Global aging and care

By Arvind M. Dhople, Ph.D., Professor Emeritus, Florida Tech

People worldwide are living longer.  Today most people can expect to live in to their sixties and beyond.  While the increased longevity and improved health at older ages seen in many parts of the world represent one of the crowning achievements of the 20th century, these trends also present significant challenges.  With the aging population, there is the potential that the world will become a huge “nursing home” needed to care for many elderly patients.  This will mean a change in many nations in employment practices, pension plan structuring, health care costs, and the economic impact of an aging population.

                By 2050, 80% of older people, aged 60 years and older, will live in low-income and middle-income countries, and that the rate of increase in the older adult population will surpass that of high-income countries.  Approximately two thirds of people living with dementia currently live in low-income and middle-income countries.  

                Older adults in all countries have experienced disproportionately poorer outcomes of COVID-19, dictated by both greater age-related vulnerability and insufficient resources allocated to geriatrics.  In exposing the fragility of geriatric care, the pandemic has uncovered an alarming reality: global health-care systems are underprepared for our aging population.  Aging populations will place a large demand on health-care infrastructure, given the associated increase in age-related diseases and multimorbidity.  There will also be an increased need for non-medical care: the number of older people who need support for activities of daily living in these countries is predicted to quadruple by 2050.To shoulder the burden, resources need to be funneled into long-term care infrastructure, relieving financial strain for patients and families and alleviating the burden on informal caregiving, often carried out by female family members.

                To ensure healthcare systems have the ability to care for aging populations, specialized knowledge in geriatrics must be increased via educational strategies to encourage careers in gerontology, such as targeted curricula that improve understanding of the field, develop skills, and assuage common concerns of medical and nursing students.  Such training must balance conveying a holistic approach that recognizing the multimorbidity of the older adult population, and thereby complexity complexity of older adult care, while concurrently dismantling against notions of equating older age with decline in functioning.  To provide students with ample exposure to older adult care, and thereby preventing misconceptions of older people and aging, geriatrics should be integrated into preclinical medical training.  Capacity building must focus on upskilling not only medical students but also geriatric health-care professionals.  It is also important to strengthening longevity medicine training that upskills physicians with expertise in Artificial Intelligence (AI) technology to promote precision medicine.

                Moreover, to alleviate demands on physicians, unlicensed health-care workers can be trained as care team navigators to support older patients in navigating health-care systems.  Such patient navigation systems are not only cost-effective approaches, which could in part offset limited resources in low-income and middle-income settings, but have the important benefits of ensuring timely and appropriate care, increasing health literacy, and ultimately enhancing older patients’ autonomy and engagement with their health needs.  Finally, the multimorbidity and complexity of needs that characterized the older adult population require collaborative care models, particularly bridging health and social care: greater integration of health-care sectors increases consistency and quality of patient care.

                Funding the care of older generations is not optional.  It is an investment in the wellbeing and intrinsic capacity of older people as productive and valued members of society.