The Implications of Aging

Higher utilization rates, physician shortage are among health issues

BY DAVID A. GROSS
UK CENTER FOR EXCELLENCE IN RURAL HEALTH
RURAL HEALTH UPDATE

HINDMAN – During the course of his 21 years at the UK June Buchanan Medical Clinic, Dr. Kenneth Slone has noticed a gradual increase in the proportion of elderly patients he treats – so much so that they now comprise over half of the clinic’s total patient volume.

With their elevated level of chronic health issues, Slone’s patients who are age 65 and over also occupy considerably more of his time – about twice as long per visit as younger patients, he said.

Slone’s situation is not unique. Across Kentucky and the nation, health care providers are feeling the initial impact of the burgeoning elderly population, one aspect of which is heightened utilization of health care services.

Health and policy analysts note, however, that the full effects might not be felt for another five years, when baby boomers have begun to reach age 65 en masse.

“I don’t think anybody’s system is ready for that,” Slone said. “It’s going to overwhelm our resources. Financially and otherwise, it’s going to be a real strain for health care in the future.”

Attributable to increased longevity (the average life expectancy is now 79 years for U.S. women and 74 years for men) and the aging of the baby boom generation (the approximately 80 million Americans born between 1946 and 1964), the size of the population segment aged 65 and above is expected to increase in all 50 states through 2025.

Kentucky already is one of the nation’s grayer states, as 12.5 percent of its population was age 65 or older at the time of the 2000 Census. It is projected to have the 14th-highest proportion of elderly residents by 2025, according to the Kentucky State Data Center. At that point, those who are 65 and older are expected to comprise 21.3 percent of the state’s population.

Further exacerbating the issue is the prediction that some regions of the state – presumably rural ones – are likely to have even higher concentrations of elderly residents. Such a scenario would track national trends; the Center for Health Workforce Studies at the University of Albany (N.Y.) has reported that senior citizens are more likely to live in rural areas (24 percent of older adults, compared to 19 percent of the total U.S. population).

Health care considerations

Nationally, the number of elderly residents is expected to double by 2030 – from 34.9 million in 2000 to approximately 71.4 million (or 19.6 percent of the population). Rapid aging is not just an American phenomenon, however. At least 10 nations are expected to exceed the United States’ proportion of elderly residents in 2030, topped by Japan at nearly 32 percent of its residents.

In the U.S., the health-related impact could be most evident in states like Kentucky, where the population is disproportionately poor and rural, and there exists a high rate of chronic diseases that “get worse as one gets older,” said Michael E. Samuels, the University of Kentucky's
distinguished scholar and endowed chair in rural health policy.

For many Kentucky citizens who are at or nearing age 65, even necessary health care services – such as prescription medications – might prove too expensive.

“One of the biggest implications is the cost of health care,” said Michal Smith-Mello, a senior policy analyst with the Kentucky Long-Term Policy Research Center. “There are numerous pressures on the fixed incomes of elders. … They can only manage so many additional costs.”

In 2002, the policy research center found that a majority (52 percent) of Kentucky’s retirees reported they could not afford their medical expenses.

Another significant factor related to the growing elderly population is the state’s physician shortage. Kentucky’s physician-to-population ratio ranks as the 32nd lowest among the 50 states. The Commonwealth needs nearly 2,300 more active physicians just to match the U.S. ratio, according to a 2007 Kentucky Institute of Medicine report.

Yet the need for physicians and other health care providers is expected to increase in Kentucky and the U.S. over the next several years. It is estimated that the demand for physicians will increase by 11 percent by 2020, according to the National Center for Health Workforce
Analysis. Projections indicate a 7 percent increase in the demand for registered nurses during the same time period.

Among the factors fueling physician requirement projections – especially for non-primary care providers – is the demand that will be placed on the health care system by a much larger segment of elderly residents. Samuels, the UK researcher, has noted that the aging and growth of the population is the top factor affecting the future demand for physicians.

Additionally, the National Center for Health Workforce Analysis has suggested that an enlarged 65-and-over population will translate into more and longer physician visits and hospitalizations. It is predicted that by 2020 there will be a 7 percent increase in physicians’ patient care hours devoted to the elderly.

At the same time, the federal Health Resources and Services Administration suggests there will a shortage of at least 55,000 physicians nationally.

“More and more people with more and more problems will be chasing fewer physicians,” Samuels said. “It’s an access issue.”

Strategies that Samuels has outlined for addressing the number and distribution of physicians include: increasing U.S. residency programs; expanding the National Health Service Corps; simplifying reimbursement mechanisms; developing more community health centers; and promoting higher reimbursement in provider shortage areas.

He also advocates a fundamental change to the health care system.

“We can’t continue providing health care the way we deliver it today,” Samuels said. “There are too many things that waste precious physician time. They need to only do those things they are uniquely qualified for.”

He said non-patient care tasks should be delegated to other staff members.

Further problematic, however, is the fact that the nation’s health workforce is aging along with the population. That is apparent in Kentucky, where the median age for male physicians is 51, according to the Kentucky Institute of Medicine report.

It also has been projected that more than 40 percent of U.S. nurses will be over the age of 50 by 2010.

Statistics indicate a higher percentage of rural physicians practice into advanced age. While Kentucky’s physician workforce is comprised of a higher percentage of urban-based doctors in the under 35 and 35-44 age brackets, rural physicians make up the bulk of every other age category (45-54, 55-64, 65-74 and over 75).

A move toward readiness

There is some uncertainty regarding Kentucky’s level of preparation for the aging of the baby boom generation, but those within the health care system at least are conscious of the issue.

“At medical meetings, it is a frequent topic of conversation,” said Slone, the Knott County physician.

The state took a more formal step in 2005 with creation of the Kentucky Elder Readiness Initiative, a collaborative effort between the state Cabinet for Health and Family Services, the UK Graduate Center for Gerontology, and the Commonwealth’s 15 Area Agencies on Aging.

The initiative’s stated goal was to foster awareness, dialogue and insight into the challenges and opportunities provided by an aging population and to stimulate local and statewide projects to address the changes that will result from this process.

KERI’s four focus areas were community resources; health and safety; quality of life; and community involvement.

Among the suggestions included in the initiative’s preliminary report, issued in November 2007, were increasing employment and volunteer options for elders, developing residential options for seniors, increasing educational opportunities, providing training and support options for new caregivers, redefining the role of senior centers, developing programs to support grandparents raising grandchildren, and increasing taxes to support programs for the aging.

“We’re going to have to accommodate elderly people if we want to keep them safe, healthy and enhance the quality of their lives,” said Smith-Mello, the policy analyst who also served on KERI’s advisory committee.
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Ky. gray spots

Nine of Kentucky’s 10 ‘grayest’ counties (based on percentage of the population age 65 or older) are rural. They also predominantly are located in the western part of the state:

Hickman County........................................................................19%
Caldwell, Carlisle, Cumberland, Lyon and Marshall counties ......18%
Crittenden, Fulton, Green and Spencer counties ........................17%

Source: Kentucky Institute of Medicine, 2007
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