Rx Risks for Older Adults

The Leadership Council of Aging Organizations subcommittee on Long-Term Services and Supports met December 8, 2008 for a presentation about medication related problems and older adults. Jeffrey C. Delafuente, Director of Geriatric Programs at Virginia Commonwealth University recounted that seniors in the US account for 37.2% of total prescription expenditures and 40% of over the counter purchases. He advised that medication related problems (MRPs) are due to improper drug selection by the physician, under dosing as well as over dosing, failure of the patient to fill the prescription, adverse drug reactions that go unrecognized, drug interactions and continuing to prescribe a drug that is no longer needed.

Striking figures he cited include the cost of MRPs in 2000 were $13.8B in doctor's visits, $121.5B in hospitalizations, $5.8B in emergency room visits, $32.8B in nursing home care and $3.5B in new prescriptions amounting to $177.4B in direct medical costs. MRPs for 2006 were $217B. These costs do not account for indirect costs such as lost work time when a caregiver must miss work to care for an elderly loved one.

Older adults are at higher risk for MRPs because of age-related physiological changes, high incidence of multiple chronic diseases, visual and cognitive impairments that interfere with proper use, poverty, literacy, language and cultural barriers. Moreover, older adults may be non-compliant with their prescriptions because of lack of understanding of the use of the medication, complex drug regimen, differing doses, inconvenient scheduling, lack of perceived need, cost and social isolation.

One option for reducing MRPs is Medication Therapy Management (MTM) which provides a face to face patient assessment and intervention, as appropriate, by a pharmacist. MTM is not just dispensing but includes counseling that is patient centered not product centered. Examples of MTM services include patient assessment, monitoring drug therapies outcomes, comprehensive medication review and providing patient education to enhance compliance. Some settings for delivering these services include community pharmacies, hospitals, skilled nursing facilities, office practice and home visits. States with Medicaid MTM programs include Florida, Maryland, Mississippi, Ohio, Virginia and Vermont.

An impressive private sector demonstration in Minnesota resulted in a 19.7% increase in drug expenditures but a decrease in total health expenditures from $11,965 to $8,197 per person. The reported return on investment was 12:1.