Reach Out to Seniors and Improve Quality of Life: Expand Medication Reviews to Include Frailty Assessment
As Olivia celebrated her 67th birthday, she told friends that she was blessed to have lived that long without ever suffering a serious illness. It sounds hard to believe, but two bouts with flu and an early flare-up of diverticulitis summed up her medical history. However, a few months later, she started to slouch when walking—contrary to her normally perfect posture—and she walked at a noticeably slower pace. She figured this was a typical sign that aging was catching up with her, but in actuality these changes marked the beginning of frailty. At this stage, it can be reversed in most seniors, but since they feel fine, they’re not likely to consult a doctor and get the appropriate treatment. This is where compounding pharmacists make a difference. You have the opportunity to reverse the pending decline by expanding medication reviews to include a frailty assessment.
Early Intervention Reverses Frailty and Delays Dependence
Frailty is often taken for granted as an expected part of aging, but its onset is better viewed as a critical crossroad between successful aging versus progressive disability and increased risk for cognitive decline. On the positive side, there’s a transitional stage—a period of time when appropriate intervention determines which direction the patient takes. Multimodal strategies to reverse frailty include medical treatment, dietary supplements, and strength and balance training. But first the condition must be identified.
A large group of patients stand to benefit from pharmacist-based intercession that targets frailty. The number of people reaching the age of 65 will double between 2012 and 2050, thanks to aging baby boomers. Prevalence estimates in the United States range from 14 to 24 percent because multiple definitions of frailty syndrome produce different statistics.1 In Canada, where a Frailty Index is commonly used, prevalence is 23 percent of those over the age of 65 and nearly 40 percent for those over 85.2
Frailty Assessment Using a Geriatric Scale
Reach out to this group using medication reviews. Regularly scheduled appointments ensure consistent interaction with older patients, which makes it easier to observe physical changes. Then it’s just a matter of dedicating a small amount of time during the review perform a frailty assessment . Meeting three out of the following five criteria indicates frailty, while one or two signifies pre-frailty:
- Gait Velocity: Gait speed is a key indicator used to assess frailty and possible sarcopenia. A sluggish gait predicts pending physical decline, falls, dependency and even earlier death—slow walkers die at least six years earlier than those who maintain a typical pace. Gait speed normally begins to decline around age 70 and gradually slows at the rate of 15 percent per decade.3 If you have the space, you can time how long it takes patients to walk 15 feet and use info from the Geriatrics Evaluation and Management Tool to assess the score.4 But if you observe a change, that’s enough to encourage them to see a doctor.
- Weight Loss: Ask if they’ve lost more than 10 pounds—unintentionally—over the last year.
- Exhaustion: Does your patient notice that their activities over the last week took effort to complete? Did they have any days when they just couldn’t seem to get going. If they felt that way three or more days out of the last week, they meet this criterion for frailty.
- Low Activity Level: Burning fewer than 270 calories per week through physical activity is another frailty characteristic. This includes calories expended during normal activities. For example, 30 minutes spent standing in line burns 38 calories and cooking uses 75 calories, while grocery shopping depletes 105 calories. A half-hour of gardening and walking uses 120 calories.5
- Weakness: A person’s hand grip—tested using a hand dynamometer—is the fifth criteria measured on the frailty scale.
Review for Systemic Effects of Medications and Nutritional Deficiency
Compounding pharmacists can be the first to raise a red flag about adverse effects of medications on body systems already taxed by declining health and frailty. Remind the patient to bring prescriptions filled at other pharmacies, dietary supplements and any OTC medications they use to the medication review. After examining dosages and drug-drug interactions, check for these potential interactions:
- Medications Affecting Blood Glucose: Type 2 diabetes plays a major role in overall physical decline and frailty, so identifying medications that contribute to unbalanced blood sugar can prevent onset of diabetes or help keep it under control. Corticosteroids, warfarin, opioids, phenytoin and thiazide diuretics may increase blood glucose, while aspirin, beta-blockers, ACE inhibitors, sulfonamides and the obvious—insulin and anti-hyperglycemic agents—lower blood glucose.6
- Blood Lipid Fluctuations: Estrogen and supplemental vitamin D can increase levels of blood lipids, so consider potential interactions in patients taking statins and other cholesterol-lowering meds. Adrenal corticosteroids and chlorpromazine can also raise blood lipids, while aspirin, colchicine and niacin may confound blood tests by lowering lipids.
Seniors fighting frailty need excellent nutritional support to maintain energy and metabolic demands. At the same time, 74 percent of the elderly lose the ability to taste, which leads to eating less, and an aging metabolism makes them susceptible to malabsorption and nutrient deficiencies. Be sure to include these issues in the medication review:
- Age-Related Nutritional Deficiencies: Malabsorption of vitamin B-12 is so common in seniors that the Institute of Medicine recommends everyone over the age of 50 get most of their RDA from fortified foods and supplements. Alternatively, compounded sublingual options also improve absorption. Vitamin D insufficiency is also prevalent in the elderly, regardless of latitude, which increases the risk of falls and frailty.
- Drugs Interfering with Vitamin and Mineral Absorption: Look for over-the-counter and prescriptions medications, especially everyday meds such as antacids, that may affect appetite or interfere with absorption of nutrients. If you identify medications that can cause problems, recommend compounded solutions, such as topical NSAIDs, or refer for lab tests to assess nutritional status.
Outreach to Seniors and Compounded Solutions Improve Quality of Life
An international group of specialists wrote, “The identification of frailty as a target for implementing preventive interventions against age-related conditions is pivotal.”7 Pharmacists often have the opportunity to interact with seniors more frequently than primary care physicians, which gives them that pivotal role. By taking a few minutes to assess for frailty—and by providing individualized compounded options—you can reverse a downward trend and extend patient’s lives.
Consider Pharmaceutica North America your partner for promoting optimal health and quality of life in senior patients. Contact us today to talk about the bulk APIs, pre-weighed active kits and OTC supplements we provide to meet your patient’s needs.
- “Association of Frailty with Survival: A Systematic Literature Review,” March 2013, http://www.ncbi.nlm.nih.gov/pubmed/22426304 ↩
- “Prevalence and 10-Year Outcomes of Frailty in Older Adults in Relation to Deficit Accumulation,” April 2010, http://www.ncbi.nlm.nih.gov/pubmed/20345864 ↩
- “Gait Disorders in the Elderly,” August 2013, https://www.merckmanuals.com/professional/geriatrics/gait-disorders-in-the-elderly/gait-disorders-in-the-elderly ↩
- “Frailty: Geriatrics Evaluation and Management Tools,” 2012, http://familymed.uthscsa.edu/gerifellowship/redirect/articles/CLC/Geriatrics%20Eval%20Management%20Tool%20for%20Frailty.pdf ↩
- “Calories Burned in 30 Minutes for People of Three Different Weights,” January 2016, http://www.health.harvard.edu/diet-and-weight-loss/calories-burned-in-30-minutes-of-leisure-and-routine-activities ↩
- “Healthy Aging: Raising Nutritional Awareness for Seniors,” December 2015, http://www.uspharmacist.com/content/d/senior_care/c/58394/ ↩
- “Frailty: An Emerging Public Health Priority,” January 2016, http://www.ncbi.nlm.nih.gov/pubmed/26805753 ↩