Senior Care Pharmacist最新文献

Objective To assess the acceptability and perceived utility of the Minnesota Effective Medication Self-Management Toolkit (MEMSMT) four-step approach among participants in the Virginia Commonwealth University (VCU) Mobile Health and Wellness Program (MHWP). Methods Student pharmacist-led focus groups explored medication-related challenges faced by older adults and the perceived utility of the MEMSMT. Participants were recruited from four affordable senior apartment communities served by MHWP. Demographic characteristics of participants were collected and summarized using descriptive statistics. After an explanation of the four-step approach, participants shared their experiences with medication self-management. They then completed the Medication Self-Management Self-Efficacy Checklist and were asked, "Do you believe that the Minnesota Effective Medication Self-Management Toolkit's four-step approach can help individuals successfully manage their medications?" Comments regarding medication issues were documented and categorized according to the four aspects of self-medication management evaluated by the MEMSMT: indication, effectiveness, safety, and convenience of use. This study was approved as exempt research by Virginia Commonwealth University's Institutional Review Board (IRB), protocol HM20029554, titled "Effective Medication Self-Management at Low-Income Senior Housing." Results Five focus groups included 40 participants who took an average of 7.5 ± 5.2 medications daily. Most participants were Black (85%), female (70%), and had low health literacy (44%). The average age of participants was 72.2 years (SD ± 7.1). Examples of medication challenges were categorized as related to indication, effectiveness, safety, or convenience. Based on responses to the Medication Self-Management Self-Efficacy Checklist, participants expressed high confidence in their medication self-management skills. A vast majority of participants (94%) reported that using the MEMSMT four-step approach can help individuals successfully self-manage their medications. Conclusion Participants perceive the four-step process in the MEMSMT as a useful approach to improving medication self-management among residents of low-income senior apartment communities in the Richmond metropolitan area. Further evaluation of the Medication Self-Management Self-Efficacy Checklist is warranted.

Background Respiratory syncytial virus (RSV) can cause severe illness, particularly in older adults, leading to thousands of hospitalizations and deaths annually among individuals aged 65 and older. In May 2023, the U.S. Food and Drug Administration (FDA) approved two vaccines, Arexvy® (RSVPreF3) and Abrysvo® (RSVpreF), for the prevention of RSV-related lower respiratory tract disease (LRTD) in adults aged 60 years and older. In May 2024, the FDA approved a third RSV vaccine, mRESVIA® (mRNA-1345). In June 2024, the Centers for Disease Control and Prevention (CDC) updated its guidance to recommend a single dose of an RSV vaccine for all adults aged 75 years and older, as well as those aged 60 to 74 years old with risk factors for severe disease. Clinical trials have demonstrated that all three vaccines are safe and effective in reducing RSV-related morbidity and mortality. Objective To review the literature describing the safety, efficacy, tolerability, and clinical application of RSV vaccines in older adults. Data Sources Primary literature identified through PubMed, the U.S. clinical trial registry, and CDC resources from 2021 to 2025, with an emphasis on randomized clinical trials and key studies supporting FDA approval. Data Synthesis Arexvy® (RSVPreF3), Abrysvo® (RSVpreF), and mRESVIA® (mRNA-1345) have demonstrated efficacy in reducing the risk of RSV-associated LRTD and severe RSV-associated LRTD in adults aged 60 years and older. Reported adverse effects include injection-site pain, myalgia, fatigue, and headaches. Economic analyses suggest that all three vaccines are potentially cost-effective. Conclusion RSV poses a significant risk of morbidity and mortality, especially in older adults. Arexvy® (RSVPreF3), Abrysvo® (RSVpreF), and mRESVIA® (mRNA-1345) have been shown to effectively prevent LRTD caused by RSV in individuals aged 60 and older. Pharmacists play a vital role in supporting CDC recommendations, educating patients and optimizing preventive health strategies.

Mild psychotropic-induced hyponatremia is well in older adults. Although it is generally asymptomatic and does not require treatment, hyponatremia can increase the risk of falls, especially when combined with chronic conditions typical of frail patients. This clinical presentation adds a layer of complexity when managing pharmacotherapy and reducing fall risk in older adults. Viewing patients through the lens of the 4M framework provided by the John A. Hartford Foundation enables pharmacists to deliver holistic, patient-centered care, by addressing each of the four pillars (What Matters, Medication, Mentation, and Mobility) and adjusting care goals as patients progress through their lifespan. We present a case of an older adult with multiple comorbidities who recently experienced a fall, illustrating an approach to deprescribing and simplifying the medication regimen without compromising quality of care, while simultaneously improving quality of life.

Various comorbidities and extensive medication regimens often complicate the management of gout in older adults. Even in the general population, managing gout can be challenging, as clinicians must develop strategies for acute gout treatment, assess the need for chronic management, and optimize prophylaxis for gout flares. Several factors influence the choice of pharmacologic therapy, including the patient's medical history, current medications, social and family history, ethnicity, age, and care preferences. This article reviews gout management with a focus on older adults through a case study approach, highlighting the importance of shared decision-making. The integration of pharmacists into direct patient care introduces a novel model of pharmacist-led gout management, which can improve adherence to urate-lowering therapy and optimize medication selection. Despite the rising prevalence of gout, it remains one of the most poorly managed diseases. This review aims to emphasize key principles for effective and safe gout management, taking into account the comorbidities and medications commonly encountered in the older adult population.

Objective This study aimed to provide preliminary evidence supporting the validity and reliability of the 10-item Assessment for the Appropriate Use of Opioids in Long-Term Care. Design This analysis utilized baseline data from the study titled Testing the Pain Clinical Practice Guideline Using the Evidence Integration Triangle. Setting Six nursing homes were included in the study.Residents: Residents were eligible if they were 65 years of age or older and had evidence of pain or were receiving treatment for pain. The sample included 24 residents who were on opioid medications. Intervention/Procedure The authors collected data from electronic health records using research evaluators. Evidence of validity was established based on the internal structure of the measure and its relationship to other variables. Reliability was assessed through item reliability and internal consistency. Main Outcome Measures Descriptive variables included age, cognitive status, comorbidities, race, ethnicity, marital status, and education. Pain assessment was based on the Minimum Data Set: (1) a verbal response item and (2) four objective items. The Assessment for Appropriate Use of Opioids in Long-Term Care consists of 10 items evaluating the appropriate use of opioids. Results The mean age of the residents was 71.8 years (SD = 9.9). The majority were female (62%), White (54%), and non-Hispanic (92%). Evidence of validity was observed based on the internal structure of the measure, item fit, and associations with other variables. Reliability was supported by internal consistency and inter-rater reliability. Conclusions The study provided preliminary evidence of validity and reliability; however, future testing is needed with a larger, more heterogeneous sample.

Background Approximately 30% of individuals over the age of 65 experience at least one fall annually. Certain medications and medical conditions are known to increase the risk of falling; however, further research is needed to better understand this issue among low-income, community-dwelling older adults. Objective This study aims to identify the medical conditions and medications that increase the risk of falls among low-income, community-dwelling older adults in Richmond, Virginia. Methods The Mobile Health and Wellness Program (MHWP) was established by Virginia Commonwealth University (VCU) faculty in 2012 to provide free care coordination services for older adults living in low-income communities. Currently, MHWP serves 1,648 older adults residing in Richmond's subsidized housing communities or accessing services through a clinic. Older adults with documented fall history (self-reported yes or no), at least one medical condition, and at least one prescription medication were selected for chart review. Data for 499 participants were accessed via Research Electronic Data Capture (REDCap) and exported into IBM SPSS Statistics for Macintosh, Version 29.0 for statistical analyses. Chi-square tests were used to compare medication use and medical conditions with fall risk. Results Among the MHWP participants who met the inclusion criteria (n = 459), 27% (n = 125) self-reported experiencing a fall within the previous two years. Atherosclerotic cardiovascular disease, congestive heart failure, epilepsy, osteoarthritis, and stroke were significantly more prevalent in fallers compared to non-fallers. Additionally, the use of pain medications, antihypertensives, anti-seizure medications, and metformin was significantly more common among fallers than non-fallers. Conclusion Prioritizing community-dwelling older adults with the medical conditions and/or medications identified in our study may enable a more targeted approach to reducing fall risk.

Background Bone pain related to metastases is common among individuals who develop cancer later in life and can be debilitating. Acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and opioids are typically used to treat this type of pain. However, many patients have comorbidities, allergies, or adverse reactions that limit the use of one or more of these types of medications. Objective The objective of this review is to explore alternative medications that could be effective in treating older individuals with cancer-related bone pain while minimizing adverse effects. Data Sources The authors conducted a literature search in PubMed using "bone pain" and "medications" in the Title/Abstract field with no exclusions. After excluding articles that focused on non-cancer bone pain, those not in English, or involved animal studies, twelve articles published between 2004 and 2024 were included for analysis. Data Synthesis Several potentially useful therapies were discussed or evaluated in the articles used in the review. These include bisphosphonates, antihistamines, denosumab, antidepressants, anticonvulsants, corticosteroids, ketamine, and cannabinoids. Discussion Bisphosphonates and denosumab were found to be more effective at preventing bone pain than treating it. Antihistamines were associated with reduced bone pain in patients treated with granulocyte-colony stimulating factor (G-CSF). Antidepressants and anticonvulsants showed an improvement in bone pain with a neuropathic element. Conclusion Several alternative therapies for cancer-related bone pain were identified. However, more research is needed to determine which options are more effective for patients who cannot use or are not getting relief from standard medications.

As life expectancy increases, the older adult population is expected to grow significantly. As a result, gout cases continue to escalate in both incidence and prevalence. Gout is a chronic inflammatory condition that disproportionately affects older adults, certain racial and ethnic groups, and underserved populations. Risk factors for gout include renal impairment, genetics, select medications, obesity, and lifestyle factors. It is also associated with numerous comorbidities, such as cardiovascular disease, metabolic syndromes, chronic kidney disease (CKD), depression, and anxiety. This article examines the prevalence, pathophysiology, and risk factors of gout in the aging population. It highlights the unique challenges of managing gout in older adults, including polypharmacy, declining renal function, and the presence of other chronic conditions. The roles of diet, medication use, and lifestyle in the development and exacerbation of gout are discussed, with special attention to the complexities these factors introduce in geriatric care. The goal of this review is to equip clinicians with the knowledge needed to provide optimal care for older adults living with gout, as the need for this service continues to rise.