Is the pattern of ageing changing?
Data from the USA indicate that, over the last two decades, people there have been living longer on average but that the prevalence of disability in later life has been falling.8 This is presumably partly due to the adoption of healthier lifestyles by significant sections of the population— notwithstanding a general increase in obesity—and partly due to better medical care, and the development of less demanding environments, but there are probably other factors that have caused a decline in disabling diseases, especially of the cardiovascular system since the 1960s. It is not clear whether similar improvements in general health and function in middle and later life are occurring in the UK, although reductions in cigarette smoking among men and control of urban and industrial smoke pollution have reduced the prevalence of limiting pulmonary disease in the last three decades. Less reassuringly, British data suggest that social class differences in mortality and morbidity have been widening. The reasons for this are complex, and include changes over time in the composition of the various classes, but will also include failure of some members of the population to benefit as much as others from social and medical advances.
There are encouraging signs that the epidemic of cardiovascular disease has peaked, although the incidence may still be rising in some population groups, notably immigrants from the Indian subcontinent. If the improvements in the patterns of disability in older people seen in the USA could be made to happen here, there would be good prospects for people being fit enough to work longer for their pensions, while yet living to enjoy a sufficient and active period of retirement.