For those monitoring global trends, particularly demographic patterns in population growth, November 2022 witnessed a fascinating milestone with the change in the world’s population now exceeding 8 billion people.1 The Institute for Health Metrics and Evaluation (IHME) forecasts the world’s population will continue to grow and age substantially as people have fewer children (declining fertility) and life expectancies increase. IHME expects “the average age to increase, culminating in one-fifth of the global population being over 70 by the year 2100.”2 In 2020, 55.8 million or 16.8 percent of the total US population was 65 years and over.3 Anecdotally, Loma Linda University is located in one of the only places in the U.S. (and among the few blue regions in the world) where seniors live 10 years longer than the average American.4 As I reflect on the number of seniors within my circle of influence, I realize there are a number of persons who are living relatively healthy and productive lives. Similarly, there are others who have a set of personal characteristics that present challenges for how they navigate their activities of daily living. This dual reality is something that I believe requires more immediate attention for several reasons.
First, the increases in life expectancy have been happening over time, and we have insights into the contributing factors for this trend. This affords us an opportunity to better understand how reductions in mortality or deaths and the commensurate global burden of disease variations reflect distinctive patterns that are expressed in regions and local populations more in some places than others. Why is that the case? Additionally, we are aware of the role that disability often plays in accompanying gains in longevity. Older adults may experience little or no disability while others experience multiple, co-existing conditions. So, while individuals may be living longer, they are likely to do so while managing their disability. That is, the health status and needs of this group will require diverse levels of support systems to help them maintain their quality of life. In health services delivery, care design, care management, and patient self-management needs will not be the same throughout the system but require a continuum of care coordination, resource use, and costs for delivering them.
Second, the desire for quality of life among older adults is not a mystery. Older adults have articulated their concerns and what matters most with enough frequency for those who provide service delivery and support services to make sufficient plans to meet their needs. For example, a recent thematic synthesis of qualitative studies5 examined the meaning of quality of life to older adults and identified nine strongly connected domains that are important to this group: autonomy, role and activity, health perception, relationships, attitude and adaptation, emotional comfort, spirituality, home and neighborhood, and financial security. Therefore, it is not surprising that many of these domains are things that older adults talk about in their everyday conversations with those who ask about their well-being and their personal wishes or needs. Personally, I have heard seniors that I know talk about the importance of autonomy, the ability to stay in their own homes and neighborhoods and maintain social support with loved ones and friends, as crucial factors. At the same time, for those who may feel socially isolated, steps can be taken to diminish that reality through other social interactions with peers and support systems that foster more connectivity and feelings of community.
Third, we must adequately prepare for the anticipated demands on the support systems that older adults need during these latter years of life. Health care, social services, and public health systems, as currently configured and interface, will need to act with greater coordinated efforts and integrated intentionality to ensure appropriate resource capacity to rise to the occasion. Furthermore, these services and support systems will need a well-trained workforce, one that includes the appropriate numbers and types of health and social service professionals with training in gerontology and the unique needs of this population. This is not a call for specialization only, but for primary care and public health integration efforts that are oriented towards meeting the needs of this group.
Fourth and last, value is created through the pursuit of appropriately matched system-level interventions. One suggested health policy approach would focus on addressing and reducing the burden of disability through policies focused on the prevention of functional loss and disability progression, mitigating environmental risk factor vulnerability and other preventable conditions where disease burden could be lessened in older adults.6 Another viable approach I really like is the strategic initiative which focuses on creating age-friendly health systems.7,8 Age-Friendly Health Systems9 is an initiative of the Institute for Health Improvement and the Johan A. Hartford Foundation in partnership with the Catholic Health Association of the United States and the American Hospital Association. Described as a movement, the goal is to assist health systems with focusing on a conceptual framework they call the 4Ms. They are as follows:
- What Matters. This focuses on understanding the needs of the older adults and aligning their care accordingly. It is a patient-centric view about conversations that matter to them.
- Medication. As previously discussed, chronic disease and disability become prevalent as we age. As such, the focus here is the avoidance of overprescribing medication that is not needed and only doing so when necessary, appropriate, and safe.
- Mentation. This area addresses the importance of mental health and cognition, with screening, assessments, and actions to address common mental disorders like dementia, depression, etc.
- Mobility. This area addresses the environment of older adults, and it goes beyond fall prevention to looking at their environment holistically and how it can affect physical activity and their ability to be mobile (both within and outside of the home).
Not only do age-friendly health systems promote cross-sector collaboration among key stakeholders, but it is also supported by the logic and frameworks for driving real, lasting change that is sustainable. And for that reason, I believe its true value will benefit us all.
Author Bio:
Karl J. McCleary, PhD, MPH
Dr. McCleary is the Executive Director of the Center for Health Strategy and Innovation, Associate Dean of Strategy, and a Professor at the School of Public Health. He also serves as a Faculty Scholar in the Loma Linda University Health Institute for Health Policy and Leadership. His research interests include health policy, transformation, and strategic change; innovation, systems thinking and redesign; and population health.
References
- Bloom, D.E. & Zucker, L. M. (2023, June). Aging is the real population bomb. Finance and Development, 60 (2), 58-61. DOI: https://doi.org/10.5089/9798400240997.022
- Sirull, R. (2022, November 15). The world is getting older: Health systems should prepare now. Insights Blog, Institute for Health Metrics and Evaluation, Seattle, WA. Retrieved from https://www.healthdata.org/news-events/insights-blog/acting-data/world-getting-older-health-systems-should-prepare-now
- Caplan, Z. & Rabe, M. (2023, May). The older population: 2020. 2020 Census Briefs, U.S. Department of Commerce, U.S. Census Bureau. Retrieved from https://www2.census.gov/library/publications/decennial/2020/census-briefs/c2020br-07.pdf
- Onque, R. (2023, September 23). People live longer, happier lives in Blue Zones, and only one is in the U.S.: Here are 5 things they do differently. CNBC, Health and Wellness. Retrieved from https://www.cnbc.com/2023/09/26/loma-linda-ca-what-the-only-blue-zone-in-the-us-does-for-longevity.html
- van Leeuwen, K. M., van Loon, M. S. van Nes, F. A., Bosmans, J. E., de Vet, H. C. W, Ket, J. C. F., Widdershoven, G. A. M., & Ostelo, R. W. J. G. (2019). What does quality of life mean to older adults? A thematic analysis. PLoS ONE, 14(3): e0213263. DOI: https://doi.org/10.1371/journal.pone.0213263
- Collaborators, G. A. (2022). Global, regional, and national burden of diseases and injuries for adults 70 years and older: systematic analysis for the Global Burden of Disease 2019 Study. BMJ 376: e068208. DOI: https://doi.org/10.1136/bmj-2021-068208
- De Biasi, A., Wolfe, M., Carmody, J, & Fulmer, T. (2020). Creating an age-friendly public health system. Innovation in Aging, 4(1), 1-11. DOI: https://doi.org/10.1093/geroni/igz044
- Nelson, L. H., & Saret, C. (2023). Improving public health and health care for older adults: The three keys to cross-sector age-friendly care. Boston: convened by the Institute for Healthcare Improvement. Available at www.ihi.org/agefriendly
- Slossberg, R., Benedict, T., Pelton, L., & Fulmer, T. (2022, March). The guide to propel your health system to an age-friendly future. Issue Brief, The Johne A. Hartford Foundation, New York. Retrieved from https://www.johnahartford.org/images/uploads/reports/JAHF_IssueBrief_AFHS_IB_FINAL.pdf