[Music] the wealthy world is aging fast in 1950 around 1 in every 12 people in high income countries was over 65. by 2050 it's expected to be more like one in four and it's storing up a big problem it is a feat that we can live longer and that we can enjoy being alive for longer but it's expensive when people retire they start to cost society more money and the costs will soon be unsustainable what's becoming increasingly clear is that the three stage model of life where you educate your work you retire is fundamentally broken current approaches to care for the elderly are a massive drain on society's resources if you look at it from an economical perspective we are spending too much money on doing the wrong things and these mistakes cost more than just money i don't feel that the older population are valued i think we may be an inconvenience so how can societies provide high quality but affordable care for their growing elderly populations both today and into the future yamakita japan news crews have been sent to cover the final graduation ceremony at miho elementary school what makes this national news is that 12 year old reiki kodama is the only people in his year group the 146 year old school will close after reiki's graduation the town's population has dropped by around 30 percent over the past three decades and there simply aren't enough pupils to keep the school open japan is the oldest nation on earth with the highest proportion of elderly people in its population the changing shape of societies in the developed world is clearly shown by un population data in 1950 there were more than double the number of people in their 20s compared with those in their 60s but today the number in their 60s has nearly tripled the number of children and retirees relative to those of working age is known as the dependency ratio when this changes it can mean there are fewer workers to support the elderly which has serious economic consequences an aging population of course brings lots of uh good and exciting things but it's expensive the cost of pensions the cost of health care which is largely spent on people in their last years of life it's very costly when people retire in their 60s they tend to spend less pay less in taxes and cost society more a shrinking workforce can also cause gdp growth and investment to slow which threatens economic stagnation some countries such as france have made repeated attempts to shake up their pension systems including by raising the retirement age but this has led to fierce protests [Music] there are other ways to reduce the dependency ratio such as encouraging immigration of skilled workers and improving child care provision to encourage more women to work but these aren't enough a lot of this is about tweaking around the edges and if you really think of the magnitude of the challenge here the more fruitful thinking lies in a really quite a fundamental shift in how we think about different life stages many people are already challenging these traditional attitudes to aging at an age when most would be thinking about retiring 68 year old julie ford has reinvented herself as an entrepreneur hi bridge hi nichola how you doing i've been involved in health and fitness and i'm a pe teacher of 45 years yes let's get out in that fresh area and then i was diagnosed with breast cancer and i was physically still fit two very important things smiling and breathing if you can only do one at a time can you just please breathe julie designed and built a training aid called instep and runs workout classes using it resistance training is the best for strength scientifically proven that moving with resistance is the golden ticket of exercise julie is part of an online community called rest less which helps retirees who want to keep working it was set up by stuart lewis everything we do is tailored to this demographic of people in the 50s 60s and beyond there's a wide range of life needs that people have and we're trying to meet them across health community and social networking offering advice on jobs pensions further education and even dating restless helps people navigate one of the biggest transitions they will face in their lifetimes you've worked 45 years 50 years of your life and suddenly you stop well what do you do it is very difficult you just need to look at the impact of someone who's been out of work for two years to see the impact on their physical health but also their mental health it's the same when you're into retirement for some people it can be quite a lonely and desolate time but extending their working life might not be practical for everyone people don't all experience aging in the same way and that's a really important thing to to keep in mind i mean a starting point is of course what kind of job you did all your life well not everyone can work until they're 90. that still doesn't take away the fact that in the rich world 90 of people will now reach their 65th birthday and most of them will still have plenty of healthy years ahead of them encouraging people to make use of these healthy years could unlock economic potential that's being lost in retirement to make the most of this increasing life expectancy to reap the so-called longevity dividend you do need to make sure that you set the infrastructure up to make that possible more flexible ways of tapping into say your pension savings to employers taking a more open-minded approach so we're invaluable in society and i think we should be used or made use of more flexible attitudes to retirement could help reduce the economic burden of increasingly elderly populations but eventually most people will need some form of medical or social care and that is expensive a lot of countries just haven't really grappled with the need to set up a decent social care system social care used to happen a lot in the family sort of it used to be informally covered as we would call it there were always carers but they were just unpaid carers it's daunting because there are an awful lot of people that will need it and it's a labor-intensive thing to do in many developed countries when people can no longer care for themselves a typical answer is to move them out of their homes and communities into residential care but as well as being increasingly unaffordable this model of care can fail to address the emotional needs of elderly people the rich world have taken a fairly reactive approach to to care for the elderly the traditional approach has been essentially warehousing people in nursing homes the metrics of success have often been things like has a person had any falls have they lost any weight or did they have any bed sores and because they became the important metrics the institutions started operating around those things i think what's got lost in social care is a more community focused approach [Music] in the netherlands an organization called bertzorg is re-establishing this community approach to care ramona vanden arendt is a burtzorg nurse working in ada [Music] today she has three male patients to visit all with complex needs central to bert talks method is using local nursing teams who know the community and who are given real autonomy in managing their workload you work together as a group as a team and together you discuss what kind of tasks everybody takes in the team one of her patients today is 82 year old mr vandermeen who suffers pain from cancer in his ear managing her own timetable means ramona can give him the special care he needs to stay living safely in his own home in healthcare it's always changing how many clients you have what is needed how much time we need to spend at the clients so it's necessary that we can take decisions ourselves bert's org was set up by yoster block who had himself been a community nurse for nearly a decade so my idea was we just start from scratch and we just ask nurses to do what i think they should do not on protocols not on products look at a problem and try to solve the problem in the most effective way the other key part of burt talks philosophy is setting aside time to talk to the patient and build a deeper understanding of their needs and aspirations i think the most important thing that when you come at the client's house it's important to listen that you take the time to hear somebody's story it might seem inevitable that spending extra time with patients would drive up costs but in bert talks case the opposite is true if we trust people and we ask them to do what they think is needed then we use the capacity more effectively than we're doing now separate studies by ernst and young and kpmg found that burt's org delivered over 30 cost and 50 time savings compared with existing dutch care systems in a sector known for high staff turnover it now employs over 10 000 nurses in the netherlands and is operating in 30 countries as well as being efficient giving nurses independence also protects the independence of those in their care aging populations threaten societies with shrinking workforces economic stagnation and crippling costs for pensions and care simply throwing more money at the issue is not going to be enough from a societal perspective i think we're missing the huge opportunity we have to help people age better to live better lives dealing with aging is a opportunity but also a problem that keeps getting kicked down the road we can't just keep postponing actually dealing with it or wishfully thinking that tweaking around the edges around the retirement age will fix it needs a much much bigger more fundamental rethink i'm tom standage deputy editor of the economist and editor of the world ahead to read more of our future gazing coverage click on the link thanks for watching and don't forget to subscribe [Music]