Home' Australian Pharmacist : Australian Pharmacist December2016 Contents Australian Pharmacist December 2016 I © Pharmaceutical Society of Australia Ltd.
CONTINUING PROFESSIONAL DEVELOPMENT
Katie Hayes is a pharmacy manager and accredited
pharmacist based in Hobart, Tasmania.
After reading this article, pharmacists should be
Discuss the risk factors for medicine-related
problems in the elderly, and tools available to
identify potentially inappropriate medicines
Describe factors that may impact on medicines
adherence in elderly patients
Identify services that pharmacists can provide
to promote and assist in optimising medicines
management in older patients.
Competencies addressed: 1.2 .1, 1.2 .2, 1.3 .1, 1.3 .2,
2.1 .3, 2.3 .1, 2.3 .2, 2.3 .3, 4.2 .2, 4.2 .3, 6.1 .1, 6.1 .2, 6.1 .3,
6.2.2, 6.2.3, 6.3.2, 6.3.3, 7.1.2, 7.1.4.
Accreditation number: CAP161212B
of medicine-related problems increases
in those who6:
take multiple medicines and/or doses
have complex medicine regimens
take medicines with a narrow
take medicines that require monitoring
have adherence problems
have adverse drug reactions.
Prescribing potentially inappropriate
medicines to elderly people has been
linked to adverse drug event risk and
adverse health outcomes.
See Table 1 for a
list of potentially inappropriate medicines
for elderly people. Various measures have
been formulated to predict potentially
inappropriate prescribing. Explicit criteria
suggest that agents on the list be avoided
regardless of the patient (e.g. Beers criteria),
and implicit criteria suggest information
from the patient and evidence-based
medicine are used with clinical judgement
to assess medicine appropriateness
(e.g. Medication Appropriateness Index,
and the Inappropriate Medication Use
and Prescribing Indicators tool).
A pharmacist’s role
Pharmacists can assist with medicine
management in elderly patients in
several ways to minimise the risk of
adverse events and improve the safety
of medicines. It is useful to identify and
target patients at risk of medicine-related
problems as detailed above.
Scenarios like Dorothy’s are common
in pharmacy. Australia has an ageing
population, with the number of people
≥65 years more than tripling in the past
50 years, and the number of people
≥85 years increasing nine-fold in that
As we age, many changes
occur, some of which can have a
significant impact on health and quality
of life (QOL). Progressive physiological
changes take place such as a decrease
in cardiac output leading to decreased
hepatic blood flow, increase in vascular
resistance, a reduction in renal function,
and a reduction in lean body mass.2,3
Sensitivity to the effects of medicines
increases.3 Many health conditions
become more common with ageing,
such as arthritis and dementia.
Older people can have slowed
processing speed, which results in
many of the cognitive changes reported
in healthy older adults.
A decline in
processing speed can have implications
across a variety of cognitive domains.
One of the most common cognitive
complaints among older adults is
change in memory. Age-related memory
changes may be related to slowed
processing speed, reduced ability to
ignore irrelevant information, and
decreased use of strategies to improve
learning and memory.
Some executive function abilities,
such as response inhibition, can be
negatively impacted by ageing.
been reported older people who have
strong social networks and activity are
less likely to have a decline in cognitive
function than those elderly who are
more socially disengaged.5 There is also
reported lower morbidity and mortality
in older adults who report strong social
From this it can be seen
that it is critical to ensure older people
are able to maintain or obtain the best
health possible, not just so they feel
well, but so they can participate in social
activities, perform activities of daily
living (ADL) and maintain a high QOL,
and physical and emotional wellbeing.
Medicine risks in older adults
As the number of medical conditions
increases, more medicines may
be added to a patient’s regime.
This increases the risk for the patient of
medicine misadventure. Problems that
may arise include taking the incorrect
amount of medicine, doubling up on
medicine, and omitting medicines.
Consequences vary, but may be severe
and result in hospital admission. The risk
and a good coffee
BY KATIE HAYES MPS
Dorothy is a frail 74-year-old woman who suffers from diabetes,
hypertension and hypercholesterolaemia. Her type 2 diabetes
has left her moderately visually impaired and unable to deal with
homemaking duties. Although she is not able to see properly, she does
manage to use public transport and attends a congregate meal site.
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