An ageing population needs a different approach to housing and care. This is how to provide it

Our global population is ageing rapidly. By 2030, one in six people in the world will be aged 60 years old or over and the share of population they account for will rise from one billion now to 1.4 billion. In the US alone, it is estimated that nearly a quarter of the population will be 65 or older by 2060.

This marks a dramatic change in the demographic structure of our communities, shifting a greater need for healthcare providers specializing in care for those later in life and in making that care more readily available through changes to where and how ageing communities live.

Demographers often show the structure of a population as an age-sex pyramid. Typically, this popular image shows age by year up the centre of the pyramid, with the male population on one side and the female population on the other.

For a growing population the base of the pyramid is wide, representing the large number of children being born. As it moves up the age groups, the pyramid gets thinner until it reaches a very thin peak reflecting the portion of the population made up by the very oldest.

However, at some point in the 21st century the global population pyramid will likely flip: what was previously the top of the pyramid will become its bottom and vice versa. This will happen at different speeds in different countries but it has already happened in Japan, Italy and Spain. It will happen soon in China, and the rest of the world will follow suit over the century. It’s just a matter of time.

As of 2012, more than 60% of the US population over the age of 65 was actively managing two or more chronic conditions. Reduced mobility will be a way of life. People living with varying stages of dementia will require an increasingly sizable proportion of dependent care.

The US is a good example of what the future portends for developed countries. The current healthcare workforce is not well-positioned to provide care for this ageing population. We lack the specialized medical personnel we need to provide care for elderly patients, and this shortage has only been amplified by the COVID-19 pandemic.

We need a new paradigm to address this care gap and help our society thrive as we age. Here's how we can build that:

Trained and sustained care is expensive. We need a new, more effective and widely-available solution to provide care to those who will need it as they age.

In addition, single family homes are notoriously challenging for ageing in place, but with the square footage of many suburban homes in the US above 3,000 square feet and an average home over 2,000 square feet, repurposing these homes to house small communities with a care provider could help meet this need.

At the intersection of these factors lies a solution: repurposing single family homes to provide housing for two to three people with an in-home care provider to improve access to community and support for daily needs, reducing costs of that care, and reserving long-term care facilities for those in need of intensive care.

For example, with three to five bedrooms and a caretaker’s apartment (think: 'mother-in-law suite'), we could reimagine long term care settings to include a more independent, but social, family-like environment.

Within that context, a single care provider trained in elderly care could, for many people, provide the help needed to track medication and medical care visits; manage shopping, cooking and cleaning; and provide financial management help for those in the home. Just as important, this arrangement would help provide the simple “second set of eyes” for which many adult children are currently turning to electronic devices and video surveillance of their parents’ homes.

Much hand-wringing has been focused on the high cost and limited value of end-of-life care. This cost is a matter of human well-being as much as a financial burden. People – and their families – often describe a desire for a less medicalized ageing process, but lack good alternatives.

Solutions to reduce this impact have been proposed, but few have been implemented at scale. However, the COVID-19 pandemic demonstrated a few key solutions that have proven widely effective at increasing access to care and providing more effective tailoring of that care to need. Highest on that list is access to telehealth.

Indeed, a significant increase in telehealth during the COVID-19 pandemic has demonstrated its effectiveness, especially for elderly patients with mobility issues, for patients with dementia, and those at higher risk of healthcare-acquired infections.

Patients who would otherwise require transportation and may not have access to specialists in their area can access that care remotely, reducing the stress of travel and exposure to high-risk environments, while benefiting from experts who are often likely to more rapidly and accurately diagnose and prescribe appropriate levels of care for their needs.

Especially for patients suffering from dementia – and their caretakers, this ability to receive appropriate and tailored healthcare in non-emergency situations would be transformative.

Importantly, telehealth has also proven a valuable addition for mental health care, increasing access in rural areas, reducing the time and cost burden of seeking that care, and reducing the stigma of seeking that care.

One of the most critical goals of public health is to reduce the need for medical intervention. Comorbidities not only require treatment themselves, but increase the acuity of other health issues.

Basic public health measures: vaccination and boosters, access to primary care, healthy eating and exercise programmes, and access to low-cost mental healthcare reduce these comorbidities and, in turn, the amount of healthcare needed by these people.

The key solutions lie in basic preventative and public health: increasing vaccination rates both for boosters in the elderly and ready access to newly-developed vaccines, improving access to healthy food through delivery services and repair of food deserts, and providing inexpensive access to community-building and exercise programmes.

While the efficacy of vaccinations received as children may have waned by the time we reach our 60s and 70s, boosters are widely available.

Plus, exercise programmes provide opportunities for social engagement and cognitive gains in addition to reducing risk of cardiovascular disease and falls, the two most frequent causes of hospital admissions for those over 65.

Given the rapidly changing demographics of our communities, we need to begin implementing these solutions to address the reality of the coming decades.

These solutions require investment. They also require a creative re-envisioning of the future not just for who we are now, but for who we will be in 10 years. The clock is ticking fast, and we have no time to spare.