Australians face a decade of poor health unless they close the gap between living longer and staying well
There is an average 12-year gap between Australians' lifespan and health span that will reshape how people experience ageing, from the jobs they hold in their 60s and 70s to the products they buy, the healthcare they receive, and the way they plan for retirement.
UNSW Scientia Professor, Kaarin Anstey, one of the world's leading experts on cognitive ageing and dementia prevention, said this shift means Australians need to rethink when they start caring about brain health and what they can do to compress the years spent in poor health.
"Well, in fact, we should be caring about it throughout our lives, which is a hard answer to process when you're in your 20s. But we know that, for example, with brain ageing, the things that improve your brain as you age and protect it from cognitive decline and dementia, those exposures accumulate through the life course," said Prof. Anstey, who was recently interviewed by Dr Juliet Bourke, Adjunct Professor in the School of Management and Governance at UNSW Business School, for The Business Of, a podcast from UNSW Business School.
The implications of this are important for every Australian. By 2050, Prof. Anstey said the nation will have only 2.7 people in the workforce for every person over 65 or child outside the workforce, down from five workers at present. This means people can expect to work longer, while workplaces will need to adapt to keep workers engaged and productive across decades.
What does health span mean for your future?
Prof. Anstey, an ARC Laureate Fellow who also serves as Director of the UNSW Ageing Futures Institute, said the distinction between health span and lifespan determines whether people spend their later years in independence or dependence.
"Health span is the number of years in which you have a healthy life, and lifespan is how long you live," she explained. "For example, you might live to 100, but you become disabled in your mid-80s, in which case your health span might be 85, and you have 15 years with a disability. And so, in ageing, we're trying to compress that time spent in disability and extend that health span."
The question of when to start protecting brain health is critical to the issue of how people age. While many assume they can worry about health in later life, Prof. Anstey said research shows that behaviours accumulate throughout life which affect health and broader life outcomes. Midlife, for example, is when risk factors such as high blood pressure, type 2 diabetes, and obesity emerge, making this period crucial for decisions that will influence health in decades to come.
She also noted that the definition of midlife itself had shifted upward. "In the academic world, when we do research, we classify midlife as 40 to 65, but it's actually quite interesting, because about 15 years ago, when I was writing papers on this, it was 40 to 60," said Prof. Anstey, who has also held advisory roles with the World Health Organization since 2016.
"So, we've already expanded that upper limit to 65, and I can see a time where we almost talk about 40 to 70 is midlife."
Brain health and what technology can (and cannot) do
Cognitive health will determine whether people can maintain independence, solve problems, work, and preserve their sense of self as they age, according to Prof. Anstey, who described cognitive health as fundamental to functioning. "Cognitive health is your ability to process information, solve problems, your memory," she said.
"Basically, without cognitive health, you can't function, so you can't solve everyday problems, you can't work, you can't participate in society, and it's about the self as well. It's your identity, who you are, your memory."
Prof. Anstey also noted that technology is evolving to assist with maintaining cognitive function through stimulation and engagement, while other technology can compensate for certain health challenges.
While home monitoring systems, digital reminders, and assistant tools can help people remain in their homes as they age, Prof. Anstey said there are questions about whether outsourcing thinking to AI systems might affect cognition over time.
"We have examples from other areas, where, when people stop using particular cognitive skills, it's like physical muscles that atrophy," said Prof. Anstey, who pointed to phone numbers as an example. People once memorised dozens of contacts, but smartphones eliminated that need. Whether such changes affect brain health over the course of decades remains unknown.
Importantly, she said the solution involves ensuring that, as people delegate tasks to technology, they maintain cognitive engagement through other activities.
"What we will need to do is make sure that, if we outsource aspects of our thinking and problem solving to AI, we compensate and have other activities to engage our brain and ensure that we keep mentally active and don't lose those cognitive skills," Prof. Anstey said.
What to expect from your workplace
Prof. Anstey also told Dr Bourke that Australians can expect to work longer than previous generations, but the form that work takes will need to change. She described how ageism remained "really the one form of discrimination which is socially acceptable, and the more you become aware of it, the more you see."
However, demographic realities mean workplaces will need to adapt, and Prof. Anstey said research shows that workers want flexibility rather than simply extending careers in the same roles.
"What we're hearing is that people want flexibility," she said. "They don't necessarily want to work in the same job. They may choose and do something that they'd always wanted to try."
This could mean more time for hobbies, travel, and caring responsibilities alongside paid work, rather than working 9am to 5pm for another decade.
Evidence from organisations that have redesigned workplaces for workers across all ages shows what people can expect, according to UNSW Business School Professor Barney Tan, who also spoke on the podcast. He described how BMW's German plant created a pilot assembly line staffed mainly by workers in older age groups, who were asked to help redesign the workspace.
Prof. Tan said the result involved around 70 modifications, including flooring that reduced joint strain, adjustable workstations that allow sitting or standing, lighting improvements, screens with clarity, and job rotation to vary the demands on the body.
Importantly, productivity on the older workers' assembly line matched or exceeded that of other lines, while Prof. Tan noted that error rates and absenteeism also dropped. Workers in younger age groups also benefited from the same changes.
Prof. Anstey emphasised that workplaces would need to invest in training for workers across all ages. "The other really important area, and this is important for all of us, is lifelong learning and realising that we all constantly need to train and upskill ourselves, particularly with AI and giving people the opportunity to upskill and investing in older workers as you would invest in a younger worker," she said.
Planning for a longer life
Given these inevitable aging shifts, Prof. Anstey said Australians need to rethink retirement planning, savings, and how they balance paid work with unpaid contributions through caring, volunteering, and community participation.
People in older age groups already contribute through minding grandchildren, participating in clubs, running sports organisations, and serving on boards. "There are lots of not-for-profit boards, where you have a lot of really, really experienced older people, investing a lot of time. It has a huge economic value, which we shouldn't underestimate," Prof. Anstey said.
Policy changes will also affect how people access healthcare and support, and Prof. Anstey predicted cognitive health would move to the centre of how Australia thinks about ageing. "I think we're going to really come to grips with the need for cognitive health," she said.
"[We haven't] fully recognised the importance of the brain and cognition for ageing, but most people want to have their memory of who they are and have good cognition."
This could involve integrating brain health checks into Medicare from midlife onward, alongside addressing factors that impact long-term cognitive health, including childhood nutrition and education, as well as the food industry's role in promoting ultra-processed products over fresh food.
"You may not see a short-term effect, but over 20, 30, 40, 50 years, these things are affecting our health and our cognitive health," she concluded.
