Blog | Tuesday, January 11, 2011

Boomers 2011


In 2011, the first wave of baby boomers will turn 65 years old. Sixty-five still has currency because that's the age at which non-disabled Americans are eligible to be covered under the Medicare program (now itself having reached middle age).

As our economy continues to recover (hopefully) from the Great Recession, the entrance of millions of Americans to the Medicare rolls over the next decade and a half will be a formidable planning challenge. Click on the chart to watch the baby boomers population surge.

So is the promise of Health Care Reform (the "PPACA"), which will enlarge Medicaid by an additional 16 million Americans--about half of the projected growth in coverage for those currently uninsured.

A couple of recent patient encounters got me thinking about these phenomena, and how we are very much in historically uncharted territory:

Never have we had so many living so well for so long. We have an entire generation of people reaching "seniority" who will continue to want the most out of life, without many guideposts on how to achieve it.

As an example, take a patient of mine I'll call Ted. He'll turn 65 in 2011. He's retired, healthy, and financially secure. Every year I see him once or at most twice for a physical and preventive care. He is motivated to exercise and undergo cancer screening, since he wants to enjoy his "dotage," and not succumb to some of the ravages of aging. I say some, since each year in anticipation of his physical, he sends me an update on his health status.

His numbered list this year was about a page and half, with copious detail on various ailment and insults. But it was number six, the last item, that really grabbed my attention. His prose has a poetry all its own: "Finally, I'd like to comment on the aging process again, if I may. I have alluded to 'death by small cuts' in the past as a way of describing what I was experiencing as I think about myself. This past year I've noted several specific things: my drop in motivation to exercise; my arthritis has become more pronounced; a notable decrease in my speed in walking ...; I am slower on steps than before, but still able to do as many as I need to; I find a distinct difference in how my sons and son-in-law always take the heavier boxes, packages, air conditioners, etc. ...; [I see] distinctly more courtesy from those so inclined, in public, as doors are opened, or I'm allowed to leave elevators first, for example; it takes longer to do chores in the yard, and I must pace myself very differently than in the past; I nap for 20-30 minutes in the afternoons, when I've done something physical earlier that day. There's nothing to prescribe, I'm afraid, short of a draught form the Fountain of Youth, but I thought you'd like to know some specifics on what I'm seeing as another year goes by. It does seem to change a bit every year. I'll tell Dr. P. [a geriatrician relative of his], of course, but I really don't think I'm bringing any breakthrough ideas to the field of Geriatrics, as I begin my eligibility for that class."

A man with too much time on his hands? Perhaps. But someone in touch with his body and its rhythms, trying to capture the emotions of aging. I tell him that he's "in the 99th percentile" of my patients, in terms of his health awareness and motivation for healthful longevity, because it's true.

I was ruminating about Ted, and what to advise him, when I had a similar sort of encounter with Sally [not her real name]. Sally is also 64, and stuck in the middle. She cares for an aging mother, and no longer has her children to care for since they've been married off.

Sally's main issue at her visit, other than preventive health (she's also retired and financially independent), was her anxiety about where to focus her energies.

Then, like a lightning bolt, she asked a simple question:

Had I ever heard of a doula?

Yes! What a GREAT idea! She could volunteer her time and serve as a doula.

Voila: an idea. Let's have Boomers fortunate enough to afford retirement give back to their communities. Volunteering. Teaching. Attending.

This recent New York Times column raises the whole question of adult education as a "new frontier."

What would you suggest for our Boomer friends?

This post by John H. Schumann, FACP, originally appeared at GlassHospital. Dr. Schumann is a general internist in Chicago's south side, and an educator at the University of Chicago, where he trains residents and medical students in both internal medicine and medical ethics. He is also faculty co-chair of the university's human rights program. His blog, GlassHospital, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people that inhabit them.