Four years ago, ACT on Alzheimer’s, a voluntary Minnesota collaboration of more than 60 partner organizations, commissioned a study to evaluate potential cost-savings that could come from programs to support the caregivers and families of dementia patients. The issue isn’t just academic. The Alzheimer’s Association estimates that the number of Americans living with Alzheimer’s will more than triple by 2050. Most of the increase in Alzheimer’s will be among the elderly; by 2030, nearly one of four Minnesotans will be over age 65, double the rate from 2000.
The ACT study, published in Health Affairs, found that by providing support to caregivers – for example, counseling sessions and weekly support groups – institutional care could be delayed. The savings to Minnesota individuals, families and taxpayers would be nearly $1 billion over the next 15 years. And delaying institutional care almost always enhances the quality of life for the elderly.
The study is one example of the need to inject new thinking into how we care for the elderly. Surgeon and author Atul Gawande wrote about the challenges and some solutions in his provocative and very readable 2014 book, “Being Mortal.” One problem he points out is that too often, the elderly are treated by a medical system that doesn’t recognize their unique needs and health issues. He cites a study conducted by the University of Minnesota that evaluated whether a group of elderly treated by geriatric specialists would fare better than a similar group being cared for by their regular physicians:
“(T)he patients who had seen a geriatrics team were a quarter less likely to become disabled and half as likely to develop depression. They were 40 percent less likely to require home health services. These were stunning results,” wrote Gawande.
Instead of building on these studies – promoting more training in geriatrics or supporting family caregivers – incentives in public policy and medical care often ignore the needs of older Americans. Financial incentives in medicine, for example, encourage students to enter specialty fields. Yet, according to the American Geriatrics Society, 30,000 geriatricians will be in demand by 2030; there are fewer than 7,300 certified geriatricians practicing nationwide.
Innovation and good public policy are coming, even if government isn’t in the lead. While Congress focuses on the rising cost of health care, others in the private and non-profit sectors are creating new ways to improve the quality of care. Doing so can make the delivery of services more cost-efficient while improving the quality of life.
ACT on Alzheimer’s is one example. The group has supported the creation of “dementia-friendly communities.” In these communities – and there now are several throughout Minnesota – transportation and other public services, businesses and others in the community are redesigned to better serve those with dementia and their caregivers, helping to keep many older Minnesotans in their homes and out of institutions.
Other innovations are on the way, including the development of artificial intelligence and caregiving robots. In fact, some experts see self-driving cars as the first elder-care robots. “For the most part, however, the dominant technology and consumer electronics firms don’t view the aging as a market,” according to John Markoff who covered technology for The New York Times for 28 years.
Writing for the Berggruen Institute where he now is a fellow and the , Markoff acknowledged, “The commercial prospect of autonomous robots that might either assist or ultimately supplement human health care workers is still far in the future. What is more likely to appear in the coming decades are systems of sensors and virtual assistants that will allow aging people to remain in their homes for far longer.”
Writing for the Berggruen Institute where he now is a fellow and the Washington Post, Markoff acknowledged, “The commercial prospect of autonomous robots that might either assist or ultimately supplement human health care workers is still far in the future. What is more likely to appear in the coming decades are systems of sensors and virtual assistants that will allow aging people to remain in their homes for far longer.”
The need for creative thinking is urgent. As Gawande writes, we are sacrificing too many elderly to soul-crushing care: “The waning days of our lives are given over to treatments that addle our brains and sap our bodies for a sliver’s chance of benefit. They are spent in institutions…where regimented, anonymous routines cut us off from all the things that matter to us in life. Our reluctance to honestly examine the experience of aging and dying has increased the harm we inflict on people and denied them the basic comforts they most need. Lacking a coherent view of how people might live successfully all the way to their very end, we have allowed our fates to be controlled by the imperatives of medicine, technology and strangers.”
Health care isn’t just about cost and treatments. It must also be about quality of life.