Geriatric Pharmacy: Medication Considerations for Older Adults

Why Geriatric Pharmacy Matters

Adults over 65 consume a disproportionate share of medications, using approximately 30% of all prescriptions. Age-related physiological changes affect how drugs are absorbed, distributed, metabolized, and eliminated. Pharmacy technicians who understand these changes can better support safe medication use in older adults.

Age-Related Pharmacokinetic Changes

• Absorption - Reduced gastric acid production and slower GI motility may delay absorption of some drugs, but most oral medications are still adequately absorbed
• Distribution - Decreased total body water and increased body fat alter drug distribution. Water-soluble drugs (e.g., digoxin, lithium) have higher concentrations. Fat-soluble drugs (e.g., diazepam) accumulate and have prolonged effects.
• Metabolism - Reduced liver blood flow and decreased CYP enzyme activity slow hepatic metabolism, prolonging drug half-lives
• Elimination - Declining renal function (GFR decreases with age) impairs drug excretion. Renally cleared drugs (e.g., gabapentin, metformin, enoxaparin) require dose adjustments.

The Beers Criteria

Published by the American Geriatrics Society, the Beers Criteria lists potentially inappropriate medications (PIMs) for older adults. Categories include:

• Medications to avoid regardless of diagnosis (e.g., long-acting benzodiazepines, first-generation antihistamines like diphenhydramine)
• Medications to avoid in certain disease states (e.g., NSAIDs in heart failure)
• Medications to use with caution (e.g., aspirin for primary prevention in adults over 70)
• Drug-drug interactions to avoid in older adults

Polypharmacy

Polypharmacy (typically defined as using 5 or more medications) increases the risk of drug interactions, adverse effects, falls, hospitalizations, and medication non-adherence. Deprescribing, the systematic process of reducing or stopping medications that are no longer needed, is an important strategy for managing polypharmacy.

Practical Considerations

Easy-open caps may be needed for patients with arthritis. Large-print labels improve readability. Medication synchronization (med sync) programs align refill dates to simplify regimens. Pill organizers and blister packaging support adherence.

Geriatric pharmacy concepts appear across multiple PTCE exam domains. Understanding these principles makes you a safer, more effective technician.