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INTRODUCTION

By all demographic accounts, geriatric business will be good for some time. Medical practice will serve a growing number of older adults. Today persons aged 65 years and older currently represent a little more than one-third of the patients seen by a primary care physician; in 40 years, we can safely predict that at least every other adult patient will be aged 65 or older. The relative rate of growth varies with age. The older the old, the faster their relative numbers grow. Those over 85 are the most rapidly growing group of older individuals, with a growth rate twice that of those aged 65 years and older and four times that of the total population. This group now represents approximately 10% of the older population and is anticipated to grow from 5.7 million in 2010 to over 19 million by 2050 (Census Data, 2010). Among this old-old group, those aged 90 and above will show an even steeper rise. People in this old-old group tend to have poorer physical activity, be more dependent in activities of daily living, and have more cognitive impairment (Zhao et al, 2010).

The growth in aging spawns several concerns around numbers and dollars. As shown in Figure 2-1, the growing numbers of older people are not matched by growth in those following them. Hence, there will be fewer people to support programs like Social Security and Medicare, and fewer people to provide needed care. We hear a great deal of talk about the incipient demise of Social Security, the bankrupt status of Medicare, the death of the family as a social institution, and dire predictions of demographic cataclysms. There is, indeed, cause for concern but not necessarily for alarm. The message of the numbers is straightforward: we cannot go on as we have; new approaches are needed. The shape of those approaches to meeting the needs of growing numbers of older persons in this society will reflect societal values.

FIGURE 2-1

Change in the relationship of older persons and workers. (Data from Colby SL, Ortman JM: Projections of the Size and Composition of the U.S. Population: 2014 to 2060. US Census Bureau; March, 2015.)

Americans who view aging as a problem can take some solace in knowing that we are not aging as fast as many other countries. Indeed, we rank 48th of 228 countries and areas in the world. The costs associated with an aging society have already stimulated major changes in the way we provide care. If we face a dearth of caregivers (paid and unpaid), we will need more creative approaches to giving care.

There is actually some basis for optimism. The rate of dementia has been falling for decades. Compared to the incidence in the late 1970s and early 1980s, the ...

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