People today are living longer than ever before, and the proportion of older adults in the population is increasing. By 2040, people ages 65 and older are expected to make up 22% of the U.S. population. In light of this trend, how can America’s healthcare system evolve to better meet the unique needs and preferences of older adults?
It’s a question that health leaders need to be asking themselves now, especially amid mounting worker shortages. In 2019, the U.S. faced a shortage of nearly 14,000 primary care physicians, who provide the bulk of the care to older adults. That gap is expected to grow to as many as 48,000 by 2034.
To address this staggering discrepancy, we offer seven specific recommendations to improve care for older adults.
‘Geriatricize’ Primary Care
Geriatricians often provide primary care to older adults who have the most complicated medical and social problems. However, the number of doctors pursuing geriatrics is shrinking just as the population of older adults is growing. And while primary care physicians care for most older people, they are not trained to meet the unique and complex needs of older adults.
Know What Matters
Aligning care with patient and caregiver goals helps older adults focus on treatments that matter most to them. Older adults often deal with multiple medical conditions, which can lead to conflicting medications and aggressive surgeries that may do more harm than good. Because primary care providers often serve as the first point of contact in the healthcare system, they can actively engage with older adult patients and their caregivers to identify their specific health goals while avoiding unnecessary treatments. Providing effective and timely outpatient primary care also helps prevent, diagnose, treat, and manage illness, including complex chronic conditions.
Leverage Team-Based Care
Team-based primary care requires multiple interdisciplinary health professionals to coordinate patient care. This approach improves the coordination and application of expertise across disciplines, promoting healthy aging. Team-based primary care could also improve medication management and leverage technologies that route emails to the right physician, clinician, or staff member at the right time so that everyone on the team can practice at the top of their license.
Focus on Prevention
The aim of preventive geriatrics is to nurture a patient’s health to maintain high levels of health and function and maximize life expectancy. It involves preventing, screening for, and managing chronic diseases associated with aging such as diabetes and high blood pressure, as well as more acute diseases such as breast cancer and colorectal cancer. These measures play critical roles in optimizing a patient’s quality of life. Older adults especially benefit from annual flu vaccines, and now COVID-19 vaccines, along with vaccines to help prevent pneumonia.
Deprescribe
Older adults — particularly those with multiple chronic conditions — may see a range of specialists over the course of their care. Unfortunately, this can lead to the prescription of many different medications, which may have harmful effects when combined. One poll found that 28% of older adults ages 50-80 reported taking five or more prescription medications a week, but 80% were open to stopping one or more if their provider said it was possible.
Address Social Determinants of Health
Addressing the ongoing care needs of older adult patients often means reaching beyond the walls of doctors’ offices and into the community. Social determinants of health like nutrition, isolation, and housing can deeply affect older adults’ well-being and care.
Move More Care Into the Home
In the next 5 to 10 years, many services currently provided in brick-and-mortar hospitals may well be moved into the home. Physicians and clinicians are already bringing services directly to patients in new ways, empowering them with more autonomy and control over their care and health conditions. Physicians and health systems should also elevate the visibility of at-home care programs among patients, physicians, and staff so they know such programs provide a viable, safe option to in-hospital care.
As the number of older adults increases, healthcare organizations will need to ensure primary care physicians and specialists understand more about age-related changes, leverage team-based care, and screen for and be prepared to address social determinants of health associated with aging.
Such care principles and practices likely will become foundational building blocks of good primary care across the broader healthcare system. By adopting these care skills, primary care doctors will be better equipped to address the needs of an aging population.
Ramin Davidoff, MD, is executive medical director and chair of the board of Southern California Permanente Medical Group. He is also chair of the board and CEO of the Southeast Permanente Medical Group; chair of the board and CEO of Hawaii Permanente Medical Group; and co-CEO of the Permanente Federation.
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