Caring for an aging world. Allocating scarce resources.

It is hardly news any longer that health care for the elderly looms as one of the most daunting problems in the decades ahead. Demographic projections in every developed country point to a great increase in the number and proportion of the elderly, particularly after 2005, together with a corresponding decline in the number and proportion of younger people--those who will have financial and social responsibility for the old. The projected increase in the elderly is particularly notable for those over the age of eighty-five. While a majority of elderly people, particularly those in their late sixties and seventies, are healthy and vigorous, many are not, and by their eighties more and more will be burdened by some degree of chronic illness or disability or both. The scarcity of resources for institutional and home care is vexing, painful problem for many countries already and may only get worse in the future. The growing needs of the elderly come, unfortunately, at a time when the governments of almost all developed countries are under great budgetary pressures, exacerbated all the more by the increase in more successful--but often more costly--high-technology and acute care medical interventions with the old. Though most governments have not been indifferent to these trends, little serious planning or even serious discussion about the future has taken place. The issue of allocation of resources to the elderly is, almost everywhere, a difficult and delicate subject. While some nations have politically active groups of elderly people, speaking effectively for themselves, many others do not. And while many countries are trying to think about the health care needs of the elderly, the pressures to hold down costs seem to make few options available to them. To address some of these problems, The Hastings Center and the Institute for Bioethics in Maastricht, the Netherlands, jointly organized an international project on resource allocation and the elderly. Representatives from some eight countries took part: Sweden, Belgium, Germany, the United Kingdom, the Czech Republic, Hungary, the Netherlands, and the United States. It was a lively and interesting group, different in perspectives, disciplinary backgrounds, and cultures, but sharing a desire to bring to greater public and professional attention and developing problems in health care for the elderly. The first task of the project participants was to find a helpful way to formulate the issues, and particularly to put the health care problems in the most revealing context. …