This slideshow explores skills for addressing pharmacotherapy in an integrated behavioral health setting. It develops the SEA model for addressing medication management in team based care. The SEA model considers medication SAFETY, medication EFFICACY, and medication ADHERENCE. It explores some of the impacts of social determinents of health on clinical outcomes for elders. Safety: Medication safety changes as we age. Older adults are are not just young adults with added years. Their bodies, brains, since of self and social systems have changed. Efficacy: Aging changes medication efficacy. Medications are involved in two main effects. These are the effect of the medication on the body (pharmacokinetics) and the effect of the body on the medication (pharmacodynamics). These are both changed as people age. Adherence: Adherence is a challenge at all ages. Adherence is impact by age related changes in body, cognitive capacity, social supports, and systems of care. Having an adherence plan can change health as we age.

1. Integrated Affective
Neuropharmacology
Geriatric Culturally Responsive
Pharmacotherapy: Addressing SDOH
and Reducing Disparities

2. Village Concept – Aging in Place

3. Elder Pharmacotherapy
the “S.E.A. Model”
1. Safety: Medication safety changes as we age. Older
adults are are not just young adults with added years.
Their bodies, brains, since of self and social systems
have changed.
2. Efficacy: Aging changes medication efficacy. Medications
are involved in two main effects. These are the effect of
the medication on the body (pharmacokinetics) and
the effect of the body on the medication
(pharmacodynamics). These are both changed as
people age.
3. Adherence: Adherence is a challenge at all ages.
Adherence is impact by age related changes in body,
cognitive capacity, social supports, and systems of care.
Having an adherence plan can change health as we age.

4. Social
Location and
Aging

5. (SEA Model) Elder Pharm
Safety
Polypharmacy: Assess for Impacts Polypharmacy in elders.
Often medications can be interacting in ways that increase
risk. Assess for medication interactions and likely
symptoms from interactions.
Polypharm
Medication Risk: Assess for the appropriateness of a
medication in elders. Look for medication risk and impact
on Beers List. Assess for high-risk medication impacts.
Med. Risk
Medication X Polypharmacy: Look for ways medication
could interact with polypharmacy to create higher risk
outcomes.
Med X
Polypharm
Safe Adherence: Assess for risk factors for taking
medications in ways that increase risk, create risk of
overdose and may not be manageable with current
supports and cognitive capacity.
Safe
Adherence
Support X System X Cognitive Capacity: Consider the ratio
of level of support, effectiveness of systems and cognitive
capacity in risk reward profile for medication management.
Support by
Systems by
Cognitive

6. 4 Key Changes in Aging
Biopsychosocial-Spiritual Changes in Aging
Aging Changes Brains
Brain
Aging Changes Bodies
Bodies
Aging Changes Since of Self
Self
Aging Changes Social Location
Social

7. “The Beers list was introduced in 1991 to improve the
quality of care for older adults. It is named after the
geriatrician Mark H. Beers, MD, who worked with a
panel of experts to develop a list of potentially
inappropriate medications (PIMs) in older adults in the
early 1990s.”
Mark H. Beers, MD

8. Who What How (WWH)
Elder Support Plan
1. Who: Who needs to be involved
to help the change work? Who
are the key team members?
Family members? Medical team
members? Social services?
Mental health?
2. What: What actions will help
improve health? Changes to
medications? Changes in
systems? Changes in Support?
Changes in Access?
3. How: How is this best
approached? Is family
interventions? Medical team?
Individual plan? Medication
support? Therapy? Increased
social activities?

9. Vignette (S.E.A. Model) – Safety
Adriana Gomez is a 74-year-old woman who a third
generation Mexican American who had worked in the
packing industry in San Francisco, raised 4 children and has
survived her spouse by 10 years. Her children are close
and involved in her life. She is proud and identifies with
being the matriarch of her family. Recently she has been
having more challenges with memory, anxiety and sleep.
She has been depressed most of her life and is taking
medications that has helped her in the past. Her family
attends a primary care appointment and you work with
the physician in a warm hand off. She has a hypertension,
migraines that started in youth, hyperlipidemia, lower back
pain managed by opiate medications > 10 years. Her
medication list is: Imitrex 100 mg PRN, Toparimate 50 mg
BID, Nortriptyline 25 mg QID, Norco 10/325 TID,
Doxazosin 1 mg PO HS., Atorvastatin 20 mg PO BID, Effexor
PO 75 mg TID.

10. S.E.A. Model
Efficacy

11. (SEA Model) Elder Pharm
Efficacy
1) Continued Need: Assess for continued need for
medication. As people age there is a tendency for a
medication to no longer be helping treat. However, often
people do not assess.
2) Body Change - LADME: Assess for changes in lifestyle,
social connections, diet and activities that could impact a
medications pharmacodynamics. There are four main
components of pharmacokinetics: liberation, absorption,
distribution, metabolism and excretion (LADME).
3) Brain Changes: As we age our brains change. Dopamine
levels change, serotonin levels change and gaba levels change.
Our sleep cycles change and our default mode network
changes (changing memory and attention).
4) BEERS Medication Review: Review the medications a client
in taking for their BEERS impacts. They may have lost efficacy
or the profile of risk reward has changed.

12. LADME Changes as we Age
• Liberation: Describes how a drug is
liberated from the delivery method.
• Absorption: Describes how the drug
moves from the site of administration to
the site of action.
• Distribution: Describes the journey of the
drug through the bloodstream to various
tissues of the body.
• Metabolism: Describes the process that
breaks down the drug.
• Excretion: Describes the removal of the
drug from the body.

13. Review Beers List and Make
WWH Plan
1. Who: Who needs to be involved to help the change work?
Who are the key team members? Family members?
Medical team members? Social services? Mental health?
2. What: What actions will help improve health? Changes to
medications? Changes in systems? Changes in Support?
Changes in Access?
3. How: How is this best approached? Is family interventions?
Medical team? Individual plan? Medication support?
Therapy? Increased social activities?

14. Vignette S.E.A. Model – Efficacy
Henrietta Vinton is a 72-year-old African American woman who has lived in
the north Richmond area her whole life. Her husband of 82 lives with her but
has health challenges that make caring for his spouse difficult. She has 5
children and 10 grand children.
She has been getting more and more tired, groggy, not sleeping well, but not
able to think for several months. She recently has been ill with a UTI and
since then she has stopped taking her morning walks. Her friend who she
walked with has been away visiting children in Texas and she has not gone
out due to the cold. She has had anxiety starting from a young age.
She has been both more anxious and less able to think. She has reported
feeling more and more depressed. She has been taking Klonopin 2 mg BID
for more than 20 years. She has been taking Ambien for several years for
sleep and she feels she can not fall asleep with out it but she still has a - hour
sleep latency and wakes up through out the night.
She also takes antihistamines (Benadryl) in the evening to help her allergies
and reportedly sleep. Her family is in her life and are more and more
concerned that they may need to have her move in with them or have
people with her around the clock. Henrietta is an independent individual
who prides herself and teachers her family self-reliance. She says she does
not want people helping in her home and sometimes refuses support from
children.

15. S.E.A. Model
Adherence

17. SDOH and
Aging
• SDOH Effect health
span.
• SDOH Effect Life
Span.
• SDOH Effect access
to medication.
• SDOH Effect
medication
adherence.

18. (SEA Model) Elder Pharm
Adherence

20. (SEA Model) Elder Pharm
Adherence
People, Access, Commitment and Systems
(P.A.C.S.) Model for Medication Adherence
1. People: Our social supports can deeply impact our ability to
adhere to behavior change. Taking medication is behavioral
change.
2. Access: Assess for access to medication, SDOH, Social
Location and the impact acccess can have on adherence
3. Commitment: Assess for commitment to medication or
treatment. Many people are either in an early stage of
change, don’t understand the rational for medication or the
medication is a lower priority compared with other health
factor.
4. Systems: Systems can improve adherence. If a person takes
more than three medications in a day adherence can be
quite low. However, good systems can improve adherence.
Helping develop systems with people can improve
adherence.