Robert Wahler, clinical assistant professor of pharmacy practice, oversees the Geriatric Pharmacotherapy Initiative in Western New York.

	Wahler

Why is there a need for a specialty in geriatric pharmacotherapy?

A term that has been applied is the "demographic imperative." Looking at population statistics, the first "baby-boomers" will turn 65 in 2010. By the time that generation has retired, the number of people over the age of 65 will have nearly doubled from the present. While demographics is a major impetus, the complexity of diseases in the elderly is a difficult problem. Not everything that we know about how drugs work in the younger population holds true when applied to older patients. It is that specific knowledge of how to use medications effectively in older patients that we feel all pharmacists must have an understanding of and that those who work in areas with high elderly populations must embrace as their specialty. As the demographics show, we have less than a decade to prepare pharmacists for this.

What should older Americans who are taking medications ask their pharmacists?

The are many basic questions that should be addressed during a counseling session with a pharmacist: What the drug is called, how to take it properly and what should be expected from a therapeutic standpoint, as well as what potential adverse effects may occur and what to do if they do occur. For an older patient who may have multiple diseases of different body systems, i.e. high blood pressure, diabetes, arthritis, and therefore may be seen by different consultant physicians, there are some other questions that should be addressed. Specifically, questions about drug interactions. These include drugs interacting with other drugs, including over-the-counter and herbal products, but also drugs interacting with their other conditions. For instance, many patients with heart failure receive diuretics-water pills-to reduce excess fluid. However, this may make some forms of urinary incontinence worse. While both drugs may be necessary, it may require specific directions as to when to take the medication to avoid exacerbating the incontinence problem.

What should pharmacists be telling older Americans?

In addition to the items addressed previously, pharmacists must monitor for and intervene when drugs that may be inappropriate for older patients are prescribed. There has been much research done in this area and some comprehensive lists have be produced. These lists often include drugs that were once very popular for the elderly, but adverse effects and interactions have shown that they either cause more harm than good, worsen another problem or are just plain ineffective in comparison to newer agents.

How can you tell that a pharmacist is a good match for you as a patient?

I think the concept of being a patient advocate best describes the kind of pharmacist that makes a good match for older patients. With the specific knowledge that pharmacists will have in geriatric pharmacotherapy, the pharmacists should look at the "big picture." Often times, the aggressive treatment of one problem wreaks havoc on the control of other conditions or the patient's quality of life. At a minimum, the pharmacist needs to communicate these possibilities to the patient. To truly be an advocate, the pharmacist needs to communicate with the patient's primary physician and work with him to determine the best regimen that will treat the conditions needing treatment without causing a major impact on the patient's quality of life. One of the outcomes that we would like to see from this new program is that pharmacists across all practice settings have both the knowledge and the confidence in their knowledge to speak out and act as patient advocates. Physicians sometimes do not enjoy being questioned about therapies that they have prescribed. But if armed with specific knowledge based upon scientific research, pharmacists should be able to overcome this hurdle and act on their patients' behalf.

What challenges do pharmacists face as a result of an aging America?

I think I addressed this in two areas. The demographic imperative is one. The other challenge is in making pharmacists into better patient advocates and giving them the confidence in their abilities to do so. Additionally, the state of the health-care system is causing administrators-hospital administration and pharmacy owners, both chain and independent-to pull time away from interacting with patients and shift it toward dispensing responsibilities. This is more profitable in the short run. However, this may be more costly in the long run, as more hospitalizations due to adverse drug reactions will occur without the constant clinical interventions of pharmacotherapists.

What distinguishes UB's program in geriatric pharmacotherapy?

While still in its infancy, one of the program's strengths is its broad range. We are targeting both Pharm.D. candidates in the pharmacy school and graduate pharmacists who already are practicing. We also are trying to give all pharmacists, irregardless of practice setting, a comprehensive understanding of the principles of geriatric pharmacotherapy. In addition to this broad understanding, pharmacists who practice in geriatric settings are offered the opportunity to earn advanced education and credentials in geriatric pharmacotherapy. This should establish the UB School of Pharmacy and Pharmaceutical Sciences as a leader in geriatric pharmacotherapy education nationally.

Tell me about the relationship with the Weinberg Campus.