Introduction

The US is witnessing a demographic shift towards an ageing population. This trend poses significant challenges for healthcare and social services, yet also brings opportunities for innovation. The proportion of Americans over 65 is projected to rise from 18% today to 23% by 2054. JAMA Forum examined the complexities and breakthroughs in caring for an ageing US population.

Caring for an Ageing US Population

An ageing population brings numerous challenges. Aging often leads to social isolation, which can exacerbate mental and physical health issues, including dementia. Caring for older adults with chronic conditions is costly. In 2023, the annual cost for a private room in a nursing home exceeded $116,000, while a home health aide cost more than $75,000. Affordable housing remains scarce, and more older adults may face homelessness, especially those with dementia or mental illness. Many elderly individuals may eventually rely on Medicaid-financed nursing homes, increasing the strain on state and federal budgets.

Innovations in Healthcare and Technology

Despite these challenges, there are reasons for optimism. The US healthcare system continues to develop breakthrough drugs and methods to address debilitating conditions. For example, hip and knee replacements have transformed the lives of many older adults. Although Alzheimer’s drugs are still in early stages, there is hope for future breakthroughs.

Technologies that enable safer, more fulfilling home-based ageing are also promising. Social connection technologies like Papa help combat isolation and cognitive decline by virtually connecting older adults with friends and family. Information and communication technologies make it easier for family members and healthcare professionals to monitor changes in a patient’s condition and assist with daily activities. Advanced “smart home” technology is making home-based ageing feasible even for those with dementia. The FDA’s initiative, Home as a Health Care Hub, aims to develop home designs and technologies to improve care and advance health equity.

Innovative care and social support developments are also emerging. The CAPABLE program, for instance, involves an occupational therapist, registered nurse, and handyperson working together to plan for fulfilling ageing at home. This model has shown significant functional improvements and cost savings. Senior villages, where volunteers assist ageing neighbours, and meal delivery services like Meals on Wheels, which reduce isolation and healthcare utilisation, are also making a difference.

Rethinking Housing and Nursing Homes

The nursing home industry faces multiple challenges, prompting a reevaluation of strategies for ageing. A 2022 report by the National Academies of Sciences, Engineering, and Medicine highlighted serious shortcomings in nursing home quality. As a result, there is growing interest in alternative housing designs for older adults. Multi-age buildings and multigenerational households, where older and younger people can interact, are gaining traction. Home sharing among older adults is also becoming more mainstream.

Traditional nursing homes are exploring new models, such as the Green House model, which uses staff more flexibly and works with small clusters of residents. This model has shown success, especially during the COVID-19 pandemic. Some nursing homes are considering layout redesigns to create more social settings. For example, Keswick nursing home in Baltimore is undergoing a major renovation to foster a more community-oriented environment. However, existing regulations and payment policies can hinder efforts to connect nursing homes with their wider communities. These rules need to be reviewed and updated to allow community-dwelling older adults to access important care from nearby nursing homes.

Policy Changes Are Crucial

Adapting to an ageing population requires thoughtful policy changes. Recent federal administrations have used the Medicaid 1115 waiver process to allow states to experiment with modifications to Medicaid rules. These waivers enable states to expand nonmedical services for older adults. Medicare Advantage plans have also gained more flexibility to include social services in their benefits packages.

Conclusion

Caring for an ageing US population presents both challenges and opportunities. While the increasing number of older adults strains healthcare and social services, innovations in technology and care models offer hope. Policy changes are crucial to support these innovations and ensure a sustainable future for ageing Americans.