In a super-aged society, demand rises for care tailored to patients in their 80s and older

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St. Peter's Hospital: "Demand is high for tailored specialist care for patients aged 80 and over"

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- 'Healthy life expectancy' comes to the fore in a super-aged society… watch for musculoskeletal diseases such as spinal stenosis and degenerative arthritis

- Pain is greatest in old age, along with the risk of falls and fractures… exercise, early diagnosis and treatment help maintain musculoskeletal function

- Demand for active treatment is rising among patients in their 80s, 90s and even 100s… age-tailored treatment systems are needed

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As of 2025, Korea is a super-aged nation in which one in five people is elderly. The domestic population aged 65 and over passed 10 million at the end of last year, and some forecasts see that figure rising to 20 million by 2050. 

The problem is that as the population itself ages, individual and social medical costs alike continue to rise. According to the ‘2024 Social Security Statistics’ released by the Ministry of Health and Welfare, the average annual medical cost per older adult was 5.43 million won as of 2023 — an increase of more than 500,000 won from 4.91 million won in 2019. Meanwhile, life expectancy continues to rise steadily, reaching 80.6 years for men and 86.4 years for women, so the burden of medical costs in later life is bound to grow with each passing year.

In this age of the elderly, what matters most is ‘healthspan’. Beyond simply living long, what counts is how long you can maintain a period of ageing healthily while going about daily life. So what is the decisive factor in health in later life?

Yoon, Kangjun, President of St. Peter's Hospital — a general hospital focused on spine, joint and cerebro-cardiovascular care — points to the management of musculoskeletal function. “More than 90% of the pain experienced by people aged 60 and over in Korea is known to be musculoskeletal,” he says, adding, “The key to healthspan in later life ultimately comes down to how well you maintain the function of musculoskeletal structures such as the spine and joints.”

■ Degenerative musculoskeletal disease shortens healthy life expectancy and lifespan… chronic pain also lowers quality of life in old age

At the heart of musculoskeletal disorders in older people are functional decline from ageing and the chronic pain it brings. Degenerative arthritis is one of the most common musculoskeletal disorders among the elderly, affecting an average of 4 million people a year in Korea alone.

Spinal stenosis, in which degeneration of the spinal structures narrows the spinal canal or the neural foramen, and disc herniation (lumbar disc herniation), in which the nucleus pulposus inside the spine protrudes with age, are also common in elderly patients. As society continues to age, the number of such patients keeps rising. According to the Health Insurance Review and Assessment Service, 1,546,754 patients aged 60 and over visited hospitals for spinal stenosis in 2024 — an increase of some 530,000 from 2015, a decade earlier. The number of patients with intervertebral disc disorders is also rising by an average of 3% a year.

Such musculoskeletal conditions can shorten both healthy life expectancy and overall life expectancy in later years. Yoon, Kangjun, neurosurgery specialist and President of St. Peter’s Hospital, explains, “These musculoskeletal conditions not only make it difficult to get around in old age but are also very likely to be a direct risk factor for falls and fractures.” He adds, “Falls in particular carry very high rates of disability and mortality in patients aged 75 and over, easily leaving lasting after-effects, and this in turn becomes a factor leading to death.” A study published in 2023 also reported that older patients with osteoarthritis have significantly poorer self-rated health and tend to have more severe depressive symptoms than those without the condition. 

The pain that accompanies these conditions is also the single greatest cause of reduced quality of life. Musculoskeletal disease produces chronic pain, which in turn limits the range of daily activity. Patients with degenerative arthritis of the knee feel pain even during simple activities such as climbing stairs or standing up from a seated position, and patients in the advanced stage may have difficulty getting around because the knee feels as though it will give way merely from walking. Patients with spinal stenosis or disc herniation likewise find the distance they can walk growing shorter because of radiating leg pain and back pain. Such limits on activity lead to declines in muscle strength and general condition, which carry a high risk of reducing activities of daily living (ADL) and, ultimately, cognitive function. 

■ Prevention through exercise and early diagnosis matter most… and barriers to treatment have fallen even when surgery is needed

The best approach to musculoskeletal disorders is preventive care. Keeping the muscles around the joints and spine healthy through exercise is the single best way to prevent these conditions from developing.

The WHO recommends that older adults perform at least 150 minutes of moderate-intensity aerobic exercise or 75 minutes of vigorous-intensity aerobic exercise per week, together with strength training at least twice a week. It also recommends multi-component physical activity at least three times a week to improve balance and prevent falls. In practice, quadriceps setting exercises and supine lower-body exercises help maintain strength around the knee joint, while light lower-back strengthening exercises and stretching help prevent spinal stenosis. Sudden or excessive movements and activities, however, are best avoided.

If a problem develops in the knee or lower back, early diagnosis by a specialist matters above all. Yoon, Kangjun, President of St. Peter’s Hospital, explains, “Musculoskeletal conditions in later life are mainly degenerative and tend to worsen chronically, so early diagnosis and prompt treatment help considerably in slowing their progression.” He adds, “When diagnosis is made early, non-surgical treatments such as medication, injections and rehabilitative physiotherapy can also be highly effective.” If diagnosis is delayed and symptoms do not improve with these treatments, or if pain or paralysis is severe, surgical treatment is considered.

Even when surgery is required, a variety of techniques now reduce the burden on the patient, so the barrier to surgical treatment is very low. Particularly notable is how widespread endoscopic surgery has become. With many techniques that minimize incisions and speed recovery, even elderly patients face far less bleeding, pain and recovery burden. For the knee, endoscopic joint surgery is performed by inserting a slender endoscope 2-5 mm in diameter into the joint to diagnose and treat lesions inside it. For the spine as well, there are many minimally invasive spine surgery options — such as biportal endoscopic spine surgery and lateral lumbar interbody fusion — that lighten the burden on patients and speed their return to daily life.

Artificial joint and artificial disc surgery are also of great help in effectively relieving pain and reliably restoring lost function. In fact, a study last year by Yoon, Kangjun, President of St. Peter's Hospital, following 109 artificial disc replacement patients over the long term found that most experienced highly satisfying outcomes in functional recovery and rehabilitation up to 10 years after surgery.

■ Growing demand for active treatment of spine, joint and other musculoskeletal disease in the elderly… including visits and care for patients in their 90s and 100s

More very elderly patients are recognizing the importance of managing musculoskeletal disorders and actively coming to hospital with the aim of relieving pain and restoring function. Director Yoon, Kangjun explains, “Compared with the past, visits by very elderly patients beyond their 70s and into their 80s and above are steadily increasing,” adding, “The need for elderly-tailored treatment systems within healthcare institutions is growing to meet this demand.”

In 2024, drawing on its expertise in joint and spine care, St. Peter's Hospital launched the Elderly-Specialized Care Task Force (TF), a dedicated treatment team for surgery in patients aged 80 and over. It established a care system in which the relevant departments work together seamlessly from diagnosis through recovery, after comprehensively assessing each patient's underlying conditions and overall condition. 

In April this year, just one year after the task force launched, the number of patients aged 85 and over rose 21%, with spine and joint disease patients up more than 15% and 10% respectively. Visits and treatment cases have continued across a wide range of very elderly patients, from those in their 90s to age 100, and more patients with a strong will to recover are coming in regardless of age. 

In step with this patient demand, St. Peter's Hospital has recently taken the lead in building a safe care environment for elderly patients — relocating Neurosurgery and the Spine Center to the first floor for easier access, expanding the Emergency Room, and introducing a tailored wayfinding system.

Yoon, Kangjun, President of St. Peter’s Hospital, added, “Musculoskeletal conditions such as spinal disease have long been regarded as an unavoidable part of aging, but with advances in medicine and growing demand for a healthy later life, they are no longer conditions that simply have to be endured.” He continued, “Through proper management and appropriate early treatment of musculoskeletal conditions of the spine and joints, it is entirely possible to minimize the years spent ill in old age and enjoy a healthy daily life for the rest of one’s years.”