PACE Pharmacy

The Special Challenges of Providing PACE Pharmacy Services for Dementia Care

Jennifer Devinney, RPh, PharmD

According to the National PACE Association, nearly half of PACE participants have been diagnosed with dementia. Yet, even with the challenges of dementia, they’re living on their own with the help of caregivers. What is the role of PACE pharmacy services in helping manage dementia and mitigate its side effects to the largest extent possible? PACE medication management for participants with dementia must be multifaceted to meet the unique challenges the participants and their caregivers face. Care for these participants must include educational components, enhanced medication safety and regular medication therapy reviews. Here’s a look at the medication-related challenges dementia presents.

PACE Pharmacy Services Challenge 1: Agitation and Aggression

Agitation and/or aggression are common among participants with dementia, impacting up to 80 percent of participants. These behavioral issues can be caused by the disease itself or the medications necessary to manage the condition. In the past, antipsychotics were typically utilized to treat agitation and aggression. However, the negatives of treatment with antipsychotics often outweighed the positives. While their behavioral issues might lessen, patients treated with antipsychotics were at an increased risk of falls and associated mortality. The Centers for Medicare & Medicaid Services’ goal to decrease antipsychotic use by 30 percent in long term care facilities has resulted in a significant reduction in such treatment. During the effort to reduce use, CMS is studying the effects of reduced antipsychotic use, both positive and negative. Among its findings: The use of sedative/hypnotic medications has increased, which means that many patients are still receiving chemical treatment. An alternative method of treating agitation and aggression helps avoid chemical restraints altogether. Studies have found that treating these behavioral issues with pain medications, such as acetaminophen or low-dose morphine, is effective and doesn’t have the associated negative effects. PACE pharmacy service providers play a key role in this shift, monitoring prescriber ordering habits and making expert suggestions on how to best handle behavioral issues. [Tweet “Caring for participants with #dementia presents unique challenges for #PACEpharmacy”]

PACE Pharmacy Services Challenge 2: Enhanced Medication Safety Needs

Participants with dementia face a number of safety concerns related to activities of daily living, including medication use. PACE pharmacy providers are challenged to help mitigate those concerns as much as possible. For one, as dementia progresses, many participants will experience dysphagia, making it more difficult to swallow. Pharmacists and other clinicians will need to keep a careful eye on swallowing abilities, and switch participants to liquid medications when needed. Because caregivers will play an increasingly significant role as dementia worsens, the educational component of PACE pharmacy is magnified. This calls for more interaction with family members and other caregivers to help ensure they understand how to give medications correctly. This will include discussion of the need to provide participants with clear instructions on how to take/swallow the medication, what to do if a participant refuses to take a medication and the need to place medication in an inaccessible location. Part of this educational component is required to counteract advice given by national dementia organizations. Many recommend that caregivers place a participant’s medications in a dayminder for easy distribution. But research indicates that dayminders, also known as pill organizers, are not the most effective method of distribution, and can, in fact, be dangerous. Grane Rx’s EasyRead Pharmacy Solution and SimplePack technology provide a more appropriate method of distribution that achieves the same purposes while negating the potential safety issues.

PACE Pharmacy Services Challenge 3: Potential Drug Interactions

Many participants with dementia are affected by polypharmacy due to the large number of medications they take to treat both the dementia and comorbidities. This places them at a higher risk of drug interactions. Drug interactions are particularly common when a participant takes both a cognitive enhancer and an antipsychotic to treat the symptoms of dementia. This particular concern was mentioned above. However, other interactions do frequently occur in this population. A study published earlier this year found that severe potential drug interactions were most likely in dementia patients treated with antidepressants, antiplatelets, antipsychotics and omeprazole. Because of the likelihood of drug interactions, medication reviews take on increased importance. Participants with dementia are also more prone to experience side effects from medications. Along with looking for potential drug interactions, PACE pharmacy providers should also ascertain from clinicians and caregivers whether any negative effects are experienced and seek to adjust medication regimens accordingly. Grane Rx’s PACE pharmacy team understands the unique challenges of dementia care. Learn how we can help your PACE team by calling (412) 449-0504 or emailing paceteam@granerx.com.]]>

Jennifer Devinney, RPh, PharmD

Jennifer Devinney is the Chief Clinical Officer for Grane Rx. In this role, she works with clinical pharmacists and nurses in conjunction with facility staff to develop and oversee clinical initiatives. Additionally, she is the clinical EHR integration specialist.

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The Special Challenges of Providing PACE Pharmacy Services for Dementia Care

PACE Pharmacy Services Challenge 1: Agitation and Aggression

PACE Pharmacy Services Challenge 2: Enhanced Medication Safety Needs

PACE Pharmacy Services Challenge 3: Potential Drug Interactions

Jennifer Devinney, RPh, PharmD

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