Like many baby boomers and those from earlier generations, I have vivid memories from my younger years of my grandparents and other aging adults struggling with an assortment of ailments that their doctors told them were just an inevitable part of growing old.
They may have been family matriarchs or patriarchs, but when it came to easing their pain or getting help for underlying health conditions, the medical community basically turned a blind eye, whether they were dealing with senility, debilitating pain from arthritis, indignities like incontinence or other chronic illnesses. If you were old, you just learned to live through the despair and forget about trying to do the things that once brought joy to your life.
Slowly but surely, the nation's approach to caring for our elders began to change in the 1970s, thanks initially to the advocacy of Robert Butler, MD, a renowned gerontologist, psychiatrist and author who ridiculed the nation's medical community for discriminatory, institutional practices that ignored the suffering of older Americans. His 1975 Pulitzer Prize-winning book, Why Survive: Being Old in America, launched a social movement focused on the rights and needs of aging adults. His research awakened America that senility was not inevitable, and that "healthy aging" was achievable.
The transformative advancements made over the past half-century in meeting the physical and emotional health needs of the nation's rapidly aging population are remarkable — and that's especially important because more Americans are turning age 65 now than in any other time in our history (4.1 million in 2024, or 11,200 a day). And as we move toward a new year, every healthcare executive must examine whether we are collectively prepared to care for them in the years and decades ahead and take steps to recruit the medical specialists we need to meet burgeoning demand.
This includes orthopedics, where the prevalence of fractured hips and other debilitating injuries, America's hospitals and health systems also began focusing on ways to prevent falls, which continue to kill more than 32,000 people age 65 and over every year and injure millions of others. They also developed new methods for identifying and preventing delirium, a common disorder among seriously ill and hospitalized older adults that adversely impacts patients' brain functions, causing major confusion, lack of awareness, hallucinations and mood changes.
As providers became more enlightened of aging adults' needs, health policy changes and insurance payment reforms also helped strengthen the quality of care to older people. One important Medicare policy change was a provision included in the Affordable Care Act that paid providers for treating frail older adults in their homes instead of hospitals, nursing homes or doctors' offices. In a more-recent policy shift, the federal government is now training and compensating millions of caregivers tending to aging parents and loved ones in the home.
While America's healthcare delivery system has progressed remarkably over the past half-century, the nation's burgeoning senior population poses unprecedented challenges, in terms of both our ability to provide — and pay — for their care. Nearly one-in-five Americans, about 62 million people, are aged 65 or over. Within the next 30 years, that number is expected to reach 84 million – 23% of the population.
To avoid being overwhelmed by the demands of a graying America, federal and state governments, health care providers, and medical and nursing schools need to double-down on investments they've already made to advance geriatric, palliative and other care models that have proven beneficial.
We face significant shortages of primary care physicians and geriatricians who specialize in the needs of older adults and those with multiple chronic illnesses. Medical and nursing schools and health systems need to provide financial incentives for clinicians-in-training to enter those areas of medicine instead of more-lucrative specialties. If not, there simply won't be enough doctors or nurses to meet the needs of aging patients.
The roles of primary care physicians (PCPs), geriatricians and nurse practitioners (NPs) are critically important in promoting wellness and healthy lifestyles among aging adults, helping them maintain their health and independence through routine vaccinations and screenings. To help older people stay out of hospitals and nursing homes, we also need to further accelerate home- and community-based services that prevent the need for more-costly care.
Technology, especially telemedicine, will continue to be instrumental in enabling clinicians to remotely monitor patients in their homes and provide 24-hour access to care if there's an emergency.
The importance of integrating care for older adults with complex health needs is another key lesson we've learned over the years. To prevent older people from falling through the cracks because of social factors such as low income, poor education, substandard housing or lack of transportation, it's crucial that we take a holistic approach in coordinating medical, mental health and social services. Again, that's where PCPs, geriatricians and NPs play such an important role.
Lastly, all clinicians must embrace palliative care as part of their standard practice in managing the health of aging adults with serious illness. Obviously, the first priority is remedying the symptoms and pain that accompany chronic diseases. But perhaps more importantly in the long run, engaging patients and their loved ones in in advance-care planning discussions and their preferences for end-of-life care opens the lines of communications and helps ensure that their wishes are respected.
Michael J. Dowling is president & CEO of Northwell Health, New York's largest health care provider and private employer, and co-author of The Aging Revolution: The History of Geriatric Health Care and What Really Matters to Older Adults. Northwell Health is hosting its inaugural Aging Revolution Summit Dec. 3, convening patients and leaders across healthcare, business and philanthropy to advance age-friendly initiatives.