When someone contemplates growing older, it’s likely with a wish for physical and financial independence, joyful and engaging activities, and closeness with loved ones. Whether by playing pickleball or mah-jongg, working a part-time job, or running after grandchildren (or all of the above), the big question is how every older adult, no matter their country or socioeconomic status, can manifest what matters to them.
A new McKinsey Health Institute (MHI) survey of more than 21,000 older adults (defined as those aged 55 and older) across 21 countries finds that respondents largely agree about the importance of having purpose, managing stress, enjoying meaningful connections with others, and preserving independence.1 Consistent with external literature, and building on MHI’s previous work in this area, the analysis examined the intersection of many of those factors with respondents’ subjective, or perceived, health and well-being across the dimensions of mental, physical, social, and spiritual health (see sidebar “Methodology”).2
Among the results, unsurprisingly, is that older adults who have financial stability—no matter their country—are more likely than their peers to be able to adhere to healthy habits, including those that boost cognitive health.3 And contrary to the perception that older adults are tech laggards compared with their younger peers, the results find widespread technology adoption, especially in smartphone use, among the older adult population.
But on other topics, including how respondents perceive their health across the four dimensions, how they want to engage in society, and how they view the best ways to stay healthy, responses vary widely. In particular, respondents in high-income economies (HIEs) aren’t necessarily thriving more than their counterparts in upper-middle-income economies (UMIEs) and in low- and middle-income economies (LMIEs) are. For example, almost 20 percent of respondents in HIEs say they would like to work in their old age but aren’t currently doing so. Respondents living in HIEs also describe substantially lower levels of societal participation4 compared with their counterparts in other countries.
In the insights that follow, we share findings around mental, physical, social, and spiritual health and what a healthy lifespan can mean in a world that is growing older. They build on MHI’s previous work on six shifts needed for healthy aging, with the goal of reenvisioning perceptions of aging around capacity rather than chronological age.5 They also support MHI’s assertion that empowering individuals in optimizing health doesn’t undermine the roles of systems, institutions, countries, or cities.6 It’s our hope that every stakeholder, from employers to local governments to healthcare providers, can see what older adults want, evaluate what’s possible, and feel motivated to be a part of wide-scale aging transformation.
The factors with the greatest uplift broadly align with those identified as most important
In addition to looking at the factors that respondents report as most important to their health, our analysis looked at the factors with the greatest uplift.1 We examined what would happen if everyone could achieve the same level of perceived health as those with the best reports of a specific factor. For example, managing stress has meaningful potential uplift. Among respondents aged 65 to 79, those who agree or strongly agree that they “manage their stress levels” have a 17-percentage-point uplift, on average, in their perceived overall health.
Feeling respected by one’s community and feeling that one’s perspective as an older adult is valued also result in substantial uplifts, with the greatest effect seen in respondents in HIEs—so much so that the difference between perceived health and life expectancy almost completely disappears. This supports the idea that reframing aging has the potential to alter how older adults perceive their own health.
At first glance, there appears to be less potential uplift for respondents in LMIEs, but the picture is more complicated. Such respondents give a higher baseline rating across most factors at the onset compared with their peers. For example, among respondents in LMIEs, a sense of purpose is largely ubiquitous. So selecting for the population subset that rates purpose most favorably invariably includes almost the entire sample, leading to little room for uplift.
Many older adults who wish to work are unable to find a job
While the desire to work tends to decline with age—to 38 percent for respondents aged 80 and older, from more than two-thirds of those aged 55 to 64—a sizeable share of older adults report wanting to work. When evaluating the associated economic implications, there is the potential for $5 trillion in incremental annual GDP in HIEs. Across economies, 19 to 25 percent of survey respondents want to work but aren’t doing so. They most often cite a lack of attractive opportunities and difficulty in landing jobs as their primary barriers.
The desire to remain independent can be a barrier to accessing care
All respondents report at least one unmet care need. Participants in UMIEs and HIEs report the desire to remain independent as the main barrier to accessing care. While that’s also a concern for those in LMIEs, they report access to care and affordability as more pressing. These trends persist across gender and age cohorts.
As populations age and dependency ratios increase, health stakeholders will need to ensure not only access to care and its quality but also responsiveness of available care to older adults’ desire to remain independent. This could include increasing the focus on in-home services and other community-based types of care. In this area, Norway is a lighthouse for its use of technology, such as care coordination platforms and digital-key systems, and Singapore is a notable example of intergenerational care tied to health.1
Aging well isn’t only possible: it’s attainable. But to make this a reality for a rapidly aging population, global stakeholders should consider not only how to boost the number of years in a life but also how to enable healthy life in those years.
Some of this starts with reexamining assumptions. MHI’s previous research found that many older adults report good overall health as they age, even as their physical health declines.7 The current survey results support that research. Even among those facing the greatest disease burden, up to 46 percent report good overall health (exhibit).
Isolation is complex
No one wants to feel alone. Consistent with existing research on social isolation’s harm,1 our analysis of responses from older adults finds that isolation is a wide-ranging problem. Globally, 10 to 20 percent of respondents report feeling isolated.
Additionally, we find that more income doesn’t necessarily help in this area. While an average of 12 percent of respondents in low- and middle-income economies report isolation, the share jumps to 19 percent in high-income economies.
What potentially helps is when older adults can participate in society. In the survey, higher societal-participation2 rates correlate to decreased isolation rates: by one-third in upper-middle-income economies and up to one-half in low- and middle-income economies. How much adults benefit from the activities varies by country, potentially reflecting different structures for societal participation and perceptions of what isolation means to an individual (exhibit).
In two countries represented in the survey, India and the United States, jumping into societal activities seems to have a particularly large impact. The reported isolation rate is 8 percent for respondents in India participating in two or more activities, increasing to 33 percent for those who don’t participate in any activities. In the United States, the increase is from 9 to 25 percent. Comparatively, respondents in the United Kingdom appear to benefit less from societal participation. For UK respondents reporting no participation in social activities, the isolation rate is 19 percent, which drops minimally for those who report participation in two or more activities.
And when surveyed older adults cite lower physical-health scores, it’s notable that the rates of the other dimensions (mental, social, and spiritual) decline less rapidly—or even rise, in some countries—with older age. For example, in Japan, those aged 65 to 79 report the highest mental-, physical-, social-, and spiritual-health scores. One explanation for this could be that the other dimensions act as a buffer, protecting or mitigating the decline of people’s perception of their overall health despite a decline in their physical capabilities.
The extent to which other aspects of health could compensate for the decline in physical health, and balance people’s view of their overall health, is a topic for further research. As we consider actions to add life to years, part of any solution will need to focus on what drives people to take action to stay in good health. Purpose and meaningful connections with others are critical contributors to good health, as our research indicates.
And the underlying reasons for creating those connections and the definition of purpose vary. For example, our research on societal participation highlights the point that many older adults engage in activities for a variety of reasons, from staying healthy to being connected to their communities and, for some, pursuing financial gain. The motivations are multifaceted, but providing opportunities to fulfil those motivations must be a critical priority for societies.
Living intergenerationally might benefit one’s health
Good news for those planning to move in with their children: as noted in previous research, older adults often benefit when they can live in intergenerational households.1 As part of our research in healthy aging, we looked at survey results for older people living intergenerationally (defined in our study as those living with their adult children). Respondents in that cohort who are retired and have low levels of care needs tend to report being in better or much better than average health across dimensions compared with those not living with their children or spouse and children.
This trend varies across economy archetypes, with the greatest benefits, especially related to physical and social health, in respondents in low- and middle-income economies (exhibit). Moderate benefit is seen across all four health dimensions (mental, physical, social, and spiritual) by respondents in upper-middle-income economies. For respondents in high-income economies, those living intergenerationally report very little benefit from intergenerational living. In some countries (such as the United States), stigma against intergenerational living may contribute to an observed decline in mental health.
This research adds to an important body of evidence pointing toward the benefits of older people living with family, especially after retirement. Coupled with the trend away from extended- or nuclear-family living, this evidence suggests an opportunity to create intentional, age-inclusive communities where older adults can interact with younger generations—whether family or otherwise—in their daily lives.
Too often, society and individuals accept health declines as inevitable—the passing of time leading to physical deterioration. An important objective for many societies could be to ask “What would it take for more than half of people aged 80 and older to report good health over the next decade? What would it take to expand what it means to be in good health at ages 60, 70, 80, 90, and beyond?” For example, in forthcoming work, MHI will explore how a healthy city framework ties into older adults’ abilities to stay active, access care, and keep connected.
Healthy aging also starts with individual actions, such as a person following behaviors proven to improve health, supported by an environment that makes them accessible to all. It’s a lifelong journey, and it’s never too late to set out on the path to becoming well aged.
If you would like to learn more about the McKinsey Health Institute 2023 Global Healthy Aging Survey and the additional data and insights MHI has from the survey, please submit an inquiry via the MHI “contact us” form. The McKinsey Health Institute, as a non-profit-generating entity of McKinsey, is creating avenues for further research that can catalyze action.
