The Costs of Medical Care & The Future of Medicine – PART 2

The Cost of an Aging Population

BY:  Stephen C. Schimpff, MD

We are all getting older and like an old car our parts start to wear out. That will not change but we as individuals can delay the effect of aging with physical and mental exercise. Our organs lose some of their function at a set rate each year. For example, bone mineral density goes down about 1 percent per year beginning about 30, and so does lung function, heart function, muscle mass, etc. Good data shows that exercise slows the rate of loss of bone mineral density, heart function, lung function, muscle tone, and improves mobility, strength and a sense of well-being. Similarly, there is suggestive evidence that exercising the brain slows down memory loss and may delay the onset of dementia. Add good nutrition, a sensible diet and maintenance of normal weight and watch what happens to one’s sense of self health. But eventually, even with the best of attention, our age related malfunctions will catch up with us. Very few of us will die in the middle of the night of “old age.” Rather we will develop heart disease, have a stroke or be struck with cancer. Its treatment will be expensive unless we are at that point in life where we make the conscious decision to request only supportive or palliative care and otherwise let nature take its course as it did for generations before our time.

It is also instructive to look at a significant shift in medicine that has occurred. There has been a major change in the diseases that are prevalent. Until recently, acute diseases such as pneumonia, appendicitis, gall bladder disease and others were the major problems encountered in medical practice. Today it has changed to be chronic diseases such as diabetes, heart failure, chronic lung disease, and many more. Indeed it has been estimated that by 2030, 6 out of 10 people over the age of 65 will be coping with more than one chronic condition. And there will be three times as many people living in the USA in 2030 who are over the age of 65 than there are today so there will be plenty of chronic diseases. But it is not just the numbers of people with chronic disease but the costs of caring for chronic disease. Caring for a heart attack is expensive what with the diagnostic procedures and the new approaches to care. But for the patient who progresses on to heart failure, the costs are not only high but remain high for the rest of the patient’s life time. Same for chronic lung disease, diabetes, kidney failure, and osteoarthritis. Add to that those diseases that we call autoimmune diseases like diabetes, rheumatoid arthritis, multiple sclerosis, Crohn’s disease, lupus, and many others. These autoimmune diseases are increasing at a rapid rate, some would even say an epidemic rate and no one really knows why. But they are and all of these chronic diseases require intense, long term, expensive treatment.

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