Statement of Task

This study will seek to determine the health care needs of the target population— the rapidly growing and increasingly diverse population of Americans who are over 65 years of age—then address those needs through a thorough analysis of the forces that shape the health care workforce, including education, training, modes of practice, and financing of public and private programs.

Starting with the understanding that health care services provided to older Americans should be safe, effective, patient centered, timely, efficient, and equitable, the committee will consider the following questions:

  1. What is the projected future health status and health care services utilization of older Americans?

  2. What is the best use of the health care workforce, including, where possible, informal caregivers, to meet the needs of the older population? What models of health care delivery hold promise to provide high-quality and cost-effective care for older persons? What new roles and/or new types of providers would be required under these models?

  3. How should the health care workforce be educated and trained to deliver high-value care to the elderly? How should this training be financed? What will best facilitate recruitment and retention of this workforce?

  4. How can public programs be improved to accomplish the goals identified above?

and have less chronic disability than those in previous generations. Still, almost all Medicare spending is related to chronic conditions. Many older adults also experience one or more geriatric syndromes—clinical conditions that do not fit into discrete disease categories (e.g., falls and malnutrition). Older adults also tend to experience more mental health conditions (e.g., depression and anxiety). Many community-dwelling older adults need assistance with one or more activities of daily living (ADLs), such as bathing, and dressing, or with instrumental activities of daily living (IADLs), such as shopping for groceries and preparing meals. Severely disabled adults—that is, those who have difficulty with three or more ADLs—generally require more intensive care if they are to remain in the home.

Older adults receive health care in many different settings and are particularly high-volume users. Although older adults make up only about 12 percent of the U.S. population, they account for approximately 26 percent of all physician office visits, 47 percent of all hospital outpatient visits with nurse practitioners, 35 percent of all hospital stays, 34 percent of all prescriptions, 38 percent of all emergency medical service responses, and

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