Clinical pharmacy which plays a critical role in a hospital environment is  increasingly focusing on geriatric medication safety, appropriateness of prescribing drugs, medication errors, adverse drug reactions (ADRs), drug interaction and drug related hospital admissions among elderly patients in hospitals globally. Current role of clinical pharmacists is to identify medication errors, drug use evaluation, patient counseling and treatment decisions.

The ‘elderly’ patients are the largest consumers of medications and they are at highest risk of ADRs. Only pharmacists can help to prevent and identify ADRs and improve medication outcomes in the elderly.

There is need for constant patient review and adherence to interventions in geriatric care, said Rohan Elliott, clinical senior lecturer, Monash University and senior pharmacist, Austin Health.

The need of the hour is the continuity of geriatric care and this segment of the population of the population is now gaining increasing importance for  healthcare providers globally. Around 25-50 per cent elderly patients receive at least one inappropriate medication.  Healthcare providers are looking to have a common standard of care for many diseases covering Constructive Obstructive Pulmonary Disorder (COPD), hypertension and osteoporosis. Majority of older people above 65 years have multiple co-morbidities.  Almost 30 per cent of geriatric admissions are medication-related and 50 per cent preventable, he added.

Coming to the risk factors for adverse drug reactions, we have seen there are physiological changes that impact with ageing, frailty and disease.  Inappropriate prescribing, over-prescribing, poor choice of medication and failure to adjust doses are all a critical factors in geriatric care, said Dr Elliott who was in India recently at the International Advanced Academic Training Programme on ‘Drug use in Geriatrics’ organized at the KLE University’s College of Pharmacy, Belgaum.

Assessing appropriateness of prescribing for the elderly, Dr Elliot pointed out that medical experts need to prescribe therapy when disease and disorders manifest. There is need to avoid under-prescribing and to resort to prescribe drugs only with clearly defined indications, using an appropriate dose and specified duration. These measures would avoid unnecessary therapy,  ‘inappropriate’ medications, unsafe, high-risk drugs, interactions between drugs and unnecessary duplication.

Since the patients are senior citizens, clinical pharmacologists need to recommend affordable and efficacious drugs and ensure constant monitoring of outcomes.

On an average, present prevalence of inappropriate prescribing of drugs is estimated at 15-40 per cent and around 25-50 per cent elderly patients are not  prescribed the indicated drug. But the consequence of inappropriate prescribing leads to ADR, hospital admissions, reduced quality of life and fatality. Almost, 11.5 per cent of unplanned hospital admissions are related to ‘inappropriate’ medications. Therefore, clinical pharmacologists need to take an account of individual circumstances, treatment goals, life-expectancy, treatment cost when handling elderly patients, stated Dr Elliot.