For elderly patients, developing a relationship with a pharmacist and using one pharmacy can help ensure consistency in care. A pharmacist can help prevent drug-related problems, which are a particular risk for the elderly (see The Dying Patient).

For elderly patients, pharmacists are often the most accessible health care practitioner. In addition to dispensing drugs, pharmacists provide drug information to patients, monitor drug use (including adherence), and liaise between physicians or other health care practitioners and patients to ensure optimal pharmaceutical care. Pharmacists also provide information about interactions between drugs and other substances, including OTC drugs, dietary supplements (eg, medicinal herbs), and foods.

Patient adherence

Pharmacists can help improve patient adherence by doing the following:

• Assessing the patient's ability to adhere to a drug regimen by noticing certain impairments (eg, poor dexterity, lack of hand strength, cognitive impairment, loss of vision)
• Teaching patients how to take certain drugs (eg, inhalers, transdermal patches, injectable drugs, eye or ear drops) or how to measure doses of liquid drugs
• Supplying drugs in ways that are accessible to patients (eg, easy-open bottles, pills without wrappers)
• Making sure that drug labels and take-home printed materials are in large type and in the patient's native language
• Teaching patients how to use drug calendar reminders, commercially available drug boxes, electronic drug-dispensing devices, and pill splitters or crushers
• Eliminating unnecessary complexity and duplication from the overall drug regimen

Settings

Many pharmacists work in a community pharmacy. But they may also work in any health care setting, including hospitals, long-term care facilities, the home (with a home health care agency), mail service and online pharmacies, organized health care systems, and hospice settings (see Table 5: Provision of Care to the Elderly: Various Duties of Pharmacists).

Table 5
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Various Duties of Pharmacists Setting Duties Hospital Help obtain a detailed drug history from the patient or caregiver Accompany physicians and other practitioners on patient rounds Make drug recommendations Provide drug information when appropriate When discharge is imminent, provide oral and written drug-related information to the patient or caregiver Long-term facilities* May accompany physicians and other practitioners on patient rounds Participate in facility quality-improvement committees Assess and interview patients Assess drug effectiveness and monitor patients for drug interactions, adverse drug effects, and therapeutic failures If pharmacists identify a problem or a high risk of drug-related problems, contact the patient's nurse or physician directly As required by federal law, conduct a monthly drug regimen review for all patients Mail service and online pharmacies Provide consultation by telephone to patients Review and validate prescription orders Participate in drug utilization review and formulary management Help ensure quality control Develop education materials for patients and health care practitioners Organized health care systems May develop, implement, and manage formularies, computer-based adverse event tracking systems, and performance measurement indicators (to improve quality) May help design therapeutic guidelines and manage drug utilization programs Hospice Make recommendations for appropriate drugs to control symptoms Ensure the timeliness of drug delivery Minimize duplicative and interacting drugs Help improve cost-effective use of drugs Teach patients about the best way to use the prescribed drugs Monitor therapeutic responses and recognize drug-related problems Advise hospice team members about appropriate drugs and potential drug interactions with other substances (eg, medicinal herbs) Compound drugs or dosage forms extemporaneously as needed *Pharmacists who work in long-term care facilities are called consultant pharmacists.

Last full review/revision June 2009 by Mary Ann Anderson, PhD, RN