Q&A: Primary care faces 'incredible strain' as aging population grows

About one in five Americans will be aged 65 years or older by 2030, according to data from the U.S. Census Bureau.

The Census Bureau also estimated that the proportion of older adults in the U.S. will increase 9 percentage points by 2060, from 15% of the population to 24%.

According to Elsevier Health’s “Clinician of the Future” report, 93% of participating clinicians identified aging and the aging population as key drivers of change in health care. 

This growing population will likely present challenges for primary care and family medicine physicians, who may see an increasing number of patients with multimorbidity. 

Healio spoke with Daron W. Gersch, MD, FAAFP, a family physician at CentraCare hospital in Long Prairie, Minnesota, and the vice speaker of the American Academy of Family Physicians, about how providers can adapt to meet the needs of their older patient population.

Healio: What proportion of patients are aged 65 years or older?

Gersch: I would say adults aged 65 years or older make about one-fifth of the population, but they make up more about one-third of clinic visits, and maybe even as much as half of hospital visits. They do use a larger proportion of the health care resources compared with younger people. A lot of that has to do with as they get older, they get sicker and require visits more frequently. I do think this demographic will increase as time goes on.

Healio: How is the growing aging population challenging PCPs?

Gersch: One of the biggest challenges the aging population is bringing to primary care is keeping up on their preventive care. The aging population has a lot of prevention that we want to try and do in order to maintain their health. As family physicians, we believe in maintaining health, and that an ounce of prevention is worth a pound of cure. Trying to get people who are over age 65 years to do their preventive care will continue to be one of the bigger challenges we face. The challenges that come with that include having the time and the staff required to do these preventive visits. 

Healio: How do chronic conditions and multimorbidity impact the aging population?

Gersch: Right now, we are seeing large increases in the 65 years and older population. However, we are also seeing more  adults who are over 80 years old. That increase is primarily tech-driven. Say someone has a heart attack at age 70. They can get a stent put in and live to be age 80, but they have morbidity after having that heart attack and that stent, so they are now not as healthy as before. They require more resources, more time and more finances in order to keep them healthy. We would like to see preventive services start earlier. We may be able to prevent that heart attack from happening in the first place; then they don't have that morbidity and mortality and they can live a healthier and more productive life while using less resources.

Healio: Does telehealth help or hinder care for the aging population?

Gersch: Telehealth will help with the care of the elderly because we can do some evaluations over the phone or computer. That will help the elderly because they won't have to travel. I've had a lot of elderly patients who canceled appointments because they couldn't get someone to drive them in or the weather was bad.. Telehealth can help with a lot of those follow-up visits. 

Healio: Do you have the resources necessary to care for this patient population in the future?

Gersch: If you would have asked me 10 years ago, I would have said we had the resources to manage what needed to be done. Now we are getting to a point where those resources are getting strained, and you see a lot of primary care clinics struggling to try and keep up. In 5 to 15 years from now, there is going to be an incredible strain on primary care clinics as they try and work with the growing number of elderly patients who they provide care for.

Healio: How should physicians prepare for the future?

Gersch: One of the things that we’re focused on is called care coordination, where you have a team of people to take care of the individual. Let’s say a preventive visit takes about an hour. It’s asking a lot of one person, whether it would be a physician or someone else on the medical team, to get everything done in that hour. 

A team of physicians, nurses, social workers, counselors and pharmacists embedded into the clinic would allow a person to come in for their preventive care and enable them to see their physician for 10 minutes to 15 minutes, a nurse for 10 minutes to 15 minutes, and then a social worker or pharmacist. This way, the patient can get a more holistic visit. We are also going to need more primary care physicians, more family medicine physicians, more clinic nurses, more social workers; we’re just going to need more people. We need to figure out how we can incentivize people who are going to school now to work in primary care. 

Healio: Should medical training be adapted to better care for this patient population?

Gersch: Family medicine residencies have done a good job with encompassing the care coordination model. I am also seeing nurses go more towards RNs and physicians go toward specialty care. We need to incentivize doctors to go into family medicine vs. a specialty. We are starting to teach family medicine residents the care coordination model. You can teach me that model, but if we don’t have the staff we need or payment to keep them, that is going to be an even bigger problem.

References:

Clinician of the future report 2022. https://www.elsevier.com/connect/clinician-of-the-future. Published March 15, 2022. Accessed March 23, 2022.

Projections of the size and composition of the U.S. population: 2014 to 2060. https://www.census.gov/content/dam/Census/library/publications/2015/demo/p25-1143.pdf. Published March 2015. Accessed March 23, 2022.