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Ask Dr. Hallberg: Living longer, but living sicker

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Dr. Jon Hallberg
Dr. Jon Hallberg is assistant professor in family medicine at the University of Minnesota, and medical director at Mill City Clinic. He is a regular medical analyst on MPR's All Things Considered.
Photo courtesy Tom Bloom

We're living longer, but also living sicker, according to a study published in the Journal of the American Medical Association. Tom Crann spoke with Dr. Jon Hallberg about the findings.

JON HALLBERG:: These are the findings from a group called the Global Burden of Disease 2010 Study group. Some 500 scientists from 50 countries looking at 300 diseases and risk factors that can lead to death. They're basically just looking at the health landscape for the last 20 years trying to decipher what's going on.

TOM CRANN: Basically over those 20 years what patterns emerged here in the U.S.?

HALLBERG: It's interesting. There's not a lot of change at the top in terms of what's causing death. The top five causes: heart disease, lung cancer, stroke, COPD or emphysema and then road injuries. No major surprises there.

CRANN: What are the bright spots in this study?

HALLBERG: I think the good news is that we're living longer, death occurring at earlier ages is being pushed back a bit. That's of course great news.

CRANN: What about the not-so-good news?

HALLBERG: Two major areas there. 1) Half of health care expenditure in this country is now going to chronic diseases, things that we're living with. I think we're suffering more. We're not dying as young but we're living longer with chronic disease. 

2) We're simply not keeping pace with other countries around the world, other wealthy countries. Every one of the top diseases that you look at, we're not doing well.

CRANN: When it comes to those chronic diseases, give us some examples.

HALLBERG: Right at the top of the list is heart disease. We're dying of that at the highest rate but also we're not dying as much as we once did because we're getting through it. But then people are living with congestive heart failure, for example, or they have chronic kidney disease and might require dialysis, for example. We're having all kinds of pain syndromes and dealing with pain.

CRANN: We didn't see those before because people died before those happened — or is that over-simplifying?

HALLBERG: I think that's really at the heart of it. We have technology and medication and we are being more aggressive about trying to do what we can about hypertension and diabetes and things like that. But nevertheless, we're still at some point in life going to develop problems and kidney disease is a great example of that.

CRANN: What surprising findings jumped out at you?

HALLBERG: The biggest increases in things that are taking our lives -- Alzheimer's disease - it jumps something like 168 percent in 20 years. So clearly there too we're living longer and now we're dealing with things like Alzheimer's in enormous numbers. Drug use disorders and I think within that because of chronic pain people are on pain medications more. It's not just that these are heroin overdoses but we're certainly seeing problems with opiate pain medication. Chronic kidney disease jumping markedly. And falls. So three of those four are related to getting older.

CRANN: Are the findings of the study reflecting what you're seeing in the clinic day in and day out?

HALLBERG: Oh yeah. Absolutely. On the one hand, we're doing a lot of screening things. Trying to do a good job with blood pressure, people's weight and height proportionality, screening for diabetes, all that kind of stuff because that ties into this. But I'm seeing more and more people in their upper 80s and low 90s. I haven't seen that to this degree before. So now we're entering this uncharted territory. What are we going to do when people are developing signs of memory loss? And what are we going to do to really prevent falls in the home, which are hard to do, whether it's their home or assisted living facility or memory loss care unit? Some things are inevitable and it's very sobering. I definitely think we're entering this new era of taking care of the very old who are actually living independently and I'm not sure we're equipped very well to handle that. 

Dr. Hallberg is MPR's regular medical analyst for All Things Considered, with host Tom Crann. Hallberg is a physician in family medicine at the University of Minnesota and medical director of the Mill City Clinic.