Spending Now to Avoid It Later : Why not give more study to ailments of elderly?
The United States ages. More than 33 million Americans have passed t 65th birthday, more than 3 million are 85 years old or older; this latter age group is growing six times faster than the rest of the population. Concurrently, health care costs for the aging population have exploded. Between 1977 and 1987 (the last year for which figures are available), they rose from $45 billion a year to $162 billion. In the next decade, says a new report from the Institute of Medicine, those costs will double again, unless new ways can be found to delay or prevent disabling illnesses.
Is that a credible goal? The report says it is, and for a fairly modest cost--rising over five years to $312 million annually--in additional research funds. The potential payoff, both in an improved quality of life for the elderly and in reduced health care costs, could be enormous.
The institute, which was chartered by Congress to advise the government and is affiliated with the National Academy of Sciences, proposes a 50% increase in the $600 million a year now spent on research into the ailments of the elderly. In addition, it calls for a onetime expenditure of $110 million for new laboratories and support facilities. What stands to be gained? Julius R. Krevans, chancellor of UC San Francisco and chairman of the committee that produced the report, offers a compelling example.
“If we were able to postpone for one month the onset of the type of disability that leads to an elderly patient being placed in a nursing home, we would be talking in terms of savings of more than $3 billion a year.” The savings in this one area alone could be 10 times as great as the proposed increase in research funds. Cost-benefit ratios don’t come much better than that.
Krevans emphasizes that expanded research would aim not at extending longevity but at improving the quality of life, mainly by preserving function so that the elderly could remain independent and freer from incapacitating diseases. Some areas where more intensive research could add to the quality of life turn out to be remarkably obvious.
Take hip fractures. About 200,000 a year occur in the United States, mainly in the elderly. What accounts for the loss of balance, the dizziness and fainting that cause older people to fall and suffer hip fractures that often prove to be permanently disabling? Dr. John W. Rowe, president of Mt. Sinai School of Medicine in New York and a committee member, notes that although the question is simple, research into answers has never been done. Finding answers could spare many older people the pain and hardship of crippling bone injuries.
We are all, with luck, destined to grow old. But we are not inevitably doomed to be disabled by the illnesses and loss of functions traditionally linked to aging. The Institute of Medicine proposes spending about $912 million a year by the mid-1990s to study how the quality of life can be improved for an expanding proportion of the population. That would represent 0.5% of health care costs for that population. A wise investment? Yes, but more than wise, it would be profoundly humane.
