That the world’s population is ageing rapidly is old news. Driven by falling fertility rates and a sustained increase in longevity, many countries—especially in the developed world—are now bracing themselves for the fact that their fastest-growing demographic is the over-80s. Moreover, the linear trend that life expectancies have followed for over a century is set to continue.

Of course, any demographic shift brings with it social and economic challenges, not least for healthcare systems. The notion of a greying population is usually framed in terms of the added demands and pressures they will bring. But although there will be challenges in adjusting, the overall picture is far from bleak if policymakers enact sensible change. On the individual level, an increased lifespan is welcome news to most. Although many of those living longer do have long-term conditions, they are also showing a heartening ability to manage them—and data suggest that the onset of the most severe disabilities may be coming later in life. In other words, old age is not itself a disease. While the baby boomers will live longer than any generation before them, they are not necessarily happy to retire at 65 and count the days until they have to enter a nursing home.

For this report, the Economist Intelligence Unit analyses the latest thinking relating to provision of healthcare for ageing societies. Below are some of the issues that need to be addressed if healthcare is to adapt to an ageing world

Change assumptions about the financial impact of ageing on healthcare
Demographic change has had less of an impact on health spending than is widely believed. In reality, birth and death account for the majority of an individual’s lifetime healthcare costs. The final two years before death consume about one-quarter of this total cost, no matter whether this comes at 8 years or 88. Although there is a link between healthcare costs and age, those costs rise more in the over-65s mainly because more people die in this age bracket.
There are other factors at play. Although the proportion of the elderly that faces severe disability is falling sharply, there is generally a stronger susceptibility to various chronic conditions and mild disability. Once again, however, the impact of this in the elderly segment of the population is not as great as is often assumed. According to a study in Health Affairs, a policy journal, the average growth in healthcare costs related to ageing within OECD countries between 1970 and 2002 was 0.5% per year, and just 0.3% in the US. In contrast, real growth in GDP per head accounted for 2%.
The real financial issue related to ageing is a decrease in the proportion of people in the workforce. The impact of this goes far beyond healthcare. But it is worth noting that even if ageing populations are not significantly driving up health costs, medical provision will take place in a context of fiscal
constraint. This may limit what societies will be able to do for older citizens.

Make geriatric care a bigger part of medical training
The shift in the specific healthcare needs of an older population will require major adjustments. One key challenge for policymakers and health providers will be a shake-up of medical training. Quite simply, not enough talent will gravitate towards geriatric care until the field is given the attention
it warrants. Harvard Medical School did not require basic training in geriatrics for all medical school students until just two years ago. In many other countries, geriatric training is barely provided.
Financial incentives play a part, too. While a radiographer earns an average of US$400,000 per year in the US, geriatricians make about US$150,000. To make the field more attractive, some thought willneed to be given as to how prospects might be improved for future graduates. This is especially true as the existing population of healthcare professionals starts to retire. Canada, for example, has just one-fifth of the 1,000 geriatricians it currently needs—and 20% of them are near retirement. The US has about half the geriatrics specialists it needs, but their absolute number has actually fallen over the past decade.

Reconsider care options
Given the rising demand for social care services from an ageing population, governments are increasingly keen to share their responsibility for meeting this need. Even in the UK, where healthcare is overwhelmingly state-funded, the private sector is now the main provider of nursing home beds. In the US, where the cost of one care-home bed is US$70,000 a year, the government is proposing a new insurance scheme to help people to stay out of nursing homes for longer. Once out of fashion, home-based care is coming back into vogue as governments grapple with the costs and management challenges of aged care and because older individuals, ever more likely to exercise their consumer power, prefer to live at home. Medical professionals agree. In a survey conducted in early 2009 by the Economist Intelligence Unit, care in the home was selected by medical professionals as the second most important area for healthcare investment, after hospitals and clinics.
Depending on how it is set up, community or home-based care can offer strong economic benefits. In the US state of Illinois, for example, the Department on Aging spends about US$117 per day for people in nursing homes, versus a monthly total of US$650 for home care. Existing plans, such as San Francisco’s On Lok, provide a possible model for a middle path by aiming to bridge the gap between medical and non-medical services. But getting such schemes right will require a better understanding of the needs of the elderly.

Make treatments more appropriate to older populations

Just one of the problems facing policymakers and healthcare professionals is widespread ignorance about responsiveness to and tolerance for drug treatments in a population of over-65s—let alone one of over-80s. Clinical trials for new drugs rarely address populations of over-75s as a sizeable cohort. More importantly, there has been little attempt to encourage post-market studies of existing drugs in elderly populations. Rising pressures will compel policymakers to insist on more research. As the elderly become the biggest demographic, new opportunities will emerge for pharmaceutical and related companies.

• Beyond this, a greater understanding of the needs of the elderly is also required. Older bodies are different—they have different conditions and they metabolise differently to younger people. And they simply get frailer as they age. Some of this is well known, but even in the medical community there is a lack of awareness about the seriousness of falls, or the high suicide rate, among the elderly.
• Use technology to deliver key skills remotely and enable home-based care
• Technology will play an increasingly active role in providing care to ageing populations. At a basic level, it can be applied to support medical professionals by relieving them of routine, mundane tasks. In Japan, “robot nurses” already provide assistance in the form of cleaning, assisting patients from wheelchairs and onto beds, for example.
• More broadly, the wider adoption of telemedicine and remote monitoring systems will likely assist in making home-based care more feasible and safe. This enables medical professionals to provide advice remotely, and by monitoring patients’ vital signs it gives nurses time to focus on more important tasks. There are also knock-on benefits for developing countries—in 2005, almost one-quarter of a million people were employed in telemedicine in India, up from barely 30,000 five years previously. The European Commission has suggested that member states should go as far as establishing a legal framework in place by 2011 to promote telemedicine.
• But technology alone is not the whole answer. Pilot trials have been relatively small, partly because the infrastructure required to support larger trials does not exist in many places. Nor is there yet appropriate support for full-scale telemedicine. There are also ethical concerns to consider. Some people find certain technologies rather inhumane and frightening, and more needs to be done to address the fear that they could replace the more human aspects of care for the elderly.

Reset public mindsets about the elderly

The key challenge when dealing with an ageing population is the need to change assumptions about what it is to be “old”. In particular, ageism needs to be urgently addressed in medical treatment. In the UK, for example, 80-year-olds have been shown to be about half as likely as 50-year-olds to
receive appropriate secondary prevention drugs. A study of 12,000 patients in Scotland showed that the elderly were less likely than other age groups to receive appropriate care, including admission to intensive care. Much of this relates to mindsets that society has about the elderly. Society needs to come to terms with the fact that people are not going to die off simply because of age. A recent survey found that 72% of British doctors believe older people are less likely to be referred for essential treatment. Such studies are mirrored elsewhere too, notably the US. New legislation to make age discrimination illegal within the UK’s National Health Service (NHS) has been specifically aimed at resetting attitudes regarding what is normal as a population ages.

• More broadly, the idea that people should feel obliged to stop working and retire in their mid-60s, when many are healthy, alert and at the peak of their experience, is often perverse. Aside from helping address skills shortages and financial pressures by paying taxes for longer, there can be health benefits too: one recent study highlights clear mental health benefits to part-time working after retirement.
• All this emphasises another key point about the nature of ageing populations. People will continue to vote, irrespective of their age—and in fact older people are often among the most likely to vote. This will make the older population the most important voting bloc in years to come. In any future healthcare reforms, it will be essential for governments to address the needs of this generation if they are to remain in power.