Author: Kathleen Pace Murphy, PhD, MS, GNP-BC; Jennifer Larson, MSE
The National Medical Therapy Management (MTM) Advisory Board's (2011) definition of a Comprehensive Medication (CMR) Review is:
…a systematic process of collecting patient-specific information, assessing medication therapies to identify medication-related problems, developing a prioritized list of medication-related problems, and creating a plan to resolve them with the patient, caregiver and/or prescriber.
Older adults (aged 65 and older) use approximately 33% of prescription medications and 75% of all over the counter medications in the United States.
Ninety percent of those aged 65 or older take at least one drug per week. Forty percent take five or more drugs per week, and 12% take more than ten medications per week. (Katzung, 2007, Pham & Dickman, 2007).
Age influences medication therapy. As a person ages there are pharmacokinetic alterations that occur, such as, changes in drug absorption, distribution, excretion and metabolism. Advancing age may mean additional co-morbidities, which may further impair drug absorption, distribution, excretion and metabolism.
Socio-economic changes may also affect an older adult's medication therapy plan and adherence. Co-morbidities may mean additional costly medical appointments with specialists as well as primary care physicians. Complicated daily medication routines and pharmaceutical cost can also influence the older adult's adherence and/or compliance to the medication therapy plan.
Self-administration of complementary and over-the-counter medications and herbal remedies may further complicate the medication therapy plan if this information is not freely discussed between the older adult and the health care provider.
Health care providers must utilize their pharmacology knowledge to understand potential adverse drug effects. Asking the right questions is always a good start.
AssessmentMedication review questions to ask of patients include the following:
Adapted from Hamdy, Moore, Whalen, Donnelly, Compton, & Testerman, et al., (1995).
InterventionThe following interventions are simple and easy to follow when caring for an older adult:
American Geriatric Society (2012). AGS Beers Criteria for potentially inappropriate medication use in older adults. Accessed September 17, 2013 at http://www.americangeriatric.org/health_care_professionals?clinical_practice/clinicalguidelines_recommendations/2012
CHAMP: Advancing Home Care Excellence (2009). Geriatric Medication Management Toolkit. Accessed September 19, 2013 at http://champ-program.org/page/101/geriatric-medication-management-toolkit
Clinical medication review: A practice guide (February, 2013). NHS: Cumbria. Accessed September 18, 2013 at http://cumbria.nhs.uk/ProfessionalZone/MedicineManagement/GuidelinesReview-PracticeGuide2011.pdf
Hamdy, R.C., Moore, S.W., Whalen, K., Donnelly, J.P., Compton, R., Testerman, F., et al. (1995). Reducing polypharmacy in extended care. South Med J, 88, 534–538.
Katzung, B. (2007) Special aspects in geriatric pharmacology. In: Katzung, B. Basic and Clinical Pharmacology. 10th Ed. New York, NY: McGraw Medical; 983-990.
National MTM Advisory Board, (2011). Definition of medication therapy management definition. Accessed September 19, 2013 at http://www.businesswire.com/news/home/20110804006226/en/National-MTM-Advisory-Board-Releases-Pharmacist-Service
Pham, C. B., & Dickman, R. L. (2007). Minimizing adverse drug events in older patients. American Family Physician, 76(12), 1837-1844.