The aging of America will test the U.S. healthcare system in ways it has never been with higher prevalence of chronic disease including heart disease, high blood pressure, obesity, diabetes, cancer, and Alzheimer’s disease. In addition, 1 in 4 older adults fall each year, and falls are a leading cause of injury for this age group. It will also put more strain on a workforce that is already short on primary care providers, home health aides, geriatricians and caregivers.
A fast-growing aging population will soon come face to face with a fragmented and inefficient system that is neither scaled, structured or ready to meet their needs, challenges and desires. Will this next generation of older adults be better or worse off than previous ones? Experts say the system must adapt to ensure Americans are not just living longer, but that they’re living better, healthier, and can receive the right kind of care when they need it at a reasonable cost. But reform cannot come soon enough.
Major Population Shift
The number of people 65 and older has increased almost five times faster than the total U.S. population over the last century, according to the 2020 Census. Nearly 60 million older adults live in America and account for 16.8% of the population, a number expected to grow to 20% by the year 2030, when for the first time in U.S. history, older people will outnumber children and young adults.
More Chronic Disease, More Complex Care
The National Council on Aging (NCOA) estimates nearly 80% have two or more chronic diseases, which are on the rise across all age groups, though older adults face the greatest risk of either having or developing one. A greater focus on reducing the incidence and severity of these diseases could substantially improve health outcomes across generations and cut costs, which can be 3 to 10 times greater for people living with chronic conditions. According to the CDC, 1 in 4 seniors report they are in either fair or poor health.
The Rise of Age-Friendly Care
Age-friendly care models are increasingly being adopted throughout the country providing healthcare based on what research shows are the most important things to focus on as people get older -- the 4Ms: What Matters, Medication, Mind and Mobility.
The Institute for Healthcare Improvement (IHI) recognizes more than 4,500 hospitals, practices and long-term care organizations as Age-Friendly Health Systems Participants and Committed to Care Excellence. Delivering care based on the so-called 4Ms Framework helps reduce hospital readmissions, decrease length of stay and improve health outcomes.
Recently, Brigham and Women’s Hospital (BWH), a national leader in geriatric care, and the West Health Institute, announced the creation of the West Health Accelerator at Mass General Brigham, a multi-million dollar initiative that will help speed the transformation of healthcare for older adults across New England and the nation. It builds on the hospital system’s Superior Treatment of Elders Pathway (STEP) Program, which has improved patient outcomes and reduced hospital readmissions for thousands of seniors after surgical procedures since it began in 2016.
The Accelerator team will expand the program within the health system and develop a geriatric care model program that healthcare settings nationwide—from small community hospitals to large medical centers—may readily adapt for use in their own communities.
Emergency care tailored specifically for seniors is also spreading throughout the country. Learn more about the Geriatric Emergency Department (GED) movement.
Mental Health Crisis Across Generations
The mental health crisis is growing across all age groups in America. An estimated more than 1 in 5 U.S. adults or 59.3 million people were living with a mental illness in 2022 and little more than half (50.6%) received treatment for it.
Though older adults are the least likely to struggle with mental health issues, this group did have the largest percentage increase in their prevalence. A recent report from nonprofit FAIR Health found a 57.4% spike in diagnoses among those 65 and older and a 35.9% increase in adults aged 51 to 64.
The most common mental health issues in older adults include anxiety, depression, cognitive decline, loneliness, social isolation, Alzheimer’s and other forms of dementia.
Aging in Place Whenever Possible
More than three-quarters of older adults express a desire to age at home, with 58% receiving some form of home-based care. At the same time, the number of older adults receiving home health services is projected to increase by 40% by 2030.
Home- and community-based care models offer a safe and effective complement to traditional hospital-based care, but limited insurance coverage and too few programs keep them out of reach for millions of older Americans. The idea is to meet patients where they are, and for many seniors the best place is in their own homes or alternative sites of care within their community. For example, home-based primary care programs have been shown to significantly reduce emergency department (ED) visits by 15%, hospitalizations by 30%, and long-term care admissions by 15%.
Healthcare Affordability - Medicare No Shield from High Drug Prices
Medicare is a primary source of health insurance for older Americans, but it doesn’t cover everything – especially the high cost of some prescription drugs. The percentage of Americans readily able to access and afford quality healthcare when they need it has dropped six percentage points since 2022 to 55%, the lowest since West Health and Gallup began tracking healthcare affordability in 2021. Personal healthcare spending on older adults was $1.2 trillion and $22,356 per person in 2020, according to the Centers for Medicare & Medicaid Services (CMS). An analysis by KFF found, the health spending burden was twice as large among Medicare households than non-Medicare households in 2022.
In the West Health-Gallup survey, although people 50 and older are more likely to be considered “cost secure” -- meaning they have had no recent problems affording care or medicine and can easily access care -- their scores have fallen faster and further over the past two years than other age groups. The percentages of cost secure adults aged 50 to 64 and 65 and older have both dropped eight points since 2022, to 55% and 71%, respectively. At the same time, the percentage of younger adults has slipped five points, from 52% to 47%.
Concerns over the potential insolvency of Medicare abound among those under 65, with 73% now expressing worry that it won’t be available when they need it, up from 67% in 2022, according to the West Health-Gallup 2024 Survey on Aging in America. Worry rose most amongst those aged 50 to 64, up 13 percentage points to 74%. Higher percentages express concern about the future of Social Security, with 80% of people under 62 and 86% of people aged 40 to 49 fearing it will not be around once they become eligible.
According to the annual Social Security and Medicare Trustees Report, there is cause for concern. Medicare’s hospital insurance trust fund is forecast to be depleted in 2036 and Social Security’s trust funds are expected to run dry in 2035, making the programs unable to pay full benefits to retiring Americans.
A Plan for an Aging America
Most Americans agree their communities need of more affordable housing, healthcare and social supports and services to help people live independently as they age, according to a recent survey from West Health and Gallup. Sixty percent see a need for more affordable health and social supports and services.
Adding urgency to the situation is other recent research showing two-thirds of adults (including 69% of those aged 50 to 64) believe the country is not sufficiently prepared to care for its aging population over the next decade. The good news is most states are developing or are already implementing multi-sector plans for aging. California’s Master Plan for Aging is already in its third year and proving successful for the state’s older adults.
There is also a national set or recommendations on aging in the works. In May 2024, the U.S. Department of Health and Human Services released “Aging in the United States: A Strategic Framework for a National Plan on Aging - PDF” to lay the groundwork “for advancing healthy aging and age-friendly communities that value and truly include older adults.”
Dig deeper here.
The bottom line is Americans are worried about what the future holds for them as they grow older. Will Social Security and Medicare still be around? Will they be able to afford their medical bills? Will they receive quality care when they need it? Will the healthcare system be affordable and easy to navigate and sensitive to their specific needs? The answer to all these questions should be yes but innovative and equitable practice and policy reforms must be enacted. Successful aging in America is too important to be left to chance.