Immunizing Older Individuals Requires Flexibility, Nuance

Nothing highlighted the need for and importance of vaccinations in older adults more than the COVID-19 pandemic. Like any infectious disease, COVID-19 struck hardest and most lethally in individuals 65 years or older, particularly those in congregate care settings, such as assisted-living and skilled-nursing centers. At press time, nearly 800,000 Americans 65 years or older have died because of COVID-19.¹ The race to develop vaccines and the subsequent race to deliver them felt like preparing for war. It was a massive undertaking that needed to be done as quickly as possible. In that haste, many of the ills that plague our health care system were amplified.

In 2016, well before the pandemic, retired pharmacist Truman Lastinger, RPh, wrote that in the 1950s, “most rural customers did not have enough money to go to the doctor, even though an office visit was often $3 to $4...so druggists saw and [managed] cuts, bruises, bee stings, goiters, hernias, mastoid problems, sore throats, colds, rashes, ringworm, sandworm, athlete’s foot, and influenza, just to name some of the common problems. They [also managed] constipation, diarrhea, dyspepsia, [anemia], sexual dysfunction, [and] just about anything in the community that required attention.”²

That was only the beginning. Starting with managed care, all health disciplines saw the deterioration in the patient relationship part of their practices. Health care became about doing more faster and more efficiently, like the manufacturing boom of the industrial age. Cost became king, and the value of the unique relationship between pharmacist and patient in communities was lost.

Once the COVID-19 pandemic hit, that relationship became even more of a challenge. Millions of individuals were suddenly at risk. Access to pharmacies and pharmacists was purposely decreased. Fortunately, as in all emergencies, flexibility was granted. Pharmacies and pharmacists could test, vaccinate, and eventually order treatments. Vaccination became central to not only community practice but all long-term care.

Even though older individuals represent the fastest-growing segment of the population, immunizing older adults is not a population health initiative, especially in an emergency. It is still a patient-centered initiative.

Immunizing older adults requires careful consideration and a deep understanding of the nuances of patients as they age. The older adult population is not homogeneous. Individuals do not all age the same way, and body systems within bodies do not age at the same rate. Not all older adults can walk to a corner drugstore, with access limited by their mobility and location.

Many older adults did visit their community pharmacies to obtain COVID-19 vaccinations, but some pharmacists provided these vaccines in patients’ homes. Some pharmacists had to rely on the experiential skill they developed during years of working in settings such as assisted-living communities and nursing homes and encountering cognitive deficits, dementia, and other complex comorbidities.

Individuals in those settings did not fit the efficient and rapid model set forth by government agencies; they required careful consideration from their existing health care providers, and they relied on the relationships that already existed with their pharmacies and pharmacists.

Pharmacists stepped up during the pandemic and now stand to make permanent the flexibilities granted to infectious disease testing, management, and vaccination. Using the buzz phrases patient centered, population health, and relationship, the government and pharmacy profession can better protect older adults and reestablish the accessible, trusted, and long-standing relationship between older adults and their pharmacists.

References

1. Number of coronavirus disease 2019 (COVID-19) deaths in the U.S. as of November 2, 2022, by age. Statista. November 8, 2022. Accessed November 12, 2022. https://www.statista.com/statistics/1191568/reported-deaths-from-covid-by-age-us/

2. Lastinger T. The golden age of pharmacy. Drug Topics. March 30, 2016. Accessed November 16, 2022. https://www.drugtopics.com/view/golden-age-pharmacy

About the Author

Chad Worz, PharmD, BCGP, FASCP, is the CEO and executive director of the American Society of Consultant Pharmacists.