Elderly patients (seniors) have different needs in the emergency department than most other patients. A senior is someone that is over the age of 65. For example, it is common for a senior to have many chronic conditions, as well as whatever they came into the emergency room for. The hectic environment of the emergency room is often harmful to seniors, so hospitals and developing specialized emergency departments for geriatric patients across the country.
A retrospective analysis was conducted at Kaiser Permanente Colorado members aged 65 years or older who went to EMBRACE (Emergency Medicine Bridging Acute Care for the Elderly) emergency department during this study. Patients were divided into according to whether they were treated by a clinical pharmacy specialist at EMBRACE, were not treated by a clinical pharmacy specialist at EMBRACE, or not treated at EMBRACE. They measured the 30-day rate of an emergency department return visit from these participants.
A total of 4,103 patients were incorporated into the study. 154 of the patients had a medication-related problem identified by the pharmacist. The group that received medication review from the clinical pharmacy specialist did not show a significant reduction in 30-day return visits. Why do you think these were the results? How could pharmacists help geriatric patients with their medication related problems outside of the emergency room?
Shaw PB, Delate T, Lyman A, et al. Impact of a Clinical Pharmacy Specialist in an Emergency Department for Seniors. Ann Emerg Med. 2016:67(2); 177-188. https://www.clinicalkey.com/#!/content/journal/1-s2.0-S0196064415005284
This study aimed to answer the question of whether or not concurrent use of warfarin with a sulfonylurea such as glipizide or glimepiride led to an increased risk of hypoglycemia among a geriatric population. The study took a sample from medicare patients aged 65 or older who used the two medications simultaneously, and the outcome measurement was emergency room or hospital visit with a primary diagnosis of hypoglycemia. The rate of admission of patients using sulfonylurea/warfarin concurrently was then compared to the rate of hospitalization in patients only using sulfonylureas. The study found that persons using the two medications concurrently were 1.22 times more likely to be hospitalized with hypoglycemia(95% confidence interval) and were 1.47 times more likely to be hospitalized with a fall related fracture(95% confidence interval).
Because these medications are so commonly used together in older adults, with over 70,000 patients filling a script for both medications between 2006-2011, it will be important as pharmacists/pharmacy technicians to make a point to our patients that there is an increased risk of hypoglycemia and fall related fracture when taking these two medications concurrently. By providing this information to our patients, we can help prevent hospitalizations that cost the healthcare system large amounts of money each year.
Link to Article
Hearing loss has become an increasingly prominent issue in the elderly population. Because current generations will live longer lives than previous generations, the problems associated with aging, such as heading loss, will and has become a larger problem in our society. There is a huge issue in regards to treatment and availability of treatment to these patients. Medicare does not cover the cost of hearing aids, which can be very expensive and is most likely the reason why only one in five people suffering from hearing loss use hearing aids. Additionally, there is a problem in the assessment of hearing. In most cases, patients must complain about their hearing in order for a hearing test to be implemented at a doctor’s appointment being that hearing is not usually included in primary care evaluations. The medical lapse in the field of hearing loss can be associated with the idea that hearing loss is natural in the aging process and it is not due to a biological error, therefore does not need medical intervention. However, the effects of medical treatment in hearing loss have increased the productivity, independence and quality of life for these elderly patients.
As a student pharmacist aspiring to enter the medical field, it is an obligation to help patient’s in need in order to increase their quality of life. An emphasis should be placed on improving the treatment availability for hearing loss in all ages, with a concentration on the elderly population. Over 40% of individuals over 60 suffer from hearing loss and the number doubles by the time the population reaches eighty years old with 80% having hearing impairments. Identifying the problem and monitoring yearly can increase the number of patients who receive treatment and possibly prevent the delay in availability of the hearing treatment. This article emphasizes the need for an improvement in areas such as research, treatment availability and insurance coverage.
Cassel, C, Penhoet E, et al. Policy Solutions for Better Hearing. JAMA Intern Med. 2016. Published online January 21, 2016.
JAMA. Published online January 21, 2016