tegrated geriatric content, about half (49.5 percent) consider their geriatric curricula to be inadequate (Tilliss et al., 1998).

Pharmacists

There is currently a significant national shortage of pharmacists in the United States, which is due to a number of factors, including increased use of prescription medications, increased workloads, changing sites of service, demographic changes in the workforce, and expanding scopes of work (HRSA, 2000). While the absolute number of pharmacists has grown, supply has not kept up with demand, and wide variations in the numbers of pharmacists per capita exist from state to state (Walton et al., 2007). The current shortage causes problems for older adults, who tend to be heavy users of prescription drugs and to rely on pharmacists for counseling on the proper use of medications and on the monitoring of medication-related problems, such as interactions, duplications, adverse events, and adherence irregularities (Cooksey et al., 2002).

The role of pharmacists in the interdisciplinary care of older patients was reinforced in 1974 when Medicare first mandated drug regimen reviews (now called a Medication Regimen Review) in nursing homes by consultant pharmacists (Levenson and Saffel, 2007). In this setting, the role of the consultant pharmacist includes the provision information and recommendations to physicians regarding medications, identification of improper use of medications or the prescription of incompatible medications, and collaboration with the medical director and other staff to develop proper protocols for response to adverse events. This role has increased importance with the escalation of the number of medications given to the most frail and chronically ill patients. Additionally, with the advent of Medicare Part D, pharmacists potentially have a role in the education of older adults on their plan options and associated implications.

The doctor of pharmacy (PharmD) degree requires 4 years of pharmacy education. The Accreditation Standards and Guidelines for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree, adopted in 2006, implies that geriatrics should be a part of the pharmacy curriculum but does not explicitly require its inclusion. However, the science foundation of programs must consider populations that have altered pharmacological needs because of physiology or other reasons; this may include geriatric patients. Some of the competencies needed for the care of older patients include knowledge of the influence of aging on drug therapy, provision of medication and wellness counseling, and knowledge of geriatric syndromes (Odegard et al., 2007).

The American Society of Health-System Pharmacists (ASHP) accredits 1-year residencies in pharmacy, community pharmacy, or managed care



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement