As many individuals live well past retirement age, stakeholders are examining how interventions, data, and innovation can transform aging.
Today, the vast majority of adults across the world can expect to live decades past retirement age. The number of older adults 1 The term “older adults” refers to those aged 65 and older. will more than double to an estimated 1.6 billion by mid-century, 2 UN Population Division Data Portal, United Nations, 2022 revision. marking one of the most profound demographic shifts in human history. However, while global society should celebrate having, on average, an additional 20 years of life expectancy since 1960, 3 “Life expectancy at birth, total (years),” World Bank, 2020. it has not been as successful in extending the span of healthy life. A person on average will live ten more years in medium or poor health, impacting the ability to live life fully and leading to increases in care and dependency.
These are real and profound challenges. The McKinsey Health Institute (MHI), however, believes this shift is too often framed in the negative, neglecting the opportunities presented as the shape of society transforms. We suggest expanding from the legacy framing of three phases of life—childhood, adulthood, and old age to encompass healthy aging. Instead, our analysis recognizes the reality that many people will live from two to three decades past their retirement age, where one could choose to be in school at 50 and choose to be employed at 80. Society should focus on capacity, not age, recognizing the potential for many to contribute as volunteers, advisers, community leaders, workers, board members, active family members, and innovators.
MHI has identified action on six important shifts that could make it possible for governments, businesses across sectors, not-for-profit organizations, health and well-being stakeholders, and individuals to unlock improvements in healthy aging. These are as follows:
In this article, MHI examines the effects of an aging population, the framework for holistic healthy aging, and actions that can be taken on the six shifts.
The urgency to act varies among countries, driven by the expected rate of change (Exhibit 1). Countries where populations are aging more slowly—for example, Ghana, which has a projected old-age dependency ratio of 8.4 by 2040 10 UN Population Division Data Portal, 2022. —have a slightly longer runway to scale successful initiatives from superaged countries. Still, even for the countries where populations are aging more slowly, the proportion of people over 65 will almost double over the next decades. 11 Simple average of percentage increase in the share of the over 65 population for “younger societies” is 173 percent; UN Population Division Data Portal, 2022.
A healthier, more engaged generation of those over age 65 has the potential to contribute broadly around the world, whether it’s at a professional, personal, or community level. For example, in the United States, the 50-plus age group will contribute $12.6 trillion to the economy by 2030. 12 “The Longevity Economy Outlook,” AARP, accessed October 2022. In the United Kingdom, for example, it is estimated that a one-year extension of working life increases GDP by about one percent. 13 Ray Barrell, Simon Kirby, and Ali Orazgani, “The macroeconomic impact from extending working lives,” Department for Work and Pensions, 2011. This results in higher spending power and active leisure engagement, which spur new products and services tailored to the specific needs of this consumer group.
The four dimensions of health are shaped by social and personal influencing factors that support a holistic view of health (Exhibit 2). The importance of a more holistic approach to health has been demonstrated in practice. For example, the Okinawa Centenarian Study, a population-based study of 100-year-olds and other older adults in Okinawa, Japan, found that longevity and health reflected physical activity; a balanced, healthy, and calorie-restricted diet; a sense of belonging and rituals; a supportive social network (moai); and having a purpose to begin each day (ikigai) 19 “The OCS Study,” Okinawa Research Center for Longevity Science, accessed September 2022. (see sidebar “Examples of individuals across the globe show that healthy aging is possible”).
Examples of individuals across the globe show that healthy aging is possibleA 75-year-old grandmother from South Korea is an award-winning bodybuilder who regularly competes with people in their 30s. According to the BBC, she started working out, on the advice of her doctor, to help manage the pain of her spinal stenosis, a chronic back condition. She said, “I see a lot of people giving things up when they’re old. They think, ‘Now I’m getting old, there’s nothing I can do.’ But I just want to tell them, even if you’re old, do not ever give up on anything.” 1 “The 75-year-old bodybuilder wowing audiences,” BBC News, December 17, 2019.
A 76-year-old retired teacher in Lesotho, South Africa, recently founded a community organization to help orphaned and vulnerable children cope through difficult times. She works closely with the children, teaching independence and emotional strength. She says, “My advice to all the women out there, retired or not . . . is to strive . . . [to be] . . . the most educated woman in your community. Respect the old and spend time with the elderly.” 2 “A day in the life of Mosotho women: Stories of strength and responsibility,” African Clean Energy, accessed October 2022.
An Italian man was 60 years old when he founded the company that made him a billionaire at 87. After a full career as an engineer, he used his severance check to begin building probe cards—tools to test the quality of microchips in production—from his kitchen in the Milan region. This experiment resulted in his company becoming one of the top two probe card manufacturers in the world. His lifelong “inventiveness,” according to his nephew, shows age is no barrier to entrepreneurial success. 3 Giacomo Tognini, “How to become a billionaire at 87,” Forbes, June 1, 2022.
This concept of health extending beyond physical attributes resonates with older adults. A recent MHI survey found that the majority of older adults think all four dimensions of health are important. 20 Clément Desmouceaux, Martin Dewhurst, Daphné Maurel, and Lorenzo Pautasso, “In sickness and in health: How health is perceived around the world,” McKinsey Health Institute, July 21, 2022. Notably, perceived health and quality of life do not necessarily decline with age, underscoring the idea that individuals’ perception of personal health extends beyond the physical. While respondents over age 65 were more likely to have one or more health conditions, two-thirds reported good or very good perceived overall health. Another recent MHI survey focused on understanding generational differences found that 70 percent of baby boomers perceived their overall quality of life as high—eight percentage points higher than Gen Z respondents. 21 “Addressing the unprecedented behavioral-health challenges facing Generation Z,” McKinsey, January 14, 2022.
The personal and social influencing factors can include how physical and cognitive fitness overlap. For example, numerous studies have shown a link between higher levels of physical activity and better brain health. This includes a 2019 meta-analysis concluding that physical activity, especially that of a moderate to vigorous intensity, had positive impacts on cognition and that physical activity even reduced the risk of developing cognitive disorders, including Alzheimer’s disease. 22 Kirk Erickson et al., “Physical activity, cognition, and brain outcomes: A review of the 2018 physical activity guidelines,” Medicine & Science in Sports & Exercise, June 2019, Volume 51, Issue 6.
When examining social and spiritual engagement, social scientists have identified social isolation and loneliness as an increasing problem, with rates of reported loneliness in older adults reaching 20 to 34 percent across China, Europe, Latin America, and the United States. 23 “Social isolation and loneliness among older people: Advocacy brief,” World Health Organization, July 29, 2021. According to the US Centers for Disease Control and Prevention, social isolation increases the risk of premature death—a risk that is similar to those seen with smoking, obesity, and physical inactivity. 24 “Loneliness and social isolation linked to serious health conditions,” US Centers for Disease Control and Prevention, accessed October 2022.
People living in high-income countries enjoy up to a 27-year difference in healthy life expectancy (HLE) at birth, compared with people born in low- and medium-income countries. 25 “Healthy life expectancy, years,” World Bank, 2017–19. However, within a country, the HLE can vary widely—for example, in England, people living in the least advantaged areas have a 19-year lower HLE than those in the most advantaged areas. 26 “Health state life expectancies by national deprivation deciles, England: 2017 to 2019,” Office of National Statistics, released April 25, 2022.
MHI has identified six shifts that would be needed to see a step change in healthy aging across the four dimensions of health (Exhibit 3).
A key focus for MHI is improving brain health, which includes strengthening cognitive function, improving mental health, and effectively preventing and treating mental, neurological, and substance-use disorders. Mental and neurological disorders contribute a substantial portion of disease burden in individuals over 65. The likelihood of individuals requiring improvements in brain health as they age only increases as people live longer lives with more years spent in less-than-optimal health.
To protect brain health as individuals age, we must look across all dimensions of health—mental, physical, social, and spiritual—for both risk and protective factors. Risk factors for cognitive decline include some mental- and physical-health conditions, such as depression, high blood pressure, and diabetes, as well as some medications. As individuals live longer with these conditions or more years in poor health, the risk of these conditions negatively affecting brain health increases. Addressing inactivity, social isolation, and loneliness may help prevent cognitive decline, and individuals who maintain hobbies, reduce or better manage stress, keep a daily routine, and have sufficient sleep may have improved brain health. These elements act as pillars for optimal social and spiritual health.
Globally, there is underinvestment in prevention of disease or impaired mobility. For example, European countries invest, on average, 2.8 percent of their health budget on prevention. 27 The case for investing in public health, World Health Organization, 2014. While the path to healthy aging begins at adulthood, there is much that can be done for individuals in later years. More prevention efforts should be focused on conditions correlated to age, such as dementia and sensory impairments. 28 According to the World Health Organization, up to 35 percent of those over age 65 fall each year. See WHO global report on falls prevention in older age, March 17, 2008. Other prevention efforts could focus on how adults manage conditions such as depression throughout their lives, how older adults can continue to find purpose, social connections, and financial security, and strategies to encourage lifelong physical activity, even as mobility changes with age. Moreover, previous studies have indicated that prevention programs—both clinical (for example, hearing technology for those hard of hearing) 29 In the United Kingdom, one study found that 30 percent of outpatients tested had an undiagnosed hearing loss that could be addressed. There is strong evidence that provision of hearing technology to people with hearing loss supports social activity, decreases risk of depression, and may reduce the risk of dementia. See What works: Hearing loss and healthy ageing, NHS England, May 2017. and nonclinical (for example, focusing on improving housing, social connections, and fitness) 30 Nonclinical factors—housing, social supports, financial security, personal security, nutrition, opportunities to learn and make decisions, mobility, the ability to build and maintain relationships, and the ability to contribute—all contribute to older adults’ broader health and capacity. See World report on ageing and health, WHO, 2015. —can improve the quality of life for older adults, which can reduce the need for medical care over time. Interestingly, only 20 percent of the modifiable contributors to an individual’s health are related to medical care, with nonclinical factors driving the other 80 percent 31 Sanne Magnan, “Social determinants of health 101 for health care: Five plus five,” National Academy of Medicine, October 9, 2017. (see sidebar “The burden of aging in older adults could be improved through preventative lifestyle interventions” (Exhibit 4).
What if science could ‘target’ and potentially slow down the detrimental effects of aging?In the future, pharmacological and dietary interventions may be focused on preventive targeting of the modifiable mechanisms of aging. Regulators are beginning to recognize aging as an underlying, targetable condition, generating more focus on and funding for aging research and initiatives. “There has been a shift in how we have considered aging, from something that we needed to account for and eliminate by statistical adjustment to a causal factor in disease […] This shift in thinking is important because it places aging at the forefront of medicine,” said Luigi Ferrucci, Scientific Director, National Institute on Aging. 1 Sebastien Thuault, “Reflections on aging research from within the National Institute on Aging,” Nature Aging, January 14, 2021. One example is the TAME trial (Targeting Aging with Metformin), a clinical trial approved by the FDA targeting aging. 2 “The TAME Trial: Targeting the biology of aging. Ushering a new era of interventions.” American Federation for Aging Research. In another example, the National Institutes of Health in the United States increased its budget for aging-related research and conditions from $2.6 billion in 2014 to $5.7 billion in 2021, which is more than double in seven years. 3 “Estimates of funding for various research, condition, and disease categories (RCDC),” NIH, May 16, 2022. The private sector also is continuing to double down on aging research: venture capital (VC) has been raising their investment in anti-aging research. Notably, longevity VC investment had reached a record of $3.8 billion in 2021. 4 PitchBook Data funding data as of June 1, 2022.
Companies such as BioAge Labs are amassing longitudinal data of centenarians to understand, on a molecular biological level, the factors underpinning a long and healthy life. This involves the multiomic study of high-quality longitudinal data sets, with proteomic, metabolomic, and transcriptomic analysis of thousands of proteins and RNA transcripts. Unraveling the biological process of aging requires comparisons both within the same person (understanding how the pathways change with age) and among different people (identifying the differences responsible for longevity).
Eric Verdin from the Buck Institute said, “When you modify aging you are actually targeting the biggest risk pathway for diseases. Medicine right now is targeting diseases as if they were independent occurrences, and granted, they have their own risk factors, but they also have a common trunk, and the biggest common trunk is aging. As a risk factor, your age is seven times more important than your cholesterol level concerning your risk of a heart attack. Aging used to be considered unmodifiable, but now we have identified several pathways that control the aging rate. Dialing these pathways up or down can change not only life expectancy but also health span, the healthy years of life.”
Investing in these preventative measures—across all four dimensions of health—can enable older people to enjoy a higher quality of life, increase social and economic contribution, and potentially reduce long-term healthcare costs. Investment should be complemented by research to identify future evidence-based preventative measures, with real-world data-based trials for promising interventions, such as wearables, as well as “moonshot” interventions, such as targeting and treating aging itself (see sidebar “What if science could ‘target’ and potentially slow down the detrimental effects of aging?”).
Even in high-income, technologically advanced countries, no standardized data set can illuminate older people’s diverse health capacity over time across the four dimensions of health, let alone their surrounding personal attributes, behaviors, and environmental factors. Although technologies to capture the various data exists, gaining access to and integrating and linking these data sets remain a major challenge. Additionally, these measurements are limited and do not always reflect an older adult’s priorities, whether it’s lifting a grandchild, driving long distances, or still being able to sew.
The first step may be to define a standardized data catalog and measurements leveraging several existing examples. 32 There are several possible examples to consider, including the Intrinsic Capacity (IC) created by the World Health Organization. See World report on ageing and health, WHO, 2015 and 2018 Active ageing index analytical report, United Nations Economic Commission for Europe, October 2019. Governments may also consider sharing and integrating data sources across public institutions, healthcare, academia, businesses, and individuals to create high-quality, integrated longitudinal data spanning all four dimensions of health. Achieving this requires establishing a collaborative exchange of data that protects patient privacy, including strict data privacy measures and intellectual-property rights. This richness in data could enable a better understanding of the widely varying needs of older adults and passively track conditions specific to older adults (for example, cognitive performance over time), providing a solid evidence base for policies or personalized interventions. The long-term goal is to create data-driven measurements of holistic health, supported by standardized, integrated data.
Examples of scalable interventions can include the following:
Learning from successful interventions in other countries: South Korea’s impressive journey toward increasing the healthy life expectancy holds lessons for all
Innovation should include, but also exceed far beyond, the traditional focus on life sciences. To drive innovation across the four dimensions of health as a society, society needs to foster and fund collaborations at the intersection of life sciences, digital, technology, and services. There is already substantial venture capital entering the field of aging, and some companies are starting to tailor their product and service to the older population (for example, remote assistance and fast medical consultation services). 47 “How to close the digital gap for the elderly,” World Economic Forum, January 19, 2021. Governments could further support these efforts by taking a whole-of-government approach to healthy aging, promoting the role of collaboration and support across all departments. It could also champion “focused research organizations” for topics that fall through the cracks as neither viable for private-sector investment nor large enough for government investment—for example, availability of comprehensive data sets 48 Adam Marblestone et al., “Unblock research bottlenecks with non-profit start-ups,” Nature, January 11, 2022. (see sidebar “Learning from successful interventions in other countries: South Korea’s impressive journey toward increasing the healthy life expectancy holds lessons for all”).
There are two areas that would benefit from greater, more ambitious innovation:
In the United States alone, the cost of informal caregiving for the elderly exceeds $500 billion annually.
Health is relevant across all sectors, and there is potential to develop products and improve infrastructure to support healthy aging. Non-health players could both develop products and services for the needs of older adults and provide inclusive infrastructure, especially in the workplace. Employers could offer eldercare funds, integrate older adults into the workforce (for example, by creating formal “second-career” pathways for older adults who have retired to reenter the workplace—such as Unilever’s U-Work program, first piloted in ten countries, which was so successful that Unilever began an internship program for those over age 60 in Argentina) 58 Andrea Felsted, “Every business could use a granfluencer,” Bloomberg, May 6, 2022. —and work to reduce age discrimination in the workplace. The most exciting interventions are likely to come from cross-sector collaborations—imagine receiving free rides on public transport for each completed short workout, 59 For example, both Mexico and Russia have trialed free subway tickets in return for 10–30 squats. See Kate Carter, “Mexico’s latest way to beat the obesity epidemic: make commuters do squats for free subway tickets,” Guardian, January 27, 2015. stage-appropriate nutrition nudges at the grocery store checkout, or smart-home technology that could identify and prevent physical or cognitive decline. These interventions can complement “age tech” innovations seen in traditional older adult medical-care settings, such as the Bocco Emo robot, which monitors older adults in nursing homes and engages patients in “conversation” while notifying staff that nursing care is required. 60 Catherine Shu, “Startups at CEs showed that elder tech can help everyone,” TechCrunch, January 6, 2022.
Additional potential examples of how sectors could support healthy aging through products, services, or infrastructure include the following:
Individuals have an important role to play in their own health. MHI believes that a combination of health education, public- and private-sector innovation, and the robust application of public policy will improve individuals’ ability to influence their own health outcomes. For the aging world, this will require several measures:
At a time of rapid demographic change, it is vital to seize this opportunity to promote healthy aging and participation for older adults. Whether considering one’s own mortality, the aging of family members, or the greying of the workforce, it’s important to ask: How can people live longer in better health? MHI, in its focus on “adding years to life and life to years,” believes healthy aging is an imperative. People should expect and demand an extended health span in their older years and will need to decide on how to use this capacity.
Increasing years spent in good health is possible if all stakeholders embrace both the potential and the challenge. Together, MHI seeks to engage with leading organizations globally to catalyze practical action on the most pressing challenges facing the aging world today.
We know what is possible. Together, society can create a world where older adults and societies can expect a longer and higher quality of life.
Martin Dewhurst is a senior partner in McKinsey’s London office and a McKinsey Health Institute coleader; Katherine Linzer is a partner in the Chicago office; Madeline Maud is an associate partner in the Brisbane office; and Christoph Sandler is a senior expert in the Tokyo office.
The authors wish to thank Jay Avery, Anthony Darcovich, Kana Enomoto, Clarissa Forneris, Janin Grajcarek, Lars Hartenstein, Nur Amalina Ismail, Tom Latkovic, Eric Liu, Chonghao Peng, Paula Schabel, and Architha Srinivasan for their contributions to this article.
This article was edited by Elizabeth Newman, an executive editor in the Chicago office.
