90 percent of all nursing-home use. Just over 60 percent of disabled older adults living in the community obtain some long-term care services, most commonly in the form of help with personal care and household chores. The vast majority of these services are provided by informal caregivers, typically a spouse or child.


The future elderly population will be different from today’s older adults in a number of ways. The demographic characteristics of older Americans will differ from previous generations in terms of their race, family structure, socioeconomic status, education, geographic distribution, and openness regarding their sexual orientation. All of these factors can affect health status and utilization of services. Trends in illness and disability will influence the need for services among the future older adult population, though the direction and the magnitude of the effects cannot be predicted with certainty. Declines in smoking rates, for example, could lead to a decreased need for health care services, but that decrease could be offset by increased utilization associated with high rates of obesity. Medical advances and technologies may extend or improve life for older patients. In the future, more health care may be provided remotely, and older adults may be better able to monitor their conditions and communicate with health care providers from home. Finally, older adults in the future may simply have different preferences for care than their predecessors.

Changes in Medicare or Medicaid policies could also have a significant effect on service utilization by older adults—and, given that a severe cost crisis in the Medicare program is widely expected, such changes are likely. While a full consideration of likely health expenditures is beyond the scope of the committee’s charge, committee members were mindful of financial realities during the course of their deliberations. Whether or not the current patterns of health status and utilization continue, one prediction is certain: the future elderly population will have a greater collective need for health care services than those who have come before it.


With few exceptions, all types of health care workers need to be educated and trained in the care of older adults. First, while efforts to educate and train the formal (i.e., paid) workforce in geriatrics have improved, they remain inadequate in both scope and consistency. Second, much of the care for older adults falls to informal caregivers, yet these unpaid workers receive very little preparation for their responsibilities. Finally, the

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