In early November, 2015 the New York Times published a report indicating that for the first time since WWII Americans between the ages of 45 and 54 are exhibiting worse health status and shorter life expectancies, but not all 45-54 year olds. Research analysis reveals that those affected are white, both men and women, and with lower educational attainment, high-school education or lower. Indications are that the majority of health problems for this age group may be related to alcohol/drug abuse, overdose and suicide. These dramatic changes in overall health do not affect those Americans who are better educated, Latino or Black. The assumptions of many healthcare providers had been dashed.

I had raised this topic for discussion with many colleagues as I tried to grasp the full implications of this for all RNs — RN Case Managers in particular — and for the healthcare system as a whole, then moved on.

In Mid-December, 2015, I read a post from Kaiser Health News highlighting Boomer health in retirement and related Medicare cost implications. Turns out Medicare “can expect significantly higher costs in 2030 both because of the high number of beneficiaries and because many are expected to be significantly less healthy than previous generations.

The typical Medicare beneficiary who is 65 or older [in 2030] will more likely be obese, disabled and suffering from chronic conditions such as heart disease and high blood pressure than those in 2010…” Though I had spent much of my nursing career focused on elder case management and quality of life, “the report said that in inflation-adjusted dollars, Medicare is projected to spend 72 percent more for the remaining lifetime of a typical 65-year-old beneficiary in 2030 than a 65-year-old in 2010.”

Fig. 1 Significant Increases in Medicare Beneficiaries with These Chronic Conditions Forecast by 2030

2010 2017
Hypertension 67% 79%
Heart disease 36% 43%
Diabetes 24% 39%
3 or more Chronic Conditions 26% 40%


Clearly, the need to achieve the Triple Aim was on my mind. With the Accountable Care Organization changes being implemented in over 700 participating healthcare systems and the ACA’s insistence on developing higher quality care at lower cost, I had been well aware of the rapidly increasing numbers of older people. I had even been fully aware of the increasing number of chronic diseases affecting the elderly, but hearing that, “The people about to become eligible are more sick and obese [than past beneficiaries], even though there are treatments that will keep them living longer,” said Etienne Gaudette, a lead economist from the Schaeffer Center, made me realize again the importance of knowledgeable, committed RN case Managers in the years ahead.

Then came another shocker. In January, 2016 the New York Times published a piece titled, Drug Overdoses Propel Rise in Mortality Rates of Young Whites. According to this report, “The rising death rates for those young white adults, ages 25 to 34, make them the first generation since the Vietnam War years of the mid-1960s to experience higher death rates in early adulthood than the generation that preceded it.” The depth of examination of data conducted by the New York Times reporters is impressive, and made the data much more significant as I reviewed the numbers. In this analysis of nearly 60 million death certificates collected by the Centers for Disease Control and Prevention from 1990-2014, death rates for non-Hispanic whites are either rising or flattening for all the adult age groups over age 65. This is a trend that is particularly pronounced in women even as medical advances have reduced deaths from traditional killers like heart disease. Death rates for blacks and most Hispanic groups continue to fall.  This analysis shows that the rise in white mortality extends well beyond the 45-54 year old group.

So what have I concluded? This is our future we’re talking about. The systemic and financial changes currently underway and intended to transform our healthcare system are important, but to date have focused primarily on chronically ill elderly. This will not be enough to make the future U.S. population healthy. Something is very, very wrong, and nurses must rethink who needs our care, and how and where we will provide it. We are a profession with a historical foundation in holistic health and compassionate care. I look forward to a day when every patient has an advocate and partner in health – and that partner advocate is a Registered Nurse case manager!

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Read More at:

Kolata, G.  – Death Rates Rising for Middle-Aged White Americans, Study Finds, New York Times, Nov. 2, 2015.  Access at:

Gillespie, L. – Baby Boomers Set Another Trend:  More Golden Years in Poorer Health.  Kaiser Health News, Dec. 17, 2015.  Access at:

Kolata, G. and Cohen, S. – Overdoses Propel Rise of Mortality Rates in Young Whites.  New York Times, Jan. 16, 2016.  Access at: