Medicating Elders Safely

As people age, they tend to accumulate the three Ds: diagnoses, doctors and drugs. With the first baby boomers starting to turn 65 next year, the need for pharmacists who specialize in caring for the elderly will escalate.

Geriatric pharmacists are trained to understand how medications affect older persons, as well as how drugs interact with one another in an older person's body. They may work in nursing homes, assisted-living facilities, continuing care communities, home health agencies, hospitals or in pharmacies that serve such facilities. Some also work in the pharmaceutical industry and for government programs like Medicare. The Commission for Certification in Geriatric Pharmacy (ccgp.org) offers certification.

The learning curve

All pharmacy students at the University of Minnesota (pharmacy.umn.edu) take at least one course that emphasizes geriatric pharmacotherapy and may take an additional course as an elective, according to Tom Larson, professor and associate dean of Clinical Affairs at the college. They are encouraged during their final year of pharmacy school to complete a clinical rotation in a geriatric setting and may go on to do a post-doctoral residency or fellowship in geriatrics, Larson said.

"We have embedded in almost every one of our courses some content that is related pharmacotherapy in geriatric patients," he added. "The majority of our experiential education involves the geriatric population."

Geriatric pharmacists who work in nursing homes focus on identifying medication-related problems or side effects, according to Al Barber, director of pharmacy for Golden Living Clinical Services. Golden Living operates 13 skilled-care nursing facilities in the Twin Cities metropolitan area.

"We also utilize them to train our nurses on the proper administration of medications," Barber said.

Geriatric pharmacists can help prevent emergency room visits and re-admissions to the hospital after a patient is transferred from the hospital to a care facility or to the home. That's when confusion may arise among patients and their caregivers about which medications they need and which should be discontinued. "Increasingly that's a role for all pharmacists, but especially for geriatric pharmacists, that those duplications and omissions don't happen and that patients understand what they're taking and why," Barber said.

While new pharmacists generally may expect to earn $80,000 to $100,000, geriatric pharmacists may start at $100,000 to $120,000, according to Barber, who is incoming president of the American Society of Consultant Pharmacists (ascp.com), a professional association of geriatric pharmacists.