alive, but if my brain went, let me go. But I know that what I think is likely to change, and I want to be in circumstances where I can re-evaluate and have that conversation about my priorities.

We all live for something larger than ourselves – it might be family and community connections, or making our own contribution to the world. Those are the things I want to hang on to. I also want to be in a place where I have some freedom to choose how I cope with my limitations; where I can have a cookie, even if it isn't the healthiest thing to do.

NZ Retirement Villages

The Crees are part of a small but growing minority of elderly people choosing to sell their homes and enter into the complex financial trans­action that is an occupation right agreement (ORA) in a retirement village.

The ageing population, combined with the increasing popularity of the retirement village lifestyle, has triggered a tsunami of developments in recent years. According to valuation company CBRE, the number of retirement village townhouses and apartments targeted at the independent elderly has increased by almost 38% since 2008. If the developments currently on the drawing board go ahead, the number will surge by a further 49%.

Although the business of housing the elderly was largely in the hands of churches and the not-for-profit sector in the past, today it’s overwhelmingly dominated by private companies and developers. Retirement villages are springing up on sprawling sites where once stood schools, hotels, supermarkets, orchards and farms. In Auckland alone, almost 4000 new townhouses and apartments to be marketed under the ORA model are in the pipeline, according to Jeremy Simpson, an analyst with sharebroking firm Forsyth Barr.

The three largest retirement village and aged care providers – sharemarket-listed Ryman Healthcare, Metlifecare and Summerset – now account for almost a 10th of the value of the NZX 50. Two further operators, Oceania and Hercules – a new outfit to be formed from the merger of 19 smaller operators – are expected to list on the stock exchange in the coming months, taking advantage of strong investor interest in the gold rush of retirees.

The booming sector – which includes 98 small operators with just one or two villages each and 32 with multiple villages – is worth around $9 billion, according to John Collyns, executive director of the Retirement Villages Association.

The retirement village population is still only a small proportion of the over-75 age group, at about 10.5% nationwide – although in the Bay of Plenty the so-called “penetration rate” is more than 16%. But a combination of gradually rising penetration rates and New Zealand’s ageing demographic profile has pushed the total number of retirement village residents to around 30,000 – similar to the population of Timaru.

And there’s much more to come, with the number of people aged over 75 projected to double in the next two decades to more than 500,000. Based on conservative estimates, valuation company Jones Lang LaSalle says the number of over-75s living in retirement villages will reach at least 64,000 by 2036, with 170 new villages needing to be built. But if the sector continues to increase in popularity – that is, if penetration rates rise to around 13% of over-75s – the number choosing to live in retirement villages will hit 83,000 by the mid-2030s.

PROFITS TO BE MADE

Across town from the Crees’ apartment in a tree-lined residential street in south Christchurch, the morning exercise class is under way at the near-new Diana Isaac Retirement Village on the edge of the working class suburb of Mairehau. The room is full of banter and hilarity, as well as keen concentration as participants balance rubber balls on trays while stepping over obstacles and do resistance exercises with thick rubber straps.

Neil and Rosalie Kennedy break briefly from their daily workout to discuss their decision 18 months ago to move into the village. Neil, a 77-year-old retired school principal, and Rosalie, a 76-year-old former teacher, had lived in their family home for more than 40 years. Both were active and well, but the lawns and home maintenance had become a “nuisance”.

“It’s the best thing we’ve ever done,” says Rosalie of their decision to sell their home and buy the right to live in their new village townhouse. She says their four adult sons were supportive of their move. They understand that only 80% of the capital sum their parents paid to the village operator, Ryman Healthcare, will be repaid at the end of their tenure and that there won’t be any capital gain.

“They know we’re safe and warm and happy,” she says. Not to mention enjoying a vibrant social life: aside from the exercise classes, there are morning teas, concerts, retail sessions, walking groups and happy hours. And Neil can spend the day on the golf course knowing he doesn’t have to come home and mow the lawn.

With 247 townhouses and care facilities for 200 frail elderly, Diana Isaac is like a resort town, complete with tinkling water features, airy atriums, hotel-quality lounges and fittings and a cinema, swimming pool, hair salon and bowling green. Ryman, which listed on the stock exchange in 1999, is the biggest and most successful operator in the retirement village sector, notching up record profits year after year. It has accumulated a property portfolio of townhouses, apartments and rest-home facilities valued at more than $2 billion, and is now developing its second Melbourne village.

Like other commercial operators in the sector, Ryman has built its success on the back of a business model originally developed by religious organisations as a way of housing their elderly parishioners. Ryman chief executive Simon Challies says these groups often had land but no capital to develop their facilities, so the ORA evolved whereby incoming residents paid a capital sum to secure accommodation and access to a village’s communal facilities, with the village operator undertaking to repay a percentage of that capital when the resident died or moved on.

The corporate operators who began moving into the sector from the 1980s have finessed the ORA model. Despite the fact that ownership of the dwelling remains with the village operator, ORAs sell for prices that shadow average house prices in the suburb the village is located in. At Ryman’s Edmund Hillary Retirement Village in Auckland’s Remuera, for instance, an ORA for a two-bedroom, one-bathroom apartment is on the market for $780,000. A one-bedroom apartment at Oceania group’s Lady Allum village in Milford, North Shore, is available for $440,000.

At the Russley, a new upmarket village close to Christchurch International Airport, an ORA for a three-bedroom townhouse can cost $840,000 and an ORA for a one-bedroom unit $335,000, says its developer, Graham Wilkinson. The idea is that incoming residents will sell their family home, enabling them to hand over a large wad of capital for the right to live in the townhouse or apartment, and still have around 25% of the proceeds from their house left over to pay for travel and leisure.

The developer of a new village will aim to cover costs and make a margin on the sale of an ORA to the first resident to move into a townhouse or apartment, which helps to fund the village facilities and the repayment of bank debt. But the real money is made when the resident dies or moves into care, at which point the “deferred management fee” – which can amount to between 20% and 30%, depending on the operator – is deducted from the capital sum owing to the resident or the estate. The profits made on the ORA side of the business also subsidise the provision of aged-care facilities, which these days are regarded as uneconomic to develop outside the retirement village structure – although some operators, including Bupa and Oceania, are weighted more heavily towards care facilities than townhouses for the independent elderly.

Wilkinson, who developed Auckland’s Ranfurly Village and Tauranga’s Pacific Coast Village, as well as the Russley, calls the ORA model a “pay later” arrangement that works for both parties, enabling residents to enjoy high-quality new homes and facilities they’d not otherwise be able to afford.

The average period of tenure in an ORA unit is seven or eight years. When the occupant dies or moves into care, the operator spruces up the unit and sells a fresh ORA to the next resident at a price that reflects the real estate market in the area at the time. The operator does not pay tax on any increase in the value of the ORA because the under­lying ownership has not changed hands, and the capital has to be paid back to the new resident (minus the deferred management fee, which is taxed).

When that person leaves, the cycle is repeated – over and over again, with the operator taking as much as 20-30% for deferred management each time. It’s a highly efficient way of recycling capital.

The village operator retains complete control of the resale of the unit after a resident dies or vacates. Many operators repay the capital owing to the previous occupant (or their estate) only once they have a new occupant signed up. In addition to the deferred management fee, villages charge an ongoing weekly or monthly fee, usually $100-180, to cover insurance, gardening, rates and the like. Although some village operators, including Ryman and Metlifecare, undertake to fix the weekly fee for the duration of a resident’s time in the village, others increase it in line with the CPI, and in some cases there are no limits on future fee increases.

VICE-LIKE CONTROL

Bill Atkinson is both a highly satisfied customer of the retirement village industry and one of its most dedicated critics. Grey Power’s spokesman on the industry, he agrees with the oft-cited surveys that show the vast majority of residents are extremely happy with village life. But he also has enough insight into the industry’s business model to know that people like him and his wife, Chris, are not the sort of customers retirement villages want.

The couple moved in 15 years ago and although Chris has suffered several strokes, they continue to live independently. Their tenure has so far been about twice as long as that of the average retirement village resident, which means that the owner of their village hasn’t yet been able to reap the deferred management fee and bring in a new resident at today’s much higher market prices – although Atkinson hastens to point out that the present operator bears him and Chris no animosity for this.

They chose their village because of its location near the beach and because there were verbal promises that a hospital-care wing would be built. Like many retirement village residents, they were attracted to the idea that if one spouse needed to move to a higher level of care, they’d be able to remain in the village. But the hospital never materialised (although the current operator has revived plans and building is expected to start soon). Atkinson argued for a reduction in the deferred management fee, but his plea was ignored.

Although the 2003 Retirement Villages Act, which came fully into force in 2008 with the introduction of a code of practice, has improved the quality of regulation in the sector, Atkinson says there remains ample scope for “unscrupulous operators” to exploit the permissive rules. A common complaint he hears is that operators charge the deferred management fee when a resident transfers within a village – from a townhouse to a smaller apartment after the death of a spouse, for example. In such a situation, the resident is not only losing 20-30% of the capital, he or she also has to pay again at current market rates for an ORA on the smaller unit, and then pay the deferred management fee again when vacating that unit.

Atkinson also increasingly hears from residents at villages around the country that their ORA contract imposes an obligation to shoulder any capital loss that might be incurred on the resale of the right to occupy the unit after they vacate – even though they’re shut out of any capital gain.

And although in the current overheated housing markets of Auckland and Christ­church capital losses seem unlikely, he says it could happen if the housing market tanks, the supply of new residents slows down and ORAs become hard to sell.

But the biggest bone of contention among residents and their families is the vice-like control village operators retain over the resale of ORAs after a townhouse or apartment has been vacated. In most cases, the operators hang onto the residents’ capital until the right to occupy the unit has been resold – and, notes Atkinson, retain full use of these funds to use as they please.

Blenheim’s Peter Bruce discovered this to his dismay after his mother died and his father had to move out of his ORA apartment into rest-home care. His parents had paid $175,000 for the right to live in their apartment, having chosen a village that had a hospital and dementia unit because they wanted continuity of care. The deferred management fee was set at 2% of the capital value a month, up to a maximum of 24%, which meant that after they vacated the apartment, they’d be repaid $131,000.

“But then they [the village operator] couldn’t sell it,” says Bruce. While the apartment sat vacant, the family had to continue paying the weekly fee. As he puts it, “we had to pay the ongoing costs of an apartment we didn’t own”. The apartment sold after five months for $190,000 – $59,000 more than the sum repaid to Bruce’s parents’ estate. He says the only investment made by the village operator in the apartment was about $400 worth of cleaning. According to his parents’ ORA contract, if the unit had resold at a lower price than they’d paid, they would have had to absorb that loss.

But it could have been worse. Auckland lawyer Tony Fortune, who specialises in advice to the elderly, has dealt with one case where the former resident’s capital was locked up by the village operator for close to two years until a new ORA buyer was signed up.

Fortune says operators impose a range of terms in the period when a unit is vacant but a new resident has not yet been signed up: some stop charging as soon as the unit becomes vacant and some continue charging it, although it has to be reduced by half after six months.

“Apart from the lack of any capital appreciation, the fact that it can take so long to get your money out is of real significance, and so the type of village that you go into at the beginning is very important,” says Fortune. “Our experience has been that in some of the lifestyle villages that don’t have any rest home or hospital care [about 35% of villages], it can be harder to dispose of the units, and they can be the ones that have a longer sale period. So that’s one of the very important aspects to look at: what’s the resale like, and how many other units are available.”

Bruce and Atkinson also object to the fact that retirement village operators advertise their townhouses and apartments as being “for sale” when merely the right to live in the property is for sale, not the property itself. “This is both misleading, and I believe unethical, in that it’s incorrect,” says Atkinson. “Unfortunately, older people often don’t read all the paperwork, because there’s so much of it, and their legal advisers don’t understand enough to see all of the potential pitfalls that do need a complete understanding.”

The underlying assumption of the ORA model is that having sold their family home, signing up for a retirement village unit will be the last housing transaction an elderly person will make. But as Fortune points out, circumstances can change – for instance, the resident may wish to move towns to be nearer to family, but he or she may find themselves effectively locked in because they’ll lose the deferred management fee and may not have enough capital left to buy into another village at current market prices. The longer a resident has been living in a village under an ORA – the longer he or she has been disconnected from the ability to make capital gain on a property – the harder it is to move, he says.

However, some operators, including Ryman and Summerset, allow residents to leave and receive a full refund of their capital if they decide within three months that they don’t like the village.

THE DARK SIDE

The burgeoning retirement village industry is attracting more residents than ever before, but it has its share of horror stories.

The Christchurch earthquakes brutally revealed the vulnerability of retirement village residents under the ORA model. Bill and Rona Thomson, both 92, paid $305,000 in 2009 for the right to live in a townhouse in the Kate Sheppard village in New Brighton.

“We went into it with our eyes open, but I said at the time that this was the most one-sided agreement I’d ever signed,” says Bill, a WWII veteran who was badly injured in the Battle of Monte Cassino in 1944 and spent his working life as an accountant.

Despite their reservations about the ORA, the village gave them the benefits they wanted – security, support and proximity to family – and they were happy there until disaster struck in February 2011. They were rescued from the destroyed village by their daughter – and never went back. The village was later red-zoned and has not been rebuilt.

Of their original investment, the couple was repaid only $267,000 – the capital sum owed by the village operator, Lance Bunting, minus the $38,000 deferred management fee. Bill says there was no opportunity to negotiate with the owner and everything was handled by lawyers. He considered it a “mean and exploitative” outcome of a disastrous situation, although he pragmatically accepted that Bunting was acting within the letter of the ORA contract.

The Thomsons were left with enough capital to resettle at another village, in Ashburton, although they’ve since moved into a care facility in Christchurch. But many of their former neighbours, who had taken up residence at Kate Sheppard years earlier and for whom the value of their capital repayment had greatly diminished, were severely disadvantaged. One received only $100,000, with which she had to find a new home on the open market.

The Retirement Villages Code of Practice has since been amended so that residents must be repaid their full capital sum if their village is destroyed and not rebuilt – but the Thomsons and their former neighbours received no benefit from this reform.

A NEED FOR REVIEW

And what if a village goes broke? Just how secure is the large wad of capital that residents have paid for their ORA? Retirement villages are required under the Retirement Villages Act to be registered with the Companies Office. Unless they’ve been granted an exemption, they must also appoint a licensed statutory supervisor – which includes trustee companies such as Covenant Trustee Services and Corporate Trust – to monitor village finances and hear residents’ complaints.

A memorandum must also be placed on the title to retirement village land so that if the operator goes bust, the residents can continue living in their homes and the village is kept together as a going concern, rather than being carved up and sold off in bits by a receiver.

But whether they, or their estates, get their capital back if banks or other secured creditors are owed money by the defunct operator depends on the fine print of the contract.

Lane Neave lawyer Peter Orpin says a statutory supervisor will typically hold a security over the village that ranks ahead of the banks, so that if the operator becomes insolvent, the residents will get their money back before any other creditors.

But there’s no guarantee in law that such an arrangement will exist in any given village – prospective residents need to make sure their lawyer checks that this protection is in place, says Orpin, who was previously a retirement village statutory supervisor with Covenant Trustee Services.

Wanaka Bay Retirement Village in New Plymouth hit financial strife in 2012, with only a handful of a planned 150 units built and none of the resort-like facilities that had been marketed to prospective residents. The few residents who had already purchased ORAs and moved in endured 18 months of uncertainty and stress before a solution was found.

John Collyns claims the fact that the development was eventually sold to another operator and that the residents got all their money back and were resettled at other villages shows the system of statutory supervision works well.

But Frank Lowry, head of the Association of Residents of Retirement Villages for Taranaki, takes a starkly different view. Although he lives in a different village, he came to the assistance of the distressed Wanaka Bay residents, whose village had been abandoned by its manager and who had found the statutory supervisor “less than helpful”.

Lowry’s perception is that progress was made towards a solution only when he asked then-Retirement Commissioner Diana Crossan to intervene. The residents were resettled, but the experience came “at a cost” to their well-being, he says. Retirement Village Residents Association of New Zealand’s Rob Wilson at Maygrove Village, Orewa. Photo/Stephen Robinson For the likes of Atkinson, Lowry and Orewa retirement village resident Rob Wilson, sagas like Wanaka Bay and the Christchurch earthquakes underscore the need for a thorough review of the rules governing the retirement village industry. As a first step, they’ve been working to establish a national organisation to represent the interests of residents and provide a counterweight to the influence that the increasingly powerful retirement village industry exercises in Wellington. The inaugural meeting of the Retirement Village Residents Association of New Zealand was this week.

Wilson argues that residents need access to an independent agency similar to the Tenancy Tribunal, where evidence can be collated and presented to the Government as a case for changes to the Code of Practice. In its current form, the code is “inadequate” and open to wide interpretation by village operators.

He says residents are often too fearful to “rock the boat” when they have concerns over issues like rising fees or declining standards, or they struggle alone in an uneven contest with village operators.

Although retirement village residents may be elderly and in declining health, their numbers are rising and, as Wilson points out, they collectively possess a powerful array of skills accumulated during their lives. If those skills can be harnessed and organised, the balance of power between residents and operators, he hopes, will become much more even.

10 essentials to check before you sign

The Retirement Villages Act requires that all intending residents of a retirement village must receive independent legal advice before signing an ORA. The lawyer must also certify that he or she has explained how the ORA works and its implications. There’s then a 15-day “cooling off” period, during which the resident can change his or her mind.

Among the key questions to ask when considering a retirement village are:

• Is the village registered and does it have a statutory supervisor?

• What’s the financial position of the operator? The audited financial statements of the operator must be filed on the Retirement Villages Register and are publicly available.

• What’s the weekly or monthly fee? Does the operator guarantee not to increase it, or can it escalate?

• What’s the deferred management fee (also called a “village contribution” or “fixed deduction”)? Typically this fee accrues over the first three to five years of occupation to a total of 20-30% of the capital sum paid by the resident for the ORA.

• Does the village have 24-hour nursing facilities and rest home and hospital care? Do residents of the village’s townhouses and apartments have priority access to care beds?

• Does the weekly or monthly fee cease from the day you vacate, or will it continue to be charged until the right to occupy the unit is sold to a new resident? Or does it reduce by half after six months if the unit still isn’t sold?

• When you leave or die, when will the village repay your capital (minus the deferred management fee)? Is it paid immediately, after a maximum of six months, or only when a new resident buys an ORA for the unit?

• Are you exposed to any capital loss if the ORA for your townhouse or apartment is onsold for less than you paid?

• Will the village refund your money in full if you decide within 90 days of moving in that you’re not happy there?

• What happens if the village is destroyed in a natural disaster? Does your village operator have other villages in which it can offer you alternative long-term accommodation?

Human Care

Staff at the Prince of Wales Residential Home wear their pyjamas to work. Not all the time, just at night when they are looking after the 49 elderly residents who live in the only care home in England to be rated “outstanding” by inspectors. Since most residents have dementia in some form, coming across a member of staff at night in ordinary day clothes could be disorientating.

Wearing pyjamas is a small thing, but it separates this Ipswich-based care home from the rest of the pack. There are other differences, too. Residents and their families interview recruits for every job, from manager to maintenance man, all of whom are trained in dementia care.

Residents can also be found peeling potatoes for lunch, laying the tables, dusting and putting away own laundry. It is their home, says the home’s director Emma John, and these tasks are an important part of everyone’s home life.

Mrs John and her sister Rachel Fitton run the seven homes that make up the family business, Partnership in Care, after taking over from their parents a decade ago. “I suppose our ethos is to enable individuals to live as they choose . . . we, the staff, are guests in their home and that is how we should behave,” Mrs John said.

Residents are encouraged to move in with something from their own home to make their bedroom familiar. That meant a chandelier in one case, even though it dwarfed the ceiling. Rooms are painted according to personal taste, often by the residents themselves.

Having fun is also a priority. There are numerous parties throughout the year culminating in a big Christmas festival. This Christmas an ice-rink was built. “One of our residents said she wanted to skate one more time, so we made sure she did,” Mrs John said.

Hugging and hand holding, out of fashion in many care homes these days, is also a big feature. It means staff forge close relationships with often very frail residents who do have not long to live. That takes its toll emotionally, but it is essential, Mrs John said.

The Care Quality Commission this week gave Prince of Wales House its first “outstanding” rating under a new, tougher inspection regime launched in October. Inspectors praised in particular the commitment of the entire staff to the wellbeing of residents.

Mrs John believes the size of the business makes their success possible — it is small enough to check things are being done as they want them but big enough to have scale. Both in their thirties, the sisters are also among the youngest to hold directorships in the care sector.

“We have fond memories of playing with residents as children, having our paddling pool in the garden and throwing balls with them,” said Mrs John. “That is what we remember and we wanted to bring it back.”

Care Suggestions

Developed nations facing a demographic timebomb are trying to care for their elderly with everything from robots to social engineering. Times correspondents look at their innovative ideas.

China tightened its laws in 2013, requiring children to provide emotional as well as financial care for their parents. They are obliged to visit and keep in touch, although the precise number of visits is vague.

The revised Law for the Protection of the Rights and Interests of the Elderly was Beijing’s response to its fast-ageing population. China estimates that 35 per cent of its population — nearly half a billion people — will be over 60 by 2053.

China’s entrepreneurs spotted an opening. There are hundreds of online stores offering the services of professional visitors who will pop in to other people’s parents, have a cup of tea and watch some television — all on the client’s behalf.

Zhu Yang said that he could earn 300 yuan (£32) per visit, but that it was not easy money. “You can’t just turn up, leave some presents and then go away. You have to stay for a while and provide good company. You should never expect to get away in less than two hours.” japan Japan is turning to robotics to avert a slow-motion economic disaster known as the “silver tsunami”.

It is the world’s fastest-ageing society: the old live longer while fewer are born to look after them. One in four Japanese people is over 65, and in 20 years’ time it will be one in three.

Last year the Japanese company Innophys launched a “muscle suit” that allows users to lift weights far beyond their normal ability. The device, which costs ¥600,000 (£3,400), can be used by elderly people who have lost strength and also by carers responsible for lifting and moving them.

Panasonic is developing a bed that turns itself into a wheelchair, without the need for its user to get up.

Last year Yaskawa Electric launched a robot that allows a bed-bound person to be carried to the lavatory with the help of a single care worker, rather than two. Japan could also ease immigration laws and admit carers from other countries. It is a sign of the country’s conservatism, however, that it is easier to spend vast sums on artificial people than to take advantage of the willing ones already at hand.

Cities in western Germany are experimenting with mixed living communities to help the elderly to feel comfortable in downtown areas and avoid isolation.

In Stuttgart, several apartment blocks belong to the Wohngemein-schaften (“collective living”) or WG project that allocates flats next to women over 60 to women in their 20s and 30s. “Nobody ever wants to move again,” said Marlies Pilz, 83, who has lived in a WG block since she was 70. When her husband died, she moved from the small town of Backnang 19 miles to the north of Stuttgart. united states In Silicon Valley, where a growing number of people believe that they can live far beyond 100, technology is seen as the solution (Rhys Blakely writes). Google has invested in robots that might one day assist the elderly with household chores and relay information to doctors. In Cuppertino, where Apple is based, one nursing home has already tried out a robot that resembles a small fluffy seal. It is supposed to provide companionship. the netherlands Aretirement home in Deventer, 100km east of Amsterdam, offers places for six university students alongside its 160 residents. In return for free accommodation at Humanitas, the students devote at least an hour a day to socialising with their elderly neighbours. australia The government is trying to persuade bosses to take on an ever larger number of older workers. One nationwide hardware chain, in which a quarter of the workforce is over 50, is being held up as a model for all employers.

There are now two Australians of working age to support each one not working — in four decades there will be only one Australian working for every seven who need support. new zealand Projections are very similar to those of Australia, with an additional twist: the loss of young adults overseas. New Zealand’s solution over the past three years had been to enlarge migration from Asia and to try to entice some of the hundreds of thousands who have moved to Australia to consider moving back home.

Smart Plug

Iris Purdham woke up in bed last month to find that she could not move. She would later discover that she had three compression fractures at the base of her spine.

Mrs Purdham, 83, who lives alone, had an emergency button and a mobile phone that could send an SOS to doctors, but both things were out of reach. Her family was unaware that something was amiss until just after 9am. Each of them received a text message to say that she had not switched on the kettle at the usual time. After calls went unanswered, her son Steve paid her a visit to find her in her bed. “She hates technology,” he said. “She hates wires. She never could programme the video recorder.” Even the simplest device — a red emergency button — had failed her.

The reason the family knew that she might be in trouble was 3rings, a “smart” plug that alerts families when an elderly relative fails to switch on a kettle, television or other electrical device in a certain period of the day.

The 3rings is inserted into a power socket and the plug for the electrical device is inserted into 3rings. It then detects when the device is switched on.

It is connected wirelessly to an internet service that allows family members to set “rules” for when they are to be alerted.

“The plug showed that she had not boiled the kettle,” Mr Purdham said. “We have it set up so that it sends an alert if it’s not boiled between 5am and 9am, when she usually has her first cup of tea.”

That the system had been set up in her house was not a complete surprise. Mr Purdham, 57, is an entrepreneur who designed 3rings. “My mum is my guinea pig,” he said. “She’s tried out lots of technology that’s failed for her. People in their eighties and nineties come from a generation that doesn’t like technology. So this is about bringing technology into an environment where Mum doesn’t have to be aware of it, or where it doesn’t feel like technology. It’s also about technology that helps with care but doesn’t replace it.”

His company, Assistage, which opened online last week, recommends gadgets to help with the care of elderly relatives. It takes a commission when it sells the gadgets recommended on its website. His mother is also testing True-Kare, a mobile phone via which a medication reminder is sent. A thermometer that flashes blue when the house gets too cold is being assessed.

“Most technology will work, but it won’t necessarily work in the hands of my 83-year-old mum,” Mr Purdham said. “It’s about making sure things work in the environment they’re supposed to.”

Elder Orphans

One in five over-65s risks becoming “elder orphans” with no relatives to look after them in the last decades of their lives, experts have warned. Increasingly dispersed families, fragmented neighbourhoods and a declining birth rate have left hundreds of thousands of pensioners in danger of becoming hidden in plain view, deprived of the care they need, according to a study.

Maria Torroella Carney, head of geriatric and palliative medicine at the North Shore-Long Island Jewish Health System in New York state, warned that many older people living alone were effectively shut out of their local communities and at heightened risk of a range of mental and physical health problems.

“There is potentially no structure to address this population as this population is hidden right before us,” she said before presenting her findings to the American Geriatric Society.

Ageing Without Children, a British charity, said the situation in the UK looked “very similar” to that in the US.

By 2030, two million pensioners in Britain will have no adult children, with some 230,000 of them requiring at least 20 hours of care each week, according to a report published last year by the Institute for Public Policy Research.

“If current official estimates show that 20 to 23 per cent of the adult population have no children, it will not be difficult for almost a quarter of adults to have no ‘familial support’ by the age of 65, as adult children may be unwilling or unable to step in for a variety of reasons,” the charity said.

Kirsty Woodard, Ageing Without Children’s founder, said she was uncomfortable with the term “elder orphans”. “I think it equates older people with children, which feels extremely ageist.”

Nevertheless, she said, the plight of the tens of thousands of elderly people who needed extensive care and had no relatives near by to provide it was “invisible”.

“It is broader than just health and care, though,” she said. “In the UK, people ageing without children are worried about having no one to speak up for them, feeling lonely, being abused or neglected, but they also worry about being cut off from younger generations and becoming disconnected from the community.

“The government needs to stop assuming that older people will have families who will step into the breach as social care provision particularly is rolled back. Inevitably this means investing in social care but also in other services such as advocacy, practical support, co-housing and inter-generational programmes to connect communities.”

Caroline Abrahams, charity director at Age UK, called on people to get involved and spend more time with over-65s living alone in their neighbourhoods.

“Communities can make a huge difference to the lives of older people living alone, particularly those who have no children or relatives,” she said. “This can be as simple as making time for older friends and neighbours.”

Bye-bye Arms

I was watching Jane Fonda in the new Netflix show “Grace and Frankie,” in which she plays a woman who has just been dumped by her husband, and I was amazed to see Jane, who is 77, with the universally dreaded Inner Upper Arm Wiggle Waggle.

You know what that is, even if you’re not old enough to have it. The flesh of the inner upper arm hangs slack from the bone, as if it’s given up hope. If an inner upper arm could talk, it would say: “Oh, why bother? No one is ever going to give me work/take me to bed/ask my opinion of PBS’s ‘Wolf Hall’ versus Broadway’s.”

Fitness trainers will tell you that arm lifts with light weights can prevent wiggle waggle. But if that were true, would Jane Fonda have it?

This is hard-body Jane, the woman who, back in the ’80s, produced the best-selling workout videos. When she was 72, she made two more, though they included things like exercises for arthritic hands (and wore a leotard that covered her arms).

Five years later, Jane not only bares her upper arms, she pokes the flesh so that it shakes like Jell-O. This is a move women do only to torture themselves in department store dressing rooms when trying on sleeveless dresses, or alone in front of their bedroom mirrors. It’s a kind of negative self-affirmation: Who could ever love me with this?

Jane was doing it on TV. I wanted to leap off the couch and scream, “Give that woman an Emmy now!”

Excuse me, I have an email question from a reader: Couldn’t Jane’s slack arm flesh, which in its most extreme form has been called “bat wings” or “chicken wings,” been a prosthesis?

Theoretically, yes. But the jiggling flesh of the upper inner arm has historically been considered so horrifying that the special-effects people decided years ago never to make it. Reels of intestines spilling out of the bodies of the walking dead? Love it! Slimy newborn alien leaping out of an astronaut’s chest? Brilliant! That hanging flesh you see on older men and women? That’s repulsive.

Where was I?

Oh, yeah: this frankly-embracing-our-aging-bodies thing that I’ve been seeing on TV. You can’t actually call it a tender embrace; it’s more like the pro wrestler Bad News Barrett slamming you with his bull hammer elbow.

But at least this stuff is being acknowledged. Like in that recent “Inside Amy Schumer” sketch in which Julia Louis-Dreyfus, Tina Fey and Patricia Arquette are celebrating Julia’s last day as cinematic sex object.

The skit plays off Hollywood’s obsession with youth. It ends with Tina saying she has to go home to wax her beard. I was stunned.

I am 67, although most days I can easily pass for 66 and 10 months, and about a year ago, I spotted a single coarse hair on my chin. It appeared overnight, as if one of those cinematic prosthetic makers had sneaked into my room and glued it on. A few weeks later, I noticed soft peach fuzz all over my chin.

I come out of the spill-it-all Woodstock generation, but this was too ghastly to confide to anyone. When I spotted a manicure and waxing salon at an out-of-the-way upstate mall, I had what I thought was an original idea: getting my chin waxed.

I honestly thought I was the first person to come up with this. When I took the cosmetologist aside and asked how much such a procedure might cost, she pointed to the price list on the wall: “Chin wax, $8.” I was amazed: So I am not alone on Hair Chin Island?

True, the hair chin stuff and Inner Upper Arm Wiggle Waggle are being played for laughs on-screen, but I can remember when “yogurt” was a laugh word on TV. There may soon be a day when sagging arm flesh is considered hot. Maybe Helen Mirren has something to contribute here. She wore a sleeve past her elbow at the Met Gala, which is promising.

Oh, sorry, now I’ve got a question from my friend Sybil: Why don’t they have Spanx for arms?

Surprise — it turns out they do. There’s a product called Sleevey Magic, a tight long-sleeve undershirt, available in white or black, that appears from the video to work like sausage casing. I’ve also seen this sort of packaging used on precooked polenta, if that’s an image you prefer.

You have Sleevey Magic on top and Spanx on the bottom, and when some buff widower takes you in his arms at his niece’s wedding, he thinks he’s with a retired Olympian. Then he gets you naked in his hotel bed, and you spread out like pancake batter.

But here is the secret: Once they have you in the sack, men do not care. Especially the old guys, who are pretty jiggly themselves. They cannot believe their good luck. In their 11th hour, the universe has served up ice cream.

It’s women who make themselves nuts worrying about these things. The old guys are thinking, “Oh, yeah, jiggle it for me, baby!”

Today's OAPs

Old age, according to Shakespeare, “Is second childishness and mere oblivion / Sans teeth, sans eyes, sans taste, sans everything”.

Helen Van Winkle, 87, from Kentucky, has become a social media star as Baddie Winkle — catchline “Stealing your man since 1928” — in her greatgrand-daughter’s clothes, and counts pop stars Rihanna and Miley Cyrus, left, among her fans.

These days, it seems he is right in describing it as a second childhood, but the only thing today’s retirees are sans is an inheritance to pass on – they have spent it all on cruises and fashion.

A study has found that far from sitting around waiting to hand out Werther’s Originals, pensioners are more likely to bump into their grandchildren shopping in the same stores. And when they do happen upon them in Primark or H&M, they could talk about something else they have in common: almost half are watching the same shows on BBC Three or E4.

Given the amount of time they are spending travelling, carousing and generally wasting their children’s inheritance — 77 per cent say living life to the full is more important than leaving money behind — their grandchildren might be lucky to see them at all.

The report, commissioned by the retirement builders McCarthy and Stone, found that most pensioners think they are younger than their real age. One in eight of the almost 1,700 surveyed felt 20 years younger than their actual age.

Dr Patricia O’Neill, a gerontologist, said that this reflected a changing view of growing old. Pensioners, she said, “are redefining what it means to add years of life”. Instead of growing old then, the survey found baby boomers taking full advantage of being the first — and, given the cost to the taxpayer, possibly the last — generation to have almost 30 years of retirement.

Almost half are divorced, but a fifth have joined online dating agencies, and two thirds of people aged 65 to 74 have an active sex life. The effects of this trend are not just being seen in rising rates of STDs but also in a preoccupation with looks. While a clean flat cap and a blue rinse might have counted as making an effort for their parents, 70 per cent of today’s pensioners say their appearance really matters to them, and a third follow fashion.

Almost a quarter have been on a diet in the past year, with the 5:2 being the most popular; and four fifths say they exercise as much as or more than they did before they retired, with one in ten putting in more than ten hours a week.

Dr O’Neill said that society needed to adjust to a new form of retirement — and get used to the fact that being old no longer means being invisible. “Those who area nearing or at the traditional ‘retirement age’ do not want to disappear into the background or be isolated from the community at large,” she said. “These people are interested in all aspects of life. They want to participate in it. Moreover, they still have a lot to offer. Either get on board with them, or get out of the way. They have paved the way in the past and will continue to pioneer the future.”

Cash In Pension To Buy Supercars

Most people would not normally go to their garage to check the status of their life savings, but one businessman is doing just that after cashing in his pension to buy a Bugatti, a Jaguar and two Ferraris.

The man, who wishes to remain anonymous, spent £1.3 million on the classic supercars, using new freedoms that allow anyone over 55 to release cash from their pension. Last year, Steve Webb, the pensions minister, said he felt relaxed about savers blowing their pension cash on fast cars. “If people do get a Lamborghini, and end up on the state pension, the state is much less concerned about that, and that is their choice,” he said.

The businessman used his pension to buy a Bugatti EB110, a Jaguar XJ220, a Ferrari 512M and a Ferrari 430 Scuderia. Some were registered in the 1990s, which makes them modern classics.

He released more than £500,000 from his pension for a deposit and borrowed £800,000 to buy the cars. Tim Marlow, of Magnitude Finance, a car finance specialist that arranged the loan, said that his client saw the cars as an investment. “The guy is a bit of a petrolhead but he spent a lot of time researching the cars and has decided to shift his asset class from stocks and shares to cars. And the cars pay a dividend as well; you get to drive them, although not too much because you don’t want the mileage racking up as that might hit their value.”

Over the past ten years classic cars have outperformed every other investment class, and have risen by almost 500 per cent since 2005, according to Historic Automotive Group International’s TOP index. Over the same period the art market has risen by 224 per cent, stamps by 195 per cent and the FTSE 100 index by 17 per cent.

Antique furniture has lost value over ten years, having fallen 24 per cent, according to Knight Frank. Experts estimate that more than a quarter of a billion pounds has been withdrawn from pensions and spent on cars since April when the new rules came into force.

Japan

DESIGNING underwear to fit human curves is tricky. For decades, Wacoal, a global manufacturer of lingerie based in Kyoto, has been measuring the female form and making products that factor in the toll of time and gravity. Its research is proving ever more rewarding. The company’s sales to senior citizens—who are just as interested in a graceful silhouette as women decades younger—are growing by double-digit rates each year.

Many societies are ageing, from America to China, but Japan has a head start. One in four Japanese are over 65; by 2035 it will be one in three. So the country is serving as the world’s laboratory for selling to older consumers. Elderly Japanese outspend younger ones, says a study by the Boston Consulting Group. They now account for two-fifths of personal consumption.

Many of the country’s biggest firms have adjusted their strategies to tap into the grey yen. Panasonic, a maker of domestic appliances, has rolled out a string of new products, including foot heaters and lightweight vacuum cleaners. Aeon, a giant retailer and shopping-centre operator, has a “Grand Generation” strategy, which ranges from providing one-stop medical clinics on the premises to making in-store signs easier to read. Fujitsu, an electronics firm, has sold 20m of its “Raku Raku” mobile phones, with larger buttons and simplified functions, and is now introducing them into Europe.

Japanese firms have been equally inventive in the area of medical products for the elderly. But this is an area where cumbersome regulation can hold them back. Cyberdyne, a spin-off from the University of Tsukuba, designed a robotic exoskeleton suit to give mobility to the elderly and disabled. Although it gained approval for clinical use in Europe in 2013, it has yet to do so at home. Testing for medical products is costly as well as slow in Japan, and getting new devices covered by health insurance is a long and arduous process. Having opened up a lead in robotics for nursing care, the country risks losing it.

Regulation is not the only pitfall firms face, however. Businesses are finding it is easier to invent products that the elderly might find useful than it is to market those products to them. One reason is that older consumers do not appreciate being reminded that they are old. A recent report by McKinsey, a consulting firm, describes how one Japanese firm, Bridgestone, made the mistake of promoting a new line of golf clubs as being for senior citizens; a rival brand did better by avoiding any explicit mention of age, but stressing its clubs’ ability to make the ball travel far, tapping into older golfers’ anxieties about not being able to whack it like they used to.

With this in mind, advertising campaigns often tread delicately around the age issue. Toyota, a carmaker, uses silver-haired, middle-aged models to target ageing baby-boomers but those of pensionable age seldom appear in ads of any kind unless accompanied by young actors representing their children or grandchildren.

Some companies, such as Wacoal, have created separate brands and marketing campaigns for their new products designed for older consumers, so as to avoid damaging the “young” image of their main brand. However, Florian Kohlbacher, co-editor of “The Silver Market Phenomenon”, a marketing handbook, argues that it is often better, instead of creating separate products just for the old, to design ones that bridge the generations. Toyota increasingly loads its cars with lasers, cameras and sensors to prevent collisions, for example. Such safety features can be marketed to drivers of all ages, but the main beneficiaries are the increasing numbers of elderly motorists: although total traffic deaths in Japan have roughly halved over the past two decades, the number of fatalities involving the over-65s is rising.

Debates such as these will soon enough be part of boardroom discussions outside Japan, too. In the end, says Mr Kohlbacher, all managers will have to find ways to market to the old without either offending them or putting off younger consumers. They might start by actually talking to the elderly, who have more experience of shopping, after all, than anyone else.

Countering Loneliness

It is sometimes a struggle to fill the hours, but Joan Hanley finds doing jigsaw puzzles on her iPad a great form of entertainment. The 82-year-old retired civil servant is now an expert. “You sit there night after night . . . but luckily this is my saviour,” she said, clutching her pink-cased tablet. “I have done nearly 5,000 jigsaw puzzles on my iPad. If I am feeling low, I just open it and have a go. I recommend this to anybody old.”

Ms Hanley, from Gravesend in Kent, has another precious lifeline. One Sunday a month she is picked up and taken for tea at the home of a volunteer from the charity Contact the Elderly. The choice of day is not an accident. Sundays are regarded by many in old age as the loneliest day of the week. Few other charities or services operate and friends are often busy with family.

Loneliness is a blight on our rapidly ageing population and one of the greatest challenges facing our society. Half of all over-75s live alone and, for many, television is their main source of company. Loneliness is not just hard to bear, it is bad for health, with some studies suggesting that it is just as damaging as smoking.

Yet charities such as Contact the Elderly can make a profound difference, not only with the prospect of a welcoming tea party in a volunteer’s home once a month, but also with the guarantee of the same driver to ferry the elderly person to and fro. That in itself is the source of regular company and often a meaningful friendship.

For Ms Hanley, who never married and has no children, there is another advantage: “It is the only chance I get to have an intelligent conversation with someone younger me.” She lives in a retirement complex with more than 100 other elderly people. The complex has a communal room to enable residents to meet up, but Ms Hanley said that she found it quite depressing. “All these people want to talk about is their illnesses because that is what their life consists of.” By contrast, the six families in Gravesham in Kent who take it in turn to host the Contact the Elderly get-togethers each month mix up the generations, from their guests aged from early 80s to late 90s, to the younger volunteer drivers, to their own relatives and friends.

“I find it so lovely that I can come here and converse with people who are younger than me,” said Ms Hanley, her eyes twinkling as she looked around a crowded dining-room area and kitchen at the house of last month’s hosts, Cheryl and Graham Price. A toddler, the grandson of one of the volunteers, pressed his face to one of the windows to admire a large dog in the back garden, while four silverhaired women and two men made themselves comfortable on a sofa and an array of chairs. They chatted to the hosts and a group of Mr and Mrs Price’s friends and fellow volunteers who had come to join in the fun, which included a traditional turn at stirring the Christmas pudding.

Mrs Price, a tall woman with a friendly face and jolly laugh, said that she and her husband got huge enjoyment from hosting the teaparties, something they had done for the past two years. Both have lost their own parents. “It feels as though there is something missing at the top of the tree,” Mrs Price said. “For us, it fills that gap. You look around and see old people and then they start talking about the lives they have led, the things they have done, it is just mind blowing. It’s the best thing we do.”

Other volunteers miss their grandparents. Louise Stapley, 29, a risk manager at a bank, decided to become a driver for the charity after her grandmother died five years ago. “I used to take her out every week and she loved it,” Ms Stapley said. “I used to get enjoyment out of it just as much as she did and I really missed that.” She now drives Dorothy Rook, 86, every month to tea parties around Gravesham. It is the only time that the former foster mother, a widow, who has cared for more than 130 foster children in her life, leaves her sheltered accommodation.

Contact the Elderly, which was established 50 years ago, runs more than 600 groups like this across England, Scotland and Wales, offering friendship to more than 4,800 people aged 75 and over who live alone. Some 8,000 volunteers provide the service — a number that the charity hopes to double to 16,000 by the end of the decade, with a goal to create 600 more monthly tea-party groups and drivers.

Ms Hanley, who uses a walking frame, had to give up driving recently because of her poor eyesight. Other guests also need assistance to move around, making the volunteer drivers essential. Yet the time commitment is modest at only a few hours once a month. It makes it manageable for those with busy lives. Douglas Rapley, 91, another of the guests at the Gravesham party, has a son and a daughter he sees regularly, but he still finds that weekends can be a lonely time, especially since his wife died at the start of the year.

“I don’t like Saturdays and Sundays. The world stops, you don’t see anybody around,” said Mr Rapley, who served in the RAF during the Second World War until he suffered an injury to both of his legs. He had to spend 15 months in hospital. One of the veteran’s granddaughters suggested that he try the Contact the Elderly tea-parties. Mr Rapley said they had since given him a rare weekend treat to look forward to. “It is very nice. I thoroughly enjoy it,” he said. “I get up in the morning on a Saturday and think: Oh, I am going out and I am happy.” Ms Hanley has two sisters, one of whom bought her the cherished iPad, and two brothers as well as their respective children.

Mr and Mrs Price have also become good friends. “I actually look forward to coming to this because it’s so lively and people are talking about things. They are talking about life, not old age and not illnesses. It is really good,” she said. “They are such lovely people.”

Growing Old Disgracefully

Checking into the honeymoon suite with a mistress at Le Bristol hotel in Paris, a veteran businessman named Michael makes a quick mental check of his hand luggage. Viagra, condoms? Check. Lingerie? Check. It is the start of an adventurous weekend made all the more remarkable by the fact that Michael is 70 and his lover is less than half his age.

But then Michael is a “graver” — one who raves to the grave. The gravers are the baby boomers who are growing old disgracefully and loving every precious minute — and their numbers are growing fast. “I’ve always been a charmer,” said Michael, a roguish advertising executive from London whose wife of 45 years is also 70, and whose two children, aged 45 and 50, are older than his “several” mistresses.

“I’ve always preferred younger girls and enjoy long-term affairs, and have always been open with my wife about my affairs. She accepts me for who I am and likes her lifestyle. “I love my wife but I can’t be monogamous. I still have sex with my wife, but it’s not as good as the affairs. I still had five on the go when I was 65.”

For gravers like Michael, cruising does not mean a ship in the Mediterranean, but trawling bars and clubs, looking for love. “I still walk into bars and chat up women, and always go for women that are at least 30 years younger than me,” he said. “I’m good-looking and haven’t really aged: I still look 50. When I was younger my work often took me abroad, and when I was 40 I fell in love with a 19-year-old French woman, who became like a second wife. My wealth allowed me to set her up in a house in Paris.

“I treat my other mistresses to weekends abroad, nice restaurants, hotels and buy them expensive gifts. I’m very sophisticated: the way I dress, I like fine wines, I take them to the theatre and art galleries. I’m a gateway to a better life that younger men can’t offer.”

While many retirees favour statins, Michael’s drugs of choice tend to be illicit. “I got into ecstasy in my forties and I’ve always dabbled with cocaine, although recently I’ve discovered I have a heart condition, so I’ve wound it back,” he said. “I got a taste for Viagra when it came out in 1998 and it changed my outlook . . . I still feel like I’m a teenager.” Retirement no longer consists of listless twilight years of golf and allotments for gravers like Michael. Today’s more affluent pensioners are more likely than ever before to have affairs, divorce, party and travel the world.

As the musician and graver icon Neil Young, 70, once put it: “It’s better to burn out than to fade away.”

The graver lifestyle is not all about endless partying and sexual trysts, however. After a life in the fast lane, some brave gravers defy convention in other ways. Last week Ronnie Wood, the 68-year-old Rolling Stone, announced that his third wife Sally Humphreys, 37, is expecting twins. She is younger than two of his four children. Wood is following in the footsteps of the perennial playboy and nightclub magnate Peter Stringfellow, 75, who became a father for the fourth time this year.

While “Stringy” no longer boozes in his clubs, 21% of over-65s admitted in a recent survey that they exceeded the weekly guidelines of 21 units of alcohol for men or 14 for women. The top 5% of drinkers regularly knock back more than 49 units per week — about five bottles of plonk.

And with promiscuity in later life becoming more socially acceptable, cases of chlamydia, herpes, genital warts, syphilis and gonorrhoea in the over-65s in 2013 were reported to have increased by 8.2% in a year.

A huge driving force behind the gravers is a surge in “silver splitters” — late-life divorcees who want a second bite of life’s cherry. Divorce rates overall are falling, but over the past decade there has been an 11% rise in splits among the over-50s, with more than 60,000 separations in England and Wales in 2013.

Becoming single again is merely the beginning of a new chapter of fun for gravers. After 21 years of marriage, Jackie Morris, 52, a divorced retail executive and mother of three from Essex, took control of life and love and has never looked back. “When my youngest boy went to university three years ago, I thought: this is my time,” she said. “I refused to give in to empty nest syndrome. I refused to lie down and be broken. So I joined dating websites and was immediately bombarded with offers, and from an awful lot of young men. It was extremely flattering, but some were my son’s age — and he’s only 21.

“Younger men think you want to be naughty, that older women don’t have so many rules. And sometimes, that’s true. “I had some great sex. I had a relationship with a guy who was 30. I went motorbiking with him, I felt so free and easy, we had wild some nights on campsites. I was doing things I felt I should have done if I hadn’t married so young.”

Morris believes online dating gives the power back to women. “I got such a kick out of it,” she said. “I took control and renewed my shattered confidence. I lived my teenage years again, but with the added security of being my own person, and with financial security. Now, I’m concentrating on me. Age means nothing. It’s only how old you feel. And I feel amazing.”

Some gravers are dabbling with drugs, too. A report by researchers at King’s College London in 2013 said 888 pensioners had been admitted to hospital after being poisoned by drugs such as cocaine, cannabis and amphetamines in 2012, compared with just 283 in 2002. Benedict, 73, a retired publisher from Oxford, said: “I did a line of cocaine at a dinner party, and one minute I felt on top of the world, the next I felt like I’d been kicked in the chest by a mule.” He was rushed to A&E and now sticks to gin.

David Raynes of the National Drug Prevention Alliance said: “I am in no doubt we will see an increasing ‘bulge’ of pensioners who are hitting the NHS because of illegal drug abuse. These are whole-of-life users who experimented with drugs in their youth and, despite the pressures of careers, mortgages and children, never gave up.”

Not all gravers want to live life in the fast lane. Some, like Peter Fairbrother, 66, and his wife Carol, 64, prefer a more sedate, if unconventional, retirement. Earlier this year, the couple sold their family home and swapped their suburban existence for a life on the road. “We decided to spend what we’ve earned over a lifetime doing exactly what we wanted,” said Carol, a retired teacher. “We downsized our four-bedroom house in the suburbs to a one-bed apartment, bought a camper van and for three months went to every music festival we could. “Being children of the Sixties we’ve always been free-spirited, but we’ve even shocked ourselves. We raved at Glastonbury, Bestival, Reading and Leeds. We’d expected to stand out but there were lots of pensioner couples like us and we’ve made some great friends. We’re even planning a trip to Burning Man in Nevada with a few of them next year. A few of our friends think we’re a bit of a joke, but their idea of fun is a trip down the gardening centre.” Her husband said the adventures had refreshed their marriage. “It’s fair to say that our three kids resent the way we live,” he added. “We’ve always done well for them and now they are trying to tell us how we should spend our money. We’ve worked for everything we’ve got but all they hear is the sound of their inheritance going down the drain. They’d better get used to it. This is our time to live again.”

Like Wood and Stringfellow, Andrew Simms, 64, from Sheffield, decided to have children late in life with a much younger woman. “I’d been running my car dealership for nearly 40 years when a rival bought me out for life-changing money, and for the first time ever I could do what I want,” he said. “I’d been married since my early twenties, and we’d drifted into becoming friends. We didn’t have kids, so we split the money and went our separate ways. “After the divorce I travelled the world, visiting the Grand Canyon, Thailand and India, but it wasn’t till I met Marianne in a Parisian bar that I considered I might spend my life with someone else. Despite her being in her early thirties, we clicked instantly. It was like being a teenager again. We’d have aimless walks in the park holding hands and long days in bed.” The subject of children came up quickly. “I thought, ‘Why the hell not?’ Friends pointed out the pitfalls; that I’d be the oldest dad at the school race or I’d be mistaken for their granddad, but I knew it was a step I wanted to take. “We’ve now got a boy, Oscar, 3, and a girl, Mathilde, 7 months. I’m not going to lie and say it’s been easy, but I don’t think it was any harder for me than a younger man.”

Simms speaks for many rejuvenated gravers, saying: “I’ve had a second wind in life.”

Life Expectancy

THE gap in life expectancy between rich and poor is widening for the first time since the late 1870s. After a long period when all parts of society benefited from advances in public health, including clean water, antibiotics and mass vaccination, the trend towards greater equality has gone into reverse.

Research shows the richest 5% of men in Britain are living on average to 96.2 years, 34.2 years longer than the poorest 10%. The gap has grown by 1.7 years since 1993, when it was at its narrowest. The richest women reach on average 98.5 years, 31.5 years more than the poorest. The female gap reached its smallest in 2005, but has since grown by 0.4 years.

Unhealthy lifestyles have been blamed. Les Mayhew, professor of statistics at City University London’s Cass Business School, and coauthor of an upcoming paper that reveals the change, said: “Many of the big gains from public health improvements are in the past and personal choices are now key.”

Although many deaths are still caused by public health problems — such as air pollution from diesel particulates — Mayhew said: “Most people now die from chronic rather than infectious diseases, so life choices are highly significant.” Poor men were the most likely to make damaging lifestyle choices. “They put themselves in harm’s way much more than women do . . . they smoke more, drink more and there are periods in their lives when they do crazy things.”

Unlike in America, where the life expectancy for the poorest white women has fallen by three years since 1990, even the poorest groups in Britain are still living longer than they used to. The poorest 10% of men lived to a mere 39.7 on average in 1879, rising to 56.6 in 1980 and 62 in 2010.

By comparison, the poorest women reached 40.6 in 1879, 61.2 in 1980 and 67 in 2010. All life expectancy figures are calculated for people aged 30 to avoid distortions such as infant mortality. In 1879 the gap in life expectancy between the richest and poorest was 44.9 years for men and 46 for women.

Although data connecting income to longevity is not available for the whole period, the link is consistent with other research. Isaac Sasson, a fellow in population health at the London School of Economics, said the poorest groups were falling victim to the “cumulative effects of decades of poor lifestyle” and of income inequality. He, too, said the figures since the 1970s reflected the repercussions of unhealthy behaviour along with income inequality, and should not just be blamed on a rise in obesity or other recent problems.

According to Sasson, the rich used to be just as vulnerable as the poor to the “random” impact of disease but are much better placed to fend off many modern killers. “Healthy behaviour spreads much faster through educated networks: for example, they were the first to quit smoking.

“If you start chlorinating water, everybody benefits but resources come into play if you need an MRI appointment, or want to see the best specialist.”

The findings help to explain the rise of the “nanny state” with proposals for taxes on sugar and a minimum unit price for alcohol. Mayhew said: “If people don’t help themselves, it is tempting for governments to intervene.

Harmful Lyrics

They have been blamed for everything from the decline of morality in the West to the growth of recreational drug use.

Now rock stars have been accused of posing a serious health risk to the elderly because their lyrics about them are so insulting.

An academic study said that persistent references to hair loss, physical decline and loneliness in pop music were so unremittingly grim they could contribute to heart failure in this age group. The study by Anglia Ruskin University, in Cambridge and Chelmsford, analysed the lyrics of 76 songs that dealt with old age or ageing.

They found that 72 per cent of the titles, including When I’m 64 by the Beatles and Because Of by Leonard Cohen, gave a negative portrayal of the later years.

Common themes were physical frailty and the fear of approaching death. Old age is invariably associated with being unloved, unlovable or an object of pity, the study said.

It concluded with the finding that part of the problem was that most pop songs were written from a young person’s perspective. These negative connotations of growing old risked affecting the confidence and self-esteem of the elderly, which in turn could lead to other health problems.

The study’s authors urged musicians to make their songs about old age “less hip-op and more hip-hop”. Jacinta Kelly, a senior lecturer in nursing at the university, said: “With significant increases in life expectancy and a huge rise in the number of people aged 65 or older during the coming decades, ageing is a matter of national and global importance. However, most research focuses on age-related disease at the expense of examining the social and cultural influences on the ageing experience. The negative representations of age and ageing can affect confidence and the esteem of older people. “Negative emotions experienced by older people are connected to poor outcomes in mental and physical health, particularly cardiac health.” She said she hoped that song writers would take notice but drew the line at censoring content and forcing pop music to carry health warnings.

The research, published in the Journal of Advanced Nursing, found that the 1980s had the highest number of negative songs about old age of any decade since the 1930s.

It singled out for particular criticism Those were the Days by Mary Hopkin and The Grouch by Green Day, in which the American punk band sings: “I’ve decomposed, yet my gut’s getting fat. Oh my God, I’m turning out like my dad.” The paper also disapproves of Old by the English soul band Dexys Midnight Runners, who sing: “Old have memories to keep all cold away.”

The authors, however, praise Bob Dylan for his more positive portrayal of age in Forever Young, and Dusty Springfield for Goin’ Back.

The Old and the Very Old Move In Together

When property prices first forced the boomerang generation to move in with their parents, the arguments were about dirty ashtrays in the sink, strange visitors on the landing and who would take the rubbish out.

But now they are about sherry glasses on the bridge table, hair dye in the bathroom — and no one remembers when the recycling van comes. That’s because it is now seventysomethings — and in some cases 80-year-olds — joining their mums and dads in retirement villages. With dramatic improvements in life expectancy, owners of retirement villages are beginning to notice a new trend which allows families to stay together while keeping down the costs of nursing or residential care.

Jane Ashcroft, chief executive of Anchor, the housing and care charity, knows of at least four sets of parents who have moved into the group’s villages with their own elderly children.

Often the “children” rent or buy nearby apartments, enabling them to support or even care for their parent while also preparing for their own old age. One such family are Thelma Foxhall, who is 80 this month, and who lives with her mother, Hilda Hammock, in a retirement complex in Selby, North Yorkshire.

“When I first moved into my firstfloor flat, I knew it wouldn’t be long until my mum joined me, after all we do come as a package,” said Ms Foxhall. “A year later she moved into a flat downstairs.” Ms Foxhall said they had considered nursing homes for her mother but that the joint solution suited them far better. “I spend time with my mum at least twice a day; usually in the morning and in the afternoon after I’ve been shopping. But living here also means she can continue to be independent — even into triple figures.”

Ms Ashcroft said they have the best of both worlds. “They are there for one another but also have the freedom and independence that is offered from sheltered housing.This is something we expect to increase as grown-up children and parents look for flexible options for great quality of life as they get older.”

The number of over-70s in the UK has risen by 15 per cent in the past decade to just under eight million. The number of people aged over 100 has increased by nearly 75 per cent in the same period to about 14,500. Last year there were an estimated 295,000 multigenerational households, a 50 per cent increase from ten years ago.

French posties monitor aged

On a quiet Saturday afternoon, Aurore Raguet, a fifty-year-old mail carrier, followed her route through the streets of Revin, a small French town near the Belgian border. The houses in Revin are sturdy boxes in gray, white, and the color of wet sand. Aurore stopped at one of them, making her way through its untended lawn to the front door.

Jeannine Titeux, the owner of the house, appeared after the fifth knock. “You’re early,” she said. Jeannine, who is eighty-eight years old, wore her short hair, dyed light brown, tucked behind her ears. She led Aurore inside, into a living room so rigorously decorated that it inspired good posture. Aurore took careful steps past a candelabra with blue candlesticks, a pyramid of green digestif glasses, and a miniature plaster nude on a fluted pillar. She smiled and glanced down at her tablet. Ordinarily, she uses it to scan packages. Now it displayed a list of scripted lines designed to initiate conversation:

Introduce yourself to the client and talk about a subject that might interest her.

What weather we’re having!
Did you watch TV last night?
Have you received any visits lately?

Jeannine didn’t need any prompting. She launched into a story about the time when, as the wife of Revin’s mayor, she had directed the town’s ballet school; she had allowed a young girl with polio to dance. “I don’t know what became of her,” Jeannine said, addressing the room. Aurore listened. A month of these weekly visits plus an emergency-call button costs Jeannine €37.90. The fee is collected by La Poste, the French postal service, as part of a program called Veiller Sur Mes Parents (“Watch Over My Parents”). Every day except Sunday, postal workers inform the program’s subscribers, through an app, if their elderly relatives are “well”: if they require assistance with groceries, home repairs, outings, or “other needs.” Since V.S.M.P. was introduced, in 2017, about six thousand elderly women and fifteen hundred elderly men have been enrolled across the country. The program mandates no minimum visit time, but data collected by La Poste shows that conversations tend to last from six to fifteen minutes, long enough to soft- or hard-boil an egg. At the end of each visit, the elderly person signs the carrier’s tablet, providing proof of life as though accepting a package.

Jeannine has three children, ten grandchildren, and eighteen great-grandchildren. They didn’t sign her up for V.S.M.P., however, and they don’t receive the app’s automated updates; Jeannine subscribed herself, after a long holiday at home without her housekeeper. “I don’t want to be found two weeks after the fact,” she has told Aurore, about the prospect of her own death. Jeannine’s housekeeper comes six days a week, Aurore on the seventh.

“On Sunday, not even a car went by,” Jeannine told Aurore. “Not one car!”

“It’s calm,” Aurore said.

“It’s tedious!” Jeannine corrected.

Jeannine talked about what she used to do, what she can no longer do, and what she does now to make time pass. Every now and then, she wondered at the flow of the conversation: “I’m not sure why I’m talking about this,” she said. Aurore leaned back in her armchair, her head against a lace doily. She laughed in the right places and didn’t rush to fill the silences. “All those young girls I knew are old ladies now,” Jeannine said, trying to recollect the name of the dancer with polio. “Every life is a novel.” On the wall behind her, an acrylic self-portrait showed a much younger Jeannine smiling into the distance.

In a sense, Watch Over My Parents was created by accident. The service began in 2013, after a heat wave, when a number of overburdened city halls asked their local post offices to check on vulnerable and elderly residents. Éric Baudrillard, the director of V.S.M.P., told me that there has always been a “natural link between the French and their postal workers.” At first, La Poste was happy to do the check-ins for free. Soon afterward, though, it proposed a paid version of the program, called Cohésio, for insurance companies and municipal governments. The service was extended to the general public in 2017, under the name V.S.M.P.

Revin’s current population of six thousand is half of what it was when Aurore was growing up.

La Poste, which became a public-private hybrid in 2010, is adapting to changing conditions. It must continue to fulfill its mandate of uniform delivery to every address in France. But where, a decade ago, La Poste delivered eighteen billion letters, it now delivers less than ten billion. The cost of mailing a letter went up eight cents this year, to eighty-six cents; still, revenue from stamps alone can no longer support the postal service. As a result, the definition of “postal work” has been expanding. In some places, French postal workers now pick up prescriptions, return library books, and deliver flowers. Last year, only twenty eight per cent of La Poste’s revenue came from sending mail.

In France, as in many developed countries, people are living longer than ever before. By 2035, a third of the population will be over sixty. Millions of people over the age of seventy-five already live alone. As the population ages and disperses, with more young people moving away from their birthplaces, traditional safety nets—family, community, the government—may not be enough to support the elderly. V.S.M.P. is a response to this grim prognosis; La Poste sees opportunity in “la silver économie.”

On a Tuesday morning this summer, I watched Aurore, one of the few female mail carriers and among the oldest employees at Revin’s branch of La Poste, load a yellow electric bicycle with the day’s mail. Aurore has broad cheekbones, blue-gray eyes, and a commanding, contagious energy. She refers to her co-workers who are in their thirties—most of whom make deliveries by car—as “the kids.”

We set off for the center of Revin, up a low hill above a horseshoe bend in the Meuse River. For the most part, the view was green in all directions, dotted with rapeseed fields and forests home to wild boars. There are still factories for Hermès bags and corrugated cardboard in the region, but Aurore told me that Revin, where she has lived her entire life, “has everything except jobs.” The current population of six thousand is half of what it was when she was growing up. In the nineteen-seventies, the now-defunct factory where her father worked exported tens of thousands of bathtubs each month. Fifteen years ago, hundreds of employees in one of the town’s factories produced an Electrolux washing machine every twelve seconds. Today, in the same building, twenty-four people assemble motors for electric blinds.

Aurore delivered mail to a two-star hotel; to the office for the Fight Against Illiteracy; to one of the town’s two butcher shops; to the jewelry store. The owner of a store selling lottery tickets and hard candies announced that she would be retiring at the end of the week: Did Aurore have the necessary paperwork to reroute her mail?

Since V.S.M.P. was introduced, in 2017, about six thousand elderly women and fifteen hundred elderly men have been enrolled across the country.

During certain hours of the day, some Revin residents leave their houses unlocked so that Aurore can let herself in and hand-deliver their mail. Walking her bike through the open-air market, between stands for local honey and off-brand phone chargers, Aurore received unsolicited summer fruits. People stopped her in the street to ask after their mail; invariably, without checking her bag, Aurore remembered whether they had received any letters. She heard the same joke again and again—“They’re only bills, anyway!”—and laughed warmly each time.

She cycled past modest row houses, scanning for clothespins attached to front gates or to the metal flaps of mailboxes. The clothespin signal—which indicates that one of her elderly clients, who can’t make the trip to the post office, has mail for her to pick up or would like to purchase stamps—predates V.S.M.P. “I invented this system so they wouldn’t have to watch out for me all day,” she explained.

Aurore speaks quickly and assuredly, with the kind of breezy conclusiveness you’d want from a nurse or a pilot. When her sentences run the risk of tapering off, she punctuates them with a short, decisive voilà. Over the years, she explained, her professional role has become more personal: “I got along well with people, and they got to know me well, and so . . . voilà.” She is, in many ways, a model of the nostalgic ideal on which V.S.M.P. is based. A survey commissioned by La Poste found that French citizens rank mail carriers among their “favorite figures encountered in daily life,” second only to bakers. During certain hours of the day, people leave their houses unlocked so that Aurore can let herself in and hand-deliver their mail. One older man considering the service told me that V.S.M.P. reminded him of the “doorbell culture” of his youth, when people would drop by unannounced for casual coffees. (With V.S.M.P., of course, he’s entitled to a refund if no one rings his bell.)

Aurore stopped along her route to drink a glass of orange juice with Yvette, who wore a floral house dress and walked with a cane. She briefly visited Joelle, staying long enough for Joelle’s grandson to model each of his virtual-reality headsets. A few years ago, when Joelle had cancer, Aurore began checking in on her. Now it’s a matter of habit. “We got used to seeing each other,” Aurore said. She knows that “some people just deliver mail, period, nothing else,” and is quick to insist that she doesn’t hold it against them. Even if other mail carriers don’t “share the same appreciation for the human touch,” she told me, many of them keep a compassionate watch from a distance.

For La Poste, the modest success of V.S.M.P.—the number of subscribers is lower than anticipated, but only slightly—has been tempered by considerable criticism. Postal unions have challenged La Poste for monetizing an activity that was once done for free; they also argue that the fee is exclusionary, barring those who might benefit most from the service but cannot afford it. La Poste, in turn, sees V.S.M.P. as a way to standardize and preserve an admirable tradition that has come under threat. “The free time on a route allocated to these informal services was only made possible thanks to a surplus of revenue,” the C.E.O. of La Poste, Philippe Wahl, told the newspaper La Croix, in an interview. When there were fewer old people and La Poste was more profitable, it was easier to stop when the clothespins beckoned.

In 2012, Joe Dickinson was recovering from a stroke at home in Jersey, the largest of the Channel Islands, when he had an idea for the local post office, where he worked as an “innovator.” Much like V.S.M.P., the resulting service, Call&Check, enlists mail carriers to monitor the sick and elderly. Unlike caretakers or social workers, who “sort of intruded into their life on official business,” Dickinson said that mail carriers offered a “relaxed form of connecting with people who are particularly lonely and isolated.” Loneliness, he explained, is the new smoking; epidemiologically speaking, it’s as unhealthy as smoking fifteen cigarettes a day. (Though there is broad agreement among researchers about the downsides of loneliness, there is some disagreement about whether we are in the midst of what many journalists have called a “loneliness epidemic.”) The Call&Check doorstep visit—free for those who qualify, £6.75 for everyone else—is now offered island-wide.

In the U.K., the privately owned Royal Mail has piloted its own version of the program, called Safe and Connected, funded by the Home Office, which is responsible for immigration, security, and policing. (In addition to health-related queries, Safe and Connected’s emissaries ask, “Are you having problems with anyone bothering you?”) As of last year, South Koreans with parents over the age of sixty-five can sign their elders up for visits from postal workers, who send relatives photo updates. In Japan, monthly conversations between mail carriers and senior citizens have been available since 2013. For several years, Finnish post offices offered seasonally appropriate services, such as lawn-mowing or leaf-raking, on a weekly basis; now there is a year-round “befriending” service, through which elderly customers can request long walks through subarctic snowscapes with a postal worker, described as an “outdoor buddy.” (Several American companies have designed smartphone apps for checking in on the elderly—Snug Safety, for example, prompts users to press a large green check mark on their phones at the same time every day—but such systems rely on touch screens, rather than human touch.)

The commercials for V.S.M.P. strive for an upbeat, playful tone. They feature adult children who are conscientious and resourceful—they aren’t outsourcing their filial responsibilities so much as seeking the best for their parents. In one TV spot, an elderly woman in a knit cardigan remarks, incredulously, “We don’t have children just so that they can take care of us!” She laughs and sets down a tray of coffee and biscuits for her postal worker. The program’s slogan is “For your peace of mind, we’ll care for your parents’ peace of mind.” There’s no way around the sadness of the situations portrayed in the advertisements. Still, they present V.S.M.P. as a commonsense way of coping with modern life’s atomized reality. The program assumes the good faith of all involved; it lightens the burden of caring too much, not too little.

At the post office in Revin, a man in slippers bought downloadable stamps and a young mother collected welfare benefits. People in line fanned themselves with messages that could not be sent from their phones. Aurore was working in the back in a fluorescent-lit storeroom. The night before, in a nearby city, the next day’s mail had been machine-sorted; she preferred to sort it a second time, rearranging the letters in the order in which she would deliver them. Watching her thoughtful and meticulous movements, it was easy to forget that the envelopes mostly contained bank statements and promotional flyers. When Aurore had first started her job, in 1998, personal correspondence already accounted for just about five per cent of the mail delivered by La Poste.

Aurore prefers to sort the machine-sorted mail a second time, rearranging the letters in the order in which she will deliver them.

That afternoon, Aurore visited Jeannine Titeux’s neighbor, Monique Jaspart, the eighty-nine-year-old former secretary of Revin’s town hall, who lives on property that her parents bought before the Second World War. Aurore entered the house through a side door without knocking. Monique was waiting at the kitchen table beside a vase of papery beige flowers, a collection of supermarket coupons, and some roast chicken. She offered Aurore a chair and pulled up a stool for herself. She liked to be ready, she explained, spinning toward the counter and miming hostess gestures.

Monique, who has delicate features and a voice so high that it often cracks, has lived in Revin for her entire life — much of it alone. She and Aurore met more than a decade ago, when Aurore first started on Monique’s route. Monique told her to stop in “when you are thirsty, when you are cold, whenever you need,” and they’ve had coffee at least once a week ever since. Monique speaks with strict enunciation and dated conjugations, but she has long since shifted to the informal tu with Aurore. “I worked my whole professional life, and I understand that people who work need a little smile, a little welcome,” Monique said.

“Madame Titeux wanted me to tell you that she says hello,” Aurore said, leafing through the local newspaper on the table. “Maybe it would be good if you gave her a call.”

“Yes, yes,” Monique agreed. She stood to return a stick of melting butter to her Electrolux refrigerator.

A copy of L’Ardennais, the local newspaper, lay open on the table; an article announced that the Revin branch of Monique’s bank would be closing. “The money that they have of mine there, in stock, what will they do with it?” Monique asked. By way of an answer, Aurore read the article aloud.

In the past year, Monique has encountered various “problems”—a fall in the garden, a slip on the stairs. She describes them as if they were avoidable mistakes, the result of her absentmindedness. A few months ago, her refrigerator door came off in her hands. She fell and, from the floor, considered different strategies for standing up without slipping on the yolk- and milk-covered tiles. When Aurore heard this story, she recommended V.S.M.P., in part for the security of the emergency-alert system, which is included in the program’s “premium” offering. Monique’s nephew visits once a week, but her daughter lives on the Atlantic coast and her neighbors are often away. “Don’t you see?” Aurore asked. “If you hadn’t been able to get up, how long would you have stayed there?”

Monique doesn’t always know the whereabouts of her new emergency-call button, which looks like a waterproof watch with gray plastic where the time would be. Still, she wore it that afternoon, assuring Aurore that she wouldn’t take it off.

When they first met, Monique felt charitable inviting Aurore in. Now she feels that the reverse is true: Aurore is doing her a favor. “She brought a breath of fresh air straight from the center of Revin,” she told me. “When I have a little problem, I think, ‘Ah, I’ll tell it to Aurore!’ ” Recently, Monique broke her hip, and has since been confined to the ground floor of her house. Monique’s daughter, a retired teacher with two children of her own, discussed transitioning to daily visits with Aurore and planned to call the regional office to confirm the upgrade. But, at €112.40 a month, daily visits turned out to be too expensive.

“How would she do it, though?” Monique sighed.

“It’s fine the way it is now,” Aurore reassured her. “We’ll leave it like it is.”

Aurore will continue to visit on Tuesdays; she cannot now, in fairness to La Poste and the other V.S.M.P. subscribers, stop in casually on other days, as she might have before. On the other hand, with V.S.M.P., visits to Monique are guaranteed. When Aurore went to Corsica for summer vacation, a substitute mailman stopped by. (“A young man, I believe,” Monique reported. “He was pleasant enough. But it’s not the same thing.”)

The visit came to an end. Aurore held out her tablet for Monique to sign, reminding her not to use her nail to inscribe her signature. Monique signed the screen with her fingertip, in tight, slanted loops.

Over lunch in the post-office break room, as Aurore ate careful spoonfuls of yogurt, I asked her if she could imagine one day becoming a client of the service. “I have a son,” she responded abruptly, perhaps a little offended. He is twenty-eight and lives with Aurore, along with her seventy-eight-year-old father, in a house across the river, not far from the marina and the nearly vacant factory. There will be no need for any postal worker other than herself.

The AI care home: the smart tech making old people safer

The care home manager Christine Bunce gestures at a list of names and room numbers on the computer screen in her office, pointing out one highlighted in orange. “I can see Derek has had four disturbed nights this week,” she says. “There could be something wrong, like an infection, so I’ll talk to his carers this morning and see whether we need to call the GP.”

She can chart Derek’s night-time activity on a computer dashboard thanks to an infrared and acoustic monitor in his room that detects his movements. The device, called Ally Cares, uses artificial intelligence (AI) to learn his behavioural patterns, and alerts staff to anything unusual, such as if he uses the lavatory more frequently or is restless.

This is just one of the new AI and smart technology systems coming to care homes around the country. Others include devices that predict and prevent falls, adjust air quality, detect when someone with dementia is in pain — even monitor how regularly staff sanitise their hands.

Bunce oversees the welfare of 73 residents, about half of whom have dementia, at the upmarket KYN Bickley care home in Bromley, southeast London, where room-only full-board costs £1,650 to £2,128 per week and care packages start at £250 per week. Having spent three decades working in elderly care before starting her job here last year, she believes smart tech and AI will “genuinely make a difference” to some of the issues she’s witnessed over the years, including residents being repeatedly woken for checks at night, falls being missed and disparities in how each carer interprets residents’ needs.

Staff at KYN are also using an AI app called PainChek, developed from an idea by Professor Jeff Hughes at the School of Pharmacy at Curtin University in Western Australia. The app uses the camera on an ordinary smartphone or tablet to scan faces for tiny changes called micro-expressions to detect pain in non-verbal residents, including those living with advanced dementia. The company does not disclose the cost as it varies from home to home, but one Canadian evaluation of the technology said it was typically $50 (Canadian dollars — about £28) per bed per year.

Multiple studies, including by the Picker Institute, a care research charity, have shown that up to four in five care home residents experience pain but are unable to communicate fully.

“People living with dementia might express pain through a distressed reaction or behaviour,” says Emma Hewat, director of dementia care at KYN. “It’s not ‘just’ their dementia — we have to understand triggers and causes of behaviour, including pain, which we can then manage.”

Traditionally, care staff have relied on a standardised printed checklist called the Abbey Pain Scale to assess pain levels. This asks the carer to mark the patient on a rising numeric scale across a series of observable signs, such as “vocalisation — eg whispering, groaning, crying” and “change in body language — eg fidgeting, rocking, guarding part of body, withdrawn”. But this was heavily subjective and often used ineffectively as a “tick-box exercise”, Hewat says. “I might look at you and decide you look like you’re in pain, but someone else might assess you differently.”

Staff also use PainChek at Loveday Abbey Road, a private members’ club-style nursing home in London with joining fees of £2,000 and care packages from £3,000 per week. The general manager, Izabela Klaczkiewicz, says PainChek minimises the risk of subjectivity because it always assesses residents by the same standards, regardless of which staff member uses it.

One of the people under her care is the former easyJet CEO Ray Webster, 78, who was diagnosed with Alzheimer’s in 2021 and moved into care from his home in Hampstead last autumn. His wife of 36 years, Brigitte Piroulas-Webster, 66, a retired business consultant, is delighted by his high-tech care. “I cared for Ray at home for four years and, from what I’ve experienced, if you ask him what the problem is, he can’t tell you. So anything that helps the carers understand what he needs is brilliant.”

A creaking system

Despite promises of reform over decades, Britain’s adult social care system is on the brink of being overwhelmed by rising demand from a population that is growing older and sicker. The number of over-65s in the UK is expected to rise from 12 million to 20 million by 2041, with the fastest growth in the over-85s group. At the same time, average healthy life expectancy (the age to which people live without chronic health problems) has stalled at about 63 years and nearly one million people are now living with dementia. More people are needing health and care support for longer.

But the supply of care home places has not kept pace with demand, the Care Quality Commission (CQC) revealed in its latest State of Care report last month. Nearly half of all cases of bed-blocking — where patients are unable to be discharged from hospital — are now caused by waits for care beds or at-home support.

More than half of care homes are already struggling to recruit staff, according to a separate CQC report last autumn. Their ability to afford staffing costs will be hit by the rises in employer national insurance contributions and the minimum wage in the latest budget, according to Care England, which represents care home providers.

Understaffing is already affecting carers’ “ability to provide safe and effective care”, the CQC says. It also affects residents’ quality of life, with many experiencing as little as two minutes of social interaction with staff per day.

Labour has already pledged to use AI to improve NHS services and, at a session at its latest party conference, speakers agreed technology must also form “part of the solution” in tackling the social care crisis.

The care home developer Peter Owen-George, 62, has spent 30 years building large care homes for private companies but became disillusioned. “There were very few I would be happy putting my mum into,” he says. “These homes become huge monoliths. It is very difficult to give personalised care or understand individual needs when you have 70 residents to monitor.”

Owen-George is launching a series of small, Scandinavian-inspired care homes in Cornwall, which will be heavily equipped with smart and AI tech. There is already a waiting list for the first home, Malmö St Kew, which will start construction in the New Year and is due to open next September. It will use AI and smart tech to strengthen infection control, with fees for each of its 24 bedrooms expected to cost between £1,860 and £2,300 per week.

Staff hand-sanitiser dispensers will use sensors to alert managers if they are not being used enough, while each room will have its own smart air conditioning (AC) system, bringing in fresh air from outside to limit the transfer of airborne viruses such as Covid-19. The AC units automatically detect air quality and adjust filtering levels accordingly. The home’s heat-pump system will use AI to buy energy at the cheapest prices to maximise efficiency — meaning rooms are kept warm in winter and prevented from overheating in summer.

Catch a fall

Malmö is also one of the growing number of care homes using AI sensors to monitor residents in their rooms. Owen-George’s preferred system is RoomMate by Sensio, a discrete Norwegian-designed infrared smart sensor that detects unusual movements and sends staff alerts via an app on their phones — for example, if a resident wakes up to go to the loo more often than usual at night, or is motionless in bed. The system, which will cost the home about £1,100 per room to install, plus a weekly £7 software subscription, can also detect residents leaving their bed, opening doors or calling out at night.

If someone suffers a fall, the system alerts staff within 30 seconds, displaying an animation showing how the person fell. It means residents get help quickly without having to press a buzzer, and carers can see what caused the fall without intruding on residents’ privacy by filming them in their rooms.

A trial of the system at Richmond Manor care home in Ampthill, Bedfordshire, earlier this year found the number of falls reduced by 83 per cent owing to a combination of staff being alerted to risky situations — such as residents starting to get out of bed — so they could intervene, and the system revealing the causes of falls, so managers could make changes to a resident’s room or care plan. Staff said they felt the quality of care they provided at night had improved because they focused on the residents who needed support without disturbing others.

A pilot trial last year of similar technology — the Belgian-designed Nobi system — by the NHS Lancashire and South Cumbria Integrated Care Board found that it helped to prevent four out of five falls and typically enabled carers to attend falls within two minutes — a dramatic increase from previous response times of up to an hour.

KYN Bickley’s monitoring system, Ally Cares — a UK-developed product — also detects unusual movements and listens to sounds in residents’ rooms, sending alerts to staff devices. It was founded and designed by Thomas Tredinnick, a former aerospace engineer turned start-up entrepreneur. Ally Cares does not disclose costs publicly, but care homes in Dorset are being offered government grants of up to £10,000 each to install the technology as part of an £8.2 million Digitising Social Care programme.

At KYN Bickley, I sit down with Daphne Duke, 99. She recently moved in from her home in Tonbridge, Kent. A grandmother and a retired secretary, she says she “hasn’t noticed” any of the technology but says she feels safe here. “My favourite thing is not having to do much myself,” she says. “I feel extremely well looked after.”

Although KYN gets consent from residents and their families to monitor them, on a day-to-day basis most, like Daphne, forget the technology is there. With decor and plush soft furnishings by the interior designer Nina Campbell, the bedrooms feel more country-house hotel than space age. The only sign of activity from the small circular monitor above the bed is when it flashes green when staff activate it using a keycard reader by the door.

Tom Kennefick-Clark, a household care lead at KYN, says the system has been particularly useful for residents such as James, 87, who has Parkinson’s disease and falls frequently. “Previously, the first thing we would know about it was when we found him on the floor,” he explains. “Now the team gets an alert when he’s getting up, so whoever is nearest can rush to help steady him. He still has some falls but nowhere near as many — and it helps prevent serious injuries.” Ally claims it reduces bedroom falls by 63 per cent.

Kennefick-Clark still has memories of visiting his grandfather, who also had Parkinson’s, in a care home and seeing him covered in bruises from falls. “This technology is so important. It’s not going to completely eliminate falls but it gives us a much better chance of preventing them.”

Another benefit of remote monitoring systems is they enable residents to sleep undisturbed. In traditional homes, carers must check on each resident every one to two hours — meaning they might be woken repeatedly yet problems can still be missed.

“If someone has only been checked every two hours, what’s going on between those two hours?” Bunce says. “[With remote monitoring] you don’t have to disturb anybody, which means people get restful nights, better sleep, better outcomes.” Shoaib Ghaffar, 90, moved into Loveday Abbey Road earlier this year after his wife died and he spent time in hospital. As a retired engineer, the grandfather is fascinated by the technology in the home. Loveday uses smart acoustic monitors and video cameras in bedrooms, which send alerts to staff smartphones or tablets. It has an AI-driven lighting system that mirrors natural circadian rhythms and automatically turns on if members (as Loveday calls its residents) get up in the night.

Ghaffar jokingly refers to the monitor in his room as “Big Brother on the ceiling watching me all the time”, but assures me he is “extremely comfortable” with its presence — “except when I’m changing clothes”. “I find it very reassuring, especially because I’m at an advanced stage of physical disability, to know that if something happens to me or I am struggling, then someone will come straight away,” he adds.

Members, or their relatives with lasting power of attorney, are always given the choice as to whether to have monitoring in their rooms. Some people on short-term respite stays prefer full privacy and opt out, but the families of those with dementia tend to choose to have it for peace of mind.

Ghaffar is particularly impressed that the lights automatically turn on when he heads to the bathroom. “These little touches are very useful, especially because I can’t take my hands off the walker to turn on the switch,” he explains.

Klaczkiewicz, the general manager, has really noticed the circadian lighting making a difference, compared with other homes she has worked in over a 20-year career. “It’s common for people living with dementia to become agitated in the afternoon and evening, and this has been hugely beneficial in helping them to stay peaceful,” she says.

“The most important thing is it doesn’t feel like an institution, it’s like a second home,” says Ray Webster’s wife, Brigitte. “The technology is very discreet, you’re almost not conscious it’s there, but it gives the staff time to focus on the care. I visit Ray almost every day but when I’m not there I’m relaxed, as I know that if anything happens they will pick it up straight away. It also reassures me that he is protected against any bad treatment, as the monitors also help ensure staff act appropriately.”

Other Resources

• Books About Old Age
• Anecdotes About Old Age
• Quotations About Old Age