You may have heard this story before: it begins with an older man or woman, retired, and living on a fixed income. As they age they develop health complications; heart disease or depression, osteoporosis or glaucoma, arthritis or other chronic pain. Inevitably, the number of medications they take increases — one pill for arthritis, two for the heart, one more for back pain, and down the road more and more as complications develop.
Everyone will deal with these problems to some degree as they age. If you could take a survey of the medicine cabinets of the retired people in your community, you’d likely find shelves packed with antidepressants, vasodilators, analgesics, antibiotics, and beta blockers — a veritable arsenal of pharmaceutical firepower to help in the fight for health and comfort.
But as we age, the costs and complications of our medical care increase. Eventually, most people will face one or both of two major problems. The first is medical and the second is financial: either the cost of their prescriptions will exceed their budget, or the medical cocktail supposedly keeping them healthy will start creating more complications than it solves.
Pharmaceutical science has advanced more quickly than nearly any other field over the past decade, but we are still far from fully understanding medicine. Different medicines work differently for different people, it’s the price we pay for being unique — and unfortunately, this can create huge complications, particularly for the elderly.
In a report published by the Office of Health and Policy Outcomes at Thomas Jefferson University, authors David Nash, Jennifer Koenig, and Mary Lou Chatterton note that “A ‘one drug fits all’ approach does not work for elderly patients because they are exposed to unique health variables that are rare in younger patients.” These variables include differences in general degeneration as well as differences in the development of chronic diseases. Different medications can even effect otherwise equally healthy people of different sex or ethnic background differently, making the “one drug fits all” approach truly ineffective.
“Due to considerable variation from patient to patient, there may be no one ‘best practice’ for treating every patient,” notes the report.
Instead, pharmacists and doctors advocate that, if possible, elderly patients seek individualized medical and pharmaceutical care, and that treatment information is coordinated between medical professionals. Usually, you don’t need the most powerful drugs, you just need the right drugs at the right time.
Individualized, coordinated medical treatment sounds great, but as is often the case, costs can be prohibitive. Affordable, reliable access to medicine continues to be a huge issue for the elderly. According to research done by the Centers for Medicare & Medicaid Services, the elderly account for just 13% of the population but 34% of of healthcare expenditures. Per-person healthcare spending for the elderly was $18,424 in 2010, 5 times the spending for children and 3 times the spending for working-age adults. Prescription drugs alone account for an average 12% of that spending.
The often-prohibitively high cost of prescription medication is a problem that is at the heart of the health care conversation. An article published by the American Academy of Family Physicians asked the question outright, “Can your patients afford the medications you prescribe?” The answer is, often, no. One survey of older adults with chronic illness found that every single one of them admitted to under-using their medication in the past year in order to make it “stretch” because they couldn’t afford more.
A way forward
The same survey found that two-thirds of patients didn’t talk to their doctors about their ability to afford the medication. This makes a certain amount of sense given that 60% of them didn’t believe their doctor could do anything to help with the cost of the medication, but this is a tragic mistake. Doctors, pharmacists, and health care providers sometimes can help address affordability issues.
Of those patients who did talk to their doctors about affordability, nearly 75% found the conversation helpful. Medical professionals can help by searching for cheaper prescriptions, alternative medications, and most importantly, by investing in preventative care. By working one-on-one with a professional, the elderly can greatly increase the effectiveness of their treatment, and hopefully achieve more comfort and a higher quality of life.
If the cost of medical care is a conversation you are having with yourself, with family, or with friends, you should know that there may be options out there. Talk with your doctor, your pharmacist, and your health care provider to find out what they are.