Caring for an aging America: Pharmacists have a critical role
Help avoid unnecessary hospitalizations
A large segment of the American population, and one that will grow enormously in the coming years, can use a helping hand from pharmacists. The elderly have special needs that pharmacists can help fill.
In 1990, approximately 13% of the U.S. population was older than 65. In the year 2015, 20% of Americans are expected to be part of that population, Melissa Webb, PharmD, CGP, assistant professor at the University of Kansas Medical Center’s Center on Aging, tells Drug Utilization Review. "The over-85 group is the fastest-growing segment of older adults," Web explains. "Our older adults have special needs, the greatest of which is maintaining their independence. Many hospital admissions occur because the patient is on the wrong medication or because of a drug-drug interaction occurring between two of their medications. Pharmacists can make a huge difference in patient care by being alert to potential drug-related reasons for hospitalization upon admission."
Throughout the hospital stay, pharmacists can detect and prevent drug-related problems for patients as medications and doses are changed. "Older adults should have their doses adjusted based on calculated creatinine clearance, not simply based on serum creatinine," Webb adds.
When depression occurs in older patients, it often goes untreated, although depression does not have to be a part of older age. Finances enter as another area of need because many older adults lack the funds necessary to support the medications they need. "Finances have become a vogue topic in this election year," Webb notes, "but it remains a very real need for patients."
In addition, she says, pharmacists should ask patients about use of herbal therapies and vitamins. Patients still are not asked about alternative medications routinely, although many patients use them, and the potential for interactions is real.
Webb encourages pharmacists to counsel patients on their medications when possible during a hospital stay, especially when drugs are changed. Upon hospital discharge, pharmacists again can help patients by providing clear written instructions regarding administration of drugs to be taken at home.
"Written instructions are important, as patients will often forget details of the counseling session. It’s also important to review the patient’s medications with the caregiver present," she says.
Make no bones about it
Among several other diseases, osteoporosis is more prevalent in older people. The Food and Drug Administration recently approved a new drug for treatment of osteoporosis. Actonel (risedronate) is a bisphosphonate that may be used for the treatment and prevention of osteoporosis in postmenopausal women and of glucocorticoid-induced osteoporosis in men and women.
The National Osteoporosis Foundation (NOF) commended the FDA for its approval of Actonel. "With approval of Actonel, women now have another choice of therapy for this disabling disease," says Sandra C. Raymond, NOF executive director.
"This therapy for the prevention and treatment of osteoporosis and its associated fractures will help at-risk women remain active, strong, and independent throughout their lives. This can only happen if women past menopause talk to their physicians to evaluate their bone health and, if appropriate, take action," Raymond explains.
At the same time, Lilly has reported tremendous sales growth for the post-menopausal osteoporosis drug Evista (raloxifene HCl) since its launch in 1999.
In May, the NOF launched its "Step On It America!" campaign for a lifetime of bone health. The campaign is a nationwide multiyear program. The first year focuses on the importance of weight-bearing exercises meant to build and maintain bone strength, helping to prevent painful fractures in the future. Weight-bearing exercise, as defined by the NOF, is any type of physical activity in which the bones and muscles work against gravity. It should be performed for 30 minutes at a time, four times a week to promote good bone health.
In the future, the campaign will emphasize other steps to bone health, including:
1. a diet rich in calcium and vitamin D;
2. abstinence from smoking and excessive alcohol consumption;
3. bone-density tests and preventive medications, if appropriate.
"Bone-density tests are not typically a routine part of a physical for older adults," says Webb. "However, they are often performed for patients who, after assessment or by history of a fracture, appear at higher risk for osteoporosis and bone fractures." She adds that bone-density tests are covered by most insurance plans.
Whether pharmacists recommend preventive tests or provide good medication counseling, Webb says, "We owe it to our patients to do everything we can do to help them prolong good quality of life."
• Melissa Webb, PharmD, CGP, Assistant Professor, University of Kansas Medical Center, Center on Aging, Kansas City, KS. Telephone: (913) 588-5372.
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