doctor with older patient

When the Doctor Says ‘You’re Just Getting Old’

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It happens all too frequently: An older adult goes to see their doctor, complaining of a new discomfort, pain or difficulty.

The doctor listens and then replies with some version of, “Well, what do you expect at your age?”

The older adult leaves the appointment without a diagnosis — but plenty of dissatisfaction.

Any older adult who experiences such treatment has a right to be dissatisfied. But I wouldn’t say the doctor’s approach is necessarily totally wrong. It is, however, frustratingly incomplete.

All of us experience declines in physical and sometimes mental function as we get older, and some of them lead us to the doctor’s office. It makes sense that the doctor would note this during the visit.

But that can’t be the entire response — “You’re just getting old, and there’s nothing you can do about it.” (I should note that Ashton Applewhite called this out effectively in a recent post.)

A better response from the doctor might sound like this:

“Some of what you’re experiencing may well be due to physical aging. That said, if this is something that concerns you, let’s work on an action plan to address the things we can address.”

No action plan will allow a 65-, 75-, or 85-year-old to act and feel like they are 25, 35 or 45 again. But there are many instances where something can be done. An older patient doesn’t have to sit back and accept their condition just because of their age.

There are ways to forestall and, in many instances, even restore muscle function, and we can slow memory loss as well — if the older patient takes an active role.

And that brings me to the second part of this equation. Just as a doctor needs to go further than saying “What do you expect at your age?” the patient can’t just ask for a miracle cure. Expecting a pill or a procedure to instantly fix problems and make you feel 20 or 30 years younger isn’t realistic.

Just as the doctor’s response of “What do you expect” is a cop-out, it’s also a cop-out for an older adult to deny that their bodies are getting older and expect simple, no-effort solutions.

The doctor’s incomplete response is rooted in ageism and looking for the easy way to end the conversation. And the older patient’s denial is internalized ageism and looking for the easy solution that requires little or no individual effort.

Neither leads to good outcomes.

The Forgotten Middle

Why ‘One Size Fits All’ Solutions Won’t Fit the Forgotten Middle

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One of the best things about this New York Times piece is that it shines a light on something many don’t appreciate: There are multiple layers to the “forgotten middle” challenge looming over housing and healthcare for older adults. Grasping that fact is vital to solving the problem.

Paula Span’s Times piece was well-timed. It was published a few days before the Milken Institute released a report — sponsored by the National Investment Center for Seniors Housing & Care (NIC) and CVS Health — examining innovative financing models to scale affordable housing and care solutions for this same group.

Both the Times and Milken make it clear that the forgotten middle is a very broad cohort. And because of that, there will never be a one-size-fits-all solution for this group’s housing and long-term care needs.

Instead, solutions will have to be tailored to the income and resources, as well as the healthcare needs, of those being served.

(All of this, of course, builds off the seminal Forgotten Middle study published in Health Affairs, authored by Caroline Pearson and the research team at NORC at the University of Chicago and underwritten by NIC. See link at the bottom of this post.)

The Times piece paints a vivid picture: There are two very different markets for healthcare and housing among older adults in the American middle class. The upper half has, in many instances, seen their financial situation, health and longevity all improve over the last two decades.

Meantime, the lower half of the forgotten middle has not seen those gains. In fact, many have lost ground — both financially and in terms of their health and longevity.

The lower middle class tends to be sicker with more chronic conditions and less financial stability. They’re often one fall or other health incident away from falling into poverty and qualifying for Medicaid.

We need to understand those differences if we’re going to be able to craft programs that meet all of the forgotten middle’s needs — making long-term care and housing affordable and accessible for all.

I applaud the leadership of NIC which, through its case studies, research and programming at its conferences, not only first brought attention to this issue, but now is focusing on the variety of strategies and models needed to serve this huge demographic cohort. It’s a segment of the population that will total nearly 16 million in less than a decade — so the time to act is now!

Housing For Middle-Income Seniors

Middle-Income Seniors – The Forgotten Middle

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When it comes to senior housing, wealthy seniors can pay their own way and low-income seniors often qualify for Medicaid. The real problem is for those in the middle. They aren’t wealthy enough for private pay, yet they are too well-off for Medicaid. To make matters worse, the number of people stuck in the middle will nearly double over the next decade. Senior housing operators and policymakers have the opportunity to serve this new market, but how and to what extent?

Nexus founder and Fellow Bob Kramer discusses “The Forgotten Middle” with Nexus Fellow Caroline Pearson, senior vice president health care strategy, NORC at the University of Chicago in an episode of Foresight TV hosted by Steve Moran of Senior Living Foresight.

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