The creation of the Institute for Pediatric Innovation stemmed from founder and president Donald Lombardi’s passion for helping children, and from the realization that the needs of pediatric patients are not being sufficiently met. Having now lost two elderly parents, I have realized that, similarly, there are needs of geriatric patients that are not sufficiently met. If I ever make it big, like Lombardi, I will found the Institute of Geriatric Innovation.
After leaving Children’s Hospital at Harvard, Lombardi realized that medications and medical devices are designed and tested for safety and efficacy in adults. They have mostly been modified ineffectively for children. Lombardi wanted to fund research and development work for medical devices and medications specifically for children. I see the exact same problem in geriatrics.
Anthony Martin’s book “Problems in Geriatric Medicine” demonstrates that there is certainly a recognition by the medical profession of the social and physical disorders associated with geriatrics, such as disorders of the cardiovascular system, neurologic disorders, incontinence, stroke, and others. But the system in place for treating these disorders in the elderly, similar to what Lombardi saw in pediatrics, uses medications and treatments designed for middle-aged adults and shoehorns them to fit the elderly.
Why does the problem exist? Scientists know that as we age, our metabolism morphs. Part of it is breakdown, part of it is genetics, and part of it is the result of what we are exposed to during our lives. It could be blows to the head playing football, it could be swinging too hard playing tennis for 40 years, and it could be exposure to Agent Orange while serving in Vietnam. Whatever the cause, what happens to a pill swallowed by a 35-year-old is very different from what happens to a pill swallowed by a 90-year-old. In comparing the two, we know that liver function is different, stomach acids are different, the heart functions differently, and the macro- and micro-vasculature structural integrity differ, to name a few. Yet, if you look at dosing charts, there is no direction to doctors from manufacturers on dosing geriatrics. At best, there are warnings.
As stated in the Merck Manual, the result of the above are medication-related problems that are common in the elderly and include drug ineffectiveness, adverse drug effects, over-dosage, under-dosage, and drug interactions. Drugs may be ineffective in the elderly because clinicians under-prescribe (e.g., because of increased concern about adverse effects, abiding by the above- mentioned warnings) or because adherence is poor (e.g., because of financial or cognitive limitations). Adverse drug effects are effects that are unwanted, uncomfortable, or dangerous. Common examples are over-sedation, confusion, hallucinations, falls, and bleeding. Among ambulatory people ≥ 65, adverse drug effects occur at a rate of about 50 events per 1,000 person-years. Hospitalization rates due to adverse drug effects are four times higher in elderly patients (about 17 percent) than in younger patients (4 percent). All of this is hardly trivial.
An example is anti-seizure drugs, which are prescribed at a dose that prevents further seizures but induces delirium. What good is a pill that prevents death from a seizure but leaves the patient catatonic?
Other examples are common, and we all see them all the time with family and friends. Doctors prescribe pills that an elderly person cannot swallow. The best remedy I have seen is directions to crush the pill or open a capsule and add to food. But a pharmacologist, such as myself, will tell you that the pill was constructed to be absorbed effectively. Changing its structure can drastically affect its absorption and, ultimately, its efficacy.
In view of the above, I see a great practical and moral need for a foundation to finance development work in this area because, presently, it is not being done. If I do not get the chance to found it, I sincerely hope that someone else does. We all should be hoping for the same, because if all goes well, we will be geriatrics in the same boat heading toward the waterfall.
By Ken Kohn
Dr. Kenneth I. Kohn has a PhD in pharmacololgy and minor in immunology from Wayne State University Medical School and a JD from Wayne State University Law School. He is owner of Kohn and Associates, an intellectual property firm in Farmington Hills, Michigan. He is also a managing partner of several start-ups, including Prebiotic Health Sciences, Pipe Problem Solutions, and others.