Senior Care Pharmacist最新文献

This case highlights the pharmacist's role in the outpatient management of an older patient with complex cardiovascular conditions following a stroke. The patient lives in the community and is seen in a pharmacist-run clinic for chronic disease state management. The focus is on secondary stroke prevention through lifestyle modifications and optimization of comorbid conditions, including smoking cessation, antithrombotic therapy, and management of hyperlipidemia, hypertension, and diabetes.

This is the second in a series of Age-Friendly case studies developed as a function of the John A. Hartford Foundation grant to the American Society of Consultant Pharmacists and the Peter Lamy Center on Drug Therapy and Aging at the University of Maryland School of Pharmacy to Leverage Pharmacists as Age-Friendly 4Ms Champions. This series presents a case for each of the 4Ms: What Matters, Medication, Mentation, and Mobility, and examines how these elements interrelate to optimize care for older patients.This case presents an interprofessional framework for optimizing a patient's medication regimen. It includes tools and suggested deprescribing guidelines to help pharmacists prioritize medication recommendations. Using the Age-Friendly 4Ms framework, the authors reviewed and adjusted the patient's medications, aiming to support her "What Matters" goal of returning to volunteer work at her church, which she had given up because of unsteadiness, low energy, and difficulty focusing. The care team developed a plan involving interprofessional collaboration among a social worker, physical therapist, primary care provider, and to support the patient in reaching her goal.

Pharmacists have emerged as important members of the health care team to optimize outcomes for older patients. Demand for pharmacists with experience caring for adults aged 65 years and older is expected to increase as the population continues to age. Cooperman Barnabas Medical Center (CBMC) is an acute care hospital located in Livingston, New Jersey, that offers a Post-Graduate Year-2 (PGY2) Geriatric Pharmacy Residency Program. The hospital performs a variety of surgical services for many older patients annually. The authors aimed to outline a residency rotation developed within this program that was designed to introduce the resident to the peri- and post-operative setting. Over a four-week period, the resident identified 70 opportunities to optimize medication use in surgical and postoperative older patients. Of these recommendations, 70% were accepted, indicating potential value to the health care team. Creating this rotation enabled the residency program to achieve its goal of developing a specialized clinician to serve the medical needs of older patients.

With the increasing prevalence of polypharmacy, age-related physiological changes, and the need for individualized pharmacotherapy in older patients, understanding new drug approvals is crucial to optimizing medication management. This paper synthesizes the latest evidence and offers insights into prescribing considerations, potential drug-drug interactions, and strategies to mitigate adverse effects. We believe this work will be of significant interest to health care professionals, including pharmacists, physicians, and geriatric specialists, as they navigate the evolving landscape of pharmacotherapy in older adults.

Background Older adults are at increased risk for opioid-related harm due to decreased drug metabolism and elimination, polypharmacy, and comorbid conditions. The ONE (Opioid and Naloxone Education) Program is a pharmacy-based opioid risk mitigation initiative that employs evidence-based patient screening to identify risk of opioid-use-disorder (OUD) and opioid overdose (OD). Based on screening results, pharmacists provide patient-specific education and interventions. Objective To compare the risk of OUD, OD, and the opioid harm reduction interventions provided to adults aged 65 and older to those under 65 recieving opioid medications. Design The screening tool used in this study is a paper-based, patient-facing instrument intended to be completed by the patient. Pharmacists recommend patients to complete the screening tool and participate when presenting an opioid prescription to be filled. However, completing the screening tool is voluntary for the patient. Setting The ONE Program invited all registered pharmacists in the state to participate in a free three-hour continuing education (CE) program, offered live or online. The training consisted of education including but not limited to risks associated with opioids and accidental overdose, the role of naloxone, and the use and interpretation of the opioid risk screening tool. The program began in 2018 in North Dakota and now spans over 75 community pharmacies across the state. Methods Patient demographics, opioid risk screening results, and pharmacist-delivered interventions were analyzed from 2022 to 2023. Statistical analysis and age stratification were conducted on 15,025 screenings to evaluate OUD risk, OD risk, and delivered interventions. The North Dakota State University Institutional Review Board approved the methods and research design of this study (IRB0003838). Results Patients aged 65 and older had a 36% higher risk of OD, while those under 65 had a 51% higher risk of developing OUD. The older age group received a statistically significant higher proportion of naloxone education and dispensed naloxone from the pharmacy. Concurrent use of benzodiazepines and muscle-relaxants was significantly higher in the younger age group; however, the 65 and older age group reported taking multiple opioids nearly twice as frequently as those under 65. Conclusion A comparison of opioid use, opioid risk stratification, and interventions for patients under 65 and 65 and older showed statistically significant findings. Community pharmacy-based opioid risk screening offers an innovative approach to identifying high-risk patients and delivering tailored interventions directed to opioid-harm reduction.

This case study focuses on the treatment of a patient who develops acute kidney injury due to multiple medications used to treat her comorbidities. Older people are at higher risk of developing acute kidney injury compared to the general adult population and are also at the highest risk of morbidity and mortality from this disease state. This case reviews the approach of assessing and adjusting therapy in an older patient and the common etiologies of acute kidney injury.