Evaluating Medication Regimensin the Elderly<br />Yesenia Martinez<br />Nova Southeastern University<br />College of Pharm...
  Purpose and Objectives<br />What medication-related problems (MRPs) are specific to the geriatric population and what pu...
  MRPs - Definition<br />“Undesirable event experienced by a patient that involves, or is suspected to involve, drug thera...
  MRPs – Statistics & Significance<br /><ul><li>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 o...
Confusion or changes in mental status
Electrolyte imbalance</li></li></ul><li>  MRPs – Eight Categories<br />Disease with no treatment<br />Treatment for no app...
  Elderly at Risk - Polypharmacy<br />Drug Use Among the Elderly:<br /><ul><li>3 to 4 medications (community)
3.5 to 8 medications (hospital – acute care)
~6 medications on average (nursing facility)</li></ul>Illness Among the Elderly:<br /><ul><li>48% of Medicare beneficiarie...
Define standards of care
Focus on improving quality of care
Address single diseases</li></li></ul><li>  Elderly at Risk – Other Reasons<br />Increased Risk for MRPs Due To:<br /><ul>...
Underrepresentation in clinical trials
Shortage of health care professionals trained in geriatric pharmacotherapy</li></li></ul><li>  Risk Factors for ADRs Among...
   High Frequency of ADRs Among Elderly<br />Reasons:<br />Multiple physicians prescribing independently<br />Patient nona...
Medication Nonadherence<br />Reasons for Intentional Nonadherence:<br />Feeling of being overmedicated<br />Limited income...
Medication Nonadherence<br />Risk Factors:<br />Chronic conditions (≥ 3); Medications (≥ 5); Daily dosages (≥ 12); Prescri...
   Inappropriate Prescribing<br />Beers Criteria:<br /><ul><li>Medications to be avoided
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Medisort - Evaluating Meds In Elderly

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Medisort - Evaluating Meds In Elderly

  1. 1. Evaluating Medication Regimensin the Elderly<br />Yesenia Martinez<br />Nova Southeastern University<br />College of Pharmacy<br />
  2. 2. Purpose and Objectives<br />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?<br />What actions are taken by the pharmacist in order to identify, correct, and prevent MRPs?<br />
  3. 3. MRPs - Definition<br />“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”<br />
  4. 4. MRPs – Statistics & Significance<br /><ul><li>28% of hospital admissions among older patients can be attributed to MRPs
  5. 5. MRPs in nursing facilities cost an estimated $4 billion
  6. 6. For about every dollar spent on drugs in nursing facilities, about $2.00 is spent on health care resources for treatment of MRPs</li></li></ul><li> MRPs - Presentation<br />MRPs are often mistaken for normal consequences of aging or progression of disease<br />Examples:<br /><ul><li>Falls and/or movement and gait disorders
  7. 7. Confusion or changes in mental status
  8. 8. Electrolyte imbalance</li></li></ul><li> MRPs – Eight Categories<br />Disease with no treatment<br />Treatment for no apparent disease<br />Wrong drug<br />Drug that is not the most appropriate<br />Too little OR too much of correct drug<br />ADR<br />Drug interaction<br />Improper drug administration<br />
  9. 9. Elderly at Risk - Polypharmacy<br />Drug Use Among the Elderly:<br /><ul><li>3 to 4 medications (community)
  10. 10. 3.5 to 8 medications (hospital – acute care)
  11. 11. ~6 medications on average (nursing facility)</li></ul>Illness Among the Elderly:<br /><ul><li>48% of Medicare beneficiaries over 65 years old have at least 3 chronic conditions</li></li></ul><li> Elderly at Risk - CPGs<br />Clinical Practice Guidelines:<br /><ul><li>Are based on clinical evidence and expert consensus
  12. 12. Define standards of care
  13. 13. Focus on improving quality of care
  14. 14. Address single diseases</li></li></ul><li> Elderly at Risk – Other Reasons<br />Increased Risk for MRPs Due To:<br /><ul><li>Age (especially over 75 years)
  15. 15. Underrepresentation in clinical trials
  16. 16. Shortage of health care professionals trained in geriatric pharmacotherapy</li></li></ul><li> Risk Factors for ADRs Among Elderly<br />Polypharmacy<br />Multiple illnesses<br />Use of high-risk medications<br />Factors related to hospitalizations<br />History of alcohol abuse or prior ADRs<br />Living with confusion or dementia<br />Certain patient characteristics (i.e. weight, age, and renal function)<br />
  17. 17. High Frequency of ADRs Among Elderly<br />Reasons:<br />Multiple physicians prescribing independently<br />Patient nonadherence<br />Inappropriate self-medication<br />Inadequate patient education<br />Age-related physiological changes<br />
  18. 18. Medication Nonadherence<br />Reasons for Intentional Nonadherence:<br />Feeling of being overmedicated<br />Limited income<br />Other Reasons for Nonadherence:<br />Poor communication<br />Declining cognitive function<br />Complicated drug regimens<br />
  19. 19. Medication Nonadherence<br />Risk Factors:<br />Chronic conditions (≥ 3); Medications (≥ 5); Daily dosages (≥ 12); Prescribers (≥3); Medication regimen changes in previous 12 months (≥ 4)<br />Living alone in community<br />Significant cognitive/physical impairment<br />Recent discharge from hospital<br />Relying on caregiver<br />Low literacy level<br />History of poor medication adherence<br />
  20. 20. Inappropriate Prescribing<br />Beers Criteria:<br /><ul><li>Medications to be avoided
  21. 21. Maximum doses for certain medications
  22. 22. About 7.5% to 27% of elderly patients use a Beers list drug
  23. 23. Most common: propoxyphene, diphenhydramine, doxepin, amitriptylline</li></li></ul><li> Inappropriate Prescribing<br />Medication Appropriateness Index:<br />Indication?<br />Is it effective?<br />Correct dose and directions?<br />Practical directions?<br />Clinically significant interactions?<br />Unnecessary duplications of therapy?<br />Acceptable duration of therapy?<br />Is it the least expensive alternative?<br />
  24. 24. Medication Regimen Review<br /> Step 1: Create a patient database<br /> Step 2: Review each medication<br /> Step 3: Create a problem list<br /> Step 4: Create a plan<br /> Step 5: Execute the plan<br /> Step 6: Follow up<br />
  25. 25. Medication Regimen Review<br /> M – Minimize number of drugs used<br /> A – Alternatives should be considered<br /> S – Start low and go slow<br /> T – Titrate therapy<br /> E – Educate the patient<br /> R – Review regularly<br />
  26. 26. Geriatric Assessment<br /><ul><li>A multi-dimensional, diagnostic process designed to quantify an elderly person’s medical, psychosocial, and functional capabilities
  27. 27. Components:
  28. 28. Mental, Functional, Social, Economic, and Physical status
  29. 29. Values
  30. 30. Health maintenance</li></li></ul><li>Final Thoughts<br /><ul><li>Pharmacists should be asking…
  31. 31. Is each medication necessary?
  32. 32. Are nonpharmacological alternatives available?
  33. 33. Is the lowest effective dose being used?
  34. 34. Any unaddressed medical or medication-related problems?
  35. 35. Communication among pharmacist, physician, nurse, patient, and patient’s caregiver is of utmost importance</li></li></ul><li>Questions?<br />Miller, SW. Evaluating Medication Regimens in the Elderly. Consult Pharm. 2008 July; 23(7):538-47<br />

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