Why the Aging Population is Such a "Problem"

Michael Gordon MD, MSc, FRCPC is a geriatrician working at Baycrest Health Science System. He is medical program director of the palliative care program, co-head of the clinical ethics program and a professor of Medicine at the University of Toronto. He is the author of Late Stage Dementia, Promoting Compassion, Comfort and Care; Moments that Matter: Cases in Ethical Eldercare and Brooklyn Beginnings: A Geriatrician's Odyssey. For more information see drmichaelgordon.com

This original entry was derived from BestThinking. Jul. 22, 2010

Whether in health care, public spending, or any arena of “public” life especially, solutions sometimes appear not only when least expected but when the “problem” is re-configured. This seems to be the case when one discusses the “challenge” of the current aging population in the United States and Canada with both countries sharing similar demographic distributions and fiscal pressures. The current construct of the “aging problem” is; “With an aging population, how can we address the rising costs and the burden on the health care system associated with the rapidly increasing prevalence of chronic illnesses, especially dementia which often results in the need for many years of institutional long-term care and an increasing use of costlier medical interventions? That is the current common framing of the situation in the media and government offices with the so-called experts arguing back and forth as to the best way to address what is often powerfully and negatively referred as the tsunami of the aging population.

            What if we started the conversation with a different perspective? The gains we’ve made in the function, longevity and comparative health of our seniors is one of the most phenomenal success stories in medicine and in the global concept of health care in general. When you explore the issue with the perspective of the history of our species and of modern medicine, the years of health promotion and disease prevention campaigns, with adoption of major efforts of public health to assure safe water and food and the gradual elimination of noxious agents and products in our shared environment we have actually achieved what hundred years ago would have been considered wildly imaginative thinking. The parallel would be the way that the “Dick Tracy Watch” of comic book fantasy fame has been morphed into a Smart Phone with many more functions than Dick Tracy could have imagined. When all is said and done, more people are living longer, and with a higher quality of life, than ever before in human history.

            Without doubt, some members of this aging population will develop certain conditions, and draw on more resources to maintain their health and well-being. That is the price we pay for what, in societal terms, is a tremendous benefit – a group of citizens who are able to enjoy life, continue to contribute, and be treasured members of their families and communities. If we formulate that as problem and an obstacle to our society achieving its financial stability, we’re in trouble. If on the other hand we formulate it as a byproduct of scientific and medical advances in a progressive and civil society, we have to accept that there are costs that come with that.   So why do we focus so much on the sustainability of the health care system as it specifically pertains to the aging population? Think of how western nations responded to the economic downturn. Over the last three or four years, with little dissent, we’ve spent untold billions to keep western economies going with bail outs out partially due to what some would call unwieldy (some would say corrupted) financial systems. Is it possible that however much we pay lip service to the value of the elderly; our society is ageist in many ways? Perhaps it’s because once someone leaves the workforce they’re perceived to be “unproductive” and their lives become ignored and less valued. Clearly an aging population poses tremendous health care pressures. An inordinate portion of a person’s lifetime health care costs occur in the last year or two of life. Changing that would be a significant accomplishment. The only dilemma – we can never identify that last year or two for sure until after the fact.

            So what might we do about these real financial costs? Do we start to have conversations, as families and as a society, of whether the expense of an ICU or a nursing home bed for an extra week or two of life, or month or two or three or six, is worth it not just in financial terms but in quality and meaning of life terms. Do we create a new social contract – full health coverage until a certain age, say, and then you’re on your own? Do we institute mandatory contributions for long-term care, along the various retirement support programs that exist in Canada and the United States? Do we consider new funding options to regain some of the money spent on senior programs? As one possibility, we could recoup some of the special financial gains made by health care product manufacturers (quite separate from their general taxation contributions) to be directed back into the health care system. For example, pharmaceutical companies would make an extra contribution into the government drug programs as the cost of those program increases to the benefit of the pharmaceutical industry?

            It’s time to re-think the “problem” we have. With all the enormous demands on the health care system, there are also many creative ways to re-distribute our collective resources for health care for all. Most important is that we must not forget that our aging population is an asset, and should not be deemed a burdensome cost. Unless we’re prepared to say that they’re expendable, we simply have to come to terms with valuing, supporting and investing in them— who are of course the us of the future.