Self-management programs: one way to promote healthy aging.

The United States population is aging rapidly. In 2007, about 38 million people in America were aged 65 and older, about 13% of the population. That number is expected to nearly double by 2030 to an estimated 71.5 million Americans.1 Unfortunately, chronic illnesses often accompany the aging process. In 2002, the top three causes of death for U.S. adults aged 65 or older were heart disease (32% of all deaths), cancer (22%), and stroke (8%). These illnesses accounted for more than 60% of all deaths in this age group. Currently, at least 80% of older Ameri­ cans are living with at least one chronic condition, and 50% of them have at least two conditions.2 Not surprisingly, health-care expenditures increase as people age and their health deteriorates. Experts at the U.S. Department of Health and Human Ser­ vices (HHS) project that the cost of health care will reach $3.6 trillion in 2014, up from $2.2 trillion in 2007. The mean annual rate of growth of health-care costs through 2018 is projected to be 6.2%. Medicare spending grew 7.2% to $431 billion in 2007. Hospital expenditures grew 7.3% in 2007, up from 6.9% in 2006. It is projected that in 2018, Medicare spending will be nearly $935 billion.3 A number of older adults, especially members of racial/ethnic minority groups, have difficulty locating health-care services. In many communities, access to quality health services—and the costs of those services— remains a major obstacle for these and other segments of the population. To ease this problem of access and provide the needed comprehensive care to older Americans, the U.S. must more than triple the current number of clinicians with specialized geriatric training, according to the Alliance for Aging Research.4 Indeed, the U.S. has only about a quarter of the people needed to train students, residents, and physicians in geriatrics. Additionally, the need for community-based service programs will increase, including nutrition, physical fit­ ness, and fall prevention programs, which play a critical role in helping seniors to maintain and even improve their health. Many of the nation’s leading health-care experts are recommending a combination of clinical and community-based interventions to address the growing prevalence of chronic conditions. RADM Steven K. Galson, Acting Surgeon General