Preparing for What's Needed for an Aging Population

Despite awareness of a rapidly increasing size and proportion of older persons in the United States, the nation is not investing sufficiently in keeping people healthy late in life, and significant deficiencies are predicted in our capacity to deliver the medical, public health, and support services needed for the future frail and ill older population, according to a recent Viewpoint article in JAMA.

John W. Rowe, MD, and Linda Fried, MD, of Columbia University Mailman School of Public Health in New York City, and Terry Fulmer, PhD, RN, of the John A. Hartford Foundation in New York City, wrote that valuable advances are needed in 4 vital directions central to the health and well-being of older persons, especially those at greatest risk because of social disadvantages or medical conditions.

Develop new models of care delivery

Existing strategies for care delivery that add value require broader dissemination and new approaches that address the clinical and financial challenges presented by multiply impaired frail patients.

Patients with comorbidities are a challenge to both clinical management and control of costs, and all clinicians must coordinate in setting goals and sharing information if effective care is to result. Evidence-based strategies are available to improve the care management of frail older persons with comorbidities, such as the Transitional Care Model, a nurse-led care coordination model proven to yield benefits in quality care and well-being while reducing expenditures, according to the authors.

Unfortunately, the authors wrote, the limits of organizations, reimbursement restrictions, and a lack of effective coordination and sharing of data among clinicians and hospitals and clinics has hindered dissemination of useful strategies.

Augment the elder care workforce

Specialists in geriatric medicine, across all health professions (including public health) must be strengthened to conduct research, provide specialized care, and lead educational efforts to enhance the geriatric competence of all healthcare practitioners who manage the care of older persons.

The challenge included increasing both the number of these workers and their competency. Training enough board-certified geriatricians has long lagged behind national goals, and similar deficiencies exist in all other relevant components of the elder care workforce. Poor compensation for these jobs is a big problem that cannot be ignored either. There is also a lack of sufficient training and demonstrated competence of all healthcare and public health practitioners who care for older patients.

Promote the social engagement of older persons

Enhancement of public and private programs to encourage the engagement of older persons in the labor force and in volunteering will yield substantial benefits in both health and well-being. The US needs to reverse a decades-long trend toward the disengagement of older people through measures such as strengthening on-the-job and community college training for middle- and later-life workers.

Transform advanced illness and care at the end of life

Widespread weaknesses in the care received by people with advanced illness, especially those at the end of life, can be improved through the use of available evidence-based approaches. These efforts will help maintain dignity and improve care quality while reducing the waste of resources. Also needed is payment for care tailored to the complex needs of those with advanced, serious illnesses near the end of life, such as palliative care and advanced-care planning.

The authors wrote that implementing these recommendations is important for the future of the US healthcare system.

“Given the substantial increases in the number and proportion of older persons in the United States, this is a critical task, and the healthcare system and the nation cannot afford to fail,” they concluded.