Compounding Pharmacists Can Safeguard Older Adults from Polypharmacy with Targeted Outreach
At the age of 72, Dan’s prescriptions included an anticoagulant and medications to treat high blood pressure and depression. In spite of his chronic health issues, he was active, independent and cognitively sharp, so his son didn’t worry about monitoring the medications. But Dan also took herbal supplements and ended up in the emergency room after mixing warfarin with ginkgo biloba. This type of adverse reaction isn’t unusual—at least one in six older adults are likely to have a medication-related side effect. The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults aims to reduce such risks, but better communication is desperately needed. Compounding pharmacists are in an ideal position to help safeguard older adults and protect their health with regular counseling.
Summary of the 2015 Beers Revisions
The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults provides the benchmarks used to guide geriatric medication decisions and improve medication safety. An expert panel convened by the American Geriatrics Society (AGS) reviewed more than 6700 studies and clinical trials, then revised the criteria and released the 2015 version of Beers.1
As you turn to the Beers Criteria, remember that the key word in the title is “potentially.” The medication recommendations are potentially—but not definitely—inappropriate. All decisions should be guided by each individual’s health and circumstances.
A short list of the changes made to the 2015 version includes:
- Beers now has a list of alternative therapies and non-pharmaceutical treatment options.
- Older adults should not use proton pump inhibitors for more than eight weeks, unless indicated for a GI condition, due to the increased risk of bone loss, fractures and bacterial infections.
- Beers recommends avoiding antipsychotic medications altogether unless the older adult is a threat to self or others.
- A list of 20 prescription medications to avoid or adjust depending on kidney function was added.
- A new list of combinations of medications known to cause drug-drug interactions was developed to reduce the risk of falls, fractures and medication toxicity.
Compounding pharmacists can access the full clinical guidelines, patient resources, pocket cards, mobile apps, and other Beers Criteria resources on the AGS website.2
Medication Issues Affecting Older Adults
The 2015 revision of Beers is a timely reminder of the medication issues that are unique to older adults and the beneficial influence that compounding pharmacists can bring to this population. Natural aging causes changes in absorption, metabolism, and excretion of medications. Age-related changes in renal function often lead to reduced drug clearance, even when renal disease is absent.
Polypharmacy is a significant concern because older adults often have multiple health problems that are treated with medications. While that may sound like an obvious statement, the statistics are eye opening:
- 36 percent of people aged 75 to 85 take five or more medications.
- 46 percent also report using OTC medications.
- An older adult female diagnosed with type 2 diabetes, COPD, high blood pressure, osteoporosis and osteoarthritis could be taking 12 meds prescribed by multiple doctors following appropriate protocols.3
- The risk for adverse effects increases from 15 percent when taking two medications to 58 percent when patients take five medications and 82 percent with seven of more.4
As polypharmacy increases the risk of a prescribing cascade, any new symptom that arises in an older adult should be considered a medication side effect until a different cause is determined. Unfortunately, new symptoms are often treated with yet another medication. Polypharmacy makes medication noncompliance more likely and it’s also an independent risk factor of hip fractures.
Conduct Regular Medication Reviews
Medication problems flourish often due to lack of communication. Patients don’t always tell their doctors about all medications and OTC products they take. Different specialists often don’t communicate with one another about medications they each prescribe for the same patient. Some herbs and supplements can interact with medications, yet they’re seldom discussed. For example, fewer than half of all oncologists ask their patients about herb and supplement use.5 On the flip side, one-third of all adults using complementary and alternative medicine don’t communicate to their doctor what they take.6 About half of menopausal women use CAM, but half of them don’t share this information with their health care provider.7
It’s obvious that a mutual communication problem exists. It’s also clear that pharmacists are perfectly positioned to help by scheduling medication reviews for older patients. Ask each patient to put all their meds, supplements, and OTC products into a bag and bring them to a scheduled counseling session. Then compile a master list that includes everything, including meds prescribed by other pharmacies, and compare the list with the Beers Criteria. During the medication review, also consider these points:
- Be on the lookout for medications that could be discontinued and verify the dosages to be sure the meds aren’t over- or under-prescribed.
- Determine whether there are safer alternative medications.
- Discuss with the patient about insurance coverage and financial issues that may prevent compliance.
- Organize multiple medications using a pill dispenser. Consider placing an order for custom pill boxes imprinted with the pharmacy’s name and phone number in large letters.
Finally, contact every prescribing physician and let them know you’re conducting regular medication reviews for their patient. With permission from the patient, alert them to any interaction or dosage issues and offer to send them a copy of your master list and recommendations.
Intervention by Compounding Pharmacists Can Make a Difference
When 28 pharmacies in Denmark decided to test the benefit of intervention with polypharmacy patients, they found a big improvement in outcomes. When patients received medication reviews and help monitoring prescriptions, adverse effects declined from 33 percent to 19 percent, hospitalizations went down and the number of prescription medications decreased.8 You can do the same or better for the older adults in your community.
Pharmaceutica North America provides high-quality bulk APIs, custom compounding kits, delivery systems and dietary supplements that meet the pharmaceutical needs of your older patients. We’re here to answer your questions, so please contact us today to see how we can help ensure the safety and effectiveness of your patients compounded medications.
- “Expanded AGS Beers Criteria Offer New Guidance, Tools for Safer Medication Use Among Older Adults,” October 2015, http://www.americangeriatrics.org/press/id:5907 ↩
- “AGS Beers Criteria 2015,” October 2015, http://geriatricscareonline.org/events/newly-updated-ags-beers-criteria-2015/57 ↩
- “Drug Prescribing for Older Adults,” August 2015, http://www.uptodate.com/contents/drug-prescribing-for-older-adults ↩
- “Polypharmacy in Older Adults,” November 2015, http://journals.lww.com/homehealthcarenurseonline/Fulltext/2015/11000/Polypharmacy_in_Older_Adults.3.aspx ↩
- “Cancer Doctors Don’t Discuss Herbs, Supplements With Patients, January 2015, http://healthfinder.gov/News/Article/693921/cancer-doctors-dont-discuss-herbs-supplements-with-patients ↩
- “Patient Disclosure About Herb and Supplement Use Among Adults in the US, December 2008, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2586312/ ↩
- “Concomitant Use of Prescription Medications and Dietary Supplements in Menopausal Women: An Approach to Provider Preparedness,” March 2011, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3071591/ ↩
- “Pharmacists Can Resolve Polypharmacy—Just Ask Denmark,” September 2013, http://www.pharmacist.com/pharmacists-can-resolve-polypharmacy%E2%80%94just-ask-denmark ↩