Senior Care Pharmacist最新文献

{"title":"A Retrospective Case-Control Study Evaluating Medications Associated with Inpatient Falls in a Single Veterans Affairs Medical Center.","authors":"Emma Stragand, Jennifer Armbrust, Jiahui Chen, Maria Shin","doi":"10.4140/TCP.n.2025.247","DOIUrl":"10.4140/TCP.n.2025.247","url":null,"abstract":"<p><p><b>Background</b> Falls, specifically in the older population, can lead to adverse health consequences including fractures, head injuries, and increased length of hospital stay. In addition, falls greatly increase total medical costs. Although risk factors have been identified and studied, inpatient falls still occur at a high rate. <b>Objectives</b> The primary objective of this study was to identify the medications associated with inpatient falls when compared to a matched control group of patients who did not fall at a Veterans Affairs Medical Center (VAMC). <b>Methods</b> This single-center, case-control, retrospective study reviewed patients admitted to a VAMC from August 2018 to August 2023. Patients were included if they were 65 years of age or older and admitted for at least 48 hours. Patients admitted to the intensive care unit or hospice unit were excluded. Fall patients were matched 1:1 to the control group for age, gender, length of stay, and service type at time of fall. The primary outcome was identifying medications associated with falls. <b>Results</b> Antipsychotics (<i>P</i> = 0.009), non-sedating antidepressants (<i>P</i> = 0.011), and finasteride (<i>P</i> = 0.034) were found to have a higher association with falls compared to the control group. Comorbidities with higher association with falls were history of falls (<i>P</i> = 0.001) and urinary incontinence (<i>P</i> = 0.013). <b>Conclusion</b> Administration of antipsychotics and nonsedating antidepressants increased risk of inpatient falls in this study. Further research is needed with larger and more diverse patient populations to validate these results.</p>","PeriodicalId":41635,"journal":{"name":"Senior Care Pharmacist","volume":"40 6","pages":"247-254"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Power of Peer Review.","authors":"Demetra Antimisiaris, Patricia W Slattum","doi":"10.4140/TCP.n.2025.235","DOIUrl":"10.4140/TCP.n.2025.235","url":null,"abstract":"","PeriodicalId":41635,"journal":{"name":"Senior Care Pharmacist","volume":"40 6","pages":"235-236"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilization Rates of Beneficial and Potentially Harmful Medications in the Outpatient Management of Chronic Kidney Disease.","authors":"Andrea Callas, Kelsey Buckley, Nicole K Early, Kathleen A Fairman","doi":"10.4140/TCP.n.2025.255","DOIUrl":"10.4140/TCP.n.2025.255","url":null,"abstract":"<p><p><b>Background</b> An estimated 14% of U.S. adults are affected by CKD, of whom about 34% are aged 65 years or older. Certain prescribed or over-the-counter medications can exacerbate or help slow CKD progression. <b>Objective</b> To evaluate prescriptions or recommendations for potentially beneficial and harmful medications in patients with CKD. <b>Design</b> Retrospective, cross-sectional analysis of medical records from U.S. office-based physician visits. <b>Setting</b> National Ambulatory Medical Care Survey, visits made by patients with CKD, 2014-2019. <b>Interventions</b> Comparison of rates and predictors for potentially beneficial versus potentially harmful medications including both prescribed and recommended over-the-counter agents. <b>Methods</b> CKD and related comorbidities were identified using indicators collected from the record regardless of the reason for the sampled visit. Medication classification was based on current guidelines and studies. Analyses included descriptive statistics of patient characteristics and predictors of beneficial versus harmful medication prescriptions/ recommendations. <b>Results</b> A total of 2,805 adult patients with a diagnosis of CKD were sampled. A plurality were aged 75 years or older (47.4%); majorities were White non-Hispanic (64.0%) with comorbid hypertension (78.8%). Beneficial medications only were prescribed/ recommended to 12.2% of patients, harmful medications only to 20.6%, a mix of beneficial/ harmful medications to 26.7%, and neither to 40.5%. Strong positive predictors of potentially harmful medication prescriptions/recommendations included polypharmacy and diagnoses of cerebrovascular disease or congestive heart failure. <b>Discussion</b> Prescribing patterns for patients with CKD highlight the importance of medication optimization to balance therapeutic benefits and harms. <b>Conclusion</b> Pharmacists can educate providers to improve prescribing practices in patients with CKD.</p>","PeriodicalId":41635,"journal":{"name":"Senior Care Pharmacist","volume":"40 6","pages":"255-270"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why The American Medical Association's Position on Enhanced Pharmacists' Services Misses the Mark.","authors":"Chad Worz, Leigh Davitian","doi":"10.4140/TCP.n.2025.271","DOIUrl":"10.4140/TCP.n.2025.271","url":null,"abstract":"","PeriodicalId":41635,"journal":{"name":"Senior Care Pharmacist","volume":"40 6","pages":"271-273"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mentored Quality Improvement Strategies to Enhance Deprescribing During COVID-19: A Case Series of Three Nursing Homes.","authors":"Kristina M Niehoff, April Hanlotxomphou, Mattie Brady, Carole Bartoo, Anna H Gallion, Isaac T Schlotterbeck, Anna F Gaudette, Tara B Horr, Sandra F Simmons, Sunil Kripalani","doi":"10.4140/TCP.n.2025.237","DOIUrl":"10.4140/TCP.n.2025.237","url":null,"abstract":"<p><p><b>Background</b> In post-acute and long-term care (PALTC) facilities, challenges exist to optimizing medication management. During the COVID-19 pandemic, nursing homes (NHs) sought ways to streamline medication administration and deprescribe medications. <b>Objective</b> This quality improvement (QI) initiative aimed to implement medication-related projects in three NHs. <b>Methods</b> Each NH was assigned a nurse practitioner (NP) QI mentor who led the facilities through the QI efforts using validated tools during the COVID-19 pandemic. Each facility selected their medication-related topic of interest. The QI efforts were implemented by the NH staff including the director of nursing, providers, and consultant pharmacists. <b>Results</b> Two facilities focused on general medication deprescribing, and the third facility focused specifically on antipsychotic deprescribing. Successful deprescribing interventions occurred in all three facilities; however, they did not achieve all QI goals. <b>Conclusion</b> Successful deprescribing can occur using mentored implementation of QI tools. However, it is imperative to have key stakeholders within NHs who are supportive and engaged in the deprescribing process, such as facility staff (leadership and front-line staff), facility providers, consultant pharmacists, and residents/families.</p>","PeriodicalId":41635,"journal":{"name":"Senior Care Pharmacist","volume":"40 6","pages":"237-246"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a Geriatric Medication Safety Initiative (GEMSI) Pharmacist-Driven Procedure on Opioid Use in a Transitional Care Unit.","authors":"Jaylan M Yuksel, Kyle R Eilert, John Noviasky, Kelly R Ulen, Sabeena G Valentin, Vincent C Lorello, Jasmeen Kaur, Faiza Ahmed, Kenneth L McCall","doi":"10.4140/TCP.n.2025.209","DOIUrl":"10.4140/TCP.n.2025.209","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background:&lt;/b&gt; Millions of older people are hospitalized each year, and they often use pain medications during their stay. At the same time, about seven million people 65 years of age and older have filled at least one opioid prescription. Studies have found pharmacist-led interventions to minimize inappropriate prescribing and optimize medication regimens. These also may reduce adverse events and length of stay. &lt;b&gt;Objective&lt;/b&gt; A pharmacist-driven procedure, the Geriatric Medication Safety Initiative (GEMSI), was created in May 2017. The primary outcome of this study was to examine the opioid morphine milligram equivalent per day (MMED) pre- and post-implementation of GEMSI. Secondary outcomes included length of stay (LOS) and acetaminophen use per day. &lt;b&gt;Design&lt;/b&gt; This was a retrospective, single-center cohort study with pre- and post-implementation groups. Data were extracted via chart review to determine the reason for admission, length of stay, non-opioid pain medication usage, and MMED. Data are expressed as mean, standard deviation (SD), and n (%). Chi square, Mann Whitney U, and two sample t-tests were performed as appropriate. &lt;b&gt;Setting&lt;/b&gt; A transitional care unit (TCU) in the state of New York that has achieved an Institute for Healthcare Improvement (IHI) for Age-Friendly health level 2 center designation. It is a short-term (usual maximum of 21 days) rehabilitation and acute care setting. Patients who are medically stable after their acute admission but need additional physical and/or occupational therapy are eligible for admission. &lt;b&gt;Patients, Participants&lt;/b&gt; Patients greater than or equal to 65 years of age admitted to the TCU in 2016 or 2018 were included. Patients were excluded if they were acutely ill and/or transferred off the TCU. &lt;b&gt;Intervention&lt;/b&gt; This was a single-center (ie, a short-term inpatient rehabilitation facility), retrospective, cohort chart review study that was exempted from Institutional Review Board (IRB) review. &lt;b&gt;Results&lt;/b&gt; In total, 566 patients were included. The overall mean MMEDs pre- and post-GEMSI were 9.5 (+/- 18.0) compared to 8.5 (+/- 22.7) mg/day, respectively (&lt;i&gt;P&lt;/i&gt; = 0.186). The TCU length of stay decreased from a mean of 12.4 to 11.1 days (&lt;i&gt;P&lt;/i&gt; = 0.005) and the average acetaminophen use increased from 673 to 722 mg/day from pre- to post-GEMSI (&lt;i&gt;P&lt;/i&gt; &lt; 0.001). Lidocaine doses utilized per day were not statistically different between pre- to post-GEMSI (0.14 doses per day vs 0.20 doses per day; &lt;i&gt;P&lt;/i&gt; = 0.798). In a subgroup analysis of patients who reported pain, the mean MMEDs were 15.3 (+/- 21.3) compared to 10.9 (+/- 18.7) mg/day, respectively (&lt;i&gt;P&lt;/i&gt; = 0.038). &lt;b&gt;Discussion&lt;/b&gt; This retrospective study demonstrates that the implementation of a pharmacist-driven procedure, such as GEMSI, is associated with decreased opioid exposure and increased use of non-opioid analgesics such as acetaminophen. By decreasing the exposure to opioid medications, we expect that ","PeriodicalId":41635,"journal":{"name":"Senior Care Pharmacist","volume":"40 5","pages":"209-216"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Secondary Stroke Prevention Trends in Low-Income Community-Dwelling Older Individuals.","authors":"Joanna Nguyen, Sara Arnaout, Brenna Levison, Nhi Lo, Elvin T Price, Emily P Peron, Ericka L Crouse, Lana Sargent, Kristin M Zimmerman, Patricia W Slattum, Krista L Donohoe","doi":"10.4140/TCP.n.2025.223","DOIUrl":"10.4140/TCP.n.2025.223","url":null,"abstract":"<p><p><b>Background:</b> Effective secondary stroke prevention is crucial in reducing recurrence and improving patient outcomes, particularly in low-income community-dwelling older individuals who face barriers to health care access. Proper management of modifiable risk factors, such as hypertension, hyperlipidemia, and atrial fibrillation (AF), is essential to prevent subsequent strokes in this vulnerable population. <b>Objective</b> This study describes medication use for secondary stroke prevention among low-income community-dwelling older individuals in Richmond, Virginia. <b>Design:</b> This study involved a retrospective chart review using data provided by the Mobile Health and Wellness Program (MHWP), formerly known as Richmond Health and Wellness Program. The data included patient-reported disease states and prescription medications, which was collected by faculty and students during medication reviews in the last two years. <b>Setting</b> The MHWP was established by the Virginia Commonwealth University in 2012 to provide free health care coordination services for older individuals living in low-income communities, including five Section 8 housing buildings in the east end of Richmond, Virginia. <b>Patients, Participants:</b> The study included 499 participants who were patients in the MHWP system between 2021 and 2023. Most participants were 65 years of age and older, female, and Black or African descent with a reported income of less than $1,000 per month. <b>Interventions:</b> Data from the MHWP charting system (2021-2023) were analyzed using SPSS 29.0 to determine antiplatelet and anticoagulation use among participants with a history of stroke/transient ischemic attack (TIA) or AF/flutter. <b>Results:</b> Of 499 participants, 62 (12.4%) reported having a history of stroke/TIA, and 19 (3.8%) reported AF/flutter. Aspirin was the most prescribed antiplatelet (46.8% for stroke/TIA, 36.8% for AF/flutter). However, 33.8% of stroke/TIA survivors and 21% of participants with AF/flutter were not taking any antiplatelet or anticoagulant. Stroke/TIA survivors had higher rates of hypertension (<i>P</i> = .011), atherosclerotic cardiovascular disease (<i>P</i> = .005), and epilepsy (<i>P</i> = .006) versus those without prior stroke/TIA. <b>Discussion:</b> Understanding the unique socioeconomic and health care challenges of this population in the context of secondary stroke prevention is crucial for developing effective interventions tailored to this population. In comparing disease states reported by patients with a history of stroke/TIA with other MHWP participants, hypertension emerges as the most prevalent condition. Hypertension stands out as an important modifiable risk factor for ischemic stroke due to its role in atherosclerosis development.⁹ <b>Conclusion:</b> More than one-third of stroke/ TIA survivors were not receiving antiplatelet or anticoagulation therapy, and almost 40% of stroke/ TIA survivors were not receiving statin","PeriodicalId":41635,"journal":{"name":"Senior Care Pharmacist","volume":"40 5","pages":"223-229"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medicaid Uncovered: Exploring the Many Dimensions of a Misunderstood Program.","authors":"Leigh Davitian Jd","doi":"10.4140/TCP.n.2025.230","DOIUrl":"10.4140/TCP.n.2025.230","url":null,"abstract":"","PeriodicalId":41635,"journal":{"name":"Senior Care Pharmacist","volume":"40 5","pages":"230-234"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medication Reconciliation at Transition of Care in a Geriatric Primary Care Setting: A Pilot Program.","authors":"Kimberly Atkinson, Andrea Koff, Carl Smith, Ilyarosa Perez Palacios, Paige Rhein","doi":"10.4140/TCP.n.2025.217","DOIUrl":"10.4140/TCP.n.2025.217","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background:&lt;/b&gt; The transition from hospital to home for older individuals can be complicated, as they are more likely to have complex health and/or social care needs. Several published studies have outlined positive outcomes from pharmacist-driven transition of care programs. At our four geriatric primary care clinics affiliated with a large academic medical center, there is no medication reconciliation process to evaluate a patient's medications after being discharged from the hospital to home. &lt;b&gt;Objective:&lt;/b&gt; The objective of this pilot program was to demonstrate the need for a pharmacist-led transition of care medication reconciliation program within a geriatric primary care setting. &lt;b&gt;Design:&lt;/b&gt; This is a retrospective evaluation of a pilot program that took place from July 1, 2022, to June 30, 2023, within 4 geriatric primary care clinics affiliated with a 523-bed, full-service medical and surgical acute care hospital. Electronic medical records (EMR) were utilized to identify patients who were discharged from the hospital within 24 to 72 hours to their homes. Documentation in the patient's EMR by the primary care clinic's clinical pharmacist contained confirmation of a hospital follow-up appointment, completion of medication reconciliation, notification to the provider for pharmacotherapy concerns, and patient counseling on medication changes. Information on number of patients requiring clinical pharmacist intervention prior to hospital follow-up appointment, intervention type, average number of medication discrepancies per patient, and percentage of hospital follow-up appointments with a medication reconciliation completed prior to visit were also documented. &lt;b&gt;Setting:&lt;/b&gt; Four geriatric primary care clinics affiliated with a 523-bed, full-service medical and surgical acute care hospital in Gainesville, Florida. &lt;b&gt;Patients, Participants:&lt;/b&gt; A total of 881 unique medication reconciliations were completed for this retrospective pilot program study. Patients were included if they were discharged from the hospital to home during that time period and were active patients of a provider at the primary care clinic. Patients were excluded if they were discharged from the hospital to another acute care facility (such as a skilled nursing facility, rehabilitation facility, or hospice), if the patient expired during their hospitalization, or if they were not an active patient of a provider at the primary care clinic. &lt;b&gt;Intervention:&lt;/b&gt; A primary care clinical pharmacist reviewed each discharged patient's EMR from the hospital to reconcile their medications with the medication list within the patient's primary care EMR. A transitions of care medication reconciliation evaluation progress note was created for each patient discharged home for documentation. Within this note, the pharmacist documented the number of medication discrepancies, medications added, medications discontinued, and medications with dosage adjustments. The pharmac","PeriodicalId":41635,"journal":{"name":"Senior Care Pharmacist","volume":"40 5","pages":"217-222"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacists and Care Transitions for Older Adults.","authors":"Antoinette B Coe","doi":"10.4140/TCP.n.2025.201","DOIUrl":"10.4140/TCP.n.2025.201","url":null,"abstract":"","PeriodicalId":41635,"journal":{"name":"Senior Care Pharmacist","volume":"40 5","pages":"201-202"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}