Stay-at-home orders across the nation last year challenged all of us, but for older adults, social isolation had an even greater and more devastating effect on overall well-being. Feelings of distress, loneliness, depression and anxiety within this population are common issues that providers routinely battle, and adding a pandemic to the mix only made things worse.
The negative psychological effects of this long period of social isolation and restriction on an already disconnected population were significant. Loss of daily interactions with friends or loved ones, decreased activity levels and uncertainty due to COVID-19 could manifest in rapid deterioration of physical and mental health.
With a resurgence of cases due to variants such as omicron and its BA.2 variant, it is starting to feel like 2020 all over again, particularly in our senior living communities. What makes this situation so extreme is that, although many of us might go back to losing social supports such as daily workplace interactions, dinners with friends or cancelled celebrations, people who reside in senior living communities may have no other contact with any other person on a day-to-day basis, as shared meals and community-driven activities begin being put back on hold.
CMM is a win-win
Recent statistics from the Centers for Disease Control and Prevention show that 78% of adults aged 55 years and over have at least one chronic condition such as diabetes, asthma or hypertension. Medications are a critical component of disease state management, but too often, medications are misused, which leads to unnecessary side effects and poor health outcomes.
Older adults are particularly vulnerable to drug therapy problems due to polypharmacy, multiple transitions of care and legacy prescribing. Comprehensive medication management, or CMM, is a whole-person approach to medication management that ensures that medications are appropriate, safe and effective, and that they support the individual’s clinical and personal goals.
To achieve this, a clinical pharmacist can spend anywhere from one to two hours speaking with the resident. T his “clinical encounter” actually comes in the form of a warm, friendly, one-on-one chat with the older adult and his or her trusted pharmacist over the phone or via HIPAA-compliant video. Residents enjoy the individual attention and care, and the clinically trained pharmacist can look for any red flags that might be present to bring in additional support while addressing drug therapy problems.
Building a CMM program that works for your organization
Before implementing CMM, ask for input from your whole care team so you can formulate a plan to identify and engage with residents who can benefit from CMM as an additional clinical service. Ask where your organization has an opportunity to improve care and what your population’s unique needs are.
CMM programs can target those with chronic disease states such as diabetes, hypertension, chronic obstructive pulmonary disease or asthma. They can focus on meeting measurable health goals and start with those not meeting those markers first. Or you could use isolation specific criteria such as living alone, a history of mental health conditions, or a lack of family and social support as your inclusion criteria. You can use a short questionnaire to identify anyone experiencing feelings of isolation, anxiety or loneliness; or ask questions about understanding, concerns or wanting additional education regarding medications and health conditions. Simply letting your residents know that you are thinking about them and want to help them stay happy and healthy during this difficult time can go a long way!
Stories of success
Feelings of social isolation, depression and anxiety are major health concerns for us all due to the COVID-19 pandemic, but many residents of senior living communities are facing a perfect storm of risk factors. They may live alone, have existing mental health problems, manage multiple chronic health conditions, have little social interaction outside of the community, be unfamiliar or uncomfortable using technology, or be restricted to their apartment or room for long periods of time to reduce their risk of contracting COVID-19.
An ongoing CMM program can give those individuals an opportunity to interact with another person while also addressing those concerns with a health professional who is trained to gather information and address health concerns in a non-judgmental way. Clinical pharmacists hear their patients’ concerns about disrupted sleep schedules, weight gain, anxiety and missed primary care visits, and they can work with them to make positive changes. We provide education on disease state management, side effect reduction and resources that are available.
Consider this recent example: A patient recently confided to one of our pharmacists that he was feeling especially anxious and depressed after being home alone for several months due to COVID-19 concerns and his underlying health conditions. He let the pharmacist know that he had stopped taking his antidepressant a while back because he had been feeling much better after being on it for about six weeks.
The two talked about how that kind of medication works; that to continue to receive those benefits, he would need to take the medicine continuously; and about how this might be a bad time to go off this treatment with all the stress he was under currently. He was very grateful for the medication information as well as the other non-pharmacologic tips the pharmacist gave him for maintaining a healthy sleep, activity and nutrition plan, and he resolved to re-start his medication and follow-up with his primary care doctor.
Undoubtedly, the use of CMM as a solution to engage and interact with residents while simultaneously addressing health concerns and letting an individual know someone cares about him or her is an essential component of care for the older adult population going forward. CMM is a practical communication strategy to enable remote visits with individuals, consult with other members of the care team and engage with family members. It can be implemented now, whether through telemedicine or even by phone. Medication management is more crucial now than ever before to aid in reducing each individual’s risk of becoming seriously ill or requiring medical care escalation during this crisis.
Karmen L. Stephens, PharmD, BCGP, is an executive-level pharmacy thought leader and board-certified geriatric pharmacist with more than 20 years of experience in a variety of pharmacy practice settings. She currently is the vice president of clinical for Consana, where she is responsible for strategic direction and clinical development. Over the past 12 years, her primary clinical focus has been high-risk populations, with a particular interest in deprescribing through comprehensive medication management in older adults and patients with intellectual/developmental disabilities. Stephens is an active member in the American Society of Consultant Pharmacists, Get The Medications Right Institute and the Health Information Management Systems Society. She may be contacted at [email protected].
The opinions expressed in each McKnight’s Senior Living marketplace column are those of the author and are not necessarily those of McKnight’s Senior Living.
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