This document discusses medication-related problems (MRPs) that are common in the elderly population due to factors like polypharmacy and age-related changes. MRPs increase risks of adverse drug reactions and costs of healthcare. The pharmacist's role includes identifying MRPs using tools like the Beers Criteria and Medication Appropriateness Index. A medication regimen review involves minimizing drugs, considering alternatives, educating patients, and regular follow-ups. Assessing patients holistically through geriatric assessments can help optimize medication safety and efficacy for the elderly.

1. Evaluating Medication Regimensin the Elderly Yesenia Martinez Nova Southeastern University College of Pharmacy

2. Purpose and Objectives 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? What actions are taken by the pharmacist in order to identify, correct, and prevent MRPs?

3. 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”

5. MRPs in nursing facilities cost an estimated $4 billion

7. Confusion or changes in mental status

10. 3.5 to 8 medications (hospital – acute care)

12. Define standards of care

13. Focus on improving quality of care

15. Underrepresentation in clinical trials

17. High Frequency of ADRs Among Elderly Reasons: Multiple physicians prescribing independently Patient nonadherence Inappropriate self-medication Inadequate patient education Age-related physiological changes

18. Medication Nonadherence Reasons for Intentional Nonadherence: Feeling of being overmedicated Limited income Other Reasons for Nonadherence: Poor communication Declining cognitive function Complicated drug regimens

19. Medication Nonadherence Risk Factors: Chronic conditions (≥ 3); Medications (≥ 5); Daily dosages (≥ 12); Prescribers (≥3); Medication regimen changes in previous 12 months (≥ 4) Living alone in community Significant cognitive/physical impairment Recent discharge from hospital Relying on caregiver Low literacy level History of poor medication adherence

21. Maximum doses for certain medications

22. About 7.5% to 27% of elderly patients use a Beers list drug

24. 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

25. 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

27. Components:

28. Mental, Functional, Social, Economic, and Physical status

29. Values

31. Is each medication necessary?

32. Are nonpharmacological alternatives available?

33. Is the lowest effective dose being used?

34. Any unaddressed medical or medication-related problems?