Our health care system is simply not ready for so many older adults.
Every day 10,000 people turn 65, and that will keep happening — every single day — for the next 17 years. By 2060, 98 million Americans will be 65 and older. And right now in the entire United States, there are only 7,500 geriatricians (physicians who specialize in care of older adults). That means we have one geriatrician for every 6,100 elders.
Older adults have multiple chronic health problems that require thoughtful diagnosis and treatment. As part of our care, we are prescribed medications. And we also go to the grocery store to pick up a few nonprescription items (multivitamins, mineral supplements, antacids, etc.) We are a purposeful and obedient demographic, so we take our medications, often in large quantities. Sometimes in dosages that do not reflect age and circumstance.
If you are a fan of a certain ongoing, person-centered blog (www.nextavenue.org), you will have encountered a recent article, “The Top 10 Drugs for Older Adults to Avoid.” If you’re taking sleep meds for insomnia or medications for anxiety or depression, the article is worth reading and printing out — maybe even sharing with your health provider.
In this article, two pharmacists offer sobering commentary, beginning with the premise that prescribing for older adults is “more challenging." There are many reasons. Drugs do not clear our systems as easily as we age. They are metabolized differently by our liver and secreted differently by our kidneys.
And many of the drugs prescribed for us have not been researched on age peers. The sampled population for drug trials often has a younger age profile. And drugs, new or old, can be more toxic as we age. Even the same drug you have taken for many years can affect you differently than it did when you were younger, the article points out.
One illustration stood out for me. These are a pharmacist’s words: “Every day I look at the records for people on 14 or 15 medications and try to get them down to eight or nine. Instead of stopping a drug that causes a certain side effect, doctors often prescribe a drug to “fix” that side effect.” Or we, as patients, expect we get a “fix” if it comes in a small, plastic container with a snap-off cap.
No indictments here — just information. The "system” does not incentivize physicians to prescribe fewer medications or educate patients to take fewer medications. Add to that, our television sets offer countless provocative, persuasive advertisements that position drugs as a panacea. The stated side effects are tallied quietly at the end of the ad, while music plays and happy, healthy older adults frolic.
Pharmacists are our most accessible health providers. Where else can you go to a retail establishment with an embedded pharmacy, stand in line for a few minutes and talk to a health professional. Better yet, we might call ahead and schedule a time to talk that’s convenient to the pharmacist’s busy schedule. They often have little private rooms adjacent to pharmacy counters — not often in use by my observation. Maybe we should change that.
— Sharon Johnson is a retired Oregon State University associate professor. Reach her at Sharon@agefriendlyinnovators.org.