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McKinsey Study Sheds Light on What Matters to Older Adults

Updated: Jun 25, 2023

Respondents who engaged in work, volunteering, education and community activities reported better overall health, with the greatest gains seen in volunteering.

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. 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.

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. 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 participation compared with their counterparts in other countries.

MHI asked survey participants about 53 factors, ranging from societal participation to exercise, to assess what matters most to older adults and how those individual factors may affect health. The analysis reveals that purpose, stress, physical activity, lifelong learning, meaningful connections with others, and financial security are the factors most strongly associated with respondents’ overall perceived health. While there are nuanced differences by country, overall, respondents in HIEs and UMIEs emphasize stress and financial decisions, while those in LMIEs highlight the importance of exercise and sleep. These factors often tie into how respondents perceive their mental, physical, social, and spiritual health.

Mental and spiritual health are the most favorably rated dimensions

Overall, survey respondents’ perceived health across all four dimensions declines with age. Physical health has the sharpest drop—38 percent—when looking at the average response, across all countries, between the youngest and oldest cohorts. For those aged 55 to 64, mental health tends to be the most positively rated dimension. For those aged 65 and older, spiritual health becomes the most positively rated dimension.

When examining economies and whether they affect health, the picture is mixed. On average, respondents in LMIEs report better average health than those in HIEs did. Yet respondents in HIEs report an increase in health across all dimensions from about age 55 to about age 79, which may be correlated to retirement.

Of the countries represented in the survey, Australia and Japan were the only two where perceived mental, social, and spiritual health increased with age, with scores among those aged 80 and older higher than those of their counterparts aged between 55 and 64. Respondents in China report the smallest declines in physical health, while those in Sweden report the smallest declines in mental and social health. Respondents in Egypt, Nigeria, and South Africa—the African countries represented in the survey—report the smallest declines in spiritual health.

Yet perceptions of health don’t always connect to life expectancy.

Living longer may not mean better perceived health

On average, older people can expect to have an additional 20 years of life expectancy compared with those in 1960.1 But survey respondents living in countries with higher healthy life expectancy in old age (as measured by the WHO2) don’t necessarily report better perceived health. What’s more, those with chronic conditions don’t necessarily report poor health. The report rates of perceived overall positive health status of respondents with the greatest disease burden are 27 percent, 40 percent, and 53 percent by those in HIEs, UMIEs, and LMIEs, respectively. This reaffirms that health is much more than the absence or presence of disease and consists of multiple dimensions.

Across the 21 countries represented in the survey, Japan has the highest healthy life expectancy for those in old age, but the share of Japanese respondents reporting very good or good perceived health is among the lowest. In general, a lower share of HIE respondents reports very good or good perceived health compared with other economies. The exception is in Saudi Arabia and the United Arab Emirates, where respondents have relatively high perceptions of their health.

Greatest perceived-health benefit is seen with volunteering and employment

Participating pays off. Reports of overall health are better for survey respondents who engage in working, volunteering, education, and community activities than for those who don’t. The greatest gain is seen with volunteering (eight percentage points, on average). When looking at country and country income archetypes, results vary, but in one example, the perceived benefit of volunteering correlates to increased wealth.

Declining health can be a barrier to overall societal participation but isn’t a deal-breaker. Our data show that there is strong demand in this area even for those in less-than-ideal health. More than one-fifth of respondents in poor health report working, and the rates rise to 32 percent and 44 percent for respondents in average and good health, respectively.

There is an opportunity to both boost older adults’ participation in society and benefit society overall. While it’s intuitive to connect more economic impact with employment, this analysis also indicates that older adults who volunteer, participate in community activities, or further their education are potentially more likely to report better health, reducing their healthcare costs in turn.

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