The Senior Patient

November 21, 2016 By Charles Adams eInsight, Patient Care 0 Comments

Adults 65 years of age and older may be your most unique customers. These patients play a significant role in the success of pharmacies – retail, specialty and long-term care. According to the Administration for Community Living’s report on health and healthcare, seniors are likely to have multiple chronic conditions. As a result, they are prone to experience transitions of care; consequently, they generally incur more out-of-pocket healthcare expenses.¹ Adults are living longer than ever and are prescribed more drugs than ever. Not only do patients in this age group need your help now, but they will also require your assistance in the future.

Their Changing Needs

A majority of seniors have distinct needs. For example, most don’t sleep as well as they used to. “Older adults need about the same amount of sleep as younger adults. As you get older, however, sleeping patterns might change. Older adults tend to sleep more lightly and for shorter time spans than do younger adults.”²

Additionally, many seniors seek remedies for aches and pains they didn’t experience when they were younger. Dietary supplements are aggressively marketed to this demographic as well. Vitamins and minerals should come from the food one ingests. If an individual’s diet doesn’t provide the necessary vitamins and minerals, adjustments to diet might be the best alternative. However, supplements may be needed in conjunction with diet in some instances. In those cases, pharmacists must ensure supplements recommended to seniors do not interact with medications they are currently taking or will be taking in the future.

Increased Chronic Conditions

As our bodies age, not only are we likely to experience new aches and pains, but we are also more likely to experience new ailments. Per the Administration for Community Living:

Most older persons have at least one chronic condition and many have multiple conditions. In 2012-2014, the most frequently occurring conditions among older persons were: diagnosed arthritis (49%), all types of heart disease (30%), any cancer (24%), diagnosed diabetes (21% in 2009-2012), and hypertension (high blood pressure or taking antihypertensive medication) (71% in 2009-2012).³

Pharmacists are well positioned to assist patients with chronic conditions. The American Pharmacists Association’s Medication Therapy Management Digest states, “The most common disease states are those largely managed by the use of medications, indicating a growing recognition of the role of pharmacists in contributing to the care of patients…”⁴

A Variety of Care

Any population subset that experiences more significant ailments will need more care from different healthcare professionals as a consequence.

In 2014, 6.8 million people age 65 and over stayed in a hospital overnight at least one night during the year. Among this group of older adults, 11% stayed overnight 1 time, 3% stayed overnight 2 times, and 2% stayed overnight 3 or more times. This is approximately double the number of overnight hospital stays for the population age 45 to 64 who had 5% stay overnight 1 time, 1% stay overnight 2 times, and 1% stay overnight 3 or more times. Older persons averaged more office visits with doctors than younger persons in 2014. Among people age 75 and over, 20% had 10 or more visits to a doctor or other health care professional in the past 12 months compared to 13% among people age 45 to 64.⁵

More hospital stays and doctor visits result in more trips to pharmacies. Readmission rates are high often due to poor care transitions. Pharmacists play a major role in ensuring favorable patient outcomes by working with other healthcare professionals to manage patients’ transition of care.

Patients who move between care settings are at high risk of adverse drug events when communication and care coordination are suboptimal. With shorter lengths of stay and higher levels of patient acuity, care transitions are a critical time to ensure optimal care and prevent avoidable readmissions. Pharmacists have unique contributions to make in improving care transitions…⁶

This is also where medication therapy management comes into play. Pharmacists can perform comprehensive medication reviews, provide medication-related action plans and encourage medication compliance and adherence.

The Expense

Health conditions that require therapeutic management by a team of healthcare professionals can become expensive, fast. Seniors spend more on healthcare than any other age group.

In 2014, older consumers averaged out-of-pocket health care expenditures of $5,849, an increase of 50% since 2004. In contrast, the total population spent considerably less, averaging $4,290 in out-of-pocket costs. Older Americans spent 13.4% of their total expenditures on health, as compared with 8% among all consumers. Health costs incurred on average by older consumers in 2014 consisted of $3,951 (68%) for insurance, $954 (16%) for medical services, $721 (12%) for drugs, and $223 (4%) for medical supplies.⁷

Compared to other healthcare professionals, pharmacists are more accessible and can help drive down healthcare costs by engaging and educating patients and promptly providing meaningful information to other clinicians involved in managing patient outcomes.

Living Longer

Statistically, most seniors have plenty of life to live after their 65th birthday. “In 2014, persons reaching age 65 had an average life expectancy of an additional 19.3 years (20.5 years for females and 18 years for males).”⁸ According to data from the Centers for Disease Control and Prevention, seniors are taking more prescriptions than ever. From 1988 to 1994, 73.6% of those 65 years and over took at least one prescription drug in any 30-day period; from 2009-2012, that increased to 89.8%. From 1988-1994, 35.3% of seniors took three or more prescription drugs in any 30-day period; from 2009-2012, that increased to 64.8%. From 1988 – 1994, 13.8% of seniors took five or more prescription drugs in any 30-day time frame; from 2009-2012, that increased to 39.1%.⁹ Those 65 and over are consistently more capable of taking care of themselves. However, they still require assistance from healthcare providers.

Sources:

^1,3,5,7 “Administration on Aging Profile of Older Americans: 2015 Health and Health Care.” Administration for Community Living. May 23, 2016. Web. 26 Aug. 2016. http://www.aoa.acl.gov/Aging_Statistics/Profile/2015/14.aspx

² Olson, Eric, M.D. “How many hours of sleep are enough for good health?” April 6, 2016. Web. 26 Aug. 2016. http://www.mayoclinic.org/healthy-lifestyle/adult-health/expert-answers/how-many-hours-of-sleep-are-enough/faq-20057898

⁴ Medication Therapy Management Digest. American Pharmacists Association. March 2013. Web. 28 Aug. 2016. https://www.pharmacist.com/sites/default/files/files/MTMDigest_2013.pdf

⁶ Hume, Anne, Pharm.D., et al. “Improving Care Transitions: Current Practice and Future Opportunities for Pharmacies.” American College of Clinical Pharmacy. Web. 28 Aug. 2016. https://www.accp.com/docs/positions/whitePapers/PubProfReltns2010Paper_Final.pdf

⁸ Administration on Aging Profile of Older Americans: 2015 The Older Population. Administration for Community Living. May 23, 2016. Web. 26 Aug. 2016. http://www.aoa.acl.gov/Aging_Statistics/Profile/2015/3.aspx

⁹ “Prescription drug use in the past 30 days, by sex, race and Hispanic origin, and age: United States, selected years 1988 – 1994 through 2009 – 2012” Centers for Disease Control and Prevention. 2015 . Web. 28 Aug. 2016. https://www.cdc.gov/nchs/data/hus/2015/079.pdf

Their Changing Needs

Increased Chronic Conditions

A Variety of Care

The Expense

Living Longer

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