By Kathleen T. Grimm
It often takes a robust research study to define what seems intuitive. The medical journal the Lancet recently published a report that found dementia rates had plummeted over the past two decades in England and Wales.
This news was welcomed by researchers at the U.S. National Institute of Aging and others as a critical examination of the assumption that rates of dementia will necessarily double as baby boomers age. The study supports what many have assumed: populations with opportunities for education and that remain healthy by controlling risk factors lead long, productive lives, without fear of dementia as inevitable.
There is no question that aging creates challenges, but the conversation has been about how to create larger health delivery infrastructure for aging baby boomers. This research calls for fundamental change in the view of natural aging as “disease.” In our current disease-based model, “age” has been considered disease, and the focus is then to mobilize more resources and infrastructure in one sector alone: health care delivery systems and institutions.
We have the evidence that “diseases” or changes that come with age, such as arthritis, can be bettered by giving aging citizens the ability to stay active. Depression and cognitive changes are worsened with social isolation. Would the ability to walk the sidewalk without fear of falling over old broken cement walkways create more health for seniors? Is ice removal and safe transportation as important as other “medical” interventions for aging populations?
Care of the elderly should revolutionize “primary” care. This revolution should occur not only in the way care is provided, but in the way we think of age, and how we move it outside of the disease-based model alone.
This thinking recognizes that with age there are multiple challenges, and that we need a delivery system that treats aged individuals without harm. However, we also need to recognize the significance of social structure, urban planning for aging populations and commitment to reduction of risk factors that create disease.
The characterization of aging populations as added “burdens of care” to one sector (health care delivery), while ignoring other social supports and social structure, is the incorrect way to approach population health.
“Primary” care could evolve into a robust healthy aging network, which includes neighborhood- and community-based supports that ensure health and less disease. “Aging in place” in homes and neighborhoods will involve social structure and supports outside the doctor’s office. Healthy aging involves recognition of the factors that allow aging in place for all, without bias, and an inter-sectoral approach to this transition of life that we all face.
Kathleen T. Grimm, M.D., is co-chairwoman of the Community Health Worker Network of Buffalo.