Who Will Care for Older Adults? We’ve Plenty of Know-How but Too Few Specialists

Link: https://kffhealthnews.org/news/article/who-will-care-for-older-adults-weve-plenty-of-know-how-but-too-few-specialists/



Despite the surging older population, there are fewer geriatricians now (just over 7,400) than in 2000 (10,270), he noted in a recent piece in JAMA. (In those two decades, the population 65 and older expanded by more than 60%.) Research suggests each geriatrician should care for no more than 700 patients; the current ratio of providers to older patients is 1 to 10,000.

What’s more, medical schools aren’t required to teach students about geriatrics, and fewer than half mandate any geriatrics-specific skills training or clinical experience. And the pipeline of doctors who complete a one-year fellowship required for specialization in geriatrics is narrow. Of 411 geriatric fellowship positions available in 2022-23, 30% went unfilled.

The implications are stark: Geriatricians will be unable to meet soaring demand for their services as the aged U.S. population swells for decades to come. There are just too few of them. “Sadly, our health system and its workforce are wholly unprepared to deal with an imminent surge of multimorbidity, functional impairment, dementia and frailty,” Gurwitz warned in his JAMA piece.

This is far from a new concern. Fifteen years ago, a report from the National Academies of Sciences, Engineering, and Medicine concluded: “Unless action is taken immediately, the health care workforce will lack the capacity (in both size and ability) to meet the needs of older patients in the future.” According to the American Geriatrics Society, 30,000 geriatricians will be needed by 2030 to care for frail, medically complex seniors.

Author(s): Judith Graham

Publication Date: 10 Nov 2023

Publication Site: Kaiser Health News

Death of an Elder Raises Uncomfortable Questions About Adequacy of Care

Link: https://www.nakedcapitalism.com/2022/12/death-of-an-elder-raises-uncomfortable-questions-about-adequacy-of-care.html


Yves here. I’ve taken the liberty of changing the title of this Kaiser Health New from A Family Death During the Holidays Prompts Questions and Reflection. The piece pulls its punches, perhaps because the health care journalist author Judith Graham, who regularly writes about aging, is hesitant to come off as an advocate and/or potentially alienate future sources. But you can see she is clearly not happy with the caliber of care her father-in-law received in his final days.

I’ve heard similar stories from readers and I saw it first hand with my mother, who like Graham’s father died at 94. I would be curious if practices are better or worse with the moderately and very old in other countries, particularly in Asia. The two times my mother was hospitalized in her final year, the care was horrid. And it wasn’t as if the staff was overburdened due to Covid. My mother’s aides would call for help, and after >10 minutes of getting no answer, would then go to the nurses’ station to find them doing their nails and watching TV. They also failed to keep her well hydrated and bruised her horribly.


But more broadly, an anti-aged attitude was evident. No one seemed willing to work that hard to save an old woman, or even help her have a more dignified death, particularly since she didn’t look that swell. Thanks to Covid, her hair and nails hadn’t been done for over a year and she came to the hospital in flannel pajamas. Notice the photos of the father in law below. Despite the upscale sweater, watch and glass frames, I suspect his very aged skin was held against him.

BTW, according to the Social Security life expectancy table, an average women my mother’s age typically would have lived another 3.8 years. So to hell with the bigots on staff.

And this sorry picture is set to get worse with Covid, with repeat infections reducing health baselines generally and resulting in more demands on doctors, nurses and hospitals that have no ability to increase capacity in less than many years. A sicker population will also produce more prejudice against older patients, even if they are robust and have managed to stay Covid-free.

Author(s): Yves Smith, Judith Graham

Publication Date: 9 December 2022

Publication Site: naked capitalism

Old Age Mortality Experience Study Report

Link: https://www.soa.org/resources/experience-studies/2022/old-age-mortality/



The Society of Actuaries (SOA) Research Institute released a report that examines older age mortality (OAM) with a focus on attained ages 70 and above. The report helps determine whether refinements were needed in the 2015 Valuation Basic Tables. Analysis was performed by sex, issue age and attained age, issue year cohorts, smoking risk classification, benefit band, select vs ultimate period, and interactions.


Old Age Mortality Subgroup of the Individual Life Experience Committee

Publication Date: October 2022

Publication Site: Society of Actuaries

Successful 10-second one-legged stance performance predicts survival in middle-aged and older individuals

Link: https://bjsm.bmj.com/content/56/17/975


Objectives Balance quickly diminishes after the mid-50s increasing the risk for falls and other adverse health outcomes. Our aim was to assess whether the ability to complete a 10- s one-legged stance (10-second OLS) is associated with all-cause mortality and whether it adds relevant prognostic information beyond ordinary demographic, anthropometric and clinical data.

Methods Anthropometric, clinical and vital status and 10-s OLS data were assessed in 1702 individuals (68% men) aged 51–75 years between 2008 and 2020. Log-rank and Cox modelling were used to compare survival curves and risk of death according to ability (YES) or inability (NO) to complete the 10-s OLS test.

Results Overall, 20.4% of the individuals were classified as NO. During a median follow-up of 7 years, 7.2% died, with 4.6% (YES) and 17.5% (NO) on the 10-s OLS. Survival curves were worse for NO 10-s OLS (log-rank test=85.6; p<0.001). In an adjusted model incorporating age, sex, body mass index and comorbidities, the HR of all-cause mortality was higher (1.84 (95% CI: 1.23 to 2.78) (p<0.001)) for NO individuals. Adding 10-s OLS to a model containing established risk factors was associated with significantly improved mortality risk prediction as measured by differences in −2 log likelihood and integrated discrimination improvement.

Conclusions Within the limitations of uncontrolled variables such as recent history of falls and physical activity, the ability to successfully complete the 10-s OLS is independently associated with all-cause mortality and adds relevant prognostic information beyond age, sex and several other anthropometric and clinical variables. There is potential benefit to including the 10-s OLS as part of routine physical examination in middle-aged and older adults.

Author(s): Araujo CG, de Souza e Silva CG, Laukkanen JA, et al

Publication Date:

Publication history
Accepted April 19, 2022
First published June 21, 2022.
Online issue publication
August 24, 2022

Publication Site: British Journal of Sports Medicine


Araujo CG, de Souza e Silva CG, Laukkanen JA, et al

Successful 10-second one-legged stance performance predicts survival in middle-aged and older individuals

British Journal of Sports Medicine 2022;56:975-980.

doi: http://dx.doi.org/10.1136/bjsports-2021-105360

In the Next 10 Years, Nearly All the Population Increase Will Be Age Group 65+

Link: https://mishtalk.com/economics/in-the-next-10-years-nearly-all-the-population-increase-will-be-age-group-65



The above stats from Census Bureau Projects U.S. and World Populations on New Year’s Day.

Looking ahead to the next decade the percentage of those 60 and over will rise from 23.29% to 25.93%. 

Meanwhile, the prime working age population age 20-59 declines from 52.06% to 50.75%.

And this is happening with public union pension plans severely stressed despite huge stock market gains. 

Author(s): Mike Shedlock

Publication Date: 3 Jan 2022

Publication Site: Mish Talk

As U.S. Nears 800,000 Virus Deaths, 1 of Every 100 Older Americans Has Perished

Link: https://www.nytimes.com/2021/12/13/us/covid-deaths-elderly-americans.html



As the coronavirus pandemic approaches the end of a second year, the United States stands on the cusp of surpassing 800,000 deaths from the virus, and no group has suffered more than older Americans. All along, older people have been known to be more vulnerable, but the scale of loss is only now coming into full view.

Seventy-five percent of people who have died of the virus in the United States — or about 600,000 of the nearly 800,000 who have perished so far — have been 65 or older. One in 100 older Americans has died from the virus. For people younger than 65, that ratio is closer to 1 in 1,400.


After the first known coronavirus death in the United States in February 2020, the virus’s death toll in this country reached 100,000 people in only three months. The pace of deaths slowed throughout summer 2020, then quickened throughout the fall and winter, and then slowed again this spring and summer.

Throughout the summer, most people dying from the virus were concentrated in the South. But the most recent 100,000 deaths — beginning in early October — have spread out across the nation, in a broad belt across the middle of the country from Pennsylvania to Texas, the Mountain West and Michigan.

These most recent 100,000 deaths, too, have all occurred in less than 11 weeks, a sign that the pace of deaths is moving more quickly once again — faster than at any time other than last winter’s surge.

By now, Covid-19 has become the third leading cause of death among Americans 65 and older, after heart disease and cancer. It is responsible for about 13 percent of all deaths in that age group since the beginning of 2020, more than diabetes, accidents, Alzheimer’s disease or dementia.

Author(s): Julie Bosman, Amy Harmon and Albert Sun

Publication Date: 13 Dec 2021

Publication Site: New York Times