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From the physician's perspective, the demographic curve strongly argues that medical practice in the future will include a growing number of older adults. Today persons age 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 age 65 or older. The “old-old” (older than 85), however, are the most rapidly growing group of older individuals, with a growth rate twice that of those age 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 (Day, 1993). Among this old-old group those age 90 and above will show the steepest population rise (Federal Interagency Forum on Aging-Related Statistics, 2010). 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 concern so often heard about the epidemic of aging stems primarily from two factors: numbers and dollars. 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 elderly persons in this society will reflect societal values. The costs associated with an aging society have already stimulated major changes in the way we provide care.

There is actually some basis for optimism. Data from the National Long-Term Care Survey show a decline in the rate of disability among older people. Overall, the rate of disability among older persons has decreased by 1% or more annually for the last several decades. However, the growth in the aging population more than offsets this gain. The number of disabled persons age 65 years and older in 1982 was 6.4 million. It increased to 7 million in 1994, and in 1999, the projected level of disability applied to population projections called for was about 9.3 million. It remains to be seen whether this trend toward lower disability rates can be sustained, but if so, it will greatly offset the effects of an aging population. Death rates from major killers have been falling in some areas. As seen in Figure 2-1, death in older men from heart disease has dropped precipitously, while death from cerebrovascular disease has declined somewhat, but death from cancer overall has not changed much. The pattern for women is very similar. Life expectancy at age 65 continues to increase for ...

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