The frail elderly: pharmacists’ essential role

OCTOBER 2016 – When family physician Dr. Linda Lee started a program to identify frail seniors at risk for poor health outcomes, she knew who to ask to be part of the team—pharmacist Tejal Patel. “I became very aware of the important role of pharmacy thanks to Tejal’s amazing and thoughtful work,” says Lee, who started working with Patel seven years ago at the Centre for Family Medicine Family Health Team (FHT) Memory Clinic in Kitchener, Ont. “As physicians we can do so much more with pharmacists than we can on our own.”

Patel, an assistant professor at the University of Waterloo’s School of Pharmacy, came on board to implement a screening process at the FHT, and to determine how pharmacists could help reduce polypharmacy and high-risk medication use. “When a patient is frail, it basically means he or she cannot recover from setbacks like the flu as easily, or may not go back to his or her baseline pre-illness,” says Patel. “If a pharmacist could get frail patients off high-risk medications and help them manage their medications properly, it could avoid a crisis later.”

“We can proactively identify conditions such as memory impairment, high falls risk and other factors which may contribute to frailty, and identify the medications that might be inappropriate,” adds Lee.

After screening all patients on multiple medications over the age of 75, about half of those identified as frail agreed to meet with one of three pharmacists in the program. Researchers are now analyzing the pharmacists’ interventions, and comparing those results with the patients who did not participate in the program.

So far, the research is definitely building the case for improved collaboration “As clinicians we tend to be a little scared when patients come in with complicated medication regimes because it’s going to take time and effort to clean that up,” says Lee. “This is a natural place for pharmacists to come in as they have been trained to look at these things and can help physicians. It also ensures optimal prescribing practices for this vulnerable population.”

The project is also developing a framework for frailty assessment outside of an FHT. A pilot project in an Ontario community setting is in the works.