The global population, and that of the US in particular, is rapidly aging. The combination of the largest ever demographic cohort (the baby boomer generation) reaching retirement age, plus increased life expectancy, means that the proportion of older adults to younger people is shifting dramatically. This change is already putting significant pressure on healthcare provision, and the situation will grow even more urgent in the coming years.
The nursing and healthcare sectors will have to respond both to increased demand and changing needs, as its focus shifts to those services most required by the elderly. In addition, the current and coming generations of older patients may have different requirements and expectations to their predecessors. Adding to the difficulty is the number of nurses and other medical professionals expected to retire in the next 10–20 years, depriving the sector not just of individual staff but of the skills and insights built up over years of experience.
The grey tsunami
In western nations such as the US, the years following the Second World War saw an unprecedented increase in the population, due both to a spike in birth rates and higher standards of living, resulting in more newborns surviving to adulthood. This period, roughly 1946 to 1964, became known as the baby boom, and those born during that time were labelled the baby boomer generation.
The boomers came of age during the 1960s, when the number of young people in the US outnumbered older generations for the first time. Their numbers and their significant spending power led to a much-trumpeted ‘youth revolution’ in which culture, commerce, politics, etc., became increasingly driven by the needs and desires of the young.
Now, this situation is reversed. The generation that gave us the youth revolution of the sixties is threatening to become a so-called ‘grey tsunami’, as the baby boomers reach retirement age. By 2030, this whole generation will be aged 65 or over, meaning that more than 20% of the US population will be retired.
According to the US Census Bureau, by 2035, older people will outnumber children for the first time ever, with 78 million over-65s compared to 76.7 million under-18s. More pressingly, the ratio of retired dependents to working adults will also shift. In 2020, there were 3.5 working adults for every retired person. By 2060, that will change to 2.5 working adults for every retiree.
Increased life expectancy
As we can see, projecting so far ahead, the problem is not just confined to one overlarge generation. The situation will not ‘return to normal’ once the baby boomers have passed on. The greater issue is one of overall increased life expectancy, combined with declining birth rates. Each succeeding generation is living longer than the last, and each succeeding generation is also smaller than the preceding one. This means that if current trends continue, we will have to adapt to permanently having more older people in society, alongside fewer working adults and younger people.
The overall population is also growing as it ages. In 2020 the US population was 330 million, of which 54 million were over 65. By 2060, the total population is expected to reach 404 million, with 95 million over the age of 65. Alongside this, the average life expectancy rose from 70 in 1968 to 79 in 2018, although it has since dropped to 76 in 2022, partly due to the Covid pandemic. Nevertheless, US life expectancy could still hit 85 by 2060.
Similarly, although US population growth slowed to 1% in 2021, there are still expected to be 20 million more US citizens born every year to 2040. In terms of life expectancy, more people are living to be 100 years old, and the fastest growing demographic is actually the ‘oldest old’ — those aged 85 or over — who are also the cohort most in need of ongoing healthcare, frequently complex treatment, and interventions due to injury or illness.
Supply and demand
In a sense, the success of healthcare in the US has created a rod for its own back. One of the primary reasons that people are living longer is that healthcare is continually improving. But older people still need more access to healthcare than they did when they were younger, as the elderly are still more susceptible to chronic diseases and other vulnerabilities.
Better healthcare has helped to create more demand for it. In any other industry, this would be the very model of success. But when demand threatens to outstrip supply in a sector concerned with human health then not only are lives put at risk, but questions of personal dignity, equal accessibility, alleviation of suffering and basic rights must also be addressed.
An elderly or aging population has greater and different healthcare needs. More facilities, more services, and more qualified medical professionals will be needed as time goes on. But in the US, supply is failing to keep up with demand. There is also the question of cost, with public healthcare especially feeling the strain.
In 2020, more money was being paid out of social security than was being paid in by working citizens. Most of these additional costs were in the form of public healthcare. If this continues, and the system is not overhauled, social security will be unable to meet demand by the mid-2030s. We can therefore expect to see radical changes in public healthcare funding over the next decade.
The pressure is increased by the fact that the greatest demand is for long-term healthcare, i.e., the care and treatment associated with aging. In the private sector, the market for home care equipment and staff is expected to be worth $225bn by 2024. Money is also needed to train the next generation of nurses and medical professionals, and to provide competitive wages and other benefits that will attract and retain competent, qualified individuals.
For the past few years, there has been an acute nursing shortage in the US. One of the main reasons for this is an aging population. Not only does the sector need to attract more nurses, and provide the necessary training and education for applicants, it needs to encourage more advanced practice nurses to specialize in gerontology and other areas relevant to the care of older patients.
Rockhurst University offers an online AGACNP program that allows working nurses to gain a Master of Science degree as an adult-gerontology acute care nurse practitioner. This can be completed in just six semesters studying full time, or eight semesters part time. With clinical hours included alongside 100% online coursework, this CCNE-accredited program is designed to meet the growing demand for qualified gerontology nurses.
The generation currently reaching the age where many require full-time care are more likely to want to remain in their own homes than previous generations were. In addition, they are more likely to own their own homes and to have the savings to facilitate this. The generations after the baby boomers are also likely to prefer to stay in their own homes, even though they may not have the same resources to fall back on.
It is also notable that the old people of today have fewer children than their predecessors, and their children also have fewer children. They also have fewer siblings than their parents did and are more likely to be divorced. All this adds up to the fact that whereas in the past the elderly may have been cared for by an extended family, today and in the future they are more likely to have to manage alone.
The pressure of caring for an aging population will undoubtedly accelerate the development and adoption of digital technologies in healthcare. Digital solutions like telehealth can make long-term healthcare for the elderly in their own homes more affordable than going into a nursing home or other care facilities.
Examples include mobile technology, such as wearables, that allows medical professionals to monitor patients outside of traditional clinical settings and hours. Remote patient monitoring (RPM) facilitates the electronic transmission of information between patients and their physicians. Digital blood pressure cuffs will regularly update a doctor on an individual’s pulse and blood pressure, without the wearer having to do anything.
Individuals can also monitor their own fitness, allowing them greater autonomy. Thanks to apps that remind users when to administer medication or which vitamins to take, help with eating or exercise routines and appointments, and provide other forms of vital assistance, older people can have more control over their own health and can continue to lead independent lives for longer.
More innovations in assisted living include smart pillboxes that anticipate dosage and timing, plus wearables that check for irregular movements and call for assistance if a person falls over. The Internet of Things will revolutionize home healthcare as devices will respond to voice control or motion detectors and will be able to contact medical authorities in cases of suspected emergency.
Soon we may even see personal robots programmed to help the elderly with chores like washing, dressing and preparing food. In this way, technology will not only help with the shortfall of nurses by taking the pressure off human healthcare employees, but will improve the quality of care available to older people in their own homes.
As digital technology becomes more commonplace in healthcare, there is a greater need for skilled medical professionals who understand how to use the new tools, and who can pass on this knowledge to their colleagues. Because technology is evolving so fast, nurses and other practitioners need to keep their knowledge up to date and adapt to each new innovation as it happens. Skilled nursing leaders, faculty, and research and information specialists are vital to the ongoing development of digital solutions and their successful deployment.
There is already a severe shortage of medical caregivers, with an estimated 2.3 million new healthcare workers needed over the next two years. By 2025 there is expected to be a shortfall of 290,400 nursing practitioners, 95,000 nursing assistants, and 446,300 home health aides. As boomer nurses retire, and their younger colleagues also take early retirement, we could lose 1 million nurses by 2030. It is further estimated that over half of current nurses could leave the profession in the next two decades.
Passing on skills
The immediate future of healthcare must involve addressing this problem. More effort needs to be made to encourage young people into the medical profession. In terms of caring for the elderly, it is important to recognize the increased diversity of each new generation of senior citizens. The nursing staff caring for them should reflect this diversity, with a greater percentage of nurses and other medical professionals coming from different ethnic and cultural backgrounds.
There also need to be more opportunities for training, especially in those specialties relevant to long-term care. These include gerontology, hospice care, home health, and working with chronic conditions that afflict us in later life. More places need to be available to train the next generation of nurses, with older nurses encouraged to mentor their younger colleagues. This is to ensure that the skills and knowledge gained by retiring nurses are not lost and that there is a continuity of care within the profession.
Chronic disease prevention
Modern healthcare has done much to prevent and reduce the impact of chronic disease, but we are very far from eradicating it entirely. The work done means that people are able to live longer, but it is still the case that the older we get, the more likely it is that we will suffer from one or more chronic conditions. Most of these can be managed and treated to some degree, but this requires resources in terms of drugs, facilities, equipment and trained medical practitioners.
The future of healthcare will feature more research into chronic diseases and the conditions associated with aging, many of which may be preventable. In many cases, this prevention can be achieved via lifestyle changes much earlier in life. More resources will be put into education, public health campaigns, and other measures designed to promote, encourage, and facilitate exercise, healthy eating, positive lifestyle choices and so on.
Currently, 60% of US adults have at least one chronic condition. As the population ages, this percentage will increase. An administration prepared to consider long-term solutions may realize that investing in healthy food programs for underprivileged children, or providing warm, damp-free public housing, proves more cost-effective than treating chronic conditions in older adults further down the line.
Between March 2020 and January 2021, the demand for in-home caregivers (home health aides, certified nursing assistants, and personal attendants) grew by 125%. Alongside this, there is an increasing need for hospice facilities and staff trained in end-of-life care. In this environment, the focus is shifted away from medical treatment and intervention towards comfort care and the achievement of personal goals. The aim is no longer patient recovery, but quality of life with a terminal condition.
Between 2015 and 2019, Medicare costs for hospice care coverage rose from around $15bn to over $20bn. This shows an increasing demand for hospice care and perhaps a changing attitude towards old age and death. The emphasis is not so much on trying to postpone the inevitable, but on accepting it and living well in our final years or months.
The healthcare needs of the elderly are both widespread and specific. As we get older, we are more likely to suffer from chronic illnesses, such as heart disease, diabetes and cancer. We also have greater vulnerability to physical injury and illness, as well as physical and cognitive disabilities. Older people have more limitations in terms of daily living and are more reliant on prescription medication.
Tomorrow’s healthcare will reflect these needs, as older people will increasingly make up the majority of service users. They already make more hospital visits, use nursing homes or home healthcare, and are more reliant on ambulances than younger people. As they become more of a dominant group in society overall, the elderly will be even more present as healthcare recipients.
Older people are also more likely to live in rural areas, where healthcare provision is more limited or harder to access. This will need to be addressed with a combination of more out-of-city facilities and more use of telemedicine to diagnose and treat patients remotely in their own homes.
The next few years will be a challenging time for the healthcare sector. There is already an acute shortage of trained medical professionals, including nurses and physicians, and this shortage will worsen as more reach retirement age over the coming decade. At the same time, an aging general population will put unprecedented pressure on services and facilities.
By providing the means for more dedicated individuals to enter the profession, and focusing more on gerontology-related specialisms, the medical and nursing sector will rise to this challenge. Digital technology will play an ever-greater role in patient care, alongside skilled staff able to meet the changing needs of their patients. We can all look forward to a longer life and better understanding of what is required to make it worthwhile.
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