Extra time: 10 Lessons for an Ageing World by Camilla Cavendish

The world is undergoing a dramatic demographic shift that is forcing us to redefine many of our institutions. We can’t continue to look at careers the same way. Social care and healthcare will have to be organized differently. Our old social contracts, defined in the 20th century, seem untenable in the 21st. Culture will continue to change in profound ways as we live longer and there are more people over 65 than there are children. Marketing and human resources will have to evolve accordingly too.

Yet “our systems are lagging woefully behind the new reality,” according to a key book on the topic. Too few future-of-work specialists focus on the multiple implications of this demographic revolution, which even China is undergoing. Luckily, increasing numbers of inspiring professors and journalists are tackling the subject of longevity and its consequences for work, life, and society. Andrew Scott and Lynda Gratton are among them (see our articles about the two “must-read” books The 100-Year-Life and The New Long Life). So is Financial Times journalist Camilla Cavendish, a senior fellow at Harvard’s Kennedy School, who also sits in the House of Lords.

Her Extra Time:10 Lessons for an Ageing World, which was published in 2019 before the pandemic proved its increased relevance, has been a huge success. For this book, she carried out a deeply compassionate investigation around the world, which led her to question the taboos around aging that most of us continue to entertain. To sum up the book in one sentence, it says: we all need to view longevity in a more positive way to be able to reap the benefits of this “extra time”. The book offers multiple relevant insights that decision-makers in organizations and government should heed if they want to prepare for this “new world of extra time”. Conveniently, it is divided into 10 lessons.

“In football, ‘extra time’ is the period when there’s everything still to play for. That will be true for many of us. Droves of people are ‘unretiring’ and going back to work. Advances in biology and neuroscience will help us stay younger and longer. But our institutions, and our societies, have not caught up.”

“The challenge for CEOs is considerable. The multi-generational workforce is on the way, but it will not be straightforward to manage. Even though jobs are being automated, retiring baby boomers are creating skill shortages. We need a fourth stage of education, to match the fourth industrial revolution.”

• Camilla Cavendish in Extra Time: 10 Lessons for an Ageing World

1. We need to realize that demography will shift culture and the balance of power

“By 2020, for the first time in history, there will be more people on the planet over 65 than under 5. More grandparents than grandchildren.” As children become scarce, families and networks of solidarity are changing. Our age pyramid is changing all the faster as “babies have gone out of fashion” in a lot of countries, particularly Japan. The roots of many of these changes lie in a feminist revolution: “Women are shaking off the traditions of dutiful service to husband and household and challenging men to adapt.”

If you want to catch a glimpse of our demographic future, look at Japan, writes Cavendish. Many more people there than anywhere else remain single all their lives. Japan may be a few years ahead of other countries, but it isn’t a demographic outlier. China is aging very fast: “China’s working-age population has been in decline since 2012 and is set to fall by almost a quarter by 2050 . . . By mid-century, China’s population could look much more like Japan’s—but without Japan’s affluence.” Many experts predict that China’s population will shrink quickly after 2029. As for Europe, birth rates have been low for three decades. As a consequence of high youth unemployment, Italy holds the record for the lowest birth rate in Europe.

Meanwhile, life expectancy has grown throughout the 20th century: “Between 1970 and 2011 . . . life expectancy at 65 increased 20 times as fast as in the previous century. The main reason? A massive drop in deaths from heart attack and stroke, driven by people giving up cigarettes.” These changes will transform the balance of power between countries, which are at different stages of their demographic transition and between generations within countries.

2. You are younger than you think: the stages of life are changing

Our society is aging but we are also redefining what it means to be 50, 60, or 70. In fact, every stage of our lives is being redefined. For example, the stage of adolescence lasts much longer. “The stage of adolescence should last until 24. That’s the average age at which children now move out of the family home in the UK.” It is not old age that is getting longer, Cavendish explains, it is middle age. For example, in the US, an overwhelming majority (75%) of people between 60 and 75 have no cognitive or physical impairment. Fewer people develop dementia than ever before in history. We used to believe that dementia was inevitable in old age. It isn’t.

Japan, which has the oldest population in the world, is already taking cognizance of this new reality by distinguishing between the “young-old”––those who are healthy, independent, and active––and the “old-old”––those who are frail and need help. More “young-old” people continue to work, keep active, retain a sense of purpose, and connect with other people. “We are witnessing a decoupling between biological age and chronological age. Extra Time has given us an entirely new stage of life: the stage of the “Young-Old”. We need . . . to stop lumping everyone from 60 to 100 together, and accept that it is normal to be vibrant and capable in your seventies.”

Although it doesn’t mean the same to be 65 today, most pension systems are still based on the idea that that’s when you should retire. “Right across Europe, retirement ages are not keeping pace with life expectancy.” Recruiters and media continue to use out-of-date stereotypes that are disparaging to people over 50 years old. Our language often turns people into “sub-humans, lesser beings”. There is a casualness to ageism that makes it all the more harmful. Advertising, for example, feeds off the idea that we are in a “constant battle” against old age.

The majority of people underestimate how long they are going to live because we base our expectations on the lives of our grandparents. There are stark inequalities when it comes to life expectancy, however. Education remains the strongest predictor of lifespan. “It is not clear why education is so vital. Some experts argue that education is formative. It may make us better at planning and exercising self-control, which may feed into healthier lifestyle choices. It also affects the kinds of jobs we do.”

3. If exercise were a pill, we’d all be taking it

There are stark differences in terms of biological age, though genes account for only a small part. Our biological fate depends mostly on environmental factors such as “what we eat and drink, how stressful our lives are, whether we live amid pollution, whether we exercise (and how often)”. Many studies have been published over the past three decades about exercise as a “miracle cure” for chronic disease and physical deterioration.

Unfortunately, sedentary lifestyles are increasingly common. Sitting is the new smoking, many scientists say. (The lockdowns that came as part of the pandemic may have a lasting effect on our health as we were told not to move about so much). We may be confusing the harmful impact of a sedentary lifestyle with what normal aging is all about. “We confuse the effects of true aging with what is mainly a loss of fitness, caused by too little activity.”

There are four aspects of fitness that need to be improved: strength, stamina, suppleness, and skill. All of these combined can help to prevent all sorts of physical and mental problems. But for the benefits of exercise to be real, we need to challenge ourselves at every age and not “relax” even at 80 or 90. Exercise, however, is not as easy as just taking a pill. It isn’t supported by a multi-billion-pound industry with strong lobbying power in the form of Big Pharma. And it requires a deep understanding of behavior and motivation.

Unfortunately, high levels of obesity are knocking years off people’s lives. The population of the US is the fattest of all industrialized nations and life expectancy has stopped rising there. Obesity and sedentary lifestyles are making longevity and healthy aging increasingly unequal. These are problems that are not addressed by our healthcare systems, which were historically “set up to treat disease, not to preserve health”.

4. For some people, it may make sense to postpone retirement

Retiring at 65 may seem desirable, but the truth is that it does not necessarily make people happy. “What if retirement can make you old?” asks Cavendish. The loss of purpose and recognition, lack of social life, boredom, and inactivity that often come with retirement can make many people unhappy. In Japan, the Silver Centre movement was created to restore a sense of purpose and connection to older citizens. “The first Silver Centre was founded in 1975 by a Tokyo University professor and some retired friends who wanted to supplement their income, maintain their health, and contribute to society. . . Your salary isn’t everything: having a place to shine matters.”

We often underestimate the contribution of older entrepreneurs and employees. In the United States, 55- to 65-year-olds are 65% more likely to start a business than 20- to 34-year-olds––and they have a higher rate of success too. Venture capitalists who invest in start-ups should not miss out on these enterprises: there’s no business case for ageism. More and more people choose to “unretire”––ie go back to work––after they’re supposed to have retired. “One in four Americans and Brits now ‘unretire’ after having officially retired. Their reasons are both financial and psychological.” They are often highly educated. Of course, unretirement makes more sense to those who love their job. If you hate your job, you’ll benefit more from giving up work.

Discrimination in the labor market is making it harder for many people who would like to continue working. “In 2018, a UK parliamentary committee concluded that the talents of more than a million people over 50 are being wasted, because of bias and outdated hiring practices.” This is bound to cause massive problems. In fact, countries with aging populations, such as Germany and Japan, need more elderly people to continue working if they are to address the huge shortage of talent.

The idea that older workers are inevitably less productive is false. Minor ergonomic and organizational adjustments can go a long way to maintain or boost productivity beyond expectations. In Germany, for example, BMW made some adjustments with great success. Also “a true meritocracy of continuous learning” should be created to develop and leverage potential in every age group.

5. To keep in shape, your brain will have to keep learning

Neuroscientists tell us that our brains are more plastic than had been believed. Memory loss is not inevitable. The brain is not fixed in adulthood: “We are continually remolding the connections between our brain cells as we experience the world and our behavior can actually change our brains.” It’s a case of “use it or lose it”. By learning something new, changing our environment, and seeking stimulation, we can keep our adult brains plastic. “Regular heavy-lifting produces lasting improvements.” Age doesn’t have to be a barrier to learning. There is every reason to continue to invest in your learning and to challenge yourself.

6. Anti-aging drugs are making progress

Exercise and diet have significantly more impact than drugs, but there have been stunning medical advances. There’s a “gold rush for immortality” in Silicon Valley, for example, where scientists are working on reducing the time we spend in the “old-old” stage. Entrepreneurs and the self-obsessed, who love to quantify and measure everything, are trying every new fad, such as fasting and calorie restriction, and gathering precious data to help scientists learn more. Scientists are also working on the genetics of aging. “There are genes for aging . . . and these genes can be manipulated.” Most agree that humankind faces a biological age limit of probably about 120 years. But we shouldn’t look at our experience of aging as immutable. Many more discoveries can help to push physical limits that we previously thought couldn’t be moved.

7. Everyone needs a neighborhood

“The key to healthy aging is relationships, relationships, relationships,” according to George Vaillant, a psychiatrist, and professor at Harvard Medical School. In the old days, the neighborhood was where you could feel safe and develop relationships. But our modern lifestyles are making people feel more lonely. In the UK, more than one-third of people over 65 live alone. The figures are more or less the same in a lot of countries. Those who live in homes for the elderly are often dehumanized. The death rate in such homes during the pandemic illustrates this in a tragic way.

That’s why new communities are emerging around the globe to offer elderly people more of a “neighborhood”. In Denmark and the Netherlands, for example, groups of individuals came together in “co-housing” developments in the 1960s. New housing alternatives are based on the idea that different generations should be mixed. What if students could “bring the outside world in?” Cavendish asks. “The ‘Young-Old’ do not want a quiet life, they want to live like they mean it. The ‘Old-Old’ do not wish to be warehoused and bossed around, they want to remain the authors of their own lives. What everyone needs is a neighborhood, preferably designed with their input. The clear benefits from social connections and community mean that it should be in the interests of governments to facilitate co-housing.”

8. We need a care revolution––with or without robots

In most countries, care work is undervalued, underpaid, and draining. Yet, Cavendish writes, it is actually highly skilled. As our population ages, we are going to need more and more carers but we will find it increasingly hard to recruit them. There is already a huge shortage of carers in Europe. Bureaucracy and division of labor have dehumanized health care. “Too many people find themselves pinging between different medical silos, with long waits, having to repeat their story every time. And there is an almost total disconnect between the health service and long-term ‘social care’.”

Cavendish dedicates several pages to the Buurtzorg “revolution” in the Netherlands: “This is what happens when you put humanity before bureaucracy.” Buurtzorg is a Dutch healthcare organization, founded in 2007, that empowers nurses to make their own decisions with each patient. They work in small teams of 10 to 12 and Buurtzorg’s head office is limited to a small team that handles IT and payroll. The Buurtzorg model works incredibly well for three reasons: first, continuity of care; second, the reliance on family networks; third, the absence of divisions of labor. In other systems, a lot of resources are devoted to allocating tasks to the cheapest member of staff, which is a “false economy”.

“Treating people as human, building proper relationships, and paying those who have a vocation, for what I would call the ‘craftsmanship’ of nursing, may sound like common sense. But in today’s world, it’s radical. Health systems are still organized to treat yesterday’s problems. Our post-war systems are still largely geared to fixing one-time illnesses, rather than predicting, preventing, and treating chronic long-term conditions.”

9. Finding Ikigai: purpose is vital

“Extra Time should be a gift,” writes Cavendish. But if you have nothing to do with that time, no purpose, and no neighborhood, it’s not. “We humans need a purpose to live fulfilling lives.” Studies show that old people who have a sense of purpose are happier and healthier. The Japanese Silver Centres mentioned above are organized around the concept of Ikigai, which has found its way into numerous self-help books. Ikigai merges the spiritual and practical. It connects work, family, duty, and passions.

A popular Venn diagram shows Ikigai as the intersection between “that which you love”, “that which the world needs”, “that which you can be paid for” and “that which you are good at”. For many people, Ikigai comes from helping others. In communities where the elderly find ways to help others, there’s more Ikigai. The author gives the beautiful example of Zimbabwe’s “friendship benches” where grandmothers help people from the village––and apparently are better at treating depression than qualified doctors. “Doing good makes you feel good.”

The contributions of more elderly people could solve many of the problems we have, such as the shortage of teachers and nurses, and increased loneliness and isolation. “Dedicated volunteers can also make a real, measurable difference to public services.”

10. We need a new social contract

“For the past 50 years, citizens growing up in industrialized countries have enjoyed an implicit social contract: work hard and pay tax, and you can expect rising living standards, a safety net if things go wrong, and a pension . . . But it is now under threat.” More and more young people today in Europe and the United States no longer expect to receive a pension when they grow old. The ratio of active to inactive citizens is stretching our systems in a way that will soon be unsustainable. The demographic shift, together with a dramatic increase in wealth inequality, challenges intergenerational transfers and the social contract in novel ways. We shouldn’t let current generations claim the resources of future generations. This is likely to become the social and political issues of this century.

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