Written by Behnaz Sarrami, MS, PharmD, TL1 Predoctoral Clinical Research Program alumnus
Older Americans Month (OAM) was established in 1963 to give recognition to older adults as invaluable members of our society. Older adults have gained much wisdom and experience as they have endured life’s many challenges. Many have already lived through one pandemic, the great depression and the great recession and still experience the economic and societal impact of these events. Some older adults live in poverty and have disproportionate access to care and other services. Many of these older adults are retired but remain an active member of their community by volunteering and mentoring the young through a variety of non-profit organization such as SCORE. While older adults are a resilient and active part of our communities, they are at times still vulnerable to fraud, abuse, neglect and financial distress. OAM is a time to draw attention to this and pay tribute to the work of all older adults.
As a pharmacist who talks to hundreds of people every week, I recognize that older adults need a different set of medical care that is unique to them. I see the impact that lack of transportation and social interactions, decline in mental capacity, decrease in mental health, low fixed income, high medication copays, and medication non-adherence has on the lives of some older adults. Many live on fixed social security income, which is insufficient to cover their high medication copays. Due to these high copays, some older adults have to wait for their next social security paycheck before refilling their medications, which can put them at a higher risk of exacerbating their existing medical conditions. Amongst the highest copay medications are the asthma and COPD inhalers and diabetic insulins. These diseases are irreversible conditions that put older adults at higher-risk for complications that may worsen over time. Therefore, preventing these conditions from getting worse is critical in managing them.
One of my memorable calls was to a 75-year old man about his medications and the delay in refilling his COPD inhaler. His wife answered the phone and said that her husband had no interest in speaking about his medications. When I asked why, she broke down, and we ended up speaking for almost thirty minutes. She said that her husband sleeps all day, is depressed, has COPD but smokes, and he has decided not to fill his daily inhaler because the copay is very expensive. She had made numerous attempts to help him with his health but she had eventually given up. She had realized that she was going downhill emotionally due to a recent hip injury which made her unable to walk like she used to, and she was now dependent on her husband to drive her around. She could no longer go to church, pick up her medications on time, have any social activities, and she felt herself diving into depression and not able to cope. With the COVID-19 social distancing, she felt extremely alone, lost and hopeless.
In addition to financial and transportation barriers, mental health and emotional stability plays a huge role in a person’s non-adherence to medications. If a person is depressed, with no motivation to live, why would they worry about taking their medications at the right time every day?
For this particular patient, hope and someone that cared to listen, sparked a light in her to keep her motivated to continue taking autonomy in caring for herself. But there are so many that we are not able to reach and are not on a call roster. So how do we address these barriers and help them? How about the people we do not see in poor neighborhoods where they cannot afford to visit a doctor, who are uninsured, or cannot pick up their own medications and rely on others? How about the very frail who just lost a spouse and live in isolation? Or the people at nursing homes or retirement homes in low-income zip codes and those with no family to visit? Those experiencing these barriers have haunted me for years and I continuously try to find innovative ways to not only provide resources to them but bring awareness to this group of older adults so that after years of contribution to their society and hard work, they can continue to be noticed and connected to others.
We as a society need to find more ways to reach all parts of our community. We don’t have to do anything big, but we can reach out to our own family members, friends and neighbors to offer our time and love. Most older adults have a daughter, a son, grandchildren or other family member or friend. Let’s start there! A monthly check up phone call, a post-card with pictures, a random act of kindness is all that it takes to lift up and motivate a spirit of older adults who have raised others and continue to contribute to our society. We should pay attention to this circle of life which involves us all.