Health care challenges: Let’s retire denial of decline

The National Institutes of Health recently held a briefing to discuss its vision for the future of “age management” – essentially trying to understand and find ways to “save and extend lives of older Americans,” as director Francis Collins explained. And yet, as the details of the proposal become more public, it becomes increasingly clear that the long-term plan’s basic premise may be flawed: Decline rather than decline, presumably, be a very different order of magnitude than decline. The statistics about declining life expectancy in the United States are alarming. Birth, even in the booming states of California and Texas, is coming down. The medical savings of simply avoiding hip replacement surgery seem mostly theoretical, and as for the idea that delaying treatments reduces health care costs, the evidence doesn’t support that, either. These figures are grossly underestimates in some respects. We don’t know the fate of the middle class in this country, which is declining in number more rapidly than baby boomers themselves. Home ownership has dipped sharply.

Still, that does not look like a recipe for creative health care policy. AARP, for instance, could be a leader in promoting redesign, not the reining in of a preventive medicine system. The study of aging that stemmed from the Clinical Research Network has become a closed network as a result of the push to engage in comparative effectiveness research, which many physicians and aging advocates believe is itself flawed. Still, there are obvious advantages of such research, especially since improvements in the quality of medical care over the past 40 years don’t go far enough: a more thoughtful approach to how care is delivered, especially in specialized fields such as care for seniors, would be of lasting value.

Some innovations help, especially those that allow physicians and health care workers to precisely track their interactions with patients. The development of “telehealth” and interactive health care apps can also enable greater communication between seniors and medical professionals on their preferences for care. For instance, particularly interesting is data collected from the Department of Health and Human Services’ new Medicare home health record. This new digital record system also introduces a service called “assisted living” that can help senior citizens transition into independent living arrangements more easily and effectively.

The main difference between response to FMR and the thought process at NIH that the moment is right to “optimize our short- and long-term health systems for the nation’s most vulnerable population” is that the idea that there’s a problem of decline being overstated, and instead, that there’s a problem of “decline aging” (as if aging stopped at certain ages) doesn’t bear close examination. If anything, the closing of nursing homes due to lack of financial or regulatory support, as some think it might, could represent a beneficial market response.

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