Older adults face disproportionate risks when it comes to medication safety, including a heightened risk of adverse drug events (ADEs). ADEs are a significant health threat, occurring when use of a medication causes harm.
ADEs often go unrecognized or unsuspected, but the good news is that risks associated with ADEs can be identified and mitigated among PACE (Program of All-Inclusive Care for the Elderly) participants with more mindful prescribing, personalized medication management and advanced clinical insights.
Research has shown the association of science-based risk prediction and outcomes in PACE participants. According to the study, every point increase in a proprietary medication risk score corresponded to:
- 8.6% rise in the odds of having one or more ADEs per year
- $1,037 in additional annual medical spending
- 3.2 additional ER visits per 100 participants per year
- 2.1 additional hospitalizations per 100 participants per year
By collaborating closely with pharmacists to pinpoint and address medication-related risks, PACE programs can optimize medication therapy and improve outcomes for participants.
Understanding ADEs and Risks
A number of medications commonly prescribed in older adults are known to contribute to ADEs, like anticholinergic medications that reduce certain nervous system activity. These medications can be used to treat a variety of conditions like allergies, COPD and overactive bladder.
In fact, there are over 600 medications with anticholinergic effects. These effects include dry mouth, blurry vision and confusion. If participants take more than one anticholinergic medication, it can significantly increase their risk of ADEs. According to the American Geriatrics Society Beers Criteria for potentially inappropriate medication use in older adults, taking multiple anticholinergic medications is associated with elevated risk of falls, delirium and dementia.
In addition, effects from a medication can sometimes result in a prescribing cascade. For example, if someone is prescribed a medication for depression with mild anticholinergic effects and it causes insomnia, they might take a sleeping aid with additional anticholinergic properties that increases their risk for side effects, such as dry mouth, delirium and falls.
Other factors contributing to ADEs are age-related physiological changes, obstacles associated with multiple prescribers and fragmented care, and communication and health literacy challenges.
Building a Foundation for Success
Mindful prescribing practices foster a person-centered, safety-first prescribing culture. For example, starting low and going slow when prescribing and weighing pharmacologic vs non-pharmacologic options can simplify medication regimens and reduce risk of harm. Other strategies to reduce risk and optimize therapy include:
1. Comprehensive medication safety reviews. These reviews help PACE clinicians assess, plan and deprescribe by evaluating risk and individualizing medication therapy.
2. Pharmacist collaboration. Expertise from clinical pharmacists, including those board certified in geriatric pharmacy, drives safer decisions, reduces trial-and-error and minimizes prescribing cascades. When combined with clinical decision support with real-time insights, fall-risk screenings and ADE risk stratification, this expertise strengthens analysis, supporting data-driven quality improvement.
3. Adherence support. Adherence interventions, such as tailored medication adherence cards and multi-dose packaging, help participants stay on track with their daily medication routines so they can better manage their chronic conditions and remain healthier at home.
4. Personalized care. Aligning care with each participant’s specific goals, values and preferences is key. Keeping these in mind when prescribing helps ensure medication therapy supports rather than interferes with what matters most to participants.
5. Pharmacogenomics (PGx). Genes can influence how the body metabolizes certain medications, impacting efficacy and safety. PGx testing and analysis further personalizes therapy to optimize medication routines.
6. Participant engagement and support. Talking with participants about their medications and involving caregivers and support systems promotes education and health literacy.
Achieving Better Results
Medications are a primary intervention for participant health and wellbeing. But if medication routines are not optimized, they can increase risk of ADEs. When clinicians collaborate with pharmacists, individualized, evidence-based prescribing is supported and medication safety improved. Engaging participants and caregivers and providing adherence support further elevates care.
By aligning prescribing practices with participant and organizational goals and standardizing pharmacist involvement in care planning, PACE programs can help reduce ADEs and improve clinical and cost outcomes.
