Establishing Benchmarks for Quality Care for an Aging Population: Caring for Vulnerable Older Adults

We are experiencing a demographic revolution, the aging of the United States and populations worldwide. Soon 20% of the U.S. population will be older than 65 years of age, and people will be living one third of their lives after retirement. Those 85 years of age and older are the most rapidly increasing segment of our population and contribute to the large subset of older adults that are highly vulnerable to adverse health outcomes, including disability, dependency, and death. Among the 95% of people 65 years and older living in the community, approximately one third can be considered highly vulnerable because of advanced age, compromised functional status, frailty, and diseases. This vulnerable group has been shown to benefit from clinical attention to a range of health issues, such as prevention of disease and disability and the complications of comorbid diseases, frailty, geriatric conditions, and functional decline. Specialized, geriatrically attuned approaches to care can also improve health outcomes in at-risk older adults. Some examples are team-based geriatric assessment and treatment, either on an outpatient or inpatient basis (1-5); attention to the hospital environment (5); and discharge planning and care coordination between practitioners or sites of care.

Adverse health outcomes among the aging are due to complex interactions of many factors (6). One component is the presence of comorbid conditions. Two thirds of Medicare beneficiaries have 2 or more chronic conditions, and rates of comorbidity increase with age. Comorbid conditions are more difficult to treat, adding complexity in terms of competing risks; potentially incompatible therapies; burden or costs of therapies that the patient cannot tolerate; and synergistic likelihood of adverse outcomes, including disability and death.

With aging also comes decreased physiologic resilience, or reserve, of the human organism. Older adults often become frail, losing muscle mass, weight, energy, and …