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Reliable and sustainable comprehensive care for frail elderly people.

For most of history, people died young. Just a century ago, the median life expectancy was less than 50 years of age. Growing old was rare, and even more rarely did surgeons and physicians see much benefit in treating elderly people, except to relieve symptoms. Even half a century ago, when Medicare started providing coverage for older individuals, the median age at death was only slightly above the eligibility threshold of 65 years. Today, most people in the United States who survive infancy and avoid serious injury live into their 80s and beyond. Better nutrition, occupational and obstetrical safety, prevention strategies, and improved medical treatments have yielded more years of good health, and it is likely that science will continue to make progress in delaying the effects of aging. Nevertheless, death is inevitable. As the incidence of sudden and premature deaths has declined in the United States, the last part of most individuals’ lives has come to be marked by progressive chronic illnesses and diminishing physical reserves that engender self-care disabilities and frailty. Those who live past age 65 years now average 3 years of self-care disability at the end of life, needing long-term services and supports (LTSS).1 For those living past 85 years old, nearly half will have serious cognitive decline.2