TAILORING THE TABLET
As the population of Scotland and indeed globally, continues to age, effective medication management for older adults has become a cornerstone of quality healthcare.
N
avigating this complex landscape requires a nuanced approach, focusing on optimising therapeutic outcomes
while minimising risks.
Geriatric patients often present with multiple chronic conditions, leading to polypharmacy – the use of multiple medications simultaneously. Older adults may be prescribed medications by various specialists, without a comprehensive overview of their entire regimen. This can lead to drug-drug interactions, adverse drug reactions (ADRs) and increased side effects, which can mimic symptoms of new illnesses, leading to further prescriptions in a dangerous cycle known as a prescribing cascade. A key strategy to combat this is medication reconciliation at every transition of care (admission, discharge, transfer) to ensure an accurate and up-to-date medication list.
Another critical consideration is pharmacokinetics and pharmacodynamics. As people age, physiological changes affect how drugs are absorbed, distributed, metabolised and excreted.
Renal and hepatic function often decline, impacting drug clearance and potentially leading to accumulation and toxicity. Furthermore, older adults can have altered sensitivity to certain medications, meaning a standard dose for a younger adult might be too high for a geriatric patient. This necessitates "start low, go slow" dosing principles and regular monitoring.
Deprescribing is a vital, proactive process in geriatric medication management. It involves systematically reviewing a patient's medications with the goal of reducing or stopping those that are no longer beneficial, are causing harm, or are inconsistent with the patient's care goals. This requires careful clinical judgment, considering the patient's individual health status, life expectancy and preferences. For instance, medications for osteoporosis might be less critical for a patient with a very limited life expectancy than for one with many years ahead.
Adherence and compliance are also significant hurdles. Factors such as cognitive impairment, visual or dexterity issues (making pill-taking
difficult), complex dosing schedules and economic constraints can impact a patient's ability to take medications as prescribed. Pharmacists play a crucial role here, offering simplified dosing regimens, compliance aids (e.g., dosette boxes), clear labelling and patient education.
The role of the pharmacist in geriatric medication management cannot be overstated. From community pharmacies to hospital settings, they are uniquely positioned to conduct comprehensive medication reviews, identify potential problems, recommend deprescribing opportunities and educate patients and their caregivers. Leveraging digital tools for medication reconciliation and electronic health records further enhances their ability to provide holistic and safe care.
Ultimately, effective medication management in geriatric care is about moving beyond simply prescribing, towards a patient-centred approach that prioritises safety, quality of life and the appropriate use of medicines to meet the individual needs of an ageing population.
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EFFECTIVE MEDICATION MANAGEMENT IN GERIATRIC CARE IS ABOUT MOVING BEYOND SIMPLY PRESCRIBING
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