Future ofan AgeingPopulationP1

Future of an Ageing PopulationTable of contentsExecutive Summary.6Key Findings.8Future of an Ageing Population –Evidence base .164.6 Housing - a financial assetor a financial burden .604.7 Housing to enable inter-generationalfinancial transfers.631. Introduction .181.1 The ageing population .181.2 Understanding the demographicchanges .191.3 Implications for society: dependencyand healthy life expectancy.211.4 Impact of demographic changeon policy issues .245. A Central Role for Families .645.1 Family trends occurring in parallelto ageing and because of ageing .655.2 Towards a pluralityof family structures .655.3 The changing role of womenand an ageing population .705.4 The impact of ageing and‘verticalisation’ on families,care and support .715.5 The impact of an ageing population oninter-generational caring responsibilitiesin families .742. Working Lives .282.1 Longer working lives .292.2 Differences in the lengthof working lives .312.3 Overcoming barriers facingthe ageing workforce .342.4 The importance of skillsto the ageing workforce.393. Lifelong Learning .423.1 Lifelong learning to enhancemental capital and health .433.2 Financial and technological skills .443.3 Barriers to participation in adulteducation .454. Housing and Neighbourhoods.504.1 Changing demand for housing .514.2 Meeting the changing demandfor housing .524.3 The importance of the widerneighbourhood .574.4 Homes that support better healthand care.584.5 Smarter homes for work .59P26. Health and Care Systems .766.1 Changing health and care needs .776.2 Future healthcare costs .806.3 Care in the home and community .826.4 Medical and assistive technologies .857. Physical, Social andTechnological Connectivity .887.1 Benefits of connectivity.897.2 Physical connectivityincluding transport .907.3 The built environment .937.4 Technological connectivity .947.5 Increasing links between virtual andphysical connectivity .98Conclusion – The responseto an ageing population .100Policy map .102Glossary .104References .110

ForewordPeople in the UK are living longer than ever before - a major achievement ofmodern science and healthcare. Older people make up a growing proportion ofthe population, and so make an increasing contribution to society. They are ourworkers, volunteers, taxpayers and carers.However, the UK is not making the most of the opportunities afforded by anageing population. Too many people are forced out of work in later life by poorhealth or unwelcoming attitudes in the workplace. Too few people access thetraining they need to adapt to a changing labour market. Too many familiesface the choice between working and providing care for a loved one. Too fewhomes meet the needs of older people.The ageing of the population also challenges the UK’s model of serviceprovision. If an older population means fewer workers at the same timeas greater demand for public services, this raises questions about thesustainability of the current models of working lives and care provision.The UK has a choice. Will the growing number of people in later life bepredominantly empowered, skilled, healthy and able to contribute fully tosociety? Or will we be increasingly unhealthy, disempowered and dependent?Answering this challenge cannot be Government’s job alone. Employers willneed to adapt to an ageing workforce. Families and communities have a roleto play in supporting their loved ones to age well. Individuals can, and mustbe supported to, make choices which will better prepare them for a happy,productive and fulfilling later life.The Rt Hon Oliver Letwin MPP3

Future of an Ageing PopulationPrefaceThe population of the UK has undergone a fundamental change in its agestructure, with many people having fewer children and living longer lives. Asa result the average age of the UK population is increasing. This has importantimplications for the whole of society. Growing up and living in a society whereyounger people are in a majority is fundamentally different to growing up in asociety where the majority of people are in older age groups.Responding to this demographic shift will require us to make adaptationsacross many aspects of our lives: how we work; how we care for, communicateand interact with each other; the built environment we live and work in; theway we live our lives; how we learn; and how we use technology. We need tounderstand the nature and implications of this population change in order toadapt successfully. This has been the driving force behind this Foresight projecton the Future of an Ageing Population. We have brought together expertisefrom a wide spectrum of disciplines including demography, economics, designand technology, social and health policy, geography and gerontology.We have gathered the best available evidence to understand what the ageingof the UK population means both now and in the future. We have consideredevidence from a wide range of sources: through commissioning 22 peerreviewed evidence reviews; through expert meetings to discuss topics rangingfrom health and care to housing; and through ten visits to different regionsand administrations across the UK to learn directly about local and personalexperiences of population ageing. We are indebted to the many experts whohave been involved in all aspects of this work. This report brings together theevidence that will help policymakers to develop the policies needed to adapt tothe demographic change of the UK.Professor Sarah HarperP4Sir Mark Walport

The Government Office for Science would like to thank the many contributorswho generously provided evidence, advice and guidance to the project.We would like to extend particular thanks to the project’s Lead Expert Group: Professor Sarah Harper (Chair) - University of Oxford Professor James Banks - University of Manchester and Institute for Fiscal Studies Professor Paul Boyle CBE - University of Leicester Professor Tom Kirkwood - Newcastle University and University of Copenhagen Professor Martin Knapp - London School of Economics and Political Science Professor Jeremy Myerson – Royal College of Art Mrs Mary Sinfield OBE - Former Chairman of the New Dynamics of AgeingProgramme’s Older People’s Reference Group Professor Alan Walker CBE - University of Sheffield Mr Oliver Wells - NIHR Healthcare Technology Co-operative forDevices for DignityThe project team was led by Rebecca Jones and, over the course of theproject, included Jessica Lawrence, Henry Green, Tom Wells, StephenBennett, Charles Jans, Poppy Groves, Rhian Reese-Owen, Shabana Haque,Sherelle Parke, James Pugh, Nitharna Sivarajah, Manon Ragonnet-Cronin,Kate Hamblin, Emily Georghiou, Parwez Samnakay, Philippa Shelton,Chris Bowden, Jo Dally, Moh Shabier and Chris Miles.P5

Future of an Ageing Population Executive summaryExecutiveSummaryThe UK population is ageing. In mid-2014, the average age exceeded 40 for thefirst time. By 2040, nearly one in seven people is projected to be aged over 75.These trends, partially mitigated by migration rates, will have a major effecton the UK. The Office for Budget Responsibility projects total public spendingexcluding interest payments to increase from 33.6% to 37.8% of GDP between2019/20 and 2064/65 – equivalent to 79 billion in today’s terms – due mainlyto the ageing population.This demographic change will affect the whole country. To grow old in a societywhere more people are young is fundamentally different to doing so in asociety where more people are in older age groups. It has implications for howeach of us approaches and plans for our own old age, and for the old age of ourfamily members. For government, it will shape how public services are plannedand influence every government department. Perhaps most importantly, it willrequire a co-ordinated response between departments that reflects the robustevidence for the inter-connectedness of policies affected by ageing.Without significant improvements in health, UK population ageing will increasethe amount of ill-health and disability. Chronic conditions, multi-morbidities,and cognitive impairments will become more common. At the same timefamilies will face increasing pressure to balance care with other responsibilities,particularly work. This is likely to mean that demand and supply of care willdiverge, as the UK has more people needing physical and financial support, ata time when there are fewer people able to fund public services and providecare. Successfully meeting this demand will need adaptations to health andcare systems and support for unpaid carers.As the population ages, so will the UK workforce. The productivity andeconomic success of the UK will be increasingly tied to that of older workers.Enabling people to work for longer will help society to support growingnumbers of dependents, while providing individuals with the financial andmental resources needed for increasingly long retirements. Supporting fullerand longer working lives, removing barriers to remaining in work, and enablingworkers to adapt to new technologies and other fundamental changes to theworld of work will be critical to the nation’s economic wellbeing.P6

Learning and training will become of even greater importance as the populationages. Learning throughout our lifetimes will help us to participate for longer inthe labour market, build personal and mental resilience and bring health andwellbeing benefits. Lifelong learning brings benefits to individuals, employersand wider society that will be increasingly valuable in an ageing population.Despite this, participation in adult education and training has fallen in recentyears.Suitable housing can significantly improve life in older age, while unsuitablehousing can be the source of multiple problems and costs. Poor quality housingcosts the NHS an estimated 2.5 billion per year. Homes will be increasinglyused as places of work and care. Appropriately designed housing, that canadapt to people’s changing needs as they age, has a number of benefits. Thesebenefits include reducing demand on health and care services, and enablingindividuals to work more flexibly in later life.The ageing population presents opportunities to individuals and society.However, as with any major demographic change, it also presents challengesand ignoring these could undermine the potential benefits of living longer. Thisreport brings together evidence about today’s older population, with futuretrends and projections, to identify the most critical implications for governmentpolicy and the socio-economic resilience of the UK.P7

Future of an Ageing Population Key FindingsKey FindingsWorking livesThe proportion of the working age population aged between 50 and thestate pension age (SPA) will increase from 26% in 2012 to 34% in 2050 – anincrease of over 5.5 million people. This is the result of increases to the SPA, aswell as the so called ‘baby boomers’ reaching this age band. The productivityand economic success of the UK will therefore be increasingly tied to theproductivity and success of its ageing workforce. Encouraging older people toremain in work will help society to support growing numbers of dependents,while providing individuals with the financial and mental resources neededfor longer periods of retirement. The employment rate currently declinesfrom 86% for 50 year olds, to 65% for 60 year olds and 31% for 65 year olds.Priority areas include: Supporting the ageing population to lead fuller and longer working lives.This means examining the factors that are causing employment rates atolder ages to vary across the population. Adaptations to the workplace. These include addressing negativeattitudes to older workers (see box A) and health needs, improvingworkplace design, encouraging access to new technologies, and adaptationof human resources policies and working practices. Ensuring individuals re-skill throughout their life time. As working liveslengthen, and the workplace undergoes major changes, job-related trainingwill become almost as important to people in mid-life as at the beginning oftheir career. This will require the UK to move towards a model where trainingand re-skilling opportunities are available throughout people’s careers.Lifelong learningLifelong learning has a number of benefits alongside those related to work.Many kinds of learning boost mental capitalA, which in turn increases individualresilience in later life. There are positive effects of learning on both physicaland mental health, improving wellbeing and reducing pressures on family andcommunity resources and services. Despite this, 40% of 55 to 64 year oldshave undertaken no formal training or education since leaving school. Prioritiesinclude: Addressing falling participation in lifelong education and training. Olderworkers are currently less likely than younger workers to receive workplacetraining or participate in learning, and there are differences in participationA Please see glossary for detailed explanation of all technical terms used in the report.P8

across different socio-economic groups, genders and ethnicities. Improvingparticipation in learning could enhance later life working and productivityand build mental capital and resilience. Addressing barriers to later life learning. There are significant benefits tomoving away from a model where education only happens at the beginning ofa person’s lifetime. The principle challenges may be cost and who isresponsible for paying. Others include attitudes (amongst learning providers,employers and older people) and personal circumstances, such as lack oftime, work and family commitments. Specific focus on technological and financial skills through life. These skillsare important for an ageing population, with benefits for retirement planning,work, connectivity and health. Older age groups generally experience greaterbarriers to developing and retaining digital and technological skills. Whilefuture older people will benefit from the technological skills they developduring their lifetime, it is less clear whether they too will be able to use futureemerging technologies.Housing and neighbourhoodsBy 2037 there are projected to be 1.42 million more households headed bysomeone aged 85 or over – an increase of 161% over 25 years. Suitable housingcan maximise the ageing population’s positive contribution to the success andresilience of the UK, while unsuitable housing is the source of multiple problemsand costs. Poor housing creates hazards that cost the NHS an estimated 2.5billion per year (across all ages), comparable with the cost of physical inactivity( 1 billion) and alcohol abuse ( 3.2 billion). Future homes will have an evengreater effect on health and wellbeing as technologies develop that mean theyare increasingly used as places of work and care. Priorities include: Ensuring there is appropriate housing. Demand for housing that meets theneeds of older people will increase as the population ages. Adapting existinghousing stock to meet this demand is critical as even by 2050 the majority ofhousing will have been built before 2000. Ensuring new housing can adapt topeople’s changing needs as they age will also be important, reducing demandon health and care services and enabling people to work flexibly andfor longer. Thinking ‘beyond the building’ to include the neighbourhood and community.Interventions that improve homes are likely to be less effective withoutsimilar improvements in the neighbourhood. The ability to socialise andto access services are particularly important.P9

Future of an Ageing Population Key Findings Preparing for the impact of variable home ownership rates. Housing canbe a financial asset, providing financial security, a source of funding for careand being passed on as an inheritance. However, housing can also representa significant financial burden if individuals still have large mortgages orrent when they enter retirement. Home ownership rates currently varywidely across regions, socio-economic groups and birth cohorts.A central role for familiesFamilies are a central component of the drivers and implications of populationageing. Family decisions regulate the number of children born, and familiesare responsible for transferring money and support between the generations.Families also play a major role in providing care – 73% of disabled people over65 receive some care from a spouse or other family members. The ageingpopulation, alongside a major increase in the diversity of family types, islikely to change the role of families, and challenge policies that rely on them.Priorities include: Understanding the impact of increasingly diverse family types on policy,especially adult social care. In parallel to ageing, the structure of UK familiesis becoming increasingly diverse. For example, the number of lone parenthouseholds increased over the past decade from 2.7 to 3.0 million, a growthof 11%. There is limited understanding of the impacts this trend willhave, especially on the future provision of unpaid care. Responding to smaller and more ‘vertical’ family units. Families areexperiencing a process of ‘verticalisation’ where more generations are alivesimultaneously. This provides a number of opportunities, particularly forincreasing the positive contribution of grandparents, but it may also increasethe pressure on individuals to care for dependents for longer periods of time. Considering policies’ effects on the whole life course and understandingthe dependencies between generations. Policy that impacts on youngeradult life, such as when adults are caring for young children, will impacton later life experiences and need for support, for example by affectingan individual’s ability to save for retirement. It is especially important tounderstand the gender dimension of inter-generational issues – for exampleunpaid caring responsibilities currently predominantly fall on women.Health and care systemsAgeing will increase the total amount of ill-health and disability in thepopulation. There will be an accompanying change in the nature of ill-health,with a relative shift away from acute illness towards chronic conditions, multimorbidities, cognitive impairments and long-term frailty. In parallel, familiesand communities will play an increasing role in providing care services.P10

Priorities include: Adapting health and care systems to meet changing demand. In particular,future health and care costs can be reduced and resources better used byinterventions which prevent and manage chronic conditions, and provideindividuals with the tools to take more responsibility for their health. Supporting family and other unpaid carers. Between 2007 and 2032, thenumber of people aged 65 and over who require unpaid care is projectedto have grown by more than one million. Supporting these unpaid carers tobalance other competing responsibilities, particularly work, will help meetthe increasing demand for unpaid carers. Capitalising on the opportunities from new technologies. Assistivetechnologies, home-based health monitoring equipment and smart use of bigdata all have the potential to change care in the home and community,reducing national health and care spending and improving wellbeing.Capitalising on these opportunities will require action to address thebarriers to uptake of these technologies, and sensitivity to public concernson privacy.Social, physical and technological connectivityConnectivity – the ability to use technology, access services, travel easilyand socialise – will be particularly important as the population ages. Levelsof connectivity can determine work, education, health and care outcomes.Beyond the ability to physically travel, new technologies and digital tools havean increasingly important effect on a person’s ability to interact with the worldaround them. Barriers to physical and virtual connectivity create issues forindividuals and society. Priorities include: Responding to the transport needs of different age groups. For peopleaged 70 and over, the primary challenge is maintaining physical connectivity.For the population as a whole it is important to ensure that transport optionsare as appropriate as possible for their physical, cognitive and financial needs.This is particularly the case for those older adults who are now extendingtheir working lives. Other issues include the growing population of olderpeople in rural and semi-rural areas, and the reliance on cars in areas withlimited public transport options. Successfully designing the built environment. A well-designed builtenvironment can maximise the physical mobility of older people, leading toincreased activity levels, better health, and improved quality of life for a fullrange of users. Addressing barriers to technology use. Technology can improve connectivity,P11

Future of an Ageing Population Key Findingsaddress health, work and care challenges, and help people unlockthe potential benefits of living longer. Barriers include a lack of skills andaccess, cost, and older people’s assumptions about technology’s usefulnessand affordability.A coherent response to ageingThe ageing population presents real opportunities. However, there arechallenges, and ignoring these could undermine the potential benefits of livinglonger. This report combines evidence about today’s older people with futuretrends and projections to identify the most critical implications of the ageingpopulation for government policy and the socio-economic resilience of the UK.The following principles will help to ensure a coherent response to ageing: The future success and resilience of the UK will be determined in a large partby its ageing population. Nowhere is this more apparent than the productivityof the UK workforce, which will see a major increase in the number ofworkers aged 50 and above. The effect of an ageing population on health andcare services will likewise have a major impact on the UK. Issues cannot be addressed in silos. For example, the productivity of theageing population will be influenced by the skills and health of older workers,competing family care responsibilities, and connectivity. A co-ordinatedresponse is likely to be more successful than addressing issues in isolation. Most domestic policy areas will be affected by the ageing population.Beyond the expected, such as health and care, this report illustrates that awide-range of policy areas will be affected, including housing, transport,infrastructure and technology. Factors throughout an individual’s lifetime affect how they age. To improveoutcomes for people as they age – whether in skills, health, employability,housing and assets to fund retirement – requires interventions from an earlyage, and an understanding of the impact of policies through the life course. Regional variation must be understood. Connectivity challenges will differbetween urban and rural areas, while different home ownership levels aroundthe country will create regional differences in older people’s financial assetsand the support they need. There are also important differences betweenhow the devolved administrations will experience ageing. This project hasproduced an online tool to map the different characteristics of ageing acrossthe UK (see Box B).P12

Box A: Perceptions of youth and old age across EuropeThe European Social Survey analysed perceptions of youth and old ageacross Europe. It found that perceptions of old age vary considerablybetween countries. In the UK, old age is perceived to begin at 59 – thesecond youngest of the countries surveyed. Youth is perceived to end at35 – again earlier than most countries, and far younger than in Cyprus orGreece where 52 is regarded as young.70606866 6763 63 63 63 63 63 64 64 64 64 64 64 656262626261 61 61 6159 60 605540303435 40 394440 393552 5247 44423444 44 4340 3944 44 4241 4339 383534Norway20LatviaAge HungaryCroatiaSlovakiaUKCzech Rep0Turkey10CountryPerception of life stage transition:End of youthSurvey of 54,988 people aged 15 across EuropeStart of old ageFigure A: Perceived age at which youth ends and old age starts1.P13

Future of an Ageing PopulationBox B: Mapping the ageing population: regional variationThe Future of an Ageing Population project, in collaboration with the ONS,designed 62 cartograms showcasing local disparities in factors relating tothe ageing population. Maps show the UK comprised of hexagons eachrepresenting one local lPercentage of people aged 65 in 2014Female life expectancy at age 6531Female life expectancy at 65 (years)Percentage of people aged 65 (%)3224122220186.0Lower intervalUpper intervalFigure B: Foresight mapping toolThese interactive maps choose breaks in the data to minimize the variancewithin classes and maximise the variance between classes - known as theJenks natural classification method. Please see the website for furtherinformation.15.0P1417.218.1 18.8 19.729.0


Future of an Ageing Population Evidence baseFuture of an Ageing PopulationEvidence baseThe Foresight Future of an Ageing Population team considered a wide range ofevidence and commissioned 22 peer-reviewed evidence reviews (see below).The evidence review topics were chosen with guidance from the project’s LeadExpert Group.The project team also held regional meetings with experts and localrepresentatives to discuss the effects of the ageing population in Sunderland,Margate, Swansea, Leicester, Manchester, Oxford, York, London, Stirling, andBelfast. Notes from these meetings will be made available on the projectwebsite.Evidence reviews: Abrams, D , Swift, H. J., Lamont, R. A. and Drury, L. (2015) The barriers toand enablers of positive attitudes to ageing and older people, at the societaland individual level Bennett, K. M. (2015) Emotional and personal resilience through life Buckle, P. (2015) Workplace infrastructure Damant, J. and Knapp, M. (2015) What are the likely changes in society andtechnology which will impact upon the ability of older adults to maintainsocial (extra-familial) networks of support now, in 2025 and in 2040? Damodaran, L. and Olphert, W. (2015) How are attitudes and behaviours tothe ageing process changing in light of new media and new technology? Howmight these continue to evolve by 2025 and 2040? Higgs, P. and Gilleard, C. (2015) Key social and cultural drivers of changesaffecting trends in attitudes and behaviour throughout the ageing processand what they mean for policymaking Hoff, A. (2015) Current and future challenges of family care in the UK Hyde, M. and Phillipson, C. (2015) How can lifelong learning, includingcontinuous training within the labour market, be enabled and who will pay forthis? Looking forward to 2025 and 2040 how might this evolve? Jagger, C. (2015) Trends in life expectancy and healthy life expectancy Johnson, S. (2015) How are work requirements and environments evolvingand what will be the impact of this on individuals who will reach 65 in 2025and 2040?P16

Keating, N , Kwan, D., Hillcoat-Nalletamby, S. and Burholt, V. (2015)Intergenerational relationships: Experiences and attitudes in the newmillennium Kishita, N., Fisher, P. and Laidlaw, K. (2015) What are the attitudes of differentage groups towards contributing and benefitting from the wider society andhow are these experienced by individuals in those age groups? Lookingforward to 2025 and 2040, how might these evolve? Leeson, G., Nanitashvili, N. and Založnik, M. Foresight Trends: Future of anAgeing Population McKnight, A. (2015) The income and asset profiles of cohorts born in 1960and 1975 and the likely adequacy of accumulated resources in supportingthese cohorts in retirement Mountain, G., Gomersall, T. and Taylor, J. (2015) Developing medical, fitnessand well-being environments to maintain health and well-being over the lifecourse Nazroo, J. Y. (2015) Addressing inequalities in healthy life expecta

ageing population. Too many people are forced out of work in later life by poor health or unwelcoming attitudes in the workplace. Too few people access the training they need to adapt to a changing labour market. Too many families face the choice between working and providing care for a