Identifying and Resolving Drug-Related Problems in Geriatric Patients

As individuals age, age-related biologic and physiologic changes, alterations to pharmacokinetic and pharmacodynamic variables, and multimorbidity place geriatric patients at high risk for drug-related problems. Drug therapy problems in these patients include polypharmacy, inappropriate medication use, and poor medication adherence often due to complex regimens and medication costs. Pharmacists, physicians, and advanced practice providers (APPs) are uniquely positioned to tackle drug therapy problems and must work in tandem to do so. For maximal success, routine drug assessment within the multidisciplinary team should occur across the care continuum from the intensive care unit to the general floor to the outpatient setting. Pharmacists must identify drug therapy problems through medication reconciliations performed at admission, discharge, and during transitions of care, assist with adherence strategies, and address barriers to medication access. Physicians and APPs must routinely review medication lists, deprescribe and taper pharmacotherapy when able, identify medications to avoid and their appropriate alternatives, and prevent the prescribing cascade. To do this, a variety of tools can be deployed such as the Fit for the Aged criteria, Medication Appropriateness Index, American Geriatric Society Beers Criteria, and Screening Tool of Older Persons' Prescriptions and Screening Tool to Alert to Right Treatment criteria, to aid in medication selection in older adults. This review aims to describe key geriatric physiological changes, highlight the role of the inpatient pharmacist, physician, and APP and discuss methods for assessment and optimization of drug therapy regimens in geriatric patients.