Health Care at an Advanced Age: Myths and Misconceptions

The rapid growth of America's older population that looms on the demographic horizon is by now a familiar concept. People aged 65 years and older, who today constitute about 12% of the U.S. population, will make up about 20% by the year 2020. The actual numbers are expected to double. This demographic shift comes at a time when an equally dramatic economic trend has claimed the nation's attention: the seemingly inexorable increase in health care costs as a percentage of the gross national product.

It seems nothing short of common sense to assume that the two trends are linked, and, in the current public debate about health care reform, they often are. It is a short misstep from that notion to the idea of cause and effect, that is, that America's growing older population is the major determinant of increasing health care costs. At one extreme, these concepts have yielded proposals to ration health care for older people [1]. Such proposals incorporate the assumption that care for older people is generally expensive and futile. By limiting care for the aged, the argument goes, we could save large amounts of money now being wasted on interventions that do little good.

Not surprisingly, age-based rationing has been assailed on ethical grounds [2]. Commentators also have challenged the assumption that the demographic trend is a primary factor driving the economic trend [3]. It is also important to examine the clinical assumptions that underlie these proposals. What …