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)

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/