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Health Care for the Aged: ‘Invest Now or Pay Later’ : Medicine: Study predicts a threefold rise in cost of caring for the elderly. The authors call for more public funding of research into treating diseases.

TIMES MEDICAL WRITER

The aging of America will escalate health-care costs in a way that no “cost containment” will be able to control, according to a new federal study that the researchers say supports the growing demand for more public funding for research into diseases of the elderly.

The study’s authors, from USC and the National Institute on Aging, predict a threefold increase in Medicare costs by the year 2040. To slow that rise, they called Tuesday for increased support for research into treating diseases like Alzheimer’s and osteoporosis.

“It’s a trillion-dollar issue,” said Dr. Edward L. Schneider, dean of the Ethel Percy Andrus Gerontology Center at USC and one of the authors of the study. “You can invest now or pay later. The costs for medical care are going to go into the trillions.”

The study, published today in the Journal of the American Medical Assn., comes amid growing demands from some health-policy experts and researchers for a shift in the balance of research funding toward conditions that afflict people aged 65 and over.

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Citing the study, U.S. Sen. Tom Harkin (D-Iowa) said Tuesday that he intends to introduce a bill aimed at enabling older people to remain healthy and active longer. Among other things, the bill would double federal spending for aging research to $1 billion a year.

However, some skeptics question whether increased research spending can really help control health-care costs. Some suggest that attention is best focused on changing people’s lifestyles to improve their quality of life and keep them active longer.

“There’s this wonderful faith in scientific progress benefiting mankind,” said Daniel Callahan, a prominent specialist in biomedical ethics. " . . . But scientific progress, I think, has demonstrated that it becomes very, very expensive in the health-care arena.”

“Managing old age better is not an issue best handled by waiting for the cure,” wrote Dr. James F. Fries, an associate professor at Stanford University School of Medicine in an editorial accompanying the new study.

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“It requires healthy lifestyles . . . environmental improvements . . . and (mechanisms) to limit inappropriate and inhumane terminal care,” Fries wrote.

Schneider and Dr. Jack M. Guralnik, an epidemiologist at the National Institute on Aging, used U.S. Census projections to estimate future costs for Medicare, nursing homes, dementia and hip fractures over the next 50 years.

Their findings include:

There could be 52 million to 57 million Americans over age 65 in the year 2020 and as many as 83 million by the year 2050. There could be as many as 8.6 million Americans over age 85 by 2020 and as many as 17.8 million by 2040.

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Medicare costs--"a useful reflection of the overall costs for health care for older Americans"--will nearly double by the year 2020. By 2040, when the average age of members of the Baby Boom will be 85, Medicare costs could reach $212 billion.

Nursing home costs could rise to as much as $139 billion by 2040, with as many as 6 million nursing home residents aged 65 and older. (By contrast, there were 1.3 million nursing home residents in 1985, costing $31 billion.)

As many as 9.8 million Americans could suffer from moderate to severe dementia by 2040, costing as much as $149 billion.

The medical cost of hip fractures among the aged is expected to increase from $1.6 billion in 1985 to $6 billion in 2040.

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Schneider and Guralnik argue that one answer to skyrocketing costs is a significant investment in aging research--specifically, the search for treatments or cures for diseases like Alzheimer’s that leave people alive but disabled for many years.

According to Schneider, federal funding for research into diseases related to aging now hovers around $500 million annually. He and others would like to see that figure at least doubled.

“If we don’t address (this) now, we will wake up in 10 or 20 years . . . and regret the opportunity that we lost,” Schneider said in an interview.

That view received support Tuesday from others in the field of aging, most of whom say their specialty has been relatively under-funded. Traditionally, heart disease and cancer have received a far greater share of federal research money.

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But others expressed reservations about Schneider and Guralnik’s recommendations. Some, like Fries, suggested their projections were overly pessimistic. Others questioned whether research would really result in a slowdown in the rise of health-care costs.

“I do not believe that aging can be solved by magic bullets,” said Carroll L. Estes, director of the Institute for Health and Aging at UC San Francisco. “I think a universal, publicly financed health-care program is what is necessary to contain costs.”

Callahan, director of the Hastings Center, a research organization devoted to ethical issues in medicine and biology, said research may be expected to improve the quality of life. But, he said, it will not necessarily hold down costs.


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