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Sometimes Less is More... Especially in the Geriatric Population

By Lauren Desko posted 03-27-2013 18:38

  

I have been doing my APPE rotation this month at a nursing home, caring for a primarily geriatric population, and I have learned a lot and I feel that it has been a very important experience for me.  Working with geriatrics, I have discovered that it is a completely different way of thinking!  In pharmacy school we focus a lot on learning guidelines, and trying to figure out what other medications patients need for preventative purposes, and to meet guidelines, etc.  However, in the geriatric population there is so much more of a focus on trying to decrease the number of medications that these patients are taking in order to prevent side effects.  In some cases I have even recommended going against guideline recommendations in some cases with an elderly patient, due to their age and extensive co-morbidties.

There are so many reasons why we focus on trying to decrease medications in the elderly, and one of the main reasons is the BEERs criteria.  The BEERs list has been my friend this month to say the least, and the elderly can experience so many nasty side effects from medications that it becomes extremely important to limit drug therapy as much as possible.  Elderly patients are also much more prone to side effects from any drug, not just BEERs criteria drugs, and due to changes in pharmacokinetics and pharmacodynamics, the more drugs they are on the larger risk they run of having a side effect.

As people grow older, their kidney function goes down. This is something that is hammered into our brains during pharmacy school, and rightfully so!  It is extremely important though to make sure that when you have an elderly patient you are calculating their CrCl and then assessing the medications they are taking to make sure they are properly dosed for their renal function.  Pharmacists can be extremely important assets to physicians and other health-care professionals in these cases because we know the drugs! 

All in all, it has been a really great experience and I feel that I have learned so much this month!  I have also gotten very good at doing drug regimen reviews, as I do several of those daily.  This is a review that is required to be done for each resident of the nursing home every 30 days by CMS, and you have to look at all of their medications, dosing, appropriateness of use, lab values, etc.  Easily the greatest thing I have learned this month is that with the elderly less is more, and if you don’t think they need a medication they could probably do without it.  If possible encourage physicians and other health-care providers to D/C unnecessary medication therapy especially in the elderly, but really for any patient.

Oh and just in case anyone was sitting on the edge of their seats, I did match to a residency program! I am very excited and looking forward to the next step, and hopefully continuing this blog as a resident!  Unfortunately, I don’t know much about how the scramble is working this year with the new changes due to PhORCAS; but from things I have read it appears that if you need to scramble you can still contact programs starting Match Day at 12 Noon when the list becomes available, but that you just can’t submit an application until the day PhORCAS allows you to.  So for future students looking at residencies, the rules may change and PhORCAS may change, so please read rules and emails carefully when it comes time for you to go through Match Day.

Let me know if you have any thoughts or comments about this post, and as usual if you have any questions let me know!  Until next time, which hopefully will be a post about my rotation next month at the FDA! J



#PatientSafety #Geriatricpractitioners #PharmacyStudents #BestPractices #Geriatrics
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