Healthcare on the brink: navigating the challenges of an aging society in the United States

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Abstract

The US healthcare system is at a crossroads. With an aging population requiring more care and a strained system facing workforce shortages, capacity issues, and fragmentation, innovative solutions and policy reforms are needed. This paper aims to spark dialogue and collaboration among healthcare stakeholders and inspire action to meet the needs of the aging population. Through a comprehensive analysis of the impact of an aging society, this work highlights the urgency of addressing this issue and the importance of restructuring the healthcare system to be more efficient, equitable, and responsive.

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Most cited references 52

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High-performance medicine: the convergence of human and artificial intelligence

Eric Topol (2019)

The use of artificial intelligence, and the deep-learning subtype in particular, has been enabled by the use of labeled big data, along with markedly enhanced computing power and cloud storage, across all sectors. In medicine, this is beginning to have an impact at three levels: for clinicians, predominantly via rapid, accurate image interpretation; for health systems, by improving workflow and the potential for reducing medical errors; and for patients, by enabling them to process their own data to promote health. The current limitations, including bias, privacy and security, and lack of transparency, along with the future directions of these applications will be discussed in this article. Over time, marked improvements in accuracy, productivity, and workflow will likely be actualized, but whether that will be used to improve the patient-doctor relationship or facilitate its erosion remains to be seen.

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Oxidative stress, aging, and diseases

Ilaria Liguori, Gennaro Russo, Francesco Curcio … (2018)

Reactive oxygen and nitrogen species (RONS) are produced by several endogenous and exogenous processes, and their negative effects are neutralized by antioxidant defenses. Oxidative stress occurs from the imbalance between RONS production and these antioxidant defenses. Aging is a process characterized by the progressive loss of tissue and organ function. The oxidative stress theory of aging is based on the hypothesis that age-associated functional losses are due to the accumulation of RONS-induced damages. At the same time, oxidative stress is involved in several age-related conditions (ie, cardiovascular diseases [CVDs], chronic obstructive pulmonary disease, chronic kidney disease, neurodegenerative diseases, and cancer), including sarcopenia and frailty. Different types of oxidative stress biomarkers have been identified and may provide important information about the efficacy of the treatment, guiding the selection of the most effective drugs/dose regimens for patients and, if particularly relevant from a pathophysiological point of view, acting on a specific therapeutic target. Given the important role of oxidative stress in the pathogenesis of many clinical conditions and aging, antioxidant therapy could positively affect the natural history of several diseases, but further investigation is needed to evaluate the real efficacy of these therapeutic interventions. The purpose of this paper is to provide a review of literature on this complex topic of ever increasing interest.

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Inflammageing: chronic inflammation in ageing, cardiovascular disease, and frailty

Luigi Ferrucci, Elisa Fabbri (2018)

Most older individuals develop inflammageing, a condition characterized by elevated levels of blood inflammatory markers that carries high susceptibility to chronic morbidity, disability, frailty, and premature death. Potential mechanisms of inflammageing include genetic susceptibility, central obesity, increased gut permeability, changes to microbiota composition, cellular senescence, NLRP3 inflammasome activation, oxidative stress caused by dysfunctional mitochondria, immune cell dysregulation, and chronic infections. Inflammageing is a risk factor for cardiovascular diseases (CVDs), and clinical trials suggest that this association is causal. Inflammageing is also a risk factor for chronic kidney disease, diabetes mellitus, cancer, depression, dementia, and sarcopenia, but whether modulating inflammation beneficially affects the clinical course of non-CVD health problems is controversial. This uncertainty is an important issue to address because older patients with CVD are often affected by multimorbidity and frailty - which affect clinical manifestations, prognosis, and response to treatment - and are associated with inflammation by mechanisms similar to those in CVD. The hypothesis that inflammation affects CVD, multimorbidity, and frailty by inhibiting growth factors, increasing catabolism, and interfering with homeostatic signalling is supported by mechanistic studies but requires confirmation in humans. Whether early modulation of inflammageing prevents or delays the onset of cardiovascular frailty should be tested in clinical trials.

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Author and article information

Contributors

Charles H. Jones:

ORCID: http://orcid.org/0009-0004-0368-6463

charles.jones@pfizer.com

Mikael Dolsten: mikael.dolsten@pfizer.com

Journal

Journal ID (nlm-ta): NPJ Aging

Journal ID (iso-abbrev): NPJ Aging

Title: NPJ Aging

Publisher: Nature Publishing Group UK (London )

ISSN (Electronic): 2731-6068

Publication date (Electronic): 6 April 2024

Publication date PMC-release: 6 April 2024

Publication date Collection: December 2024

Volume: 10

Issue: 1

Electronic Location Identifier: 22

Affiliations

GRID grid.410513.2, ISNI 0000 0000 8800 7493, Pfizer, 66 Hudson Boulevard, , New York, ; New York, 10018 USA

Author information

Charles H. Jones http://orcid.org/0009-0004-0368-6463

Article

Publisher ID: 148

DOI: 10.1038/s41514-024-00148-2

PMC ID: 10998868

PubMed ID: 38582901

SO-VID: 72196efa-093f-4d98-a2d6-b64b1964326c

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 24 January 2024

Date accepted : 21 March 2024

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Keywords: geriatrics,health services,public health,epidemiology

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Keywords: geriatrics, health services, public health, epidemiology

Healthcare on the brink: navigating the challenges of an aging society in the United States

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AIP Publishing: Coronavirus

Most cited references 52

High-performance medicine: the convergence of human and artificial intelligence

Oxidative stress, aging, and diseases

Inflammageing: chronic inflammation in ageing, cardiovascular disease, and frailty

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