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Microsoft word - introgeriatricpharmccgp.doc

Introduction to Geriatric Pharmacotherapy
Resource List
Commission for Certification in Geriatric Pharmacy
This document is online at:
Commission for Certification in Geriatric Pharmacy
1321 Duke Street
Alexandria, VA 22314-3563
P: 703-535-3036
F: 703-739-1500

CCGP Geriatric Pharmacotherapy Resource List Introduction to Geriatric Pharmacotherapy
Resource List
Commission for Certification in Geriatric Pharmacy 1. Introduction 2. Getting Started 3. General Geriatric Resources 4. Geriatric Journal List 5. Geriatric Primer Article Series in The Consultant Pharmacist 6. General Journal Articles 7. Live Meetings and Workshops 8. Adverse Drug Events in Older Adults 9. Clinical Practice Guidelines 10. Geriatric Syndromes 11. Potentially Inappropriate Medications in Older Adults 12. Prescribing Cascade 13. Adherence or Compliance with Drug Therapy 14. Population-Specific Activities This list of resources and links is provided for information purposes only. This list is not intended to specifically prepare pharmacists to take the
Certified Geriatric Pharmacist examination. The content of the examination is
developed by an independent committee of experts, and the resources listed
here may or may not be applicable to the examination.
With the aging of the United States population, it is increasingly important for pharmacists to understand how drug therapy principles for older adults may be different from those applied in younger adults. Just as medications can be metabolized and behave differently in children than in adults, so can medications act differently in older adults. This is especially the case in the frail elderly, those adults above the age of 85. Despite the importance of geriatrics, most health professional training programs, including those in pharmacy, lack adequate emphasis on geriatrics and the use of medications in older adults. The purpose of this Web page is to provide links to resources that may be helpful to pharmacists in learning basic information about geriatric pharmacotherapy. CCGP
Geriatric Pharmacotherapy Resource List
Here is a link to an introductory article that describes some of the issues related
to medication use in older adults:
Citation: Clark, TR. Tough decisions about medications. Aging Well magazine,
Winter 2010.
Getting Started

Two resources are especially useful to help provide a content outline of what
geriatric pharmacotherapy is all about. These resources are:
Geriatric Pharmacy Curriculum Guide, published by the American Society of
Consultant Pharmacists (ASCP). This guide is available free and can be
downloaded as a PDF file at:
The candidate handbook for the Certified Geriatric Pharmacist examination also
contains a content outline used for developing questions for the examination.
The CGP candidate handbook can be downloaded at this link:
A brief, 10-question quiz on geriatric pharmacotherapy can also be taken free at
the Web site of the Commission for Certification in Geriatric Pharmacy (CCGP).
The quiz is available here:
ASCP also has a sample 10-question quiz on geriatric pharmacotherapy. It is
located here:
Pharmacists who desire to undertake a more comprehensive self-assessment of
knowledge of geriatric drug therapy can purchase a self-assessment examination
from CCGP. This examination can be taken online and scoring is provided as
part of the process. More information is available at this link:
General Geriatric Resources

Merck Manual of Geriatrics Online

Although no longer available in printed form, this resource continues to be
available and periodically updated online. Access is free. The link is:
Geriatric Pharmacotherapy Resource List
ASCP Foundation Geriatric Clinical Newsletter

The American Society of Consultant Pharmacists Foundation launched Geriatric
Clinical News
, a bi-monthly electronic newsletter in February 2008. Since that
time, topics covered in the newsletter include:
• Evidence-based medicine and older adults • Patient preferences and clinical practice guidelines • Update on the prescribing cascade
All past issues of the newsletter are archived and available in full text at this URL:
ASCP List of Online Study Activities

The American Society of Consultant Pharmacists has a list of online continuing
education programs, organized by topic. This list, with links to the programs, is
available at:
Geriatric Pharmacy Review

The web site at www.GeriatricPharmacyReview.com has 50 hours of continuing
education in 20 modules. A fee is required to access the modules, and a
discount is available for ASCP members. This resource is provided by the
American Society of Consultant Pharmacists.

The Senior Care Online University for Professionals (SCOUP) provides online
symposia on a variety of topics. Some are free and some charge a small fee for
processing the continuing education credit. This Web site is provided by ASCP,
and is available at:
Geriatrics At Your Fingertips

This handy resource is available as a pocket size print edition, or as an electronic
edition for the PDA. It is produced by the American Geriatrics Society.
Information is available at this link:
Geriatric Pharmacotherapy Listserver

ASCP maintains a listserver for discussion of issues related to geriatric drug
therapy. Access to the listserver is free. Subscribe to the listserver at:
Geriatric Pharmacotherapy Resource List
The Silver Book

A service of the Alliance for Aging Research, The Silver Book® is an almanac of
more than 1,000 facts, statistics, graphs, and data from more than 200 agencies,
organizations, and experts. It is an online searchable database that is constantly
updated and expanded in order to highlight the latest research and data on the
burden of chronic disease and the value of investing in medical research.
This resource can be found at:
Geriatric Journal List
Age & Ageing (British Geriatrics Society) http://ageing.oxfordjournals.org/ American Journal of Geriatric Pharmacotherapy http://ajgeripharmacother.com/current.html Annals of Long-Term Care http://www.annalsoflongtermcare.com/ BMC Geriatrics (open access journal) http://www.biomedcentral.com/bmcgeriatr/ Clinical Geriatrics http://www.clinicalgeriatrics.com/ Clinics in Geriatric Medicine http://geriatric.theclinics.com/ The Consultant Pharmacist http://www.ascp.com/publications/tcp/ Drugs & Aging http://adisonline.com/aging/Pages/default.aspx Geriatrics http://www.modernmedicine.com/modernmedicine/Geriatrics/home/40131 Geriatrics & Aging (Canada) http://www.geriatricsandaging.ca/ The Gerontologist http://gerontologist.oxfordjournals.org/ CCGP
Geriatric Pharmacotherapy Resource List
Journal of the American Geriatrics Society
Journal of the American Medical Directors Association
Journals of Gerontology: Medical Sciences
Geriatric Primer Articles in The Consultant Pharmacist
The Consultant Pharmacist, ASCP’s monthly journal, has published a series of articles in their “geriatric primer” series. These journal articles are available online and are free for ASCP members. The link to The Consultant Pharmacist Web page is: http://www.ascp.com/publications/tcp/ • Pharmacokinetic and Pharmacodynamic Alterations in the Geriatric Patient (April 2008) - http://tinyurl.com/23n5o7z • Evaluating Medication Regimens in the Elderly (July 2008) - • Communicating with Seniors and their Caregivers (Sept. 2008) - • The Senior Friendly Pharmacy (Dec. 2008) - http://tinyurl.com/y8nz9bf • Home is Where the Heart Is: Living Arrangements for Older Adults (Feb. • Identifying, Preventing, and Reporting Elder Abuse (April 2009) - • Common Geriatric Syndromes and Special Problems (June 2009) - • Implications and Management of Decline for the Geriatric Patient (Aug.
General Journal Articles

Pharmaco-epistemology for the prescribing geriatrician

With the emphasis today on evidence-based prescribing, this excellent article
helps the clinician caring for older adults to understand common mistakes that
are made with interpretation and application of clinical trial evidence. Full text of
this article is available free.
D. Le Couteur and H. Kendig. Australasian Journal on Ageing 2008; 27(1):3-7.
Geriatric Pharmacotherapy Resource List
Clinical pharmacology in the geriatric patient

This article by Sarah Hilmer and colleagues is a good overview of medication use
in older adults, and the full text is available online for free. The quality and
accessibility of this article make it a good starting point for students or
practitioners who need a good overview of the topic.
Hilmer SN, McLachlan AJ, Le Couteur DG. Fundamental & Clinical
Link to abstract (full text can be downloaded free in PDF or HTML):
Appropriate prescribing in elderly people

Spinewine A, Schmader KE, Barber N, Hughes C, Lapane K, Swine C, Hanlon
JT. Appropriate prescribing in elderly people: How can it be measured and
optimized? Lancet 2007;370:173-184.
Link to abstract:
Pharmaceutical care

Although not specific to geriatrics, this classic article by Hepler and Strand
introduced and defined “pharmaceutical care” and described the eight types of
medication-related problems.
Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care.
Am J Hosp Pharm 1990;47:533-543.
Full text of the article is available at:
End of life care

Holmes, HM, Hayley, DC, Alexander, GC & Sachs, GA. Reconsidering
medication appropriateness for patients late in life. Arch Intern Med
Link to abstract:
Quality indicators for medication use in vulnerable elders

This article is one of a series from the Assessing Care of Vulnerable Elders
(ACOVE) project. The entire collection of articles was published as a supplement
to the Journal of the American Geriatrics Society.
Geriatric Pharmacotherapy Resource List
Shrank WH, Polinski JM, Avorn J. Quality indicators for medication use in
vulnerable elders. J Am Geriatr Soc. 2007;55 Suppl 2:S373-382.
Link to abstract:
Live Meetings and Workshops

ASCP Annual Meeting – The ASCP Annual Meeting is in the Fall of each year.
The 2010 Annual Meeting is in Orlando, FL on November 10-13. Link for
meeting information:
Clinical Update for the Geriatric Pharmacist Workshop – This workshop is
held in conjunction with ASCP Annual and Midyear meetings, and also at some
regional meetings. The 2010 presentations of this workshop are scheduled for:
• November 9 at the ASCP Annual Meeting
More details on these workshops are at:
Geriatric Assessment for the Senior Care Pharmacist Workshop – This
workshop is held in conjunction with ASCP Annual and Midyear meetings. The
next presentation of this workshop is scheduled for:
• November 12 and 13 at the ASCP Annual Meeting
More details about this workshop are at:
Adverse Drug Events in Older Adults

A drug burden index to define the functional burden of medications in older

Hilmer and colleagues developed a tool (drug burden index) to correlate
medication use with decline in physical and cognitive performance. Medications
with anticholinergic and sedative properties are associated with poorer function in
community-dwelling older people.
Full text is available free at:
Hilmer SN, et al. Arch Intern Med. 2007;167:781-787.
Geriatric Pharmacotherapy Resource List
Medication use leading to emergency department visits for adverse drug
events in older adults

A nationally representative public health surveillance system tracked emergency
department visits, and visits related to adverse drug events in older adults were
analyzed. Three medications accounted for one-third of all emergency
department visits for adverse drug events in older adults. Full text of the article is
available free. Link:
Budnitz DS, Shehab N, Kegler SR, Richards CL. Ann Intern Med. 2007;147:755-
Adverse drug events among older persons in the ambulatory setting

Multiple methods were used to detect possible drug-related events in this cohort
study of an ambulatory Medicare population, with over 30,000 person-years of
observation. The overall rate of adverse drug events was 50.1 per 1000 person-
years, with 38% categorized as serious, life-threatening, or fatal. Cardiovascular
medications, diuretics, and nonopioid analgesics were the most common
medication categories associated with preventable adverse drug events. The
article provides more extensive information about other types of adverse drug
events and strategies for prevention.
The full text of the article is available at:
Gurwitz JH, et al. JAMA. 2003;289:1107-1116.
Adverse drug events in nursing homes

Handler, SM, Wright RM, Ruby CM, Hanlon JT. The epidemiology of medication-
related adverse events in nursing homes. Am J Geriatr Pharmacother
Handler SM, Hanlon JT. Detecting Adverse Drug Events Using a Nursing Home
Specific Trigger Tool. Ann Long-Term Care 2010;18:17-22.
Clinical Practice Guidelines

Clinical practice guidelines and older adults

Geriatric Pharmacotherapy Resource List
Boyd and colleagues reviewed clinical practice guidelines (CPGs) for diseases
common in older adults, and evaluated implications of applying
recommendations from these CPGs to older adults with multiple morbidities.
Their review suggests that adhering to current CPGs in caring for an older person
with several co-morbidities may have undesirable effects. Basing standards for
quality of care and pay for performance on existing CPGs could lead to
inappropriate judgment of the care provided to older individuals with complex co-
morbidities and could create perverse incentives that emphasize the wrong
aspects of care for this population and diminish the quality of their care.
Link to abstract:
Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW. Clinical practice
guidelines and quality of care for older patients with multiple comorbid diseases:
implications for pay for performance. JAMA. 2005;294(6):716-724.
Patient Preferences and Clinical Practice Guidelines

This article is from the August 2008 issue of the ASCP Foundation Geriatric
Clinical News. The link is:
National Guideline Clearinghouse

This compilation of clinical practice guidelines is made available by the Agency
for Healthcare Research and Quality. The link is:

AHRQ Effective Health Care Program

The Agency for Healthcare Research and Quality maintains a Web site with a
variety of useful resources, including guidelines, literature reviews and
comparative effectiveness reviews.
Link to Web site:

Adult Immunization Schedule for 2010
The link to the schedule on the CDC Web site is:
Practice guideline for the treatment of patients with Alzheimer's disease
and other dementias

This guideline from the American Psychiatric Association was updated in 2007:
Geriatric Pharmacotherapy Resource List
Antithrombotic and thrombolytic therapy-CHEST Guidelines, 2008
Clinical Practice Guidelines for Clostridium difficile Infection in Adults:
2010 Update by the Society for Healthcare Epidemiology of America (SHEA)
and the Infectious Diseases Society of America (IDSA).
Link to full text:
COPD Guidelines—GOLD
Diabetes—Standards of medical care in diabetes-January 2010, American
Diabetes Association. Link to full text guidelines:
HIV/AIDS—Use of antiretrovirals in adults with HIV infection, from the
International AIDS Society-USA; full text of guidelines are available free on the
JAMA Web site at:
Osteoporosis—Management of osteoporosis in postmenopausal women: 2010
position statement of the North American Menopause Society. Download at:
Pharmacological Management of Persistent Pain in Older Persons

This 2009 guideline is available free from the American Geriatrics Society:
Urinary Tract Infection, Catheter-associated
The Infectious Diseases Society of America has released 2010 guidelines on
diagnosis, prevention, and treatment of catheter-associated urinary tract infection
in adults, including those who are institutionalized. The full text of these
guidelines is available free at:
Geriatric Syndromes

Geriatric Conditions and Disability: The Health and Retirement Study

Of adults age 65 years or older, 50% have one or more geriatric conditions (or
geriatric syndromes). These include cognitive impairment, falls, low body mass
index, incontinence, dizziness, vision impairment, and hearing impairment.
These conditions may be as strongly associated with disability as chronic
Geriatric Pharmacotherapy Resource List
diseases, and should be addressed in the care of older adults.
Full text of this article is available at:
Cigolle CT, et al. Ann Intern Med. 2007;147(3):156-164.
Common Geriatric Syndromes and Special Problems

Link to abstract (full text free to subscribers and ASCP members):
Sleeper RB. Consult Pharm 2009;24(6):447-462.
Delirium: Diagnosis, Prevention, and Management.

From the National Institute for Health and Clinical Excellence (NICE) in the UK.
A quick reference guide is also available. July 2010. Full text online:
Falls and medication use

Woolcott JC, et al. Meta-analysis of the impact of 9 medication classes on falls in
elderly persons. Arch Intern Med. 2009;169(21):1952-1960.
Link to abstract:
Potentially Inappropriate Medications in the Elderly

Updating the Beers criteria for potentially inappropriate medication use in
older adults

The Beers criteria are well known as a list of medications that are considered to
be potentially inappropriate in the elderly. The original list of Beers criteria
medications was published in 1991 and the most recent version is from 2003.
The full text of the 2003 update is available from this link:
Fick DM, et al. Arch Intern Med. 2003;163:2716-2724.
Zhan criteria for potentially inappropriate medication use in the elderly

The best known criteria for potentially inappropriate medication use in the elderly
are the Beers criteria. Zhan modified the Beers criteria for a study of potentially
Geriatric Pharmacotherapy Resource List
inappropriate medication use in community-dwelling elderly and reported the
The full text of the article is available free online. Here is a link to the abstract,
which also includes a long list of articles that have referenced this study:
Zhan C, Sangl J, Bierman AS; et al. Potentially inappropriate
medication use in the community-dwelling elderly: findings from the
1996 Medical Expenditure Panel Survey. JAMA. 2001;286(22):2823-2829.
STOPP and START Criteria

The STOPP and START criteria have been attracting interest among geriatric
clinicians because they are more recent than the Beers criteria and they address
undertreatment among older adults along with use of medications that are
potentially inappropriate. This article by the ASCP Foundation provides an
overview and references:
Developing Explicit Positive Beers Criteria for Preferred Central Nervous
System Medications in Older Adults

This study identified 13 preferred medications for use in older adults with four
central nervous system conditions: dementia, depression, Parkinson’s disease,
and psychosis.
Link to article:
Stefanacci RG, Cavallero E, Beers MH, et al. Consult Pharm 2009;24:601-10.
ASCP-AMDA Joint Position Statement on Beers criteria

ASCP and the American Medical Directors Association developed a Joint
Position Statement on the Beers List of Potentially Inappropriate Medications in
Older Adults. The link to the policy statement is:


Prescribing Cascade

Increased incidence of levodopa therapy following metoclopramide use

In one of the early articles about the prescribing cascade, Avorn and colleagues
used the New Jersey Medicaid database to determine whether there was an
increase in use of anti-parkinsonian therapy in older persons (65 years and over)
Geriatric Pharmacotherapy Resource List
taking metoclopramide hydrochloride. They found that metoclopramide users
were three times more likely to begin use of a levodopa-containing medication
compared with nonusers.
Link to abstract:
Avorn A, Gurwitz JH, Bohn RL, et al. JAMA. 1995;274(22):1780-1782.
Update on the prescribing cascade

Clark, TR. Geriatric Clinical News, October 2008.
Adherence or Compliance with Drug Therapy

Medication Use Safety Training (MUST for Seniors)

This Web site is sponsored by the National Council on Patient Information and
Education (NCPIE), and is available at:
Adult Meducation

Sponsored by the American Society of Consultant Pharmacists Foundation, the
focus of this Web site is on improving medication adherence in older adults. The
link is:
Center for Connected Health

The Center for Connected Health has resources on medication adherence at:
Population-Specific Activities

Shown below is a list of resources that have been recommended by Certified
Geriatric Pharmacists. These resources may have applicability to Domain #3 of
the content outline for the Certified Geriatric Pharmacist examination, “Population
Specific Activities.”
Full text journal articles

Below is a series of six articles from the Canadian Medical Association Journal
that provide an overview of statistics and literature evaluation. The full text of the
articles is available free online.
Geriatric Pharmacotherapy Resource List
Wyer PC, et al. Tips for learning and teaching evidence-based medicine:
introduction to the series. CMAJ. Aug. 17, 2004. 171(4):347-348.
Barratt A, Wyer PC, Hatala R, et al. Tips for learners of evidence-based
medicine, Part 1: relative risk reduction, absolute risk reduction, and number
needed to treat. CMAJ. Aug. 17, 2004. 171(4):353-358.
Montori VM, Kleinbart J, Newman TB, et al. Tips for learners of evidence-based
medicine, Part 2: measures of precision (confidence intervals). CMAJ. Sept. 14,
2004. 171(6):611-615.
McGinn T, Wyer PC, Newman TB, et al. Tips for learners of evidence-based
medicine, Part 3: measures of observer variability (kappa statistic). CMAJ. Nov.
23, 2004. 171(11):1369-1373.
Hatala R, Keitz S, Wyer P, et al. Tips for learners of evidence-based medicine,
Part 4: assessing heterogeneity of primary studies in systematic reviews and
whether to combine their results. CMAJ. March 1, 2005. 172(5):661-665.
Montori VM, Wyer P, Newman TB, et al. Tips for learners of evidence-based
medicine, Part 5: the effect of spectrum of disease on the performance of
diagnostic tests. CMAJ. Aug. 16, 2005. 173(4):385-390.

Woloshin S, Schwartz LM, Welch HG. Know Your Chances: Understanding
Health Statistics. 2008. This inexpensive paperback book was written for lay
audiences and is very readable.
Link to Amazon.com: http://tinyurl.com/29s42d2
Malone P, Kier K, Stanovich J. Drug Information: A Guide for Pharmacists. 2006.
Has a chapter on “clinical application of statistical analysis,” which is reportedly
very good. The book costs over $50 though.
Link to Amazon.com: http://tinyurl.com/2g8app6
Online Continuing Education

A Primer on Interpreting Published Studies, 1-hour continuing education. Cost =
$10. Available at: http://www.theceinstitute.org/
CCGP Geriatric Pharmacotherapy Resource List Module #19 at www.GeriatricPharmacyReview.com is 1 hour of continuing education on “Evaluation and Use of Clinical Information to Improve Patient Care.” Access to this module can be purchased for $14 for ASCP members and $35 for non-members. ##

Source: http://www.nhpharmacists.net/docs/IntroGeriatricPharmCCGP.pdf


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