The past decade has witnessed a proliferation of studies examining anxiety in older populations. This research underscores how anxiety is not just an ancillary symptom of depression, but a clinical issue on its own. Not only does anxiety cause suffering in older adults, but anxious older adults also have more functional disability (Brenes et al., 2005) and a reduced quality of life (Wetherell et al., 2004) compared to non-anxious older adults. In conditions that are common in later life (i.e., poor physical health, depression), those older adults experiencing comorbid anxiety typically have greater disability compared to non-anxious adults with these conditions. Cognitive functioning and the presence of neurocognitive disorders are aspects of comorbidity that have garnered increasing research attention (Beaudreau & O’Hara, 2008). This exciting new research underscores the complexity of the relations between anxiety and cognitive functioning in older individuals.

This chapter concentrates on health and well-being, drawing on 11 New Dynamics of Ageing (NDA) projects covering the whole range, from basic biology to the arts and humanities. Our main purpose is to employ the findings from our projects to examine the barriers to healthy ageing and how to overcome them. By way of introduction to this discussion of healthy ageing we first consider some key concepts in this field: ageing and ill health, older age, quality of life and subjective well-being. We begin with an overview of the main demographic changes that underline the importance of research on healthy ageing.

Key concepts for healthy ageing

Demographic changes

Major demographic shifts are currently under way in countries of the developed world such as the UK. In the 25-year period from 1985 to 2010 the number of adults aged over 65 in the UK increased by 1.7 million, and the number of those aged over 85 almost doubled to 1.4 million (ONS, 2011a). This is partly due to improvements in mortality leading to higher numbers in old age. Life expectancy is increasing at a rate of two years per decade in developed societies. However, there are sharply divergent views about how trends in life expectancy may develop during this century. For example, Christensen et al (2009, p 1196) pointed out, ‘if the pace of increase in life expectancy in developed countries over the past two centuries continues through the 21st century, most babies born since 2000 … [in] countries with long life expectancies will celebrate their 100th birthdays … research suggests that ageing processes are modifiable and that people are living longer without severe disability.’ On the other hand, Olshansky et al (2005, p 1142) stated, ‘as a result of the substantial rise in the prevalence of obesity and its life-shortening complications such as diabetes, life expectancy at birth and at older ages could level off or even decline within the first half of this century’.

The magnitude and implications of population ageing depend heavily on the magnitude of mortality improvement in decades to come. At present, overall age-standardised mortality rates (both sexes combined) are improving at about 2.5 per cent per annum in the UK (based on ONS, 2012a), but current trends are heavily influenced by patterns at ages where deaths are concentrated.

Introduction

In October 1990, the East German state (the German Democratic Republic – GDR) collapsed and its territory and people were absorbed by West Germany (the Federal Republic of Germany – FRG), even though just months before almost no one had expected this to happen. Western troops did not fire a single shot; easterners were fleeing to the West. Yet, the strange fate of East Germany makes sense as part of Germany’s path through the modern world, which has been influenced strongly by external political and economic challenges. A precarious military-strategic position in Europe made it difficult for one German polity to rule over everyone who is in one way or another conceivably German. Even today, millions of German-speaking people and considerable territories that were formerly governed by German rulers remain outside of the unified state. Germany’s economic success as a middle-developer means that the country still has powerful influence beyond its own borders: in the wake of the recession of 2008–2010, other European governments called for more German assistance and cooperation even as they feared heavy-handed intervention and criticized Germany’s reluctance to provide more resources.

The challenges that Germans faced and their responses were characteristic of what happens when a major power takes a middle path through political and economic development. Germany was at a disadvantage with respect to the early developers. In politics, German rulers could not match France in establishing strong central authority over a vast territory. In economics, German industrial development lagged behind Britain’s. Along with these military and economic disadvantages, however, the rapid diffusion of new ideas into Germany offered certain opportunities. Germany’s newer bureaucracies skipped over incremental improvements to traditional practices and instead adopted only the latest and best organizational techniques. German industries, unimpeded by false starts, implemented advanced technology on a massive scale. In the struggle with the early developers, Germany developed powerful political institutions (a professional army and an authoritarian monarchy), mobilizing identities (ethnic conceptions of nation), and significant economic interests (heavy industry and labor-repressive agriculture), all of which imperiled liberalism and democracy.