Introduction

Geriatric Essentials

• The elderly are at high risk of drug-related problems, a common cause of poor clinical outcomes.
• Pharmacists can help prevent drug-related problems by working as part of an interdisciplinary team.
• Pharmacists can simplify drug regimens and take other measures to facilitate patient adherence.
• Pharmacists can work with prescribers to decrease costs and adhere to formulary guidelines.
• For elderly patients, developing a relationship with a pharmacist and using one pharmacy can help ensure consistency in care.
• Some pharmacists specialize in geriatrics.

For elderly patients, pharmacists are often the most accessible health care practitioner. Pharmacists not only dispense drugs, but they also provide drug information to patients, monitor drug use (including adherence), and liaise between physicians (or other health care practitioners) and patients to ensure optimal pharmaceutical care. Pharmaceutical care includes providing appropriate drug therapy to achieve outcomes such as disease prevention, cure or symptom relief, and slower functional decline. Major responsibilities of pharmacists include prevention, rapid identification, and resolution of drug-related problems (see Table 10-1).

Drug-related problems are a common source of preventable morbidity or mortality and increase overall medical costs. The elderly are particularly vulnerable to drug-related problems because of the following:

• They often take several prescription and OTC drugs concurrently.
• Age-related changes in pharmacokinetics and pharmacodynamics predispose them to adverse drug reactions.
• They frequently do not adhere to drug regimens, often overusing or underusing drugs; rates of adherence do not change because of age per se but because of other factors common among the elderly.

Patient adherence: Pharmacists assess the patient's ability to adhere to a drug regimen by recognizing certain impairments (eg, poor dexterity, lack of hand strength, cognitive impairment, loss of vision). For example, pharmacists can see whether patients can open drug containers (eg, bottles, wrappers) and determine whether patients can describe the drug regimen.

Pharmacists can, when appropriate, take measures that facilitate adherence to a drug regimen. They may teach patients how to take certain drugs (eg, inhalers, transdermal patches, injectable drugs, eye or ear drops) or how to measure doses of liquid drugs. They may supply drugs in ways that are accessible to patients (eg, easy-open bottles, pills without wrappers) and may ensure that drug labels and take-home printed material are in large type and in a patient's native language. Pharmacists can teach patients how to use drug calendar reminders, commercially available drug boxes, or electronic drug-dispensing devices as well as pill splitters and pill crushers. Pharmacists can help eliminate unnecessary complexity and duplication from the overall drug regimen. They can also provide information about drug-drug interactions (including those that involve OTC drugs), drug-dietary supplement (eg, medicinal herb) interactions, and drug-food interactions.

Training: Pharmacists receive a baccalaureate degree in science (BS), which requires at least 5 yr of higher education with extensive didactic training in biochemistry, medicinal chemistry, anatomy, physiology, pathophysiology, and clinical pharmacology (including pharmacokinetics and clinical therapeutics). The doctorate in pharmacy program (PharmD) is typically a 6-yr program and includes more extensive clinical and didactic training. At least 1500 h of advanced pharmacy practice experience (experiential training) is also required; this training may include clinical experience (eg, patient care and consultation) and nonclinical experience (eg, distribution of drugs). Most schools of pharmacy are accredited by the Accreditation Council for Pharmacy Education. Because demographics are changing and drug use by elderly people is disproportionately high, the need for knowledge of geriatric pharmacotherapy has increased. Pharmacy schools across the country are slowly adding such courses to the curricula. Also, residencies, fellowships, doctorate programs, and other postgraduate geriatric training programs are becoming increasingly prevalent. An examination for geriatric certification is offered by the Commission for Certification in Geriatric Pharmacy (see http://www.ccgp.org/). A geriatric pharmacist can be located through this site or through http://www.seniorcarepharmacist.com.

This topic was last updated July 2006.