Living Well at the End of Life

The pattern of American life and death has shifted dramatically in the last century. People live longer, healthier lives. Relatively few die of acute causes. Instead, most Americans die from lingering illnesses that eventually prove fatal. Dementia and frailty shape the last years of life for a large part of the population. By 2030, the baby-boom generation of the 1950s will begin to turn 85, an age when most people are showing evidence of frailty. In 2000, 4.2 million Americans were 85 or older. In 2030, the number will be 9 million. The final years of life account for the overwhelming preponderance of all health care costs incurred during one’s lifetime. As the baby boomers age, health care costs — and the pressure on Medicare and Medicaid — will increase dramatically. The authors identify the following options for reforming the care system to meet the needs of chronically ill elderly patients: Address the looming shortage of caregivers; reallocate federal financing to promote continuity of care across different settings; pay more attention to the wishes of elderly people, who often prefer reliable nursing care and family support to expensive medical treatment; assess life possibilities for patients with dementia; and define priorities to develop reliable end-of-life care.