Yesenia Martinez

1. Evaluating Medication Regimensin the Elderly Yesenia Martinez Nova Southeastern University College of Pharmacy

2. Purpose and Objectives What medication-related problems (MRPs) are specific to the geriatric population and what puts these patients at a higher risk for experiencing adverse drug reactions (ADRs) and MRPs? What actions are taken by the pharmacist in order to identify, correct, and prevent MRPs?

3. MRPs - Definition “Undesirable event experienced by a patient that involves, or is suspected to involve, drug therapy, and actually or potentially interferes with a desired patient outcome”

5. MRPs in nursing facilities cost an estimated $4 billion

7. Confusion or changes in mental status

10. 3.5 to 8 medications (hospital – acute care)

12. Define standards of care

13. Focus on improving quality of care

15. Underrepresentation in clinical trials

17. High Frequency of ADRs Among Elderly Reasons: Multiple physicians prescribing independently Patient nonadherence Inappropriate self-medication Inadequate patient education Age-related physiological changes

18. Medication Nonadherence Reasons for Intentional Nonadherence: Feeling of being overmedicated Limited income Other Reasons for Nonadherence: Poor communication Declining cognitive function Complicated drug regimens

19. Medication Nonadherence Risk Factors: Chronic conditions (≥ 3); Medications (≥ 5); Daily dosages (≥ 12); Prescribers (≥3); Medication regimen changes in previous 12 months (≥ 4) Living alone in community Significant cognitive/physical impairment Recent discharge from hospital Relying on caregiver Low literacy level History of poor medication adherence

21. Maximum doses for certain medications

22. About 7.5% to 27% of elderly patients use a Beers list drug

24. Medication Regimen Review Step 1: Create a patient database Step 2: Review each medication Step 3: Create a problem list Step 4: Create a plan Step 5: Execute the plan Step 6: Follow up

25. Medication Regimen Review M – Minimize number of drugs used A – Alternatives should be considered S – Start low and go slow T – Titrate therapy E – Educate the patient R – Review regularly

27. Components:

28. Mental, Functional, Social, Economic, and Physical status

29. Values

31. Is each medication necessary?

32. Are nonpharmacological alternatives available?

33. Is the lowest effective dose being used?

34. Any unaddressed medical or medication-related problems?