"Death Over Dessert" - A conversation with pharmacy students about what really matters in the end.

BACKGROUND AND PURPOSE: Pharmacists will encounter the death of patients and loved ones throughout their career. Though this is a part of our profession as health care providers, many pharmacy students express discomfort and even fear of discussing death and dying with their patients. "Death Over Dessert" has been developed as a loosely structured discussion held during a required geriatrics advanced pharmacy practice experience (APPE). EDUCATIONAL ACTIVITY AND SETTING: "Death Over Dessert: uses principles of "Death Over Dinner," a free online program, "Where I Stand" scales from The Conversation Project, and a series of written reflection questions for after the activity. The discussion is led by two faculty members and ranges from two to six APPE students per offering. A mixed-methods approach was used to assess participant responses to reflection questions. FINDINGS: Of the 19 participants, all (n = 19, 100%) found the activity to be beneficial despite many mentioning the topic can be uncomfortable. There were five overall themes identified that broached personal and professional views: significance of end-of-life discussion with family, important aspects of personal wishes at end-of-life, the definition of living, approaches to end-of-life discussion, and the role of end-of-life in the pharmacy curriculum. SUMMARY: "Death Over Dessert" is a new teaching modality for faculty and preceptors to consider using in their classrooms or rotation activities.

ABH Gel: Comforting Cure or Pricey Placebo?

Despite a lack of evidence of benefit, the compounded product ABH gel (lorazepam, diphenhydramine, and haloperidol) continues to be prescribed for individuals in hospice and palliative care settings for the treatment of nausea and vomiting and terminal delirium. More effective and reliable pharmacological and nonpharmacological strategies exist for the treatment of these conditions in the palliative care and hospice settings. We discuss the pharmacokinetic and clinical evidence for the individual components of ABH gel, as well as the compounded product, and attempt to understand the mechanism of effect that some purport to see, as well as why the compound continues to enjoy such a cult following. Truly, the continued use of ABH gel makes for a pricey placebo and delays the treatment of end-of-life symptoms with modalities that work.

Safety and Efficacy of Lithium for Treating Bipolar Disorder In the Older Adult.

The population of older adults with bipolar disorder is growing, not only because of the increase in the percentage of the population 65 years of age and older, but also because of an increase in awareness about mental health issues in this population. For years, lithium has been one of the first-line options for treating bipolar disorder, but data in the older population have mostly been inconclusive or extrapolated from younger populations. Questions of tolerability and safety in the older adult have also arisen, as well as its efficacy in comparison to newer agents on the market. This manuscript aims to examine the evidence of lithium use in the older adult and whether or not this drug should still be recommended for use in this population.

Drug Therapy for Gender Transitions and Health Screenings in Transgender Older Adults.

Transgender medicine is a relatively new field in health care, with only a small amount of evidence-based literature available for reference. This is especially true for the older adult population, for whom most information must be extrapolated from younger adults. Be it a newly transitioned older adult or a transgendered individual who has been undergoing hormonal therapy for many years, it is important that healthcare professionals be aware of the significant effects that transgender pharmacotherapy can have on older adults. Healthcare providers must also recommend appropriate preventative screenings to transgendered persons.

Perceptions of Direct-to-Consumer Advertising and the Older Adult Population.

Direct-to-consumer advertising (DTCA) has become a prominent feature of our society and reaches many consumers through their televisions, radios, and computer screens. In 2004, the average United States citizen was exposed to more than 16 hours of DTCA per year, and the number of hours has steadily increased. Drug advertising is a multi-billion dollar business for pharmaceutical manufacturers and affects public perception of medications, both prescription and over-the counter. Studies have shown advertisements can have both positive and negative effects, including educating consumers, but can harm the patient-physician relationship. This article addresses the perceptions older adults have toward DTCA and discusses how pharmacists can play a role in helping older adults understand and effectively use DTCA.