ABSTRACT
Populations around the world are aging at a very fast rate, so much so that care for the elderly will soon rupture even the most carefully planned, enlightened care provisions societies can offer. The demographics in advanced countries demonstrate this dilemma, even without projections based on antiaging medications that may be possible in the near future, and a healthier lifestyle that has preoccupied the yuppies for about 10 years. Some facts are worth citing here for their importance in projecting an ethical response to the crisis:
One out of four elderly persons in the world today is Chinese. Traditionally such individuals were cared for at home by their children. But with the population policy in China, limiting each family to a single child for the most part, there will be a “suck-out” of the middle-aged population who could perform this task in the future. The result will most certainly be social chaos.
Fewer caregivers and wage earners to support the elderly is the most fearful part of every projection. For example, in the United States today, 1.5 million persons are over 85 years-of-age, and this is the fastest growing population. In 40–50 years, there will be 15 million persons over 85 and 1 million over a 100 years-old. A corresponding shrinkage occurs in the population under 65 years-of-age who will have to bear the burdens of providing for the prior and the future generation.
Many people we now call the “old old,” those over 85, will have to care for even older persons who are over 100. Indeed, projections include a significant portion of the population that will live to be about 125 years-old. Contrary to proposals that there is a natural life span of about 80 years, scientific and medical advances will regularly add 20–25 years to this life span.
Such extremely elderly persons, when hospitalized or otherwise institutionalized, use on average three times as much of the health care dollar per event that those under 65 years-old. Care at home for the elderly is significantly less expensive than care in an institution; fairly intensive care at home may cost about half as much as institutional care. Yet with fewer people in the middle of the population to render this care, as they do now, institutional options may be increasingly forced on us.
The costs of healthcare increase dramatically over inflation, especially in a country like the United States where little control is exercised at present over the costs, apart from managed care programs like Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs), in which some measure of advance payment to providers controls costs. Eventually the care of the elderly will bankrupt most nations if some sort of rationing or allocation is not mandated by the populace.
432Recently worldwide, for the first time in history, there are more persons over 65 years-of-age than newborns. To reemphasize the problem, it is global in scope. 1
Also for the first time in history, the elderly demonstrated angrily at street barricades in Utrecht in early October 1993 over a proposal to cut benefits for the elderly. One woman screamed that she worked all her life for others, and now was entitled to the benefits she now received. Some thinkers postulate a time when the intergenerational gap will be so fractious that the elderly will resort to armed rebellion! Although this fear is extreme, there is no question that it will be hard to recover a time of balance between obligations to individuals and sections of society (like the elderly) and the common good itself, with its many imprecations.
