April 2015, Vol 3, No 4 - Inside Pharmacy
Elizabeth Hauss, PharmD, CGP

Although patients of all ages are seen in the retail pharmacy setting, older adults make up a large portion of that population.

Patients older than 65 years of age are often taking multiple maintenance medications, and they rely on their pharmacist for guidance and advice when they begin taking a new medication, have to switch medications, or are diagnosed with a new disease. Geriatric patients (age ≥65 years) who have low health literacy, limited income, and vision or hearing difficulties require even more attention and help from their pharmacist.

I became a Certified Geriatric Pharmacist (CGP) to address the needs and concerns of a growing older population. Obtaining geriatric certification provides retail pharmacists with a great opportunity to expand their expertise and better serve their patients.

Treating Geriatric Patients

Geriatric pharmacy focuses on treating the entire patient, not just looking at each drug or disease individually. In the retail setting, it is easy to focus on 1 prescription at a time, but that is not what these patients need. Polypharmacy, multiple disease states, and decreased organ function demand that geriatric patients get specialized attention from pharmacists.

As a retail pharmacist, the majority of my daily practice is spent dispensing medications. Using the Beers criteria during data entry and product review has enhanced my ability to identify possible dangerous interactions. My expanded knowledge has also improved my recommendations to prescribers. As a CGP, I am now better equipped to make specific recommendations for my geriatric patients that take into account their specific needs.

For example, for a younger patient with anxiety issues, a benzodiazepine is often used as a quick and easy fix by prescribers, especially for short-term use; however, benzodiazepines come with a great risk for dizziness, sedation, and falls. For a younger patient, a fall may not be seen as a serious risk or event with major consequences, but for an older patient, a fall could mean internal bleeding if the patient is on warfarin, or a delay in treatment if the patient is isolated and unable to move. The most devastating consequence of a fall in elderly patients is a fracture; after experiencing a hip fracture, 20% of patients die in the following year.1 With this statistic in mind, the potential for falls should always be a top priority when managing medications for older patients.

Over-the-counter (OTC) recommendations are a vital aspect of retail pharmacy. By taking geriatric concerns into account for my older patients, they receive more tailored recommendations and therefore have a decreased risk for adverse events. For example, a 70-year-old man asking for a cold and flu medication recommendation is more likely to experience confusion from an antihistamine, or urinary retention from a decongestant compared with a younger patient. Advanced age may make a 70-year-old patient a better candidate for saline nasal rinses and analgesics instead of the popular combination cold and flu products.

Providing Medication Therapy Management

Because medication therapy management is a growing aspect of retail pharmacy practice, having advanced knowledge of geriatric pharmacy is an invaluable resource in the treatment of older patients. As dispensing rates decrease, pharmacies and pharmacists are realizing the value of fee-for-service programs. After becoming a CGP, I am better equipped to conduct Comprehensive Medication Reviews and Drug Utilization Reviews for my older patients. By working with patients individually and reviewing their complete medication lists—including OTC medications and supplements—I am able to identify a variety of safety concerns. Oftentimes, elderly patients are experiencing unnecessary side effects from medications that can be avoided by switching to more geriatric-appropriate medications. Prescribing cascades occur when medications are prescribed to treat side effects of other medications. This often leads to the use of multiple unnecessary medications. Identifying and replacing offending agents can eliminate the need for several medications, and reduce pill burden.

My employer also offers patients a Medicare Part D review session every year during open enrollment. Patients bring their medication lists, and by using a computer program, the pharmacy staff is able to show them plans based on their preferred pharmacies, estimated premiums, and projected out-of-pocket costs for medications. This insurance review allows patients to choose the plan that is right for them, and presents a valuable opportunity for pharmacists to look at complete medication lists, and possibly identify any duplicate therapies or inappropriate choices. In addition, when treating elderly patients on limited income, prescribing ideal drug choices is irrelevant if the patient is unable to afford the medication, and therefore unable to follow through with therapy. This review session is a chance for pharmacists to identify any drugs that can be switched, with the prescribers’ consent, to safer or more affordable options.

Branching outside of retail pharmacy, the most obvious market for CGPs is within long-term care settings. Whether they are dispensing or consulting, nursing homes and assisted living facilities will always need pharmacists with geriatric knowledge to keep their patients safe and improve medication efficacy. Acute care can also benefit from geriatric specialists, because older people make up a larger portion of the patients. In hospitals, geriatric patients account for 53.1% of drug-related adverse events.2 The opportunity for geriatric pharmacists to improve the quality of patient care in all pharmacy-related fields is plentiful.

Any pharmacist currently licensed and with a minimum of 2 years of experience practicing pharmacy is eligible to take the CGP examination through the Commission for Certification in Geriatric Pharmacy. The examination is offered in 2-month blocks 4 times annually, at various locations. The test comprises 150 multiple choice questions on a variety of geriatric pharmacy topics, ranging from socioeconomic concerns to pain management and statistical analysis. Pharmacists who pass the examination are certified for 5 years.3 During those 5 years, pharmacists can choose to complete 75 designated continuing education credits, or retake the CGP examination to be recertified.4

Conclusion

Whether you are looking to improve your practice, move up within your current job, or switch practice areas altogether, having the additional geriatric certification is a valuable asset. It shows employers and patients that you are committed to providing patients with exceptional care through your skills and geriatric knowledge. We are committed as healthcare professionals to provide our elderly patient population with exceptional patient care.




References

  1. Centers for Disease Control and Prevention. Hip fractures among older adults. www.cdc.gov/HomeandRecreational Safety/Falls/adulthipfx.html. Updated September 18, 2014. Accessed March 4, 2015.
  2. Lucado J, Paez K, Elixhauser A. Medication-related adverse outcomes in US hospitals and emergency departments, 2008. Healthcare Cost and Utilization Project. www.hcup-us.ahrq.gov/reports/statbriefs/sb109.jsp. Published April 2011. Accessed March 4, 2015.
  3. Commission for Certification in Geriatric Pharmacy. Recertification process. www.ccgp.org/recertification. Accessed March 4, 2015.
  4. Commission for Certification in Geriatric Pharmacy. Certified Geriatric Pharmacist recertification. www.ccgp.org/sites/default/files/CGP_Recertification.pdf. Accessed March 4, 2015.
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