A looming explosion in the population of frail and elderly persons is pushing the U.S. toward a crisis in caring for the aged, a White House commission warned Thursday.

The number of elderly Americans is set to double by 2050, spurring massive demand for health and nursing home care for millions of aged Americans. It could also cause huge cultural shifts as tens of millions more working-age Americans become caregivers for elderly parents.

In one alarming statistic, the number of Americans with dementia caused by Alzheimer’s disease is expected to triple to 12 million by 2050.

Yet the nation and its leaders have scarcely begun to consider the far-reaching implications of the aging of the U.S. population, the commission’s report cautioned.

“We are on the threshold and may have already crossed the threshold of a large crisis of long-term care,” says Leon Kass, chairman of the President’s Council on Bioethics, which released the report Thursday.

“The first thing we wanted to be sure is understood is that this is serious and this is real,” he says.

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. A lack of qualified workers threatens to lead to “warehousing” of elderly person in nursing homes too poorly equipped to care for them ethically, it states.

The report also directly opposes 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, says Kass, also an ethicist at the University of Chicago.

Advance Directives Discouraged

At the same time, the report discourages doctors from delivering medical care intended to prolong life at all costs when the care is unduly burdensome to patients. The issue gained a national spotlight last year during the Terri Schiavo debate.

That episode caused widespread interest in advance directives, which many experts said would have made Schiavo’s wishes for her care known and would have spared her and her family drawn-out court battles and attempted interventions from Congress.

But the report criticized advance directives as “limited and flawed” in their ability to predict what care elderly patients at the end of life will actually need. The documents often do little to instruct family members and doctors about a patient’s wishes, the council said. Instead, the report promotes the use of “proxy directives,” which appoint a trusted family member or other person to make decisions for incapacitated patients.

The documents could become especially important because of a lack of standards for appropriate end-of-life care in U.S. hospitals, says Joanne Lynn, PhD, a senior scientist and aging expert at the RAND Corporation.

“It is uncommon in Oregon for a person with Alzheimer’s to die in the hospital. It is commonplace in New York and Newark. There are enormous variations, no social consensus,” she said.

Gail Gibson Hunt, president and CEO 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 health care with little training, she told reporters.

Few federal programs aid family caregivers with lost wages or lowered pensions, and those that do “are just a drop in the bucket,” she says.

The report was the last due to be issued by the council, which has put out previous reports on stem cell research, cloning, and other issues.

Even as the report was released, panelists said they did not have the expertise to deal with 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.

By Todd Zwillich, reviewed by Brunilda Nazario, MD

SOURCES: “Taking Care: Ethical Caregiving in Our Aging Society,” President’s Council on Bioethics, Sept. 29, 2005. Leon Kass, MD, PhD, chairman, President’s Council on Bioethics. Joanne Lynn, PhD, senior scientist, RAND Corp. Gail Gibson Hunt, president and CEO, National Alliance for Caregiving.