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White House panel warns of aging crisis


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WASHINGTON, Sep 29, 2005 (UPI via COMTEX) -- A looming explosion in the U.S. population of elderly and frail citizens threatens to force a crisis in long-term care in the United States, a White House advisory group reported Thursday.

The number of aging Americans is set to double by 2050, spurring demand for healthcare and nursing-home capacity for millions more people, the President's Council on Bioethics said in its report, "Taking Care: Ethical Caregiving in Our Aging Society." The trend also could cause huge cultural shifts, as tens of millions more working-age people become caregivers for elderly parents, the report said.

In one alarming statistic, the number of people in the United States with dementia caused by Alzheimer's disease is expected to triple -- to 12 million by 2050. Yet the nation -- and its leaders -- scarcely has begun to consider the far-reaching implications of the aging of the U.S. population, the report cautioned.

"We are on the threshold and may have already crossed the threshold of a large crisis of long term care," Dr. Leon Kass, the council's chairman, said at a news briefing. "The first thing we wanted to do be sure is understood is that this is serious and this is real."

The report warned that the number of health workers qualified to deliver long-term care is dropping, even as the number of elderly persons rises. The lack of qualified workers threatens to lead to "warehousing" of the elderly in nursing homes too poorly equipped to care for them ethically.

The report also directly opposed the use of assisted suicide and euthanasia, warning that shortages in qualified caregivers could push doctors and nurses to "abandon" elderly patients out of convenience.

"This is going to be an increasing temptation, and we have to guard against it," Kass told reporters.

At the same time, the report said doctors should be discouraged from delivering medical care intended to prolong life at all costs, when the care is unduly burdensome to patients. The issue gained the national spotlight last March during the debate over Terri Schiavo, the young woman who was presumed to have lived in a persistent vegetative state for many years, until a court ordered her to be denied food and water. She died March 31, 13 days after her feeding tube was removed.

That episode caused widespread interest in advanced directives, which many experts said at the time would have made Schiavo's wishes for her care known and would have spared her and her family the drawn-out court battles that occurred.

The council's report criticized the use of advanced directives, however, as "limited and flawed" in their ability to predict what kinds of care elderly patients actually would need at the end of life. Such documents often do little to instruct family members and doctors about patients' wishes, the report said. Instead, the council promoted the use of "proxy directives," which appoint a trusted family member or other person to make decisions on behalf of incapacitated patients.

Gail Gibson Hunt, president and chief executive officer of the National Alliance for Caregiving, criticized the report for not adequately addressing the demographic shift's impact on family members. Millions of adults with frail parents could be forced to quit work and provide healthcare with little training, she said.

Few federal programs provide family caregivers with compensation for lost wages or lowered pensions, and those that do constitute "just a drop in the bucket," she said.

The report was the last due to be issued by the president's council, which has published previous reports on stem-cell research and cloning, among other issues.

Even as the report was released, council members said they did not have the expertise to deal with the huge economic implications of the aging of the population. Instead, they recommended the formation of a new national commission on the economic and policy impact of aging and dementia on long-term care.

Todd Zwillich covers healthcare policy matters for UPI. E-mail: sciencemail@upi.com

URL: www.upi.com 

Copyright 2005 by United Press International

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