Aging in Healthcare — Perspectives from an Older Population

We live in a Golden Age of medicine. With a cutting edge and increasingly diverse wealth of disease diagnostics, prevention, and treatment, people across the world are living stronger, healthier, and longer. In the past fifty years alone, the average lifespan of citizens in the US leaped from 69 to 78[1]. Especially in developed countries, population aging is expected to rapidly accelerate in the next fifty years; the number of people aged 65 or older is projected to triple from 500 million in 2010 to nearly 1.5 billion in 2050[2].

Population aging is a powerful and multifaceted demographic force, yet we are only just beginning to see its impact on healthcare resources. With a population characterized by aging more than ever before, how can our healthcare system adjust to the increasing costs? How can we optimize care for our seniors, even as the number of retirees begins to outnumber the working population? How are current policymakers and public health researchers collaborating to address potential issues caused by population aging?

Faced with a never-before-seen challenge, public health professionals are encouraged to adapt their strategies in order to better support an accelerating aging population. These approaches attack divide population aging into three challenges: an increased healthcare burden, a reduction in workforce size, and a dramatic increase in noncommunicable diseases.[3] The Center for Medicare and Medicaid Services’ (CMS) has led a number of initiatives tackling the foremost of these challenges, aiming to provide preventive and restorative measures to Medicare beneficiaries inside their own homes and to reduce unnecessary medical costs[4]. These initiatives have had a lot of success, reducing the patient hospitalization rate to less than 2% and patient quarterly medicare expenditures to near zero in some cases. Because of the realization that premature mortality can result from factors beyond the expected physiological scope, CMS has also focused on reducing the use of unnecessary psychoactive drugs and the rates of rehospitalization. Deemed the “enhanced care and coordination providers”, the CMS partnered with several healthcare providers to send pods of nurse practitioners and physician assistants to maintain on-site “clinics” in long-term care facilities in order to reduce the need to transfer unnecessarily to hospitals. Generally, the new programs have been designed to bring healthcare to the patient and to proactively prevent disease.

Indeed, one of our most powerful weapons against noncommunicable diseases, like stroke, diabetes, and dementia, involves disease prevention[5]. Armed with data from 32 programs involving employee health risk reduction, the CMS identified several characteristics that consistently enabled employees to care for themselves, even after the programs’ end[6] . In 2007, CMS created the Senior Risk Reduction Demonstration, which again partnered with private companies to disseminate tailored programs for elderly health. The findings, released in 2012, saved up to $958 in healthcare costs per patient, and it reduced their likelihood for hospitalization by 14.2%[7]. Since then, there’s been an explosion of private vendor programs, all aiming at providing evidence-based health promotion for seniors[8].

Finally, public health researchers and policymakers have been collaborating to address the issue of a diminishing workforce. In theory, allowing older adults to continue engaging in work will allow them to better maintain their mental faculties[9], as well as reduce the stress on the Medicare system. Many argue to do this by delaying the retirement age; however, current policymakers have utilized less drastic measures in order to acclimatize the political climate to this change. For example, the Social Security Administration offers up to 32% additional benefits for those who retire after age 70, which has led to a number of articles[10][11]exploring the opportunities and highlighting the personal benefits of delayed retirement. It seems that the effects of this policy have yet to be fully understood, but for now, the results certainly seem promising[12]!

The relationship between health and age involves not just public health but an interdisciplinary wealth of economical, political, and environmental factors. A better understanding of what exacerbates aging is a fundamental step to building infrastructure in order to support our aged population. In recent decades, geriatric public health has initiated many more holistic approaches to elderly care, and it will be exciting in future years to see how health and aging intertwine.

Sources:

1. Life Expectancy at Birth, Total (Years) | Data. https://data.worldbank.org/indicator/SP.DYN.LE00.IN. Accessed 22 Oct. 2017.

2. Global Health and Aging. https://www.nia.nih.gov/sites/default/files/2017-06/global_health_aging.pdf.

3. David E. Bloom, Axel Boersch-Supan, Patrick McGee, and Atsushi Seike. Population Aging: Facts, Challenges, and Responses. May 2011. PGDA Working Paper No. 71.

4. Health Affairs. Aging and Health. http://content.healthaffairs.org/content/36/10/1696/F1.large.jpg . Accessed 19 Oct. 2017.

5. Frailty, Heart Disease, and Stroke: The Compression of Morbidity Paradigm. – PubMed NCBI. https://www.ncbi.nlm.nih.gov/pubmed/16389144. Accessed 22 Oct. 2017.

6. Goetzel, Ron Z., et al. “Can Health Promotion Programs Save Medicare Money?” Clinical Interventions in Aging, vol. 2, no. 1, Mar. 2007, pp. 117–22.

7. Centers for Medicare. SRRD_Eval_First_Year_Report. 4 Apr. 2012, https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Reports/Research-Reports-Items/SRRD_Eval_First_Year_Report.html.

8. National Council on Aging. Highest Tier Evidence-Based Health Promotion/ Disease Prevention Programs. https://www.ncoa.org/resources/ebpchart/. Accessed 18 Oct. 2017.

9. Williams, Kristine, and Susan Kemper. “Exploring Interventions to Reduce Cognitive Decline in Aging.” Journal of Psychosocial Nursing and Mental Health Services, vol. 48, no. 5, May 2010, pp. 42–51. PubMed Central, doi:10.3928/02793695-20100331-03.

10. Maranjian, Selena. 3 reasons to Delay Taking Social Security. https://www.fool.com/retirement/2017/02/26/3-reasons-to-delay-taking-social-security.aspx). 16 Feb. 2017. Accessed 19 Oct. 2017.

11. Wohlner, Roger. Tips on Delaying Social Security Benefits. 4 Jan. 2017. http://www.investopedia.com/articles/financial-advisors/010416/tips-delaying-social-security-benefits.asp.

12. Shoven, John B., and Sita Nataraj Slavov. “Does It Pay to Delay Social Security?*.” Journal of Pension Economics & Finance, vol. 13, no. 2, Apr. 2014, pp. 121–44. Cambridge Core, doi:10.1017/S1474747213000309. Public Health and Aging: Trends in Aging — United States and Worldwide. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5206a2.htm. Accessed 19 Oct. 2017.

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