|The Senior Care Pharmacist|
Early June 2020 Article Release
The COVID-19 pandemic is a rapidly evolving phenomenon that presents serious practical challenges and complex clinical considerations for health care workers, health care administrators, and policy formulators. The Senior Care Pharmacist carries periodic updates addressing matters relevant to pharmacotherapeutics and pharmacy practice as these relate to the care of older people in the time of the pandemic. The brief news items that are provided here are not intended to be substitutes for a careful and comprehensive consideration of the issues involved, but rather, they serve to provide initial awareness of concepts and to stimulate more complete situational analysis.
IN THIS ISSUE
May 2020 | Volume 35 | Number 5
Now, more than ever, older people need pharmacists to protect them from medication-related problems inherent to psychotropic drugs. It is clear that, because of their specific training and technical knowledge in the area of pharmacotherapy, pharmacists have a logical place in any multidisciplinary context where drug treatment is prescribed—and always will be.
The COVID-19 pandemic presents many medical and social issues for older people. This article offers a range of information arising from related areas that have impact on the safety and efficacy of drug therapy for older people.
There are many opportunities for pharmacists to contribute to the better use of anxiolytic and sedative-hypnotic drugs, typically overprescribed and maintained for longer than recommended. Our research group has conducted a series of in-depth qualitative analyses that have deepened our understanding of the impact of organizational culture in long-term care facilities on the use of psychotropic medications.
FAnxiety disorders may be the most common mental disorder among the older population. Experts estimate its prevalence to be between 1.2% and 15% in community samples and 1% and 28% in medical settings. These patients manifest the symptoms of anxiety, and they are also at risk for increased disability, decreased health-related quality of life, and possibly mild cognitive impairment. For this reason, it is important for pharmacists to understand the challenges in assessing anxiety and the treatment options that are safe and effective in the older adult population. Additionally, pharmacists must be able to communicate well with these patients despite their tendency to perseverate and fixate.
Changes in Psychotropic Prescribing for Patients With Dementia, 2014-2016: Potential Implications for Pharmacists
Behavioral and psychological symptoms of dementia, also known as neuropsychiatric symptoms of dementia, often cause significant distress for patients and caregivers. Statistically significant increases in the prescribing of anticonvulsants and sedatives in physician visits from 2014 to 2016 suggest the possibility that these agents are being used to combat behavioral and psychological symptoms in patients with dementia. Further research is required to assess the rationale, efficacy, and safety of these uses.
The use of anticholinergics is often the go-to solution for urinary incontinence and over-active bladder; however, it is important to realize that an overrelaxed bladder can cause postvoid urinary residual that can lead to increased symptoms—rather than improved symptoms—for any patient. The newer class of beta-3 agonists also relax the bladder, as do anticholinergic agents, and should be used with caution with persons with urinary retention. The additional impact of anticholinergic medications on cognition and functional status can make successful toileting very challenging.
Structural and functional degeneration of the kidneys occur as the human body ages, making older people especially susceptible to the consequences of acute kidney injury. The use of nephrotoxic agents, combined with the increased incidence of acute kidney injury, makes geriatric patients prone to the development of drug-induced kidney disease. This article discusses the mechanisms of drug induced kidney disease with regard to vancomycin, daptomycin, and ceftaroline to provide insight as to their safety profiles with regard to the elderly. A clear understanding of this topic will aid clinicians in selecting drug therapy and may lead to shortened hospital stays, lower hospital costs, and improved outcomes of critically ill older people.
In this study, the inclusion of a pharmacist in an interdisciplinary team in an ambulatory geriatric-care clinic was associated with a positive impact on care by substantially increasing the number of drug related problems detected in older patients. The pharmacist has an added value to the interdisciplinary team in an ambulatory geriatric care clinic. By detecting these problems, the pharmacist can suggest appropriate changes to patients’ drug therapy, and, therefore, they may improve patient health, quality of life, and reduce adverse drug reactions.
The decision of the Centers for Medicare & Medicaid Services to suspend routine surveys in favor of focused inspections targeted at infection control is the first signal that long-term care will be at the epicenter of federal oversight.
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The Senior Care Pharmacist® is the official peer-reviewed journal of the American Society of Consultant Pharmacists (ASCP). It is the only journal dedicated exclusively to the medication therapy needs of older adults. ASCP members receive The Senior Care Pharmacist® as a member benefit. All articles (2004 to present) are free online for members.
2020 ASCP Integrated Media Kit
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Chris Alderman, B Pharm, PhD, FASCP, FSHP, BCGP, BCPP
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Timothy W. Meyers Ph.D., RN
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