Diseases of aging: high costs. High risks.

• Author: Stomierowski, Peg
• Position: HEALTH & MEDICINE

As Alaska celebrates 50 years of Statehood amid changing demographics, planners wonder how to best care for its elderly, especially those most vulnerable to general decline or such chronic illnesses as cancer and cardiovascular problems. Amid rising costs and concern about gaps in knowledge, access and quality of services, will living longer for most mean living better? Can we invite health even as we treat symptoms?

GETTING OLDER

For a state traditionally associated with a young and hardy populace, the answer involves strategic challenge. The median age of Alaskans rose from 29.4 in 1990 to 32.4 in 2000, said Marilyn Walsh Kasmar, executive director of Alaska Primary Care Association. The number of elders grew by 48 percent in the last decade, with the 65-plus population projected to continue growing rapidly, almost tripling from 43,000 to 124,000 between 2005 and 2025. This will pose new demands on public health, mental health, general health, social work and protective services--particularly geriatric services. It's the kind of demographic that plays into the care and cost discussion in obvious ways.

EIGHTY PERCENT AFFECTED

According to the U.S. Centers for Disease Control and Prevention (CDC), chronic diseases disproportionately affect older adults and are associated with disability, quality-of-life strains and associated high costs for health and long-term care. An estimated 80 percent of older adults have at least one chronic condition, and at least half have two--often manifesting in years of pain and loss of function.

Alaska's elderly, observed Dr. Jay Butler, the state's chief medical officer, tend to smoke and drink more than seniors elsewhere. They tend to eat fruits and vegetables and be physically active despite the challenges of cold weather and snow. And many face challenges in finding adequate healthcare even if they're on Medicare and live in the city.

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Elderly Natives living in Native communities are at higher risk of getting cancer as they live longer, Butler said, and cigarette smoking tends to be more prevalent. At the same time, non-Natives who come to Alaska to experience its lifestyle aren't as likely to leave when they retire.

ILLNESSES OF THE ELDERLY

Some leading causes of death that Butler identifies for older Alaskans are cancer and heart disease, strokes, chronic respiratory illnesses--including chronic obstructive pulmonary disease (COPD), Alzheimer's disease and dementia. The top five causes of death for Alaskans in general are cancer, heart disease, injuries, stroke and COPD, with the next five being diabetes, Alzheimer's, suicide, influenza and pneumonia, and kidney disease.

While smoking is...