The quality, not the longevity, of one’s life is what is important.
– Martin Luther King Jr.
100 Year Lifespan: The coming reality
The 100 Year lifespan is coming. As of 2014 there were 72,000 centenarians (U.S.) and projections of as many as 1 million by 2050. In the industrialized world, people over 90 years of age are the fastest growing segment of the population. By the end of this century the average life expectancy is expected to be 100 years. Notably, Japan’s centenarians, who number about 30,000, have quadrupled in the last 10 years.
Now there are 43 Million Americans over age 65 years age. By 2050 that number is expected to rise to 108 million. The number of those over 85 years could increase five-fold by that time.
The above dramatic statistics do not consider the potential (added longevity) effect of successful anti-aging initiatives. Over the past decade, there have been multiple anti-aging, and longevity research initiatives at sites including: The Buck Institute, University of Michigan, University of Texas, University of California at San Francisco, Google’s Calico, Human Longevity Inc (created by biotech entrepreneur Craig Venter) and the Palo Alto Longevity Prize and others. All hope to extend human lifespan well beyond 100 years.
Their challenge, however, is to extend the number of healthy years and not to simply add unhealthy years. Most current medical treatments target the cause of specific diseases, having the untoward result of allowing people to live longer, only to be affected by dementia or the other chronic diseases of aging (heart disease, cancer etc). The hope of seeking a unified cause of aging is to circumvent the tragedy of longer unhealthy years.
Impact on Healthcare
To Sustain Longevity, You Have To Evolve.
– Aries Spears
What does the 100 year lifespan mean for our healthcare systems? How is it possible to care well for all people over their 100 year lifespans, through both the healthy and sick years?
Out of both necessity and patient’s desire, self management of one’s own health is being recognized as the smartest way forward, with the following goals: Educate and empower patients with their own health data, give them relevant information tailored to their conditions, online access to expert advice and, when needed or wanted, to have in person examinations with a physician or other health care professional.
However a system of supported self-care means that much more responsibility for one’s ongoing health status and general health care will fall to patients. Although on the face of it, this seems like a radical change, people have been managing some of their own health and self-caring for years (with advice, treatments of physicians). What most people haven’t done however is the follow the lifestyle health and wellness advice of healthcare professionals: good nutrition, adequate moderate exercise, adequate sleep, maintaining normal weight etc. Thus, although people are living longer because of advances in medical care, except for a select few, these added years are unhealthy years.
Communities of Increased Longevity
The Seventh Day Adventists enjoy about a decade more life expectancy than others their age. Thomas Perls of Boston Medical Center who analyzes centenarians commented about them:
They don’t drink or smoke, most are vegetarians, they exercise regularly even when old, and take a true weekly day of rest.
But what struck Perls the most was that Seventh Day Adventists maintained active, large social groups:
Constant interaction with other people can be annoying, but overall seems to keep us engaged with life.
These, so called “Blue Zone” communities have been beautifully described on the Blue Zones website, in the book, and in numerous articles and talks (see references ). If we could replicate more of these communities in the U.S., it would be wonderful.
Communities of Decreased Longevity
The single best predictor of a person’s life span is their educational attainment. Research has shown that American women with no high school diploma have experienced relatively small life span increases since the 1950s whereas the life expectancy of highly educated women has soared since that time. Today the difference in education can make a lifespan difference of 10-14 years.
Educational differences are a proxy for most of the other social determinants of health, and these influence greatly our quality of health, and our longevity. Such determinants include poverty, poor education (low literacy and health literacy), limited job opportunities, suboptimal built environment (limited safe exercise areas), increased stress, shift work & multiple jobs, and poor nutrition (food deserts). It is thought that approximately 23.5 million Americans live in food deserts, areas devoid of ready access to healthy foods.
To answer healthcare’s prohibitive costs, the increase in chronic disease, the needs of an aging demographic and to combat waste & error in healthcare, multiple major trends are emerging:
- Population Health: melding of Social Care & Healthcare in select populations, predictive modeling
- Technology: telemedicine, telehealth, robotics, wearables (including implantables, ingestibles), connected devices (healthcare IOT), electronic medical records (shared/joint /open -patients plus MDs plus other HCPs) personal health cloud (each patient’s complete healthcare data/history including data from devices/wearables etc.) big data (machine learning & predictive intelligence), selfcare, wellness & healthcare apps
- Multiple & changing venues for care: Retail clinics, Fast med clinics, Community health centers, consolidated/merged hospitals, physicians/allied health professionals, online=telemedicine/telehealth
- Quality Control: Outcomes, Value Based Care and Quality of life, transparency of care (Open Notes/Open Records)
- The Responsibility of Self Care: lifestyle changes, shared decision making, self education
- Emphasis on better end of life care: geriatric care, & palliative care, long term care facilities, electronic advanced directives, choice about death/ assisted death (controversial)
- Government regulation: Affordable Care Act, CMS/ ONC initiatives, Meaningful Use, Clinical Decision Support, fee for service to value based care
- Caregiving/Carer initiatives: to address shortage
- Patient empowerment initiatives: patient data
- Physician burnout: increased physician advocacy, regulation
- Open conversation: online, through social forums
It is yet to be seen which of the above initiatives will prove successful in addressing the care of the aging older person, and facilitating a person’s “best days” until the end of life.
(Some) Major Challenges
The following are major challenges facing successful implementation of “Healthcare as Supported Self-Care” throughout life:
- Lack of universal broadband access
- Lack of Interoperability of medical records, patient ownership/ access to their health data
- Lack of Educational/Health Literacy
- Lack of Social Support for the devastating effects of social determinants of health
- Lack of Social Support for caregiving
- Lack of Robust Community/Public Health Services
- Lack of Nimble Healthcare Systems w/ Providers as Diverse Teams w/allied healthcare professionals
- Lack of patient engagement in their own health.
- Shortage of Quality Long Term Facility & In Home Care Workers
- Shortage of geriatricians and palliative care providers
- Shortage of high quality acute rehabilitation and long term care facilities
- Lack of adequate infrastructure/safe built environments
Finally, there is much promise in aging. An older age individual with a greater number of relatively “well” years likely will have abundant joy, as evidenced by this 93 year old woman gleefully modeling her grand-daughter’s designs.
If I knew I was going to live this long, I’d have taken better care of myself.
– Eubie Blake, George Burns
“What Happens When We All Live to 100?”, Gregg Easterbrook, The Atlantic, October 2014,http://www.theatlantic.com/features/archive/2014/09/what-happens-when-we-all-live-to-100/379338/, accessed June 20 2015
“Changes in the health care system driven by self-service & DIY health”, Jane Sarasohn-Kahn, O’Reilly Radar, April 22 2014, http://radar.oreilly.com/2014/04/changes-in-the-health-care-system-driven-by-self-service-and-diy-health.html, accessed June 20 2015
“Patients Need More Options for Self-Managing Their Own Healthcare”, Dan Munro, Forbes, June 26 2012, http://www.forbes.com/sites/danmunro/2012/06/26/patients-need-more-options-for-self-managing-their-own-healthcare/, accessed June 20 2015
“Pediatric Rehab Hospital Uses Telemedicine Robot for Physicians to Interact with Patients”, Fred Pennic, HIT Consultant, April 24 2014, http://hitconsultant.net/2014/04/24/pediatric-rehab-hospital-uses-telemedicine-robot/, accessed June 20 2015
“Secrets to Longevity Revealed in Denomination’s Lifestyle”, Lorie Johnson, CBN News, April 9 2015,http://www.cbn.com/cbnnews/healthscience/2015/February/Secrets-to-Longevity-Revealed-in-Denominations-Lifestyle/, accessed June 20 2015
The Blue Zones – https://www.bluezones.com/about-blue-zones/
The Island Where People Forget to Die http://www.nytimes.com/2012/10/28/magazine/the-island-where-people-forget-to-die.html?smid=tw-share
“Keep Things Simple For A Healthy, Long Life” http://www.npr.org/sections/health-shots/2015/12/16/459970110/keep-things-simple-for-a-healthy-long-life?utm_campaign=storyshare&utm_source=twitter.com&utm_medium=social
“Why I Hope to Die at 75”, Ezekiel J Emanuel, The Atlantic, October 2014,http://www.theatlantic.com/features/archive/2014/09/why-i-hope-to-die-at-75/379329/, accessed June 20 2015
“Lifestyle advice for would-be centenarians”, Krister Svahn, The Sahlgrenska Academy, April 8 2015,http://sahlgrenska.gu.se/english/research/news-article/lifestyle-advice-for-would-be-centenarians.cid1285361, accessed June 10 2015
“Are Populations Aging More Slowly Than We Think?”, Science News, April 15 2015,http://www.sciencedaily.com/releases/2015/04/150415155322.htm, accessed June 10 2015
“Live for ever: Scientists say they’ll soon extend life well beyond 120”, Zoe Corbyn, The Guardian, January 11 2015, http://www.theguardian.com/science/2015/jan/11/-sp-live-forever-extend-life-calico-google-longevity, accessed June 20 2015
“Internet-based Patient Self-care: The Next Generation of Healthcare Delivery”, June Forkner-Dunn PhD RN, JMIR, May 3 2015, http://www.jmir.org/2003/2/e8/, accessed June 20 2015
“Preparing Patients for Long Term Self Care”, Our Lady of the Lake University,http://onlineprograms.ollusa.edu/resource/nursing/preparing-patients-for-long-term-self-care, accessed June 20 2015
“General Health Status”, Office of Disease Prevention and Health Promotion,http://www.healthypeople.gov/2020/about/foundation-health-measures/General-Health-Status, accessed June 20 2015
“A convenient truth: Self-service works in healthcare”, Jim Dowling, October 31 2013, Healthcare IT News, http://www.healthcareitnews.com/blog/convenient-truth-self-service-works-healthcare, accessed June 20 2015
“The Opportunities and Challenges of a Lifelong Health System”, Neal Hamilton MD MPH et al, The New England Journal of Medicine, April 25 2013,http://www.nejm.org/doi/full/10.1056/NEJMp1215897, accessed June 20 2015
“The Determination of Health Across the Life Course and Across Levels of Influence”, Sandro Galea MD, May 24 2015, BU School of Public Health, http://www.bu.edu/sph/2015/05/24/the-determination-of-health-across-the-life-course-and-across-levels-of-influence/, accessed June 20 2015
“Robot animals make strides in therapeutic patient care”, Ashley Gold, Fierce HealthIT, April 8 2013,http://www.fiercehealthit.com/story/robot-animals-make-strides-therapeutic-patient-care/2013-04-08, accessed June 20 2015
“Robear robot care bear designed to serve Japan’s aging population”, David Szondy, Giz Magazine, February 26 2015, http://www.gizmag.com/robear-riken/36219/, accessed June 20 2015
“Emotional Robot Sells Out in A Minute”, Angad Singh, CNN, June 23 2015,http://www.cnn.com/2015/06/22/tech/pepper-robot-sold-out/, accessed June 20 2015
“Why Robots Are The Future of Eldercare”, Mark Hay, Good Magazine,http://magazine.good.is/articles/robots-elder-care-pepper-exoskeletons-japan, accessed June 20 2015
“Health records in your hands”, Mike Freeman, The San Diego Union-Tribune, June 19 2015,http://www.utsandiego.com/news/2015/jun/19/humetrix-medicare-tricare-veterans-scripps-topol/, accessed June 20 2015
“U.S. Younger Than Much of Europe and Japan, Older Than Most Other Regions”, Pew Research, May 20 2015, http://www.pewresearch.org/fact-tank/2015/05/21/americans-are-aging-but-not-as-fast-as-people-in-germany-italy-and-japan/ft_15-05-19_agingmap/, accessed June 20 2015
“Health Literacy Framework: A Definition of Terms”, Ramona Nelson, HIMSS, June 18 2015,http://www.himss.org/ResourceLibrary/genResourceFAQ.aspx?ItemNumber=42786, accessed June 20 2015
The Determination of Health Across the Life Course and Across Levels of Influence http://www.bu.edu/sph/2015/05/24/the-determination-of-health-across-the-life-course-and-across-levels-of-influence/
Being Mortal by Atul Gawande M.D.
Header Image: The 93 year old fashion icon Iris Apfel