Drug Performance in an Aging Workforce 

Contributing Author:  Jonathan Rowell, Pharm. D., Clinical Pharmacist, Enlyte

In 2018 29% of baby boomers aged 65 to 72 were still working or were seeking employment. According to the U.S. Census Bureau  by 2030, all baby boomers will be older than age 65 and one in five will be of retirement age and will outnumber children for the first time. Between 1996 and 2026 workers 55-64 will nearly double and nearly triple for workers 65 and older. 

Workers 60 and older have historically seen fewer work-related injuries; however, this seems to be changing, and when injuries happen for this age group their cost can range between 15% more for the 35-49 age group and 140% higher than injuries from younger counterparts between 18-24. Their injuries can also be more serious, as well as having more comorbidities or medical conditions unrelated to their work injury that can delay recovery.

When a work injury occurs age-related challenges need to be considered given employees are working longer. Furthermore, the impact of how medications perform in younger vs. older populations shouldn’t be overlooked when considering return to work and recovery.

Understanding Pharmacological Processes for Aging Workers 

Generally aging is associated with loss of function within organs and tissue that disrupt the physiologic processes that maintain internal stability and normal function. But as workers age their physiologic, musculoskeletal, and neurologic systems don’t perform the same way as their younger peers. Understanding of age-altered pharmacokinetics (the fate of pharmacological substances in the body) and pharmacodynamics (the course of action, effect, and breakdown of drugs within the body) can assist in medication selection, as well as dosing adjustments that can prevent unexpected medication reactions and effects on older patients. 

Forty percent of adults over 65 years of age take five to nine medications per day and 18% take 10 or more. Patients who are over 75 are three times more likely to suffer adverse drug reactions than middle-aged adults. All this must be considered when an older worker is hurt on the job and needs medication for their work-related injury in conjunction with medications they regularly take for non-work related conditions.

How drugs are absorbed, distributed, metabolized and excreted are all influenced by aging. For example, the pH of the aging gut is reduced making it more acidic, which may affect the rate and extent of a drug’s dissolution. Reduced blood flow to the intestine, where most drug absorption takes place, may result in a reduced amount of drug absorption. Age-related reductions in liver mass and blood flow may also result in reduced metabolism of medications whose bioavailability is increased as a result. In addition, a reduced number of nephrons (the filtering and excretory unit of the kidney) and kidney blood flow in older persons can result in a lower rate and extent of drug elimination.  

“Starting low and going slow” is a popular universally accepted rule in drug dosing for older patients that follows an appreciation that drug clearance may be less efficient, creating the potential for overdose toxicity at lower doses than are recommended for younger patients. High doses and long-acting formulations of opioids are especially concerning in this respect.

The course of action, effect, and breakdown of drugs within the body are equally important challenges in predicting differences in drug responses between older and younger adults. Specifically, differences in drug receptor sensitivity and related responses, as well as impaired ability to adjust core body functions like blood pressure, bladder function, temperature and blood sugar levels make drug side effects more likely and potentially more clinically significant for older patients. Older individuals are especially sensitive to side effects of medications that are active in the central nervous system, such as benzodiazepines (increased sedation), neuroleptic medications (delirium, arrhythmias, postural hypotension) and opioids (respiratory depression, constipation). An older population also exhibits exaggerated responses to anticoagulants or certain antihypertensive medications. 

Aging, taken together with the increased number of treated conditions and prescribed medications, becomes a significant cause for vigilance in prescribing. Health care providers who treat aging patients are all very familiar with a set of evidence-based prescribing criteria called the Beers Criteria for older adults (named for its original author). It is updated and published by the American Geriatrics Society, which identifies potentially inappropriate medications and cautions associated with their prescribing in persons over 65. Your pharmacy benefit manager can also help you understand the specialized needs of this aging population, and if you have questions about prescriptions for an aging worker, they should be reviewed with a health care professional such as the prescribing doctor or dispensing pharmacist. 

About the author

Jonathan is a clinical pharmacist for Enlyte Pharmacy Solutions and works in Pharmacy Benefit Management (PBM) clinical operations. Prior to joining Enlyte, Jonathan worked as a pharmacy manager for a large pharmacy retail chain. He has over two years of experience within the workers’ comp PBM industry having previously worked in long-term care, hospice, and retail pharmacy. 

Jonathan is also a regular contributor to the Ask the Pharmacist Series where portions of this article originally appeared.

www.mitchell.com/ask-the-pharmacist

References:

https://pubmed.ncbi.nlm.nih.gov/22111719/
https://www.merckmanuals.com/professional/geriatrics/drug-therapy-in-older-adults/overview-of-drug-therapy-in-older-adults
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1884408/
https://pubmed.ncbi.nlm.nih.gov/30693946/

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