medisort - evaluating meds in elderly
DESCRIPTION
Yesenia MartinezTRANSCRIPT
Evaluating Medication Regimens
in the Elderly
Yesenia MartinezNova Southeastern UniversityCollege of Pharmacy
Purpose and Objectives
1) What medication-related problems (MRPs) are specific to the geriatric population and what puts these patients at a higher risk for experiencing adverse drug reactions (ADRs) and MRPs?
2) What actions are taken by the pharmacist in order to identify, correct, and prevent MRPs?
MRPs - Definition
“Undesirable event experienced by a patient that involves, or is suspected to involve, drug therapy, and actually or potentially interferes with a desired patient outcome”
MRPs – Statistics & Significance
28% of hospital admissions among older patients can be attributed to MRPs
MRPs in nursing facilities cost an estimated $4 billion
For about every dollar spent on drugs in nursing facilities, about $2.00 is spent on health care resources for treatment of MRPs
MRPs - Presentation
MRPs are often mistaken for normal consequences of aging
or progression of disease
Examples: Falls and/or movement and gait disorders Confusion or changes in mental status Electrolyte imbalance
MRPs – Eight Categories
1) Disease with no treatment2) Treatment for no apparent disease3) Wrong drug4) Drug that is not the most appropriate5) Too little OR too much of correct drug6) ADR7) Drug interaction8) Improper drug administration
Elderly at Risk - PolypharmacyDrug Use Among the Elderly: 3 to 4 medications (community) 3.5 to 8 medications (hospital – acute
care) ~6 medications on average (nursing
facility)
Illness Among the Elderly: 48% of Medicare beneficiaries over 65
years old have at least 3 chronic conditions
Elderly at Risk - CPGs
Clinical Practice Guidelines: Are based on clinical evidence and
expert consensus Define standards of care Focus on improving quality of care Address single diseases
Elderly at Risk – Other Reasons
Increased Risk for MRPs Due To: Age (especially over 75 years) Underrepresentation in clinical trials Shortage of health care professionals
trained in geriatric pharmacotherapy
Risk Factors for ADRs Among Elderly1) Polypharmacy2) Multiple illnesses3) Use of high-risk medications4) Factors related to hospitalizations5) History of alcohol abuse or prior ADRs6) Living with confusion or dementia7) Certain patient characteristics (i.e.
weight, age, and renal function)
High Frequency of ADRs Among Elderly
Reasons:1) Multiple physicians prescribing
independently2) Patient nonadherence3) Inappropriate self-medication4) Inadequate patient education5) Age-related physiological changes
Medication Nonadherence
Reasons for Intentional Nonadherence:1) Feeling of being overmedicated2) Limited income
Other Reasons for Nonadherence:3) Poor communication4) Declining cognitive function5) Complicated drug regimens
Medication Nonadherence
Risk Factors:1) Chronic conditions (≥ 3); Medications (≥ 5);
Daily dosages (≥ 12); Prescribers (≥3); Medication regimen changes in previous 12 months (≥ 4)
2) Living alone in community3) Significant cognitive/physical impairment4) Recent discharge from hospital5) Relying on caregiver6) Low literacy level7) History of poor medication adherence
Inappropriate Prescribing
Beers Criteria: Medications to be avoided Maximum doses for certain medications About 7.5% to 27% of elderly patients
use a Beers list drug Most common: propoxyphene,
diphenhydramine, doxepin, amitriptylline
Inappropriate Prescribing
Medication Appropriateness Index:1) Indication?2) Is it effective?3) Correct dose and directions?4) Practical directions?5) Clinically significant interactions?6) Unnecessary duplications of therapy?7) Acceptable duration of therapy?8) Is it the least expensive alternative?
Medication Regimen Review
Step 1: Create a patient database Step 2: Review each medication Step 3: Create a problem list Step 4: Create a plan Step 5: Execute the plan Step 6: Follow up
Medication Regimen Review
M – Minimize number of drugs used A – Alternatives should be considered S – Start low and go slow T – Titrate therapy E – Educate the patient R – Review regularly
Geriatric Assessment
A multi-dimensional, diagnostic process designed to quantify an elderly person’s medical, psychosocial, and functional capabilities
Components: Mental, Functional, Social, Economic, and
Physical status Values Health maintenance
Final Thoughts
Pharmacists should be asking… Is each medication necessary? Are nonpharmacological alternatives
available? Is the lowest effective dose being used? Any unaddressed medical or medication-
related problems? Communication among pharmacist,
physician, nurse, patient, and patient’s caregiver is of utmost importance
Questions?
Miller, SW. Evaluating Medication Regimens in the Elderly. Consult Pharm. 2008 July; 23(7):538-47