ADA Standards of Medical Care in Diabetes: implications for Older Adults.

Each year, new literature and recommendations are incorporated into updates in the American Diabetes Association's Standards of Medical Care in Diabetes. The 2020 update increased the focus on the rising cost of care for diabetes, long-term outcomes of newer antihyperglycemics in reducing macrovascular and microvascular complications of diabetes, and the importance of individualized treatment goals. These principles are of particular significance when managing older people with diabetes. This article focuses on updates pertinent to care of the older people.

Understanding Clinical Laboratory Interference.

Laboratory tests play an essential role in diagnosing disease and in determining and monitoring medication therapy. Laboratory interference-inaccuracies resulting from other properties in the sample-from both endogenous and exogeneous sources, can potentially lead to erroneous diagnosis and changes in medications. Some types of laboratory interference are particularly common for elderly individuals. Pharmacists and other practitioners need to be aware of various common sources of interference with laboratory results so they can better assess the validity of laboratory values for their patients.

The Other Side of the Opioid Debate: Treating Older Adults With Chronic Pain.

Prescriptions for opioids and opioid-related overdoses have been on the rise-and in the news-in the United States for more than a decade. New guidelines and legislation related to opioid prescribing provide clinical challenges for many pharmacists and prescribers, particularly in the treatment of older adults with chronic pain. Careful patient selection, along with proper opioid dosing and monitoring, enables the pharmacist and prescriber to continue to treat the older adult with pain effectively.

Getting Paid for Clinical Services.

Increasingly, pharmacists are providing advanced, patient-centered clinical services. However, pharmacists are not currently included in key sections of the Social Security Act, which determines eligibility to bill and be reimbursed by Medicare. Many state and private health plans also cite the omission from Medicare as the rationale for excluding reimbursement of pharmacists for clinical services. This has prompted forward-thinking pharmacists to seek opportunities for reimbursement in other ways, allowing them to provide value to the health care system, while carving out unique niches for pharmacists to care for patients.

Controlling Diabetes: Continuous Glucose Monitoring for the Older Adult.

Obtaining and maintaining adequate blood glucose control in the older adult with diabetes offers unique challenges. Intensive blood glucose control can increase the risk of hypoglycemia, which can be particularly risky in the older adult. Adding and adjusting diabetes medications in elderly patients with multiple comorbidities and numerous other medications can also be challenging. The use of professional continuous glucose monitors-which are worn by the patient for up to two weeks and record blood sugars every 5 to 15 minutes-provides pharmacists and other health care professionals with valuable data for managing the care of the older adult with diabetes.

Demystifying Probiotics: Use in the Elderly.

Pharmacists and other health care professionals can be perplexed by the growing body of literature regarding the use of probiotics for a variety of symptoms and conditions and by an increasing number of probiotic products available to consumers. Understanding the functions of the intestinal microbiome, the possible mechanisms of actions of probiotics, the research supporting or refuting probiotic use, and criteria for selecting a probiotic product is essential to making a rational recommendation for patients.

Vaccines for Older Adults.

Several vaccine-preventable diseases-influenza, pneumonia, herpes zoster, and pertussis-threaten the health of older adults in the United States. Both the costs associated with treating these diseases and the potential to increase morbidity and mortality are high for this patient population. Pharmacists and other health care professionals play a significant role in ensuring the elderly patient receives the recommended vaccines at the recommended intervals.

Antibiotic Stewardship in Long-Term Care: A Call to Action.

The Centers for Medicare & Medicaid Services and the Centers for Disease Control and Prevention are focused heavily on curbing the misuse of antibiotics in health care facilities. Regulations governing the management of antibiotics in the nursing facility will likely be changing in the near future, which will put the pharmacist at the forefront of a clinical team that is dedicated to proper antibiotic utilization. Savvy pharmacists are embracing this opportunity to engage long-term care facility staff to improve the care of their residents.

Implementing an Antimicrobial Stewardship Program.

The Centers for Medicare & Medicaid Services is expected to expand requirements for antimicrobial stewardship in nursing facilities during 2016. Many facilities are looking to pharmacists to help them take the initial steps toward developing these coordinated programs to promote the appropriate use of antimicrobials.

Antibiotic Stewardship: New Frontier, Familiar Journey.

Recent changes in regulations by the Centers for Medicare & Medicaid Services require long-term care facilities to meet specific requirements on antibiotic stewardship, promoting the appropriate use of antibiotics and antimicrobials. The goal is to improve patient outcomes and decrease the spread of infections caused by multi-drug-resistant organisms. Consultant pharmacists can help facility personnel implement policies and procedures for effective antibiotic stewardship, assist prescribers and facility staff in understanding how to use the facility's antibiogram, find appropriate resources, and provide facility personnel with feedback on their antimicrobial stewardship efforts.

Antibiotic Stewardship: New Frontier, Familiar Journey.

Recent changes in regulations by the Centers for Medicare & Medicaid Services require long-term care facilities to meet specific requirements on antibiotic stewardship, promoting the appropriate use of antibiotics and antimicrobials. The goal is to improve patient outcomes and decrease the spread of infections caused by multi-drug-resistant organisms. Consultant pharmacists can help facility personnel implement policies and procedures for effective antibiotic stewardship, assist prescribers and facility staff in understanding how to use the facility's antibiogram, find appropriate resources, and provide facility personnel with feedback on their antimicrobial stewardship efforts.

Implementing an Antimicrobial Stewardship Program.

The Centers for Medicare & Medicaid Services is expected to expand requirements for antimicrobial stewardship in nursing facilities during 2016. Many facilities are looking to pharmacists to help them take the initial steps toward developing these coordinated programs to promote the appropriate use of antimicrobials.

Antibiotic Stewardship in Long-Term Care: A Call to Action.

The Centers for Medicare & Medicaid Services and the Centers for Disease Control and Prevention are focused heavily on curbing the misuse of antibiotics in health care facilities. Regulations governing the management of antibiotics in the nursing facility will likely be changing in the near future, which will put the pharmacist at the forefront of a clinical team that is dedicated to proper antibiotic utilization. Savvy pharmacists are embracing this opportunity to engage long-term care facility staff to improve the care of their residents.

The Changing Landscape of Consultant Pharmacy Part 1 of 2.

A dramatic increase in the senior population, along with adjustments in reimbursement for health care services, is altering the landscape of consultant or senior care pharmacy. An increased focus on quality, rather than quantity of services, offers new opportunities and challenges for pharmacists and all members of the health care team. This article features the viewpoints of three leaders in senior care pharmacy, and their visions for the future of this dynamic profession.

Improving dementia care: new initiatives, new opportunities.

The Centers for Medicare & Medicaid Services (CMS) has recently increased its focus on appropriate care for individuals with dementia who reside in nursing facilities. As part of its program, "Partnership to Improve Dementia Care in Nursing Homes," CMS has updated portions of the State Operations Manual, the document that guides how care should be provided in nursing facilities. Pharmacists and other health care practitioners working in these facilities need to be aware of these changes, which may require adaptations to policies, procedures, and documentation for residents with dementia. In addition, it may affect the use of certain types of medications for these residents.

Lessons learned from hospice care.

Pharmaceutical care of the hospice patient offers unique challenges in the management of pain and other symptoms. Lessons learned in providing hospice care can be used in the care of nonterminal patients as well to optimize patient-specific care, regardless of care setting or life expectancy.

Wound care basics for the pharmacist.

Elderly skin is prone to wounds as a result of age-related changes and comorbidities such as diabetes and vascular disease. Wound healing is a complex process that can become compromised, leading to the development of chronic, nonhealing wounds in a frail elderly patient. Pharmacists and other practitioners who care for the elderly should be attuned to the wound-healing process and to the types of medications and wound care products available to aid healing.

Recognizing and preventing medication administration errors.

Proper medication administration in the long-term care facility is vitally important, as many medications have specific administration parameters that are essential to their optimal efficacy. Pharmacists servicing long-term care facilities play an integral role in observing medication administration in the facility and educating facility staff on proper administration techniques. By being vigilant to potential problems, pharmacists can help ensure that facility residents receive their medications appropriately.

Anticipating and managing opioid side effects in the elderly.

Pain is a common complaint in the elderly, and opioids are useful agents for management of both acute and chronic pain. Opioids are known to cause a variety of adverse effects, and these adverse effects can be particularly problematic for the frail elderly patient and may limit their use. As a result, this can lead to undertreatment of pain and poor patient outcome. Understanding, anticipating, and managing opioid side effects is an important component of care for the elderly patient.

Avoiding errors during transitions of care: medication reconciliation.

When medication errors occur, they often are the result of discrepancies in medication information during transitions of care, i.e., moving the patient from one setting to another. Pharmacists can play an essential role in performing in-depth medication reconciliation, which promotes positive patient outcomes and decreases health care costs.