Blog post by Bernadette Keefe MD
The quality, not the longevity, of one’s life is what is important.
– Martin Luther King Jr.
100 Year Lifespan: The coming reality
The 100 Year lifespan is coming. As of 2014 there were 72,000 centenarians (U.S.) and projections of as many as 1 million by 2050. In the industrialized world, people over 90 years of age are the fastest growing segment of the population. By the end of this century the average life expectancy is expected to be 100 years. Notably, Japan’s centenarians, who number about 30,000, have quadrupled in the last 10 years.
Now there are 43 Million Americans over age 65 years age. By 2050 that number is expected to rise to 108 million. The number of those over 85 years could increase five-fold by that time.
The above dramatic statistics do not consider the potential (added longevity) effect of successful anti-aging initiatives. Over the past decade, there have been multiple anti-aging, and longevity research initiatives at sites including: The Buck Institute, University of Michigan, University of Texas, University of California at San Francisco, Google’s Calico, Human Longevity Inc (created by biotech entrepreneur Craig Venter) and the Palo Alto Longevity Prize and others. All hope to extend human lifespan well beyond 100 years.
Their challenge, however, is to extend the number of healthy years and not to simply add unhealthy years. Most current medical treatments target the cause of specific diseases, having the untoward result of allowing people to live longer to be affected by dementia or the other chronic diseases of aging (heart disease, cancer etc). It is hoped that a unified cause of aging can be found (as a cause of most of the other diseases), thus impacting longevity in a major way (improved length AND quality of life).
Impact on Healthcare
To Sustain Longevity, You Have To Evolve.
– Aries Spears
What does the 100 year lifespan mean for our healthcare systems? How is it possible to care well for all people over their 100 year lifespans, through both the healthy and sick years?
Out of both necessity and patient’s desire, self management of one’s own health is being recognized as the smartest way forward, with the following goals: Educate and empower patients with their own health data, give them relevant information tailored to their conditions, online access to expert advice and, when needed or wanted, to have in person examinations with a physician or other health care professional.
However a system of supported self-care means that much more responsibility for one’s ongoing health status and general health care will fall to patients. Although on the face of it, this seems like a radical change, people have been managing some of their own health and self-caring for years (with advice, treatments of physicians). What most people haven’t done however is the follow the lifestyle health and wellness advice of healthcare professionals: good nutrition, adequate moderate exercise, adequate sleep, maintaining normal weight etc. Thus, although people are living longer because of advances in medical care, except for a select few, these added years are unhealthy years.
Communities of Increased Longevity
The Seventh Day Adventists enjoy about a decade more life expectancy than others their age. Thomas Perls of Boston Medical Center who analyzes centenarians commented about them:
They don’t drink or smoke, most are vegetarians, they exercise regularly even when old, and take a true weekly day of rest.
But what struck Perls the most was that Seventh Day Adventists maintained active, large social groups:
Constant interaction with other people can be annoying, but overall seems to keep us engaged with life.
Communities of Decreased Longevity
The single best predictor of a person’s life span is their educational attainment. Research has shown that American women with no high school diploma have experienced relatively small life span increases since the 1950s whereas the life expectancy of highly educated women has soared since that time. Today the difference in education can make a lifespan difference of 10-14 years.
Educational differences are a proxy for most of the other social determinants of health, and these influence greatly our quality of health, and our longevity. Such determinants include poverty, poor education (low literacy and health literacy), limited job opportunities, suboptimal built environment (limited safe exercise areas), increased stress, shift work & multiple jobs, and poor nutrition (food deserts). It is thought that approximately 23.5 million Americans live in food deserts, areas devoid of ready access to healthy foods.
To answer healthcare’s prohibitive costs, the increase in chronic disease, the needs of an aging demographic and to combat waste & error in healthcare, multiple major trends are emerging:
- Population Health: melding of Social Care & Healthcare in select populations, predictive modeling
- Technology: telemedicine, telehealth, robotics, wearables (including implantables, ingestibles), connected devices (healthcare IOT), electronic medical records (shared/joint /open -patients plus MDs plus other HCPs) personal health cloud (each patient’s complete healthcare data/history including data from devices/wearables etc.) big data (machine learning & predictive intelligence), selfcare, wellness & healthcare apps
- Multiple & changing venues for care: Retail clinics, Fast med clinics, Community health centers, consolidated/merged hospitals, physicians/allied health professionals, online=telemedicine/telehealth
- Quality Control: Outcomes, Value Based Care and Quality of life, transparency of care (Open Notes/Open Records)
- The Responsibility of Self Care: lifestyle changes, shared decision making, self education
- Emphasis on better end of life care: geriatric care, & palliative care, long term care facilities, electronic advanced directives, choice about death/ assisted death (controversial)
- Government regulation: Affordable Care Act, CMS/ ONC initiatives, Meaningful Use, Clinical Decision Support, fee for service to value based care
- Caregiving/Carer initiatives: to address shortage
- Patient empowerment initiatives: patient data
- Physician burnout: increased physician advocacy, regulation
- Open conversation: online, through social forums
Some major challenges facing successful implementation of “Healthcare as Supported Self-Care” throughout life:
- Lack of universal broadband access
- Lack of Interoperability of medical records, patient ownership/ access to their health data
- Lack of Educational/Health Literacy
- Lack of Social Support for the devastating effects of social determinants of health
- Lack of Social Support for caregiving
- Lack of Robust Community/Public Health Services
- Lack of Nimble Healthcare Systems w/ Providers as Diverse Teams w/allied healthcare professionals
- Lack of patient engagement in their own health.
- Shortage of Quality Long Term Facility & In Home Care Workers
- Shortage of geriatricians and palliative care providers
- Shortage of high quality acute rehabilitation and long term care facilities
- Lack of adequate infrastructure/safe built environments
If I knew I was going to live this long, I’d have taken better care of myself.
– Eubie Blake, George Burns
Please see references below and join us for #HCLDR on Tuesday June 30 2015 8:30pm ET (for your local time click here) to discuss the following:
- T1 How long would you like to live? Age 75 (like E.J.Emanuel), or longer? Would that change if you had a chronic condition (ie: dementia)
- T2 How prepared are you to self-care for the rest of your life? What do you need in place to do this well?
- T3 How do we prepare upcoming generations to self-care for 100 year lifespans?
- T4 Should $ billions be devoted to longevity given we have yet to achieve healthy aging & are unable to care for our elderly now?
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“Changes in the health care system driven by self-service & DIY health”, Jane Sarasohn-Kahn, O’Reilly Radar, April 22 2014, http://radar.oreilly.com/2014/04/changes-in-the-health-care-system-driven-by-self-service-and-diy-health.html, accessed June 20 2015
“Patients Need More Options for Self-Managing Their Own Healthcare”, Dan Munro, Forbes, June 26 2012, http://www.forbes.com/sites/danmunro/2012/06/26/patients-need-more-options-for-self-managing-their-own-healthcare/, accessed June 20 2015
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“Robear robot care bear designed to serve Japan’s aging population”, David Szondy, Giz Magazine, February 26 2015, http://www.gizmag.com/robear-riken/36219/, accessed June 20 2015
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“Why Robots Are The Future of Eldercare”, Mark Hay, Good Magazine, http://magazine.good.is/articles/robots-elder-care-pepper-exoskeletons-japan, accessed June 20 2015
“Health records in your hands”, Mike Freeman, The San Diego Union-Tribune, June 19 2015, http://www.utsandiego.com/news/2015/jun/19/humetrix-medicare-tricare-veterans-scripps-topol/, accessed June 20 2015
“U.S. Younger Than Much of Europe and Japan, Older Than Most Other Regions”, Pew Research, May 20 2015, http://www.pewresearch.org/fact-tank/2015/05/21/americans-are-aging-but-not-as-fast-as-people-in-germany-italy-and-japan/ft_15-05-19_agingmap/, accessed June 20 2015
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Robear by Riken, The Guardian, http://icdn4.digitaltrends.com/image/robear-by-riken-680×453.jpg