Demographic transition calls for the adaptation of healthcare: the example of emergency surgical procedures

Abstract

Evaluation of: Ingraham AM, Cohen ME, Raval MV, Ko CY, Nathens AB. Variation in quality of care after emergency general surgery procedures in the elderly. J. Am. Coll. Surg. 212(6), 1039–1048 (2011). It is well known that most countries are confronted with a demographic transition entailing a greater proportion of people in the upper age bracket. This demographic transition calls for societal adaptation in several areas. In particular the healthcare system needs to rethink its knowledge base, how to apply various medical and surgical interventions as well as how healthcare is organized. In addition, the interventions applied in different health conditions need to be questioned regarding their adaptation to the situation of people in the later stages of the lifespan and to the result of the aging process. The knowledge base for various types of medical or surgical interventions is poor, mainly because research tends to exclude elderly people from studies on the grounds of comorbidities or other functional problems. Thus studies may have very good internal validity but poor external validity when it comes to informing clinical practice about procedures for elderly patients. The aging process, including less reserve capacity in most organs, as well as the morbidities and comorbidities, also makes the individual more vulnerable to the interventions applied. Thus the healthcare system needs to accept and act upon the fact that most of their patients will be people in the upper age bracket. The improved longevity taking place in most countries in the world is a success story but it also brings with it challenges of treating people who are more vulnerable to a variety of complications.