How the Aging Population Is Changing the Healthcare System

By Susan E. Matthews, Everyday Health Staff Writer

By 2030, one in five Americans will be over age 65, and the healthcare system is just beginning to feel the burden.

How the Aging Population Is Changing the Healthcare SystemThanks to the baby boomers, who began turning 65 in 2011, the population of older Americans is expanding. By 2030, one in five Americans will be a senior citizen, nearly double the 12 percent in 2000, according to “The State of Aging and Health in America,” a 2013 special report from the U.S. Centers for Disease Control and Prevention (CDC).

Not only are there more seniors, they’re also living longer. In the past century, life expectancy has increased by nearly 30 years. Men born in 1900 could expect to live until age 48, but by 2000, men’s life expectancy had jumped to 74. In 1900, women could expect to live 51 years, but as of 2000, their life expectancy had also jumped to 74 years, and by 2050, the average woman may make it to age 86 (men can expect to live to age 80).

This massive shift in the country’s demographics will put new pressures and demands on the healthcare system — even Google knows it. The search engine giant has ventured into new territory with Calico, a company it launched in September 2013 to address the “challenge of aging and associated diseases.” Doctors will have to rethink every aspect of care for the older population, even rethinking how we die. In addition to the big picture, the country will also have to figure out how to pay for this extra care and how to support an older population. “It’s a vulnerable segment with the largest care needs,” says Thomas Gill, MD, a geriatrician and director of the Yale Program on Aging. “This will be a very important issue to address from a policy standpoint. We’re probably going to need to be a little more creative with how we finance and provide care to that segment of the population.”

How We Die – Then and Now

As the number of people living into their seventies and eighties has increased, so have incidences of the diseases that cause their deaths. In 1900, infectious disease was the leading cause of death in America, with influenza, pneumonia, tuberculosis, and gastrointestinal infections accounting for almost half of all deaths, not to mention being a relatively quick way to go. Today, however, only pneumonia and influenza even crack the list of leading causes of death, and while this is for the entire population, the shift also applies to the elderly, says David Jones, MD, PhD, professor of global health and social medicine at Harvard University. Instead, chronic conditions — heart disease, cancer, non-infectious airway diseases (such as fibrosis) have taken over the top spots. In 2010, the CDC reported that accidents and Alzheimer’s disease were the fifth and sixth leading causes of death, showing how modern medicine has conquered certain diseases, causing a shift in how we die.

Eventually, a whole other slew of diseases might do us in, suggests an analysis published by Jones and his colleagues in the 200th anniversary edition of the New England Journal of Medicine in December 2012.

“By the time antibiotics and vaccines began combating infectious diseases, mortality had shifted toward heart disease, cancer, and stroke,” they wrote. “Great progress has been made to meet these challenges, but the burden of disease will surely shift again. We already face an increasing burden of neuropsychiatric disease for which satisfying treatments do not yet exist.”

Jones says he believes that in the near future, heart disease may fall below cancer, which will take over as the leading cause of death. “One thing we’re sure of is that the human body, left to its own devices, will deteriorate over time,” he says. Doctors may be very successful at prolonging life by preserving the physical body, but the brain will decline, as will essential functions like hearing and eyesight. For example, Jones’ grandmother lived until she was 102, he says, but by the time she was a centenarian, she suffered from failing vision and hearing, which caused her to be cognitively isolated. “It’s very easy to imagine a world where people will have limited quality of life because of vision or hearing or bone structure,” Jones says.

Rethinking the Healthcare System

Two-thirds of all people over age 65 experience multiple chronic conditions, making specialized geriatric care even more critical. In fact, according to the CDC, 95 percent of older Americans’ healthcare costs are for managing their many chronic conditions. Facing several chronic conditions at once is called multi-morbidity, and having geriatricians who are trained to handle these scenarios is critical, says Gill. Otherwise, an older adult could end up receiving medications for each condition — possibly as many as 15 or more daily medications — which geriatricians work to avoid. Geriatricians help to not “miss the forest for the trees,” according to Dr. Gill. “Geriatricians keep the forest in mind in trying to address things in a broader approach rather in this disease-oriented approach,” Gill says.

Sometimes, the decisions behind treatment are made even more complicated by the cognitive decline that often accompanies aging — one in every eight adults over age 60 has cchanges in thinking, including confusion and memory loss, the CDC reported. Nearly 5 million Americans currently suffer from Alzheimer’s disease. This often requires caregivers to fundamentally rethink the relationship between quality of life and length of life. The field of palliative care has come about during McGee’s time as a practitioner, which she says is promising. Palliative care focuses treatment on reducing the amount of pain a patient is experiencing, rather than traditionally trying to treat the diseases the patient may have.

Jones notes that physician-assisted suicide is consistently a controversial topic, and was voted down in his home state of Massachusetts. He supports the idea, however, particularly considering his grandmother’s last two years of life, when she was blind and deaf. “Every night she went to bed thinking she hoped she died in her sleep,” he says. He also cites research that showed that in states where it is legal, most people who take advantage of doctor-assisted suicide are doctors themselves. “We could all get to a point where our quality of life is miserable because of neurodegenerative diseases,” says Jones. “We should all be able to say enough is enough — ‘I want to die with dignity.’”

The Yale Program on Aging helps to educate physicians on how to address the elderly’s unique needs, and even more, to encourage them to conduct more research on older adults’ health needs, using older adults as subjects. “This is a population that often isn’t included in clinical trials,” Gill says, but if more research is conducted now, treatment may improve down the road. For example, some older adults are retaining much of their cognitive function, and later in our package you can read about what researchers have found is different in these super-agers’ brains.

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