Senior Care Pharmacists Can Provide Essential Services for Older Adults

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.

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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.

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