|The Senior Care Pharmacist|
IN THIS ISSUE
February 2019 | Volume 34 | Number 2
In this issue, a pharmacist describes her experience with caregiving for family members with declining health. The article is a unique expression of the complex nature of caregiving and all of the processing, communication, and decision making involved. And, when transitions of care are thrown into the mix, the challenges become even greater.
While most pharmacists recognize that the health care system has problems, especially at transitions of care, few fully appreciate how serious these problems can be for older adults. A pharmacist’s personal journey through the health system—for both the patient and the caregiver—with two older individuals, this narrative discusses how difficult it is for patients to understand what’s happening around them. It also discusses the clinical inertia in addressing geriatric issues and offers suggestions to health care providers facing similar situations.
Optimal care for the older adult with heart failure (HF) is complex and requires specialized knowledge of the disease state. Pharmacists have a unique role to play in helping patients with medication review and education, either alone or as part of a multidisciplinary team. Pharmacists can be involved with these patients in a variety of settings, including the hospital, community, outpatient clinics, and nursing facilities, and they can have an impact on the transition of care among these settings. Being knowledgeable about updated recommendations for HF pharmacotherapy and best practices is essential to optimize the role of pharmacists to improve patient outcomes.
Meropenem-vaborbactam is a newly approved antibiotic for complex urinary tract infections (cUTIs) and treating carbapenem-resistant Enterobacteriaceae infections. Its advantage over meropenem is the beta-lactamase inhibitor, which slows bacterial resistance. This medication has been studied in numerous countries and has relatively few side effects. There were slightly higher incidences of alanine aminotransferase and aspartate aminotransferase elevations and infusion-site phlebitis, but less anemia, vaginal infections and discontinuation when compared with pipercacilin-tazobactam. The combination drug’s relevance for the geriatrician is that older adults are at higher risk for cUTIs.
The results of this study suggest that direct oral anticoagulants used with older adults in a real life outpatient setting are frequently dosed inconsistently in terms of current recommendations established by the Food and Drug Administration (FDA). Older age and moderate renal impairment were noted to be factors in patients more likely to be under dosed. Other factors commonly seen in older adults such as frailty and bleeding may have been aspects considered by clinicians when deciding dosing but were not assessed by this review. Dosing inconsistent with FDA-approved recommendations has been shown to potentially lead to adverse outcomes.
This study found an extraordinarily high level of prescriptions in very old long-stay nursing facility residents. The results of this quality assurance study indicate that this high number of prescriptions in this unique population is possibly because of 1) the substantial comorbidities of the very old residents or 2) the prescribing habits of their physicians. While this study showed a statistically significant decrease in total number of medications prescribed by geriatricians, it may be difficult to reduce the total number of medications ordered to fewer than 10 prescriptions in a very old resident population.
Medicare Part D and Medicare Advantage comprise the largest share of pharmacy revenue, followed closely by Medicare Part A, from which pharmacies get paid through the nursing facility prospective payment system. Entitlement programs supply more than 90% of the typical long-term pharmacy’s revenue.
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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.
2019 ASCP Integrated Media Kit
Nonmembers can access online abstracts to journal articles. Full articles are available for $35.00 each.
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