Accepting the “New Challenge”

By: Kandace L. West, Pharm.D.

People are now living longer with HIV due to increases in research and development for antiviral therapies and now – possibly – prevention therapy for HIV infection for high risk groups (i.e. Tenofovir, read more here http://www.medscape.com/viewarticle/805739). This has led to a surprising problem not previously contemplated for people with HIV: how to live well and enjoy life while also controlling their disease? So while HIV/AIDS is no longer the terminal diagnosis it once was, no one would argue that it would be far better to not have to battle it at all. Therefore, the “New Challenge” is not only increasing awareness for this disease for the older adult population so as to prevent its spread, but also how to provide support for individuals with this disease, which is challenging enough at a younger age. September 18th is National HIV/AIDS and Aging Awareness Day and in honor of that, understanding the risk factors for what places an Older Adult at risk for HIV helps to prevent it from occurring and increase awareness.  So let’s talk about risk factors for HIV in the Older Adult:

(1)   Lack of awareness: For the older adult, there is a fundamental disconnect with who they see as the face of those infected. Posters and advertisements to get tested usually display younger counterparts – hip, youthful, and active. Never is an older adult considered at risk for the disease, even though there are a growing number of people living well into their older adulthood with the disease or being infected with HIV as an older adult in their 40s, 50s, 60s, or even 70s. Also, an older adult who already may be struggling with isolation associated with older age will perhaps be further distanced from others by the diagnosis of HIV.

(2)   Least likely to have protected sex: For the older adult, many grew up in a time when both condoms were rarely used, and HIV was not part of the Sexually Transmitted Disease flora. Fact was the only diseases that were heavily considered were those that were luckily curable: Chlamydia, Gonorrhea, and Syphilis. This previous experience, cemented in their consciousness, coupled with the ordinary discovery that menopause makes conception impossible, and at last drowned in the dangerous misconception that the older adult population is least likely to get HIV, are all the reasons why HIV/AIDS has so effortlessly claimed so many older adults.

(3)   Medications: The older adult man is likely to be taking pharmaceuticals such as Viagra or Cialis. A research study by Medical News today (04/30/2007) found that a third of sexually active men taking Viagra were unlikely to use protection despite not being in a relationship. Again, this ties into beliefs about protected sex, but also medications play a role in stimulating sexual activity. Those substances that impair judgment (e.g. illicit drugs, certain prescription drugs, and alcohol) may also have a role in increasing the risk for HIV when combined with sexual activity in the older adult population.

(4)    No routine testing in Primary Care: Do I need to explain this? Most primary care physicians do not routinely test for HIV; I think it should at least become part of an annual exam for individuals over 50? Ask for it during your next doctor’s appointment.

You can find more info about HIV and Aging here    http://aids.gov/hiv-aids-basics/staying-healthy-with-hiv-aids/taking-care-of-yourself/aging-with-hiv-aids/

Needles, Shots and the Older Adult: Do they need Vaccines?

By: Kandace L. West, Pharm.D.

Needles, needles, needles . . . who can honestly say that they like to get a shot- anyone?  Most people are creeped out by the thought of needles, shots and blood! But, scheduled vaccinations are an important part of healthcare, especially for kids, and more importantly as we age for the Older Adult. The question I most often get as a Medication Care Pharmacist who specializes in geriatrics is: “why do I need to get shots? didn’t I get all of mine when I was a kid?” This question provides an excellent opportunity to explain the importance of vaccinations on an individual and a global healthcare level.

The first point is that immunizations are needed in our society because if administered to everyone, some diseases can become rare if not extinct. According to the CDC (Centers for Disease Control and Prevention), the greatest example of this is polio or diphtheria. For someone born today in the U.S., it is very rare to contract or develop these diseases.[1] This is because the U.S. has employed a strong effort to vaccinate against these diseases very early on and for those of us born here in the U.S. we often times have unknowingly experienced the luxury of vaccinations as an infant or during our childhood. However, there are many people in other parts of the world, who are less fortunate.

On a side note, The Bill & Melinda Gates Foundation helps to address the unfortunate odds for people born in other countries that cannot afford to provide vaccinations for their citizens. The Foundation is committed to eradicating a number of vaccine preventable diseases. For example, the Foundation has reduced the number of polio cases by more than 99%, saving 10 million children worldwide from polio’s lifelong debilitating paralysis.[2] The humanitarian effort produced by the Bill & Melinda Gates Foundation is tremendous because they are reducing the number of people affected by vaccine preventable disease and will in the near future eradicate this and other diseases from infecting and harming people worldwide.

http://www.gatesfoundation.org/

So, the next point is that although vaccines are routinely administered to children, there are a number of vaccine preventable illnesses in Older Adults. Getting recommended vaccines for Older Adults reduces complications and death from many vaccine preventable diseases. According to the CDC there are the 4 recommended vaccines for the Older Adult[3]:

http://www.cdc.gov/vaccines/adults/rec-vac/older-adults.html

(1)    Annual Influenza (Flu) vaccine: The flu is a very common illness that is usually seasonal (October-March). Every year the vaccine is tailored to protect against the most common strains of Flu anticipated to infect people worldwide. For this reason, it is important to get the Flu vaccine annually because it only provides coverage for that Flu season, becoming obsolete thereafter. Flu shots can be administered conveniently at community pharmacies without an appointment, and no longer requires a physician’s prescription.

(2)    Shingles Vaccine: Anyone who has had chicken pox as a child can get shingles as an adult due to reactivation of the virus that lies dormant in the body and many times, unfortunately it tends to be more serious in the older adult. This is because of the reduction in the body’s immune function that naturally occurs as we age. Shingles affects more than 1 million Americans who are 60 years and older, and often times 20% of the Older Adults who get shingles are left with long-term debilitating pain even after the rash heals and is resolved.

(3)    Tetanus, diphtheria, pertussis (Tdap) Vaccine: Each one causes a different disease. Tetanus is a serious bacterial infection that is painful and affects the muscles and nerves. Diphtheria is a serious bacterial infection that causes sore throat and swollen glands. Pertussis causes whopping cough that can be spread to infants and kids who are not immunized. This 1 shot reduces the risk of getting any of these 3 harmful infectious diseases and prevents its spread to others.

(4)    Pneumococcal Vaccine: This shot protects against bacterial infections in the lungs, blood, and brain. It can also prevent complications from the disease, including death, especially for many Older Adults who are more at risk.

There are some rare individual instances where vaccinations may not be given to an individual due to serious allergies, or previously experienced rare but serious side effects. But, for the majority of people in our population, it is not an issue and these vaccinations are pivotal in preventing and spreading disease. I hope that this emphasizes the importance of vaccinations not only for individuals here in the U.S., but for humanity worldwide and for our most vulnerable populations: children and the – equally important and often overlooked – Older Adult population.



[1] (Centers for Disease Control and Prevention, 21)

[2] (Bill & Melinda Gates Foundation, 2013)

[3] (The Centers for Disease Control, 2011)

SPF: Spells Summer

By: Kandace L. West, Pharm.D.

Summer is officially here! For Older Adults sun can be overwhelming and too much is never good. Short term sun exposure increases risk of dehydration and long term exposure for skin cancer. Protective clothing is one of the best ways to stay covered and protected from the sun. Never underestimate the value of a broad brim hat, thin long sleeves and pants, sunglasses, and if possible shade or a tent. If you will be participating in outdoor activities this summer, do you know the best sunscreen to get? It can be a little confusing and there certainly are many products out there when visiting the sunscreen shelf at the store.

So what is important when buying sunscreens for summer?

(1)    SPF: Sun Protection Factor is the most important number to know. The good thing is that there have been some new changes by the Food and Drug Administration (FDA) for sunscreen labeling. The minimum SPF that is now required to be sold for sunscreens is SPF 15. You will not find any sunscreens with an SPF less than 15. This is great, but American Academy of Dermatology recommends that most people purchase sunscreen with SPF 30.

http://www.aad.org/dermatology-a-to-z/health-and-beauty/general-skin-care/sun-protection/is-sunscreen-safe

 

(2)    UVA/UVB: UltraViolet light rays are also very important to know. Fortunately the FDA has made the decision making process on UVA/UVB easier. The easiest way to remember is UVA is for Aging and UVB is for Burning. You want a sunscreen that protects from both the sun’s harmful rays that cause long term skin damage and/or aging (UVA) as well as sunburn (UVB). Again, the FDA has made this decision making process easier by ensuring that all sunscreens sold have coverage for both UVA/UVB and refers to sunscreens having “BROAD SPECTRUM” coverage.

http://www.fda.gov/forconsumers/consumerupdates/ucm258416.htm

 

(3)    Waterproof/Sweatproof and all related terms out there. Be aware of the time frame needed to reapply. Many sunscreen users make the mistake of applying only once, because of the “Proof” term and get burned as a result! Always apply sunscreen 15 minutes before going outside or participating in water sports and re-apply often! Be sure to read the label as to when the sunscreen will need to be re-applied and keep track of time.

 

(4)    Check Expiration Dates! Most people often have the same old bottle in their bathroom or medicine cabinet and do not check the expiration date before using sunscreen. Please check the date before using and dispose if it is expired. It will not provide protection from the sun if it is expired.

 

Enjoy the summer!

The Unmentionable: HIV and the Older Adult, Are they at Risk?

By: Kandace L. West, Pharm.D.

I came across this recent statistic: by 2015, 50% of people with HIV will be 50 years or older http://www.aoa.gov/AoARoot/AoA_Programs/HPW/HIV_AIDS/

In case you may not realize it, it is now 2013 and 2015 is a year and a half away! So what does this mean?

This means: (1) not only are people living longer with HIV due to an increase in antiviral therapies (which is an amazing accomplishment), but (2) unfortunately many older adults are unaware of their risk of HIV and are becoming newly infected as adults in their 40s, 50s, 60s and sometimes 70s as well. So, why is this?

Well let’s think about the numbers. Currently, according to the CDC, there are 1.1 million people living with HIV/AIDS in the U.S. and roughly a quarter are 50 years and older: 275,000 people. Again, when I talk about the numbers, does anyone imagine an older adult, mother, father, grandmother, aunt or uncle being at risk for this disease? No, no one does and most people still believe it is a disease that only affects people in their teenage years or early twenties, the LGBT community or non-married people. It is precisely this lack of awareness that leads to an attitude lacking in precaution. The reality is that a growing number of people age 50 and older represent 25% of the population of people with HIV/AIDS in the U.S. and this segment will continue to grow so long as the pervasiveness attitude of unawareness is allowed to persist.

June 27th is National HIV TESTING DAY and an excellent opportunity to take the time to learn more about HIV testing and how to keep individuals, especially our older adults safe and healthy from this disease.  Below is the link to find more information for testing and to increase awareness for the unmentionable risk group, the older adult.

http://aids.gov/news-and-events/awareness-days/hiv-testing-day/

Medicine Cabinets Must-Have, NOTs: The Simple Sixes

By: Kandace L. West, Pharm.D.

People are very nostalgic over what is in their medicine cabinets, and despite that many of the items are old, faded and more often than not expired, people feel such great emotional relief that a particular item resides on the same shelf in the medicine cabinet for years. The medicine cabinet houses prescription medications, over-the-counter products, and home remedies for the most common aches, pains, and illnesses, but unfortunately a number of items in there may not even be necessary, are well past their shelf-life, or have the potential to cause harm if taken. As a Medication Care Pharmacist, along with checking prescription medications, over-the-counter products, herbals and supplements for safety in the comfort of the individual’s home, I am always astonished at the number of items that any one person manages to gather in their medicine cabinet. When I ask the question “Why do you still have this?” the overwhelming response is, “I bought it and it’s mine and I will keep it because I might need it in the future.”

My Commitment as a Medication Care Pharmacist is to ensure medication care and safety. And fulfilling this commitment usually means explaining why a medication may or may not be necessary. In this scenario, when people are holding onto what they believe are “medicine cabinet must-haves” I find this an opportunity to explain the reasons why many times a medicine cabinet can harbor dangerous items, especially in the Older Adult Population.

And so I’ve developed some basic rules for the Medicine Cabinet Must-Have Nots called: ‘The Simple Sixes’ to guide anyone through a Medicine Cabinet Clearing Session!

(1)    If the medicine cabinet is in the bathroom, where the shower is located and is subject to moisture and steam from a shower . . . guess what? Everything being stored in there is not as good quality as it should be because most medications (prescription and over-the-counter) should be stored in a cool dry place, otherwise they degrade faster and may not be as effective. The best place to store medications is in a cool dry place such as a bedroom closet or cabinet in the kitchen. The cabinet should be within arm’s reach for an adult but if there are small kids around it should be stored up and away.     http://www.upandaway.org/

(2)    Check expiration dates! All prescription medications, over-the-counter herbals, and supplements should be labeled with an expiration date. Medications used after their expiration date are not guaranteed to work the same as non-expired products, and sometimes individuals can suffer undesired side effects from expired medications.

(3)    Before storing medications, keep all medications in their original containers. Never combine medications, or refill bottles. Each bottle has an individual lot or batch number and this is helpful in case there is a drug recall. The FDA places information on their website that is often relayed in our local news regarding specific drug recalls, and if the medications are not in their original containers, who is to know if it has been recalled?     http://www.fda.gov/Drugs/DrugSafety/DrugRecalls/

(4)    Please do not flush medications down the toilet! The medication, active ingredient and bi-products end up in our drinking water!  Disposal of expired, unwanted, unnecessary medications can be done by getting more information from the DEA (Drug Enforcement Administration). They host an annual take back day, where they collect medications for disposal locally. It’s a great opportunity to set National Take Back Day as your annual medicine cabinet cleaning day. http://www.deadiversion.usdoj.gov/drug_disposal/takeback/

You can also check if local pharmacies in your area collect medications for disposal. http://www.disposemymeds.org/

(5)    Over-the-counter products for acid reflux, sleep-aid, weight loss, and combination cold-flu products should not be used unless you have sought professional advice from a medical doctor or pharmacist who knows all the medications you are currently taking. Many over-the-counter products are just as strong as prescription medications and can interact with other medications, so it is necessary that they are recommended by a professional. So, if you have not sought professional advice prior to using, I recommend discarding these items; refer to Step (4) for disposal methods.

(6)    Prescription medication that was prescribed for a limited time period, such as antibiotics, pain medications and steroids (prednisone) should not be stored for another illness, unless instructed to do so by a medical doctor. Many of these medications if used by an individual based up their personal judgment of an illness may cause harm. These medications should properly be disposed of. Please refer to Step (4) for disposal methods.

It’s hard to develop a hard and fast list of everything, but I hope that the Simple Sixes will help many of you start an annual medicine cabinet cleaning session!