|The Senior Care Pharmacist|
IN THIS ISSUE
September 2020 | Volume 35 | Number 9
In this edition of The Senior Care Pharmacist, we publish a variety of contributions addressing the issue of vaccination. As the Northern Hemisphere enters the autumn/fall period, this matter assumes a renewed significance, with the rollout of immunization as a preventive strategy for the benefit of both individual patients and the wider community. It is, perhaps, ironic that though effective vaccination services are now available for a range of communicable diseases such as influenza, and that these have only become relatively recently available in the course of medical history, health care workers promoting this approach now face a different problem that has sometimes been referred to as "vaccine hesitance."
Improving Vaccination Coverage in All Age Groups Is a Global Imperative: Our Profession Must Be PreparedDominique Jordan
Vaccination is a global imperative, and the pharmacy profession must be prepared. International pharmacy organizations defined the administration of medicines, vaccines, and injectable medications as a key role of our profession. Vaccines are second only to clean water in terms of their impact on public health.
One of the greatest innovations in health care has been the development of vaccines and immunization programs that have significantly minimized the morbidity and mortality resulting from vaccine preventable diseases. While vaccines were traditionally used against infectious diseases, recent advances in technology have led to the development of vaccines for noncommunicable diseases and chronic conditions. Vaccinations are considered the most cost-effective intervention in public health that has the potential to save millions of lives every year. Despite the availability and effectiveness of vaccines for many diseases, immunization programs, and service uptake remain underused in many countries. This is mainly because of the lack of easy access to vaccinations, risk-benefit perceptions, false beliefs, and concerns about the side effects. Vaccine hesitancy—the reluctance or refusal to vaccinate, is listed as one of the top 10 threats to global health.
Skin tears are a common occurrence in older people, though many are unfamiliar with them until late in life. These painful wounds are more likely to occur with age as the skin experiences age-related changes. Numerous factors including declining dermal thickness and loss of elasticity contribute to their development. Polypharmacy is a risk factor. Prevention is the best approach, but once skin tears develop, treatment needs to be tailored to the tear’s grade.
In this case, a 93-year-old woman declines rapidly following glossectomy surgery and experiences rapid weight loss. She becomes withdrawn and uncommunicative and is diagnosed as failure to thrive and potentially cognitively impaired. The eventual explanation for her decline is unexpected, surprising—and counterintuitive. This case illustrates the importance of investigating every aspect of medication use related to outcomes including medication administration, therapeutics, and health system dynamics.
This case report suggests a possible association between delirium and oseltamivir use in older people, more specifically in those with a history of a neurocognitive disorder. Given that influenza is a seasonal epidemic globally, oseltamivir use continues to climb. Currently, it is recommended for those who are otherwise healthy and living in a long-term care facility to be treated with neuraminidase inhibitors in the setting of an influenza outbreak, exposing many seniors to the medication regardless of their influenza infection or immunization status. The authors hope that this case report highlights the importance of careful consideration when utilizing oseltamivir prophylaxis in older people in those with or without previous history of a neurocognitive disorder.
With the approval of the adjuvanted inactivated influenza vaccine quadrivalent (aIIV4), clinicians now have an additional option to prevent influenza in people 65 years of age and older. The vaccine has been shown to be safe and immunogenic compared with Tdap and aIIV3. AIIV4 carries warnings regarding its use in patients with a history of Guillain-Barr syndrome occurring within six weeks of influenza vaccination. The most common adverse reactions associated with aII V4 are injection site pain, fatigue, headache, arthralgia, and myalgia.
The Drug Enforcement Administration has agreed to publish a proposed rule that, if approved, would give nurses the legal authority to contact the pharmacy on behalf of the prescriber concerning controlled substances.
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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.
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