5/15/2016
CAREGIVING &
CARETAKING FOR
GERIATRIC
PATIENTS
CRIS DUVALL,PHARMD
PHARMACY MANAGER,
FRIDAY HARBOR DRUG
CKDUVALL@W SU.EDU
DISCLOSURE
• Presenter has no actual or potential conflict of interest in relation to this presentation.
• Presenter will not promote off‐label and/or investigational use of medications.
OBJECTIVES
At the end of the presentation, participants will be able
to:
•
Differentiate between caregivers and caretakers
•
Apply palliative care considerations to pharmacy
practice
•
Discuss tools used to assess medication risks vs
benefits in geriatric populations
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SEMANTICS
•
care·giv·er (kâr′gĭv′ər) n. 1. An individual,
such as a physician, nurse, or social worker,
who assists in the identification, prevention,
or treatment of an illness or disability. 2. An
individual, such as a family member or
guardian, who takes care of a child or
dependent adult.
•
care·tak·er (kâr′tā′kər) n. 1. One that is
employed to look after or take charge of
goods, property, or a person; a custodian. 2.
One that temporarily performs the duties of
an office.
Source: American Heritage® Dictionary of the English Language, Fifth Edition.
Copyright © 2011 by Houghton Mifflin Harcourt Publishing Company
KEY QUESTIONS IN TWILIGHT
•
What are your biggest fears and concerns?
•
What goals are most important to you?
What trade offs are you willing to make or not?
•
Source: Being Mortal: Medicine and What Matters in the End by Atul Gawande
SENIOR CARE FACTS
•
Today there are over 43.1 million adults
aged 65 and older in the United States; by
2040, that number will rise to 79.7 million.
•
Seniors represent 13.7% of the United
States population, about 1 in 7 Americans.
•
Nearly 92% of older adults have at least
one chronic condition, and 77% have at
least two.
•
Some type of disability (e.g. difficulty in
hearing, vision, cognition, ambulation, selfcare, or independent living) was reported
by 36% of adults aged 65 and over in 2012.
Source: Administration on Aging, 2012; Center for Disease Control
and Prevention, 2012; National Council on Aging, 2014
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•
Seniors represent just over 13% of the population, but consume 40% of
prescription drugs and 35% of all over the counter drugs
•
On average, individuals 65 to 69 years old take nearly 14 prescriptions
per year, individuals aged 80 to 84 take an average of 18 prescriptions
per year
•
15% to 25% of drug use in seniors is considered unnecessary or
otherwise inappropriate
•
Adverse drug reactions and noncompliance are responsible for 28% of
hospitalizations of the elderly
•
36% of all reported adverse drug reactions involve an elderly individual
•
Each year 32,000 seniors suffer hip fractures caused by medicationrelated problems
Source: Food and Drug Administration Report, 1996
•
In 2011, 1.5 million adults aged 65 and older lived in an institutional
setting such as a nursing home (1.3 million).
Source: Administration on Aging, 2010; Administration on Aging, 2012
ESTIMATED ANNUAL COST OF
MEDICATION RELATED
PROBLEMS
•
In the community population, medication-related problems cost $177.4 billion a year.
Source: Ernst F. R., A. J. Grizzle. Drug-related morbidity and mortality: updating the cost-of-illness model. J Am Pharm Assoc
2001;41:192–9.
•
Hospital admissions cost $121.5 billion
•
Long-term care admissions cost $32.8 billion
•
Physician visits cost $13.8 billion
•
Emergency department visits cost $5.8 billion
•
Additional treatments cost $3.5 billion
•
An additional $24 billion is spent on medication-related problems in other settings
•
$20 billion in acute care facilities, such as hospitals
Source: Bates D. W., Spell N., Cullen D. J. et al. The costs of adverse drug events in hospitalized patients. JAMA 1997;277:307–11.
•
$4 billion in nursing homes
Source: Bootman J. L., Harrison D. L., Cox E.. The health care cost of drug-related morbidity and mortality in nursing facilities. Arch
Int Med 1997;157:2089–96.
"ANY SYMPTOM IN AN ELDERLY PATIENT SHOULD BE
CONSIDERED A DRUG SIDE EFFECT UNTIL PROVEN
OTHERWISE."
-- J. GURWITZ ET AL. BROWN UNIVERSITY, LONG-TERM
CARE QUALITY LETTER, 1995.
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HELPFUL CRITERIA
•
•
2015 ACS Beers Criteria
•
Updates address renal dosing & DDI
•
Available at geriatricscareonline.org
2014 STOPP (Screening Tool of Older Persons' Prescriptions) criteria for potentially
inappropriate drugs and START (Screening Tool to Alert doctors to Right, i.e.
appropriate, indicated Treatment) criteria for potentially appropriate, indicated drugs
•
Version 2: new STOPP categories for antiplatelet/anticoagulant drugs, drugs
affecting, or affected by, renal function and drugs that increase anticholinergic
burden; new START categories include urogenital system drugs, analgesics and
vaccines.
•
Available at ageing.oxfordjournals.org
KEY QUESTIONS FOR THE
HEALTH-CARE-GIVER
•
What are your biggest fears and concerns?
•
What goals are most important to you?
•
What trade offs are you willing to make or not?
•
What other questions do you have?
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