A Perfect Storm Brewing in Healthcare for Older Adults

As the U.S population continues to age, we are seeing over 10,000 Medicare enrollees entering into the system each and every day. As a result of the aging generation, the US Census bureau, predicts older adults are expected to outnumber their children for the first time in U.S. History by the year 2034. As such, a recent study projected a shortage of filled positions for health care related jobs caring for older adults. How will the U.S. healthcare system be able to manage this surge of growing need?

The unfortunate recent impact of the COVID-19 crisis unmasked the vulnerabilities of our health care delivery and its inability to support older adults in the U.S. and abroad. As the repercussions of delayed care and pent up demand come about, the health system will continue to face growing pressure. With the overwhelming aging population and lack of support and critical infrastructure , new approaches to caring for older patients need to be quickly considered.

Traditional medical care has always relied upon the local “brick and mortar” model whether it be an office or hospital based location. As efficiencies in delivering such care became the standard, moving patients through the system as quickly as possible became the goal. Unfortunately, the needs of older adults with chronic or complex conditions combined with episodic assembly line care leaves serious gaps in the ability to be more proactive in our approach. Similar to the approach that pediatricians have taken with anticipatory care and guidance of growing children, geriatric care requires a similar slant. However, one fundamental difference with geriatric care is the fact that the older adult is more often the patient and decision maker. With limited time to address more acute issues, often the anticipatory care or planning is last on the list of items for a 20 minute office visit.

Traditional medical care has always relied upon the local "brick & mortar" model

As a result of the reactive approach to adult medical care, we see worsening of conditions or health related issues that require the needs for emergency or more urgent and costly acute care. Many proponents of the use of telemedicine and remote monitoring capabilities have taken the approach of arming the brick and mortar provider with these tools to offer more frequent access and touch points along the care continuum. However, time and time again, I have seen the office based providers struggle to jump between in person and virtual/telemedicine care all within the busy office schedule. During this recent pandemic, many providers have told me that they find bouncing between such visits challenging and stressful. Rather than force office based providers to engage in virtual and digital care tools, could we wrap a virtual medical care team around high need populations to better engage and manage emerging issues or concerns quickly and efficiently. Often many issues handled in the office environment could easily be dealt with via regular home monitoring and video/digital engagement. Furthermore, understanding several data points around the personal home environment as well as trended data can have highly predictive benefits for emerging risk issues.

For example, by understanding a patient's blood sugar measurements over time combined with known activity, dietary habits, general lifestyle patterns, and compliance to recommended care, a medical care team may better understand why higher blood sugar measurements are occurring. Combining activity, diet, and other lifestyle factors that an engaged care team gathers passively can provide deep insight into ability to proactively improve a patient's diabetic control over time. Any changes in medications can easily be implemented without need for an in person office visit. Even the ability to check laboratory tests can be done under electronic orders at a local reference laboratory location with results discussed via digital or video communication.

Understanding several data points around the home environment as well as trended data can have highly predictive benefits for emerging risk issues.

While technology such as mobile or video communication can be a challenge for adults born in the post WWII generation, the current retiree population of today is coming out of a workforce familiar with the technology boom of Microsoft, Apple, Fitbit, and Zoom capabilities. As such, the older adult and their caregivers are more than familiar with the tools of a virtual world. Furthermore, the application of these technologies due to COVID-19 have only accelerated the adoption and use cases for this proposed care model enabled by technology. Granted, ease of use and simplicity as well as adaptability and access to broadband are key functions and features that need to be understood for this model of care to be utilized on a massive scale. But, similar to the speed of adoption that the smartphone saw in such a short time, we anticipate a similar revolution in health care delivery over the coming years!

About the Author- Kurt M. Tamaru is a board certified family physician & innovator with over 25 years of experience in creating or managing integrated health care service companies with the goal of better care and quality for all. With extensive background in value based care delivery, Dr Tamaru is looking to create the next generation of health care services to better meet the growing needs of older adults and "at risk" populations under his privately funded company Guardiant Health.