Senior Care Pharmacist最新文献

Objective: This review summarizes recent case reports where the consumption of dietary supplements by older adults may have caused an adverse event. Data Sources: In December 2023, PubMed was surveyed for case reports published from 2000 onwards, using two medical subject heading (MeSH) terms, "aged" and "dietary supplements," where the latter was combined with the MeSH subheadings "adverse effects," "poisoning," or "toxicity." Major clinical trials for dietary supplements were identified at ClinicalTrials.gov, an online database of clinical research studies, or in PubMed, and screened for information on adverse effects. Data Synthesis: The described search strategy yielded 820 publications, including 122 case reports, which were then manually screened for relevant and informative case reports involving dietary supplements and people 65 years of age or older. Consequently, 41 publications were selected describing 46 individual case reports. Etiologies of adverse events included interactions of dietary supplements with prescribed medication, ingestion of higher-than-intended or instructed supplement doses, intake of the same supplement from multiple sources, and supplement contamination. Prominent adverse events encompassed hypercalcemia (vitamin D), thyroid test interference (vitamin B7), neuropathy (vitamin B6), oxalate nephropathy (vitamin C), and interactions with warfarin therapy (vitamins E and K, and omega-3 fatty acids). Conclusion: Health care practitioners are advised to consider dietary supplements as contributors to adverse clinical symptom presentations, while patients are encouraged to provide current records of their prescribed medications and dietary supplements to their health care providers. This is particularly important for older adults where both medication intake and supplement consumption are high.

Editor Emeritus Chris Alderman reflects on his past five years in his role with The Senior Care Pharmacist. This editorial is his farewell address to the readers as new editors in chief take the helm.

Background: Cholinesterase (ChE) inhibitors enhance central cholinergic function and are considered as standard treatments to ameliorate symptoms relating to Alzheimer's disease. Though anticholinergic medications directly antagonize the effects of ChE inhibitors, they are commonly prescribed among hospitalized adults. Objective: To determine the impact of high anticholinergic burden (ACB) on length of stay (LOS) and 30-day readmission rates among hospitalized patients receiving concomitant ChE inhibitors. Methods: This was a retrospective cohort study conducted at a tertiary care academic medical center involving hospitalized patients on medical floors who received any Food and Drug Administration-approved ChE inhibitors during their hospital stay from October 1, 2022, to September 30, 2023. The primary outcome of the study was to compare hospital LOS among patients with high (ACB ≥ 3) versus low (ACB < 3) ACB. The secondary outcome was to assess the impact of ACB burden on 30-day readmission rates. Results: Among hospitalized adults, patients with high ACB exposure had a significantly longer hospital LOS (median: 5.50 vs 4.25 days; P < 0.001) than patients with low ACB exposure, after adjusting for covariates. Analysis of secondary outcome revealed that though the high ACB group had a higher 30-day readmission rate compared with the lower ACB group (6.8% vs. 2.2%), the difference was not statistically significant (OR = 3.46, 95% CI 0.85-14.08; P = 0.083). Conclusion: A high ACB exposure among older individuals taking concurrent ChE inhibitors is associated with a longer hospital stay.

While there is existing literature on medical ethics and geriatric care, this paper offers a unique perspective by examining the specific ethical challenges and obligations faced by pharmacists caring for older people. It provides a comprehensive ethical framework tailored to this specialized area of pharmacy practice. The findings and recommendations presented in this paper have significant implications for enhancing patient-centered, ethically grounded care for older people in pharmacy settings. It offers practical guidance for navigating complex ethical dilemmas and upholding the highest standards of care for this vulnerable population.

Health care providers, at some point in their careers, will experience grief and loss of a patient. Grief is a natural response that many people experience, especially working in those fields such as community pharmacy, hospitals, hospice, and others. Pharmacists serve as community leaders and need to be properly trained early on how to deal with grief and loss both personally and within their teams. Pharmacist leaders can lead their team through hard times by developing a toolbox of skills. These skills include emotional intelligence, communication, and leadership skills to work through personal grief.