Advancements in medicine and public health have significantly extended our life expectancy, allowing us to live longer than ever before. However, this blessing comes with a challenge: a prolonged period spent managing an increasing number of chronic conditions.
As you age, understanding how these conditions can impact your quality of life becomes crucial. This blog post delves into the complexities of chronic conditions and their influence on healthcare decisions, emphasizing the importance of engaging in advance care planning early. Through such planning, you can ensure your healthcare aligns with your personal values and maintain control over your care and dignity as you age. We'll explore the rising challenges of chronic conditions, how they may affect where you die, and when to consider options like palliative and hospice care.
Changes in your health mean changes in your care needs and keeping your advance care plan up to date is essential. Fortunately, tools like MyDirectives offer free online solutions to help you appoint a surrogate if you become incapacitated and address all key areas of healthcare planning. Let's navigate the aging landscape together and find solutions to help maintain the quality of life you desire.
The Phenomenon of Longevity
Today, the concept of longevity is not just about reaching a ripe old age; it's about understanding the factors that have dramatically extended our life expectancy over the past century.
How Long Will We Live?
Historically, the average life expectancy at birth hovered around 40 to 45 years, but this statistic was heavily skewed by high infant and child mortality rates. Contrary to popular belief historians in share in The History of Old Age, that the remarkable increase in lifespan over the twentieth century owes more to advancements in public health—like sanitation, nutrition, and immunizations—than to direct medical interventions.
From the mid-20th century onward, the population numbers began their steady climb, fueled by improved diets, economic advancements that enhanced food and goods transportation, and burgeoning social welfare programs that increased survival rates among impoverished mothers and children. These shifts laid the groundwork for today's demographics, where approximately one in 6 people in the United States is aged 65 and over, a stark increase from the less than one in 20 ratio of 1920.
The Shift in Demographics
The demographic landscape in the U.S. has shifted dramatically, with the fastest-growing age groups being individuals over 85 and centenarians (those 100 and over). This growth is propelled by the aging baby boomers, who began turning 65 in 2011. Predictions suggest a twelvefold increase in centenarians by 2060, highlighting that a child today has a 50% chance of living beyond 100 years.
This rise in extreme old age is set to triple the number of people aged 85 and older by 2060—from 6.7 million to 19.0 million. This segment of the population is most likely to require long-term care services, underscoring a crucial need for strategic healthcare planning and resources.
Why This Matters to You
Understanding these trends is vital as you plan for your future health needs. As life expectancy increases, so does the potential need for extended healthcare, including palliative care and hospice services, particularly as chronic conditions prevalent in older age become more common. This demographic shift challenges us to rethink how we approach healthcare, emphasizing the importance of advance care planning to ensure that your care preferences are respected throughout your later years. In fact, your likelihood of living with one or more chronic conditions is increasing, making it essential to articulate your healthcare preferences clearly and early.
What Does It Mean to Be "Old"?
Historically, old age has not been defined merely by the number of years lived but rather by one's physical capability and independence. In many cultures and times, a person was considered old when they could no longer support themselves or when their vital abilities needed for daily life began to decline. This recognition of old age varies widely among individuals, occurring at diverse stages in life.
Stages of Old Age Defined by Geriatricians
Geriatricians, specialists in the health care of elderly people, categorize old age into specific stages based on health and functionality. Louise Aronson, in her best-selling book Elderhood, breaks down older adults into four distinct categories:
Healthy. You are considered healthy when you can live independently without chronic diseases significantly impacting your daily activities.
Chronically Ill. In this stage, you may manage one or more chronic conditions that affect your lifestyle but still maintain a level of independence.
Frail. Being frail means you have limited physical functionality and are often dependent on others for daily care due to the severity of health issues.
Dying. In this final stage, the focus often shifts to managing discomfort and providing quality of life as you approach end-of-life care.
The Impact of Increased Longevity on Health
The extended life spans we enjoy today bring their own set of challenges, particularly in terms of health. As you age, your body's cells have more time to undergo replication errors and accumulate exposure to various toxins. This prolonged cellular activity can lead to chronic diseases and the deterioration of critical organs such as the brain, heart, lungs, liver, and kidneys. It's not uncommon for non-essential body parts, like ears, eyes, joints, and feet, to wear out even if your vital organs are still functioning well.
This natural wear and tear on the body highlight the importance of understanding how aging can change your health needs. Recognizing the stages of aging and the potential health implications on your lifestyle. By doing so, you empower yourself with the knowledge to make proactive decisions about your health and care preferences, ensuring that you maintain the highest possible level of independence, even as challenges arise with age.
The Rising Challenge of Chronic Conditions in Aging
The likelihood of developing chronic conditions significantly increases as you age. Today, unlike in the past, many people live into old age but often experience years of disability due to chronic illnesses. Knowing this shift is inevitable helps you be proactive about your future healthcare.
Common Chronic Conditions Affecting Older Adults
You, or your loved one, may be at risk of developing one or more of the following common chronic conditions that frequently affect older adults:
Hypertension
Diabetes Mellitus
Various Types of Cancer (excluding minor skin cancers)
Chronic Lung Diseases (including emphysema, but excluding asthma)
Coronary Heart Disease
Congestive Heart Failure
Stroke (cerebrovascular diseases)
Arthritis and musculoskeletal pain syndromes
Psychiatric Problems (including major depressive disorders, depressive symptoms, and dementia)
These conditions are not just common; they are also major drivers of disability, illness, and healthcare costs, which increase with age.
The Growing Prevalence of Chronic Conditions
Statistics show a concerning trend: by 2035, 35.66% of the U.S. adult population aged 50 and older is expected to have at least one chronic condition, and this is projected to rise to 47.81% by 2050. Additionally, the incidence of multimorbidity (having multiple chronic conditions) is expected to increase from 3.659% to over 5% during the same period.
This increase is particularly significant among those aged 60 to 79, with an expected surge in individuals over 80 having one or more chronic conditions by 2050. This demographic shift means that soon, the number of older adults, a significant portion living with multiple chronic conditions, will surpass the number of young people under 18 and women aged 18 to 55—the traditional caregiving demographic.
The Harsh Realities of Chronic Conditions
In geriatrics, the aim is to personalize care based on your unique combination of health status, abilities, values, and care preferences—regardless of how healthy or sick you are. This personalized approach is essential, especially when navigating the complexities of multiple chronic conditions.
These conditions often follow a pattern of steady progression or a gradual decline punctuated by acute deteriorations. Initiating advance care planning (ACP) early ensures you have ample time to discuss your values, goals, and care preferences. This process is not just about preparing for the end; it's about making choices that align with your values and desired quality of life at every stage.
For many individuals, certain health states associated with chronic conditions are considered worse than death. These conditions significantly impact your quality of life and personal autonomy, often leading to a reevaluation of care priorities and life choices.
Experiencing Bowel and Bladder Incontinence. Losing control over your urinary and bowel functions can lead to significant emotional distress, social isolation, and a decreased sense of dignity. It affects not only your physical health but also your mental well-being, as it can be both embarrassing and severely limiting to your daily activities.
Lacking Ability to Get Out of Bed. Being bedridden can drastically limit your independence and quality of life. This state often leads to further health complications such as pressure sores, muscle atrophy, and increased dependency on others for basic needs, making it a particularly dreaded outcome.
Needing Around-the-Clock Care. The requirement for constant care can strain your personal relationships and lead to a profound sense of loss of privacy and autonomy. It also puts significant emotional and financial pressure on your family, often necessitating professional care.
Eating Via a Feeding Tube. Dependency on a feeding tube for nutrition signifies a severe decline in your health state, where normal eating is no longer possible. This can affect your enjoyment of life and your social interactions around meals, which are often central to familial and social gatherings.
Breathing Using a Ventilator. Reliance on mechanical ventilation to breathe can drastically reduce your quality of life and personal interaction, confining you to medical facilities and constant medical supervision.
Being in Constant Confusion. Conditions like dementia that lead to persistent confusion can profoundly alter your personality and cognitive functions, making meaningful communication and relationships challenging. This often results in a significant emotional burden for both you and your loved ones.
If you’re facing these conditions, advance care planning becomes crucial. It allows you to articulate your preferences for treatments and interventions before such difficult health states arise, ensuring that your medical care aligns with your values and goals for quality of life.
Where You Die Is Up to You
Your underlying health conditions significantly influence where you might spend your final days. For instance, if you have heart disease or respiratory issues, your chances of dying in a hospital are notably higher—71% and 48% respectively—compared to those suffering from dementia.
Conversely, if you're battling cancer, you're 27% less likely to die in a hospital compared to dementia patients. Additionally, frail individuals or those with long-term illnesses like cancer are more likely to die outside of a hospital, which starkly contrasts with the experiences of those with heart or respiratory diseases. Being frail and disabled increases your likelihood of dying outside of a hospital by 46%.
These statistics highlight the importance of ACP in making informed decisions about where you would prefer to receive care and ultimately spend your final moments.
The Role of Hospice and Palliative Care in Supporting Your Choices
Hospice and palliative care are essential supports that align with ACP, particularly for those facing chronic conditions. While some patients might choose to endure current discomfort for the hope of a cure or more time, it's important to balance this hope with other priorities such as:
Avoiding suffering
Remaining mentally aware
Spending time with friends and family
Not imposing burdens on others
Both palliative and hospice care options help address these priorities by providing comfort and support, ensuring that your serious illness and end-of-life care respects your wishes and values.
If you're considering how best to manage your care needs amidst chronic conditions, you might find it useful to refer to the prior post, How and When Do You Choose Between Palliative and Hospice Care? This resource will help you better understand the specific supports these care options can offer, aiding in symptom management and providing the supportive care you need.
Complete Your Advance Care Plan for FREE with MyDirectives
Remember, advance care planning is not just about making end-of-life decisions; it's about taking control of how you live with chronic conditions, ensuring your care aligns with your values and delivers the dignity you deserve as you age. Advance care planning is beneficial, especially if you're managing a chronic, life-limiting illness.
We recommend that you take advantage of the MyDirectives website to complete your advance care plan. This free online tool provides a guided question-and-answer format that helps ensure you cover all essential aspects of your care preferences. Once completed, you can store your documents in its nationwide database, which is accessible anytime and anywhere within the healthcare system.
If your circumstances change, you can log in to your account 24/7 to modify your plan. At a minimum, engaging with MyDirectives allows you to name your healthcare surrogate, giving you peace of mind knowing exactly who will speak for you should you become incapacitated. This step is crucial in ensuring that your healthcare decisions stay in trusted hands.