It is known as the “2030 problem.” That’s when the health care system in the United States will be challenged by caring for an elderly population projected to be twice what it is today.
Much of this growth will come from aging baby boomers, who in 2030 will be between 66 to 84 years old and will number 71 million people. Those born prior to 1946 are projected at 9 million people in 26 years.
“It is certainly true that we will need greater medical services and facilities to adequately meet the demands of our aging population,” said Larry Lindahl, medical director of the Institute on Aging in Peoria, Ill. “We are, of course, going to need more nursing homes, more assisted living facilities and more apartments for independent living.”
Also needed is a greater emphasis on training in geriatric medicine, Lindahl said.
“We need to better train doctors in the medical problems of the elderly,” Lindahl said. “For any medical field to advance, you need specialists in that field.”
Geriatric training seems to be woefully inadequate now, according to the journal Geriatrics: Medicine for Midlife and Beyond. Only one in 10 American medical schools requires course work in geriatric medicine, fewer than one in 30 graduating medical students have taken an elective course in geriatrics and only five of the 145 medical schools in the United States have departments of geriatric medicine. There are 42,000 pediatricians in this country compared with only 9,000 trained geriatricians — a ratio of one geriatrician to 8,500 baby boomers, according to the journal.
To properly address the 2030 problem, a change is required in the ‘culture of ageism’ that pervades the health care system, according to the Alliance for Aging Research, a nonprofit organization dedicated to accelerating the pace of medical discoveries to improve the lives of the elderly. In addition to a lack of training in geriatrics among physicians, the Alliance contends:
• Older patients are less likely than younger people to receive preventive care.
• Older patients are less likely to be tested or screened for diseases and other health problems.
• Older people are often excluded from clinical trials, even though they are the largest users of approved drugs.
“It is true that clinical trials in the past tended to exclude older people,” Lindahl said. “But there has been a shift in recent years to include older people.”
In his 20 years as a geriatric specialist, Lindahl has seen significant advances in medical care for the elderly.
“While much more is needed, medical schools across the nation are providing their students more exposure to the medical problems of the elderly,” Lindahl said. “And new technology is allowing us to treat illnesses we couldn’t in the past. For instance, joint replacement is very common and very successful now. That was something that was seldom offered to the elderly 30 years ago.
“In terms of medication, we have markedly improved options for heart disease and many other diseases. While we may not be at a place where we can offer a cure for many illnesses that accompany aging, we have many more options to help the patients. For instance, in the treatment of Alzheimer’s disease we now have medications that can reduce the symptoms of the disease. We didn’t have those medicines 10 years ago.”
And more than any previous generation, baby boomers are aware of the benefits of healthy living.
“Baby boomers are more conscious of their cholesterol, good eating habits and the importance of exercise and not smoking,” said Dr. John Coon, a geriatric specialist with the University of Illinois College of Medicine at Peoria. “They can avoid many health problems that their parents faced.”
Outpatient treatment will continue to be a medical trend, Coon said. And in the future, there will be greater emphasis on independent living for the elderly, especially those younger than 85. This could put greater strain on family caregivers. With baby boomers having smaller families, that means fewer children to care for them.
Even with healthy aging and increasing alternatives to nursing-home care, there will be increased demand for nursing home beds. Today there are 1.9 million nursing home beds. By 2030, it is projected that 3 million residents will be living in nursing homes.
“In the future, we are going to see hospitals with geriatric floors and more nursing homes with acute care units,” Coon said. “These acute care units will be like mini hospitals in nursing homes. Now, if you undergo a hip replacement you may spend a week or two in the hospital. Rather than staying in a hospital, patients may spend time recovering in an acute care unit in a nursing home.”
There may be a health-care crisis on the horizon, but there is time to deal with it. According to projections from the Census Bureau, there will be a moderate increase in the elderly population until about 2010, then a rapid increase for the next 20 years before a return to moderate increase between 2030 and 2050.
“There will continue to be advances in technology and medicines,” Lindahl said. “As demands in health care services and facilities increase, I’m confident we will respond to those demands.”