As of December 2, 2015,
the United States has a total resident population of 322,267,564, making it the
third most populous country in the world.
There were about 125.9
million adult women in the United States in 2014. The number of men was 119.4
million. At age 85 and older, there were almost twice as many women as men (4
million vs. 2.1 million). People under 21 years of age made up over a quarter
of the U.S. population (27.1%), and people age 65 and over made up one-seventh
(14.5%). The national median age was
36.8 years in 2009.
As of 2012, people are
distributed by age as follows:
- 0–14 years: 19.8% (male 31,639,127/female
30,305,704)
- 15–64 years: 66.8% (male 101,612,000/female
104,577,000)
- 65 years and over: 13.4% (male
18,332,000/female 23,174,000) (2012 est.)
America faces an
unprecedented challenge. The number of people reaching retirement will double
in number by 2030, accounting for an increase from 12 percent of the U.S.
population to almost 20 percent.
Population Aged 65 and Over for the United
States: 2012 to 2050:
Mortality: Driver of Trends in the Older
Population
The size and composition
of the older population in 2050 will be largely determined by two factors: the
size and composition of the population 27 years and over in 2012 and the future
course of mortality for that population. While past fertility rates were the
main driver shaping the size of these cohorts to date, mortality will influence
the pace at which that population declines at the older ages.
Nearly everyone who will
be 65 years and over and living in the United States in 2050 already lives
here. No one born after 1985— those 27 and younger in 2012— can add to this
population, because they will not be over the age of 65 by 2050. Since most immigrants
are projected to be under the age of 40 when they arrive in the United States,
international migration will play a limited role in creating the future
population over age 65. Future migration will have even less of a role in
shaping the future population over age 85.
The 65 and over
population is growing, and that certainly is contributing to overall rising
rates of prescription drug use; nearly 40 percent of adults 65 and older
reported use of five or more medications. However, 8 of the 10 most
commonly used drugs are used to manage heart disease, high blood pressure,
diabetes and high cholesterol, all conditions and health complications that may
develop as a person gains weight.
Prescription drug use
has increased steadily in the U.S. for the past decade. The percentage of
people who took at least one prescription drug in the past month increased from
44 percent in 1999-2000 to 48 percent in 2007-08. Spending on prescription
drugs reached $250 billion in 2009 the year studied, and accounted for 12
percent of total personal health care expenditures. Drug-related spending is
expected to continue to grow in the coming years.
Overall, women and older
adults receive more prescriptions. Vaccines, antibiotics and anti-asthma drugs
are most commonly prescribed in people younger than 19. Antidepressants and
opioids are most common among young and middle-aged adults. Cardiovascular
drugs are most commonly prescribed in older adults. Women receive more
prescriptions than men across several drug groups, especially antidepressants:
Nearly 1 in 4 women ages 50-64 are on an antidepressant.
Among people older than
60, about 88 percent were using at least one medicine, and more than one-third
were taking five or more.
- About half of all Americans in 2007-2010
reported taking one or more prescription drugs in the past 30 days. Use
increased with age; 1 in 4 children took one or more prescription drugs in
the past 30 days compared to 9 in 10 adults aged 65 and over.
- Cardiovascular agents (used to treat high blood
pressure, heart disease or kidney disease) and cholesterol-lowering drugs
were two of the most commonly used classes of prescription drugs among
adults aged 18-64 years and 65 and over in 2007-2010. Nearly 18 percent
(17.7) of adults aged 18-64 took at least one cardiovascular agent in the
past 30 days.
- The use of cholesterol-lowering drugs among
those aged 18-64 has increased more than six-fold since 1988-1994, due in
part to the introduction and acceptance of statin drugs to lower
cholesterol.
- Other commonly used prescription drugs among
adults aged 18-64 years were analgesics to relieve pain and
antidepressants.
- The prescribing of antibiotics during
medical visits for cold symptoms declined 39 percent between 1995-1996 and
2009-2010.
- Among adults aged 65 and over, 70.2 percent
took at least one cardiovascular agent and 46.7 percent took a
cholesterol-lowering drug in the past 30 days in 2007-2010. The use of
cholesterol-lowering drugs in this age group has increased more than
seven-fold since 1988-1994.
- Other commonly used prescription drugs among
those aged 65 and older included analgesics, blood thinners and diabetes
medications.
- In 2012, adults aged 18-64 years who were
uninsured for all or part of the past year were more than four times as
likely to report not getting needed prescription drugs due to cost as
adults who were insured for the whole year (22.4 percent compared to 5.0
percent).
- The use of antidepressants among adults aged
18 and over increased more than four-fold, from 2.4 percent to 10.8
percent between 1988-1994 and 2007-2010.
- Drug poisoning deaths involving opioid
analgesics among those aged 15 and over more than tripled in the past
decade, from 1.9 deaths per 100,000 population in 1999-2000 to 6.6 in
2009-2010.
- The annual growth in spending on retail
prescription drugs slowed from 14.7 percent in 2001 to 2.9 percent in
2011.
In 2009–2012 compared
with 1999–2002, the percentage of adults aged 55–64 who took selected
prescription drugs was 54% higher for cholesterol-lowering drugs, 78% higher
for gastric reflux drugs, 40% higher for antidepressant drugs, and 29% higher
for antidiabetic drugs. In contrast, the percentage of adults aged 55–64 who
took prescription cardiovascular agents (which include heart, blood pressure,
and kidney drugs) and the percentage who took prescription analgesics were
similar to the levels in 1999–2002.
In 2009–2012, nearly
one-half (45.0%) of adults aged 55–64 took a prescription cardiovascular drug
in the past 30 days, nearly one-third (31.8%) took a prescription
cholesterollowering drug, and 16.0% used prescription gastric reflux
medications (for anti-acid reflux and stomach ulcers). Fifteen percent of those
aged 55–64 used prescription analgesics (narcotics, nonsteroidal
anti-inflammatory drugs, and aspirin), and 14.4% used prescription
antidepressants in the past 30 days. Antidepressant drugs can be prescribed for
a wide variety of clinical reasons. In 2009–2012, 12.9% of those aged 55–64
used prescription antidiabetic agents.
For adults aged 55–64,
the percentage who delayed or did not receive needed medical care due to cost
in the past 12 months, or who did not receive needed prescription drugs due to
cost in the past 12 months, was higher in 2012–2013 than in 2002– 2003 and varied
by insurance coverage.
Forgoing or delaying
needed health care can have serious health effects (92). Access to care is a
complex process that addresses the extent to which a population can connect
with health care and reflects the affordability, availability, and acceptability
of health services. Health insurance facilitates access to health care by
connecting individuals to health care providers and by covering a portion of
the cost of care.
In 2012–2013, 13.2% of
adults aged 55–64 delayed or did not receive needed medical care in the past 12
months due to cost, 39% higher than in 2002–2003 (9.5%). For adults aged 55–64
who were insured for the entire past year, the percentage who delayed or did
not receive needed medical care due to cost was 32% higher in 2012–2013 (7.8%)
than in 2002–2003 (5.9%). The percentage of adults aged 55–64 who were
uninsured for all or some of the past year and who delayed or did not receive
needed medical care due to cost was 14% higher in 2012–2013 (44.2%) compared with
2002–2003 (38.7%).
In 2012–2013, 8.8% of
adults aged 55–64 did not receive needed prescription drugs in the past 12
months due to cost, 26% higher than in 2002–2003 (7.0%). For adults who were
insured for the entire past year, the percentage who did not receive needed
prescription drugs due to cost was 25% higher in 2012–2013 (5.5%) than in
2002–2003 (4.4%). For those who were uninsured for all or part of the year,
26.7% did not receive needed prescription drugs due to cost in 2012–2013,
similar to the level in 2002–2003.
An association exists
between not receiving needed medical care and prescription drugs due to cost
and insurance status. In 2012–2013, for adults aged 55–64, those who were
uninsured for some or all of the past year were 5.7 times as likely to delay or
not receive needed medical care due to cost and 4.9 times as likely to not
receive needed prescription drugs due to cost as those who were continuously
insured in the past year.
Startling
Statistics
10.7% of hospital
admissions in older adults are associated with adverse drug reactions (ADRs)
ADRs cause over 100,000
deaths per year in the United States, making ADRs the fourth leading cause of
death in the United States
Older adults are 2.5
times more likely to visit an emergency room due to an ADR than younger
individuals
Warfarin, insulin, and
digoxin together account for over 1/3 of emergency department visits for ADRs among
older adults
About 1 in 3 older
persons taking at least 5 medications will experience one adverse drug event
each year, and about 2/3 of these patients will require medical attention
Getting the Whole Picture
Elderly comprise 13% of
population
Use 25-30% all
prescription medications; 25% of nonprescription medications
75% of older adults take
one or more prescription medications
25% of older adults take
5 or more medications on a regular basis
Use 5.8 Rx drugs
concurrently with 3.2 OTC drugs
The elderly are one of
the most fragile patient population and it should be our common goal to
dedicate a special attention to their well-being. The elderly represent an
extremely heterogeneous patient population that differs significantly in terms
of functional capabilities, their morbidity and co-morbidity without any
relationship to the numerical age. Due to the increasing probability to develop
chronic diseases with age, elderly are the main user group for medicinal
products. As such, the medicinal products contribute to the increasing life
expectancy of humans and the maintenance of the individual’s health and
independence, but unfortunately also to medication related problems.
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