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  • Writer's pictureSociety of Bioethics and Medicine

Elder Care: An Unheard Crisis

Written by Rayyan Bhuiyan

Edited by Cara Chang



Medicine today is advancing at unprecedented levels, with quantum computing allowing for faster drug discovery times and higher medical imaging resolutions, and Artificial Intelligence shortening diagnosis times from one month to three minutes. At the same time, organ transplants and therapies that involve stem-cells, antibiotics, and vaccines are constantly improving. Such evolution in medical treatment, alongside the declining birth rate in America, contributes to a larger proportion of elderly people making up the population (Fitzpatrick & Beheraj, 2023). In fact, the number of Americans over 65 has increased by 38% from 2010 to 2020, where they are found to be one in every six Americans (Administration on Aging, 2022). Today, this number is approaching one in five. While having longer lives may be desirable for reasons like enjoying more time with family, it does not come without consequences. America is facing an elder care crisis; there is a lack of healthcare staff and affordability for the elderly.


As you age, you are more likely to develop various diseases, many of which are chronic conditions. Common health complications for the elderly include cardiovascular disease, strokes, hypertension, cancer, diabetes, Alzheimer’s, hearing loss, and more (Basaraba, 2022). What is even more troublesome is that the elderly must often deal with multiple issues at once. Such chronic conditions often result in an increased risk of developing other chronic conditions (Harvard Health, 2023). Given the nature of these conditions, this involves continuous healthcare checkups, especially with healthcare professionals like geriatricians who are accustomed to the complex care the elderly require.


Unfortunately, the current healthcare system is not supplied with enough healthcare workers to meet the demands and challenges of an increasingly elderly population. Even though the elderly are treated by all types of doctors, geriatric medical training is not mandatory in medical school (Graham, 2023). Geriatricians thus become even more critical today, as they have extensive training specifically to understand the aging body and how to manage multiple and complex health conditions. They are well versed in the negative side effects of taking multiple drugs and focus on allowing patients to live a more preferred and comfortable life, even if it means taking less medication. Such abilities often allow them to have better outcomes than other specialties would when dealing with the elderly (John Hopkins, 2021). 


The ratio of elderly patients to geriatricians is now 1:10000, even though the recommended ratio is 1 geriatrician to 700 patients, according to the American Geriatric Society (Gurwitz, 2023). Statistics predict that in just seven years, we will need 30,000 geriatricians. However, not enough geriatricians are being trained, with even 30% of residency seats being unfilled this past year (Graham, 2023). Geriatrics is known to be one of the lowest-paying and most emotionally demanding medical fields, resulting in a very high burnout rate, making it unappealing to many. Even so, it is not just geriatricians who are required to care for the elderly, especially in regards to long-term care.


In addition to geriatricians, workers like physical therapists, nursing assistants, and nurses are essential in dealing with the elderly, especially in-home care and extended care facilities like nursing homes. They help patients with bathing, dressing, and feeding, and overall allow the geriatric to be cared for to live more comfortably. However, there is a great shortage of workers. In 2020 alone, nearly 400,000 nursing home and assisted living staff quit their jobs, and people continue to leave their jobs despite the increased demand for them (Moe, 2022). Jobs often overwork employees, which can lead to injuries, mental health challenges and workers often being mistreated, leading to high burnout rates (Walton & Rogers, 2017). Without enough workers, extended care facilities are unable to provide patients with the appropriate care, causing people to be very dissatisfied with their living conditions. Beyond the lack of healthcare workers, the structure of the healthcare system itself is not designed for the elderly.


Today's healthcare system provides the elderly with support through programs such as Social Security and Medicare. But these utilities were not designed to withstand the complications of today’s geriatric population, as they were made in the mid-1900s when the life expectancy was 61 and medical issues like heart attack were much more fatal (Edwards, 2017). Medicare does not compensate for extended care options like nursing and housing facilities. Only 100 days of skilled nursing are covered, and the average cost of nursing homes is $92,000 (Simmons, 2016). Furthermore, only 10% of elderly Americans have insurance to cover this type of long-term care, which is often expensive and truly unaffordable for most Americans to be cared for at an old age (Simmons, 2016). 


Fortunately, it may still be possible for America to support an older society. While it may be difficult to see the immediate changes necessary to support today’s elderly population, there are some implementations that can lead to better lives for senior citizens. Firstly, geriatric education may need to become mandatory in medical schools, as if every doctor is more trained, we can hope more senior citizens are treated appropriately. More affordable long-term care insurance needs to be advocated for as well, as they currently cost several thousand dollars yearly – something most people cannot afford (Weston, 2019). Support programs like Medicare can be modified as well to help cover extended care options. Unfortunately, great resistance may be found in trying to implement changes, as the healthcare system is often reluctant to change (Baum, 2023). However, if improvements are made to the healthcare system, in both medical and business aspects, the growing aging population of America can finally be accounted for. 


Currently, the ability to extend our lives with new medical technology is far outpacing society’s capacity to ensure healthy elderly lives. There is a massive shortage of appropriate healthcare staff, and it is unaffordable for most people to obtain the consistent healthcare they need. America must revise its elder care system now, or we will forfeit the promise of a longer, healthier life for all.


References:

Administration on Aging. (2022, November). 2021 profile of older Americans - ACL administration for Community Living. acl.gov. https://acl.gov/sites/default/files/Profile%20of%20OA/2021%20Profile%20of%20OA/2021ProfileOlderAmericans_508.pdf


Basaraba, S. (2022, November 18). 13 of the most common age-related diseases and conditions. Verywell Health. https://www.verywellhealth.com/age-related-diseases-2223996


Baum, N. (2023, July 21). Inertia in healthcare: Overcoming resistance (friction). Physicians Practice. https://www.physicianspractice.com/view/inertia-in-healthcare-overcoming-resistance-friction-


Edwards, H. S. (2017, November 16). Death and dilemmas in America’s elder health care system. Time. https://time.com/5027076/dignity-death-and-americas-crisis-in-elder-care/


Fitzpatrick, A., & Beheraj, K. (2023, October 4). U.S. birth rate declined 30% in 15 years — here’s where, mapped - axios. axios.com. https://www.axios.com/2023/10/04/birth-rate-fertility-rate-decline-data-statistics-graph-2022


Graham, J. (2023, November 2). Who will care for older adults? we’ve plenty of know-how but too few specialists. CNN. https://www.cnn.com/2023/11/02/health/older-adults-specialists-kff-health-news/index.html


Gurwitz, J. H. (2023, August 22). The paradoxical decline of geriatric medicine as a profession. JAMA. https://jamanetwork.com/journals/jama/article-abstract/2808221


Harvard Health. (2023, August 4). Having one chronic condition can boost the risk for others. https://www.health.harvard.edu/staying-healthy/having-one-chronic-condition-can-boost-the-risk-for-others


John Hopkins. (2021, November 23). Specialists in aging: Do you need a geriatrician?. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/wellness-and-prevention/specialists-in-aging-do-you-need-a-geriatrician



Simmons, L. (2016, November 15). What’s behind America’s elder care crisis. Stanford Graduate School of Business. https://www.gsb.stanford.edu/insights/whats-behind-americas-elder-care-crisis


Walton, A. L., & Rogers, B. (2017, May 19). Workplace hazards faced by nursing assistants in the United States: A focused literature review. International journal of environmental research and public health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5451994/#:~:text=Aides%20have%20higher%20injury%20rates,5.7


Weston, L. (2019, May 10). What will you spend on health care costs in retirement?. NerdWallet. https://www.nerdwallet.com/article/insurance/medicare/what-will-you-spend-on-health-care-costs-in-retirement

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