Document: Role of the Clinical Laboratory in Response to an Expanding Geriatric Population
Classification: Position Paper
Revised: September 2012
Status: Approved by the ASCLS House of Delegates August 3, 2013
As the mission of the American Society for Clinical Laboratory Science (ASCLS) is to champion for excellence in practice, patient-centered healthcare and universal quality laboratory medicine, and as the global population’s average age increases, it is essential that the role of the medical laboratory practitioner in the provision of laboratory services for the geriatric population be clearly defined.
In 2010, the US Census Bureau projected that by 2050, there will be 88.5 million Americans aged 65 and older. 1 The “Baby Boom Generation” will be largely responsible for this increase in the older population; the oldest of this generation turned 65 in 2011. By 2030, nearly one in five U.S. residents will be aged 65 and older.1
Longevity is associated with an increase in the occurrence of acute disease and the prevalence of chronic conditions. Typically, older adults are afflicted with multiple diseases and chronic conditions including heart diseases, malignant neoplasms, cerebrovascular diseases, bronchitis, emphysema, Alzheimer’s, pneumonia, influenza, and chronic obstructive pulmonary diseases.2 Thus, among older adult populations, there is an increased need for healthcare services. Simultaneously, research and technological advances in medicine are being made almost daily which may or may not be applicable to this population. Evidence based practices that address the validity and reliability of new technology such as genetic testing and their applicability to older adults are needed. 3
Meeting the increasing demand for laboratory testing in diagnosis, treatment and follow-up care for healthcare consumers, particularly older adults, is crucial. The Bureau of Labor Statistics estimates an employment growth of 15% as the volume of laboratory testing continues to rise.4 The increasing demand coincides with a shrinking supply of qualified laboratory professionals. Medical laboratory scientists must therefore examine their contributions to quality gerontological services and geriatric care, including the important, emerging role as clinical consultants charged with educating consumers about laboratory services, while advising on integration and management of various sources of laboratory information.
The cost of health care and the impact on medical laboratory services must be considered because any cost containment can potentially impact the access to and quality of services. The US government, through Medicare and Medicaid is the leading third-party payer for US healthcare expenditures for older adults. In fact, the total healthcare expenditures in the US increased from $214.6 billion in 1980 to $1130.4 billion in 2000, to $2267.2 billion in 2010.5,6 With the implementation of the Affordable Care Act, healthcare costs are projected to rise to $3,840.7 billion as opposed to the $4,564.3 billion originally projected by 2020.6 While less than 3% of the total Medicare expenditures are related to laboratory services, reimbursement for laboratory services has been cut substantially since 1984 hampering the community’s ability to educate enough individuals to ameliorate the laboratory personnel shortage.
Reduced reimbursements, increased costs, and personnel shortages threaten access to quality laboratory services. However, medical laboratory services for the older adult population remain crucial to the maintenance of health and wellness, as well as diagnosis, treatment and follow-up care for this group.
The older adult patient presents challenges that medical laboratory professionals must address to effectively ensure quality health care services, such as:
- Specimen collection issues unique to the geriatric population
- Interpersonal skills required to deal with geriatric patients
- Reference intervals evaluation for an aging demographic cohort
- Interpretation of laboratory data in relationship to patient age and associated physiology/pathology
- Access and affordability of health care services
- Need for medical laboratory science research to expand the knowledge base and practice of geriatric laboratory medicine
- Medical laboratory personnel education relevant to geriatric medicine
ASCLS supports the active participation of medical laboratory professionals in the development of testing modalities, education of non-laboratory personnel responsible for testing, as well as the supervision and evaluation of all processes associated with the generation of test results for geriatric adults.
ASCLS supports the development of reliable criteria, such as reference intervals specific to this age group, to be used with laboratory test interpretation for geriatric adults.
ASCLS supports the development of outcomes research that provides medically relevant data useful for medical decision-making.
ASCLS supports the educational preparation of medical laboratory practitioners to participate as active members of the healthcare team and encourages primary care providers to fully utilize medical laboratory professionals’ expertise through consultation, particularly as related to gerontology and geriatric care.
- US Census Bureau, US Department of Commerce Economics and Statistics Administration (May 2010). The Next Four Decades, The older Adult Population in the United States 2010 to 2050: Population Estimates Projections. Washington. (P 25-1138). DC: US Government Printing Office.
- Healthy People 2020. Closer Look: Health Disparities Compare the Top 10 Causes of Death across Populations. Retrieved from. http:www.healthypeople.gov.
- Healthy People 2020. Genomics. Retrieved from http://healthypeople.gov/2020/topicsobjectives2020/overview.
- Bureau of Labor Statistics Report. The 2010-20 Job Outlook. http://www.bls.gov/ooh/Healthcare/Medical-and-clinical-laboratory-technologists-and-technicians.htm#tab-6
- National Health Expenditure Projections 2010-2020 Retrieved from https://www.cms.gov/NationalHealthExpendData/…/proj2010.pdf
- Projections of National Health Expenditures: Methodology and Model Specification, July 28, 2011. Retrieved from www.cms.gov/nationalhealthexpenddata/…/projections-methodology