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MY 19-YEAR-OLD GODDAUGHTER IS looking over my shoulder as I write. Will she be reading this again in 2150, when she will be 150? That is the subject of a $1 billion bet made by two American experts on ageing.

Steven Austad, chair of biology at the University of Alabama at Birmingham, has predicted that there will be a 150-year-old human by the year 2150, based on the many breakthroughs which are slowing ageing in mice (see Chapter 6). His friend Jay Olshansky, public health professor at the University of Illinois, disagrees. He thinks the brain will be an insuperable barrier. ‘We can replace hips, hearts and so on, but we can’t replace the brain,’ he has said.¹

The two men made the bet in 2000. They each put $150 into an investment fund, and signed a contract certifying that the winner’s heirs will cash it out in 2150. They later doubled their initial investment, and now expect the jackpot to be around $1 billion. If Austad is right, someone alive today will still be around to see who wins the bet.

While we wait to see whether lifespans jump to 150, some other changes have already crept up on us. At 19, my goddaughter ought to be emerging from adolescence into adulthood. But she’s just started university, is racking up debt and expects to be living with her parents for years to come. So many people are now in this situation, some experts argue that 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, France, Germany and Australia.

The Australian professor Susan Sawyer has argued that adolescence should be extended in both directions: starting at 10,² to reflect the fact that puberty is now starting at that tender age in some girls, and lasting until 24. Extended parental involvement through this later period can be highly beneficial, the psychologist Laurence Steinberg has argued, because we now know that the brain continues to mature into the twenties.

If adolescence now lasts for 14 years, what happens to the subsequent stages of life? They are also lengthening. We saw in the last chapter that people are having children later. Beyond that, mature independent adulthood is lasting longer too.

It’s Not Old Age That’s Getting Longer, It’s Middle Age

Last winter, a doctor friend of mine was in charge of the influenza vaccinations for the over-65s at his local clinic. A crowd of grey-haired strangers walked in. They’d never come to see him before, because there was nothing wrong with them.

These people are part of a growing group who are defying all the labels. They don’t see themselves as old, don’t act old and won’t buy products marketed at the old either.

In England, the proportion of over-65s with any kind of impairment has been falling for two decades.³ In America, three-quarters of people under 75 have no problems with hearing or vision, no difficulty walking, and no form of cognitive impairment.⁴ These are fully fledged citizens with plenty left to offer, not retirees on their way out. Step up a generation, to those aged between 75 and 84, and half still have none of those disabilities.

That doesn’t mean that older people don’t forget their keys, or lose concentration. But it does mean that some of our fears are overdone. In surveys, most people say they think that everyone will get dementia (or Alzheimer’s, a form of dementia) if they live long enough.⁵ But only one in six people over 80 have dementia:⁶ many never get it. And in Denmark, Sweden,⁷ the UK and US, the risk of getting dementia is a fifth lower than it was 20 years ago.⁸ In 2000, the average age for receiving a diagnosis of dementia in the US was 80.7; by 2012, it had crept up to 82.4, even though doctors had got better at spotting it.⁹

Experts are not sure why the incidence of dementia is dropping but the Framingham Heart Study, which has tracked 5,000 people over 60, suggests that rates of dementia have mirrored improvements in heart health.¹⁰ In the UK, dementia rates have fallen faster for men than for women, which may be because men previously smoked more. There will still be news headlines about dementia being on the rise but what’s growing is the total number of older people, not our own individual risk.

The ‘Young-Old’: The New Kids on the Block

The Japanese, whose society is now the oldest on the planet, caught up with the reality of Extra Time long ago. The group who are still hale and hearty and rushing around after grandchildren they call the ‘Young-Old’. Those who are frail and in need of support they call ‘Old-Old’.

‘The Young-Old are very active and healthy and productive – totally different from 30 years ago,’ says Professor Takao Suzuki, Professor of Gerontology at Tokyo’s J F Oberlin University. ‘Walking speeds are much faster, for example. The World Health Organization defines “old” as 65, but as gerontologists and geriatricians, our main concern is with the Old-Old, who are very different from a health standpoint.’

Sketching energetically on his whiteboard, Professor Suzuki is, endearingly but disconcertingly, wearing a thin black cowboy tie over his pristine white shirt. He draws a matrix showing the Young-Old starting at 60, and Old-Old from 75 – but says the start date of becoming Old-Old can be much later than that. Professor Suzuki attributes Japan’s uniquely long-life expectancy to good medical care, prosperity and improved nutrition after the Second World War, when people could afford to eat far more protein, mostly fish. Consumption of carbohydrates, fat and sugar has barely changed, he says, as fast food outlets are still relatively few. Unlike Western experts, he worries more about under-nourished widows than obesity. (Some widows were not eligible for their husband’s full pension, he says, and have trouble getting to the shops to buy groceries.)

The Oldest Stewardess in the World

Bette Nash, 82, is telling me about the time she flew with Jackie Kennedy. It was 1965, and the glamorous wife of the former US president walked onto the flight where Bette was a stewardess. ‘We used to have to wear white gloves. I was pulling them on with my back turned and I heard this voice asking, was this flight going to Washington? She was real sweet, never asked for any attention.’

The plane, Bette remembers, was a Constellation – very different to the Airbus she flies now. For Bette Nash is still working. She is probably the oldest stewardess in the world. American Airlines, her employer, recently threw a party to celebrate her 60th anniversary. Regular passengers on the Washington, DC–Boston shuttle bought her gifts.

Bette says she has no intention of retiring: ‘I thrive on people.’ She talks fast and exudes energy: ‘If I’m ever off for a few days and think about stopping, as soon as I get my uniform back on and drive to the airport, it’s great. It’s the people who work for the airline and it’s the customers. I know their little needs. I know the commuter who likes his tomato juice plain in the winter and on ice in the summer. I feel so comfortable going to work.’

Technology has changed in the past 60 years – Bette doesn’t have to handwrite the tickets any more – but people haven’t changed. ‘It’s being kind to people, and them being kind to you. A little love and kindness is what everyone needs.’

The job is physically tiring, but Bette makes few concessions: ‘If I have free time I don’t sit down, I walk the cabin and talk to people. I do have a nap in the afternoon – I’ll admit that – but younger people get tired too.’ She gets up early in the morning and prepares a meal for her son before driving the hour to the airport. On the way home, she says, she does feel more tired. ‘Before, I might have gone to the store on the way home, and done other things; now I might just get gas.’

What is her secret? She pauses. ‘When I think about it now, I think my goal in life is to keep moving,’ she chuckles. She may sit down to watch TV, but never for long. ‘There’s always something to do.’ She doesn’t follow an exercise regime, and admits to eating chocolate, but laughs: ‘I can still suck in my tummy.’ Almost without knowing it, she seems to have been following three of the tenets of the old-age lifestyle gurus: keep active, retain your sense of purpose and connect with people.

Is Bette Nash old? She thinks for a moment. ‘I don’t feel like I’m an old person. I have a handicapped son, I don’t have the chance to feel old; his needs are so great. My sister has Parkinson’s and dementia and I look at her and I think she’s old, but she’s younger than I am.’

Bette is not ‘old’ in the way we used to think of it. But her younger sister is. And this is where the debate gets confused. The stereotypes don’t fit any more. What we are witnessing is the decoupling of biological age from chronological age.

New Stages Require New Signals

When Otto von Bismarck, the German chancellor, created what was arguably the world’s first state pension in 1889, he set the pension age at 70. Few would ever draw it, since the average German lived to around 45.

Today, life expectancy in Germany is 81. But Germany’s pension age is 65¹¹ and the average German gives up work at 62. Right across Europe, retirement ages are not keeping pace with life expectancy. In the UK, men leave the labour force earlier than they did in 1950.¹²

If current trends continue, some of us living in Europe, parts of Asia and North America could spend a quarter of our lives retired. That is crazy.

Lord Adair Turner chaired the independent UK Pensions Commission which recommended in 2005 that the British government should raise the pension age to 66 by 2030, and to 68 by 2050. He now thinks this wasn’t sufficiently far-sighted. The UK government now intends to raise the pension age to 67 by 2028, but he thinks ‘this won’t be nearly enough. In 1950, average male life expectancy at 65 was 12 years. By the time we were looking at it, in 2003, it was 20 years. Life expectancy at 65 could be another 35 years by the time we reach mid-century. We should have started increasing the pension age years before.’

Actuaries, he says, simply didn’t realise how fast life expectancy was growing: ‘There was a dominant hypothesis about a limit to life. They kept producing curves showing life expectancy growing, but then tailing off. Eventually we said there’s no reason to tail off.’ Why did they get it so wrong? ‘Smoking. The tobacco companies were mass murderers,’ says Turner – and no one thought their power would wane.

Pensions are one of many signals which influence how we see older people – and ourselves. These signals need updating.

What it means to be 65 has changed utterly. In the 1950s, a 65-year-old woman in Britain could expect to live a further 14 years.¹³ Today, according to the UK’s Office for National Statistics, the average 65-year-old woman can look forward a further 23.4 years.¹⁴

Yet 65 is now the age at which many institutions impose a concept of old age upon their citizens. It’s the moment when Germans, Swedes, Canadians, Australians and Brits can officially retire, and Americans become eligible for full Medicare (federal health insurance). It’s a tipping point for financial advisers, who will often start switching your pension portfolio into bonds when you hit your 50s. And ‘65+’ is often the maximum age bracket cited in questionnaires, with no other boxes to tick – as if it’s the beginning of the end.

In London, everyone gets a free bus pass when they turn 60. It’s called an Older Person’s Bus Pass – something which causes a great deal of blushing among the many still-vibrant commuters who could perfectly well afford to pay their own fare. In the US it is entirely normal to call people ‘Seniors’, and to offer them Senior discounts, for a period of what could, these days, end up being 30 years. Yet much of that period will be spent as Young-Old, not Old-Old.

What if, instead of defining people by how many birthdays they’ve enjoyed, we define them by how many years they have left? Obviously, that’s hypothetical. None of us can know individually when we will meet our end. But we do know the average. And if we apply that average, things look different.

If we defined old age as having 15 years or less left to live, we wouldn’t call many baby boomers ‘old’ until they hit 74. Up to that point they’d be middle-aged. This is a crude measure. Not everyone will be in good health at 74: some will need support. But it’s still a useful thought experiment, which has been carried out by a group of demographers at the International Institute for Applied Systems Analysis in Vienna.

The Austrians wanted to challenge the use of 65 as the onset of old age in Europe.¹⁵ First, they ran the numbers for remaining life expectancy. Next, they drew up a list of characteristics which we usually associate with being ‘old’, such as reduced mental agility and dependency on others. On this basis, across four different countries – Norway, Japan, Lithuania and the US – they concluded most baby boomers remain middle-aged until their mid-seventies.

The insight that chronological age is a poor way to classify who is ‘old’ came originally from the Canadian-American demographer Norman Ryder, who realised in the 1970s that expected lifespan is a better indicator than age of our need for state support: which is, after all, what the state is interested in.

‘If you don’t consider people old just because they reached age 65, but instead take into account how long they have left to live, then the faster the increase in life expectancy, the less ageing is actually going on,’ explains demographer Sergei Scherbov, leader of the Vienna study. ‘Two hundred years ago, a 60-year-old would have been a very old person,’ he tells me. ‘Someone who is 60 years old today, I would argue, is middle-aged.’

Scherbov is now working with the UN to redesign traditional measures of ageing, using what he calls ‘characteristic-equivalent ages’. In 2015, for example, the average Japanese woman of 65 could expect to live another 24 years. But the average woman in Nigeria had to be much younger – 46 – to get 24 more years life expectancy. To be equitable, their pensions would need to start at different ages.

Evolving lifespans should make governments careful about what signals they send, to encourage people to save enough. ‘You don’t need to tell a 25-year-old when their retirement should be,’ says Lord Turner. ‘If you tell them there is a fixed retirement age, you are not telling them that things are uncertain. It would be better to tell them, look right now you’re in a pension scheme which retires at 65, but that may change with life expectancy.’ Lord Turner has suggested making the pension more generous from 70, and means-testing other benefits before that age.¹⁶

Our Stereotypes Are Out of Date

Institutional signals of this kind are one reason why we have not caught up with the reality of Extra Time. Another is the media. We journalists are deeply confused about age.

In 2018, The Times gave a double-page spread to a French lady called Mylène Desclaux,¹⁷ who had published a book about how to be sexy at 50. The breathless article advised women never to give a birthday party after 49, to avoid wearing reading glasses which might give the game away and to change their first name if it sounded too dated. In other words, lie. At 50! What would she suggest women do at 70, I wondered?

If 50 is old to some journalists, 65 is beyond the pale. Sub-editors love to bung ‘pensioner’ into headlines, making the subject an object of pity no matter what the story. ‘Plucky Pensioner Patrols Crime-ridden Streets Armed Only with Torch’ was a recent headline in Cape Town, South Africa. ‘Plucky Pensioner Chases Bag Thieves’ was another in England’s Swindon Advertiser, about a 69-year-old who sprinted after a wallet thief. The implication, as usual, was that anyone brave and fit enough to do this at 69 was extraordinary. In fact, the multitude of stories entitled ‘plucky pensioner’, from all over the world, suggests to me that courage, energy and strength are not uncommon among people who are, in fact, in extended middle age.

The media also has a strange tendency to move from the active to the passive when describing the elderly. ‘She had a fall’, we report of a grandmother, rather than ‘she fell down’. We would never say that of George Clooney. So why do we demean older people in this way? Unconsciously, our language turns people into sub-humans, lesser beings. My mother used to loathe being called ‘dear’ by strangers: she felt she’d fallen into some void, some category of oldness which robbed her of her identity.

I’ve fallen into the same trap myself, by focusing on age when it was irrelevant. When I interviewed Margaret Atwood, bestselling Canadian novelist and author of The Handmaid’s Tale,¹⁸ I asked her how she felt about having 1.6 million followers on Twitter at the age of 77. Atwood, who is one of my heroines, shot back sharply: ‘It’s 1.75 million!’ I felt ashamed. She went on to say, ‘A lot of them are robots. You know they are robots when they send you a message saying, “I miss your great big dick”.’ That was her graceful way of telling me to stop being so bloody patronising. What was I thinking?

‘There is a casualness of ageism,’ says Professor Martin Green, CEO of Care England. ‘People say things they would never say if the word “old” was replaced by “gay” or “black”. They say silly old people, shouldn’t be driving. But 19-year-olds are worse drivers than 80-year-olds.’

‘Everybody ghettoises the old,’ says the broadcaster Joan Bakewell. ‘But the old is us.’ Bakewell, 85, is a poster girl for ageing well. She looks fabulous and has lost none of her sharpness. But when she presented the TV programme Life at 100 in 2017, she had to keep challenging the production team for referring to older viewers as ‘they’. ‘There shouldn’t be that distinction,’ she says. ‘We are all in this together.’

Language matters. Baroness Sally Greengross, a formidable campaigner for older people, told me about a friend in her eighties who went to hospital and was admitted to the ‘geriatric’ ward. ‘But I’m not geriatric!’ she protested furiously, as they wheeled her away down the corridor. ‘Take me somewhere else!’

Women are thought to suffer ageism earlier, and more consistently, than men.¹⁹ That’s partly because we care more about how women look. The multi-billion-pound cosmetic industry, with its claim to reverse ageing, may be doing more harm than good. Personally, I see nothing wrong with trying to avoid wrinkles. But advertising does feed off the idea that we are in a constant battle against ‘old’. If anti-ageing is becoming synonymous with being anti-old people, we have a problem.

Becca Levy, Associate Professor of Epidemiology and Psychology at the Yale School of Public Health, has found that individuals’ own health is influenced by their perceptions of what ageing is like. Her team followed several hundred Americans over 50 for 20 years, and found that those who held more positive views of ageing lived an astonishing 7.5 years longer than their peers.²⁰

Negativity is rife. Broadcasters, galleries and museums spend hours worrying about how to reach more youthful audiences – despite the fact that older people have more time and money, and are growing in number. We value youth, tech and energy over wisdom and maturity, or so it seems.

The extreme youth of Silicon Valley plays into all of this. In 2014, the median age of Facebook employees was 29; at Amazon and Google it was 30. Facebook founder Mark Zuckerberg famously quipped, ‘Young people are just smarter.’ Many of us unthinkingly bought his line – just as we’ve bought some other lines from Facebook.

The Value of Experience

Chesley ‘Sully’ Sullenberger was 58 when he safely landed US Airways Flight 1549 in New York’s Hudson River after both engines were disabled by a flock of geese, saving everyone on board. The plane juddered across the Manhattan skyline and plunged safely into the icy water between the narrow banks. It was an extraordinary feat, which was turned into a Hollywood movie – Sully (2016) – by Clint Eastwood.

‘One way of looking at this,’ Sully reflected afterwards, ‘might be that for 42 years, I’ve been making small, regular deposits in this bank of experience, education and training. And on January 15, the balance was sufficient so that I could make a very large withdrawal.’

That wonderfully modest, laconic statement sums up the value of cumulative expertise. I’m not claiming that every 58-year-old is a hero-in-the-making – and I’ve seen good ideas from young people being ignored because they are not considered mature enough – but I do feel that we live in a world more interested in ‘digital skills’ than judgement, which only comes with experience. Personally, I don’t want to be flown by a novice pilot any more than I want to be operated on by a surgeon still in training. I want the guy who’s done the same procedure a thousand times.

Some economists believe that ageing workforces are behind the decline in Western productivity. But what if part of the problem is that baby boomers are retiring in droves, taking with them valuable experience and institutional memory?

‘I am of the old school,’ said English barrister Jerry Hayes, 64, describing how he intervened to save an innocent young man from being jailed for rape.²¹ Hayes was supposed to be prosecuting the man, but his 40 years of experience at the English Bar made ‘alarm bells ring’ when he took over the case at the eleventh hour and asked a police officer whether there were any mobile-phone messages from the man’s accuser. The officer insisted he hadn’t bothered to show the messages to the defence as there was nothing in them, but Hayes stood his ground and demanded the evidence. 40,000 messages were then handed over, which showed that the so-called ‘victim’ had been pestering the man continually for sex. The case collapsed and a terrible miscarriage of justice was avoided – but only because of the intuition, experience and sheer bloody-mindedness of a man with a white beard who believed that getting justice was more important than nailing up another successful prosecution.

How Much Extra Time Might You Get?

To get an idea of your life expectancy, type a few facts about yourself into an online pension calculator. Let’s say you tell it you are a healthy white Englishman, born in 1958. The calculator will give you a life expectancy of 90.

That may come as a shock. Most of us massively underestimate how long we have to live. We tend to think ‘when did Granny die?’ rather than realising that we have gained Extra Time. People in their fifties and sixties underestimate their chances of survival to age 75 by 20 per cent according to the UK Institute for Fiscal Studies. Widows and widowers are especially pessimistic.

None of us likes to think about death. But if we fear it’s around the corner when it isn’t, there’s a risk we may start to feel ‘old’ too soon. We won’t save enough, plan our career far enough ahead, or, frankly, feel positive enough about our future.

Of course, averages don’t tell us much about our own individual prospects. Our longevity can be boosted by all sorts of things: our income, fitness, even whether we are married or not (married people live longer). But the single most powerful predictor of how long each of us will live turns out to be our level of education. The more time you spent in education in early life, the more Extra Time you are likely to have at the end. And the better your chances of spending that Extra Time in good health.

The figures are surprising. In 2008, white American men with one or more degrees were expected to live up to 14 years longer than black American men who didn’t finish high school.²² In OECD countries, the gap between men with those education levels is around 7 years.²³

Education is a stronger predictor of lifespan than wealth. Well-educated Cuba, though dirt poor, has higher life expectancies than America. Oil-rich but poorly educated Equatorial Guinea, on the other hand, has low average life expectancies. So stark are these differences, one expert has suggested that governments should invest more in schools than in hospitals.²⁴

The Geography of Life Chances

I’m standing outside the Abbey Road Studios in London’s St John’s Wood. This is where The Beatles recorded some of their greatest hits and the traffic has stopped as four French tourists attempt to re-create the Fab Four’s famous Abbey Road album cover, by walking across the black-and-white zebra crossing. I cycle past here regularly, and I know that every tourist imagines they were the first to have the idea. A taxi driver gives me a weary look.

From Abbey Road, a prosperous area in the Borough of Westminster with red-brick mansion blocks and detached houses, I’m cycling south to meet a friend for coffee. I’m going to do a route I take often, along backstreets. What I didn’t know, until recently, was that this route spans 10 years of life expectancy.²⁵

At Abbey Road, female life expectancy at birth is around 87 years and 85 for men. I cycle south, towards Lord’s cricket ground, into Church Street ward. Here, female life expectancy has dropped to 81 years and it’s 80 for men. I make a right turn towards St Mary’s Hospital, Paddington, where I was born, and cut along the canal to Westbourne Park tube station, where I’m meeting my friend. By now, female life expectancy has dropped to 77 years and to 75 for men. In a 15-minute trip, life expectancy has changed by a decade. A baby girl who is born and who lives her life in Abbey Road can expect to live, on average, 10 years longer than one born just 1.5 miles away.

You can find similar gaps in many Western regions. Raj Chetty of Stanford University has found a 15-year gap in lifespan between the poorest and richest Americans. But he has also found that absolute income seems to matter less than where you live. The poorest live five years longer in New York and Los Angeles than they do in Tulsa and Detroit. In those areas, Chetty’s work suggests that smoking, drinking, stress and obesity have more impact on lifespan than income inequality or unemployment, although of course the two are linked.

Are You Heading for a Nursing Home, or the Beach?

‘In the end,’ as Abraham Lincoln said, ‘it is not the years in your life that count. It is the life in your years.’ In surveys, people say repeatedly that they don’t want to live to 100 if that means spending their last years in some ghostly half-life of senescence.

In the twentieth century, when most of us died from infectious diseases, increases in life expectancy generally implied an improvement in health for everybody. In the twenty-first century, that link has broken. Longevity is bringing some people more years of good health, but others more years of frailty.

There are two reasons for this. First, medical advances mean that things which used to kill us, like heart attacks and stroke, are less often fatal. We can keep people alive, stumbling gratefully on, some in good shape, others less so. Second, there has been an explosion in chronic conditions, like type 2 diabetes, high blood pressure, dementia and respiratory disease, which are often linked to smoking, drinking and lack of physical activity.

Differences in those behaviours are one reason why people living in the South East of England, for example, are likely to enjoy eight more years of life free from disability than those who live in the North East, according to the Newcastle epidemiologist Carol Jagger.²⁶

To get a handle on all of this, statisticians have started to track not only life expectancy but ‘healthy life expectancy’, defined as the years spent in ‘very good’ or ‘good’ health, and ‘disability-free life expectancy’: the years spent without any limiting condition. The methodology is not terribly robust as it’s all based on surveys people fill in, reporting how they feel. The categories are broad too: being in ‘poor health’ could mean that you suffer from arthritis and can’t walk as far as you used to, or that you have early stage dementia. There’s an urgent need for better data. But even so, the patterns are striking.

From as young as 40, some less-educated people report having a ‘functional limitation’ in walking, driving, or some other aspect of daily life. By the age of 60, graduates are in significantly better health than non-graduates. At 85, over half of graduates are still living happily, with no functional limitation.²⁷ We will see in Chapter 5 that some highly educated people also seem to have ‘cognitive reserve’, which can be protective against Alzheimer’s.

It is not clear exactly 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 kind of jobs we do. Lower-skilled jobs can be physically taxing, emotionally stressful and – it turns out – bad for health.

The legendary Whitehall II Study of British civil servants,²⁸ led by the epidemiologist Sir Michael Marmot in the early 2000s, found that staff doing the lowest skilled jobs, like messengers and doorkeepers, had a mortality rate three times higher than permanent secretaries and top managers. They also had far higher levels of cortisol, the stress hormone associated with coronary heart disease.²⁹ Marmot’s findings may seem counter-intuitive, but they make sense. Senior executives may work longer hours and face gruelling decisions, but support staff have lower social status, far less control over their working environment and probably a longer commute.

Life has never been fair. But as we live longer, less-educated and poorer people are becoming ‘Old-Old’ earlier than richer and more educated ones, and the gap is widening.³⁰ Professor James Nazroo, at the University of Manchester, has found that when they turn 80, the richest third of Britons is only just beginning to experience the limitations that people in the poorest third have been suffering from 70.

Narrowing that gap, providing people with more equal life chances, must surely be one of the most important social justice missions of our times. The rich and well educated already know some of the secrets to making the most of Extra Time – and there are more in this book. But unless we spread that knowledge to everyone, we will all be the poorer.

One country is leading the way. The Japanese government has set itself an explicit aim of ‘extending Healthy Life Expectancy more than the increase of Average Life Expectancy’ through its Health Japan 21 initiative.³¹ Ministers are working to actively combat what they call ‘lifestyle-related diseases’ with detailed targets for everything from salt intake to blood pressure levels, to the number of steps people take every day. Different provinces run programmes encouraging people to stay fit, reduce their smoking and drinking, and to take care of themselves.

These schemes are getting traction. The average Japanese man gained an entire extra year of healthy life between 2013 and 2016 (women gained six months).³² This was a win for Extra Time, since life expectancy at birth rose by nine months for men and six months for women in the same period.³³

These schemes build on the strong Japanese tradition of self-reliance. Many Japanese people I have interviewed do not want to be a burden to their children as they age, nor do they expect the state to do everything. They are willing to try and ditch bad habits. If other countries emulate this approach, tackling behaviour throughout the life course, not just at the beginning or the end, we might close the gap.

You’re Only as Old as You Feel

Spring Chicken, a British start-up which sells home gadgets to the elderly, conducted a survey which asked: ‘What age do you feel – on the outside, and on the inside?’³⁴ Most people between 50 and 90 reported feeling a few years younger than their actual age on the outside, but considerably younger on the inside. The older the respondents, the bigger the gap. Eighty-year-olds in the survey reported that they felt about 50 years old on the inside. Are they delusional, or might they just be on to something?

‘People will say things like, “I still feel 30, it’s just my knees are letting me down,”’ says Anna James, who founded the business after a fruitless and frustrating search for gadgets to help her father, who is 74 and has Parkinson’s. Her father now works in her business and tests out products, yet even he refuses to see himself as needing help. In 2017, James realised her father was getting to the point where he was going to need an electric wheelchair, but he wouldn’t consider it. ‘You’ve got to battle with the psyche,’ she says. So she asked him to test out electric wheelchairs and write a blog about his favourite model. Eventually, the time came. ‘Could I borrow that wheelchair for a few weeks?’ he asked. ‘He took it on a cruise with my mother,’ she says, ‘and ended up selling one to another guest on board!’ This was a man who was still young and dynamic inside – and able to make a sale.

Reasons to Be Cheerful

Extra Time has given us an entirely new stage of life: the stage of the ‘Young-Old’. We need to catch up with this new reality, stop lumping everyone from 60 to 100 together, and accept that it is normal to be vibrant and capable in your seventies. Media editors should take a look at how they portray ‘pensioners’, and question whether they are falling for a narrow narrative about youth. Governments must raise retirement ages in line with life expectancy and make this explicit: as part of signalling that the average lifespan has changed. And all of us need to challenge our own attitudes. Prejudices we build up against the ‘old’ will only hurt us when we reach that stage ourselves.

One vital question is what proportion of the over-60s will be ‘Young-Old’, thriving and capable like stewardess Bette Nash, and how many will be ‘Old-Old’, needing care, like her sister. On the answer to that question rests the future of our economies and the cohesion of our societies. If there are too many ‘Old-Old’, our welfare states and healthcare systems will be overloaded and younger generations will bear the burden. But if we can help people to stay healthy and productive, if we can abolish prejudice, we could see a new era of extended middle age, with most people staying vital almost to the end.

Later in this book I describe breakthroughs in genetics and neuroscience which may transform the youthspan, elongating our ‘Young-Old’ period and limiting the ‘Old-Old’. But we don’t have to wait for those. We already hold two of the keys in our hands to improving our Extra Time: diet and exercise.