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Principles of Drug Use: Prescribing for the Elderly Thomas R. Clark, RPh, MHS ASCP Director of Policy & Advocacy. “Medications are probably the single most important health care technology in preventing illness, disability, and death in the geriatric population”.
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Prescribing for the Elderly
Thomas R. Clark, RPh, MHS
ASCP Director of Policy & Advocacy
“Medications are probably the single most important health care technology in preventing illness, disability, and death in the geriatric population”
Avorn, J. Medication use and the elderly: current status and opportunities. Health Affairs. 1995(Spring):278-86.
Source: Health, United States, 2005. Figure 2. www.cdc.gov/nchs/data/hus/hus05.pdf
By 2050, nearly 20 million Americans will be age 85 or overAging Trends
About half those age 85 and over have some degree of cognitive impairment
About one out of five live in NFAging Trends
Source: Center on an Aging Society, Georgetown University, 2000
By 2020, seniors will comprise 16% of the population and will consume 49% of prescriptions
Source: US Census, IMS National Prescription Audit, July 2005Rx Use and Seniors
Sir William Osler, in H. Cushing, Life of Sir William Osler (1925)Polypharmacy
Sir William Osler, Aphorisms from his Bedside Teachings (1961) p. 105.Polypharmacy
Oliver Wendell Holmes, 1860Polypharmacy
Rochon PA, Gurwitz JH. Prescribing for seniors: neither too much nor too little. JAMA, 1999;282:113-5Undertreatment
Preventive care suffers the most
Physicians often fail to prescribe recommended medications
Care for geriatric conditions (e.g. falls, incontinence) is poorer than care for medical conditions such as hypertension
Source: Rand Researchhttp://rand.org/pubs/research_briefs/2005/RB9051.pdfQuality of Health Care for Older Adults
Gurwitz J, Monane M, Monane S, Avorn J. Polypharmacy. In: Morris JN, Lipsitz LA, Murphy K, et al. Quality Care in the Nursing Home. St. Louis, MO: Mosby Year Book;1997:13-25.Adverse Effects
Rate of ADEs requiring hospitalization is nearly seven times greater for persons age 65 or over versus persons under age 65.
Source: JAMA 2006;296(15):1858–66Adverse Drug Events (ADE)
Nonadherence costs the U.S. health care system $100 billion per year
Source: Vermiere E. et al. Patient adherence to treatment: three decades of research, a comprehensive review. J Clin Pharm Ther 2001;26:331–42.Medication Adherence
Source:Nancy Richardson, 60, of Wayland, Mass., referring to risk versus benefit of estrogen therapy. Quoted in New York Times, December 18, 2006 article by Gina Kolata, “Breast Cancer News Brings a Range of Reactions”Goals of Therapy
Be aware of assumptions behind clinical practice guidelines
Disease management may not be adequate or appropriate if multiple chronic diseases are presentPrinciples of Drug Use