Call it what you like: the aging of America. The gray wave. The silver tsunami.
They all refer to the fact that, within fourteen years, the number of people 65 years and older will be greater than the number of children under 18.[1] America’s population is aging, and that is already putting pressure on our healthcare system. As a result, certain healthcare challenges will become more common.
Why Does the Aging Population Matter?
It’s true that Americans are living longer and healthier lives than ever before. But older adults are simply more likely to suffer from multiple medical conditions and need multiple prescriptions to maintain their health.[2] When a person has several health concerns and is taking more than one drug — potentially with some over-the-counter drugs in the mix — they are instantly at higher risk for adverse drug events.
These events are often preventable. Providers may not have the time or drug knowledge to proactively avoid them, however. That’s where pharmacists can step in and make a difference.
What Is an Adverse Drug Event?
Before we get too far ahead of ourselves, let’s define adverse drug events. These are injuries caused by the use of a drug and can result either from reactions to the drug or errors in prescribing, dispensing, patient adherence, or monitoring.[3] These events range in severity, running the gamut from mild rashes and dizziness to renal failure and death.[4] Not all adverse drug events are preventable, but in one wide-ranging study of Medicare members, severe adverse drug events were more likely to be preventable than less severe events.[5]
When Do Adverse Drug Events Happen?
Adverse drug events can happen at nearly every point in the patient’s medication journey. At the prescription stage, the provider could write a script for the wrong drug or wrong dose, or, if they’re in a hurry and the patient doesn’t ask any questions, they might not adequately educate the patient on how to use the drug.[6]
Poor adherence can cause adverse drug events too: the patient might take too many or too few of their pills, forget to take it consistently, or keep taking medication their doctor has directed them to stop. A difficult-to-open package or labeling in a too-small font could be a barrier for older adults who struggle with arthritis or poor vision.[7]
Once the patient is taking the medication, there are still opportunities for errors in monitoring. Perhaps a patient has been on therapy for several months and hasn’t reported any side effects. This doesn’t mean there aren’t any, but the provider might take their word for it and fail to do lab testing. That can lead to drug toxicity, which could have fatal consequences. In the previously-mentioned study of Medicare enrollees, toxicity caused two deaths: one by lithium, one by digoxin.[8]
How Can Pharmacists Help?
Providers don’t have to shoulder the burden of catching adverse drug events by themselves, though. The Ohio Pharmacists Association (OPA) put together a striking collection of pharmacists’ stories from across Ohio describing how they helped patients manage their therapy. The stories cover all of the stages described above.
There are cases in which patients weren’t trained to take their medication. One patient wasn’t shown how to use an Advair inhaler and wasn’t receiving a therapeutic dose; another patient didn’t know that her Lantus pen needed needles to work properly.[9] In other cases, doctors prescribed the wrong dose or the wrong therapy, or didn’t adequately educate the patient on the importance of adherence.
Regardless of the situation, the pharmacists in these stories take medication errors in stride and see them as opportunities to work with providers. Nearly every single one of the OPA stories mentions the pharmacist working closely with the patient’s doctor. It is unfortunate that the pharmacists aren’t brought in earlier to weigh in on the patient’s care plan, but it’s clear that making them part of the care team helps patients stay healthy. It's helpful to ensure that pharmacists aren't distracted by tasks like arranging prescription delivery, too.
Takeaways
America’s healthcare industry is faced with a challenge: the gray wave of older Americans and their increased healthcare needs. However, pharmacists have the potential to make a clinically significant and positive impact. Including pharmacists at every stage — prescribing, adherence, and monitoring — will improve the health, well-being, and longevity of patients. That’s a solution that can turn a silver tsunami into smooth sailing.
[1] “Older People Projected to Outnumber Children for First Time in U.S. History.” United States Census Bureau, 2018-2019. https://www.census.gov/newsroom/press-releases/2018/cb18-41-population-projections.html
[2] [7] Yap AF, Thiru Thirumoorthy, Yu Heng Kwan. Medication Adherence in the Elderly. Journal of Clinical Gerontology and Geriatrics. 2016; 7(2): 64-67.
[3] [4] [5] [6] [8] Gurwitz JH, Field TS, Harrold LR, et al. Incidence and Preventability of Adverse Drug Events Among Older Persons in the Ambulatory Setting. JAMA. 2003; 289(9):1107–1116.
[9] “Ohio’s MTM Story.” Ohio Pharmacists Association, 2018. https://ohiopharmacists.org/aws/OPA/asset_manager/get_file/123504?ver=3247791