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Serving a Gnayer America
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Servinga~er America Age has a funny habit of creeping up on us. While working with the contemporary experts on geriatrics in developing this special issue on aging, a revelation struck me- I'll qualify for Social Security in the year 1999. When we're young, we tend to avoid the thought of growing old . Most of us don' t want to think beyond the next year, let alone grapple with life in the 21st century. We certainly aren't prepared to deal with our age-or our infirmities-20 years hence. But time is irreversible. Aging is a natural process of living. Perhaps the philosopher was right-you're only as old as you feel. What makes the difference, however, is your state of health-physical and mental-and attitudes-yours and those of people around you. When you constantly hear that you are old, crippled, senile, you begin to believe it. But if, in the eyes of your friends, relatives, and colleagues, you are "young for your age," you'll remain young; and spry, and alert. What does all of this philosophizing have to do with your practice of pharmacy? Plenty! Currently, America's elderly, while accounting for only about 11 % of the population, use more than 25% of all prescription drugs and an even higher percentage of nonprescription products. Some 30% of all acute medical and surgical hospital beds and 95% of the 1.2 million nursing home beds are occupied by people over the age of 65. At the same time there is a large and growing number of elderly ambulatory care patients. By the year 2020 there will be 43 million Americans over 65-twice today' s elderly population. The percentage of elderly among the entire population is rising dramatically. The health care needs of the elderly are obvious, and they are clearly different from those of other segments of the population . The elderly are known to require proportionately more medication-both prescription and nonprescription drugs . They are more sensitive to the drugs they take and to the relationship between those drugs and their diet, smoking, ·alcohol consumption, drugs of abuse, and the environment. They are less compliant, save and share medications more, and generally abuse or misuse their bodies through lack of exercise, poor nutrition, higher consumption of hazardous products, and degeneration of bone, muscle, and tissue. There are significant opportunities, whether in the community pharmacy, long-term care facility, hospital, or home environment, to expand pharmaceutical care and to apply clinical pharmacy. What most elderly patients need is a medication manager; pharmacists are best prepared to fill that need. Pharmacists, like other health professionals, must recognize and overcome one major stumbling block-the prejudice called "ageism."* Unlike civilizations of the past that treated old age with reverence, our society has a youth fixation . Today, ageism is reflected in attitudes such as age-based retirement policies and the belief that the aged universally lose their memories. Ageism, unfortunately, denies the medical facts: about half of all acute confusional states may be reversible if properly diagnosed and treated; 80% of elderly stroke patients will return to their homes with full or partial function; a large portion of chronic organic brain syndrome in elderly patients may have reversible causes, including drugs and/or depression. It also denies the fact that a large majority of people over 65 can and do contribute . intellectually and physically to our society. There is a real opportunity to provide professional services to the segment of the population that can most appreciate and most benefit from your service . For all pharmacists, young and old, there must be a general recognition that older people need at least as much compassion and empathy as they need medication. They need personal understanding as well as proper professional care. A little role playing might help, considering that, if we're fortunate, someday we'll all be old. -WES
•An excellent discussion is provided by Frederick T. Sherman, MD, physicia n in charge of the divisio n of geria tric medica l educatio n, Jew ish Institu te for Geriatric Care, in the Mount Sinai Journal of Medicine, Vol. 47, No. 2, 1980.
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Servinga~er America Age has a funny habit of creeping up on us. While working with the contemporary experts on geriatrics in developing this special issue on aging, a revelation struck me- I'll qualify for Social Security in the year 1999. When we're young, we tend to avoid the thought of growing old . Most of us don' t want to think beyond the next year, let alone grapple with life in the 21st century. We certainly aren't prepared to deal with our age-or our infirmities-20 years hence. But time is irreversible. Aging is a natural process of living. Perhaps the philosopher was right-you're only as old as you feel. What makes the difference, however, is your state of health-physical and mental-and attitudes-yours and those of people around you. When you constantly hear that you are old, crippled, senile, you begin to believe it. But if, in the eyes of your friends, relatives, and colleagues, you are "young for your age," you'll remain young; and spry, and alert. What does all of this philosophizing have to do with your practice of pharmacy? Plenty! Currently, America's elderly, while accounting for only about 11 % of the population, use more than 25% of all prescription drugs and an even higher percentage of nonprescription products. Some 30% of all acute medical and surgical hospital beds and 95% of the 1.2 million nursing home beds are occupied by people over the age of 65. At the same time there is a large and growing number of elderly ambulatory care patients. By the year 2020 there will be 43 million Americans over 65-twice today' s elderly population. The percentage of elderly among the entire population is rising dramatically. The health care needs of the elderly are obvious, and they are clearly different from those of other segments of the population . The elderly are known to require proportionately more medication-both prescription and nonprescription drugs . They are more sensitive to the drugs they take and to the relationship between those drugs and their diet, smoking, ·alcohol consumption, drugs of abuse, and the environment. They are less compliant, save and share medications more, and generally abuse or misuse their bodies through lack of exercise, poor nutrition, higher consumption of hazardous products, and degeneration of bone, muscle, and tissue. There are significant opportunities, whether in the community pharmacy, long-term care facility, hospital, or home environment, to expand pharmaceutical care and to apply clinical pharmacy. What most elderly patients need is a medication manager; pharmacists are best prepared to fill that need. Pharmacists, like other health professionals, must recognize and overcome one major stumbling block-the prejudice called "ageism."* Unlike civilizations of the past that treated old age with reverence, our society has a youth fixation . Today, ageism is reflected in attitudes such as age-based retirement policies and the belief that the aged universally lose their memories. Ageism, unfortunately, denies the medical facts: about half of all acute confusional states may be reversible if properly diagnosed and treated; 80% of elderly stroke patients will return to their homes with full or partial function; a large portion of chronic organic brain syndrome in elderly patients may have reversible causes, including drugs and/or depression. It also denies the fact that a large majority of people over 65 can and do contribute . intellectually and physically to our society. There is a real opportunity to provide professional services to the segment of the population that can most appreciate and most benefit from your service . For all pharmacists, young and old, there must be a general recognition that older people need at least as much compassion and empathy as they need medication. They need personal understanding as well as proper professional care. A little role playing might help, considering that, if we're fortunate, someday we'll all be old. -WES
•An excellent discussion is provided by Frederick T. Sherman, MD, physicia n in charge of the divisio n of geria tric medica l educatio n, Jew ish Institu te for Geriatric Care, in the Mount Sinai Journal of Medicine, Vol. 47, No. 2, 1980.
4
g