A challenge is on the horizon: In 2011, there will be about 200,000 seniors in Allegheny County, and more than 30,000 of them will be 85 and older.

Many of them, particularly the very oldest, will have multiple medical conditions, take more than a dozen drugs and see several specialists. While the most disabled might live in nursing homes and the healthiest will live independently, most will turn to family members and social services for support.

But will that safety net be strong enough?

According to research findings compiled by the Caregiving Initiative, a project launched by Johnson & Johnson Consumer Products Co., an estimated 46 million American adults take care of an ill friend or family member for free. Such caregivers provide 80 percent of all long-term care in the country, and businesses lose between $11 billion to $29 billion annually because of workers' caregiving responsibilities.

	Our aging population: by the numbers Key numbers for U.S. population 65 and older: 36.3 million -- The number of people that age in the United States on July 1, 2004, -- or 12 percent of the population. 86.7 million -- Their projected population in the year 2050, or 21 percent of the population. $24,509 -- Median 2004 income -- of households with members 65 and older. 9.8 percent -- Their poverty rate -- in 2004, down 0.4 percentage points -- from 2003. 39 percent -- Percentage that Social Security payments represent of their annual personal income. 5 million -- The number of them in the labor force. 47,000 -- The number who are college students. 31 percent -- The percentage -- who are widowed. 81 percent -- The proportion who own their homes. 19 percent -- Their share of the votes cast in the 2004 presidential election. 41 percent -- Their projected share of the votes to be cast in the 2040 presidential election. 78 percent -- Percentage of older households in which someone owns a motor vehicle. 40 percent -- Percentage of the -- age group who have -- a home computer. Source: U.S. Census Bureau

Public health researchers at the University of Albany pointed out in a report last month that demand for health care services will grow even as large numbers of health care workers retire. A lack of geriatricians and a shortage of nurses will make it tougher to meet the needs of an aging population.

Efforts must get under way to prepare for the changing demographics, experts say. The results could reshape the way health care is delivered and reinvent seniors' expectations about their lives.

A new reality

According to Dr. Neil Resnick, director of the University of Pittsburgh Institute on Aging, getting old is a fairly new phenomenon.

"Of all the people who ever lived to age 65 since the Dawn of Man, two-thirds are currently walking the face of the Earth," he noted. "Aging was not something people had to pay much attention to since it was more theoretical than actual."

Before the Civil War, at most 2 percent of the American population lived to age 65. By 1900, the percentage doubled, and then in the next century it tripled, to 13 percent.

"We're now at 38 million or so," Dr. Res-nick said. "The number is going to double again in the next 20 to 25 years. We expect to have more than 75 million old people."

He added that the projection will probably turn out to be an underestimate.

At the beginning of the 20th century, the most common causes of death were diseases that rarely, or never, occur now, such as diphtheria, smallpox, polio and tetanus.

Now, the leading causes of death are cardiovascular disease, stroke and cancer. Treatment advances will continue to be made, and less than half of the people who could benefit are currently getting them, Dr. Resnick pointed out.

It's expected that "more people will get the benefits of what we already know can postpone death," and therefore live longer, he said.

Already, if all centenarians competed to get birthday greetings on national television, the competition would be fierce.

"Getting into Harvard is a walk in the park in comparison," Dr. Resnick joked. "There are nearly 60,000 100-year-olds."

We're special

Allegheny County is growing gray faster than the rest of America, said Richard Schulz, director of Pitt's University Center on Social and Urban Research. Soon, the region will have substantially higher numbers of people who are 85 and older.

"We're going to see an increase in the number of old, old people in Allegheny County," he said. "It'll be in about five years."

After that, if immigration and mortality trends hold, there will be a small dip followed by another rise toward 2035 as the baby boomers age.

Meanwhile, the rate of disability is declining, suggesting that seniors of the future will be more able to live independently, Dr. Schulz said.

"There is one fly in the ointment here," he cautioned. The current epidemic of obesity could contribute to greater disability down the road. Nor is it known if mortality will be higher in that group.

Just as the county is at the vanguard of what has often been called the graying of America, it could also lead the way to create settings and provide services to accommodate the needs of large numbers of seniors.

As Dr. Schulz put it, "We're going to need to reorient ourselves toward that old, old population, both within the formal healthcare provider sector and within social service systems."

Survey on care

For the Johnson & Johnson project, he and his colleagues surveyed a thousand or so adults from around the nation about caregiving.

About two-thirds expected they'd have to take care of an older relative some time in the future, but when asked about specific tasks such as assisting with bathing and dressing or providing advice about health insurance, "the majority say they don't have a clue what they would do," Dr. Schulz said.

Nearly half of those surveyed don't think they'll need care in the future, and more than a third said they'd never thought about it. Two-thirds haven't discussed or made plans for future care. Three-quarters are confident that a family member would take care of them if necessary.

But people have been having fewer or no children in recent generations, Dr. Schulz pointed out.

So "while the need for informal care is going to increase dramatically as the baby boomers get older, the availability of that informal care is going to decline," he said. "How that gets resolved is going to be a big issue for the next decade."

Researchers also expect a need for more doctors, nurses, therapists and other health professionals. And as illness patterns shift from acute, short-term problems to chronic, insidious conditions, medical systems must adapt, Dr. Resnick said.

"Chronic illness really does require the patient playing an active role" in prevention and treatment, he noted. One of the aging institute's goals is "to help patients have better tools with which to learn so they can be empowered."

Health care workers have to develop strategies to optimally manage chronic diseases right now and not just wait for research aimed at cures or new treatments to come to fruition, which could take years, Dr. Resnick said.

Decentralized care that is delivered in communities rather than large medical centers and better information technology to help doctors track their chronically ill patients' condition is also important, he added.

"We need a financing system that will pay doctors to do more preventive care," Dr. Resnick said. "We've learned that prevention probably has the biggest bang for the buck in the elderly."

For example, treating 70-year-olds for high blood pressure will prevent more strokes than treating 40-year-olds because the problem is more common in the older age group.

The aging institute is trying to develop models to allow primary care physicians to take better care of their senior patients, who might have as many as six chronic medical problems and take a dozen medications.

In the typically brief office visit, "the doctor is forced to make judgment after judgment on the fly," Dr. Resnick said. "It's very scary for the doctor ... and, of course, it's frustrating for patients who don't feel they have enough time and a sympathetic ear to open up to because the doctor is so madly trying to keep up with the onslaught."

If measures that successfully meet the needs of growing numbers of seniors are developed, they could be copied elsewhere.

"The region as a whole is beginning to emerge as a center of development for what you might call quality-of-life technology," Dr. Schulz said. "The bottom line is, old people don't want to live in nursing homes. They want to live in the community."