The Role of Pharmacists in Geriatric Care: A Comprehensive Review

Geriatric care has undergone immense change in the last few decades. This change is primarily due to the increase in the aging population globally. In the background of this demographic change, there has been growing recognition of special health needs for older adults. Pharmacists are now more recently recognized as integral members of the health care team, particularly in medication management optimization and improvement of health outcomes in the geriatric patient. The current review covers different roles played by pharmacists within the process of geriatric care: medication safety, transitional care, patient education, and general healthcare coordination.

The Pharmacist in Geriatric Care

This leads to a state of polypharmacy, where the older adult generally presents with complicated health profiles and often hosts a myriad of chronic conditions that require them to take many medications. This further refers to the situation by raising the risks for subsequent adverse drug events, medication errors, and readmissions to the hospital. The pharmacist is uniquely positioned because they specialize in pharmacology, medication counseling, and management; thus, they are specifically called upon to help solve the problems described above. They can bring tremendous improvements in the safety of their patients and adherence to medication regimens, thereby improving the quality of life for older adults.

Reducing medication-related problems

Medication-related problems are very common in elderly patients and are most expected during the transition of care, particularly at the time of discharge from the hospital. Multiple studies have shown that pharmacist-led interventions are very effective in reducing medication-related problems after discharge. These interventions mainly involve medication reconciliation, patient education, and follow-up consultations. For instance, a pharmacy-led transitional care program that has incorporated the key elements of medication reconciliation, teach-back methodology, and health care provider communication has considerably reduced the incidence of medication-related problems. This hence brings into context the central role of a pharmacist in so far as ensuring the secure and effective use of drugs among geriatric patients.

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Medication Adherence Improvement

Problems associated with adherence are common in geriatric care. Among the factors contributing to this are cognitive decline, complex medication regimens, and poor patient education. The pharmacist can make a difference by promoting adherence. through individual patient counseling, treatment regimen simplification, and medication adherence aids like pill organizers or reminder systems. Finally, some other interventions, such as the use of mobile health applications, have shown some promise in improving adherence among older adults. In this line, the pharmacist has a duty to actively engage the patient and caregiver in ensuring that medications are taken as instructed for optimal therapeutic outcomes.

Prevention of Adverse Drug Events

Adverse drug events remain one of the major issues related to geriatric care and are among the leading factors for increased hospitalization and rising healthcare costs. It is estimated that a pharmacist’s intervention in medication management can significantly reduce ADE risks through a variety of mechanisms, including detailed reviews of medications, possible drug interactions, and potential monitoring for side effects. Multiple studies demonstrated that pharmacist-led intervention, including participation in rounds in hospitals and post-discharge follow-up, reduced the incidence of ADEs. These literature findings support the integration of pharmacists into multidisciplinary health care teams to promote improved patient safety.

Optimizing transitions of care

The most vulnerable times for older adults are transitions of care, especially from the hospital-to-home setting. These are usually periods associated with an increased risk of medication discrepancies and ADEs. This is where pharmacists can considerably contribute to the optimization of these transitions through accurate and complete medication reconciliation and patient education. 

For example, medication-related interventions conducted not only in a hospital but also after discharge were shown in systematic reviews to reduce readmissions and increase adherence to medications. Pharmacists can help reduce transition risks by facilitating accurate transfers of information relative to medications and other technical support. Collaborative care models Research has shown that the inclusion of a pharmacist in a collaborative care model can have positive health outcomes for geriatric patients. 

Such models are often multidisciplinary teams in which the pharmacist works collaboratively with physicians, nurses, and other health care service providers. For example, the Pharm2Pharm model links specially trained hospitals and communities. pharmacists, has been associated with a reduction in medication-related hospitalizations for medication harm and has shown efficacy in community-acquired and hospital-acquired medication harm. It is a collaborative approach that capitalizes on the strengths of pharmacists in providing holistic care to the geriatric patient.

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Best Practices in Medication Management

The best medication management practices have to be implemented to optimize the treatment of the geriatric patient. The development and implementation of those best practices occur at the forefront of the activities of pharmacists through a range of initiatives. For example, medication reconciliation practices in hospitals are very vital in avoiding medication discrepancies that might end up causing harm to the patient. Evidence exists to support that such interventions work, especially those engaging high degrees of activity by pharmacy staff and those targeting care for high-risk patient populations.

Overcoming some other impediments that pharmacists are faced with when attending to the elderly is contained in dealing with particular challenges in geriatric care. These include multiple medications, cognitively declining patients, and effective communication with the patient and their caregivers. Individualized interventions, like pharmacist counseling on discharge and follow-up phone calls, have reduced preventable ADEs and improved outcomes for the patient. Adherence barriers, which include forgetfulness or a lack of understanding regarding medication use, are quite important to get over. A pharmacist’s ability to individualize a range of care and support is key to overcoming such barriers.

The Future of Pharmacist Involvement in Geriatric Care

There is an acceptance that pharmacists roles in geriatric care will further increase as the healthcare environment continues to change. With improvements and innovations in technology, particularly the use of mobile health applications and telemedicine, it now provides pharmacists with new channels to practice medication management and patient education. Further research and the implementation of its evidence-based practices will remain the future directions for the evolution and growth of a body of literature on the contributions of pharmacists. Ensuring that there is a proper skill mix among pharmacists will become even more critical as the population ages and the health care needs of older citizens become more complex.

Conclusion

Pharmacists play a very important role in geriatric care. Their participation promotes better medication safety, adherence, and total health outcomes for older adults. Usually, a pharmacist provides individually tailored patient education regarding the medication regime and other interdisciplinary health services to help surmount special problems relating to patients in their geriatric years. In such a view, there is no doubt that, with the fast-changing arena of healthcare, the role of pharmacists in geriatric care definitely becomes even more paramount in securing the best care possible for the elderly.

References

  1. Anzuoni K, Field TS, Mazor KM, Zhou Y, Garber LD, Kapoor A, Gurwitz JH. Recruitment Challenges for Low-Risk Health System Intervention Trials in Older Adults: A Case Study. J Am Geriatr Soc. 2020 Nov;68(11):2558-2564. doi: 10.1111/jgs.16696. Epub 2020 Jul 25. PMID: 32710671; PMCID: PMC7722200.
  2. Daliri S, Boujarfi S, El Mokaddam A, Scholte Op Reimer WJM, Ter Riet G, den Haan C, Buurman BM, Karapinar-Çarkit F. Medication-related interventions delivered both in hospital and following discharge: a systematic review and meta-analysis. BMJ Qual Saf. 2021 Feb;30(2):146-156. doi: 10.1136/bmjqs-2020-010927. Epub 2020 May 20. PMID: 32434936.
  3. Daliri S, Hugtenburg JG, Ter Riet G, van den Bemt BJF, Buurman BM, Scholte Op Reimer WJM, van Buul-Gast MC, Karapinar-Çarkit F. The effect of a pharmacy-led transitional care program on medication-related problems post-discharge: A before-After prospective study. PLoS One. 2019 Mar 12;14(3):e0213593. doi: 10.1371/journal.pone.0213593. PMID: 30861042; PMCID: PMC6413946.
  4. Pellegrin KL, Krenk L, Oakes SJ, Ciarleglio A, Lynn J, McInnis T, Bairos AW, Gomez L, McCrary MB, Hanlon AL, Miyamura J. Reductions in Medication-Related Hospitalizations in Older Adults with Medication Management by Hospital and Community Pharmacists: A Quasi-Experimental Study. J Am Geriatr Soc. 2017 Jan;65(1):212-219. doi: 10.1111/jgs.14518. Epub 2016 Oct 7. PMID: 27714762.
  5. Lee JK, Slack MK, Martin J, Ehrman C, Chisholm-Burns M. Geriatric patient care by U.S. pharmacists in healthcare teams: systematic review and meta-analyses. J Am Geriatr Soc. 2013 Jul;61(7):1119-27. doi: 10.1111/jgs.12323. Epub 2013 Jun 24. PMID: 23796001.
  6. Krumholz HM. Post-hospital syndrome–an acquired, transient condition of generalized risk. N Engl J Med. 2013 Jan 10;368(2):100-2. doi: 10.1056/NEJMp1212324. PMID: 23301730; PMCID: PMC3688067.
  7. Mueller SK, Sponsler KC, Kripalani S, Schnipper JL. Hospital-based medication reconciliation practices: a systematic review. Arch Intern Med. 2012 Jul 23;172(14):1057-69. doi: 10.1001/archinternmed.2012.2246. PMID: 22733210; PMCID: PMC3575731.
  8. Kripalani S, Roumie CL, Dalal AK, Cawthon C, Businger A, Eden SK, Shintani A, Sponsler KC, Harris LJ, Theobald C, Huang RL, Scheurer D, Hunt S, Jacobson TA, Rask KJ, Vaccarino V, Gandhi TK, Bates DW, Williams MV, Schnipper JL; PILL-CVD (Pharmacist Intervention for Low Literacy in Cardiovascular Disease) Study Group. Effect of a pharmacist intervention on clinically important medication errors after hospital discharge: a randomized trial. Ann Intern Med. 2012 Jul 3;157(1):1-10. doi: 10.7326/0003-4819-157-1-201207030-00003. PMID: 22751755; PMCID: PMC3575734.
  9. Budnitz DS, Lovegrove MC, Shehab N, Richards CL. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med. 2011 Nov 24;365(21):2002-12. doi: 10.1056/NEJMsa1103053. PMID: 22111719.

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