Challenges of providing information on medicines to
elderly people
Speaking at a Pharmacy Information Section symposium
on the information needs of elderly patients on 6 September, William Simonson,
president, American Society of Consultant Pharmacists, United States,
said that providing information on medication to older people poses a
significant challenge to pharmacists. That older people are at greater
risk of medication-related problems because of their increased use of
medicines and the complexity of their medication regimens was well known.
But pharmacists worldwide needed to grasp the opportunity.
In the US, use of prescription medicines in older
patients had increased by 45 per cent between 1992 and 2000 and was projected
to increase by a further 35 per cent by 2010. In addition, more than 700
drugs were in development for this group of patients, with the human genome
project having the potential to spark exponential growth in targets for
drug innovation.
Although many benefits could be expected as a result
of this growth, so too could problems, particularly if medicines were
not used appropriately. A US study had shown that this was already the
case, with estimates for medication-related problems (MRPs) in ambulatory
care increasing from $76bn in 1995 to $177bn in 2000. Another study in
1997 had indicated that MRPs cost $100bn, more than the cost of treating
diabetes mellitus ($92bn) and just less than that of cancer ($104bn).
However, the fact that 80 per cent of MRPs were
preventable and the obvious desire on the part of purchasers to reduce
medicine costs presented a golden opportunity for pharmacists, particularly
in relation to residents in nursing homes, where the fact that staff frequently
did not understand drug therapy was “a recipe for disaster”.
A 1999 study involving 2,193 people in nursing homes
had shown that 9.9 per cent of prescriptions were inappropriate and 39.7
per cent of residents had inappropriate prescriptions. And if that had
not highlighted the potential opportunity for pharmacists, a further study
had indicated that care provided by a pharmacist could improve therapeutic
outcomes by 43 per cent, reduce treatment failure by 35 per cent and problems
with new medication by 21 per cent. Of significance, however, was the
fact that the pharmacists involved in this latter study were specially
trained in medication issues in older patients.
Unique pharmacists for unique patients
The need for pharmacists who were experts in geriatric
drug therapy and the unique medication needs of older people was increasingly
recognised in the US, according to another speaker, Michael Martin, of
the Commission for Certification in Geriatric Pharmacy, Virginia, US.
Founded in 1997, the CCGP aimed to identify pharmacists with such expertise
by offering a practice-based examination which tested issues related to
geriatric pharmacy practice. To date, there were approximately 600 certified
geriatric pharmacists (CGPs) in Australia, Canada, Sweden and the US,
he said.
Dr Bradley Williams (University of Southern California,
Los Angeles, US) explained how certified geriatric pharmacists worked.
Essentially, they worked as part of a team which included care managers,
nurses, doctors, dietitians, and also home helps, who, trained to look
for problems, were often the people who referred older people to pharmacists.
CGPs conducted all the obvious activities such as
medication reviews, generation of medication reports, evaluation of medicine
storage in the patient’s home and removal of any unsafe medicines. On
average they saw 10 clients a day, and sometimes up to 23.
Continued documentation of the value of CGPs was
necessary, Dr Williams said, but “we see certification as a vital bridge
for increased professional growth and enhanced clinical responsibility
for this group of patients. Unique patients need unique pharmacists,”
he concluded.
OTC drugs — high risk for interaction in older
patients
The potential for interactions between OTC medicines
and prescription medicines is high and increasing in older people, according
to Dr Rosaly Correa-de-Araujo, of the American Society of Consultant Pharmacists,
US. Retail sales figures indicated that older people consumed one third
of all OTC medicines in the US, with 84 per cent regularly using one OTC
medicine and 6 per cent taking five or more OTCs each day.
She went on to say that as the elderly population
increased together with the number and demand for OTCs, the risk of adverse
effects could be expected to grow exponentially. However, consumers invariably
tended to see OTCs as safe, partly because of their easy availability
on open shelves in stores, and also because pharmacists and doctors often
failed to ask questions about their use. Of additional concern was the
fact that more than half of the older population who used OTCs did so
without consulting their doctors, she said.
Pharmacists, in particular, should be aware of potential
OTC-prescription drug interactions, take appropriate medication histories,
encourage rational prescribing and counsel patients effectively.
Swedish nursing home study
Bodil Lidstrom (Apotek AB, Sweden) described a study
whose aim was to look at the appropriateness of prescribing in nursing
homes in Sweden. Working as part of a multidisciplinary team, pharmacists
identified drug-related problems. Among 568 patients in 16 nursing homes,
pharmacists made 966 interventions, 76 per cent of which resulted in a
positive outcome for the patient in terms of helping to achieve the therapeutic
goals in their care plan, while 5 per cent of interventions had a negative
effect and 19 per cent no discernible effect.
“As a member of an interdisciplinary team, the pharmacist
contributes information about new medicines, understanding of drug therapy
in older people, enhanced therapeutic outcomes and improved well being
in the residents,” Ms Lidstrom concluded.
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