W3 – Person-centered medication review in older people with comorbidities

Link to EAHP Statements
Section 1 – Introductory Statements and Governance: Statements – 1.1, 1.3, 1.4
Section 4 – Clinical Pharmacy: Statements – 4.1, 4.3, 4.5, 4.6, 4.7
Section 5 – Patient Safety and Quality Assurance: Statements – 5.1, 5.6

 Abstract
As we get older, we tend to develop more co-morbidities, with the usual approach being to use medicines to manage them. The aging population across Europe presents a growing challenge for healthcare systems, particularly in helping people cope with often complex medication regimens. Polypharmacy is associated with increased risks of adverse drug events, drug-drug interactions, and medication non-adherence. As conditions progress and the clinical context changes, the risk benefit ratio for some medicines change with some medicines moving from benefit to burden. When there is no or a limited evidence base for safely stopping medicines, a pragmatic and safe approach is needed, making sure the person and/or their carers are at the centre of these decisions. Meaningful conversations, where risks and benefits of medication choices are carefully explained, are a key to this.
This facilitated, interactive, case-based workshop will use clinical case studies and vignettes to explore medication review in older people. The cases will allow for brief discussions regarding the therapeutics at play. The session will also allow for and include brief discussions around decision making and communication in this complex area of healthcare, focusing on how to have meaningful conversations with patients, carers and other healthcare professionals. The session will discuss how prescribers and those who influence prescribing, faced with a changing clinical context, can be become more confident in taking an approach to safely stopping medicines in older people, where this is agreed with the person.

Learning objectives

• Improve understanding of the problems of polypharmacy in older people.
• Identify the principles of safely stopping medicines in older people.
• Learn to recognise and deal with specific circumstances for reviewing medicines in older people e.g. cardiovascular medicines, anticoagulants, diabetic medicines and certain primary prevention medicines.

The seminar will also seek to explore the following:

• An increased confidence in dealing with medicines in older people.
• Understand the clinical reasoning of a geriatrician and how shared decision making is employed at the bedside.
• Improve your situational awareness and understanding what’s going on.
• Better conversations to identify scripts and phrases to improve conversations with patients and carers.
• How to learn and react, when it doesn’t go as expected

Educational need addressed
This session will address the value of having meaningful conversations with patients, carers and healthcare professionals and how this can enable pharmacists to become more confident in reviewing medicines in older people, and stopping them where appropriate and consensual.

Keywords
Aging, Communication, dementia, end of life, ethics, evidence-based medicine, geriatrics, medication therapy management, pain management, pharmaceutical care, polypharmacy.