Senior Care Pharmacists Research Articles

Senior Care Pharmacists, Audiologists, and Otologists: Improving Hearing Health for Older Patients Through Interprofessional Collaboration.

The purpose of this manuscript is to provide pharmacists with education on hearing loss that colleagues in audiology believe is most critical for pharmacists. As well as highlighting insightful interventions pharmacists can make in collaboration with hearing professionals, such as audiologists, otolaryngologists, and otologists, to improve patient care. This project was initiated by professional students at the University of Maryland in both Baltimore and College Park campuses, after completing the interprofessional elective course IPE Care in Geriatrics. Upon completion of the course, the authors performed an extensive literature search and reviewed publications pertaining to pharmacy, audiology, and their integration.Hearing loss can have a significant impact on a patient's quality of life. Older people are at an increased risk for experiencing hearing impairment, but often do not seek help from health care providers. Collaboration between audiologists, otolaryngologists, and pharmacists has the potential to improve patients' access to hearing health and break barriers for patients. Important interventions that pharmacists can make to better serve their patients with hearing loss include screening, enhancing communication, and hearing aid assistance. This article also provides guidance on identifying patients who would be candidates for over-the-counter hearing aids and patients who should be referred to a hearing professional. This skill will become increasingly relevant with the emergence of over-the-counter hearing aids.

Senior Care Pharmacists Must Be the Disruptive Force that Reduces Adverse Drug Events in Older People.

A rapidly aging world increasingly reliant on medications to maintain the health of the population and productivity in society must confront stark facts: Adverse drug events (ADEs) lead to an estimated 99,628 hospitalizations per year, and fatal ADEs have been estimated to rank between the fourth and sixth leading cause of death in the United States.

Part Three: A Brief Primer of Non-Insulin Treatments for Type 2 Diabetes Mellitus in Older People.

Diabetes is a heterogeneous condition that manifests differently in each patient. Fortunately, there are multiple different medication classes that can be used to help patients achieve their treatment goals. Diabetes is highly prevalent in older people, including patients who have been living with the condition for many years and those who are newly diagnosed. It is essential for senior care pharmacists to evaluate patient-specific goals, compelling indications, and risks and benefits of treatment. When evaluating therapy appropriateness, pharmacists must take into consideration the impact of medication therapy beyond glucose-lowering effects, including the overall impact on cardiovascular, renal, heart failure, and weight-related outcomes.

Part Two: Diabetes Part 2: A Review of Insulin Therapy in Older Patients.

Diabetes mellitus is a common disease state among older people, with type 2 diabetes making up most cases. As the disease progresses, many patients will need to transition to insulin therapy. Pharmacists can play a pivotal role in the care of older people with diabetes by providing recommendations related to insulin therapy. Senior care pharmacists need to be knowledgeable about the pharmacokinetics, dosing, adverse effects, and cost concerns related to insulin therapy.

Letter to the Editor

Pharmacist Ashley Walker, who is also deaf, responds to the March 2022 issue of The Senior Care Pharmacist which was themed around American Sign Language and foreign language services. She provides additional resources for pharmacists to assist patients who are deaf or hard of hearing.

Admissions and Mortality Related to Urinary Tract Infections in Male Veterans with Dementia.

Objective To examine mortality and hospital readmission rates in male veterans with dementia diagnosed with urinary tract infection (UTI) compared with patients without dementia. Design Retrospective cohort study. Setting Veterans Healthcare Systems (VA). Participants Male inpatients with a diagnosis of UTI who were treated at any VA Healthcare Center from January 1, 2009, to December 31, 2018. Interventions None. Main Outcome Measures Mortality and hospital readmission for patients with and without dementia at 30, 60, and 90 days from UTI diagnosis. Results 262,515 veterans admitted with UTI were analyzed, and 58,940 (22.5%) had dementia. The mean age for veterans with dementia was 80.0 +/- 9.7 years. Veterans with dementia experienced less mortality than patients without dementia at 30 days (8.3% vs 8.5%; P < 0.001), but more mortality at 60-day (4.9% vs 4.7%; P < 0.001) and 90-day (3.6% vs 3.3%; P < 0.001) intervals. Death was 20% less likely at 30 days in patients with dementia. Veterans with dementia were readmitted more than those without dementia at 30-day (18.4% vs 16.0%), 60-day (4.5% vs 2.8%), and 90-day (3.4% vs 2.5%) intervals; P < 0.0001. Conclusion Though patients with dementia are at an increased risk for death long-term, risk of death is less than those without dementia shortly following UTI diagnosis. This highlights the possibility that veterans with dementia may be hospitalized and diagnosed with UTIs when in actuality they have asymptomatic bacteriuria. Patients with dementia and UTI therefore represent an important group of geriatric patients that could benefit from the oversight of a senior care pharmacist to help prevent unnecessary treatment of asymptomatic bacteriuria.

Elder Suicide: What Senior Care Pharmacists Need to Know.

Older individual suicide is a growing community health problem in the United States. It is also preventable, and senior care pharmacists can increase awareness of the prevalence of suicide risk in older patients. Despite high exposure to many serious suicide risk factors and a high rate of suicide mortality, older people tend to be overlooked in suicide prevention efforts that lean mostly toward younger age groups. Senior care pharmacists can help remedy this situation by monitoring reports on older patients for possible signs of suicidality, alerting the care team if signs of potential suicide risk are present, and adding suicide prevention information to their education and counseling roles. An understanding of the nature of older individual suicide, the warning and danger signs of suicidality in older people and how and when to respond is needed. Providing this background would assure that senior care pharmacists have the skills and confidence necessary to embed suicide prevention in their practice.

It Takes Action to Prevent Falls in Older People. What Role Will You Play?

The July issue of The Senior Care Pharmacist featured two excellent articles about the essential role of pharmacists in reducing falls and falls-risk factors among older people. It is up to senior care pharmacists to contribute to a rational and balanced discussion of pharmacotherapy options, which are best achieved through a multidisciplinary approach where the pharmacist?s unique and important input can be integrated into the treatment plan.

Sometimes Falls Are Difficult to Prevent. What Comes Next?

The World Health Organization highlighted that older people have the highest risk of death or serious injury from falls, and the associated risks increase with age. The effects of medications are an important contributor in the overall equation for the risk of falls-related morbidity and mortality, and that is consistently demonstrated in research from around the world. In this edition of The Senior Care Pharmacist, there is further evidence presented, and the importance of this information cannot be challenged. However, the question remains: why has effective remediation of this risk consistently defeated the clinical community around the world?

Sometimes Falls Are Difficult to Prevent. What Comes Next?

The World Health Organization highlighted that older people have the highest risk of death or serious injury from falls, and the associated risks increase with age. The effects of medications are an important contributor in the overall equation for the risk of falls-related morbidity and mortality, and that is consistently demonstrated in research from around the world. In this edition of The Senior Care Pharmacist, there is further evidence presented, and the importance of this information cannot be challenged. However, the question remains: why has effective remediation of this risk consistently defeated the clinical community around the world?

The Expanded Potential Role of Pharmacogenomics.

The topic of phenoconversion was chosen for discussion in this editorial to add to the work presented by Cox and Marshall in this issue of The Senior Care Pharmacist. When considering the increased sensitivity that older patients have to medications, the inclusion of pharmacogenomics (PGx) information can be of great importance. Understanding the consequences of phenoconversion can further expand the role of PGx in patient care.

Risk Factors for Mortality in an Older Veteran Population With infective Endocarditis.

To determine 30-day and 1-year mortality in patients treated for infective endocarditis (IE) in a VA population. The secondary objective was to identify risk factors for increased risk of mortality in veterans diagnosed with IE. A retrospective cohort study. Veterans Affairs Western New York Healthcare System PARTICIPANTS: Patients who had a diagnosis of IE between the years 2005 and 2016. Patients were identified via International Classification of Diseases (ICD) codes. None. Factors for death and survival were compared using a bivariate analysis. Significant factors were built into a multivariate logistic regression analysis to determine risk factors for death at 30 days and 1 year. Between 2005 and 2016, there were 153 patients with IE. All-cause mortality at 30 days was 14% versus 39% at 1 year. Patients were more likely to die at 1 year with higher Pitt Bacteremia Scores, older age, and lower number of minor criteria according to Duke Criteria. Comorbidities were similar between groups. Older patients with higher Pitt Bacteremia Scores and lower numbers of minor criteria are more likely to experience mortality at one year. Given the high rates of death at one year, close monitoring, even after completion of therapy may be necessary in older patients. Senior care pharmacists are in a unique position to monitor these patients.

A Clinical Conundrum: The Pharmacist's Role in Evaluating Comorbid Urinary incontinence and Heart Failure.

Heart failure (HF) is a complex disease to manage, and treatment strategies for older adults are complicated by the presence of comorbidities such as urinary incontinence (UI). There is a therapeutic competition that exists in the treatment of patients with both HF and UI, as many of the agents indicated for control of HF may directly exacerbate UI. A reported 80% of adults with HF are older than 65 years of age, and 50% of HF patients have UI. The prevalence of conflicting therapeutic objectives in older patients presents an opportunity for intervention by senior care pharmacists. Pharmacists are equipped to optimize medication outcomes through the provision of appropriate prescribing and deprescribing recommendations, when necessary. This provides an opportunity for shared decision making to improve patient-centered outcomes and goals of care within this population.

A Clinical Conundrum: The Pharmacist's Role in Evaluating Comorbid Urinary incontinence and Heart Failure

Heart failure (HF) is a complex disease to manage, and treatment strategies for older adults are complicated by the presence of comorbidities such as urinary incontinence (UI). There is a therapeutic competition that exists in the treatment of patients with both HF and UI, as many of the agents indicated for control of HF may directly exacerbate UI. A reported 80% of adults with HF are older than 65 years of age, and 50% of HF patients have UI. The prevalence of conflicting therapeutic objectives in older patients presents an opportunity for intervention by senior care pharmacists. Pharmacists are equipped to optimize medication outcomes through the provision of appropriate prescribing and deprescribing recommendations, when necessary. This provides an opportunity for shared decision making to improve patient-centered outcomes and goals of care within this population.

An Evaluation of Antimicrobial Prophylaxis for Dental Procedures at a Veterans Healthcare System; A Role for Senior Care Pharmacists?

OBJECTIVE: The primary objective of this study was to determine the prevalence of appropriate use of antibiotics before a dental procedure.<br/> DESIGN: Retrospective cohort study.<br/> SETTING: Veterans Healthcare Systems.<br/> PARTICIPANTS: Veterans who filled outpatient prescriptions for antimicrobial dental prophylaxis at the Veterans Administration Western New York Healthcare System from December 1, 2017, through October 1, 2019.<br/> INTERVENTIONS: None.<br/> MAIN OUTCOME MEASURES: Use of antibiotic dental prophylaxis was deemed appropriate if in accordance with guideline recommendations. Descriptive statistics were used to summarize data.<br/> RESULTS: A total of 130 veterans receiving antibiotics for dental prophylaxis were included in this evaluation. Of those who were included, only 16.9% received appropriate antibiotic dental prophylaxis. Patients with a prosthetic joint were significantly more likely to be inappropriately prescribed antibiotics for dental prophylaxis. Approximately 87% of patients who were inappropriately prescribed antibiotic prophylaxis had prosthetic joints (P < .0001).<br/> CONCLUSION: Most antibiotics for dental prophylaxis are prescribed inappropriately. The large amount of inappropriately used antibiotics in this study highlights the need for dental stewardship in our veteran population. Antibiotics for dental prophylaxis therefore represent an important stewardship target in the outpatient setting. This may be an ideal opportunity for senior care pharmacists to intervene upon.

Vaccine Hesitance: Risks, Persuasion, and influence

In this edition of The Senior Care Pharmacist, we publish a variety of contributions addressing the issue of vaccination. As the Northern Hemisphere enters the autumn/fall period, this matter assumes a renewed significance, with the rollout of immunization as a preventive strategy for the benefit of both individual patients and the wider community. It is, perhaps, ironic that though effective vaccination services are now available for a range of communicable diseases such as influenza, and that these have only become relatively recently available in the course of medical history, health care workers promoting this approach now face a different problem that has sometimes been referred to as "vaccine hesitance."

Vaccine Hesitance: Risks, Persuasion, and influence.

In this edition of The Senior Care Pharmacist, we publish a variety of contributions addressing the issue of vaccination. As the Northern Hemisphere enters the autumn/fall period, this matter assumes a renewed significance, with the rollout of immunization as a preventive strategy for the benefit of both individual patients and the wider community. It is, perhaps, ironic that though effective vaccination services are now available for a range of communicable diseases such as influenza, and that these have only become relatively recently available in the course of medical history, health care workers promoting this approach now face a different problem that has sometimes been referred to as "vaccine hesitance."

COViD-19: Face Mask Effectiveness, Hand Sanitizer Shortages, and Rapid Medication Therapy Trials.

The COVID-19 pandemic is a rapidly evolving phenomenon that presents serious practical challenges and complex clinical considerations for health care workers, health care administrators, and policy formulators. The Senior Care Pharmacist carries periodic updates addressing matters relevant to pharmacotherapeutics and pharmacy practice as these relate to the care of older people in the time of the pandemic. The brief news items that are provided here are not intended to be substitutes for a careful and comprehensive consideration of the issues involved, but rather, they serve to provide initial awareness of concepts and to stimulate more complete situational analysis.

COViD-19: Face Mask Effectiveness, Hand Sanitizer Shortages, and Rapid Medication Therapy Trials

The COVID-19 pandemic is a rapidly evolving phenomenon that presents serious practical challenges and complex clinical considerations for health care workers, health care administrators, and policy formulators. The Senior Care Pharmacist carries periodic updates addressing matters relevant to pharmacotherapeutics and pharmacy practice as these relate to the care of older people in the time of the pandemic. The brief news items that are provided here are not intended to be substitutes for a careful and comprehensive consideration of the issues involved, but rather, they serve to provide initial awareness of concepts and to stimulate more complete situational analysis.

On the Pharmacy Radar: COViD-19 and Older People.

The COVID-19 pandemic presents many medical and social issues for older people. Presented here is a range of information arising from related areas that have impact upon the safety and efficacy of drug therapy in the context of COVID-19. Issues include pharmacy practice, clinical therapeutics, and possible new treatments for the virus. More information will be published in coming issues of The Senior Care Pharmacist.