Older adults consume 35-40% of all prescription medications. Healthcare organizations that care for older adults, including pharmacies, hospitals, and long-term care facilities, need pharmacists with geriatric expertise to help ensure the appropriate use of medications in this population.
Pharmacists with expertise in the care of older adults are better equipped to:
- Help ensure optimal outcomes from medication use
- Prevent medication errors
- Reduce the risk of medication adverse effects in the elderly, including the risk of falls,delirium and other geriatric problems
- Manage drug costs by ensuring appropriate use of newer, more expensive drugs
The Certified Geriatric Pharmacist has passed a comprehensive examination to demonstrate knowledge and expertise in the use of medications in older adults.
Why Hospitals Need Certified Geriatric Pharmacists
- Adults aged 65 and over account for 48% of all inpatient hospital days.
This percent will increase as baby boomers continue turning 65. Effective medication therapy management in older adults requires knowledge of issues in which many pharmacists fail to receive adequate training, such as:
A recent report from the HHS Office of Inspector General found that about 1 in 7 hospitalized Medicare beneficiaries experienced an adverse event. Of the adverse events identified, 31% were medication-related.1
- Potentially inappropriate medications
- Geriatric syndromes (e.g. falls, delirium)
- Prescribing cascade
Medication use presents unique challenges and issues in older adults, due to their susceptibility to delirium, falls, hypoglycemia, hypotension, and organ damage. Traditional therapeutic targets, such as blood pressure and hemoglobin A1C, may need to be adjusted in this population to prevent adverse consequences from overly aggressive therapy.
A recently reported review of rates of patient harm in North Carolina hospitals found that 25 harms were identified per 100 adult admissions. Of these harms, 28% were medication-related.2 Since pediatric patients were excluded from this study, the majority of hospital patients reviewed were elderly. The findings from this study are consistent with the report from the HHS OIG described above.
Another analysis of adverse events in hospitals found that 33% of patients admitted to a hospital experienced an adverse event, and the most common type of adverse event was medication-related.3
An analysis of medication-related adverse outcomes in U.S. hospitals in 2008 found that these adverse outcomes occurred in 4.7% of all hospital stays. 53.1% of these drug-related adverse outcomes occurred in adults aged 65 and over.4
A hospital with one or more Certified Geriatric Pharmacists demonstrates understanding of the need for expertise in medication use in older adults, and a commitment to improving care for older adult patients.
Why Certified Geriatric Pharmacists are Needed in Ambulatory Care
- Among adults aged 60 and over in the United States, 37% use five or more medications and 64% use at least three medications.5
- Approximately 4.5 million ambulatory visits related to adverse drug events occur each year in the United States. Adults aged 65 and over have the highest age-specific rates of adverse drug events.6
About 72% of these visits were in outpatient care settings, and the remainder was in emergency departments. About 32% of all visits were for adverse drug events in older adults.
- An analysis of emergency department visits in 2008 found that approximately 2,157,128 visits were made by patients for adverse reactions to medications. Older adults accounted for more than half (51.5%) of these visits.7
- Medication therapy management services provided by pharmacists in the ambulatory setting can prevent, identify and resolve medication-related problems.8 The Certified Geriatric Pharmacist credential is ideal for the pharmacist who provides medication therapy management services to older adults.
Why Certified Geriatric Pharmacists are Needed in Long-Term Care
Approximately 90% of residents in nursing facilities and assisted living are age 65 or over. It is especially important that pharmacists who serve long-term care residents have demonstrated expertise and knowledge in the use of medications in the elderly. In fact, one large nursing facility chain now requires that their pharmacists obtain the Certified Geriatric Pharmacist credential.9
- Levinson DR. Adverse events in hospitals: national incidence among Medicare beneficiaries. Department of Health and Human Services Office of Inspector General. November 2010. OEI-06-09-00090.
- Landrigan CP, et al. Temporal trends in rates of patient harm resulting from medical care. N Engl J Med 2010;363:2124-34.
- Classen DC, et al. ‘Global Trigger Tool’ shows that adverse events in hospitals may be ten times greater than previously measured. Health Affairs 2011;30(4):581-589.
- Statistical Brief #109. Healthcare Cost and Utilization Project (HCUP). April 2011. Agency for Healthcare Research and Quality, Rockville, MD.
- Gu Q, Dillon CF, Burt VL. Prescription drug use continues to increase: U.S. prescription drug data for 2007–2008. NCHS data brief, no 42. Hyattsville, MD: National Center for Health Statistics. 2010.
- Sarkar U, et al. Adverse drug events in U.S. adult ambulatory medical care. Health Services Research. 2011; accessed online July 12, 2011.
- Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (February 24, 2011). The DAWN Report: Emergency Department Visits Involving Adverse Reactions to Medications among Older Adults. Rockville, MD. Accessed online July 12, 2011.
- Smith M, et al. In Connecticut: Improving patient medication management in primary care. Health Affairs 2011;30(4):646-654.
- Golden Living requires CGP credential for pharmacists. Credential Newsletter, Fourth quarter, 2011.