Health Care for the Elderly and Inhaler Misuse

A recent German study reveals what many of us guessed - dry powder inhalers (DPIs) are frequently misused by patients with chronic obstructive pulmonary disease (COPD) and newly diagnosed asthmatics. The study was presented at the international scientific assembly of the American College of Chest Physicians and underscores the importance of clear, concise and memorable health care professional teaching and on-going care.

 

It seems that 32.1 percent of the 224 patients made at least one important error while using a DPI and the error rate increased with the age and severity of the condition. A DPI varies from the typical metered-dose inhaler (MDI) because it relies on the force of the patients' inhalation to deliver the medication to the lungs. The DPI offers a different taste and feel from the typical pressurized mini-blast of the MDI.

 

The number of errors rose significantly with age -- patients under 60 had a 20 percent error rate compared to a 41.6 percent error rate in patients over 60 year of age. Patients with normal lung function had an error rate of 25 percent while patients with severe obstruction had an error rate of 63.6 percent.

 

The dramatic difference in the senior vs. younger population made me think of medication and the aging issues. My daughter works for the National Council on Aging so you can guess I am exceptionally aware of the cascade of potential problems.

 

Here are some of the sobering facts based on Prescription Drug Coverage and Seniors: Findings from a 2003 National Survey by Safran in Health Affairs, 2005.

 

90 percent of seniors take medication on a daily basis

• Nearly half (46 percent) take five or more
• More than half (54 percent) have more than one doctor who prescribes medications
• About one-third (35 percent) use more than one pharmacy.

 

These facts focus on the medication-physician-pharmacy juggling that is taking place in the homes of our seniors. When a new medication/delivery system is prescribed, additional instruction, demonstration and observation of patient use must occur. If not, medication-related problems (MRPs) are likely.

 

It's a sad reality for patients, their families and for Americans, in general, that 46 to 80 percent of Emergency Room visits related to MRPs in seniors 65 years and above are preventable and caused by:

 

• Non-adherence
• Inappropriate prescribing or monitoring
• Lack of patient counseling
• Specific medication use. *

 

Patients of all ages need and deserve thoughtful prescribing followed by appropriate medication training so they can achieve optimal health. But our aging population is hungry for healthcare professionals who truly understand the complexity of their healthcare...and prescribe and educate accordingly.

 

*(Gurwitz, JAMA 2003;289:1107-16; McDonnell 2002;Tafreshi 1999; Hanlon 1997; Dennehy, AJHP;53:1422-6).