Is that a birthday? 'tis, alas! too clear; 'Tis but the funeral of the former year.
Alexander Pope (1688-1744)1
Ageing refers both to the ageing of the population and to the increasing number of people reaching that age:2 and the UK, in common with most developed countries, is ageing on both counts. Between 1985 and 2010, the number of those aged 65 and over in the UK rose by 20%, while the number aged 85 years or more doubled.2 In 2008, British pensioners outnumbered the under-16s for the first time and the Dilnot Committee in 2011 predicted a trebling of 90+ year olds over the next 20 years.3 Longevity is claimed as a public health success, but, as this issue reveals, success is a relative concept for society and its older citizens. For one in ten of those over 65, the care costs already exceed £100,000.3
Whether we grow wiser is an age-old debate: "You're only as young as the last time you changed your mind", said the 60's rebel Timothy Leary. The poet TS Eliot did not believe one grows older: "what happens early on in life is that at a certain age one stands still and stagnates". While the longer one lives, the more it seems true that youth is wasted on the young, the certainty of body ageing cannot be disputed, with all its attendant health and social problems. Mental health inpatients include 30% aged 65 or more and around a fifth of the over 85s are estimated to suffer poor psychosocial wellbeing.4 Sexual health - well sufficient to say that mature age is no protection against STIs, as Minichiello and colleagues explain within these pages.5 Partner and family support is no longer guaranteed, with a rise in 'silver separators' who divorce in their 60s6 and the decline in extended family networks.
So is successful ageing the ability to come to terms with these challenges, or the good fortune to elude the worst of them? Our guest editor, Dr Gareth Morgan, considers whether successful ageing and healthy ageing are interchangeable terms, observing the considerable overlap (p. 157). In relation to services and opportunities, society is proving slow to adjust to larger numbers of both healthy and unhealthy older people. For the former, there are economic and status dilemmas: a controversial UK Supreme Court ruling in late April allowed an employer to compulsorily retire a man at 65,7 which highlighted other cases of reluctant retirees. The mandatory retirement age was abolished in the UK in 2011, but arguments used in this legal case included addressing "intergenerational fairness" and limiting the need to expel "underperforming" older employees. The old should allow progression by the young, but surely successful old age includes working for as long as one wishes, with associated adjustment of working roles and hours. The "leisure evening of life" rejected by Trollope8 is no more appealing to many active over-65s today. As for keeping the elderly in good health, papers in this issue question whether health services in high-income countries are dealing efficiently with disability and chronic disease. …