Article by Pamela Tabar, Editor-in-Chief, IAdvance Senior Care
“Memory care providers have been using the same arsenal of drugs to treat dementia symptoms for years. But the geriatric population has changed a lot in the past decade, calling for deeper medication management strategies, says Joseph Marek, RPh, CGP, director of pharmacy services at CommuniCare Health Services and president of the American Society of Consultant Pharmacists, in an educational session at the Fall Memory Care Forum in San Diego.
“Our skilled nursing patients are older than they used to be,” Marek says. “We’re now treating the oldest old, which enhances problems with liver and kidney function and can exacerbate the length and strength of a medication’s effects and how it is absorbed.”
The Beers Criteria lists about 200 drugs that should be avoided for residents with dementia because they have a high potential of interaction or adverse events, they carry risks with little support of benefits, or they need to be adjusted for people who have high risk of poor renal function. But with a limited number of dementia drug choices, clinical staff needs to place higher emphasis on monitoring residents for adverse events. For example, “If you’re giving Aricept, you need to be monitoring for bradycardia,” Marek says. “I’ve even seen some facilities get cited because they weren’t monitoring for that. The same goes for drugs like Namenda that call for renal dose adjustment.””