Changes in Family Structure

Over time, the composition of family has changed. We moved from living in extended families with multiple generations under the same roof to having smaller nuclear families. Our families are more spread out geographically; it's no longer common for an entire clan to live all in one neighborhood. And now the Millennials are changing things even more. The so-called Generation Y are marrying later, having children later, and delaying rites of passage. It's been described as the Peter Pan effect; these Millennials are living with their parents longer and pursuing longer routes of education. How will this change health care in a couple decades?

I've been pondering this as I've seen a small uptick in the number of people undergoing surgeries unaccompanied by a family member or friend. Most of these procedures are small outpatient surgeries, but it's still surprising when I hear their plan after surgery is to take Uber or Lyft home. (That in itself, is a question - is it safe to discharge a patient from a hospital to a smartphone transportation service?).

But what happens when the Millennials get old? When we are hospitalized in the intensive care unit with a pneumonia or after cardiac bypass surgery or from a car accident, who will make our decisions? The vast majority of surrogate decision makers I see in the ICU now are spouses and children. But with the Millennials, we might start seeing other people take that role. Even those with children are having them later. If a sixty year old man has a stroke and would not want to live dependent on machines, would his thirty year old daughter be able to make that heartbreaking call? What about a twenty year old daughter? Those of us who are unmarried and have no children may depend on our siblings or other relatives more. What if we don't have any? Will we rely on our friends to make life-altering medical decisions? Will we be able to make those for our friends?

When we leave the hospital, who will help us with the recovery? If a third of us are unmarried and have no children, will we lean on those more-distant relatives? Friends? Neighbors? Childcare and elder care has changed a lot now that few households have multiple generations living under the same roof. Will new societal innovations change how we deal with illness in the setting of changing family structures?