Vaccination is crucial in reducing the spread of disease and improving overall patient mortality. Limited information exists regarding pharmacist accessibility outside traditional medical settings or impact on older patients' intention to vaccinate. This study aimed to examine patient perceptions regarding pharmacist accessibility and vaccination intention. Researchers used a quantitative research method of older people from Ohio, Kentucky, and Indiana. A survey was given to community-dwelling older people who attended different vaccine clinics. The survey included 10 questions describing reasons for not receiving vaccines in the past, how likely they are to receive vaccines if administered at community events, and the importance of having easy access to vaccines. For Likert-type items, a 5-point scale was used. The surveys were collected electronically and anonymously from several community events. Aggregate data were analyzed with descriptive and inferential statistics. One hundred seventy-eight responses were collected. The average age of participants was 75 years, and 70.8% were females. Of the respondents, 44.9% preferred to receive vaccines at a community center, 17.4% at the doctor's office, 4.5% at a clinic, and 9.6% at a sporting event like a boxing match. Men were more likely to receive a vaccine at a sporting event, while women were more likely to be interested in receiving a vaccine at a community center (P < 0.05). Respondents somewhat agreed (median = 4, interquartile range = 3-5) that they do not have transportation to places with vaccines. Age was significantly and negatively correlated with educational attainment (P < 0.001). However, as participants' ages increased, they were significantly more likely to have a belief that vaccines do not work (P = 0.011). The study addressed how pharmacists should consider more community outreach events in convenient locations, like community centers, for older people to improve vaccination rates.

Background The Southern Arizona VA Health Care System (SAVAHCS) implemented a delirium prevention and treatment protocol in 2019. Objective The primary objective of this study was to determine if the implementation of a delirium protocol influenced deliriogenic medication use in hospitalized geriatric veterans. The secondary objectives were to compare the rates of delirium diagnosis, hospital length-of-stay, and rates of newly started deliriogenic medications during admission pre- and post-protocol. Methods This study was a retrospective, secondary data analysis study. Veterans 65 years of age and older who were admitted to an inpatient medical ward at the SAVAHCS for 24 hours or more between January 1, 2018 and December 31, 2018 (pre-protocol) or January 1, 2021 and December 31, 2021 (post-protocol) were included. Patients were excluded if they had a diagnosis of alcohol or benzodiazepine withdrawal upon admission. Results A total of 5491 patients were included in this study; 2940 (53.5%) in the pre-protocol group and 2551 (46.5%) in the post-protocol group. Patients received at least one deliriogenic medication during their admission in the post-protocol group (36.2%) compared with the pre-protocol group (34.1%), but there was no statistically significant difference (P = 0.098). There were also no significant differences in the rates of documentation of delirium as a diagnosis at discharge, hospital length-of-stay, or the rates of newly started deliriogenic medications during admission between the groups. Conclusion Implementation of a delirium prevention and treatment protocol at the SAVAHCS did not significantly impact the use of deliriogenic medications in hospitalized geriatric veterans.

The 2023 update of the American Geriatrics Society Beers Criteria® provides a comprehensive set of guidelines for optimizing medication use in older people. While this update is based on a rigorous review of evidence from clinical trials and research studies published between 2017 and 2022, its application in low- and middle-income countries (LMICs) may present unique challenges and considerations. LMICs often face different health care realities compared with high-income countries, such as limited access to medications, varying prescribing practices, and resource constraints. As a result, the Beers Criteria® 2023 update, which includes the addition, deletion, and revision of medicines based on new evidence, may not be entirely applicable or feasible in these settings. This commentary aims to explore the implications of the 2023 Beers Criteria® update for LMICs, highlighting the need for context-specific adaptations and strategies to optimize medication use and improve health outcomes for older people in resource-limited settings.

Dementia is a disease most prevalent in the older adult population. The cognitive symptoms of dementia include impairments in problem-solving, memory, and language. Some patients experience noncognitive symptoms in addition to the cognitive symptoms of dementia. These noncognitive symptoms are called behavioral and psychological symptoms of dementia or BPSD. The primary objective of our study was to examine the therapeutic options, guidelines, and clinical considerations for the management of BPSD. The existing literature about BPSD was reviewed with searches in PubMed, MEDLINE, and online search platforms. Dysregulation of neurotransmission involving acetylcholine, dopamine, and serotonin has been shown to cause behavioral and psychological symptoms of Alzheimer's disease. BPSD can include hallucinations, agitation, delusions, anxiety, apathy, abnormal body movements, irritability, depression, disinhibition, and sleep or appetite changes. Pharmacologic therapies used in the treatment of BPSD include antidepressants, antipsychotics, anxiolytics, and anticonvulsants. Treatment can be tailored to the specific noncognitive symptoms that are experienced. The use of these agents may be limited based on recommendations from the Beers Criteria®, STOPP criteria, treatment guidelines, and FDA warnings.

In recent years, scientists have initiated a renaissance in psychedelic research following decades of prohibition. Compounds such as ketamine, LSD, and psilocybin 'once primarily associated with recreational use' are now being investigated for their therapeutic potential, with promising results. An estimated 40-60% of people with post-traumatic stress disorder (PTSD) do not respond to selective serotonin reuptake inhibitors, which are the first-line medications for this condition. However, one standout among these psychedelics is methylenedioxy methamphetamine (MDMA), which has demonstrated exceptional efficacy in treating PTSD and medication-resistant depression. Growing results in research were so positive that, in 2017, the US Food and Drug Administration (FDA) designated MDMA-assisted psychotherapy as a breakthrough therapy. Though MDMA is not yet officially legal or approved for clinical use, Phase 3 trials are underway, and expanded access status was granted in 2020 in the United States and Israel. Preliminary clinical studies are extremely promising, and the FDA could approve MDMA-assisted psychotherapy for PTSD as early as 2024, offering a potential treatment for this crippling mental health condition that affects almost 3.5% of US adults.

The imperative for pharmacists to play a more significant role in working with patients affected by cognitive impairment has never been greater. This is a rapidly evolving issue, and data from the organization Alzheimer's Disease International presents a range of epidemiological facts that should be of concern to health practitioners, health administrators, governments and other funders, policy makers, and the wider public. Consumers have every right to expect, and indeed to demand, action from agencies that can and should act. According to Alzheimer's Disease International, the number of cases of dementia worldwide is expected to increase by 100% over the coming 20 years.

Recent research in new drug treatments for dementia such as anti-amyloid therapies have certainly piqued interest in the future possibilities for dementia pharmacotherapy. However, as with many medicines, the drugs have side effects, are expensive, and the evidence is still evolving. Furthermore, the first principles in any disease state management are prevention and non-pharmacological management. In this editorial, I invite you to look at dementia management based on three pillars. These, in my view, are all equally important. They are preventive and social medicine, medicine (prescribing), and deprescribing.

Background In older inpatients, anticholinergic medications can increase the risk of complications that may increase length of stay (LOS). Cyclobenzaprine is an anticholinergic medication associated with mental status changes, falls, and injuries in older patients. Objective The purpose of this study is to determine whether use of a lower cyclobenzaprine dose (5 mg) compared with higher dosing (10 mg) will affect LOS, 30-day readmission rates, and need for injectable psychotropic agents in inpatients 65 years of age and older. Methods This was a retrospective cohort analysis comparing outcomes in patients 65 years of age and older who received either a 5 mg or 10 mg cyclobenzaprine dose during their inpatient admission over a 2.5-year period. The primary outcome was hospital LOS, adjusted using multivariate linear regression. Secondary outcomes included 30-day readmission rate adjusted using logistic regression and use of injectable antipsychotics or benzodiazepines. A sub-analysis evaluated the impact of the institution's implementation of a geriatric prescribing context (GEM-CON) on cyclobenzaprine dose selection. Results The adjusted LOS was 32.7% longer (95% CI 25.9%-39.9%) for patients exposed to higher-dose cyclobenzaprine. Use of injectable antipsychotics or benzodiazepines was also significantly greater in the higher-dose group (P < 0.001; P = 0.025). Cyclobenzaprine dose was not significantly associated with readmission on multivariate analysis (OR = 0.93, 95% CI 0.45-1.93). After GEM-CON implementation, there was a significant increase in use of the recommended lower cyclobenzaprine dose (P < 0.001). Conclusion Use of lower cyclobenzaprine dosing in older inpatients is associated with reduced hospital LOS and need for injectable antipsychotics and benzodiazepines.

There is limited research on the impact of fall prevention education for older community-living people led by student pharmacists, which includes a medication review to identify Fall Risk-Increasing Drugs (FRIDs). Study objectives were to first assess the knowledge and behavioral intentions of older people after attending a student pharmacist-led fall-prevention program (FPP) and secondly to quantify the number of FRIDs identified during a medication review. Between October 2022 and April 2023, four independent-living facilities and two senior centers served as programming locations. Events began with a fall prevention-focused presentation provided by student pharmacists. Attendees voluntarily filled out surveys to assess their knowledge and behavioral intentions regarding fall prevention. Optional medication reviews were offered. Additional survey questions were asked of medication review participants. If FRIDs were identified, the individual was provided documentation to share with their prescriber. Fall prevention bingo was offered at select events to review educational content and engage those waiting for a medication review. Eighty-six older people attended the presentations; 45 people completed medication reviews across six sites. Survey information was available for 65 presentation attendees and 29 medication review participants. After programming, 64 out of 65 participants stated they felt comfortable speaking to their pharmacist or provider about falls and their medications. Most survey respondents correctly selected which medications increase fall risk. Twenty-two of 29 medication review participants were taking at least one FRID. The FPP described showed positive results through a post-survey evaluation. Participants demonstrated knowledge of fall hazards including medications and a willingness to discuss falls and FRIDs with health professionals. These factors may lead to concrete interventions to avoid falls and their associated health consequences for older people.

The objective of this analysis is to investigate the risk of hyperkalemia in hospitalized patients using sulfamethoxazole-trimethoprim (Co-trimoxazole) and a potassium-sparing drug (potassium-sparing diuretic or renin-angiotensin system [RAS]-inhibitor). Researchers conducted a nested case control study within a cohort of hospitalized patients using a potassium-sparing diuretic and/or a RAS-inhibitor from the PHARMO Database Network. Researchers estimated the odds ratios (ORs) and 95% confidence intervals (CI) for the risk of hyperkalemia in patients receiving both Co-trimoxazole and a potassium-sparing drug compared with patients only receiving a potassium-sparing drug. Among a cohort of 25,849 patients, researchers identified 2054 cases of hyperkalemia during hospitalization in patients also using a potassium-sparing drug. Using Co-trimoxazole in addition to a potassium-sparing drug was associated with an increased risk of hyperkalemia in hospitalized patients (ORadj = 1.65, 95% CI 1.26-2.16) compared with using only a potassium-sparing drug. There was a trend of a more pronounced association between hyperkalemia and the co-use of Co-trimoxazole and potassium-sparing drugs in patients with an estimated GFR of 15-29 mL/min (ORadj = 3.15, 95% CI 1.29-7.70). The number needed to harm for hyperkalemia induced by adding Co-trimoxazole to patients receiving a potassium-sparing drug is 19.5. Using the combination of Co-trimoxazole with a potassium-sparing drug in hospitalized patients increases the risk of hyperkalemia compared with using only a potassium-sparing drug. Physicians and other prescribers should be aware of hyperkalemia and routinely monitor serum potassium levels in hospitalized patients using this combination of drugs.