Publication

Article

Pharmacy Times
August 2024
Volume 90
Issue 8

Senior Care Pharmacists Can Provide Essential Services for Older Adults

Examples include reviewing antibiotic doses, identifying drug-drug interactions, and implementing fall prevention strategies.

According to the National Council on Aging, approximately 95% of older adults have at least 1 chronic medical condition.1 Additionally, polypharmacy is a major risk factor for adverse health outcomes, especially in patients 65 years and older.2 Polypharmacy typically means a patient is taking at least 5 medications.2 Senior care pharmacists can play an important role in providing medication therapy management (MTM) services for older adults.

Hand of eldery woman with her caregiver at home. Home care or Elderly care concept - Image credit: chompoo | stock.adobe.com

Image credit: chompoo | stock.adobe.com

Senior Care Pharmacists and MTM

Senior care pharmacists focus on pharmacotherapy for the geriatric population and provide a variety of MTM services. Reducing potential inappropriate medications (PIMs) and identifying drug-drug interactions are examples of senior-care pharmacist roles.3 Pharmacists can assess the American Geriatric Society Beers Criteria for PIMs in patients 65 years of age and older.4 Anticholinergic medications, such as antihistamines like diphenhydramine (Benadryl; Johnson & Johnson), can increase the risk of falls and delirium.4 Another example of PIMs is proton pump inhibitors such as omeprazole (Prilosec; Procter & Gamble). These medications carry a variety of risks including Clostridioides difficile, pneumonia, gastrointestinal complications, bone loss, and fractures.4 Senior care pharmacists can play an important role in deprescribing unnecessary medications.

About the Author

Jennifer Gershman, PharmD, CPh, PACS, is a drug information pharmacist and Pharmacy Times contributor who resides in South Florida.

One systematic review evaluated MTM programs and PIM use.5 MEDLINE (PubMed) was searched for peer-reviewed studies that included the following criteria: a Medicare population; based in the United States; evaluated an MTM program; study design, either randomized controlled or observational; and available in English.5 Among the 7 studies evaluated, MTM reduced PIM use in 5 of them.5 There was a reduction in the average number of PIMs between hospital admission and discharge (P < .01).5 The investigators concluded that MTM programs reduced PIM usage in studies that involved a follow-up period of 4 months or less from the patients' initial MTM consult.5

Pharmacists can serve as part of a multidisciplinary team in a physician office setting to resolve medication-related issues. This can include providing clinical recommendations, adjusting medication doses through a collaborative practice agreement, implementing fall prevention strategies, developing antimicrobial stewardship protocols, and administering immunizations.3 Additionally, pharmacists may provide continuing education (CE) programs and supervise medication distribution services. Senior care pharmacists can also practice in other settings, including long-term care (LTC), hospice, ambulatory care, correctional facilities, adult day care facilities, home health, hospitals, mental health facilities, residential care, community pharmacies, and pharmaceutical companies.3

Antibiotic misuse can lead to a variety of complications such as adverse effects, drug-drug interactions, and antimicrobial resistance.6 Approximately 30% of antibiotic prescriptions in the community setting are likely unnecessary, and it is estimated that 40% to 75% of antibiotic prescriptions in LTC settings are unnecessary or inappropriate.6 The American Society of Consultant Pharmacists and the Society of Infectious Diseases Pharmacists issued an updated joint position statement on the role of senior care pharmacists in antimicrobial stewardship.6 Senior care pharmacists can play an integral role in antimicrobial stewardship in health care settings for older adults through the following activities6:

  • Review antibiotic dosing, drug interactions, and pharmacotherapy selection at the time of prescribing.
  • Encourage evidence-based communication among health care professionals regarding antibiotics.
  • Collaborate with leaders to promote antimicrobial stewardship.
  • Provide education regarding the facility-specific antibiogram.
  • Develop assessments for antibiotic allergies.
  • Implement prospective audit feedback programs for antimicrobial use.
  • Participate in CE programs to enhance clinical skills.
  • Support antimicrobial pharmacotherapy treatment decisions for patients enrolled in hospice and/or palliative care.
  • Review antimicrobial therapy for specific conditions such as HIV-related opportunistic infections, chronic steroid use, chemotherapy, and chronic infections.
REFERENCES
1. Get the facts on healthy aging. National Council on Aging. October 20, 2023. Accessed May 31, 2024. https://www.ncoa.org/article/get-the-facts-on-healthy-aging
2. Nguyen K, Subramanya V, Kulshreshtha A. Risk factors associated with polypharmacy and potentially inappropriate medication use in ambulatory care among the elderly in the United States: a cross-sectional study. Drugs Real World Outcomes. 2023;10(3):357-362. doi:10.1007/s40801-023-00358-2
3. What is a senior care pharmacist? American Society of Consultant Pharmacists. Accessed June 2, 2024. https://www.ascp.com/page/whatisacp
4. 2023 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052-2081. doi:10.1111/jgs.18372
5. Rao P, Hung A. Impact of medication therapy management programs on potentially inappropriate medication use in older adults: a systematic review. J Manag Care Spec Pharm. 2024;30(1):3-14. doi:10.18553/jmcp.2024.30.1.03
6. Chahine EB, Clifford KM, Ladikos N, et al. The essential role of senior care pharmacists in antimicrobial stewardship: an updated position statement on behalf of the American Society of Consultant Pharmacists and the Society of Infectious Diseases Pharmacists. Sr Care Pharm. 2023;38(11):452-456. doi:10.4140/TCP.n.2023.452
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