Redesigning health systems for better aged care
At the “Health Care Systems & Public Health: A Workshop for the Global Roadmap for Healthy Longevity Initiative” event held at Singapore’s National University Health System in early February 2020, there was a broad consensus amongst speakers and attendees that current health systems are badly designed for older populations to retain health for as long as possible.
“This is because the current health systems were designed from the start of the 19th century, with a very focus on infectious disease and acute conditions so it was about identifying those conditions and curing them,” explained John Beard, Co-Chair of the Workshop and Professor at the ARC Centre for Excellence in Population Aging Research, University of New South Wales, Australia.
With rapidly aging populations around the world, health systems need to be more focused on how they can provide ongoing care and handle complex situations.
“The goal of the (health) system should be to maximize the functioning and help an older person retain that for as long as possible. There is a need to focus on integrated care and overall functioning as an outcome. Care also needs to be much more personalized and person-centered – it’s no longer one size fits all anymore,” he added.
Managing aging populations and the role of technology
With an aging population around the world, governments are concerned about the tsunami of older people or ‘silver tsunami’ that is going to exert significant pressure on healthcare systems, increasing demand and cost of health services. However, evidence also suggests that a much bigger driver in the increase of healthcare costs is due to technology. According to an article by the Hastings Center, healthcare economists estimate that 40–50% of annual cost increases can be traced to new technologies or the intensified use of old ones.
“What this means is that if we can look at technology and use it in a rational way, many of the challenges in terms of financing the (health) system can be addressed,” Prof Beard said.
He elaborated that what needs to be done is to really step back and identify which technologies are going to have the biggest impact on people’s function. Typically what happens is that when a new technology arises, for instance, in a particular disease area, the people working in that field will think it is absolutely essential – this leads to a very significant increase on previous costs. This problem is compounded by people in other specialties saying the same thing, which further exerts pressure on the health system.
“What is important is that we are able to step back and compare the benefits of different technologies in terms of the impact on the overall functioning of the person, not on the progress of a specific disease. That will help us understand which technologies we should really prioritize.”
In terms of specific technologies dealing with aging populations, Prof Beard said that there is a lot of work happening in the fields of monitoring, wearable devices and using data from other sources to monitor people’s health in an ongoing way. Within five to ten years’ time, he expects that there will be new norms for how health monitoring happens across time.
There are also a lot of technologies which are designed to help people compensate for loss of capacity – examples include hearing aids and glasses which are improving rapidly and this will help people to continue to live lives of meaning and dignity.
Lastly, he predicts that the whole field of science in which people study the underlying drivers of all chronic conditions which become more prevalent at older ages is going to have very big advances in the coming years. An example was the use of the drug called Metformin, which is for diabetes. Studies of diabetes found that people with diabetes who take Metformin actually live longer than people without diabetes. The use of the drug is having an effect not just on the glucose tolerance and the pathway of diabetes, it is also having a broader impact in terms of people’s health.
Combating ageism and rethinking the human life course
Another topic Prof Beard mentioned that came up during the workshop is the importance of what is known as ageism, which is discriminating or thinking about people differently just on the basis of chronological age.
“What this leads to is that people tend to have a stereotype of what an older person is. Subsequently, our social responses, medical responses and the research we do are framed around that stereotype, which often leads to reinforcing the stereotype rather than inventing a new way for the 21st century.”
“That is a very big challenge to break down and we’ve been talking about it at the Commission* – how we can completely reframe the way we think about the whole life course is trying to move from the stereotype that people study till they’re 25, work till they’re 65 and then retire. We need to try to understand that life is a continuum and there are periods you can contribute in different ways.
There will be different needs for security across that whole period and trying to really think of that in an innovative way because that outdated three-stage paradigm is going to be very self-limiting.”
*The International Commission will recommend global priorities and actions to be addressed by 2030 to optimize the health, function, and well-being of all people into later life and is part of the US National Academy of Medicine’s Global Roadmap for Healthy Longevity. The workshop which was held in Singapore from 3 to 4 February 2020, is the second of three that will inform the Global Roadmap for Healthy Longevity initiative.