Comorbidities and cognitive impairment worsen non-adherence to anti-seizure medications in older adults.
The prevalence of epilepsy increases as we age, with a steady rise after 50 years of age and a peak occurrence in those 75 years of age and older. Coupled with aging brain pathologies, such as Alzheimer disease and other comorbidities, the risk of medication nonadherence in older patients greatly increases. Breakthrough seizures and hospital visits are likely related to anti-seizure medication treatment failure.
The journal Epilepsy & Behavior has published an original study demonstrating the impact of ambulatory care pharmacists on hospitalization rates in older adults with epilepsy in a multi-disciplinary epilepsy clinic. Although past studies have shown positive patient care outcomes associated with pharmacist intervention, this study found similar rates of hospitalization between the study and control groups.
“Older adults have the highest prevalence of epilepsy of any age group,” the study authors wrote. “Care in this group is complex because of comorbidities, polypharmacy, and cognitive impairment. We aimed to assess the impact of an ambulatory pharmacist in decreasing hospital visits in this group.”
It is important to note the study group had a more complex patient profile as determined by higher comorbidity scores and baseline seizure frequency. This potentially suggests that without pharmacist intervention, this group would have higher hospitalization rates.
Using a self-reported medication adherence rating scale (MARS), study group patients reported medication administration as low as 17%-42%. In addition, the study group had worse overall appointment adherence. Only 38% of patients attended their second or later appointments compared to 54% of patients in the control group.
Comorbidities and cognitive impairment worsen non-adherence to anti-seizure medications in older adults. In turn, this increases the rate of hospitalizations and is associated with increased hospital costs and inpatient days.
Historically, pharmacist contributions to patient care have improved medication adherence and health outcomes in the outpatient setting. In older adults with epilepsy, pharmacists should target patients with a seizure frequency of >1 episode per month and those with cognitive impairment.
Furthermore, pharmacists should utilize tools to improve adherence barriers, such as providing telehealth consultations, and provide education and counseling not only to independent patients, but their caregivers as well.
Due to limitations in the study, additional research is recommended comparing similar complexity patients and factoring in other indicators of care such as quality of life, rate of seizure-free days, and mental health status.
“This study demonstrates the multifactorial complexity of older adults with epilepsy,” the study authors concluded. “While the presence of a pharmacist resulted in similar hospital visits as the control group, the study group had a much more complex patient population. More studies are required to assess the best use of a pharmacist in older adults with epilepsy outpatient care.”
About the Author
Emilia Welch, PharmD, MBA, is a pharmacist at Walgreens in Newington, CT.
Burns C V., Lucas K, Faraj M, Millis S, Garwood C, Marawar R. Impact of ambulatory pharmacist on hospital visits in older adults with epilepsy: A case-control study. Epilepsy & Behavior. 2023;140. doi:10.1016/j.yebeh.2023.109109