Background: Medication adherence among older adults with cognitive impairment is a major challenge in home care and often results in frequent in-person visits for reminders or medication administration. While digital reminder tools show promise, evidence supporting their integration into routine home care practice remains limited. In publicly funded home care services, medication-related visits are resourceintensive and increasingly difficult to sustain amid workforce constraints, making the identification of safe and scalable alternatives a growing priority. Methods: A quality improvement pilot project was conducted within a publicly funded home care program in Quebec, Canada. A smart clock was implemented to deliver cognitively accessible medication reminders and enable remote confirmation of intake. The technology was integrated into existing clinical workflows through nursing assessment, structured installation, user and caregiver training, and ongoing monitoring. Descriptive quantitative measures assessed device use, substitution of in-home visits, user experience and safety, and a preliminary break-even cost analysis. Results: Forty-eight older adults received the smart clock. Thirty-five participants (72.9%) were considered successful, defined as maintaining accurate medication intake. Use of the smart clock was associated with 6,276 avoided medication-related home visits across the pilot and time savings of 39.6 minutes of home care staff time per device per day. No major medicationrelated safety events were observed. Conclusion: This pilot suggests that a clinically integrated, cognitively accessible digital intervention can support the safe substitution of medicationrelated home visits. Findings highlight the importance of interdisciplinary collaboration and implementation practices in developing sustainable technology-enabled home care models.

Background: Older adults with chronic obstructive pulmonary disease (COPD) often experience physical and cognitive changes that complicate diagnosis, medication administration, and management of multiple comorbidities. Clinical assessment is further challenged when tools are not adapted to a patient's level of care, cognitive status, or ambulatory function. The L-mMRC is a novel tool developed by consultant pharmacists in collaboration with skilled nursing facility (SNF) registered nurses. It incorporates long-term care resident self-performance codes for ambulation to provide population-specific COPD staging. Objective: To assess patient COPD ABE GOLD classification using the L-mMRC compared with the mMRC tool or COPD Assessment Test (CAT) score. Methods: This study evaluated the accuracy of the L-mMRC tool in staging COPD among patients in the SNF setting. Participants were SNF residents aged ≥ 65 years with an active COPD diagnosis. Patients with a concurrent diagnosis of asthma or those receiving hospice care were excluded. The primary outcome was the agreement of L-mMRC classifications with mMRC or CAT scores for GOLD staging. Results: Of 283 patients reviewed, 243 met inclusion criteria. The majority of participants were female (68.7%), with a mean age of 79 years. Residents were prescribed between 0 and 6 respiratory medications (mean = 1.2). The mean L-mMRC and CAT scores were 3.04 and 13.17, respectively. Conclusion: Due to the limited availability of baseline CAT and mMRC scores in patient documentation, further evaluation of baseline respiratory status by a pulmonologist or respiratory therapist is needed to validate the accuracy of the L-mMRC tool. These findings also highlight a critical gap in COPD-related care among older adults.

Alzheimer's disease (AD) is a progressive neurodegenerative disorder marked by cognitive decline and functional impairment, primarily driven by the accumulation of amyloid-beta (Aβ) plaques and tau tangles. Historically, treatments have focused on symptomatic relief; however, recent therapeutic advances have focused on disease-modifying monoclonal antibodies (mAbs), notably lecanemab and donanemab, which target Aβ pathology in early-stage AD. This review explores the clinical efficacy, safety profile, and limitations of lecanemab and donanemab, emphasizing key findings from the CLARITY-AD and TRAILBLAZER-ALZ 2 trials. In these studies, lecanemab was shown to slow cognitive decline by 27% over 18 months, while donanemab achieved a 28.9% reduction over 76 weeks, with the greatest benefits observed in patients presenting with lower baseline tau pathology.Despite these promising outcomes, challenges remain, including possible reduced efficacy in women based on subgroup analyses of trial data, racial disparities in trial representation, adverse effects such as amyloid-related imaging abnormalities (ARIA), and substantial cost and accessibility barriers. This review underscores the need for more inclusive research, personalized treatment strategies, and continued exploration of AD's complex pathology beyond amyloid clearance.

Antimicrobial resistance remains a leading global health threat, often exacerbated by inappropriate antibiotic use, particularly among the growing population of older adults. This commentary highlights the urgent need for geriatric-focused antimicrobial stewardship programs that balance efficacy, safety, and resistance mitigation. Age-related physiological changes, multimorbidity, and polypharmacy significantly increase the risk of antibiotic-associated adverse effects and drug interactions in older adults. Key challenges include inaccurate estimation of renal function and hypoalbuminemia, which alter antibiotic pharmacokinetics, as well as inappropriate treatment of asymptomatic bacteriuria and increased susceptibility to Clostridioides difficile infection. Clinical complexities such as prosthetic joint infections and antibiotic-induced neurotoxicity further underscore the need for individualized dosing regimens and vigilant monitoring. Certain antimicrobial classes, including fluoroquinolones, and specific agents such as trimethoprim/sulfamethoxazole and rifampin, require particular caution because of their potential for serious toxicities and drug interactions in this population. Pharmacists play a central role in optimizing antibiotic selection, dosing, and monitoring across care settings. Expanding their leadership in antimicrobial stewardship programs is critical to improving outcomes and minimizing preventable harm. Strengthening antimicrobial stewardship requires targeted policies and outcomes-driven research to identify best practices that effectively reduce adverse events. As the aging population continues to grow, it is imperative that pharmacists in geriatric and long-term care settings develop and implement robust antimicrobial stewardship programs that prioritize safety across the continuum of geriatric care.

Background: This case study reviews the use of glucagon-like peptide-1 receptor agonists (GLP-1 RA) for weight management in older adults. A 69-year-old male patient discusses weight loss goals with his health care provider and seeks pharmacotherapy options in addition to lifestyle modifications. His medical history includes type 2 diabetes mellitus (T2D), coronary artery disease (CAD), prior coronary artery bypass graft, heart failure with reduced ejection fraction (HFrEF), hypertension, hyperlipidemia, and allergic rhinitis. He initiated weight loss efforts following a myocardial infarction; however, dietary and physical activity changes alone have not resulted in substantial weight reduction. Assessment: This patient is an appropriate candidate for GLP-1 RA therapy given his T2D, obesity, CAD, and a recent elevation in serum creatinine (SCr). The patient will initiate semaglutide, a medication approved for weight management with demonstrated cardiovascular benefit. The dose will be titrated to a maintenance dose of 2 mg once weekly, with ongoing monitoring of tolerability and weight loss.Given his age, there is concern for sarcopenia associated with excessive weight loss. The patient will be advised to maintain a balanced diet with an emphasis on protein intake and to engage in regular physical activity to minimize loss of muscle mass. Outcome: The patient experiences weight reduction within the first few weeks of therapy and tolerates treatment well. He has incorporated additional strength training into his exercise routine and increased his intake of vegetables and protein. The patient has insurance coverage for semaglutide due to his comorbid T2D; therefore, medication cost is not a barrier to treatment. Conclusion: When evaluating the use of GLP-1 RA agents in older adults, these agents demonstrate benefits beyond glycemic control and weight loss, including cardiovascular and renal outcomes. However, GLP-1 RA-associated weight loss may contribute to muscle loss, which is of particular concern in older adults who are at risk for frailty or falls. Patients receiving GLP-1 RA therapy should be encouraged to maintain adequate protein intake and engage in regular physical activity, particularly resistance training, to preserve muscle mass. Additionally, the high cost of GLP-1 RA agents may limit access for patients without insurance.

Background Community-dwelling older adults are at an increased risk of falls for multiple reasons. Community-based initiatives are needed to prevent these devastating events. Objectives This observational cohort study evaluated community fall-prevention events led by pharmacists and student pharmacists. The primary outcome was the change in Stopping Elderly Accidents, Deaths, and Injuries (STEADI) score among participants aged 55 years and older. Secondary outcomes included participant-reported changes in the number of fall hazards in the home, the number of medications taken by participants that increase fall risk as recorded during the community event, and participants' confidence in performing the chair-rise exercise after the community event. Methods The fall-prevention events included education on fall risk, prevention strategies, identification of home fall hazards, review of high-risk medications, and instruction on safely rising from a chair. Results The change in STEADI assessment scores from before compared to 30 days after attending the community event was significant (P < 0.0001). Participants identified an average of 2 (± 1.5) home fall hazards after the community event, and 92.6% made changes to their home environment. Participants also reported taking an average of 2 (± 1) high-risk medications at the community event and demonstrated significantly improved confidence in their ability to safely rise from a chair post-activity (P = 0.0005). Conclusion Pharmacist- and student pharmacist-led fall prevention events decreased fall risk, as evaluated by the STEADI assessment. Participants were encouraged to make changes to their home environment, received education about high-risk prescription and over-the-counter medications, and demonstrated increased confidence in performing the chair-rise exercise. Overall, these findings demonstrate that pharmacist-led community outreach events can lead to meaningful behavioral changes to help prevent falls in older adults.

Background Propofol is an intravenous hypnotic agent widely used for anesthesia and sedation in critically ill, mechanically ventilated patients due to its rapid onset and offset, which facilitate ventilator weaning and extubation. Despite these benefits, propofol's lipid emulsion formulation poses an infection risk and is associated with propofol-related infusion syndrome (PRIS). PRIS is characterized by acute bradycardia that is resistant to treatment and may progress to asystole. Objectives We report the case of a 76-year-old woman who sustained full-thickness burns covering 30% of her total body surface area, involving the chest, abdomen, bilateral upper extremities, and right leg. She was sedated with propofol during her critical care management. The patient's clinical course was closely monitored for complications, and risk factors associated with PRIS were assessed. Results The patient developed PRIS despite the absence of typical risk factors, including high-dose propofol exposure, steroid therapy, young age, or inborn errors of metabolism. Despite supportive care and efforts to mitigate PRIS progression, her clinical condition deteriorated, resulting in a fatal outcome. Discussion This case highlights a rare occurrence of PRIS in a patient without common risk factors, emphasizing the need for continued vigilance in monitoring, even in atypical cases. Further investigation into alternative risk factors and methods for early detection is warranted. Conclusion The senior care pharmacist plays an important role in the prevention, early detection, and management of PRIS. This case emphasizes the importance of daily clinical pharmacist reviews and highlights the critical role of senior care pharmacists in early identification and management of PRIS, even among low risk older adult patients receiving low-dose propofol regimens.

Objective To evaluate the characteristics of psychotropic medication use under pro re nata (PRN, or "as needed") orders for patients treated in a psychogeriatric hospital ward. Design A retrospective point-prevalence, cross-sectional study comparing PRN order parameters with standards published by the Australian Commission on Quality and Safety in Health Care. Setting An inpatient psychogeriatric unit in a South Australian public teaching hospital. Participants Data were collected from inpatient charts and case notes during a single, continuous 24-hour sampling period. All PRN medication orders were reviewed, including documentation of actual drug administrations, and these were matched with the associated clinical outcomes. Data were collected from 26 patients, for whom a total of 38 PRN psychotropic medication orders were analyzed. Result The majority of PRN orders (81%) met the criteria of the relevant Australian National Standards; however, of the 19 medication administration occasions, only 26% had adequate documentation that included both specific reasons for administration and the outcomes associated with the PRN treatment. Overall, it was noteworthy that a relatively high proportion of these PRN orders (61%) were actioned during the 24-hour snapshot period. Conclusion The use of PRN psychotropic medications remains an important component in the treatment of older patients with mental illness. Continued efforts to improve and optimize the documentation associated with PRN psychotropic drug administration warrant ongoing attention.