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An Age-Old Question: Warfarin or a Direct Oral Anticoagulant in Frail Adults?

It is now uncommon to see warfarin therapy initiated for stroke prevention. However, quality patient care is never a “one-size-fits-all” approach.  New evidence from the FRAIL-AF trial suggests that some of our most vulnerable older adults might be better off maintained on a vitamin K antagonist rather than (automatically) switched to a direct oral anticoagulation (DOAC).  

Guest Author:  Matthew Cantrell, PharmD, BCPS

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Driving + Older Adult + Medications = An Accident Waiting to Happen?

While driving autonomy plays a crucial role in supporting mobility, social connections, and access to healthcare, older adults face elevated risks on the road. Rigorously collected data would equip us to educate patients about potential dangers, help us engage in collaborative discussions with patients and providers about deprescribing, and improve road safety for this vulnerable demographic.

Guest Authors: Mary Eva McClure, PharmD and Tavajay Campbell, PharmD, BCACP, CDCES

Guest Expert:  Michael Brodeur, PharmD, BCGP

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Heartburn Headache: Cumulative PPI Use and Dementia Risk

Omeprazole ranks among the top 10 most prescribed medications in the United States, and many patients take proton pump inhibitors (PPIs) for years. Widespread PPI use persists despite data about potential serious adverse effects.  Some worry that PPI use increases the risk of dementia.  Are those worries supported by data?

Guest Authors:  Molly M. Corder, PharmD, BCPS, BCACP and Ryan S. Ades, PharmD, BCPS

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Over-the-Counter Hearing Aids – Where Do They Fit?

Approximately 1 in 6 adults in the United States report some trouble with their hearing. Despite the prevalence and implications of hearing loss, hearing aid use is strikingly low due to cost and accessibility. In late 2022, the FDA finalized regulations for over-the-counter hearing aids to be sold without medical evaluation or the services of a hearing professional. But will self-fitting OTC hearing aids be as effective as audiologist-fitted prescription hearing aids?

Guest Authors:  Lucas A. Berenbrock, PharmD, MS, BCACP and Elaine Mormer, PhD, CCC-A

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The Generic Levothyroxine Conundrum

Would you be willing to pay three times more for a brand-name levothyroxine product than a generic equivalent? Clinical practice guidelines recommend against switching between products. As a result, levothyroxine has higher brand-name product dispensing rates than other medications, costing patients and the healthcare system much more money.

Guest Authors:  Connie Liang, PharmD and Kathleen Pincus, PharmD, BCPS, BCACP

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SAGE Wisdom: Analysis of a Self-Administered Gerocognitive Test

When was the last time your patients or loved ones were screened for cognitive changes and dementia? Patients and caregivers both fear and accept cognitive decline as part of the aging process, but often delay screening. However, early detection of cognitive impairment can assist healthcare teams to make proactive interventions to slow cognitive decline and promote healthy aging.

 

Guest Authors:  Rebecca Heath, PharmD, MSCR and Kimberly L. Zitko, PharmD, BCACP, BCGP

 

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Age is Just a Number: Discontinue Statins with Care

More than 14 million Americans age 75 years and older face a dilemma. They are at high risk for atherosclerotic cardiovascular disease (ASCVD). On the other hand, older adults are more susceptible to adverse effects associated with statins. Many adults, often in their 60s or early 70s, decide to initiate statin therapy for the primary prevention of ASCVD. However, at some point in a patient’s life, the potential benefits may no longer be so clear … or the risks and costs increase. Unfortunately, there is little information on the potential consequences of stopping statin in patients who are tolerating statins.

Guest Authors:  Maricar Conson, PharmD and W. Cheng Yuet, PharmD, BCACP

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D-PRESCRIBE Study: As Age Goes Up, The Medication Must Go Down!

The D-PRESCRIBE study provides compelling evidence that a focused, systematic medication review conducted by community-based pharmacists coupled with patient education and written recommendations to prescribers results in a significant reduction in the use of potentially inappropriate medications.  In this episode, Christine Dimaculangan reviews the methods and results of the D-PRESCRIBE study and our expert panelists discuss its implications and implementation.

Guests: Christine Dimaculangan, PharmD.; Nicole Brandt, PharmD, MBA, BCPP, BCGP; and Emily Prohaska, PharmD, BCACP, BCGP

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Keeping Intensive Blood Pressure Goals in MIND: Does it Impact Cognitive Decline?

Intensive blood pressure (BP) control reduces the risk of cardiovascular events and mortality, but the verdict isn't in yet on the benefits of intensive control to prevent the development of dementia. Previous studies have shown an inconsistent relationship between blood pressure control and cognitive decline. SPRINT-MIND, using data from SPRINT, was designed to evaluate the effects of intensive BP control on cognitive outcomes including probable dementia and mild cognitive impairment.

Guest Authors:  Michelle Balli, PharmD, BCACP and Amy Robertson, PharmD, BCACP

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Fall Risk and Benzos – Is Trazodone Really the Knight in Shining Armor?

Older adults are often tormented by insomnia, pain, and other comorbidities that impact their quality of life.  Medication therapy is often sought to treat and manage these diseases, but healthcare providers often overlook the risks of prescribing medications to patients who are older, frail, and at high risk for falls.  Trazodone is increasingly prescribed for insomnia instead of benzodiazepines presumably because it is considered to be safer and it does not appear on either the Beers or STOP/START lists.  But is trazodone really safer for patients than benzodiazepines?

Guest Authors:  Anthony M. Todd, PharmD and Nicole A Slater, PharmD, BCACP

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