The numbers are increasingly disturbing: By 2050, some 88 million Americans will be over 65, with more than 20 million over 85. That such huge demographic shifts portend a challenge to the medical system goes without saying.
The traditional American response holds that such needs will be filled by an innovative business culture responsive to market demand.
But that simply has not happened. American business have had two decades of demographic forecasting to respond to the basic health issues of elderly life—and failed. There are no good drugs for Alzheimer’s. There are no good drugs for arthritis. None to ward off frailty. And there are no substantial improvements in large-scale nursing home design.
In fact, the few private sector initiatives that have taken place are at best marginal in impact and idiosyncratic in response.
One is the so-called “successful aging” crowd. This comes our way via our increasingly money-oriented professoriate—go-ahead academics who like to sell books and brain train devices—and an unthinking, unscrupulous “health media” that needs to fill air time with allegedly useful programming. The most well known might be called “the Sudoku school.” It is largely based on brain imaging that shows short term changes in cerebral blood flow when an individual does crossword puzzles or other brain exercises. But they do nothing—repeat nothing—to delay, prevent or sooth the suffering of dementia. Ditto all those “brain healthy” diets.
The second response is the enterprise known as “anti-aging” medicine, purveyed by an endless stream of retiring physicians who set up all-cash shops in retirement communities to sell hormones. At best, the impact of hormones is modest. The cost is not. A regimen of growth hormone, which is as likely to do nothing as it is to help, can cost $25,000 a year. The enterprise is almost completely unregulated, with the anti-aging trade associations refusing to even consider doing their own safety and effectiveness monitoring.
It is now, of course, a $50 billion-a-year industry.
The real question is: why hasn’t the “great American entrepreneurial impulse” gone after the real issues of elderly life?
The most important and tangible of them is a problem almost all Americans who have an aging parent know too well: poly-pharmacy—the prescribing of multiple drugs for multiple conditions by multiple doctors who know nothing about what each other are doing. It is getting worse. Recently added to the average gero-pharmacopeia of statins, diabetes drugs, and ace inhibitors are Prozac, Ambien and Valium. This is despite the
recognized fact that the latter should almost never be prescribed for people over the age of 65. Where is the great “entrepreneurial fix” for this?
What about frailty and the environment that makes it so deadly? There are no affordable, wide-spread products for effectively safety-proofing the modern house. There are expensive fixes in pricey communities, yes, but the rest of us get padded toilet seats and hand bars in the shower.
Diet also looms large. The aging gut changes dramatically, but save for Ensure, American industry has done little to retool food products for the aged. Contrast this to Scandinavia, with an equally large chunk of aged. It is investing heavily in ways to add minor ingredients to everyday food that improve digestion and blood sugar levels, the scourge of the elderly.
Lastly, there is the great unspoken killer: loneliness and loss. Here “the market” has come up with exactly one “innovation:” pricey retirement villages with equally pricey social opportunities. Those who don’t have the money and who hate Arizona and Florida are on their own.
There, then, are the real medical problems.
American business once recognized such as opportunities. We are waiting for them to turn these into real help for the elderly. And real profits for the coming gero-economy.
Greg Critser is the author of the recent Eternity Soup: Inside the Quest to End Aging (Crown Harmony)