We’re getting older and living longer. An American who is 65 today could live, on average, roughly 20 more years, according to data from the Administration for Community Living (ACL). That’s good news, but due in part to this aging patient population, demand for healthcare services is increasingly outpacing supply.
In fact, the 85+ population is projected to increase 123% from 2017 to 2040, according to the ACL. U.S. Census Bureau data shows that by 2030, all baby boomers will be older than 65; by 2034, there will be 77 million people 65 and older versus 76.5 million under 18.
These changes will affect the way you practice medicine, perhaps dramatically. Geriatrics and primary care will of course face tremendous challenges, but so too will various surgical subspecialties, neurology, endocrinology, rheumatology, psychiatry, cardiology, pulmonology, orthopedics and ophthalmology. If your practice sees senior patients today, you’ll see a lot more of them tomorrow, and you’ll see them get older.
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Special concerns
Senior patients are, on average, sicker than younger ones; about 80% of those 50 and older have at least one chronic condition, according to an AARP report. Regardless of your specialty, there are numerous issues related to an aging patient population that you need to pay attention to. Here are just three.
Dementia and Alzheimer’s
According to the Centers for Disease Control and Prevention, Alzheimer’s disease (AD) is the sixth-leading cause of death among adults in the U.S. and the fifth-leading cause of death among Americans age 65 and older. The incidence and prevalence of AD will only increase as baby boomers age, and this will have a direct impact on your practice, affecting everything from obtaining truly informed consent for procedures to discussing medication therapy.
Diabetes
In the U.S., those 65+ comprise more than a quarter of the total population with diabetes, according to Diabetes Spectrum. That means if, somehow, diabetes incidence rates were to plateau, prevalence would still double over the next two decades as the population becomes older. Why single out diabetes? Aging and diabetes independently increase the risk of an array of problems, including cognitive dysfunction, depression, falls and fractures, urinary incontinence and chronic pain.
Medication
In addition, older patients may have an increased risk of drug accumulation because of decreased renal function. Getting the medications right may be more important for this population than others. This is especially true for pain management.
Beyond the clinical
Especially if you’re new to the practice of medicine, working with an aging patient population requires a deft touch.
Organizations like the National Institute on Aging (NIA) offer helpful guides for understanding your older patients. Much of the advice focuses on communication; though some of the following recommendations may seem obvious, consider them a refresher.
- Use preferred names. Find out how your patient wants to be addressed. Mrs. Smith? Ms. Smith? Dr. Smith? Marla? Your older patients may be more likely to want something more formal, but always ask. (And really, that’s a good tip for any patient.)
- Listen—don’t interrupt. An oft-cited Annals of Internal Medicine study found that doctors interrupt patients within the first 18 seconds on average.
- Make sure your patients can hear you. Half of those over 75 have serious hearing loss, according to the NIA. If necessary, speak slowly and write out what you’re saying. But don’t take this too far. The last thing you want to do is patronize or condescend to your patients.
- Allow extra time, if possible. This doesn’t apply just to you. For example, your MA may need more time checking vital signs and prepping patients for visits.
More patients, fewer doctors
Patients aren’t the only ones getting old. Physicians 65 and older comprise 15% of working doctors, while those 55 to 64 comprise 27%, according to the Association of American Medical Colleges. As patients and providers alike age, the U.S. will see a shortfall of up to 121,900 physicians by 2032.
Doctors will need to deploy innovative approaches to improve patient access while controlling costs. Team-based care is one possibility for this; care coordination and gathering data are also crucial. As your patients age, see more doctors and take more medications, you will want access to longitudinal patient data, aggregated from multiple sources. This will give you (and, ideally, their other providers) a complete picture of your patients and their needs, helping you identify the tools you need to provide better care.
An aging patient population will change the way you practice medicine, and now is the time to prepare.
