Allied Health and the Challenge of the Coming Age Wave in the U.S.

July 19, 2023
Deborah Larsen, Ph.D., president of the president of the ASAHP—Association of Schools Advancing Health Professions—talks about the coming age wave in the U.S.

How are the professional educational institutions training the full range of clinicians and other healthcare professionals strategizing forward to meet the future? When it comes to the aging population in the United States, the level of need is growing fast. Even as the overall population of the United States grew fivefold, or 200 percent, from 1920 to 2020, the population of older Americans grew from 4.9 million, or 4.7 percent of the total U.S. population, in 1920, to 55.8 million, or 16.8 percent of the overall population, by 2020—representing a 1,000-percent growth rate. Put another way, the U.S. Census Bureau notes that, while in 1920, only one in 20 Americans were age 65 or older, by 2020, that proportion had risen to one in six Americans. And that wave of aging has been driven by the aging of the Baby Boomers—Americans born between 1946 and 1964—as the Boomers began turning 65 in 2011.

Of greater concern, the Urban Institute notes that the number of Americans ages 65 and older will more than double over the next 40 years, reaching 80 million in 2040; in fact, one in every five Americans will be 65 years old or older by that years, with demographers and others predicting an intense burden on all the systems in our society, including of course, the healthcare system.

One of the individuals who has spent years thinking about and strategizing around this situation is Deborah Larsen, Ph.D., FASAHP, president of the Washington, D.C.-based Association of Schools Advancing Health Professions (ASAHP). The ASAHP’s website notes that “Although ASAHP originally was intended to be an organization of university and college based-education units dedicated to the education of allied health professionals, the overwhelming response received from hospitals, clinical facilities, and professional societies to ASAHP as a unifying organization prompted the Executive Committee to undertake development of a plan for the reorganization of ASAHP as an organization representing the totality of allied health education and practice in the United States. The reorganization was endorsed by the membership and the name of the organization was officially changed to the American Society of Allied Health Professions in 1973. The new name preserved the ASAHP acronym, but the reorganization and shift in direction ultimately proved to be problematic for the Association, primarily due to conflicting interests between educators and practitioners. Throughout the 1980s, the membership of clinical facilities and professional organizations significantly diminished in size and the dominance of the university and college programs eventually resulted in changing the name of the organization back to the Association Of Schools of Allied Health Professions in 1991. As of 2017, ASAHP’s membership consists of 116 academic institutions and four professional associations. In 2019, the membership voted to change the name of the organization to the Association of Schools Advancing Health Professions (ASAHP).”

Deb Larsen retired from Ohio State University last year after 32 years on the faculty there. She is a physical therapist by training and professional background. Larsen spoke recently with Healthcare Innovation Editor-in-Chief Mark Hagland about the challenges and opportunities involved in preparing what used to be called the allied health professions, for the future. Below are excerpts from their interview.

Tell me about how you and your colleagues at the ASAHP are looking at the changing landscape around aging in this country, and strategizing around what the healthcare industry can do to prepare to care for the millions of Americans who are joining the older cadres of our population?

ASAHP really represents institutions across the U.S. that educate what used to be called allied health professions. We try not to use that term anymore, as it’s outdated and suggests a level of dependency that doesn’t exist anymore. Everything but nursing, medicine, pharmacy. So we’re the physical therapists, occupational therapists, physician assistants, respiratory therapists, radiologic technologists, dieticians, medical lab technologists. We’re that group of people. And if you add those groups all together, we’re as large as the profession of nursing.

What are the biggest challenges facing this diverse group of professions?

We’re professions that have a longstanding commitment to aging populations. And we’ve expanded the curriculum to look more at wellness and prevention and less just on disease and disability. The goal is to help older adults age with dignity and in safety, and if possible, in their own homes.

How is education changing in the schools among these professions?

For one thing, these used to predominantly be bachelor’s or even associate’s degrees; most programs are master’s degree-level programs, and some are doctoral-level. That allows for greater independence in practice, especially around conditions that occur in older adults.

What will be the biggest challenge in making that shift?

The biggest challenge will be successfully recruiting young adults into these professions, and trying to encourage them to see the possibilities involved in working with older adults. I’m a Boomer, and we Boomers have been redefining health and fitness, and we’re trying to take that with us into our older years. So adjusting exercise programs, address fall risk, supporting older adults around issues like balance.

And the professional schools are shifting forward in that regard?

Yes, they are. For example, Ohio State has an undergraduate minor in aging, and a graduate specialization in aging—as well as making people across campus aware of some of the issues facing older adults. Anyone can take those courses along with a core set of courses, whether a dietician, a PT, or an exercise physiologist.

How will this shift in the education and preparation of these health professionals evolve forward?

My expectation is that there will be more and more opportunities for people to be trained in elder care, both at the bedside and outpatient, as well as in home health, to keep older adults in their homes longer. There are greater and greater opportunities to develop special training. PTs and OTs do driver evaluations and can train older drivers, using simulators, to learn to drive more safely, through such things as gauging stopping and starting times, and can train them to bring their skill level up to what it should be, especially after a stroke or similar, when somebody needs to regain their abilities.

Do we have enough people trained in order to address the aging of the population?

We know that there’s a nursing shortage and a physician shortage, but there’s a huge opportunity for health professionals to meet the needs of older adults. Your primary care physician is not the main person who should be helping you with your diet as you age; a dietician should be working in the primary care office and performing that role—that includes people with diabetes and with kidney disease and with metabolic disease, and with older adults in general.

What should the leaders of health systems be thinking about, in this context?

We’ve been talking about team-based care for a long time, and we see that team-based care is the best care, and wellness care is the best care. And in the past decade or so, we’ve started to be thinking about prevention and wellness, and these health professions are very much geared towards wellness and diet and similar issues. And you need to be seeing the right practitioner for the right information, when you need it. Sometimes, that’s a physician therapist, sometimes an occupational therapist, a dietician; sometimes even an athletic trainer, as older adults want to be involved in sports, to resume a more active lifestyle.

Is there anything you’d like to add?

I should mention that all kinds of research is being done across the country by professionals, by academics in these fields, looking at issues such as averting fall risk, appropriate diet, helping older adults to be able to live in their homes longer. So it’s not just teaching students, but moving towards meeting the needs of older adults.

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