Before the Deluge: What Changing Demographics Mean for Imaging

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Aging.jpg - Aging

Age catches up with us all at some point. For the Baby Boomers, that point is arriving year after year, with 10,000 Americans turning 65 every day from now until 2030. It’s no secret our elderly population will grow to levels never before seen in the U.S. Meanwhile, the obesity epidemic rages on and other macroeconomic forces, such as the recovering economy and widespread health policy reforms, also promise to change the equation in healthcare. Are we prepared?

It’s a story best told by the numbers. In 2010, the number of Americans aged 65 or older was 40.5 million. By 2050, that number will more than double to 89 million—making up about a quarter of the U.S. population. And, since medical advances are now helping Americans to live longer, 5.8 million of those seniors are projected to be older than 85.

This all means a lot of birthday candles, but it also means a growing strain on the healthcare system. More than 92 percent of elderly individuals reported having one or more chronic diseases in 2008, according a 2013 report by healthcare analysts from business intelligence firm IHS, published in Health Affairs.

Concordia University recently broke it down like this: the average American over 65 has multiple chronic conditions such as hypertension (72 percent), arthritis (51 percent), heart disease (31 percent), cancer (24 percent) and diabetes (20 percent). These account for one third of all healthcare spending in America.

All the numbers add up. “You’re not just talking about more people over 65,” notes Frank J. Lexa, MD, MBA, professor in the Department of Radiologic Sciences at Drexel University College of Medicine in Philadelphia, “you’re talking about more people over 75, more people over 85, than we’ve historically had in the U.S.”

It becomes a supply and demand issue, says Lexa, with the Medicare-aged population growing, creating more financial strain on those still working and paying into the system.

And what will they be paying for? That same Health Affairs analysis also projected future demand for healthcare services, and broke it down by specialty. Radiology was among the fastest growing, with demand for radiology services expected to rise 18 percent by 2025. This is in line with the growth projections for neurological surgery and general surgery. The services with the highest projected demand growth were vascular surgery at 31 percent and cardiology at 20 percent, according to the report.

A big concern for radiologists is the impact on reimbursement, especially since about a dozen various reimbursement cuts have been levied against imaging services since the Deficit Reduction Act of 2005. But Lexa notes that one of the largely unspoken worries is that while cuts may target the cost of individual services, it’s hard to imagine aggregate healthcare spending going down given the macroeconomic forces in play. This will have varying impacts depending on the type of condition.

 - AD: Change in Deaths

Growing burden of Alzheimer’s

As baby boomers reach the age of greatest risk for Alzheimer’s disease (AD), what is currently one of the nation’s most serious health threats will only intensify. According to the Alzheimer’s Association’s 2014 Alzheimer’s Disease Facts and Figures report, 5.2 million Americans are living with AD, but by 2050, that number will spike to as many as 16 million people aged 65 and older with the disease.

The emotional toll exacted by AD is tremendous by itself, but it is also a huge financial burden. The cost of caring for AD patients and others with dementia will reach $214 billion this year, and that doesn’t include unpaid caregiving time and effort from family and friends, itself valued at more than $220 billion a year, according to the Alzheimer’s Association. Medicare reportedly spends almost $1 in every $5 on people with Alzheimer’s or other dementias, and that’s just the current situation. If no major breakthroughs are made in the near future, changing demographics will push national costs past $1 trillion by 2050 (not adjusted for inflation), including a 500 percent increase in combined Medicare and Medicaid spending.

Given the looming challenge, there’s a lot of effort being put into finding a method for identifying those at risk for developing AD before they become symptomatic. This is not all that different from how researchers approach many other diseases, explains Jennifer Weuve, ScD, of the Rush Institute for Healthy Aging in Chicago, but with AD it’s becoming more apparent that any interventions