The Silver Tsunami is Coming: Will Pharmacy Be Swept Away with the Tide?

Abstract

It's been called the silver tsunami, the age wave, the geriatric imperative, among others. It is the aging baby boomers and the first of this cohort turns 65 years old in 2011. From a health care perspective, the numbers are scary. Seventy-six million boomers will enter the fragmented, under funded health care arena for older people. Today the elderly constitute 12% of the US population and use approximately 35% of all medications. Medication use will likely grow with increased use of multiple medications to treat illnesses and increase longevity. Over the next 20 years, 1 in every 5 Americans will be over 65 years of age, and even more important, the 85-plus cohort will expand to 15 million over the next 40 years-about the same length of time that our recent graduates will be in practice. This raises the question: Are our graduates able to provide excellent care to the ever increasing older population? Older people, particularly those more than 85 years old, utilize massive healthcare dollars, have the poorest outcomes from adverse drug events (ADEs), and often receive inadequate, inappropriate, or poorly managed medication therapy.The incidence of avoidable adverse outcomes from drug therapy in older people is shameful. For example, 28% of ADEs in ambulatory geriatric patients are deemed preventable; even more shocking, 50% of the life-threatening and fatal ADEs are preventable.1 Why aren't they being prevented? Who's responsible for prevention? The main causes of these preventable ADEs include prescribing inappropriate medications, wrong dosing, and inferior monitoring. Poor patient adherence and lack of patient education account for more than 20% of preventable ADEs 1 -clearly a pharmacist intervention opportunity. In older adults the incidence of emergency department visits as a consequence of ADEs increases with age and accounts for 25% of all ADE-related emergency department visits.2 Improper therapeutic monitoring is a major cause for these visits, and approximately 50% of seniors with drug-related emergency department visits are hospitalized as a result of their ADE, highlighting the vulnerability of older people using medications.2 Given these and other alarming data, what is going to happen over the next 20 years when our population is 20% geriatric? Will pharmacists be on the front lines rendering better care in the future than what is currently being provided?The Institute of Medicine's 2008 report, Retooling for an Aging America: Building the Health Care Workforce, makes the case that ''the geriatric competence of virtually all members of the health care workforce needs to be improved through significant enhancements in the educational curricula and training programs.'' 3 Like most health disciplines, pharmacy education is woefully inadequate in geriatrics. Few US colleges and schools of pharmacy mandate a geriatric-focused advanced practice experience, although most schools offer this as an elective. 4,5 In addition, few pharmacy schools have a required geriatrics course or module and integrate ge...

Evaluation of pharmacy students´ clinical interventions on a general medicine practice experience

“…The acceptance rate in our study is consistent with other studies that have reported an acceptance rate of 64% to 97.9% 12-19. All recommendations were verbally presented to the physician.…”

“…All recommendations were verbally presented to the physician. In two studies evaluating written versus oral recommendations made by pharmacy students, it was found that verbal recommendations had a higher acceptance rate 18-19. Pound and Miller reported an 82.8% acceptance rate of verbal recommendations compared to 54.2% of written recommendations (p<0.0001) 18.…”

Emergency Department Stay Associated Delirium in Older Patients*

“…By 2031, the proportion of the population over 65 will nearly double. (1) Undeniably, the “Silver Tsunami” (2) will have consequences on the health care provided in EDs.…”

Perioperative Outcomes and Safety of Atrial Fibrillation Catheter Ablation in Octogenarians: A Retrospective Study and Review of the Benefits of Rhythm Control

“…The aging of the population in the USA has been called a “silver tsunami” [16] and an “aging revolution” [17], and as such it has both health and economic implications [18]. Given the prevalence and impact of AF, it is incumbent upon physicians to use appropriate modalities and resources to care for this growing and particularly vulnerable population.…”