Inside: Elderly patients need special consideration at the pharmacy. Here’s how pharmacists can help prevent complications from polypharmacy.
America’s population is aging.
By 2040, the number of people age 65 and over is projected to reach more than 82 million, making up more than 21 percent of the U.S. population. Combine that growing population with the health problems that accompany getting older and it’s no surprise that seniors are an important part of any pharmacy’s business.
Elderly patients aren’t keeping pharmacies afloat just from their numbers; they’re also using a lot of medications. Researchers estimate that 25 percent of Americans age 65-69 take at least five prescription drugs. For people age 70-79, that number jumps to 46 percent.
Managing so many medicines brings serious risks to your elderly patients.
What’s at Stake
There are at least three major dangers of polypharmacy.
1. Drug interactions
The risk of drug interactions increases with every drug added to the mix. One study estimated that more than 20 percent of adverse drug reactions are caused by underlying drug interactions. Drug interactions can be particularly dangerous for elderly patients, who are more vulnerable to health issues.
2. Falls
Medications that affect the central nervous system (CNS)—like opioids, tranquilizers, antidepressants, and antipsychotics—raise special concerns. These medications can cause drowsiness or confusion, increasing a patient’s risk of falling.
And seniors are increasingly taking multiple psychotropic drugs. According to data analysis in JAMA Internal Medicine, CNS polypharmacy more than doubled from 2004 to 2013.
Falls are one of the greatest threats to elderly patients’ health and independence. They’re the leading cause for traumatic brain injury and hip fractures in the elderly. Every 20 minutes, an older adult dies from a fall.
3. Side effects
The more medication patients take, the higher their risk for severe or multiple side effects.
For example, researchers in the JAMA study discovered some drug combinations with troubling side effects, including two blood thinners (aspirin and clopidogrel) that together increase the risk of bleeding with long-term use. And aspirin and naproxen that together can cause bleeding, ulceration, or perforation of the stomach lining.
The Best Solution to Polypharmacy
Pharmacists can have a powerful impact on patient outcomes through medication management.
In fact, a 2015 study in the Journal of the American Pharmacists Association found hospital readmission rates were two-thirds lower for patients who received medication therapy management from a pharmacist after discharge.
Medication management can include a number of services, from performing assessments to communicating with a patient’s primary care providers.
But a comprehensive medication review is the key element of effective medication management. Research suggests medication reviews really work. In a study of pharmacist-led medication reviews, 21 percent of identified pharmaceutical care issues were resolved by information found in notes. Another 8.5 percent was resolved through patient interview.
And if you’re worried about stepping on other practitioners’ toes, don’t be. In the study, general practitioners agreed with 96 percent of all care issues the pharmacists documented.
Combing through the patient’s records can help you identify common polypharmacy problems:
- Two or more medications that are used to treat the same problem (possibly prescribed by different doctors)
- Medications that shouldn’t be taken together
- Medications that aren’t advisable for your patient (for example, drugs that are contraindicated for people with suppressed immune systems when your patient has a compromised immune system)
- Medications treating acute problems that may have gone away (acid reflux is a common offender)
5 More Ways Independent Pharmacists Can Help
1. Consolidate the patient to one pharmacy
It’s harder to get a full view of a patient’s medications if she’s using more than one pharmacy. If you know your business can meet all of a patient’s needs, work with them to transfer everything to your pharmacy.
This will likely save the patient time and energy picking up prescriptions at multiple locations and save them the trouble of remembering which prescription is where. In doing what’s best for the patient, you’ll also pick up revenue from the added prescriptions.
2. Provide medication lists to patients
If your patient has multiple chronic conditions, chances are he also has multiple doctors. Help your elderly patients give complete, accurate information to each practitioner with a handy printed list of medications and dosages.
If you’re up to it, use these print-outs as an opportunity for branding. Include your pharmacy’s logo on the sheet and consider laminating it. Now everyone who sees the list—practitioners, caretakers, maybe even visitors to your patient’s home—will be aware of your pharmacy.
3. Provide compliance packaging
About half of patients with chronic diseases don’t take their medication as prescribed, according to the World Health Organization. For older patients who are still managing their healthcare on their own, keeping three or four (or more!) medications straight is a real challenge.
Compliance packaging makes managing medication easier. By separating each dose into packets or blister packs with the name of the medication, dose, and time on the outside, patients don’t have to worry about keeping track. And importantly, it ensures they aren’t taking more pills than prescribed.
Here are some medication adherence options to explore:
- MedicineOnTime offers a complete adherence system. It includes a workstation, software, compliance packaging, and a network of support mechanisms
- RxSafe’s RapidPakRX system focuses primarily on the packaging
- Amplicare offers a system that identifies patients who are at risk of non-adherence and prompts you with an opportunity to care for them
- AdhereTech’s wireless pill bottles include sensors and wifi that alert patients when they’ve missed a dose
4. Be aware of drugs deemed unsafe for seniors
If you serve a large number of seniors, consider keeping a copy of the Beers List on hand. Developed by the American Geriatric Society, the Beers List includes medications that may be unsafe for seniors.
When you see senior patients are taking a drug on the Beers List, you may want to check in with the prescribing doctor. Some doctors may determine the risk of using the drug is worth the potential benefit to the patient and prescribe it anyway. Others may be unaware that the drug is inappropriate for elderly patients. Flagging something that seems off to you could prevent a serious problem.
Also be aware that the American Geriatric Society is currently working on revisions to the Beers List. Be ready to familiarize yourself with the changes when they’re finalized in late 2018 or 2019.
5. Bring in a caretaker, when appropriate
Just about everyone wants to remain self-sufficient and fully in charge of their own health for as long as possible. Because of this, suggesting that a patient needs additional help can be delicate.
For a longtime patient you know well, it may be as simple as saying “Hey, have you considered asking your son to help you manage these? I’d be happy to give him a call for you.” For a newer patient or one you don’t have much rapport with, you’ll need to start by asking about what support (if any) the patient has available to them.
The goal is to make sure someone else is familiar with the medication, the dosing, the potential side effects, and the general directions. Cluing a loved one in means they can help when the patient forgets something, and they can more quickly ascertain when there’s a problem.
Vigilant medication management helps seniors stay safe. Work as a team with patients, doctors, and caretakers for the best outcome.
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PBA Health is dedicated to helping independent pharmacies reach their full potential on the buy-side of their business. Founded and owned by pharmacists, PBA Health serves independent pharmacies with group purchasing services, wholesaler contract negotiations, proprietary purchasing tools, and more.
An HDA member, PBA Health operates its own NABP-accredited secondary wholesaler with more than 6,000 SKUs, including brands, generics, narcotics CII-CV, cold-storage products, and over-the-counter (OTC) products — offering the lowest prices in the secondary market.
