Key concepts in medication management in older persons for pharmacists practicing in non‐geriatric specialties

Godbole, Gauri; Bolitho, Richard; Pont, Lisa G.

doi:10.1002/jppr.1765

Cited by 2 publications

(1 citation statement)

References 43 publications

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“…Medicines management for older adults is complex and physiological, functional, cognitive, physical, and social changes all impact the safety, effectiveness, and ongoing requirement for medications. 1 Emergency departments (EDs) are chaotic environments in which complex, frail, older adults are sometimes subjected to prolonged lengths of stay, excessive tests, and develop iatrogenic complications. 2 Therefore, EDs are often a vital touchpoint in their healthcare journey.…”

Section: Introductionmentioning

confidence: 99%

Multidisciplinary care of older adults in the emergency department to influence deprescribing in older adults: a cohort study

Reilly,

Buikstra,

Strivens

et al. 2023

Pharmacy Practice and Res

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BackgroundInappropriate polypharmacy in older adults is a major health problem associated with poor clinical and health service outcomes.AimWe aimed to evaluate the effectiveness of a geriatric pharmacist service in the emergency department (ED) identifying potentially inappropriate prescribing (PIP).MethodBetween 1 June 2018–31 May 2019, adults ≥70 years of age presenting to ED were reviewed by the Geriatric Emergency Department Intervention (GEDI) pharmacist. The intervention consisted of pharmacist‐led medication review using Screening Tool of Older Person’s Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) criteria, patient education on recommendations, an updated medication list, and a letter sent to their general practitioner (GP) electronically. For eligible consenting older adults, telephone calls were made at least 28 days post‐discharge to assess the effectiveness of the intervention. A survey with GPs after 6 months determined how recommendations were perceived. Ethics approval was granted by the Metro North Health B Human Research Ethics Committee (reference no: HREC/18QCH/69–1245) and research governance approval was granted by the study site (Cairns Hinterland Hospital and Health Service, reference no: SSA/Q12345/40673). Informed consent was obtained from all participants via a project information sheet and either the completion of a written consent form (patient participants), verbal consent before interview (GP participants), or implied consent via email responses (GP participants). Routinely collected health data obtained for this study were de‐identified and data included in the follow‐up study was de‐identified.ResultsThe GEDI pharmacist reviewed 1214 older adults with an average age of 81 years. The median number of prescribed medications was 10 and 36.8% of older adults had STOPP recommendations. When contacted (n = 35), of those enrolled in the follow‐up study, 71% had stated their medications changed, 40% reported all STOPP medications had ceased, and 69% had START medications commenced, suggesting the recommendations provided were clinically appropriate and readily accepted by their GPs.ConclusionIntegration of a geriatric pharmacist demonstrated ample opportunities to address PIP in targeted older adults presenting to ED. This study shows that the pharmacist was able to promote appropriate prescribing through patient education and recommendations communicated to the GP on discharge.

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Section: Introductionmentioning

confidence: 99%

Multidisciplinary care of older adults in the emergency department to influence deprescribing in older adults: a cohort study

Reilly,

Buikstra,

Strivens

et al. 2023

Pharmacy Practice and Res

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Deprescribing potential of commonly used medications among community-dwelling older adults: insights from a pharmacist’s geriatric assessment

Bužančić,

Držaić,

Kummer

et al. 2024

Sci Rep

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Pharmacist’s geriatric assessment can provide valuable insights into potential deprescribing targets, while including important information on various health-related domains. Data collected from a geriatric assessment questionnaire, for 388 patients, from the Croatian cohort of the EuroAgeism H2020 ESR 7 international project, along with guideline-based deprescribing criteria, were used to analyse potentially inappropriate prescribing of four medication groups (benzodiazepines (BZN), proton pump inhibitors (PPI), opioids, and non-steroidal anti-inflammatory drugs (NSAID)), and to assess the deprescribing potential. Binary logistic regression was used to explore the effects of age, gender, number of medicines and diagnoses, self-reported health, frailty score, and healthcare utilization on the likelihood of needing deprescribing. More than half of participants (n = 216, 55.2%) are candidates for deprescribing, with 31.1% of PPI, 74.8% of NSAID, 75% of opioid, and 96.1% of BZN users meeting at least one criterion. Most common criteria for deprescribing were inappropriately long use and safety concerns. Women (aOR = 2.58; p < 0.001), those reporting poor self-reported health (aOR = 5.14; p < 0.001), and those exposed to polypharmacy (aOR = 1.29; p < 0.001) had higher odds of needing to have medicines deprescribed. The high rate of deprescribing potential warrants prompt action to increase patient safety and decrease polypharmacy. Pharmacist’s geriatric assessment and deprescribing-focused medication review could be used to lead a personalised approach.

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Key concepts in medication management in older persons for pharmacists practicing in non‐geriatric specialties

Cited by 2 publications

References 43 publications

Multidisciplinary care of older adults in the emergency department to influence deprescribing in older adults: a cohort study

Multidisciplinary care of older adults in the emergency department to influence deprescribing in older adults: a cohort study

Deprescribing potential of commonly used medications among community-dwelling older adults: insights from a pharmacist’s geriatric assessment

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