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Shifting clinical perspectives on the fast-growing older adult population
The growing population of older adults in the United States has been described as a “silver tsunami” — like an impending wave that will overwhelm resources. But a panel of health and aging experts recently suggested that view should be flipped on its head, looking instead at the opportunities that come with people living longer and contributing to society.
“We should think of this as the ‘silver reservoir,’” says Wendolyn Gozansky, MD, MPH, a geriatrician and vice president and chief quality officer of the Colorado Permanente Medical Group. “We have this population of these very wise folks that we can rely on, and it speaks to the importance of setting up intergenerational places of community.”
Dr. Gozansky spoke on the May 15, 2023, virtual Permanente Live webinar, “Meeting the Health Needs of an Aging Population,” which examined how the health care industry can prepare for the growing number of people 65 and older. This demographic shift is expected to reach 81 million people, or 22% of the U.S. population, by 2040.
4 keys to age-friendly health care
While the focus on this demographic growth looks at potential challenges, it’s important to remember the positive accomplishments of the Baby Boomer generation leading this trend. For example, almost doubling life expectancy in the last 100 years “is a pretty big deal,” says Terry Fulmer, PhD, RN, FAAN, president of the John A Hartford Foundation, calling it one of the “greatest success stories” of the growing population.
The Hartford foundation, a private philanthropic body dedicated to improving the care of older adults, promotes the creation of “age-friendly” health organizations that focus on “the 4Ms” to address the needs of older adults. They include:
- Matters: Knowing what matters to an older patient
- Medications: Paying attention to dosage and not overprescribing
- Mentation: Managing depression and delirium
- Mobility: Ensuring people move safely
Focusing on these 4 areas produces high-quality, respectful care “that changes the paradigm,” Fulmer says.
Dr. Gozansky adds that an integrated health system like Kaiser Permanente allows interdisciplinary teams to work together to focus on what the patient really wants and needs. This collaborative approach supports the quadruple AIM — improving population health, enhancing the patient experience, reducing costs, and improving care team well-being.
Still, there’s more to do to support care for older adults. The nation faces a scarcity of geriatricians as part of an overall industry-wide physician shortage — the American Geriatrics Society counts about 7,000 geriatricians in the United States.
“I would like to think geriatricians are the happiest subspecialists out there, and yet there aren’t enough of us,” says Dr. Gozansky, who believes health organizations need to “geriatricize” their primary care physicians to understand the needs of older patients. “How do we use geriatricians as specialists like a consultant?” she asks, noting that physicians at Kaiser Permanente use e-consult tools to connect with Permanente geriatricians on complex care for older patients.
“With the demographics, we all have to be able to take care of older adults” with complex conditions, Dr. Gozansky says.
Supporting older adults at ‘inflection points’
Sachin Jain, MD, MBA, FACP, is CEO of SCAN Group and SCAN Health Plan, one of the nation’s largest not-for-profit Medicare Advantage plans. He refers to significant milestones in the life of an older adult as “inflection points,” when health care organizations should intervene and support. Dr. Jain shares how he recently helped his father maneuver the health care system and how that experience shed light on the industry’s failings.
“We have a health care system and we have a Medicare program that I think has not necessarily been designed to support people during those inflection points,” he says, explaining how the federal program for older adults is no longer relevant to the needs of current patients.
“The system that we built, Medicare, is now 53 years old and it’s time for a full reboot.”
Panel moderator Stephen Parodi, MD, executive vice president of The Permanente Federation, emphasizes that the topic of an increasing older population should also consider family caregivers who are often called upon to support care of loved ones.
We have a health care system and we have a Medicare program that I think has not necessarily been designed to support people during those inflection points.
— Sachin Jain, MD, CEO of SCAN Group/SCAN Health Plan
Susan Reinhard, PhD, RN, FAAN, senior vice president and director of the AARP Public Policy Institute, says there are an estimated 21 million family caregivers in the country, providing free care calculated to be worth $600 billion in 2021. Caregivers need the support of health care professionals, and she suggested clinicians undergo training to better anticipate their needs.
“Learn how to talk in a way that invites people in and doesn’t make them feel ridiculous for asking the question or not knowing what to ask,” she says.
Related story: “What is quality health care and why it matters”
Reinhard is hopeful that the country is starting to recognize the needs of caregivers for older adults, as demonstrated by the recent national strategy outlined in a report from the RAISE Family Caregivers Act. She says more can be done, either through federal programs or policies such as family caregivers tax credits or additional paid family leave for caregivers.
Panelists also spotlight pervasive ageism found at all levels in health care, from the way physicians interact with older patients to health institutions that systematically overtreat or undertreat older adults.
Dr. Jain also touches on the mental well-being of older adults, saying the crisis of isolation and loneliness among older adults is a longstanding issue. He said health care organizations aren’t the only sector that needs to focus on this topic, but all of society. Asking what programs should be created to address isolation among older adults is the wrong approach, saying “we need more of a social movement around this particular issue. The health care system can only do so much. … We need to reinvigorate our civic lives, not everything needs to be addressed in the exam room.”
Watch the full replay of the webinar above.