There are more people older than 60 alive today than at any other point in history. The United Nations estimates that by 2050 there will be twice as many people older than 60 as there were in 2015. In fact, by 2020, the global population of individuals 65 and older may outnumber children younger than 5.
While we are living longer, we are not staying healthy: Almost three-fourths of adults in the United States older than 65 have more than one chronic condition. We have an enormous longevity opportunity, but for most people it remains unrealized.
The World Economic Forum lists aging populations as one of the top five drivers of global change. This demographic shift, when combined with the rise in chronic-disease prevalence and increasing cost pressures, will disrupt the way we think about health and deliver care. And this is good. By preparing for these changes and embracing the new tools and technologies that are available, we have the opportunity to close the gap between life span — how long we live — and health span — how long we stay healthy. It is an opportunity to change the narrative about aging — an opportunity to write a story of purpose and productivity for a chapter of life that is, for many, a blank slate.
We also have a chance to engage better with people around their health throughout their lives; and to provide goods and services to a generation of savvy consumers who expect the best in customer service.
Closing the gap
In support of our mission to build a better working world, our firm recently hosted a series of discussions on the aging opportunity around the world. We brought together senior executives from a wide variety of sectors to assess the most promising opportunities for healthy aging today. Discussion included ideas for both near-term projects and investment in tomorrow’s solutions. Over the course of each day, participants grappled with the most trenchant issues in aging in interactive forums and brainstormed creative solutions in small-group workshops.
Surprisingly, despite the participation of many health and life sciences companies, there was general agreement that providing more care was not the most promising way forward. Instead, participants agreed that easy-to-use platforms designed to meet a holistic definition of health were needed to transform care. If these platforms are able to integrate the data on social determinants of health — education, physical environment, socio-economic status, employment, social and familial supports, diet and physical activity levels — with more traditional health care activities, there is a huge opportunity to change the trajectory of health care outcomes and costs.
We see three areas of focus for healthy aging solutions. The first is to use existing and near-future technologies to create platforms that integrate health care with the social contributors to health. This requires a change in the way we think about health that incorporates the mental/emotional and financial dimensions of well-being into a definition that historically has been related to the physical.
The second area is an opportunity to invest in precision health — a path to lifelong wellness that starts with precision medicine and continues to one that is fully personalized, precise, preventive, predictive, pharmacotherapeutic and participatory. This is P-medicine: a new mindset that emphasizes prevention and greater collaboration among physicians, consumers and other stakeholders in solving health challenges and, eventually, pre-empting them.
The third area harnesses the power of the engaged consumer to build a purposeful and lifelong wellness mentality that puts the individual at the center of the health ecosystem.
Adopting a new mindset
The array of tools available today is unparalleled: a huge volume and variety of data; cheap storage, connectivity and computing power; advances in machine learning, analytics and automation; and a growing understanding of the genetic and clinical drivers of health and disease. These advances ought to be used to give all stakeholders — payers, care providers and patients — a window into how everyday decisions and exposures affect health.
In the short term, aging solutions will be more heavily weighted toward helping individuals and caregivers manage complex, chronic diseases. Longer term, as we improve our predictive capabilities by combining medical information with consumer-generated and environmental data, there is an opportunity to advance investments in precision medicine that will one day lead to precision health — interventions based on individualized risk profiles that occur before symptoms are fully manifested. This shift in mindset about what it means to be healthy — across the lifespan — will spark changes to the businesses of both health delivery and life sciences companies.
Pamela Spence is global life sciences industry leader and David Roberts is global health care industry leader at Ernst & Young.
Reimagining care through age-friendly health systems
By Jay Bhatt, D.O., and Kristina Davis, R.N.
Creating Age-Friendly Health Systems is an initiative to advance health for adults 65 and older and to decrease the strain on health systems caring for the rapidly aging American population.
The American Hospital Association, in partnership with the Institute for Healthcare Improvement and the Catholic Health Association, and with generous funding from the John A. Hartford Foundation, is working to spread the initiative to 1,000 care sites, including hospitals, ambulatory care, long-term care and post-acute care by 2020.
By helping health systems become age-friendly, the AHA aims to advance the health of older adults today while investing in the infrastructure necessary to support the care needs of this growing population. Age-friendly health systems commit to the best care possible for older adults, as well as dramatically reduced or zero health care-related incidents to older adults, high rates of patient satisfaction for older adults and value optimized for all.
By bringing awareness to the vulnerabilities within health care that older adults face, age-friendly health systems are able to develop and tailor strategies to meet the special needs of older adults. As Americans live longer and the number of Americans older than 65 continues to grow, addressing these complex social and medical needs will be key to providing high-quality care, reimagining revenue streams and reducing the disutility of health care.
New care model
This social movement reimagines and transforms health care by improving the patient experience for older adults and their families through the 4M model:
- What Matters: Know and act on each older adult’s specific health outcome goals and care preferences across settings.
- Medications: If medications are necessary, use age-friendly medications that do not interfere with what matters, mentation or mobility.
- Mentation: Identify and manage depression, dementia and delirium across care settings.
- Mobility: Ensure that older adults at home and in every setting of care move safely every day to maintain function and to do what matters.
Five health systems — Anne Arundel Medical Center, Ascension, Kaiser Permanente, Providence St. Joseph Health and Trinity Health — are already piloting materials and scaling up the initiative in inpatient, post-acute and primary care settings.
Each site implements the 4Ms in a unique way. At Trinity Health’s Glacier Hills Senior Living Community in Ann Arbor, Mich., improvements start with the “Conversations That Matter” series, with staff initiating dialogues on topics that are important to older adults. To date, 129 residents have had a conversation about what matters, often generating referrals that may have been missed otherwise.
Ascension, based in St. Louis, Mo., has integrated What Matters into its national patient and family engagement plan, rolling it out as a systemwide initiative.
Kaiser Permanente, based in Oakland, Calif., is training staff to improve advanced illness discussions with patients and families.
At Anne Arundel Medical Center in Annapolis, Md., the patient and family advisory council helps to guide implementation of the 4Ms, with patients participating in every step of the process.
Providence St. Joseph Health, headquartered in Renton, Wash., with a location in Irvine, Calif., has added whiteboards in patient rooms to record what matters and is measuring the effect of implementation on patient satisfaction.
These health systems are using the age-friendly initiative to reframe their thought processes around caring for older adults. By May, these systems will provide age-friendly care to at least 51,000 older adults in six states. Sites are collecting data on readmissions, dementia, delirium, falls and emergency department visits, among other indicators, to assess positive outcomes associated with age-friendly changes.
The 4M model is a crosscutting approach to improve and provide the best, patient-centered care without creating additional burden for patients or staff. The AHA aims to have hospitals and health systems representing more than 500 care sites committed to age-friendly care by December. Recruitment for participation and onboarding is ongoing for those interested in deploying the model.
Jay Bhatt, D.O., is chief medical officer of the American Hospital Association and president of the Health Research & Educational Trust. Kristina Davis, M.S.N., M.P.H, R.N., is a program manager at the Health Research & Educational Trust.