Drugs & Aging

, Volume 29, Issue 6, pp 495–510 | Cite as

The Role of the Pharmacist in Optimizing Pharmacotherapy in Older People

  • Anne SpinewineEmail author
  • Daniela Fialová
  • Stephen Byrne
Review Article


Prescription of medicines is a fundamental component of the care of older people, but evidence suggests that pharmacotherapy in this population is often inappropriate. Pharmacists have been involved in different approaches for the optimization of prescribing and rational medication use in older people. This article describes the different models of care in which pharmacists are involved in the optimization of pharmacotherapy in older people, and reviews the impact of these approaches on both process and outcome measures. The provision of pharmaceutical care, medication reviews and educational interventions by pharmacists in the nursing home, ambulatory and acute care settings are discussed. We selected systematic reviews, reviews and original studies, and for the latter, we focused more specifically on European publications published between 2001 and 2011.

From the literature reviewed, it is clear that when pharmacists play a proactive role in performing medication reviews and in the active education of other healthcare professionals, pharmacotherapy for older patients is improved. However, the evidence of the impact of pharmacists’ interventions on health outcomes, quality of life or cost effectiveness of care is mixed. Better results have been reported when pharmacists are skilled and work in the context of a multidisciplinary team. Opportunities remain for multicentre, European-based, pharmacist-intervention trials in all settings, to determine the effectiveness and economic benefit of pharmacist involvement in the optimization of pharmacotherapy in older people.


Nursing Home Community Pharmacist Medication Review Pharmaceutical Care Clinical Pharmacist 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This paper was written by the three authors stated above without any financial support. Research work of Dr Fialová, Department of Geriatrics and Gerontology, Charles University in Prague, Czech Republic, was supported by grants IGA MZ č.j. 10-029-4/2008.


  1. 1.
    Spinewine A, Schmader KE, Barber N, et al. Appropriate prescribing in elderly people: how well can it be measured and optimised? Lancet 2007 Jul; 370 (9582): 173–84PubMedCrossRefGoogle Scholar
  2. 2.
    Hanlon JT, Lindblad CI, Gray SL. Can clinical pharmacy services have a positive impact on drug-related problems and health outcomes in community-based older adults? Am J Geriatr Pharmacother 2004 Mar; 2 (1): 3–13PubMedCrossRefGoogle Scholar
  3. 3.
    Kongkaew C, Noyce PR, Ashcroft DM. Hospital admissions associated with adverse drug reactions: a systematic review of prospective observational studies. Ann Pharmacother 2008 Jul; 42 (7): 1017–25PubMedCrossRefGoogle Scholar
  4. 4.
    Mannesse CK, Derkx FH, de Ridder MA, et al. Contribution of adverse drug reactions to hospital admission of older patients. Age Ageing 2000 Jan; 29 (1): 35–9PubMedCrossRefGoogle Scholar
  5. 5.
    Col N, Fanale JE, Kronholm P. The role of medication noncompliance and adverse drug reactions in hospitalizations of the elderly. Arch Intern Med 1990 Apr; 150 (4): 841–5PubMedCrossRefGoogle Scholar
  6. 6.
    Steinman MA, Hanlon JT. Managing medications in clinically complex elders: ‘There’s got to be a happy medium’. JAMA 2010 Oct; 304 (14): 1592–601PubMedCrossRefGoogle Scholar
  7. 7.
    Sorensen L, Stokes JA, Purdie DM, et al. Medication reviews in the community: results of a randomized, controlled effectiveness trial. Br J Clin Pharmacol 2004 Dec; 58 (6): 648–64PubMedCrossRefGoogle Scholar
  8. 8.
    Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm 1990 Mar; 47 (3): 533–43PubMedGoogle Scholar
  9. 9.
    Hughes CM, Lapane KL. Pharmacy interventions on prescribing in nursing homes: from evidence to practice. Ther Adv Drug Safety 2011; 2: 103–12CrossRefGoogle Scholar
  10. 10.
    Zermansky AG, Alldred DP, Petty DR, et al. Clinical medication review by a pharmacist of elderly people living in care homes: randomised controlled trial. Age Ageing 2006 Nov; 35 (6): 586–91PubMedCrossRefGoogle Scholar
  11. 11.
    Patterson SM, Hughes CM, Crealey G, et al. An evaluation of an adapted US model of pharmaceutical care to improve psychoactive prescribing for nursing home residents in Northern Ireland (Fleetwood Northern Ireland study). J Am Geriatr Soc 2010 Jan; 58 (1): 44–53PubMedCrossRefGoogle Scholar
  12. 12.
    Bernsten C, Bjorkman I, Caramona M, et al. Improving the well-being of elderly patients via community pharmacy-based provision of pharmaceutical care: a multicentre study in seven European countries. Drugs Aging 2001; 18 (1): 63–77PubMedCrossRefGoogle Scholar
  13. 13.
    Sturgess IK, McElnay JC, Hughes CM, et al. Community pharmacy based provision of pharmaceutical care to older patients. Pharm World Sci 2003 Oct; 25 (5): 218–26PubMedCrossRefGoogle Scholar
  14. 14.
    Denneboom W, Dautzenberg MG, Grol R, et al. Treatment reviews of older people on polypharmacy in primary care: cluster controlled trial comparing two approaches. Br J Gen Pract 2007 Sep; 57 (542): 723–31PubMedGoogle Scholar
  15. 15.
    Richmond S, Morton V, Cross B. Effectiveness of shared pharmaceutical care for older patients: RESPECT trial findings. Br J Gen Pract 2010 Jan; 60 (570): e10–19CrossRefGoogle Scholar
  16. 16.
    Bojke C, Philips Z, Sculpher M. Cost-effectiveness of shared pharmaceutical care for older patients: RESPECT trial findings. Br J Gen Pract 2010 Jan; 60 (570): e20–7CrossRefGoogle Scholar
  17. 17.
    Krska J, Cromarty JA, Arris F, et al. Pharmacist-led medication review in patients over 65: a randomized, controlled trial in primary care. Age Ageing 2001 May; 30 (3): 205–11PubMedCrossRefGoogle Scholar
  18. 18.
    Holland R, Lenaghan E, Harvey I, et al. Does home based medication review keep older people out of hospital? The HOMER randomised controlled trial. BMJ 2005 Feb; 330 (7486): 293PubMedCrossRefGoogle Scholar
  19. 19.
    Lenaghan E, Holland R, Brooks A. Home-based medication review in a high risk elderly population in primary care: the POLYMED randomised controlled trial. Age Ageing 2007 May; 36 (3): 292–7PubMedCrossRefGoogle Scholar
  20. 20.
    Zermansky AG, Petty DR, Raynor DK, et al. Randomised controlled trial of clinical medication review by a pharmacist of elderly patients receiving repeat prescriptions in general practice. BMJ 2001 Dec; 323 (7325): 1340–3PubMedCrossRefGoogle Scholar
  21. 21.
    Spinewine A, Swine C, Dhillon S, et al. Effect of a collaborative approach on the quality of prescribing for geriatric inpatients: a randomized, controlled trial. J Am Geriatr Soc 2007 May; 55 (5): 658–65PubMedCrossRefGoogle Scholar
  22. 22.
    Gillespie U, Alassaad A, Henrohn D, et al. A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older: a randomized controlled trial. Arch Intern Med 2009 May; 169 (9): 894–900PubMedCrossRefGoogle Scholar
  23. 23.
    Hellstrom LM, Bondesson A, Hoglund P, et al. Impact of the Lund Integrated Medicines Management (LIMM) model on medication appropriateness and drug-related hospital revisits. Eur J Clin Pharmacol 2011 Jul; 67 (7): 741–52PubMedCrossRefGoogle Scholar
  24. 24.
    Lisby M, Thomsen A, Nielsen LP, et al. The effect of systematic medication review in elderly patients admitted to an acute ward of internal medicine. Basic Clin Pharmacol Toxicol 2010 May; 106 (5): 422–7PubMedGoogle Scholar
  25. 25.
    Nazareth I, Burton A, Shulman S, et al. A pharmacy discharge plan for hospitalized elderly patients: a randomized controlled trial. Age Ageing 2001 Jan; 30 (1): 33–40PubMedCrossRefGoogle Scholar
  26. 26.
    Al Rashed SA, Wright DJ, Roebuck N, et al. The value of inpatient pharmaceutical counselling to elderly patients prior to discharge. Br J Clin Pharmacol 2002 Dec; 54 (6): 657–64CrossRefGoogle Scholar
  27. 27.
    Holland R, Desborough J, Goodyer L, et al. Does pharmacistled medication review help to reduce hospital admissions and deaths in older people? A systematic review and meta-analysis. Br J Clin Pharmacol 2008 Mar; 65 (3): 303–16PubMedCrossRefGoogle Scholar
  28. 28.
    Castelino RL, Bajorek BV, Chen TF. Targeting suboptimal prescribing in the elderly: a review of the impact of pharmacy services. Ann Pharmacother 2009 Jun; 43 (6): 1096–106PubMedCrossRefGoogle Scholar
  29. 29.
    Verrue CL, Petrovic M, Mehuys E, et al. Pharmacists’ interventions for optimization of medication use in nursing homes: a systematic review. Drugs Aging 2009; 26 (1): 37–49PubMedCrossRefGoogle Scholar
  30. 30.
    Zermansky AG, Silcock J. Is medication review by primarycare pharmacists for older people cost effective? a narrative review of the literature, focusing on costs and benefits. Pharmacoeconomics 2009; 27 (1): 11–24PubMedCrossRefGoogle Scholar
  31. 31.
    da Silva DT, Santos AP, Aguiar PM, et al. Analysis of research quality regarding pharmaceutical intervention in elderly residents of long-term care facilities: a systematic review. J Am Geriatr Soc 2010 Jul; 58 (7): 1404–6PubMedCrossRefGoogle Scholar
  32. 32.
    Kaur S, Mitchell G, Vitetta L, et al. Interventions that can reduce inappropriate prescribing in the elderly: a systematic review. Drugs Aging 2009; 26 (12): 1013–28PubMedCrossRefGoogle Scholar
  33. 33.
    Marcum ZA, Handler SM, Wright R, et al. Interventions to improve suboptimal prescribing in nursing homes: a narrative review. Am J Geriatr Pharmacother 2010 Jun; 8 (3): 183–200PubMedCrossRefGoogle Scholar
  34. 34.
    Forsetlund L, Eike MC, Gjerberg E, et al. Effect of interventions to reduce potentially inappropriate use of drugs in nursing homes: a systematic review of randomised controlled trials. BMC Geriatr 2011; 11: 16PubMedCrossRefGoogle Scholar
  35. 35.
    Loganathan M, Singh S, Franklin BD, et al. Interventions to optimise prescribing in care homes: systematic review. Age Ageing 2011 Mar; 40 (2): 150–62PubMedCrossRefGoogle Scholar
  36. 36.
    Stuijt CC, Franssen EJ, Egberts AC, et al. Appropriateness of prescribing among elderly patients in a Dutch residential home: observational study of outcomes after a pharmacistled medication review. Drugs Aging 2008; 25 (11): 947–54PubMedCrossRefGoogle Scholar
  37. 37.
    Furniss L, Burns A, Craig SK, et al. Effects of a pharmacist’s medication review in nursing homes: randomised controlled trial. Br J Psychiatry 2000 Jun; 176: 563–7PubMedCrossRefGoogle Scholar
  38. 38.
    Schmidt I, Claesson CB, Westerholm B, et al. The impact of regular multidisciplinary team interventions on psychotropic prescribing in Swedish nursing homes. J Am Geriatr Soc 1998 Jan; 46 (1): 77–82PubMedGoogle Scholar
  39. 39.
    Schmidt IK, Claesson CB, Westerholm B, et al. Physician and staff assessments of drug interventions and outcomes in Swedish nursing homes. Ann Pharmacother 1998 Jan; 32 (1): 27–32PubMedCrossRefGoogle Scholar
  40. 40.
    Halvorsen KH, Ruths S, Granas AG, et al. Multidisciplinary intervention to identify and resolve drug-related problems in Norwegian nursing homes. Scand J Prim Health Care 2010 Jun; 28 (2): 82–8PubMedCrossRefGoogle Scholar
  41. 41.
    Brulhart MI, Wermeille JP. Multidisciplinary medication review: evaluation of a pharmaceutical care model for nursing homes. Int J Clin Pharm 2011 Jun; 33 (3): 549–57PubMedCrossRefGoogle Scholar
  42. 42.
    Daschner M, Brownstein S, Cameron KA, et al. Fleetwood phase II: tests a new model of long-term care pharmacy. Consult Pharm 2000; 15: 989–1005Google Scholar
  43. 43.
    Bootman JL, Harrison DL, Cox E. The health care cost of drug-related morbidity and mortality in nursing facilities. Arch Intern Med 1997 Oct; 157 (18): 2089–96PubMedCrossRefGoogle Scholar
  44. 44.
    Lapane KL, Hughes CM. Pharmacotherapy interventions undertaken by pharmacists in the Fleetwood phase III study: the role of process control. Ann Pharmacother 2006 Sep; 40 (9): 1522–6PubMedCrossRefGoogle Scholar
  45. 45.
    Patterson SM, Hughes CM, Lapane KL. Assessment of a United States pharmaceutical care model for nursing homes in the United Kingdom. Pharm World Sci 2007 Oct; 29 (5): 517–25PubMedCrossRefGoogle Scholar
  46. 46.
    Patterson SM, Hughes CM, Cardwell C, et al. A cluster randomized controlled trial of an adapted US model of pharmaceutical care for nursing home residents in Northern Ireland (Fleetwood Northern Ireland study): a cost-effectiveness analysis. J Am Geriatr Soc 2011 Apr; 59 (4): 586–93PubMedCrossRefGoogle Scholar
  47. 47.
    Eide E, Schjott J. Assessing the effects of an intervention by a pharmacist on prescribing and administration of hypnotics in nursing homes. Pharm World Sci 2001 Dec; 23 (6): 227–31PubMedCrossRefGoogle Scholar
  48. 48.
    Nishtala PS, McLachlan AJ, Bell JS, et al. Psychotropic prescribing in long-term care facilities: impact of medication reviews and educational interventions. Am J Geriatr Psychiatry 2008 Aug; 16 (8): 621–32PubMedCrossRefGoogle Scholar
  49. 49.
    Department of Health. National service framework for older people. London: Department of Health, 2001Google Scholar
  50. 50.
    Department of Health. Medicines and older people: implementing medicines-related aspects of the NSF for older people. London: Department of Health, 2001Google Scholar
  51. 51.
    Kucukarslan SN, Hagan AM, Shimp LA, et al. Integrating medication therapy management in the primary care medical home: a review of randomized controlled trials. Am J Health Syst Pharm 2011 Feb; 68 (4): 335–45PubMedCrossRefGoogle Scholar
  52. 52.
    Rosenthal TC. The medical home: growing evidence to support a new approach to primary care. J Am Board Fam Med 2008 Sep; 21 (5): 427–40PubMedCrossRefGoogle Scholar
  53. 53.
    Bates DW. Role of pharmacists in the medical home. Am J Health Syst Pharm 2009 Jun; 66 (12): 1116–8PubMedCrossRefGoogle Scholar
  54. 54.
    Castelino RL, Bajorek BV, Chen TF. Retrospective evaluation of home medicines review by pharmacists in older Australian patients using the medication appropriateness index. Ann Pharmacother 2010 Dec; 44 (12): 1922–9PubMedCrossRefGoogle Scholar
  55. 55.
    Bradley CP. The future role of pharmacists in primary care. Br J Gen Pract 2009 Dec; 59 (569): 891–2PubMedCrossRefGoogle Scholar
  56. 56.
    Kaboli PJ, Hoth AB, McClimon BJ, et al. Clinical pharmacists and inpatient medical care: a systematic review. Arch Intern Med 2006 May; 166 (9): 955–64PubMedCrossRefGoogle Scholar
  57. 57.
    LeBlanc JM, Seoane-Vazquez E, Dasta JF. Survey of hospital pharmacist activities outside of the United States. Am J Health Syst Pharm 2007 Aug; 64 (16): 1748–55PubMedCrossRefGoogle Scholar
  58. 58.
    Spinewine A, Dhillon S, Mallet L, et al. Implementation of ward-based clinical pharmacy services in Belgium: description of the impact on a geriatric unit. Ann Pharmacother 2006 Apr; 40 (4): 720–8PubMedCrossRefGoogle Scholar
  59. 59.
    Garcia-Caballos M, Ramos-Diaz F, Jimenez-Moleon JJ, et al. Drug-related problems in older people after hospital discharge and interventions to reduce them. Age Ageing 2010 Jul; 39 (4): 430–8PubMedCrossRefGoogle Scholar
  60. 60.
    Hanlon JT. Perspective: is pharmacy ready for the baby boomers? Am J Geriatr Pharmacother 2010 Feb; 8 (1): 1–3PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2012

Authors and Affiliations

  • Anne Spinewine
    • 1
    • 2
    Email author
  • Daniela Fialová
    • 3
    • 4
  • Stephen Byrne
    • 5
  1. 1.Louvain Drug Research Institute, Clinical Pharmacy Research Group - Av E MounierUniversité catholique de LouvainBrusselsBelgium
  2. 2.Université catholique de Louvain - CHU Mont-GodinneYvoirBelgium
  3. 3.Department of Geriatrics and Gerontology, 1st Faculty of MedicineCharles University in PraguePragueCzech Republic
  4. 4.Department of Social and Clinical Pharmacy, Faculty of PharmacyCharles UniversityHradec KrálovéCzech Republic
  5. 5.Pharmaceutical Care Research Group, School of PharmacyUniversity College CorkCorkIreland

Personalised recommendations