NurseWeek: Generation Rx: As demographics change, the patient of 2010 will pose new challenges

Generation Rx
As demographics change,
the patient of 2010 will pose new challenges
By Diane Sussman
August 7, 2000

The patient of the future is expected to bring more opportunity – and more responsibility – for nurses.

Photo: Margie Paschke


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Older and wiser. That’s not the promise of accumulated years, but a partial picture of what the patient of the future will be like. According to "Health and Health Care 2010," a forecast by the Robert Wood Johnson Foundation in Princeton, N.J., and the Institute for the Future in Menlo Park, Calif., tomorrow’s patients not only will be older and more well-educated, they will be more ethnically mixed, more affluent, more informed about health care and more likely to know about and want the latest technology.

"Because of the bolus of baby boomers, you have this enormous group of people who are taking their knowledgeable, intelligent, cranky behaviors and applying them to health care," said Wendy Everett, Ph.D., director of health research at the institute. "And what they are saying is that what they’ve been given in the past isn’t good enough."

The report is based on an analysis of data, surveys and trends, all with an eye toward giving health care officials and workers a heads up on the world ahead.

"One of the main outcomes of the report, which was subtitled ‘The Forecast, the Challenge,’ is for people to see the challenges of the future and prepare for them," said Maureen Cozine, communications assistant at the foundation.

Gray matters
The report confirms one demographic change already upon us: the rising number of elderly. During the next 10 years, the population will grow by 10 percent, with people older than 65 making up the fastest-growing segment of the population. By 2005, the average life expectancy will rise to 86 for women and 76 for men. Hundred-year birthday parties no longer will rate a newspaper story. By 2010, more than 100,000 people will have passed the centennial mark.

"These people are going to be redefining the way we think about age," said David Wallace, Ph.D., CEO of Wallace Productions and Consulting, a nursing and health care productions company in Concord, Calif. "There are going to be a lot of healthy 90- and 100-year-olds."

At the same time, more of these older people – including mobile and active ones – will suffer from chronic diseases and will live with those diseases for a longer period of time. By 2010, an estimated 40 percent of Americans will suffer from some type of chronic illness and another 40 percent will have more than one condition.

Rising life expectancy for women will mean millions older than 80 with strained resources will have long outlived their spouses. "It’s the triple-whammy for this group. They’re women, they’re frail and they’re poor," Everett said. "We need to think about how we will care for them, medically and socially."

The new patients also will be less homogenous. The report shows a big change in the distribution of the population, with the percentage of Caucasians dropping from 74 percent to 64 percent. These changes will be most dramatic in the West and Southwest. By 2011, 44 percent of Los Angelenos will be Hispanic, which "can’t help but have an enormous influence on language and culture," Everett said.

The new patients not only will want their DVD, they will want all the latest gene therapy, monitors, designer meds and computers. "You have a whole group of people who are used to the Nordstrom gold standard, and they are not going to be satisfied with less than the best," Everett said.

Nursing implications
If the predictions come to pass, it could mean substantial changes for nurses in ways that range from how they are taught to how they interact with patients.

Wallace speculates that the patient of the future will bring more opportunity – and responsibility – for nurses.

"One thing we have been saying is that health care works better when patients have more information. But that has a problem attached to it, which is that we have to be that much better-educated ourselves," he said.

Everett, too, sees nurses moving more into the role of information specialists and consultants.

"Nurses and physicians – although nurses have always been better at this – are going to be more involved in a shared decision-making role, not an authoritarian role," she said. "It will no longer be enough to tell someone that this is the pill they are going to be taking and that’s the end of that."

But all this will mean enormous strains on the pocketbooks of government and businesses, which will shoulder the bill for this care and technology. HMOs will help some. By 2005, the report estimates, the number of people covered by HMOs will increase 25 percent, from 78 million in 1998 to more than 100 million.

But the uninsured have fewer glimmers of hope. Their numbers could swell to 65 million from today’s 42 million. Before taking more slices from the pie, Everett would like to see a scenario where nothing is squandered.

"If we could do two things – pay attention to what we waste in supplies and labor and use our technology intelligently – we’d have plenty of money for the health of the poor," she said.