Future Demand for U.S. P&O Care Overstated?
Many observers have expressed concern about a future shortage of prosthetists and orthotists in the United States, based in large part on impending retirement of the huge cohort of baby-boomers who were born in record numbers in the years following World War II. Data from a study conducted by the National Institutes on Aging suggests that predictions that this will result in a large increase in P&O patients may not come true.
In fact, the age-specific disability rate in the United States has been steadily declining over the past two decades. The rate of chronic disability has been dropping for all age groups, but the greatest decline has been in the over-80 population: precisely the group expected to be those most in need of prostheses and orthoses.
More importantly, the drop in chronic disability has been accelerating since 1982! From 1982-1989, the rate declined an average of 1.2% per year. From 1989-1994, the decline increased to 1.5% annually. From 1994-1999, the decline grew to 2.6% per annum. Despite the population increase, there were 7 million elderly disabled people in 1999: an absolute decrease of 500,000 from the number in 1982! This trend is further confirmed by the drop in nursing home population of 200,000 during the same period.
The reason for this very positive, and somewhat surprising, trend has not yet been established. Better nutrition, better health care, higher educated citizens who smoke less and exercise more have all been cited as potential factors. More effective prescription drugs, surgeries, and preventative medicine have also been proposed to explain these results. But, since the reasons are not proven, no one knows whether this trend will continue to accelerate or not. For more details, visit the NIA site at www.nia.nih.gov/news/pr/2001/0507.htm.
Regardless of the causes, however, when disability rates decline the need for prostheses and orthoses also diminishes. One consequence is that, based on currently available data, it appears that the need for prosthetist-orthotists will not be increasing exponentially in the next decade. So, the predicted acute shortage of ABC Certified Prosthetist Orthotists may not materialize in the short term, which is fortunate since it remains very difficult to fund an increase in the number of NCOPE-accredited P&O educational programs. Another positive byproduct of the relative increase in the "healthy elderly" is that the actual costs to the Medicare system will likely be far lower than previously projected. The best news of all, though, is that there will be less Americans who need our services than anyone anticipated. This will allow us to focus on improving the quality of care for those people who do need our help, and on developing new orthoses and prostheses that can offer assistance to populations who cannot benefit from the current state of the art.