Illustration by George Folz, © 2019 Board of Regents of the University of Wisconsin System
Within the next 40 years, one in four Americans will be older than age 65.1 It is common for older adults to have at least one chronic health condition (e.g., diabetes, depression, heart failure, urinary incontinence), and many older adults have more than one. The greater the number of chronic health conditions, the greater the number of medications prescribed to manage them. Thirty to 40% of older adults take 5 or more medications and 10% take more than 10.2–5 While medications can do a lot of good, they can also produce significant drug-related harm in older adults. For example, risks associated with drug interactions are high in this population. Complicating this situation, older adults are more prone to the adverse effects of medications because of age-related changes in the way medications get into and out of the body (i.e., pharmacokinetics) and changes in the body’s response to medications (i.e., pharmacodynamics).6 Geriatric pharmacists, by virtue of their education, training, and expertise, are well positioned to manage, either directly or as a contributing member of an interprofessional team, implications for medication use based on pharmacokinetic and pharmacodynamic changes associated with aging.
Consider, as an example, a class of medications called benzodiazepines used to treat anxiety and sleep problems in older adults.7 The changes that occur in pharmacokinetics and pharmacodynamics with aging can result in adverse drug events if not accounted for when they are prescribed. Metabolism of benzodiazepines can be slowed with aging, prolonging the time these drugs remain in the body. Furthermore, as we age, our brains become more sensitive to the effects of benzodiazepines, which can exacerbate side effects and lead to troubling adverse drug events. Consequences of benzodiazepine use in older adults include an increased risk for falls and motor vehicle accidents, as well as impairments in cognition (i.e., thinking and memory) and development of dependency with withdrawal-like effects if suddenly discontinued.7–10 As a result, this class of medications is considered inappropriate for older adults.11
Nationwide recognition of the value of geriatric pharmacists dates back over 45 years.12 Given the inherent risks associated with medication use in this special population, the federal government passed legislation in the mid-1970s mandating that pharmacists perform monthly drug regimen reviews (DRRs), also referred to as medication regimen reviews, for persons residing in skilled nursing facilities. These settings are also referred to as nursing homes, or long-term-care facilities. Monthly DRRs generally entail a review of all medications the long-term care resident is prescribed at the time of the review, with the purpose of identifying ineffective or potentially inappropriate drug therapy, side effects, drug interactions, and duplicate drug therapy.13 If any of these circumstances are noted, the geriatric pharmacist intervenes with recommendations to optimize medication ...