For example, anticoagulants and diabetes medications have significant side effects that have been shown to lead to ER visits in the elderly.
Whenever starting a new medication or increasing the dose of an existing medication, the prescriber and the pharmacist should monitor the patient for efficacy and toxicity and educate the patient and family/caregiver about the effects of the medication. Beizer, Pharm D, CGP, FASCP, AGSF, is a Clinical Professor and Assistant Chair of the Department of Clinical Health Professions at the College of Pharmacy and Health Sciences, St. She also practices as a clinical pharmacist at the Stern Family Center for Rehabilitation, part of Northwell Health. Beizer served on the Expert Panel for the 20 AGS Beers Criteria and is one of the editors of the Lexicomp Geriatric Dosage Handbook, currently in its 21st edition. When looking at the problems plaguing American healthcare and the potential contributions of pharmacists to help improve patient outcomes, experts often repeat the same refrains: encourage better patient medication adherence; offe...
This is not meant to imply that opioids should always be avoided.
They have a place in pain management (and pain can increase the risk of falls).
Geriatric topics are incorporated into the required curriculum in pharmacy schools, many schools offer an elective in geriatrics, and most colleges also offer rotations in geriatric care settings such as long-term care and geriatric clinics.
There is also a certification in geriatric pharmacy through the Commission for Certification in Geriatric Pharmacy and opportunities to perform specialty residencies in geriatrics.
But when adding an opioid to an older patient’s regimen, it is important to review the other CNS depressants on the regimen to see if they could be discontinued or the dose decreased.
Age-related changes in kidney function are one of the better understood and easily studied parameters affecting drug selection and dosing. Key recommendations: Calculate creatinine clearance, and avoid estimates of glomerular filtration (e GFR) that are routinely provided on lab reports.
Psychotropic drugs — chiefly antipsychotics, antidepressants, and sedative/hypnotics — have an established track record of being problematic in older adults, both in adverse effects and limited efficacy for some conditions they are commonly prescribed to treat, like dementia.
A National PBM Clinical Pharmacy Program Manager for the U. Department of Veterans Affairs, he is also an Associate Professor, Clinical in the Departments of Medicine, Geriatrics Division, and Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine in Chicago, IL. Semla’s opinions are his own and do not necessarily reflect those of the U.
a set of pharmacologic features that make certain drugs particularly hazardous for patients over 65 years of age.
It’s important to consider the Beers Criteria not just when starting a medication, but also when presented with a patient who has been on the medication for many years.
The patient may be having side effects from the medication and not realizing it, or perhaps there are now safer medications to use.
Todd Semla, MS, Pharm D, BCPS, FCCP, AGSF, is a clinical pharmacist with 35 years’ experience in geriatric pharmacotherapy. Pressures to reduce opioid analgesic prescribing has resulted in an increased use of nonsteroidal anti-inflammatories and acetaminophen.