Elderly Patients Require Individual Pharmaceutical
Care
White Paper Finds
Efforts to Restrict Drug Options Can Have
Negative Health Outcomes
WASHINGTON, DC (October 6, 2000) — Drug therapy is the most
common medical treatment for the elderly, but a "one drug fits
all" approach cannot work because the elderly are subject to
complex health variables, according to a white paper by Thomas Jefferson
University Professor David Nash, supported by an educational grant
from the National Pharmaceutical Council (NPC).
More than any other group, older people need access to a wide range
of prescription drug options to safely meet their specific needs.
Three main factors, unique to elderly populations, underlie the
need for individualized pharmaceutical care:
- The elderly have a higher prevalence of multiple diseases, and
thus receive more prescriptions and see more physicians who must
then coordinate care,
- An older body can react very differently to medicines than a
younger one due to physiological changes, such as changes in metabolism
and organ function, and
- There is wider variation in the pharmacological actions of a
drug in elderly individuals.
"When these factors interact in an older patient, individualized
drug therapy is required," said Nash. "If restrictive
drug policies or inadequate insurance plans limit the availability
of pharmaceuticals, prescribers may be unable to choose the best
drug therapy for their patients, leading to ineffective, or even
negative health outcomes."
When treating elderly patients with multiple conditions, there is
a higher risk of an adverse drug reaction (ADR). An ADR can result
in mild to serious injury to the patient. Patients taking five or
fewer drugs have a four percent chance of an ADR. With six to 10
medications, the risk increases to 10 percent and at 11 to 15 medications,
the risk of an ADR skyrockets to 28 percent. ADRs can result from
drug-drug interactions, drug-disease interactions, and synergism.
Older bodies also differ in the ways they process drugs: drug absorption
rates fluctuate due to changes in certain organs; drugs distribute
to different places in the body depending on their chemical structure;
drugs are broken down primarily in the liver and there is great
variation in liver function among elderly individuals, and; many
drugs are eliminated from the body through the kidneys and kidney
function may be reduced by as much as 50 percent by age 75.
With age, organ systems can be more sensitive to drugs and their
effects can be enhanced or diminished. Some drug side effects can
be used to a patient's advantage, while other side effects may not
be desirable, but can be tolerated. Three types of drug side effects
that are particularly significant for elderly patients are effects
on the brain, digestive, and cardiovascular systems. In some cases,
younger patients would not experience these effects at all.
Drug policies and insurance plans that limit access to necessary
medications may compromise the health of the elderly, and overall
health care costs can rise due to increased use of other medical
services. With approximately one-third of annual U.S. health care
cost (about $300 billion) going to the care of this 13 percent of
the population, the pressure is on to find effective and efficient
treatments that reduce the need for additional medical services.
Two tactics, switching and limits, are common methods of reducing
prescription drug cost, but may not reduce overall health care costs
and may in fact be detrimental to the health of the patient. Switching
often occurs if a patient changes insurers, if drugs in the same
class are prescribed interchangeably as a cost-saving measure, or
even if dosage forms (chewable tablets, capsules or liquids) are
interchanged. Limits have been suggested as a way to promote appropriate
prescribing in nursing homes by restricting the number or range
of drugs available for reimbursement.
"The great threat to health budgets," said Daniel Perry,
executive director of the not-for-profit Alliance for Aging Research,
"is not the frequency and use of hospital days, doctor visits,
or prescription drugs. The biggest threat is loss of independence,
and the challenge is to compress chronic morbidity from age-related
afflictions, and, where possible, to restore functional independence
in older people."
Since 1953, NPC has sponsored and conducted scientific, evidence-based
analyses of the appropriate use of pharmaceuticals and the clinical
and economic value of pharmaceutical innovation. NPC provides educational
resources to a variety of health care stakeholders, including patients,
clinicians, payers and policy makers. More than 20 research-based
pharmaceutical companies are members of the NPC.
The white paper, Why
the Elderly Need Individualized Pharmaceutical Care, is
available online.
###
Please direct all media inquiries to Pat Adams, phone
(703) 620-6390.
|
