Who Will Care for an Aging America?
The IOM and other organizations have issued similar warnings over the past 30 years about coming shortages of health professionals, but now there’s a sharper sense of urgency. Although Congress has done little to address the issues in that time, Sens. Susan Collins, R-Maine, and Barbara Boxer, D-Calif., last month introduced legislation designed to attract and retain health care workers who are trained to care for older patients. The Caring for an Aging America Act is supported by AARP, which also helped fund the IOM report.
The report specially calls for much more emphasis on geriatric care in the health system because as people age, their health needs change. They often develop more than one chronic disease, such as high blood pressure, diabetes, heart problems, cancer, bronchial problems or arthritis. About half of people age 75 and over have two or more chronic conditions, and 26 percent have at least three, according to “Growing Older in America”, a recent National Institute on Aging report.
Taking care of multiple conditions, seeing how they affect the whole body and making sure that treatment for one condition doesn’t make another worse are special concerns of geriatric medicine. Geriatricians look at how a patient functions as a whole, says John Murphy, M.D., president of the American Geriatrics Society and professor of family medicine at Brown University’s medical school. “So I may be measuring their blood pressure and managing their kidney disease, but I’m also looking at whether they can get to the grocery store, get in and out of the tub, manage their finances.”
It’s a job that ideally needs a team—not only doctors and nurses but rehabilitation and nutrition specialists and social workers—to be done effectively. “Social services need to be integrated with health care services,” the IOM study says. “Providers need to be trained to work in interdisciplinary teams.”
How Healthy Will Older Boomers Be?
One big unknown is how much care boomers will actually need in old age. Will they be healthier than previous generations? Will their own attitudes and lifestyles shape the kind of care they need?
Research shows that boomers are better educated, wealthier, more open to new technologies and less likely to smoke than their parents were—all promising pointers for better health and the ability to function into old age. Chronic disability rates among older Americans have also dropped in recent years, even at the oldest ages.
But one cloud has appeared on the horizon. “Some initial analyses of the 55 to 64 age group have found evidence of deteriorated health or lack of improvement,” says Suzman of the National Institute on Aging. Although more research is needed, he says, “that’s not great news. And if we were to point to a possible factor, it’s going to be obesity and related diabetes. We need to watch this potentially ominous trend closely.”
Yet even if the decline in chronic disability continues among boomers, the IOM report says, “the size of the future older adult population is so large that, overall, the total need for services can be expected to increase.”
This raises another characteristic of boomers—they have fewer children, which translates into a smaller family caregiving force in the future. Offsetting that may be the fact that boomers are the first generation to have experience of taking care of their parents en masse, says Suzanne Mintz, president and cofounder of the National Family Caregivers Association.
“People forget that in 1900 people died at the age of 47 from infectious diseases,” she says. “Now they’re living so much longer and dying from slow, degenerative, chronic diseases, which creates a totally different scenario.”