The Senior Surge: The Growing Elderly Population and the U.S. Healthcare System

The United States is in the midst of a profound demographic shift.

By 2030, one in five Americans will be 65 or older, and by 2040, the number of people aged 85 and over is projected to nearly triple, from 6.7 million in 2020 to 14.4 million in 2040. In the United States, the increasing population of older adults is due to increased overall life expectancy coupled with the aging of the baby boomer generation. This transformation presents significant challenges to a healthcare system that is already strained under the weight of workforce shortages, fragmented delivery of care, and rising costs. As the population of older adults continues to expand, our healthcare infrastructure must evolve rapidly to meet our changing population’s complex and diverse needs.

As the United States faces a rapidly aging population with growing healthcare needs, our compromised healthcare system remains ill-equipped to meet the demands of this demographic shift. According to the National Council on Aging (NCOA), nearly 95% of seniors live with at least one chronic illness, and 80% have two or more. These conditions, ranging from diabetes and cardiovascular disease to neurodegenerative diseases such as Alzheimer’s and Parkinson’s, contribute to a rising demand for healthcare services and account for the majority of the nation’s healthcare spending. This multimorbidity (the presence of two or more chronic diseases in the same person) not only affects older adults’ physical health but also increases their risk for functional decline, hospitalization, and institutionalization. Older adults present a higher demand for specialized care due to complex health needs and chronic conditions, which can intensify existing capacity limitations, workforce shortages (especially in geriatrics), and financial burdens on healthcare systems. Despite this escalating necessity for healthcare services, the U.S. healthcare workforce is unprepared to handle the surge. A study by the Association of American Medical Colleges (AAMC) predicts a shortage of up to 139,000 physicians by 2033. While we have an overall physician shortage, physicians in the field of geriatrics are especially reduced. According to the American Geriatrics Society (AGS), there are fewer than 8,000 board-certified geriatricians practicing today (see C2R article: Geriatricians: Who They Are, Why They Are Important, and Why We Need More), a number woefully inadequate for a country with nearly 60 million seniors. Projections indicate the need for over 30,000 geriatricians by 2030; however, despite this need, most U.S. medical schools still do not require training in geriatrics. Shockingly, only 10% of medical schools require a rotation in geriatric care, compared to the 96% that require a rotation in pediatric care. This gap highlights a broader issue within the healthcare system: while pediatric care is rightfully considered essential and widely integrated into medical education, elderly care often remains an afterthought. In many ways, aging is still treated as a niche issue rather than a universal reality.

Beyond traditional healthcare settings such as hospitals and clinics, the strain extends to the home front. Over 44 million Americans now serve as unpaid caregivers, many of them supporting aging family members with minimal formal training or support. The growing reliance on family caregivers is both a solution to increased pressures faced by long-term care facilities and a source of immense stress. Caregivers often suffer from burnout, financial strain, and emotional fatigue, particularly when navigating complex health systems that fail to coordinate care or communicate effectively with families. The hidden labor of these caregivers has an estimated economic value of $873.5 billion annually, a figure that underscores their indispensable role in the broader healthcare landscape. Meanwhile, long-term care facilities face their own crisis. Staffing shortages are delaying admissions, and many facilities operate with reduced capacity. With the 85+ population expected to triple by 2040, the gap between need and availability is only widening every year. Additionally, Medicare does not fully cover long-term care, leaving many families to navigate a patchwork of insurance plans, out-of-pocket payments, and Medicaid eligibility criteria. These findings highlight the urgent need for coordinated solutions at the federal, state, employer, and individual levels to better support caregivers and long-term care facilities. This may include expanding benefits and reimbursement policies, enhancing federal tax credits and Medicare/Medicaid coverage, and encouraging individuals, especially young people, to proactively plan for future caregiving responsibilities much like they would for any other major life event.

Older adults themselves have voiced serious concerns about the quality of and accessibility to their care. A 2024 national survey by the John A. Hartford Foundation found that only 11% of older Americans believe the healthcare system is doing an excellent job of meeting their needs. 94% expressed a desire for a healthcare system that prioritizes quality of life over simply extending life. Yet, less than half reported that their healthcare providers regularly assess their ability to perform everyday tasks or screen for memory or mental health concerns. The same survey revealed that more than half of seniors found their Medicare plans too complex to navigate and experienced poor coordination between their various healthcare providers. This survey exposes how the strain on our healthcare system, including financial pressures, limited capacity, and workforce shortages, is compromising the quality of care older adults receive, as providers have less time per patient and fewer resources to meet their complex needs.

Addressing these challenges requires both innovation and systemic reform. Experts suggest that health systems must pivot toward age-friendly care models that prioritize independence, mobility, cognitive function, and social engagement. This includes integrating geriatric training into medical education, supporting interdisciplinary care teams, and embracing home-based services enhanced by technology. Telemedicine, artificial intelligence, and remote monitoring offer promising avenues to expand access and reduce costs, especially for seniors with limited access to facilities, such as those who live in rural areas or are unable to leave their homes. Equally important is the need to strengthen support systems for family caregivers. Training programs, financial assistance, and respite care must be expanded in order to prevent burnout and ensure quality care at home. An additional beneficial change would be for policymakers to revisit Medicare and Medicaid structures and incentivize preventive care and long-term support, rather than the reactive, crisis-driven interventions that our healthcare system has relied on for so long.

The “Senior Surge” is not a distant phenomenon—it is unfolding now, and its impacts can be seen in every hospital, home, and community, intensifying as the years go on. As the nation’s elderly population grows, the healthcare system must transform in tandem. The question is not whether we can afford to act, but whether we can afford not to.

The time for rethinking aging in America is now.

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