Senior Care Pharmacist最新文献

Background Urinary tract infections (UTIs) are the most prevalent infections in older patients with the potential for morbidity and mortality. Antibiotics are not generally recommended for UTI prophylaxis in this population. There is interest among the public and health providers to try over-the-counter products, such as cranberry, D-mannose, and vitamin C. The objective of this analysis was to review the literature for the efficacy and tolerability of these supplements in older individuals. Methods A literature review was conducted on PubMed using the search terms urinary tract infection or UTI, prevention/prophylaxis, cranberry, D-mannose, vitamin C/ascorbic acid. Few studies were conducted among older people; therefore, the authors included studies of all adults who had recurrent UTIs or were at increased risk of UTIs. Level (quality) of evidence were determined using the ACC/AHA Clinical Practice Guideline Recommendation Classification System. Results A total of 24 studies were included. This review captured all studies in previous reviews as well as recent publications. The authors determined that there were limited data for D-mannose and vitamin C, and randomized data for cranberry as defined by the classification system. Conclusions The three supplements reviewed appear not to be strongly supported by clinical data. For those who are interested in trying these products despite the lack of robust evidence for clinical efficacy, it may be helpful to know that the studies included in this review did not identify any clinically important signs of harm, to the extent that safety data were documented and reported.

Chronic obstructive pulmonary disease therapy management can be complex given the various types of inhaler devices available, even within a therapeutic class. Appropriateness of an inhaler relies on many patient-specific factors. Senior care pharmacists can positively impact patient care by providing appropriate inhaler assessment as well as education on inhaler technique to ensure maximal benefit from therapeutic treatment choices.

Background Currently, our institution does not have a full-time pharmacist rounding with the inpatient acute care of the elderly (ACE) team daily. We sought to evaluate the involvement of a clinical pharmacy service within the ACE team and its impact on appropriate medication use. Objective The primary outcome was the number of drug-related problems (DRPs) and potentially inappropriate medications (PIMs) detected by the pharmacist compared with no pharmacist on the ACE team. Secondary outcomes included length of stay, 30-day re-hospitalization, and accepted DRPs and PIMs recommendations made by the pharmacist. Methods This was a retrospective, single-center, cohort study. The control cohort consisted of patients seen over 3 months when no pharmacist was present. The intervention cohort comprised patients seen over 3 months when a pharmacist was present on the ACE team. Patients were excluded if there was not a documented chart note from a geriatric provider or pharmacist. Results A total of 125 patients were included in the intervention group and 106 patients in the control group. Regarding the primary outcome, the control cohort had significantly fewer identified PIMs and DRPs in comparison with the intervention cohort (P < 0.001; P < 0.01, respectively). There was no significant difference in length of stay (P = 0.317). There was a statistical difference between groups regarding 30-day readmission rates (P = 0.007). Conclusion Our study shows that the inclusion of a pharmacist on the ACE team was associated with more DRPs, and PIMs identified, creating a positive impact on patient care and 30-day readmission.

Elder abuse encompasses many types of abuse, including physical, sexual, emotional, neglect, and financial abuse. Abuse, including neglect and exploitation, is experienced by about 1 in 10 people aged 60 and older who live at home.¹ However, this is likely an underestimation. Non-fatal injury reporting is limited to those collected from emergency department visits only, and under-reporting of abuse.^1,4,15 It has been reported that only 1 in 24 cases of elder abuse are actually reported to authorities.⁴ Elder abuse is often perpetrated by the family members, caregivers, financial advisors, or other individuals trusted by the older person. Due to the COVID-19 pandemic, there have been stay-at-home orders enacted throughout the country, confining older adults to their homes, potentially increasing their risk. These stay-at-home orders have also decreased social interactions, and social isolation is a known risk factor for elder abuse. During the pandemic, many visits to physicians have been canceled, delayed, or moved to telehealth; however, visits to pharmacies remained essential. Pharmacists are mandated reporters and are able to identify potential misuse of medications and physical and emotional abuse, and neglect. The discussion highlights the continued importance of the role of pharmacists in preventing and reporting elder abuse though discussion of a patient case.

The Global Initiative for Chronic Obstructive Lung Disease Report provides guidance on prevention and management of chronic obstructive pulmonary disease (COPD), a pulmonary syndrome largely impacting older adults. Management of COPD in this patient population is often further complicated because of medication and disease state interactions. Pharmacists are in a unique position to impact patients with COPD through counseling on proper medication selection, disease state education, adherence, and proper inhaler technique.

Prevalence of dementia continues to increase with limited pharmacotherapy options available. Acetylcholinesterase inhibitors remain a mainstay of treatment. The US FDA has approved three oral medications within this class- donepezil, galantamine, and rivastigmine. In 2022, the US Food and Drug Administration approved a novel patch formulation for donepezil that could be beneficial for patients with dysphagia as well as potentially decreasing the side effect burden. The purpose of this analysis is to review the efficacy, safety, tolerability, and clinical considerations related to this novel formulation.