Discrimination against older people in health and care services must be addressed. It must be recognised that a healthy older age is the product of healthy lives and that people of all ages should have access to health advice and preventative services. In addition, older people should have fair access to operations and treatments and in situations where they require intensive support, such as in residential or nursing care, they should be treated as individuals with dignity and sensitivity.
AGE the European Older People s Platform and its Member organisations therefore considers of utmost importance to raise awareness, on the need to develop and promote the rational and equitable use of medicinal products tested and designed for Older People.
The EU has competence in this area and the European Agency for the Evaluation ofMedicinal Products (EMEA) coordinates the evaluation and supervision of medical products including medicines, throughout the European Union. For this reason, AGE would like to raise awareness and give guidance to the European Union and its Member States to develop and/or support actions on the Use of Medicinal products for Older People.
Background
In Europe the population is ageing with more people, especially women, living beyond 80 years. Better living conditions, availability of efficient medicines and the development of medical technology have contributed to this trend.
However, in many European countries a gap exists between the needs of the elderly and the health and care services provided. For example, because of the increasing resistance to antibiotics there is an urgent need for the development of new medicines to combat infectious diseases. Equally urgent is the need to find effective treatments for dementia. There is also a need to improve the adequate use of medicines destined especially for older people. The consumption of medicines increases with old age and the elderly population and health professionals need to be made aware of the irrational use of medicines and the consequential problems linked to over /under consumption and/or interaction of medication.
In November 2004 the World Health Organization (WHO) published a report on Priority Medicines for Europe and the World4. The report highlights among other things, the challenges of an aging society and the increased usage of medicinal products in Europe and in the World associated with the adverse reactions to medicines in elderly patients (especially women), co-morbidity as well as medicinemedicine and medicine disease interactions. According to the report, many of these problems appear to be preventable if medicines are used in a proper way taking into account the frailty of the elderly, the increasing prevalence of diseases affecting them together with the concomitant use of many medicines.
The WHO report has caught much interest and lead to the organisation of a high level conference in the Hague on the 8th and 9th December 2005 patronised by the Dutch Minister of Health, Welfare and Sport5. Due to the importance of the subject for older people, AGE
The European Older People s Platform has decided to produce a position statement on this subject based on these events and on contributions by AGE Health Expert group. The suggestions and recommendations were approved by AGE Council on 27-28 June 2006.
In this context, AGE concludes that there is: Lack of sufficient suitable medicines for most of the diseases that affect the elderly;
Lack of studies which include older patients and patients with polypathologies;
Insufficient use of evidence-based drugs constitutes a serious problem in terms of public health;
Polypharmacy is an area of special concern. Many older patients use multiple drugs. This causes difficulties with respect to the addition or withdrawal of medicines on the basis of sound diagnosis and indications. The more drugs a patient uses, the greater the risk of interactions between these medicines.
AGE therefore recommends the following actions and calls Member States as part of the EU Public Health Strategy to endorse the WHO recommendations on Rational Use of Medicines, in particular that: Pre- and postgraduate education on medicines and their use especially in old people should be strengthened and given not only to physicians and pharmacists but also to nurses and other health care and social welfare personnel involved in the care of elderly patients;
Old people and their informal carers should obtain clear, accurate, independent and reliable information from their national governments and family doctors on the effects of medicines on the elderly and which questions to ask the prescribing physician (how, why, and which medicines should be used);
Physicians need specific tools and guidelines for clinical practice for the elderly population;
Patients, their physicians, nurses and pharmacists need easily available and reliable information about the medicines patients use. In particular, this information should include data on drugs that patients should not use again because of severe adverse events in the patient’s history. The medicine lists of the patients should be the subject to regular auditing preferably by their physician but pharmacists or nurses can be an alternative. Special attention should be paid to medicines which are contraindicated for older people, interactions and dosages.
Drug companies should be encouraged to test medicines on older persons.
Generally, the drugs used by older people have never been tested in their age target and gender group. The leading principles by testing older and new medicines have to be equity, evidence and efficiency.
Obligation of pharmaceutical companies to test new medicines in the age groups which are going to use them.
Ensure the necessary national coordination of the use of medicines involving multidisciplinary experts and civil society to monitor medicine use.
Develop and coordinate the implementation of national action plans to promote the rational use of medicines as part of their national medicines policy according to their health structures and available resources.
AGE would like to reaffirm that there is a need to continue to raise awareness on this issue. The EU Institutions could play a useful role in promoting and exchanging good practice in rational use of medicines for older people via the Open Method of Coordination6. To achieve this, a continuous stakeholder dialogue is 6 Open Method of Coordination – is an approach to EU governance based on soft law mechanisms and mutual learning. It has been devised as an instrument to share best practices and increase policy convergence in areas which remain a primary responsibility of national governments but are of concern to the EU as a whole, such as the long term unemployment, the necessary reform of social protection systems and on health and long term care. It aims at coordination rather than harmonisation of national policies. It commits Member States to work together towards shared goals while respecting legitimate national diversity. It is also more intergovernmental and voluntaristic than the traditional EC methods.
www.age-platform.org