US Pharm. 2009;34(6):22-24.
Last June, this column addressed the recently released Institutes of Medicine (IOM) report entitled "Retooling for an Aging America: Building the Health Care Workforce."1 The IOM report indicated that the health care workforce is unprepared to adequately respond in size and ability to the average needs of the aging population, given the huge numbers of people on the verge of entering the senior care health care system. This month, as U.S. Pharmacist once again focuses on the issue of elder care, the IOM report resurfaces--with an emphasis on proposed legislation.
The Washington Legislative Connection
In 2011 baby boomers will begin to reach age 65, and by 2030 approximately one in five Americans will be 65, at which time the number of seniors will approach 70 million--nearly double the present number.2,3 What does this mean for health care professionals? Basically, the effect is that most will be faced with treating seniors as a commonplace occurrence. Furthermore, according to the IOM report, action must be taken to address a severe shortage of geriatrics health care professionals, a senior care health care system unprepared for the surge of seniors about to enter the system, and a future workforce that is "inadequate in its capacity to meet the large demand for health services for older adults if current patterns of care and of the training of providers continue."3,4
That action has begun. The expected severe shortages in pharmacists and other health care workers have been addressed in the following legislative bills: the Caring for an Aging America Act of 2009 (S 750; a.k.a. the Boxer Bill), introduced in the Senate, will provide loan repayment assistance for pharmacists and other health care professionals who specialize in geriatrics, and the Retooling the Health Care Workforce for an Aging America Act of 2009 (S 245/HR 468; a.k.a. the Kohl Bill), introduced in the Senate and House, will create opportunities for pharmacists and colleges of pharmacy and provide training opportunities for health care professionals, direct care workers, and caregivers on medication-related issues for older adults.5
These bills are currently gaining support; however, congressional cosponsorship from U.S. senators and representatives is necessary before they are scheduled for a vote.5 Pharmacists and pharmacy students--as constituents--can urge their senators and representatives to cosponsor these bills. As patient advocates, we have a responsibility to the patients we serve and to the profession of pharmacy as it moves into the future to help see these bills through in whatever way we can. National pharmacy organizations provide template letters on their Web sites to facilitate this process (see Reference 5 online). Since these bills are important to the future of pharmacy practice, pharmacists in all practice settings are encouraged to raise awareness about them and rally for their support. Opportunity is defined as time or set of circumstances that is suitable for a particular purpose. The time is now, the circumstance is a surge of baby boomers entering the health care arena, and the response is action.
Preparation Meeting Opportunity
The Roman philosopher and statesman Seneca said, "Luck is what happens when preparation meets opportunity."6 Do you feel lucky? Or, rather, are you prepared for this opportunity? Are you in a position to help prepare others? Through the years, this author has urged pharmacists to take responsibility to hone the skills necessary to perform effectively in serving and advocating for our American seniors. That call to action has not changed: Develop skills for the delivery of specialized pharmaceutical care for seniors. Whether you call it geriatric pharmaceutical care, senior care pharmacy, geriatric pharmacotherapy, or geriatric pharmacy, the unique medication-related needs of the elderly must be met--now more than ever.
Each year, evidence builds in support of the concept that, of all the preventable health-related problems facing today's seniors, the most important categories are those associated with pharmacotherapy.7,8 Each year, medication-related problems (MRPs) in the elderly cost approximately $200 billion and about 100,000 seniors die of preventable MRPs.9 Furthermore, 28% of hospitalizations in the elderly and 23% of all nursing home admissions are attributed to MRPs.9 Seniors have more chronic conditions and, since they take more medications than any other age-group, are the population most susceptible to medication errors and adverse drug events.5 Older individuals have difficulty with medication adherence, and, due to age-related physiologic changes, seniors do not metabolize medications in the same manner as their younger counterparts.5 Evidence also indicates a high prevalence of potentially inappropriate medication prescribing for geriatric patients.5
Pharmacy school curriculums, continuing education for pharmacists, education initiatives for pharmacists, and internships and preceptor sites should all address pharmacotherapy and monitoring appropriate for seniors, counseling techniques tailored to seniors, low health literacy common in seniors, and tips for caregivers of seniors--all with the goal of reducing medication-related problems in this vulnerable population. National pharmacy organizations have resources for professional development in geriatrics and senior care pharmacy (TABLE 1 and Resources box). For example, ASCP's Geriatric Pharmacy Curriculum Guide provides pharmacists with a tool to assess their learning needs and create a personal learning plan.10
Leaders provide direction and guidance. They direct activities, operations, and performance of others. It is the directors of pharmacy services with vision and mission, therefore, who will be hiring, making decisions, and problem solving with regard to pharmaceutical care for seniors.11 Gilster and Dalessandro propose that service-oriented leadership deal with putting the needs of others before one's own, discovering ways to meet those needs, and engaging employees to follow suit.11 These authors point out that educational needs do not cease with the completion of staff orientation, but rather that life-long learning and support programs are necessary to ensure the effectiveness of staff while at the same time demonstrating to staff that they are valued.11
Code of Ethics for Pharmacists
The ethics of general patient care focus on utilizing the principles of respect for autonomy and kindness to guide health care professionals in the decision-making process with patients.12 This philosophy is especially important in geriatric health care because being elderly does not represent an organ system or disease, but rather a stage in life.12 According to the American Pharmacists Association, the Code of Ethics for Pharmacists (see Reference 13 online) is prepared and supported by pharmacists and is intended to state publicly the principles that form the fundamental basis of their roles and responsibilities.13 While assisting individuals in making the best use of medications, pharmacists are practicing as health professionals adhering to principles of practice.13 These principles are based on moral obligations and virtues; they are established to guide pharmacists in their relationships with patients, other health professionals, and society in general.13 This code of ethics should be emphasized with staff and students as an ongoing reminder of professional commitment to the service of others.
Although the elderly have specialized health care needs, there is a critical shortage of medical professionals trained to meet the growing senior population. Two bills--the Caring for an Aging America Act of 2009 (S 750) and the Retooling the Health Care Workforce for an Aging America Act of 2009 (S 245/HR 468)--speak to the severe shortage of health care professionals and direct care workers who will provide care for the elderly. Both bills are important to the future of pharmacy and will broaden, train, and support all segments of the health care workforce to care for the expanding senior population. Pharmacists need to get involved in the legislative process and urge their U.S. senators and representatives to sponsor these bills. Pharmacists trained to deliver geriatric pharmacotherapy services to a population that is surging--the senior baby boomers--will ensure their place in the future of pharmacy practice.
REFERENCES1. Zagaria ME. Baby boomers on brink of health care crisis. US Pharm. 2008;33(6):20-26. www.uspharmacist.com/content/
2. Retooling for an aging America: building the health care workforce. Institute of Medicine. www.iom.edu/CMS/3809/40113/53452.aspx. Accessed May 4, 2008.
3. IOM releases report addressing growing shortage of healthcare providers trained to care for older patients; AGS president to testify at Senate hearing on workforce issues tomorrow. www.americangeriatrics.org/policy/iom_report040907.shtml. Accessed May 1, 2008.
4. Study: boomers to flood medical system. Associated Press. http://my.att.net/s/editorial.dll?pnum=1&bfromind=7406&eeid=5814656&_sitecat=1522&dcatid=0&eetype=article&render=y&ac=0&ck=&ch=ne&rg=blsadstrgt&_lid=332&_lnm=tg+ne+topnews&ck=. Accessed May 1, 2008.
5. Grassroots alert--ask your elected officials to support the Boxer and Kohl Bills that positively impact senior care pharmacists! ASCP Advocacy Center. www.ascp.com/advocacy/center/. Accessed May 18, 2009.
6. Seneca LA. Luck happens when preparation meets opportunity. http://thinkexist.com/search/searchquotation.asp?search=luck+is+what+happens+when+preparation+meets+opportunity&q=author%3A%22Seneca%22. Accessed May 18, 2009.
7. Kane RL, Ouslander JG, Abrass IB. Essentials of Clinical Geriatrics. 4th ed. New York, NY: McGraw-Hill, Inc; 2004:93-119,357-388.
8. Zagaria ME. Medication-related problems in seniors: risk factors and tips for appropriate prescribing. Am J Nurse Pract. 2009;13(3):23-27.
9. Reducing medicated-related problems in older adults. American SCP Campaign 2011 Brochure. www.ascp.com/advocacy/campaign2011/upload/Campaign2011_brochure.pdf.
10. American Society of Consultant Pharmacists.Geriatric Pharmacy Curriculum Guide. 2nd ed. 2007. www.ascp.com/education/curriculumguide/upload/2nd%20Ed%20ASCP%20Curriculum%20Guide.pdf. Accessed May 12, 2009.
11. Gilster SD, Dalessandro J. Leadership: emerging from chaos to calm. Assisted Living Consult. 2009;5(2):20-23.
12. Larlawish JH, James BD. Ethical issues in geriatric medicine: informed consent, surrogate decision making, and advance care planning. In: Hazzard WR, Blass JP, Halter JB, et al, eds. Principles of Geriatric Medicine and Gerontology. 5th ed. New York, NY: McGraw-Hill, Inc; 2003:353-360.
13. Code of Ethics for Pharmacists. American Pharmacists Association. http://www.pharmacist.com/AM/Template.cfm?Section=Search1&template=/CM/HTMLDisplay.cfm&ContentID=2903. Accessed May 18, 2009.
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