Learning to care for senior patients


CURRICULUM

According to CDC, senior patients, or those aged 65 years and older, are twice as likely as younger adults to present to the emergency department for an adverse prescription drug event. Moreover, the chance of hospitalization after an emergency visit is nearly seven times higher in senior patients, making adverse drug events a large public health problem in this patient population. These high-risk adverse drug events create an increased demand for medication therapy management (MTM) services and position pharmacists as critical health care professionals in making an impact on these patients.


The next generation of pharmacists can excel in providing optimal care to older patients; this should begin with improved geriatric education of future pharmacists. Student pharmacists at the University of Wisconsin–Madison have the opportunity to learn this information and gain these skills first-hand. Through a unique longitudinal project called the Student Pharmacist–Oakwood Partners (POPs) Program, students work with seniors with polypharmacy to learn the cornerstones of patient care for this population.


Building strong foundations


Through the POPs program, an older individual living in a local senior community center is assigned to a group of three, first-year student pharmacists. These student teams conduct five visits with their POPs partner throughout the academic year. 


During the first visit, students determine their partners’ motivations and goals for physical, mental, and emotional health using motivational interviewing. Students support their partners in achieving these goals by emphasizing their partners’ decision-making role in their care provision. 


Through recurrent visits with their partner, students learn how to conduct health and medication histories using open-ended questions. Students document changes in their partners’ health in an electronic profile called the POPs Partner Portfolio, which includes sections on demographics, family and social history, medications, and health conditions. 


By tracking their partners’ progress, students are able to better identify medication use problems, unmet health goals, and discrepancies between goals and lifestyle behaviors. With the help of course coordinators and pharmacy leaders, students provide appropriate suggestions to their partners to improve medication use and management of their disease states.


At the final POPs visit, students review their partners’ initial goals together with their partners. They celebrate their partners’ successes, determine areas for greater improvement, and 
develop future goals.


Pearls for future practice


The following are five tips for working with senior patients.


  • Develop a partnership. Pharmacists should explain the importance of two-way communication to develop collaborative patient–provider relationships. Patients should regularly talk with their prescribers and pharmacist about any questions with their therapy, and to voice preferences for their care plans. The patient’s involvement can be reinforced when pharmacists actively listen to patient concerns and questions, and respond with empathy.
  • Motivate change. Pharmacists should use open-ended questions to understand the patient’s barriers to medication adherence and therapy management. Pharmacists should suggest feasible changes and use motivational interviewing.
  • Assist patients with developing an adherence system that works. Various medication reminder systems exist, including alarms, medication boxes, and pill reminders. Pharmacists should help identify techniques that are most practical and effective for each individual patient.
  • Help patients seek and use a support system. Pharmacists should encourage patients to establish a strong support system of family and/or friends who assist patients in achieving their health goals. A caring support person can be instrumental in remembering care plans, voicing patient struggles, organizing medical information, and accompanying the patient at appointments.
  • Encourage patients to enroll in MTM services. Pharmacists should offer comprehensive medication reviews and assessments to qualified senior patients. At MTM visits, pharmacists should supplement verbal consultation with written resources to encourage patient education.

Through POPs, students gain confidence in leading recurrent patient visits and develop strong patient–pharmacist relationships. These skills are valuable considering pharmacists’ unique role in providing MTM services as part of the health care team. Through the POPs experience, our student pharmacists are positioned to ensure medication safety, serve as patient advocates, and achieve patient-driven outcomes as future practitioners.



Paria Sanaty Zadeh and Heeje Jeon are third-year PharmD candidates at the University of Wisconsin–Madison School of Pharmacy.