Multimorbidity and Patient-Centered Care in the Older Adult
Older adults commonly have multiple chronic conditions or diseases. The clinician is often required to prioritize and balance competing priorities to provide care to these individuals that is in accordance with patient and caregiver values, preferences, and goals. The American Geriatrics Society issued Guiding Principles for the Care of Older Adults with Multimorbidity in 2012. This document is a key resource in providing care to these older adults.
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Certain medications are considered to be potentially inappropriate for use in older adults because the risks of these medications generally outweigh the benefits. Geriatrician Mark Beers is credited with compiling the first such list, which has undergone several revisions. The American Geriatrics Society released an updated revision in 2015 of these Beers criteria on potentially inappropriate medication use in older adults. This journal article is open access. The AGS now periodically updates these criteria. The geriatric clinician should be familiar with the Beers criteria.
More resources and information about PIMs are available here:
A key principle of geriatric pharmacotherapy is: "Any new symptom in an older adult should be considered a drug side effect until proven otherwise." Unfortunately, medicines are often overlooked by clinicians as a likely cause of new symptoms in older adults. When this happens, the prescribing cascade is a common outcome.
Polypharmacy and Deprescribing
EIghty eight percent of older adults use at least one prescription medication and 36% of older adults use 5 or more prescription medications. Older adults often take more medications than needed, or take medications for which the risks outweigh the benefits. A plan to "deprescribe" or eliminate inappropriate medications often needs to be developed and implemented. Check this page for resources on polypharmacy and deprescribing.
Anticholinergic Medication Burden
Older adults are more sensitive to the adverse impact of medications with anticholinergic effects. Anticholinergic and sedative drug exposure is associated with poorer function in community-dwelling older people. Anticholinergic medications also can impair cognitive function and increase the risk of delirium and falls. Tools are available for pharmacists to help identify these medications and reduce the exposure of the older adult to the risks of these medications.
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Certain changes generally occur in the human body in conjunction with the aging process. These changes include:
Because of these changes, the older adult is subject to the development of what are termed “geriatric syndromes” or “geriatric conditions.” Examples of these geriatric syndromes include falls, delirium, urinary incontinence, and pressure injury.
Some medications can increase the risk of geriatric syndromes. Click here to learn more...
Clinical Practice Guidelines for Older Adults
CCGP has compiled a list of links to commonly used clinical practice guidelines for diseases and conditions in older adults. This list is periodically updated and expanded. Check back frequently for updates.
Geriatric Books and Textbooks
CCGP has prepared a list of books about geriatric pharmacotherapy and general geriatrics. Some are relatively concise and others are comprehehensive textbooks. Brief descriptions are provided and links are given to the listing of the book on Amazon.com where more information is available about each book.
Online Resources are also available:
Merck Manual of Geriatrics Online (open access)
Geriatrics at Your Fingertips (subscription required)
CCGP has prepared a list of titles and links to geriatric journals. This list may be useful to the geriatric clinician interested in resources to help keep current with developments in geriatrics and geriatric pharmacotherapy. Some of these journals are associated with membership in professional societies.
Pharmacists' Patient Care Process
The Joint Commission of Pharmacy Practitioners released the Pharmacists' Patient Care Process in May 2014, which provides the standardized framework for patient care for pharmacists regardless of practice setting. Every practicing pharmacist should become familiar with this six-page document and begin applying the principles in patient care. The American Pharmacists Association has released a book, How to Implement the Pharmacists' Patient Care Process. The book includes six sample case studies set in different patient care settings to enable the pharmacist to practice applying the patient care process.
Medicines for an Ageing Population
The National Prescribing Service of the Australian Government Department of Health and Ageing has prepared an 8-page overview of principles of medication use in older adults, designed for health professionals. This excellent resource was released in September 2013 and is available in PDF at this link. More resource information from this Department is available at www.nps.org.au/older-people.
Ten Key Journal Articles
CCGP has prepared a document, revised in April 2013, with a list and description of ten key journal articles about use of medications in older adults. This document would be a good starting point for a pharmacist with an interest in learning about geriatric pharmacotherapy.
ASCP Geriatric Pharmacotherapy Resources
The American Society of Consultant Pharmacists Geriatric Pharmacotherapy Practice Resource Center also has links to a variety of resources and web sites on geriatrics and geriatric drug therapy.
The third edition of the Geriatric Pharmacy Curriculum Guide was released by ASCP in 2015.
Resources to Prepare for Certified Geriatric Pharmacist Examination
Live geriatric board review programs and online continuing education modules, among other resources, are available for pharmacists who desire more targeted assistance in preparing to take the Certified Geriatric Pharmacist examination. CCGP does not endorse, and is not affiliated with, any of these preparatory programs. As a service to candidates, CCGP has compiled a list of resources with which we are familiar. The CCGP list of resources is made available to candidates for information purposes only. Each candidate is responsible to review and decide whether the programs may be helpful.
Patient Education Resources
A Guide to Geriatric Syndromes - from the Health in Aging Foundation
Vaccination Information for Older Adults - from the Health in Aging Foundation
CCGP welcomes input and suggestions from geriatric clinicians on recommended resources for inclusion in our list of recommended resources in geriatric pharmacotherapy. If you have a resource to recommend, please use our Contact CCGP link. Thank you.