We are the Tsunami..

Seniors lining up for food aid vouchers in Hong Kong. Lam Yik Fei for The New York Times

Today’s New York Times carries yet another article about the huge wave of elderly in need of more services than their countries can provide. This particular article focuses on Asia, particularly Japan, where almost a third of the population is over 65. The US is not far behind, with 17% of our population already over 65, and an expected 21% of us over 65 by 2040. As an elder closer to 80 than 65 years old, I care greatly about the impact of these numbers on me, my agemate friends and our children.  I am worried about

  • The difficulties in hiring caregivers for my age group. As I near 85, it is increasingly likely that I will need a caregiver; in 2018, the percentage of older adults age 85 and older who needed help with personal care was 21%, a number that will increase with each birthday. My effort to hire a caregiver for my mother just 15 years ago resulted in cash payments to a non-certified community of women with varying levels of skill and experience.  My husband and I were adamant that we wouldn’t do that to our children and thus we live in a senior community, where the task of hiring caregivers is part of what we pay for.

  •  Social Security and Medicare funding is simply inadequate, and the burden is too heavy for future generations – my children and grandchildren—to carry.  These entitlement programs are critical to my economic independence, and yet those who are funding the program are simultaneously being robbed of the financial ability to adequately prepare for their own retirement.  Entitlement programs are already politically divisive; that will continue. I recall that FDR’s social safety net, Social Security, was most popular among those with aging parents, who knew that taking care of grandma for many years wasn’t a good idea for them. In 1940, elderly parents had the good grace to die at age 60 for men and 65 for women. The actuarial tables used by Social Security anticipate that I have another 11.6 years ahead of me and many of those years could require extensive care.

  • The lack of caregivers and the expectation that elders will age without burdening their children creates an unhealthy isolation for many of us.  A recent CDC report states that about one-forth of the over-65 cohort is socially isolated, and that number is highest among the most elderly. The report goes on to cite the health impact of isolation:
    • 29% increased risk of heart disease  
    • 32% increased risk of stroke.
    • Higher rates of depression, anxiety, and suicide.
    • Among heart failure patients, a nearly 4 times increased risk of death, 68% increased risk of hospitalization, and 57% increased risk of emergency department visits.

What to do? Hope for technological answers to caregiving (robots and more AI are coming very soon). Vote for candidates who acknowledge that the solutions aren’t easy, but who are willing to address the issue. Encourage medical providers to consider the negative impact of expensive late-life care.  Address immigration meaningfully, to offset the decline in the population of workers and taxpayers.. Examine housing constraints against multi-family units, to permit aged seniors to share housing.  More?

 Our government keeps copious statistics about aging, and issues regular reports citing the details of these numbers. Here are some of those reports should you wish to deep-dive into the statistics:

“Feed Me” and the Medical System

Remember Audrey II from “Little Shop of Horrors” whose appetite was voracious?  As we age, entering a hospital can feel a lot like dining with Audrey II.  The medical system, like Audrey II, may devour us in its self-perpetuating system, encouraging increasingly complex tests, and ultimately leave us broke, exhausted and with little relief from the original malady. No wonder so many of us are hesitant to open the door to medical testing.

My “breathless” story is an example of that. I run out of breath too quickly. Our 8th grade gym teacher chased us around the track with a paddle. Despite that very real motivation, I was always the last of the runners, hampered by breathlessness.  In graduate school, I gave myself a pulmonary function test, and my FEV (Forced Expiratory Volume) was less than normal for my age.  Later, I asked a pulmonologist acquaintance whether I should re-do the test, or investigate possible causes, explaining that I had grown up with heavy smokers and had lived for a while in military housing where insecticides were regularly dropped from the sky.  My friend recommended that I simply let nature take its course, arguing that a baseline wasn’t useful.

Now in my 70s, the breathlessness is more severe, so at my request my primary care doctor sent me for a chest CT scan (June, 2019, $2300). A few days later, she called to say “Don’t move, don’t stress, but we think a heart attack is imminent, and it could be fatal.” I didn’t move for the 10 days it took to find a cardiologist (June, 2019, $500), who promptly scheduled an echocardiogram (June 2019, $2000) and a Nuclear Stress Test (July, 2019, $5800). “Never mind” he said in our follow-up appointment (July 2019, $250), “you are normal for your age. It was all a misreading of the CT scan.”  The CT scan had also found a pulmonary lesion, but a second follow-up CT scan (September, 2019, $3500) revealed that it too was of no concern.

Skip forward past a broken leg and the start of a pandemic, during which the breathlessness did not abate. The next stop was a pulmonologist (May, 2021, $600) who performed a pulmonary function test (May, 2021, $400) and requested another CT scan (April, 2021 $2400). And then, suspecting small pulmonary emboli, he requested a perfusion test (June, 2021, $2700) and a CTA test (August, 2021 $4000), ending with a sleep study (October 2021, $6000).  Today (May, 2022) the pulmonologist defined the results as “good news; there are many serious problems we know you don’t have” and recommended that I adapt to the breathlessness by taking breaks as needed. He and the cardiologist both noted that breathlessness could be impacted by arthritis, weight, conditioning, hiatal hernia, and  age.

These medical bills would bankrupt many Americans.  For me, with Medicare, I paid less than $1000 of the $30,000 in bills (note: these numbers are neither exact nor inclusive of all expenses; I left out a bunch).  Some lessons:

  • We in our insatiable curiosity have created a medical system which can give us many details about our bodies and make many diagnoses, but we still don’t understand how our organs function and dysfunction.
  • The cost of our medical care is unfairly distributed.  Those with the least amount of insurance are billed the highest rates in order to offset the negotiated prices paid by Medicare and insurance companies.
  • Medicare is perhaps the best financial benefit of being over 65 years old.