UB Today Alumni Magazine Online - Spring/Summer 2001
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Medication management is often overlooked when treating elderly individuals

By Wayne K. Anderson
Dean, UB School of Pharmacy and Pharmaceutical Sciences

odern drug therapy has a major impact on our quality of life, but the irony is that in some instances therapies intended to solve one medical problem instead beget a whole new set of medical problems for an individual. This dilemma is seen in patients of all ages, but is more common in older adults.

    Typically, older adults have more conditions that require medication. In fact, the 13 percent of the American population over the age of 65 consumes almost one-third of all prescription medications. The average person over the age of 65 uses six-and often more-prescription drugs. This same group of older persons also uses seven times the number of nonprescription over-the-counter (OTC) medications than do younger adults.

    Moreover, drug therapy in older adults presents special problems. The ability of the body to metabolize and eliminate drugs declines significantly as a result of changes in body composition, aging and disease. Adverse drug effects (ADEs) are a source of problems and "symptoms" frequently associated with aging. For example, ADEs can bring about confusion, depression and impaired motor coordination (leading to falls and loss of independence). Pharmaceutical care looks to avoid treatment of these ADE symptoms with additional drugs (a common occurrence that often creates additional problems) and, instead, to identify the ADE and solve the problem.

    No medication is completely free of undesired effects, so a drug consumer must be alert to the onset of possible "side effects" during drug therapy. The pharmacist is trained to manage drug therapy-to provide pharmaceutical care-and, using a wealth of drug knowledge, to work as a member of the patient's health-care team to achieve optimum therapeutic outcomes. Thus, if a patient's drug therapy produces detrimental side effects or fails to achieve the desired results, proper pharmaceutical care would lead to changes that could involve an adjustment of the dose or a change in the medication.

    Drug therapy management becomes progressively more complex as additional drugs are added to an individual's regimen to treat medical conditions and symptoms that might arise. The risk of adverse drug effects and medical problems caused by the drug treatment is significantly increased in persons taking multiple drugs, or polypharmacy, which must be managed carefully.


    One source of problems in polypharmacy is drug-drug interactions. The pharmacist monitors drug-drug interactions, but it is essential that he or she be informed about all the patient's medications. This includes all prescription and OTC medications, as well as herbal preparations and other related supplements.

    Other issues complicate polypharmacy in older adults. For example, weakening vision and memory lead to mistakes and possible serious drug toxicities. In addition, medication adherence problems are more common in cases of polypharmacy, particularly with more complex regimens, and can lead to drug therapy failure. One focus of pharmaceutical care is patient-and caregiver-education and the application of systems designed to promote adherence.

    A new study released in the Journal of the American Pharmaceutical Association estimates that drug misuse costs the economy more than $177 billion each year in hospital and long-term care admissions, physician and emergency department visits and added treatment costs, with an estimated 218,000 patient deaths in 2000. The study identified drug-related problems that include adverse drug reactions, drug interactions, improper dosage (either subtherapeutic or overdosage) and failure to receive drugs. Other problems included misuse due to improper drug selections, drug use without a need and no drug use when there were indicating symptoms.

    Students at the UB School of Pharmacy and Pharmaceutical Sciences now receive the Doctor of Pharmacy (Pharm.D.) as the entry-level degree for pharmacy practice. The Pharm.D. provides advanced training in pharmaceutical care, in a range of clinical practices. During the final year of the four-year, graduate-professional Pharm.D. program, students receive advanced clinical experiential training in a variety of clinical environments including geriatric outpatient, in-patient and long-term care.

    The new geriatric pharmacotherapy program at UB trains pharmacy students and postdoctoral residents in drug therapy management for older adults. Conditions that are more common in populations of older adults and medications that are inappropriate for this group are studied as well.

    With the emphasis on recognition and resolution of medication-related problems in older persons, the aims of medication therapy can be achieved. Our goals are to improve the quality of life by curing disease, or slowing the disease process while reducing or eliminating symptoms.

  Wayne K. Anderson has written extensively on polypharmacy, particularly its effects on the elderly, for Aging Today and other publications, and has been interviewed on the topic by the Washington Post and the Wall Street Journal.

School of Pharmacy and Pharmaceutical Sciences

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