Addressing the conundrum of more seniors living longer with chronic illness and disability
The U.S. is currently transitioning from the “aging society” category (7% or more people aged 65 years or older) into an “aged society” (14% or more). In a short six years, we will likely cross into the “superaged society” category with 20% or more of the population 65 or older. When coupled with advances in medical care that can treat acute illness and prolong life, an untoward effect is that more older adults are living longer but with a chronic condition, comorbidities, or disability. This creates several senior healthcare outcomes that must be addressed and planned for as a surge in the number of older adults is predicted over the next 15 years.
More older adults living longer creates challenges in healthcare for the elderly
According to AARP’s 2021 Aging Readiness & Competitiveness Report, “Although life expectancies have been increasing, evidence shows that healthy life expectancies have not kept pace (even as a proportion of total life expectancy), meaning older adults are living longer but with a chronic condition or disability.”
The increased number of older adults is and will continue to put tremendous pressure on an already-stressed healthcare system. In many ways, the current approach to healthcare does not adequately accommodate the needs of older adults. Many health systems focus on treating acute illnesses. Yet, most older adults have one or more chronic conditions requiring more regular monitoring and, many times more expensive, care.
This conundrum raises two questions: How can payers and provider organizations support healthier life spans where seniors experience less illness and disability and need less care or less costly care? Preventing and managing chronic disease is the answer.
Preventing and managing chronic illness and disability is key to aging population healthcare
Nearly 79% of adults 70 and older have at least one of seven potentially disabling chronic conditions -- arthritis, hypertension, heart disease, diabetes, respiratory diseases, stroke, or cancer. By 2030, researchers estimate that more than 60% of Baby Boomers will be managing more than one chronic conditions.
When older adults live longer but with greater illness and disability, it creates an outsized burden for each individual but also for their families, employers, and the healthcare system. Senior adults must spend more of their retirement income on healthcare and care services.
Unpaid family caregivers may not be able to work for pay or as much because of caregiving duties or work more to pay for services for the older adult. Employers may experience loss of work productivity when employees are stressed about an older loved one. A report authored by two Harvard researchers found that 80% of employees who had caregiving responsibilities said that their role affected their ability to perform at their best.
Modifiable factors where healthcare for the elderly can prevent and manage chronic disease well
Six medical, care quality, care management, and interventional areas stand out as keystones to improving healthcare for the elderly, where multiple positive outcomes are realized from achieving one important objective. These six foci can unlock greater quality of care for senior adults, as well as gain a higher quality of life at a lower cost.
Senior medical and care quality areas
Preventing cognitive decline is the first keystone area for improving healthcare for the elderly for three reasons. First, cognitive decline and dementia are a primary reason for nursing home institutionalization. Second, cognitive well-being is a fundamental determinant of positive and healthier aging. Third, if an adult has no medical co-morbidities, their healthcare is costliest and could last longer than peers.
Accelerating time-to-baseline is crucial when seniors have been hospitalized, particularly in the intensive care unit (ICU). In a study published recently in the Annals of Internal Medicine, researchers reported that after hospital admission with a stay in the ICU, older adults who were eligible for both Medicare and Medicaid “were far more likely to develop changes in physical function and were significantly more vulnerable to cognitive impairments than older adults not eligible for Medicaid.”
It’s critical for senior adults to recover their physical and cognitive function within the year after hospital or ICU admission. Otherwise, the likelihood was high that they would experience loss of independence, more nursing home stays, and higher healthcare costs.
Integrated primary care is evolving; however, models of care like the patient-centered medical home (PCMH) model, advanced primary care, and accountable care organizations (ACOs) need to expand, become more integrated and scale to prepare for the growing volume of senior adults in the coming years.
UN’s Decade of Healthy Aging Program to address gaps in senior healthcare
The UN’s “Decade of Healthy Aging” program called for four imperatives, which included “Deliver person-centered integrated care and primary health services that are responsive to the needs of the individual.” Integrated, patient-centric, team-based healthcare must take center stage for healthcare delivery systems.
Partnered or integrated with payer programs, caring for a growing population of seniors to prevent or manage chronic disease effectively will require an increased focus on prevention and health promotion at all levels. Self-management and support for family caregivers will require greater attention, as well as automating and tapping technology to streamline care processes, remote patient monitoring, and digital health interventions to avoid exacerbations and hospitalization.
Programmatic and interventional areas that address aging population healthcare challenges
Lifestyle factors are the modifiable areas that make up 75% of differences in health and function for senior adults versus 25% of the differences made up by genetics. Health promotion, literacy, and support for healthy behaviors are essential; however, many disparities in health outcomes for older adults are related to socioeconomic factors outlined below.
The use of community health workers, the growing adoption of technology support for seniors, and greater in-home or telemedicine care channels can positively affect lifestyle changes over time. Trends in age-friendly cities, the village movement, and health-centered communities have the potential to impact lifestyle factors as adults age positively.
Social determinants of health (SDoH) have a more significant impact as adults age, compounding existing disparities through ageism. Socioeconomic determinants, including where one lives, economic and societal influences, racial or ethnic background, level of education, and gender, can accumulate into greater advantages or disadvantages. Awareness coupled with proactive interventions is critical to older adults facing barriers to health and optimizing their advantages.
A 2019 report by the Gerontological Society of America (GSA) suggests, “The issue of life-course disadvantage is often not significantly addressed or understood by many professionals in gerontology.” Understanding how disadvantages accumulate as people age and the outsized impact of economic inequality on seniors dramatically affects health, quality of life, and the overall cost to the person, system, and government.
Isolation and loneliness are growing in focus. Studies have indicated that loneliness and social isolation may have the same effect on health as risk factors like smoking, high blood pressure, and obesity. The GSA reminds us that loneliness and isolation are not the same thing: “loneliness denotes how people perceive their experience or how they feel, whereas isolation is quantifiable with reference to the size of a person’s social network and amount of engagement with it, availability of transportation, and ability to access resources and information.”
Isolation is a multi-factor problem resulting from various issues, including lack of transportation or mobility, societal barriers, poverty, and cultural shifts. With more than eight million adults aged 50 years or older dealing with health effects from isolation, this area will grow in priority.
Prioritizing older adults is a sound strategic objective
Provider and payer organizations that pursue strategies, programs, and investment into seniors' challenges are not only needed as a societal commitment, but it makes sense financially and operationally. Organizations that help seniors live higher-quality lives with less chronic illness and disability will benefit from greater brand awareness, market share, and patient and family loyalty.
If you would like to discover how to address the unique needs of older adults better and how your services and care are delivering what they want and need, turn to RTI Health Advance. We can ensure that your strategies, programs, policies, and operations match your intention for person-centric care. We can also assess the impact of interventions focused on senior adults and their effects on care quality, population health, and health equity to determine these programs’ economic and community value.
Learn more about RTI Digital Health services and connect with us.