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AGING AND GERIATRIC CARE

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Demographics of Aging and its Implications for Geriatric Care

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The United States and other countries will continue to experience a rapid increase in the number of older adults who seek health care. The most rapidly growing segment of the population in the United States and many other developed countries is those aged >80 years (Fig. 464-1). Sex composition of the aging population around the world is also expected to change. Although females outlive males, an improvement in survival of the oldest males could result in more balanced sex distribution in the geriatric population in the future.

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FIGURE 464-1

Percentage of the population age >80 years from 1950 to 2050 in representative nations. (Updated data available at https://esa.un.org/unpd/wpp/Graphs/DemographicProfiles/. Accessed December 30, 2016.)

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Based on the United Nations’ 2015 World Population Aging Report, in high-income countries, consumption of health care resources will be most affected by the shift in the age distribution of the population over the next several decades. The World Health Organization continues to work actively to raise awareness of the changes necessary in current health care systems beyond increments in their budgets. Planning is increasingly being based on expected levels of disability and comorbidity. As lifespan increases, efforts should continue to focus on promoting healthy aging to reduce the burden of disability in health care systems all over the world.

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Implications of the Aging Population for Health Care Systems and System-Based Practice

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The geriatric population requires different approaches to care for several reasons. For example, acute illnesses are most often not treated in isolation, but in the context of multiple co-morbidities. Close to half of those aged >80 have three, and about one-third have four or more chronic conditions (Fig. 464-2). Functional disabilities are prevalent (Fig. 464-3), which require careful attention in the evaluation of the older patient, along with assessment of social supports available for assistance when needed for independent and safe living.

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FIGURE 464-2

Prevalence of comorbidity by age group in persons ≥65 years old living in the United States and enrolled in Medicare parts A and B in 1999. (From JL Wolff et al: Arch Intern Med 162:2269, 2002.)

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FIGURE 464-3

Percentage of people age 65+ with various disabilities. (Source: US Census Bureau, American Community Survey, 2013. Available at https://aoa.acl.gov/Aging_Statistics/Profile/2014/index.aspx. Accessed December 30, 2016.)

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Effectively caring for the geriatric population requires consideration of several key principles:

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  1. Aging is not a disease; normal aging changes generally do not cause symptoms, but do increase susceptibility to many diseases and conditions due to diminished physiologic ...

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