Some days I feel like I am in the "abyss" life stage -- parents and dear relatives are aging, ailing, and dying. My friends and I talk about staring into the abyss of aging and wondering when and how we will fail. Of course, trying to predict the future based on our experiences in the present is a mixed bag. The good news is that most of our dear ones are living fulfilling lives well into their 80s. The bad news is that for many of them their last years focus around frequent trips to the doctor, over-treatment for ailments that then cause a cascade of new health challenges (aka iatrogenic health care), and diminished cognitive capacity.
As we think about our "third metric" beyond financial security and a modicum of life successes it can be challenging to envision an acceptable end of life as a member of the "old old" generation.
Will it really be that bad? It would be folly to make predictions for any one person. Personally, I aspire to the death described by Roz in the sitcom Frasier, "When I die, I want it to be on my 100th birthday, in my beach house on Maui, and I want my husband to be so upset that he has to drop out of college."
Yet, we do make predictions for entire generations, none more evident than in our health policies. I have participated in many state and national forums about health care reform, financing, and organization. Invariably one or more speaker will put up a slide predicting health care costs out to the year 2050 or beyond. The data are alarming. One consistent message is that as a percentage of GDP, Medicare costs will at least double between 2010 and 2050. The speakers point out with great concern that as baby boomers and subsequent generations age into Medicare they will inevitably demand high-tech, high-touch health care for the myriad chronic conditions we acquire as we age. In other words, these predictions assume that the health profile of the aging population and their expectations of the health care system will be the same as the previous generation.
It doesn't have to be that way. The adults who will enter Medicare in 2050 are 28 years old now. Is their path to multiple chronic conditions unchangeable? Will they assume that good health care means being tested, diagnosed, and treated by health care providers? Of course, testing, diagnosis, and treatment are and should always be an element of effective health care. However, given the vast amounts of money spent in health care, there is enormous potential to improve our well-being.
We have the opportunity and the time to change the culture of health care and the expectations of patients and providers. We have so many effective prevention interventions that address the major causes of chronic disease and early disability and death. With the Affordable Care Act bringing more "young healthies" into the insurance pool there is a great opportunity to create a health system rather than the current sick care system.
Here's just one example. By age 55, the average American has added nearly 40 pounds of fat over the course of adulthood, and with this weight gain comes an increased risk of diabetes, heart disease, and cancer, to name a few chronic health conditions. It's hard to believe that this weight gain is completely hard-wired with age. Imagine the benefits of a health system that provided incentives for maintaining healthy weight and not just increased testing, medical visits, and medications for preventable diseases. We now have several studies that show promise for addressing maintenance of weight in primary care. These are the types of "treatments" that 28-year-olds should be demanding from our health care system.
Growing up, the light switch cover in my aunt's kitchen featured a picture of a couple wearing traditional German outfits and the saying, "We grow too soon old and too late smart." By making adjustments to our lifestyles and expectations now, we can build a health system that helps us to be "sooner smart and older healthy."
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