By 2034, ~20% of the U.S. population is expected to be over the age of 65, with more seniors than children for the first time in history and an old-age dependency ratio exceeding 0.35 (i.e., there will be more than one senior for every three working-age adults).
The scale and severity of the implications are still hard to fathom, and the urgency is most apparent to individuals on the frontlines of healthcare delivery and to informal caregivers supporting their loved ones.
Apart from the direct caregiver burden acutely felt by both formal and informal caregivers (the number of caregivers in the U.S. today exceeds 50M, a ~50% increase vs. a decade ago), the downstream societal consequences are dire. The healthcare, financial, and social infrastructures are simply not ready for the negative trajectory we are currently on.
Firstly, the healthcare system is increasingly strained, with a widening gap between supply and demand for essential healthcare staff. Demand is sharply outpacing the supply of qualified professionals – a national shortage of primary care physicians of 20,000-40,000 is projected by 2036, with a total physician shortage of exceeding 90,000 across specialties. Moreover, even as of 2021, if communities underserved by the health care system could obtain care at the same rate as populations with better access, at least 200,000 additional physicians would have been required to provide sufficient care quality and quantity. These pressures are further amplified by the financing model for both residential and non-residential / community-based healthcare for seniors in the U.S. (anchored in Medicare and Medicaid), which was designed for a demographic reality with shorter lifespans and a much smaller senior population.
Secondly, financial and retirement systems will be put under enormous strain as individuals are expected to live for decades beyond the full retirement age, which ranges between 65 and 67. While current life expectancy at birth in the U.S. is estimated at ~80 years, there is a non-trivial probability that a meaningful segment of individuals born today in the U.S. could live to 100 given the continuous and mutually-reinforcing / “bolt-on” advances in biomedicine, public health and technology. This dynamic risks creating societal upheaval driven by perceptions of unfairness, as younger adults might increasingly start feeling they are “subsidizing” older generations at their own expense.
Thirdly, society and the “human infrastructure” are under increasing duress as informal, unpaid caregivers – mostly family members and friends – struggle to balance caregiving responsibilities with building personal and professional lives of their own, including negative career repercussions (e.g., shifting from full- to part-time work), financial difficulties (especially in the long-term given savings depletion and decreased earnings potential), and deteriorating own health status (both physical and mental).
If we look at the current all-cause dementia prevalence (estimated at 6M Americans, roughly ~10% of the 65+ age segment) and the trajectory we’re on, we can expect at least 8M people to suffer from dementia by the mid-2030s, representing over 2% of the total U.S. population.
All of these factors combined are creating unprecedented challenges and vicious self-reinforcing cycles which are extremely hard to break unless concerted, multi-pronged, systemic solutions are effectively implemented, requiring collaboration between the public, private, and non-profit sectors.
The importance of maximizing independence and functional capacity
As we look forward to increasingly long lifespans, driven in large part by biomedical / technological advances over the past decades, a critical component that is often overlooked is healthspan, which essentially means quality of life. The medical system has so far been extremely effective in prolonging life and delaying mortality for seniors, but healthspan extension is often a missing piece of the puzzle in later life. As the average lifespan continues to extend, people are expected to spend an increasing number of years in ill health, with low quality of life, and in suffering. Although sustaining quality of life can be achieved even as functional capacity declines, maximizing independence will be critical to enabling older adults to remain engaged in work and other purposeful activities (e.g., volunteering, social engagement), age at home, and reduce care needs.
Achieving this will require creative approaches to (a) preventing, (b) mitigating, and (c) adapting to negative functional change – including rethinking physical environments and supporting independence even in the presence of cognitive decline (spanning both normative age-related changes and clinical pathology).
Technology as a key lever in our toolbox to drive senior independence
To navigate this demographic storm, we will need to use all tools at our disposal, targeting policy change, societal awareness and mindset shift, and technological acceleration.
Despite the irreplaceable role of policy and educating individuals throughout the lifespan to proactively plan and prepare for a 100-year life – including moving beyond the outdated three-phase life model toward multi-stage work phases and portfolio careers – technology will be a necessity given the severity and depth of the challenge. The caregiver gap alone is so significant that even coordinated public-private efforts focused on re- and up-skilling workers into essential healthcare roles amid the AI-driven restructuring of the workforce would take years to meaningfully expand supply, primarily driven by entrenched certification and education / training timelines. Technology, by contrast, offers scalability, broad reach, and strong incentives for innovation (even if the primary motivator for healthcare innovation should be altruistic, the profit incentive is necessary for innovation as it enables risk-taking and accelerates progress).
Technology can have a broad impact in two distinct but interrelated ways:
- Preventing, diagnosing, and treating disease early to reduce overall disease and disability burden – from leveraging AI to enable early and more affordable diagnosis and treatment for Alzheimer’s disease, to MR-guided Focused Ultrasound (MRgFUS) the incisionless tremor reduction in patients with Parkinson’s disease
- Facilitating and easing the caregiving burden, both quantitatively and qualitatively – from automating care documentation to increase time spent on actual care vs. admin (e.g., through AI scribes), to expanding access to high-quality at-home care through remote specialty care in chronic care management
The path ahead
As we think about the next steps, prudence and first-principles thinking will be paramount. Many technologies will be created, and most will fail. The ones that will prevail and meaningfully change the world will combine technological capability with access and affordability (including viable reimbursement pathways), seamless integration into existing care workflows, multi-stakeholder value proposition (from end-users to payers), ease of use and adoption, and robust safety and data privacy.
And as we think about new technologies and the required societal changes, we need to pivot from a deficiency to an abundance model – from over-focusing on what an individual cannot do, to making the most of the physical and mental resources at hand to maximize independence, dignity, and quality of life. This includes rethinking physical environments and thoughtfully embedding technology to support capability rather than limitation as we adapt to a new reality.
But most important of all, we should not try to supplant the social bonds and the human connections that are the most important threads of our society. Technology should be a complement, not a replacement for human touch and empathy.
Photo: Ridofranz, Getty Images
Luka Zrnic is a healthcare and technology strategist focused on aging, AI-enabled transformation, and longevity-oriented patient care. His background in gerontology and his work in digital health, AgeTech, and public health shape his perspective on how innovation can drive long-term health outcomes. He has guided and facilitated large-scale strategy and technology efforts across the private, public and non-profit sectors.
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