Overhaul needed to adequately care for aging U.S. population

By 2050, one-in-five Americans will be at least 60 years old, and the current health care system is not prepared to meet the needs of a growing elderly population.

In 2003, the United States spent about $250 billion caring for older people with chronic conditions, according to data presented at a press conference hosted by the Journal of the American Medical Association. Caring for these patients accounted for about 80% of Medicare spending, and health officials expect these figures to climb to unsustainable levels as people from the baby boom generation continue to age.

Chad Boult, MD, MPH, a professor of Public Health at Johns Hopkins Bloomberg School of Public Health and director of the Lipitz Center for Integrated Health Care, both in Baltimore, Md., said that older patients with complex health care needs often receive care that is “fragmented, incomplete, inefficient and ineffective.”

Several factors have contributed to these deficiencies, most notably: professional training and education that does not teach clinicians how to care for patients with multiple conditions; lack of interoperable health information technology across multiple patient-care settings; gaps in insurance coverage for certain services; and separate payment systems for medical and social services.

Based on a review of existing medical literature, and incorporating aspects of three existing primary care models – the Geriatric Resources for Assessment and Care of Elders, Guided Care and the Program of All-Inclusive Care for the Elderly – Boult recommended adopting the following four processes to improve care for this population:

  •       Comprehensive assessment;
  •       Evidence-based planning of care;
  •       Monitoring and measuring the success of the program over time;
  •       Promoting patient and family engagement in care.

“We've learned that for a new innovative model of care to be widely adopted it has to be appealing to all,” Boult said. “The stakeholders, doctors, nurses, payers, patients and families have to like it. If any one of those stakeholders doesn't like it, it won't work.”

The full analysis by Boult and colleague G. Darryle Wieland, PhD, MPH, research director of Geriatrics Services at Palmetto Health Richland Hospital in Columbia, S.C., was published online yesterday as part of a JAMA's Aging issue.

In an accompanying editorial, Arpita Chattopadhyay, PhD and Andrew B. Bindman, MD, of San Francisco General Hospital, wrote that increasing health care costs combined with an aging U.S. population make “the development and scaling up of cost-effective models of integrated care” an urgent matter. “Health care reform has given the Centers for Medicare and Medicaid Services new authority to promote the process. “

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