Inform - PharMerica · Inform Rx CLINICAL & REGULATORY NEWS BY PHARMERICA SEPT / OCT 2019 Treatment...

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CLINICAL &

REGULATORY

NEWS BY

PHARMERICA

SEPT / OCT 2019

Treatment of Diabetes in Older Adults In 2014, diabetes affected 29 million people and is relatively common in the older population for a variety of reasons. The disease is among the top ten leading causes of death and can lead to blindness, stroke, myocardial infarction, renal damage, and non-traumatic lower-limb amputations if untreated or inadequately treated.

Type 2 Diabetes and SNFsIn skilled nursing facilities, Type 2 diabetes is most prevalent. Residents also have a variety of co-morbidities due to age-related physiological changes, which can lead to cognitive changes, depression, falls, persistent pain, urinary incontinence, and polypharmacy. Cardiovascular changes are also common in these individuals, including hyperlipidemia, hypertension, stroke, and myocardial infarction. In addition, neuropathies are more prevalent in the older population. Increased risks for these conditions are directly or indirectly related to Type 2 diabetes.

Goals and TreatmentCurrent treatment goals for glycemic control, blood pressure, and dyslipidemia

vary depending upon the patient’s characteristics and health status. The table on page 2 specifies the current American Diabetes Association (ADA) HbA1c goals for the elderly resident.

It is important to establish personalized goals and treatment for diabetes; simplified regimens are preferred for both the resident and caregivers. Patient and caregiver education on lifestyle changes that can prevent complications such as weight loss, appropriate dietary choices, blood pressure control, smoking cessation, and physical exercise is key. In addition, there are many medication regimens available for treating the disease.

Oral Medications: Initiating treatment in Type 2 diabetes generally begins with lifestyle changes. Medication treatment is generally done in a stepwise fashion, beginning with a single agent before moving to the addition of basal/bolus insulin therapy.

Continued on page 2

InformRx PHARMACY NEWS

2 | www.pharmerica.com | SEPT / OCT 2019

Treatment of Diabetes in Older Adults, cont.

Continued on page 3

Preferences for which agent to begin a resident on depend on their comorbidities. Once a Hemoglobin A1c (HbA1c) goal has been established, the initial medications of choice would be either metformin, a glucagon-like peptide-1 receptor agonist (GLP-1 RA), or sodium-glucose cotransporter-2 inhibitor (SGLT2i). These are first-line treatments due to their increased benefit in residents with CVD, CHF or CKD. Metformin, the traditional agent of first choice, has a slight limitation in residents with renal failure, requiring a dosage reduction or the selection of an alternative agent. The resident’s HbA1c should be monitored as an indicator of the treatment success.

If the HbA1c remains elevated despite lifestyle changes and the addition of a single oral agent, the next step in the regimen may be the addition of a second first-line oral medication. If HbA1c goals continue to remain elusive, third second-line agent can be added.

Insulin: If treatment goals remain unmet despite the use of oral agents, the next step would be the addition of basal insulin. (The use of sliding scale insulin coverage is generally discouraged.) Discontinue sliding scale insulin, sulfonylureas (including chlorpropamide, glimepiride,

glipizide, glyburide, tolazamide, and tolbutamide), pioglitazone, and meglitinides (including nateglinide and repaglinide) to avoid the risk of inadvertent hypoglycemia. If these agents are combination products containing metformin, discontinue the combination product but continue metformin alone at the same dose contained in the combination.

Basal insulin goals are set for the morning fasting blood glucose measurement. If these are not achieved, add a step-wise prandial dose at the largest meal based on post-prandial glucose measurements, progressing, as necessary, with the addition of other mealtime doses until treatment goals are met.

Therapy for Related RisksBoth hypoglycemia and hyperglycemia are risks inherent in treatment of diabetes. Contributing to loss of glycemic control are frequent transitions of care, the use of sliding scale insulin regimens, variable oral intake, slowed gastrointestinal absorption, co-morbid conditions, polypharmacy, and a diminished hormonal response to glucose load. To treat hypoglycemia, which can contribute to increased fall risk and injury, in

Patient characteristics/ health status

Very complex/poor health (long-term care or end-stage chronic illnesses or moderate/severe cognitive impairment or 2+ ADL dependencies) or life expectancy <5 years

Complex/intermediate (multiple coexisting chronic illnesses or 2+ instrumental ADL impairments or mild/moderate cognitive impairment)

Healthy (few coexisting chronic illnesses, intact cognitive and functional status)

Rationale

Limited remaining life expectancy makes benefit uncertain

Intermediate remaining life expectancy, high treatment burden, hypoglycemia vulnerability, fall risk

Longer remaining life expectancy

Reasonable HBA1C goal

<8.5%

<8.0%

<7.5%

Fasting or pre-prandial glucose (mg/dL)

100-180

90-150

90-130

Bedtime glucose (mg/dL)

110-200

100-180

90-150

InformRx PHARMACY NEWS


Treatment of Diabetes in Older Adults, cont.

References1. Management of Diabetes in Long-term Care and Skilled Nursing Facilities: A Position Statement of The American Diabetes

Association; Diabetes Care 2016;39:308–318 | DOI: 10.2337/dc15-25122. America Diabetes Association: Standards of Medical Care in Diabetes—2019, January 2019 Volume 42,Supplement 11. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults: J Am

Geriatr Soc 00:1–21, 2019.

general, adding oral glucose is the preferred method. If the resident experiences loss of consciousness or the inability to swallow, then glucagon or an intravenous dextrose solution are options. For hyperglycemia, treatment may include an additional insulin dose and an adjustment to the current regimen.

Since ASCVD is the leading cause of morbidity and mortality in residents with diabetes, the ADA notes the positive benefit of simultaneously reducing cardiovascular risk factors through treatment of hypertension, hyperlipidemia, and heart failure in this population. In addition to lifestyle modification, treatments of these associated diagnoses should be individualized for each resident based on the overall benefit to be gained. For hypertension, an ACEI or ARB would be considered first-line therapy; other medications may be employed as well. For lipid management, the ADA recommends lifestyle modification with the addition of medication if non-pharmacologic interventions are not effective. Current guidelines published by the American College of Cardiology and the American Heart Association (ACC/AHA) as well as the ADA strongly recommends

moderate-intensity statin therapy for patients 40 to 75 years of age with diabetes. If the patient has a diagnosis of ASCVD or a 10-year ASCVD risk >7.5% in addition to diabetes, high-intensity statin therapy is recommended instead.

ConclusionTreatment of diabetes in long-term care facilities can be a complex and labor-intensive process. The ADA recommends a simplified approach, beginning with lifestyle changes before initiating oral therapy and progressing to basal/prandial insulin therapy as the needs of the resident dictate. Individualized regimens can be designed to improve diabetes management, lower the risk of hypoglycemia, and improve the resident’s quality of life.

For more information on Diabetes in older patients, please contact your PharMerica consultant pharmacist.

Monotherapy

Dual Therapy

Triple Therapy

• Metformin or a first-line alternative• GLP-1 RA, SGLT-2, or DPP-4 for CVD benefit• If HbA1c remains above target, advance regimen to Dual Therapy

• Metformin and a first-line alternative• GLP-1 RA, SGLT-2 or DPP-4 for CVD benefit• If after HbA1c remains above target, advance regimen to

Dual Therapy

• Metformin and• GLP-1 RA and• SGLT-2 or DPP-4 for CVD benefit• If HbA1c remains above target, consider basal insulin

InformRx CLINICAL CORNER


Herbal Supplements By Maria J. Minielly, PharmD, RPh, BCGP

Herbal supplements have been used for medicinal purposes for thousands of years. These “natural” products produce drug-like effects, but also drug-like adverse reactions. So is “natural” safer? The answer is not necessarily.

While the FDA monitors herbal supplements, it does not need to approve their manufacturing or distribution. That means these supplements are not subject to the same safety and efficacy standards as prescription medications.

Cinnamon• Comes from the bark of trees

native to China, India, andSoutheast Asia

• Uses include bronchitis,gastrointestinal problems,loss of appetite, and control ofdiabetes

• Available forms includepowders, capsules, teas, andliquid extracts

• Science says:- High-quality clinical evidence is

lacking- Five clinical trials related to

cinnamon do NOT appear toaffect factors related to diabetesand heart disease

• Cautions and side-effects:- Safest dosing = up to 6

grams daily for 6 weeks orless

Continued on page 5

- Do not use if allergic tocinnamon or its parts

- May contain coumarin,the parent compoundof warfarin, so usewith extreme caution iftaking warfarin or otheranticoagulants

Cranberry• Comes from the red berries of

plants native to North America• Uses include wound healing,

urinary tract disorders andinfections, diarrhea, diabetes,gastrointestinal discomfort, andliver problems

• Reported uses includeantioxidant and anticanceractivity

• Available forms includebeverages, extracts, capsules,and tablets

Popular SupplementsHere are some of the most common herbal supplements being used today.

In 2007, however, they became covered by the Good Manufacturing Practices (GMPs) to ensure consistent processing and quality standards, and there are regulations in place to keep the appropriate amount of the right ingredients in herbal supplements and contaminants out. There are also labeling standards for herbal supplements, which require the name of the herb being used, the name and address of the manufacturer/distributor, a complete list of active and inactive ingredients, and the serving size with the amount of active herb/ingredient.

• Science says:- Some non-definitive

evidence to support theprevention of urinary tractinfections but no evidenceto support the treatment ofexisting infections

- May reduce dental plaque,the cause of gum disease

- Preliminary evidence thatshows a decrease in theability of H. pylori to livein the stomach and causeulcers

• Cautions and side-effects:- Excessive amounts of

cranberry juice products maycause GI upset or diarrhea

- Do NOT use to treat asuspected UTI; contacta physician/healthcareprovider



Herbal Supplements, cont.

- Use with caution while takinganti-coagulants includingwarfarin and aspirin as wellas other medications thataffect the liver

Echinacea• Comes from nine known plant

species all native to the UnitedStates and Canada

• Uses include colds, flus, andother infections as well as woundhealing and skin problems

• Available forms include teas,juices, extracts, and topicalpreparations

• Science says:- Mixed study results on

whether Echinacea treats orprevents infections such asthe common cold

- Current studies includeeffects on the immunesystem as well as upperrespiratory infections

• Cautions and side-effects:- Well tolerated with little to

no side-effects when takenorally; GI upset reportedmost commonly

- Allergic reactions arecommon in patients withallergies to plants in thedaisy family: ragweed,chrysanthemums, marigolds,and daisies

- Allergic reactions are morecommon in patients withasthma

Fish Oil (Omega-3)• Can originate from fish but high

concentrations of this fatty acidare also found in nut and plantsources such as palm, soybean,grapeseed, and sunflower

• Uses include, but are notlimited to, cholesterol reduction(specifically triglycerides),coronary artery disease (CAD),hypertension, cancer, depression,and ADHD

• Available forms include tablets/capsules and liquids

• Science says:- Strong evidence through

clinical trials for the treatmentof CAD, hypertension,triglyceride reduction, andrheumatoid arthritis (RA)

- Unclear evidence throughclinical trials for the treatmentof macular degeneration,ADHD, cognition/dementia,stroke prevention, AIDS/HIV,and cancer

- Clinical trials indicated that therisk is greater than the benefitwhen used for diabetes andtransplant rejection

• Cautions and side-effects:- High doses can increase

bleeding risk, increase badcholesterol (LDL), createsugar control problems, andcause a “fishy” odor

- Avoid use with fish allergiesfor fish derived Omega-3 andnut, seed, and plant allergiesfor plant-derived Omega-3

- Multiple drug interactionsincluding but NOT limited toanticoagulants, antiplatelets,and NSAIDS

- Use with caution withdiabetes and hypertensionand while taking other herbalsupplements

- Commonly reported adverseeffects include “fishy”aftertaste and GI upset

Flaxseed and Flaxseed Oil• Comes from the seed of the flax

plant which grows throughoutthe Northwestern United Statesand Canada

• Uses include constipation,arthritis, high cholesterol, hotflashes, and breast pain as wellas cancer prevention

• Available forms include powdersto mix with water or juice, liquids,and capsules

• Science says:- The soluble fiber of flaxseed

may produce a laxative effect- Studies show the

cholesterol-lowering effectswere more apparent inpostmenopausal womenand people with high initialcholesterol results

- Not enough researchcurrently to supportflaxseed’s use in cancerprevention

- Studies are being conductedto determine the role inpreventing and/or treatingatherosclerosis, breastcancer, and ovarian cysts

• Cautions and side-effects:- Flaxseed and flaxseed

oil supplements are welltolerated with few reportedside-effects

- Take with plenty ofwater when using as asupplemental fiber source

- Avoid taking with otherconventional medicationsas it may lower the body’sability to absorb certainmedications

Continued on page 6




- Can thin the blood similarlyto aspirin; use with cautionprior to surgery or dentalwork or with bleedingdisorders

- Can interact with certainHIV medications but has notbeen well studied with othermedications

Ginkgo• Comes from the ginkgo tree,

one of the oldest trees in theworld

• Uses include asthma/bronchitis,fatigue, tinnitus (ringing in theears), Alzheimer’s diseaseand other types of dementia,intermittent claudication, sexualdysfunction, and multiplesclerosis (MS)

• Available forms include tablets,capsules, teas, and skinproducts containing ginkgoextract

• Science says:- One of the most highly

studied herbal supplementsfor dementia and memoryimpairment, intermittentclaudication, and tinnitus

- Overall results showedineffectiveness in slowingcognitive decline andlowering blood pressure

- Conflicting evidence onthe efficacy for intermittentclaudication and tinnitus

- Current studies include MS,sexual dysfunction due toantidepressants, insulinresistance, and short-termmemory loss due to ECT fordepression

• Cautions and side-effects:- More severe allergic

reactions have beenreported with ginkgo

- Headache, nausea, GIupset, diarrhea, dizzinessare more common

- Use with caution withanticoagulants and bleedingdisorders and prior tosurgery or dental work

Glucosamine/Chondroitin• Comes from shells of shellfish

(Glucosamine) and from animalsources such as cow cartilage(Chondroitin); Glucosamine canalso be synthesized in a lab

• Uses include osteoarthritis(OA), osteoporosis (OP), andin combination with iron foranemia (Chondroitin only)

• Available forms include tabletand liquid

• Science says:- Most studied for OA of the

knee, hip, and spine; noadditional benefits found inusing the combination overGlucosamine alone

- Some evidence of slowingof joint breakdown(Glucosamine)

- Possible efficacy whenused in combination withconventional medicationsfor pain and swellingassociated with OA

• Cautions and side-effects:- Avoid use with warfarin,

certain anti-neoplastic(cancer medications), andanti-diabetic medications

Continued on page 7

Garlic• Comes from the edible bulb of a

plant in the lily family• Uses include high cholesterol,

heart disease, blood pressure,and prevention of stomach andcolon cancers

• Available forms include rawor cooked cloves to make oilsand extracts as well as tabletsand capsules containing driedpowder

• Science says:- Studies have shown positive

effect for lowering bloodcholesterol levels with short-term use

- Some preliminaryresearch to show slowingin the development ofatherosclerosis

- Studies are being conductedto determine garlic’sinteraction with othermedications, the effectson liver function as well asa bioavailability study todetermine how well the mainactive compound of garlic,allicin, is absorbed by thebody

• Cautions and side-effects:- Appears safe for most adults- Breath and body odor

common along withheartburn and upsetstomach



ReferencesFDA, NIH Office of Dietary Supplements, Mayo Clinic, Pharmacist Letter, LexiComp

- Avoid use with clottingdisorders (Chondroitin)

- Avoid use with shellfishallergies (Glucosamine)

- Use with caution withasthma, hypertension, highcholesterol, and diabetes

Melatonin• A substance found naturally in the

body but can be synthesized in alab

• Uses include insomnia, jet lag,chronic fatigue syndrome (CFS),sleep-wake cycle disturbancessuch as shift-work disorder, andhelping the blind establish day/night cycles

• Available forms include tablet ororally disintegrating tablets

• Science says:- One of the most commonly

studied supplements- Likely effective for insomnia

due to trouble falling asleep,sleep disorders in the blind,and sleep-wake cycledisturbances

- Possibly effective for jet lag• Cautions and side-effects:

- Best when used short-term- Do not drive or use machinery

for four to five hours aftertaking a dose

- Use with caution withhypertension, diabetes,depression, seizure disorders,and clotting disorders

- Numerous drug interactions,including but NOT limited tooral contraceptives, caffeine,CYP450 substrates, andbenzodiazepines

Probiotics• Live organisms that provide

a therapeutic or preventativebenefit for the host, mostcommonly lactic-acidproducing bacteria known asBifidobacterium and lactobacilli

• Uses include strengthening theimmune system, recolonizingthe gut or vagina with “goodbacteria,” and protecting againstinfections, antibiotic associateddiarrhea and vaginitis

• Available forms include tablets/capsules, liquids, and yogurts/smoothies

• Science says:- Recommended as part of a

balanced diet and healthylifestyle

- Possibly effective forreducing the incidenceand duration of antibioticassociated diarrhea,including C. diff

- Insufficient evidence forreducing constipation,vaginitis or UTIs

• Cautions and side-effects:- Probably harmless in

healthy patients but maycause infection in seriouslyill or immunocompromisedpatients

- Do not use with Crohn’sdisease or asthma

- Some preparations containgluten; use with caution andread labels

Getting StartedIt is important to remember that the safety of a product labeled “natural”

depends on many things. Several medical libraries provide information about these herbal supplements. The FDA website also contains consolidated information about the safety of the supplements. However, these resources should never take the place of medical advice from healthcare providers.

Before starting an herbal supplement, it is important that residents speak with their physician or pharmacist to understand potential risks such as drug interactions with prescription medications or over-the-counter items. Patients older than 65 may also metabolize herbal supplements differently, causing harmful side effects. In addition, herbal supplements may also not be an appropriate choice patients undergoing surgery.


If an herbal supplement is an appropriate choice, these are some tips for safe use:1. Follow the package and/

or physician instructions2. Keep a list of ALL

herbal supplements andover-the-counter andprescription medications

3. Check for alerts,advisories, and recallsrelated to herbalsupplements

4. Research themanufacturer and avoidherbal supplementsmanufactured outside ofthe United States


EPA Hazardous Waste Pharmaceuticals Rule Effective August 21, 2019

InformRx F-TAG FOCUS

A final rule governing the management (removal/destruction) of hazardous waste t i t led “Management Standards for Hazardous Waste Pharmaceuticals and Amendment to the P075 Listing for Nicotine” was published in the February 22, 2019, Federal Register. The rule applies to nursing, skilled nursing, and inpatient hospice settings, but does NOT apply to ALFs, independent living communities, group homes, or continuing care retirement communities.

The rule has three parts: Subpart P, the Sewer Ban, and the Nicotine Exception. • Subpart P: This part creates

a specific hazardous wasteprogram for healthcare facilitiesand pharmaceutical reversedistributors that generatepharmaceutical hazardouswaste above certain thresholds.It is effective in Alaska and IowaAugust 21, 2019; all other stateshave until either July 1, 2021,or July 1, 2022, to adopt therule, depending on their statelegislative processes, but areallowed to adopt ahead of thesedeadlines. Tennessee is anearly adopter and Washingtonand Connecticut have indicatedthey might be early adoptersas well so be aware of what ishappening in your area. Continued on page 9

• Sewer Ban: The sewer banprevents hazardous waste pharmaceuticals from beingdisposed of down a drain orin a toilet, thereby reducingthe amount of pharmaceuticalingredients that contaminatedrinking water and endangerthe environment. While theban only applies to hazardouswaste pharmaceuticals, the EPArecommends not sewering anypharmaceutical. The ban appliesto all healthcare facilities andwill be implemented in all stateseffective August 21, 2019.

• Nicotine Exception: This partof the rule exempts over-the-counter nicotine replacementtherapies such as gums,lozenges, and patches, frombeing P-listed or defined as acutehazardous waste. Prescriptionnicotine products, e-cigs, andother liquid nicotine devices arestill be considered hazardouswaste. The part does not havean adoption timeline becauseit’s more lenient than the lawcurrently in place and states canchoose to not adopt it. Be sure tocheck with your local regulatorsfor updates.

Pharmaceut ica ls considered hazardous waste are listed on four lists: F, K, P, and U. The F and K lists do not apply to pharmaceuticals for humans so the only items of concern are those on the P (acutely hazardous) and U (toxic) lists. A pharmaceutical waste may also be considered hazardous if it exhibits one of the following four characteristics: ignitability, corrosivity, reactivity, or toxicity.

What will change at your facility?If your state is included in the first round of implementation for the rule in August, it is important to review and understand current hazardous waste generator status to determine how the rule applies.

Healthcare facilities may be categorized as:

Very Small Quantity Generators (VSQGs)• Generate less than or equal to

100 kg (220 lbs) per calendarmonth of hazardous waste or 1kg (2.2 lbs) of acute hazardouswaste


InformRx F-TAG FOCUS

EPA Hazardous Waste Pharmaceuticals Rule Effective August 21, 2019, cont.

• Facilities with 20 or fewer bedsare assumed to be VSQGs

• Facilities with greater than 20beds must demonstrate theyqualify as VSQGs

- Monthly calculations, monitoringand documentation is requiredto demonstrate that hazardouswaste is within limits of VSQGs.A copy of all documentationmust be kept for three yearsand made readily availableduring an inspection.

Small quantity generators (SQGs)• Generate greater than 100 kg of

hazardous waste and less than1,000 kg per calendar month

Large quantity generator (LQGs)• Generate greater than 1,000

kg per calendar month ofhazardous waste or greaterthan 100 kg of acute hazardouswaste

Waste StorageHazardous waste storage must be limited to one year. Containers storing hazardous waste must be labeled with the words “hazardous waste pharmaceuticals,” closed at all times, and structurally sound with no evidence of leakage, spillage, or damage.

Empty ContainersA dispensing bottle, vial or ampule or a unit-dose container (unit-dose packet, cup, wrapper, blister pack or delivery device) is considered empty and the residues are not considered hazardous waste if the hazardous waste pharmaceuticals have been removed from the dispensing or

unit-dose container by commonly employed methods and may be disposed of as non-hazardous waste. IV bags are considered empty when the contents have been fully administered. Syringes are considered empty when the plunger has been fully depressed. Other containers such as aerosols, tubes, gels, creams, ointments and nebulizers are considered empty when the contents have been removed using common practices (pouring, pumping, and aspirating) and they can’t be emptied any further, and they hold less than one inch (2.5 centimeters) of residue.

Triple rinsing of containers that held hazardous waste pharmaceuticals is now prohibited due to the sewering ban.

Non-Creditable Hazardous WasteHazardous waste pharmaceuticals in our serviced LTC facilities will be considered non-creditable since they are considered dispensed when the orders are filled at the outside pharmacy. Non-creditable hazardous waste cannot be returned to the servicing pharmacy or a reverse distributor, but must be transported to a certified treatment, storage, and disposal facility. We suggest working with your current medical waste vendor. Facilities that are VSQGs are exempt from this prohibition.

Hazardous Waste Pharmaceuticals that are Also DEA Controlled SubstancesHazardous waste pharmaceuticals are exempt from the regulation provided they are:

• Not sewered, and

• Managed in compliance withDEA regulations, and

• Destroyed by a method thatthe DEA has publicly deemedin writing to meet their non-retrievable standard, or

• Combusted at one of thefollowing types of permittedfacilities

- Large or small municipalwaste combustor (MWC)

- Hospital, medical and infectious waste incinerator (HMIWI)

- Commercial and industrialwaste incinerator (CISWI) or

- Hazardous waste combustor

TrainingFacilities managing hazardous waste pharmaceut icals in accordance with subpart P must inform all employees that handle or have responsibility for generating and/or managing hazardous waste pharmaceuticals of the proper handling and emergency procedures appropriate to their responsibilities during normal facility operations and emergencies.

Refer to the EPA Hazardous Waste Regulatory Summary for additional information at https://www.epa.gov/hwgenerators/hazardous-waste-generator-regulatory-summary.


InformRx SENIOR LIVING SPOTLIGHT

Go-To Apps for Memory CareTherapists

For long-term caregivers whose work focuses on physical therapy or speech pathology, the list of tools and resources is extensive. For those cargiver who work in assisted living memory care, however, every day poses new challenges as the mechanisms for diseases like Alzheimer’s are still not fully understood.

Restoring Cognitive HealthWhile researchers do not have a full understanding of the causes of dementia and Alzheimer’s, some studies have provided evidence that activities like brain games, puzzles and crosswords may actually help slow the progression of dementia and, for those not genetically predisposed, prevent it.

Medical researchers also continue to work to improve the quality of life for those already suffering from dementia, and they have revealed promising ways to mitigate many of the unpleasant effects, and in some cases, to slow down the progression of the disease.

For example, in 2018 the journal Gerontologist published research on established non-pharmacological approaches to treat behavioral and psychological symptoms of dementia (BPSDs). The study found that sensory practices like aromatherapy, massage, multi-

sensory stimulation and bright light therapy, as well as psychosocial practices such as validation, reminiscence, music and pet therapy may all contribute to continued cognitive health.

Some of the most promising research, however, focuses on the biology of the brain. The term “Neuroplasticity” refers to the brain’s ability to create new neural links, or paths, and it is known to diminish or fade completely in the brains of dementia patients. Assisted living memory care communities, like those of Chicago-based Pathway to Living, employ a process they call “rementia.” This approach employs techniques like environmental stimuli to reignite neural pathways, and in the process, help residents become engaged and communicative again, according to Maria Oliva, COO.

Meanwhile, along the way, research is beginning to uncover definitive links between physical and cognitive health, and therapists today are now convinced that both must be strong in order to keep the bodies and minds of aging humans whole.

Continued on page 11

Power of Mobile Apps for Dementia PatientsThe burgeoning availability of mobile “apps” has given memory caregivers and long-term care facilities a new set of tools. Many of these apps include previously discussed puzzles and brain games designed to stimulate the brains of those suffering from dementia.

Nettie Harper, MSRS, CTRS, COTP, co-founder of Inspired Memory Care, a large New York City-based training and consulting services provider, lists the following as some of the most helpful apps:

Amazon Alexa. Social engagement solution providers are finding opportunities for Alexa as a means to keep memory care residents connected to family and friends with just the power of their voice. “Families can support loved ones by setting reminders for pills, appointments, and engagement routines in their own voice,” Harper adds. The app can also provide personalized music and radio stations that promote relaxation and in some cases,


InformRxGo-To Apps for Memory Care Therapists, cont.

stimulate memory. When integrated with “smart” devices, dementia residents can use their voice to instruct Alexa to perform functions like turning on lights and controlling inside temperatures.

Streaming videos. Streaming services such as Amazon Prime Video and Netflix allow residents to access a variety of visual entertainment, bringing “high caliber learning and cultural experiences to individuals living with memory impairment or whose mobility has been restricted.”

Tactus. While Tactus is not a substitute for speech therapy, it has been used to support “procedural learning and to coach care-partners on using spaced retrieval techniques to teach their clients and loved ones new information.” Tactus provides a wide assortment of apps applicable to speech and language therapy, including some that support those living with aphasia, a condition that affects those with dementia that can result in the loss of ability to understand or express speech.

Home4Care. A tablet-based app that grew out of a National Institute of Health memory care study, Home4Care enables home health staff to utilize innovative activities with their clients. In the process, the home health providers get to know their clients better and receive training in how to provide the best possible care for those with whom they work with.

GPS location and tracking devices. GPS services are being used in a wide variety of ways to

prevent elopement or locate seniors, including those with memory issues. Many of the devices are embedded in items like pendants, bracelets and apparel.

SafeWander. This app sends an alert to caregivers’ phones when an individual leaves the bed. “The individual living with dementia does not have his or her sleep disrupted by loud alarms and a sensor is triggered by a forward shift in weight, rather than by shifting the weight off of a bed pad, meaning the signal to the carepartner is triggered earlier in the process of rising than with most bed alarms.”

SingFit. This app, according to Harper, “has allowed us to support our clients with finding their voice, sharing their emotions, and memories.” SingFit encourages the user to sing, records their voice utilizing a lyric coach and provides background music for those who have the words but need the support of melody.

Facetime. This popular app is finding its way into memory care, and its applications in programming and as an intervention for residents living with memory impairment are powerful, says Harper. “For one couple, we used it to minimize distress during a respite stay at a

SENIOR LIVING SPOTLIGHT

New technology is helping senior living communities and their staff respond to the many challenges their memory care residents face. ValueMed pharmacists also help respond to memory care challenges, with pharmacological expertise and unparalleled support so these residents can age in place. Contact us at [email protected] or 855-637-1755 to learn more.

residential treatment facility,” she recalls. “A husband was diagnosed with early onset Alzheimer’s disease at the beginning of his retirement, which eventually restricted his ability to travel with his wife as they had dreamed. When he reached the stage in which he felt he could no longer tolerate the long flights to foreign places, he and his wife discussed and decided she would ‘carry the torch’ without him.” While the husband resided for two weeks at a residential treatment facility where he could have engagement and support with medications and meals, the wife took her iPhone and a generous data plan along on their planned trip to Asia. The wife faithfully ‘Facetimed ‘ her husband from each new destination, sharing sights and stories so that he could feel connected to her and to the journey. He began to learn to use the iPad, holding it independently, accepting incoming calls, and navigating icons.

Following his wife on her journey via the iPad helped to minimize the emotional distress of their separation, as well as the feeling of being forgotten.

Inform - PharMerica · Inform Rx CLINICAL & REGULATORY NEWS BY PHARMERICA SEPT / OCT 2019 Treatment...

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Transcript of Inform - PharMerica · Inform Rx CLINICAL & REGULATORY NEWS BY PHARMERICA SEPT / OCT 2019 Treatment...