Connecting the disconnected: Leveraging an in-home team member for video visits for older adults.

Background: Older adults are interested and able to complete video visits, but often require coaching and practice to succeed. Data show a widening digital divide between older and younger adults using video visits. We conducted a qualitative feasibility study to investigate these gaps via ethnographic methods, including a team member in older participants' homes.

Medication Optimization for New Initiators of Empagliflozin for Diabetic Kidney Disease.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are recommended agents for the treatment of diabetic kidney disease (DKD). Additionally, SGLT2 inhibitors lower blood glucose, decrease blood pressure, and can be useful for volume management. For these reasons, we hypothesized that initiating SGLT2 inhibitor therapy may be associated with deprescribing of other medications in patients with DKD.

Improving Medication Reconciliation with Comprehensive Evaluation at a Veterans Affairs Skilled Nursing Facility.

Background: Unintentional medication discrepancies due to inadequate medication reconciliation pose a threat to patient safety. Skilled nursing facilities (SNFs) are an important care setting where patients are vulnerable to unintentional medication discrepancies due to increased medical complexity and care transitions. This study describes a quality improvement (QI) approach to improve medication reconciliation in an SNF setting as part of the Multi-Center Medication Reconciliation Quality Improvement Study 2 (MARQUIS2).

Opioid Use in the Nondialysis Chronic Kidney Disease Population.

Although pain is a common and burdensome condition in patients with chronic kidney disease (CKD), little is known about the use and safety of opioids in this patient population. Recommendations regarding opioid use in patients with CKD are based on pharmacokinetic data, extrapolation from non-CKD studies, and from clinical experience. Given the potential increased risk for opioid-related adverse events in patients with reduced kidney function, health care providers may be hesitant to prescribe opioids, resulting in inadequate pain control.

Pharmacologic Considerations for Opioid Use in Kidney Disease.

Individuals with kidney disease have a high prevalence of chronic noncancer pain. Although opioids are not a recommended treatment option for chronic noncancer pain in the general population, a higher percentage of individuals with kidney disease receive opioid prescriptions for chronic pain. Individuals with kidney disease have an increased risk for opioid adverse events because of changes related to kidney disease progression, normative aging, and the pharmacology of opioid medications.

There's no place like home-Integrating a pharmacist into the hospital-in-home model.

Background: Hospital-in-home (HIH) is an innovative model that provides hospital-level care in a patient's home. Pharmacists can enhance the HIH model through medication reconciliation and medication optimization.

Objectives: To integrate a clinical pharmacist into the HIH model and to conduct a formative evaluation of pharmacist contributions, including medication discrepancy resolution, cost savings, and cost avoidance.

Rapid Integration of Home Telehealth Visits Amidst COVID-19: What Do Older Adults Need to Succeed?

Objective: Our objective was to identify and address patient-perceived barriers to integrating home telehealth visits.

Design: We used an exploratory sequential mixed-methods design to conduct patient needs assessments, a home telehealth pilot, and formative evaluation of the pilot.

Setting: Veterans Affairs geriatrics-renal clinic.

Brown Bag Simulation to Improve Medication Management in Older Adults.

Introduction: Medical students must care for aging patients with growing medication lists and need training to address negative patient outcomes associated with polypharmacy. The literature shows that many trainees and practitioners are not confident in their abilities to care for this older population with complex medical conditions. We created an innovative simulation activity to teach safe, effective, and simplified medication management to second-year medical students.

Finding the Sweet Spot: An Interactive Workshop on Diabetes Management in Older Adults.

Introduction: Intensive glucose lowering in older adults with diabetes leads to increased risks with minimal benefits. Surveys indicate that clinician confidence for individualizing glycemic goals and regimens remains low. We created an interactive workshop and clinical tool kit to improve clinician knowledge of safe diabetes management in older adults.

A Pilot Study Embedding Clinical Pharmacists Within an Interprofessional Nephrology Clinic for the Initiation and Monitoring of Empagliflozin in Diabetic Kidney Disease.

Background: The American Diabetes Association (ADA) recommends sodium-glucose cotransporter-2 (SGLT2) inhibitors as the second medication to be started, after metformin, for patients with chronic kidney disease (CKD). Sodium-glucose cotransporter-2 inhibitors may cause volume, blood pressure, and electrolyte disturbances; consequently, frequent monitoring and adjustments to other diabetes, blood pressure, and/or diuretic medications may be necessary.

Objective: To evaluate the safety and efficacy of an interprofessional clinic model partnering nephrologists and pharmacists for the initiation and monitoring of SGLT2 inhibitors.

Opioid Management in Older Adults with Chronic Kidney Disease: A Review.

Chronic pain, a common comorbidity of chronic kidney disease, is consistently under-recognized and difficult to treat in older adults with nondialysis chronic kidney disease. Given the decreased kidney function associated with aging and chronic kidney disease, these patients are at increased risk for drug accumulation and adverse events. Emerging research has demonstrated the efficacy of opioids in chronic kidney disease patients, but research specifically focusing on older, nondialysis chronic kidney disease patients is scarce.

The missing piece: Clinical pharmacists enhancing the interprofessional nephrology clinic model.

Objectives: To embed pharmacy residents in an interprofessional nephrology clinic to conduct medication reconciliation in targeted high-risk patients with nondialysis kidney disease.

Setting: This pilot was a prospective quality improvement initiative conducted in an interprofessional outpatient nephrology clinic.

Practice Description: The nephrology clinic team includes nephrology providers, a social worker, and a geriatrician.

Geriatrics 5Ms for Primary Care Workshop.

Introduction: The Geriatrics 5Ms provide a novel framework for caring for older adults that directly maps to the current Accreditation Council for Graduate Medical Education (ACGME) core competencies in geriatrics for internal and family medicine residents. Using the 5Ms framework of Mobility, Medications, Mind, Multicomplexity, and Matters Most, we conducted a workshop for residents in a primary care clinic to improve care of older adults.

Methods: Through Kern's six-step approach to curriculum development, we used our needs assessment and stakeholder interviews to guide development of a half-day Geriatrics 5Ms workshop for residents in primary care.

The Role of Deprescribing in Older Adults with Chronic Kidney Disease.

Older adults with chronic kidney disease (CKD) often experience polypharmacy, a recognized predictor of prescribing problems including inappropriately dosed medications, drug-drug and drug-disease interactions, morbidity and mortality. Polypharmacy is also associated with nonadherence, which leads to recurrent hospitalizations and poorer hemodialysis outcomes in CKD patients. Further complicating medication management in this vulnerable population are the physiologic changes that occur with both age and CKD.

Brain Over Bladder: A Systematic Review of Dual Cholinesterase Inhibitor and Urinary Anticholinergic Use.

Background: Case reports have demonstrated that dual use of cholinesterase inhibitors (ChIs) and urinary anticholinergics (UAChs) in older adults may be associated with delusions, aggression, changes in cognition, and anxiety, which typically resolve on drug discontinuation. Despite opposing mechanisms of action, these drugs continue to be co-prescribed.

Objective: This systematic review evaluates cognitive and functional outcomes of dual use of ChIs and UAChs and describes its prevalence.