Safe, effective pharmacotherapy remains one of the greatest challenges in clinical geriatrics. Older adults have many chronic disorders and consequently use more drugs than any other age group. Their diminished physiologic reserves can be further depleted by effects of drugs and acute or chronic disease. About 1/3 of drug-related hospitalizations and 1/2 of drug-related deaths occur in persons > 60 yr. Aging afects the choice, dose, and frequency of many drugs. In addition, pharmacotherapy may be complicated by an elderly patient's inability to purchase or obtain drugs or to comply with drug regimens. The U.S. Department of Health and Human Services, Inspector General's Report identified the following statistics related to drug therapy in older patients:
20% receive inappropriate drugs
16% receive drugs without a valid prescription
23% don't receive their prescribed drugs
20% receive drugs inappropriate for the elderly
21% receive drugs that could interact with other drugs
32% receive more than one drug in the same class
A 1996 General Accounting Office report and another in November 1997 by the Department of Health and Human Services Office of Inspector General found approximately one-fifth of older patients are given medications considered by medical experts to be unsuitable for older people because of the high risk of unintended harm. In addition, criteria were developed by Beers (1997) to list drugs that are potentially inappropriate for any elderly person, regardless of the setting. In 1999, the federal Healthcare Financing Administration incorporated most the 1997 Beers' criteria into federal regulations governing medication use in skilled nursing facilities to decrease the incidence of adverse outcomes from selected medications.
Our staff specializes in pharamceutical consultation services to seniors residing in the community, assisted living facilities and nursing homes.
With 20+ years of combined experience reviewing medications for older adults, our staff can provide the answers to the difficult questions concerning medication usage such as:
- Is there an indication for the medication?
- Is the medication effective for the condition?
- Is the dosage correct?
- Are the directions correct?
- Are there clinically significant drug-drug interactions?
- Are there clinically significant drug-disease interactions?
- Are the directions practical?
- Is the drug the least expensive alternative compared to others of equal utility?
- Is there unnecessary duplication with other drugs?
Are you currently taking potentially inappropriate medications? Download the Beers Criteria for Inappropriate Medications below.
Polypharmacy
Polypharmacy is the unwanted duplication of drugs, and often results when patients go to multiple physicians or pharmacies. Typically, polypharmacy occurs when prescribed medications duplicate or interact with each other. However, it may also include:
-dosages that are too high or too low;
-drugs that should be avoided in older adults;
-drugs lacking in evidence suggesting effectiveness;
-medications incorrectly prescribed or filled; or
-herbal or over-the-counter medications interacting with prescribed medications.
Polypharmacy can result in an adverse drug event (ADE), drug interactions, decreased compliance with taking medications as prescribed, poor quality of life, and unnecessary drug expense. Many of these resulting issues can be prevented. There is a correlation in the number of medicationstaken by a patient and drug interactions. The correlation includes physician-prescribed, over-the-counter, and herbal medications.
What is your risk for a drug interaction leading to an adverse health consequence?
-dosages that are too high or too low;
