Collecting “ologists” and drugs: how pharmacists can assist with management of elderly patients’ medicines

I have recently retired from the pharmacy register after 57 years of enjoyable service. I owned a community pharmacy and have lived — and continue to do so — in a delightful area on the south coast of England where the age of the population is above the national average. So age-related health issues have always been to the forefront of my thinking.

A few years ago I had to have open heart surgery, when the surgeon replaced one valve and repaired another. So I collected my first ‘ologist’ — a cardiologist — together with a selection of medicines. This was closely followed by a rheumatologist and a nephrologist.

More recently, a haematologist has been added so my list of medicines continue to increase. The ophthalmologist is deliberating whether to add to my list of medicines, and my general practitioner has the task of overseeing all of these medicines and is now regularly generating the prescriptions for them. Over time, I am expecting this list to increase. Nature adds to this mixture, with its own subtle (but known) physiological changes which affect drug metabolism with the daily advancement of age.

Understandably, geriatricians now appear to be mainly concerned with dementia. As a result, it appears to me that the simple effects of age on the metabolism of drugs has seemingly been side lined. Due to time and other constraints, GPs, while overseeing the overall health of their patients, do not normally question any prescriptions written by a specialist.

I therefore suggest that pharmacists are well qualified to undertake medication reviews and make recommendations. From my own experience, although I appreciate patients will not necessarily “get better” when medication is stopped, they feel “improved” and it is this quality of life that is important in the autumn of life.

Despite educational efforts, I know that many elderly people find the variety of medicines that increase over time become confusing. Complex drug names combined with different sizes, colours and packing styles (some of which change every month) do not help. Elderly people do require additional assistance. Over the years I lost count of the number of people who asked me “what are these pills for?” and “are these the same as last time because they are different in colour/size?”

Patients’ understanding of medicines varies enormously for a number of reasons. Pharmacists can help in many ways. Hopefully, we can address these important drug management issues for the benefit of the most vulnerable.