ASCP GERIATRIC PHARMACY CURRICULUM GUIDE FOURTH EDITION Updated January, 2021

Empowering Pharmacists. Transforming Aging. ascp.com

GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION 1 ASCP GERIATRIC PHARMACY CURRICULUM GUIDE FOURTH EDITION Introduction 3 Advanced/Specialty Training for the Geriatric Specialists 22 Revision Committee 3 Additional Board Certifications through the Board of Foundational Principles of Aging 4 Pharmacy Specialties (BPS) 22

Essential Competencies for the Practice of Certificate Programs 22 Geriatric Care 5 Become a Certified Educator 22 Approach to Practice & Care of Seniors 7 Professional Designations 22 Geriatric Pharmacy Curriculum Guide Toolkit 8 Leadership 22 Learner in Geriatrics Pyramid 8 Abbreviations 23 Learner in Geriatrics: Didactic 9 Resources 24 General Topics 9 Appendices 29 Elective Topics 10 Appendix A: Crosswalk with ACPE Outcomes 29 Learner in Geriatrics: Experiential 11 Appendix B: Crosswalk with Core Competencies for Introductory Pharmacy Practice Experience (IPPE) 11 Interprofessional Collaborative Practice 36

Advanced Pharmacy Practice Experience (APPE) 12 Appendix C: Crosswalk with the Curricular Framework: Core Competencies in Multicultural Geriatric Care 38 Non-Geriatrics Specific Rotation 13 Appendix D: Crosswalk with Partnership with Health in Learner in Geriatrics: Advanced Training 14 Aging Multidisciplinary Competencies in the Care Post-Graduate Year – 1 15 of Older Adults at the Completion of the Entry-level Health Professional Degree 40 Non-Geriatrics Specific Rotation 16 Appendix E: Crosswalk with Pharmacists’ Patient Care Post-Graduate Year – 2 Geriatrics 17 Process 44

Post-Graduate Year – 2 Non Geriatrics Specialties 19

Board Certified Geriatric Pharmacotherapy Specialist (BCGP) 21

2 GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION INTRODUCTION The American Society of Consultant Pharmacists (ASCP) Geriatric Curriculum Guide is a peer-reviewed resource designed to prepare pharmacy students and pharmacists with the education needed to care for older adults. Additionally, it serves as a resource for those designing or seeking experiences in the geriatric practice setting through coursework, residency, or personal career development.

Building on the appendices added in the 3rd edition, the 4th edition adds an appendix with the Pharmacists Patient Care Process (PPCP) created by the Joint Commission of Pharmacy Practitioners.

In the learner pyramid, an additional level was added for those who have specialized in geriatrics looking for further self-development entitled ‘Beyond BCGP’. Additionally, the PGY2 section was expanded to include recommendations for geriatrics content to be included in non-Geriatrics specialty residencies.

The resources section has expanded with materials published since the last revision as well as the addition of deprescribing and pharmacogenomic references.

In addition to the revision committee below, the authors wish to acknowledge the peer reviewers who volunteered their time reviewing the guide who belong to the ASCP Education Advisory Council.

REVISION COMMITTEE CHAIR Erica Estus, PharmD, BCGP Rebecca J Mahan, PharmD, BCGP, BCACP Clinical Professor, Pharmacy Practice Assistant Professor of Pharmacy Practice- Geriatrics University of Rhode Island College of Pharmacy Texas Tech University Health Sciences Center Jerry H. Kingston, Rhode Island Hodge School of Pharmacy Abilene, Texas Hanh Kimberly Nguyen, PharmD Geriatric Pharmacotherapy Resident Amie Taggart Blaszczyk, PharmD, BCGP, BCPS, FASCP Texas Tech University Health Sciences Center Jerry H. Associate Professor and Division Head- Geriatrics and Hodge School of Pharmacy Pediatrics Dallas, Texas Texas Tech University Health Sciences Center Jerry H. Hodge School of Pharmacy Kristina M. Niehoff, PharmD, BCGP, FASCP Dallas, Texas Clinical Pharmacist, Home Care Vanderbilt University Medical Center Suzanne Dinsmore, PharmD, BSP, BCGP Nashville, Tennessee Associate Professor of Pharmacy Practice Massachusetts College of Pharmacy and Health Stephanie Sibicky, PharmD, MEd, BCGP, BCPS, FASCP Sciences Associate Clinical Professor Boston, Massachusetts Northeastern University School of Pharmacy Boston, Massachusetts Ruth Emptage, PharmD, BCGP Assistant Professor- Practice, Division of Pharmacy Chanel F. Whittaker, PharmD, BCGP, FASCP Education and Innovation Associate Professor of Geriatric Pharmacotherapy The Ohio State University College of Pharmacy University of Maryland School of Pharmacy Columbus, Ohio Baltimore, Maryland

PEER REVIEWERS Dawn Gerber, PharmD, BCGP, FASCP Laura Finn, BCGP, FASCP

Donna Lisi, PharmD, BCPS, BCPP Kacey Carroll, PharmD, BCACP, BCGP

Amber Hutchison, PharmD, BCPS, BCGP Danielle Backus, PharmD, BCGP

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GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION 3 GERIATRIC PHARMACY CURRICULUM GUIDE- FOURTH EDITION

I. FOUNDATIONAL PRINCIPLES OF AGING Competency Associated ACPE Outcome A. Demographics 1. Define the demographic, economicand medical characteristics of 2.4, 3.5 olderadults (e.g., gender, ethnicity,geographic, socioeconomic, multi- morbidity, disability, and medication usepatterns). 2. Recognize the heterogeneity of theolder adult population. 2.4 B. Biology of Aging 1. Recognize the spectrum of aging fromhealthy aging to frailty. 2.4 2. Describe the biology of aging anddiscuss common theories of 1.1 aging. 3. Discuss the physiologic changes andhow they impact the 1.1 pharmacokinetic,pharmacodynamic and therapeutic useof medications. 4. Educate an individual on factors toconsider when evaluating an 2.3, 3.2 interventionto slow the aging process. C. Socioeconomics of Aging Social Determinants of Health 1. Describe the interrelationship between social determinants of 2.3, 3.5 health and aging (e.g., family, cultural, community, housing, access to care, policy issues). 2. Recognize signs of substance andmedication misuse/abuse in 2.3 older adults. 3. Identify and manage the social issuesof medication use for an 2.3 older adult’stherapy. 4. Describe the interrelationship between an older adult and their 2.3 formal and informal care givers. 5. Recognize available resources and develop strategies to support 2.3 older adults and care givers. Ethics 6. Recognize ethical dilemmas through asystematic decision-making 4.4 processbased on clearly articulated ethicaltheories and principles (e.g., self-determination, autonomy, justice in thedistribution of resources). 7. Promote person-centered decisionmaking and care. 2.4, 3.3, 3.4 8. Describe advanced directives, livingwills and the role of a power 3.3 of attorney. Elder Abuse 9. Define elder abuse/neglect (e.g.,physical, psychological, and 2.3 financial). 10. Recognize and report the signs ofelder abuse/neglect. 2.3, 3.3 Economic Issues 11. Describe the options for coverageand benefits older adults may 3.3 utilize(e.g. Medicare, Medicaid andsupplemental coverage). 12. Consider financial/reimbursementissues (e.g., formularies, 2.3, 3.3 insurancecoverage) when making therapeuticrecommendations.

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4 GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION Cultural Competency 13. Value and appreciate ethnic, racial andcultural differences in the 2.3, 2.4, 3.5, older adult population. 4.4 14. Recognize differences in healthcarebeliefs which may exist 2.3, 3.5, 4.1 between patientsand healthcare professionals. 15. Demonstrate the ability to assesspersonal misconceptions, 3.1, 3.5, 4.1, generalities andstereotypes which may impact the care of an 4.4 ethnically, racially and culturallydiverse patient population. 16. Discuss the concept of ageism andhow it may impact the 2.3, 3.5 treatment of patients. D. Communication 1. Communicate drug and adherenceinformation to older adults, 2.1, 3.2, 3.4, their caregivers and the interprofessional team. 3.6 2. Recognize the prevalence of limitedhealth literacy in the older 2.3, 2.4, 3.1, adultpopulation. 3.5 3. Demonstrate proficiency to interviewand counsel older adults 2.1, 3.2, 3.5, with varyingdegrees of health literacy as wellas cognitive and 3.6 communicationabilities. 4. Recognize barriers to effectivecommunication (e.g., cognitive, 3.1, 3.2, 3.5, sensory,cultural, and language). 4.1 E. Continuum of Care 1. Define the continuum of care availableto older adults such as 2.2 communityresources, home care, formal andinformal caregiverships, assisted livingfacilities, nursing facilities, sub-acutecare facilities, hospice care, andhospitals. 2. Participate in interprofessionaldecision making 2.3, 3.4, 4.2 regardingappropriate levels of care for individualpatients. 3. Facilitate medication reconciliation toimprove transitions across 2.2 the continuumof care. 4. Discuss the philosophy and practiceof hospice/palliative care. 2.4 5. Incorporate life expectancy and end-of-life issues in the decision- 2.4 making ofappropriate use of medications. F. Wellness & Health- 1. Describe and advocate health care initiatives related to wellness 2.3, 3.2, 3.3 Promotion and health promotion (e.g., nutrition, physical activity, medication adherence, immunizations, and health screenings). 2. Counsel an older adult on the utility ofhealth screenings and 2.3, 3.2, 3.6 preventivemeasures. 3. Conduct a comprehensive medicationreview to minimize the 2.1, 2.3, 3.6 impact of drug-related falls. II.ESSENTIAL COMPETENCIES FOR THE PRACTICE OF GERIATRIC CARE A. Epidemiology Describe incidence and prevalence of diseases in the older adult 2.4 population. B. Pathophysiology 1. Recognize the atypical clinicalpresentation and progression 2.1 ofcommon diseases found in older adults. 2. Identify symptoms of drug-induceddiseases and geriatric 2.1 syndromes.

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GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION 5 C. Geriatric Assessment 1. Identify basic cognitive, functional,physical and safety 2.1 assessments forcommon diseases in the older adultpopulation. 2. Demonstrate the ability to conduct basiccognitive, functional, 2.1, 3.6 physical and safetyassessments for common diseases in theolder adult population. 3. Assess social and cultural determinants of health outcomes. 2.3, 3.5 4. Apply knowledge of geriatric syndromesand medication-related 2.1 problemswhen interpreting assessment results. 5. Obtain and interpret a comprehensive medication history in 2.1, 3.6 relation to patient’scurrent health status. 6. Assess a medication regimen for medication-related problems 2.1, 3.1 (e.g., polypharmacy, non-adherence, drug interactions, adverse drug event, underuse, potentially inappropriate prescribing). 7. Appropriately recommend laboratory monitoring and interpret 2.1 laboratory results for an older adult patient. 8. Identify and recognize potential functional barriers to the older 3.1 adultpatient (e.g., transportation, housing, economics, and social support structure). 9. Identify potential environmental causesof decline in activities of 3.1 daily living (ADL),instrumental activities of daily living (IADL), and cognitive function. 10. Develop a problem list and prioritize care based upon severity of 2.1 illness, patient preference, quality of life, and time to benefit. 11. Identify patients who need referrals toother health and non- 3.3, 3.4 health professionalsor services. 12. Identify when appropriate to recommend deprescribing in an 2.1, 3.1, 3.3 older adult. D. Treatment 1. Define therapeutic goals incorporating patient-specific principles 2.1 (e.g., age,functionality, patient preference, pharmacogenomics, cultural). 2. Evaluate the appropriateness of standards of practice or 1.1 treatment guidelines for an older adult patient. 3. Determine therapeutic options and therisk/benefit to the 2.1 patient (e.g., notreatment, non-pharmacologic interventions, non- prescriptionmedications, complementary and alternative medicine, and prescription medications). 4. Apply principles of pharmacokinetic and pharmacodynamic 1.1, 2.1 changes associated with aging to the design of the pharmacotherapy regimen. 5. Design and recommend age/person specific regimen including 2.1 medication, dose, dosage form, dosing interval, and route of administration. 6. Resolve and/or prevent medication-related problems in a given 2.1 older adult patient. 7. Optimize a medication regimen to minimize polypharmacy, 3.1 prescribing cascades, and anticholinergic burden. E. Monitoring 1. Develop and implement an olderperson-specific monitoring plan. 2.1, 3.1 2. Revise therapeutic plans based uponchanges in patient status. 2.1, 3.1

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6 GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION F. Education 1. Utilize educational material appropriateto the specific patient/care 3.2 giver. 2. Ensure understanding of medication useand its role in the overall 3.2, 3.5, 3.6 treatment plan. 3. Educate patient/care giver regardingpotential problems with 3.2, 3.6 patient caremanagement and administration of medications. 4. Assist the patient/care giver in identifying,procuring, and utilizing 3.2, 3.3 adherencestrategies and devices. 5. Educate interprofessional team members regarding geriatric- 3.2, 3.4, 3.6 specificpharmacotherapy principles. G. Document Actions 1. Document rationale, actions, andoutcomes from medication 2.1, 3.6 and Outcomes therapies for the healthcare team. 2. Write an action plan for use by the patient/care giver. 2.1 3. Perform and document comprehensive medication reconciliation 2.2, 3.6 across the continuum of care. 4. Acknowledge different systems for documentation and tracking 2.2, 3.6 of intervention data which can generate evidence of care. III. APPROACH TO PRACTICE & CARE OF OLDER ADULTS A. Evidence-Based Practice 1. Identify reputable sources of information for the care of an older 1.1 & Practice Evaluation adultpatient. 2. Evaluate medication utilization at thesystem level to ensure safe 2.2 and effectivedrug therapy. 3. Utilize a documentation system to evaluate outcomes of 2.2, 3.6 pharmacist intervention. 4. Evaluate and apply evidence from primary literature as it pertains 1.1, 2.1 to the care of older adult patients. 5. Evaluate the relevancy of clinicalpractice guidelines, standards of 1.1, 2.4 care and quality measures related to geriatric care. B. Practice Opportunities 1. Identify existing and emerging modelsof practice in geriatric care. 4.3 2. Recognize emerging opportunities for geriatric practice. 3.4, 4.3 3. Understand the roles and responsibilities of the pharmacist and 2.3, 3.4, 4.2 other health-care professionals within the interprofessional team. 4. Discuss board certifications available for pharmacists providing 4.4 geriatric care (e.g., BCGP, CDE, other advanced training). C. Regulatory 1. Identify agencies and organizations integral in the development 4.3 and enforcement of geriatric public policy. 2. Identify and adhere to site-specific regulations for geriatric care. 4.4 3. Develop strategies for keeping upto date on regulatory changes 4.1 and their impact on geriatric care. 4. Promote advocacy for geriatric patientcare and the pharmacy 3.3, 4.3 profession. 5. Demonstrate decision making skillswhen implementing care for 3.4, 4.2 older adults to improve outcomes and quality measures. D. Financial Factors 1. Develop, implement and assess formulary management/protocols 2.4 as they pertain to the care of the older adult. 2. Demonstrate knowledge of sources and processes of 4.3 compensation for geriatric pharmacy services.

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GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION 7 GERIATRIC CURRICULUM GUIDE TOOLKIT

Learner in Geriatrics Pyramid

Specialized Training Beyond BCGP

Professional Development

Advanced Training PGY-1 PGY-2 BCGP

Experiential IPPE APPE Curriculum

for PharmD

Didactic General Topics Elective Topics

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8 GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION LEARNER IN GERIATRICS: DIDACTIC

GENERAL TOPICS Topics and Disease states covered in this section should be covered either as stand-alone lectures or emphasized within a larger topic as best fits the model of a pharmacy program.

ELECTIVE TOPICS The aim of this section is to suggest topics/disease states in an elective course which focuses on care for older adults by going beyond what is discussed in the general curriculum.

GENERAL TOPICS (*=STAND-ALONE LECTURE) • Introduction to Geriatrics and Geriatric Syndromes o *Introduction to Geriatrics (epidemiology, biology of aging, pharmacokinetics, pharmacodynamics, elder abuse) o *Introduction to Geriatric Syndromes (falls/gait problems, weakness/frailty, dizziness/syncope, functional/cognitive decline, sensory deficit, appetite/weight loss/malnutrition/dysphagia, medication- induced disease, polypharmacy) o Explicit Criteria for Prescribing (Beers Criteria, START/STOPP) • Cardiology (ACS, arrhythmias, cardiomyopathy, CAD, CHF, hyperlipidemia, hypertension, PAD) o CVA (accurate history needed including medications) o Hyperlipidemia (new guidelines do not include aged >75, statin benefits vs risk) o Hypertension (relaxed BP goal, hypotension) • Dermatology (psoriasis, other common skin disorders) • *Head, Eyes, Ears, Nose, and Throat (glaucoma, Macular degeneration, hearing loss, dysphagia) • Endocrine (adrenal disorders, diabetes mellitus, disorders of hypothalamus, sexual/erectile dysfunction, hormone therapy, thyroid disease) o Diabetes (relaxed A1c goal, hypoglycemia) o Thyroid disease (Sub-clinical hyper/hypothyroidism) • Gastrointestinal Disorders o *Bowel-related Issues (constipation, diarrhea, fecal incontinence) o (diverticular disease, GERD/PUD, non-hepatitis hepatic disorders, inflammatory bowel disease, irritable bowel disease, nausea/vomiting, pancreatitis) • Hematology/Oncology (anemia, disorders of hemostasis/platelets/WBC, cancers) • Infectious Disease (HIV/AIDS, bone/joint infection, endocarditis, genitourinary, GI infection, herpes zoster, hepatitis, influenza, meningitis, nosocomial infections, ophthalmic infection, pneumonia, STIs, skin/soft tissue infection, tuberculosis, respiratory infections) o STIs (common in older adults  unprotected sex) • Musculoskeletal and Inflammatory Disorders o *Osteoarthritis o *Osteoporosis (Paget’s Disease, Vitamin D/PTH disorders) o (gout/hyperuricemia, rheumatoid arthritis, systemic inflammatory disease) • Neurology o *Dementia (Alzheimer’s disease, vascular-dementia, Lewy Body dementia, other) . Dementia (Cognitive function tests, cognitive impairment) o *Parkinson’s disease / Movement Disorders o (pain, CVA/TIA, headache/migraine, MS, neuropathies, seizures, traumatic brain injury, fluid/electrolytes) • Nephrology o *Chronic Kidney Disease / End-Stage Renal Disease o (acid-base disorders, acute renal failure) • Psychiatry o *Delirium o (anxiety, bipolar, depression, schizophrenia, sleep disorders, substance abuse/misuse) . Depression (slower onset of action of SSRIs, geriatric depression scale) • Respiratory (Asthma, COPD, cough/cold/allergy) • *Urology (bladder outlet obstruction, urinary incontinence) • Non-Therapeutic Issues (ethics, economics/insurance/Medicare, cultural competencies, continuum of care, wellness/health promotion, health literacy) Return to Table of Contents GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION 9 ELECTIVE TOPICS Topics (Lecture) • Advanced Geriatric Syndromes (falls/gait problems, weakness/frailty, dizziness/syncope, functional/ cognitive decline, sensory deficit, appetite/weight loss/malnutrition/dysphagia, medication-induced disease, polypharmacy) • Cardiology (Atrial fibrillation, CAD, CHF, isolated systolic hypertension/diastolic dysfunction, hyperlipidemia, HTN, thromboembolic disorder) • Dermatology (pressure ulcers) • Endocrine (diabetes, hyponatremia, menopause/andropause) • Gastrointestinal (Diverticular disease, GERD/PUD, IBS, pancreatitis, N/V, alternative feeding modalities [nasogastric, PEG tubes]) • Head, Eyes, Ears, Nose, and Throat (hearing loss and aids; cataracts, dry eyes, macular degeneration, eye inflammation/surgical medications) • Hematologic (anemias) • Infectious Disease ( Endocarditis, genitourinary, GI infection, hepatitis, herpes zoster, influenza, pneumonia, skin/soft tissue infection, URI) • Musculoskeletal and Inflammatory Disorders (pain, palliative care) • Neurology (dementias, CVA/TIA, Parkinson’s/Movement disorders, neuropathies, seizures) • Psychiatry (anxiety, depression, sleep disorders, substance abuse/misuse, delirium, agitation/behavior and psychological issues in dementia) • Respiratory (asthma, COPD, cough/cold/allergy) • Non-Therapeutic Issues (advance directives, consulting/regulations, durable medical equipment, elder abuse, ethics, economic issues/insurance/Medicare, cultural competencies, communication, health literacy, continuum/ transitions of care, options of care/dwelling, wellness/health promotion, end of life/hospice, medication adherence, interprofessional team roles and responsibilities, aging research)

Practice Opportunities

• See IPPE

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10 GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION LEARNER IN GERIATRICS: EXPERIENTIAL

Introductory Pharmacy Practice Experience (IPPE) For the purposes of this document, the aim for the learner in geriatrics in IPPE is to understand differences in older adults compared to younger adults, understand issues with communication, and empathy towards their care.

Advanced Pharmacy Practice Experience (APPE) For the purposes of this document, the aim for the learner in geriatrics in APPE is to understand and apply pharmacodynamics/kinetics to an older adult population, monitor outcomes appropriately, and recommend appropriate treatment for older adults. INTRODUCTION TO PHARMACY PRACTICE EXPERIENCE (IPPE)

SITE DISCUSSION ACTIVITIES Topic Discussions • Geriatrics Topics (how older adults are different, communication with older adults) • Medicare Part D (medications in older adults, overview of MTM, differentiate Medicare A,B, C, D) PRACTICE OPPORTUNITIES • The Geriatric Medication Game (see the game by St. Louis College of Pharmacy) • Generation Rx (see the Senior Toolkit at the far right bottom marked “Seniors”) • STAMP Out Prescription Drug Misuse & Abuse (From ASCP) • Adopt-a-Patient Project (Semester long project where students “adopt” a real patient and work with him/her to make recommendations relating to medications and overall health) • Reviewing Medicare Part D Education (Explain Part D plans for beneficiaries, perform MTM) • Vial of Life (Bring the Vial of Life into Your Home) • IPPE SOAR (Student and Older Adult Relationship Project, University of Arizona College of Pharmacy) • Helpwithmymeds.org (Consumer website through ASCP Foundation to help seniors manage their medications and educate about senior care pharmacists. There are various resources too) • Computer skills for patients (Ensure patients are comfortable with technology to access necessary telehealth platforms)

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GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION 11 ADVANCED PHARMACY PRACTICE EXPERIENCE (APPE)

GERIATRICS ROTATION Site Discussion Activities Topic Discussions • Introduction to Geriatrics and Geriatric Syndromes o Introduction to Geriatrics (epidemiology, biology of aging, pharmacokinetics, pharmacodynamics, elder abuse) o Introduction to Geriatric Syndrome (falls/gait problems, weakness/frailty, dizziness/syncope, functional/ cognitive decline, sensory deficit, appetite/weight loss/malnutrition/dysphagia, medication-induced disease, polypharmacy) o Explicit Criteria for Prescribing (Beer’s Criteria, START/STOPP) • Cardiology o CVA (accurate history needed including medications) o Hyperlipidemia (new guidelines do not include aged >75, statin benefit vs. risks) o Hypertension (relaxed BP goal, hypotension) • Head, Eyes, Ears, Nose, and Throat (glaucoma, Macular degeneration) • Endocrine o Diabetes (relaxed A1c goal, hypoglycemia) o Thyroid disease (Sub-clinical hyper/hypothyroidism) • Gastrointestinal Disorders (constipation, diarrhea, fecal incontinence) • Infectious Disease o STIs (common in older adults  unprotected sex) • Musculoskeletal and Inflammatory Disorders o Osteoarthritis o Osteoporosis (Paget’s Disease, Vitamin D/PTH disorders) • Neurology o Dementia (Alzheimer’s disease, vascular-dementia, Lewy Body dementia, other; cognitive function tests, cognitive impairment) o Parkinson’s disease / Movement Disorders • Nephrology o Chronic Kidney Disease / End-Stage Renal Disease • Psychiatric Disorders o Delirium o Depression (slower onset of action of SSRIs and higher incidence of uncommon adverse effects, geriatric depression scale) • Urology (bladder outlet obstruction, urinary incontinence) Practice Opportunities Practice Opportunities • Journal Club & Older Adult Education on Outcomes (converting Journal Club to Layperson terms) • Comprehensive MTM • Verbal Geriatric Assessment (Pain scale, Geriatric Depression Scale, Memory Scales) • Physical Geriatric Assessment (Inhaler technique, glucometer) • Outreach (Brown Bag assessment, Fall-Risk/FRAX Assessment) • SOAP/Progress notes/Documentation • In-services to Providers/Staff • Interprofessional Participation (Medication safety meeting, interdisciplinary rounds, P&T meetings, care plan meetings, falls meetings) • Transitions of Care (medication reconciliation, admission/discharge counseling) • EMR education - site specific as needed, to ensure patients are comfortable accessing their medical information

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12 GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION NON-GERIATRICS SPECIFIC ROTATION Site Discussion Activities Topic Discussions • Cardiology (ACS, arrhythmias, cardiomyopathy, CAD, CHF, hyperlipidemia, hypertension, PAD) • Dermatology (psoriasis, other common skin disorders) • Endocrine (adrenal disorders, diabetes mellitus, disorders of hypothalamus, sexual/erectile dysfunction, hormone therapy, thyroid disease) • Gastrointestinal Disorders (diverticular disease, GERD/PUD, non-hepatitis hepatic disorders, inflammatory bowel disease, irritable bowel disease, nausea/vomiting, pancreatitis, alternative feeding modalities [nasogastic tubes, PEG tubes]) • Hematology/Oncology (anemia, disorders of hemostasis/platelets/WBC, cancers) • Infectious Disease (HIV/AIDS, bone/joint infection, endocarditis, genitourinary, GI infection, herpes zoster, hepatitis, influenza, meningitis, nosocomial infections, ophthalmic infection, pneumonia, STIs, skin/soft tissue infection, tuberculosis, respiratory infections) • Musculoskeletal and Inflammatory Disorders (gout/hyperuricemia, rheumatoid arthritis, systemic inflammatory disease) • Neurology (pain, CVA/TIA, headache/migraine, MS, neuropathies, seizures, traumatic brain injury, fluid/ electrolytes) • Nephrology (acid-base disorders, acute renal failure) • Psychiatric Disorders (anxiety, bipolar, depression, schizophrenia, sleep disorders, substance abuse/misuse, PTSD) • Respiratory (Asthma, COPD, cough/cold/allergy) • Non-Therapeutic Issues (ethics, economics/insurance/Medicare, cultural competencies, continuum of care, wellness/health promotion, health literacy, adherence, interprofessional team) Practice Opportunities • Journal Club (on geriatric topic, medication, or population) • SOAP/Progress notes/Documentation • In-services to Providers/Staff • Interprofessional Participation (Med safety meeting, interdisciplinary rounds, P&T meetings) • Transitions of Care (medication reconciliation, admission/discharge counseling)

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GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION 13 LEARNER IN GERIATRICS: ADVANCED TRAINING

POST-GRADUATE YEAR – 1 The aims for the PGY-1 learner in geriatrics are to understand and apply pharmacodynamics/kinetics to an older adult population, monitor outcomes appropriately, and recommend appropriate treatment for older adults.

POST-GRADUATE YEAR – 2 (GERIATRICS) The aims for the PGY-2 learner in geriatrics are to understand, apply, and teach/educate (students/patients/ caregivers) pharmacodynamics/kinetics of an older adult population, monitor outcomes appropriately, and recommend appropriate treatment for older adults.

POST-GRADUATE YEAR- 2 (NON-GERIATRICS) The aims for the PGY-2 learner are to understand, apply, and teach/educate (students/patients/caregivers) on geriatric principles or concepts core to their specialty.

BOARD CERTIFIED GERIATRIC SPECIALIST (BCGP) The aims for the Advance Training towards BCGP learner in geriatrics are to understand, apply, and teach/educate (patients/caregivers) pharmacodynamics/kinetics of an older adult population, monitor outcomes appropriately, and recommend appropriate treatment for older adults.

ADVANCED TRAINING FOR THE CLINICAL SPECIALIST The aims for the advanced training for the clinical specialist is to provide opportunities beyond geriatric board certification for professional enhancement.

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14 GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION POST-GRADUATE YEAR – 1

GERIATRICS ROTATION Site Discussion Activities Topic Discussions • Introduction to Geriatrics and Geriatric Syndromes o Introduction to Geriatrics (epidemiology, biology of aging, pharmacokinetics, pharmacodynamics, elder abuse) o Introduction to Geriatric Syndromes (falls/gait problems, weakness/frailty, dizziness/syncope, functional/ cognitive decline, sensory deficit, appetite/weight loss/malnutrition/dysphagia, medication-induced disease, polypharmacy) o Explicit Criteria for Prescribing (Beers Criteria, START/STOPP) • Cardiology (ACS, arrhythmias, cardiomyopathy, CAD, CHF, hyperlipidemia, hypertension, PAD) o CVA (accurate history needed including medications) o Hyperlipidemia (new guidelines do not include aged >75, statin benefits vs risk) o Hypertension (relaxed BP goal, hypotension) • Dermatology (psoriasis, other common skin disorders) • Head, Eyes, Ears, Nose, and Throat (glaucoma, Macular degeneration, hearing loss, dysphagia) • Endocrine (adrenal disorders, diabetes mellitus, disorders of hypothalamus, sexual/erectile dysfunction, hormone therapy, thyroid disease) o Diabetes (relaxed A1c goal, hypoglycemia) o Thyroid disease (Sub-clinical hyper/hypothyroidism) • Gastrointestinal Disorders o Bowel-related Issues (constipation, diarrhea, fecal incontinence) o (diverticular disease, GERD/PUD, non-hepatitis hepatic disorders, inflammatory bowel disease, irritable bowel disease, nausea/vomiting, pancreatitis) • Hematology/Oncology (anemia, disorders of hemostasis/platelets/WBC, cancers) • Infectious Disease (HIV/AIDS, bone/joint infection, endocarditis, genitourinary, GI infection, herpes zoster, hepatitis, influenza, meningitis, nosocomial infections, ophthalmic infection, pneumonia, STIs, skin/soft tissue infection, tuberculosis, respiratory infections) o STIs (common in older adults  unprotected sex) • Musculoskeletal and Inflammatory Disorders o Osteoarthritis o Osteoporosis (Paget’s Disease, Vitamin D/PTH disorders) o (gout/hyperuricemia, rheumatoid arthritis, systemic inflammatory disease) • Neurology o Dementia (Alzheimer’s disease, vascular-dementia, Lewy Body dementia, other) . Dementia (Cognitive function tests, cognitive impairment) o Parkinson’s disease / Movement Disorders o (pain, CVA/TIA, headache/migraine, MS, neuropathies, seizures, traumatic brain injury, fluid/electrolytes) • Nephrology o Chronic Kidney Disease / End-Stage Renal Disease o (acid-base disorders, acute renal failure) • Psychiatry o Delirium (anxiety, bipolar, depression, schizophrenia, sleep disorders, substance abuse/misuse) o Depression (slower onset of action of SSRIs and higher incidence of uncommon adverse effects, geriatric depression scale) • Respiratory (Asthma, COPD, cough/cold/allergy) • Urology (bladder outlet obstruction, urinary incontinence)

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GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION 15 Practice Opportunities • Journal Club & Older Adult Education on Outcomes (converting Journal Club to Layperson terms) • Comprehensive MTM • Verbal Geriatric Assessment (Pain scale, Geriatric Depression Scale, Memory Scales) • Physical Geriatric Assessment (Inhaler technique, glucometer) • Outreach (Brown Bag assessment, Fall-Risk/FRAX Assessment) • SOAP/Progress notes/Documentation • In-services to Providers/Staff • Interprofessional Participation (Medication safety meeting, interdisciplinary rounds, P&T meetings, care plan meetings, falls meetings) • Transitions of Care (medication reconciliation, admission/discharge counseling) • Complete geriatric related Medication/Drug Utilization Evaluation • Attend a local, regional, or national meeting focused in geriatrics • Participate in networking opportunities with experts in geriatrics

NON-GERIATRICS SPECIFIC ROTATION Site Discussion Activities Topic Discussions • Cardiology (ACS, arrhythmias, cardiomyopathy, CAD, CHF, hyperlipidemia, hypertension, PAD) • Dermatology (psoriasis, other common skin disorders) • Endocrine (adrenal disorders, diabetes mellitus, disorders of hypothalamus, sexual/erectile dysfunction, hormone therapy, thyroid disease) • Gastrointestinal Disorders (diverticular disease, GERD/PUD, non-hepatitis hepatic disorders, inflammatory bowel disease, irritable bowel disease, nausea/vomiting, pancreatitis, alternative feeding modalities [nasogastic tubes, PEG tubes]) • Hematology/Oncology (anemia, disorders of hemostasis/platelets/WBC, cancers) • Infectious Disease (HIV/AIDS, bone/joint infection, endocarditis, genitourinary, GI infection, herpes zoster, hepatitis, influenza, meningitis, nosocomial infections, ophthalmic infection, pneumonia, STIs, skin/soft tissue infection, tuberculosis, respiratory infections) • Musculoskeletal and Inflammatory Disorders (gout/hyperuricemia, rheumatoid arthritis, systemic inflammatory disease) • Neurology (pain, CVA/TIA, headache/migraine, MS, neuropathies, seizures, traumatic brain injury, fluid/ electrolytes) • Nephrology (acid-base disorders, acute renal failure) • Psychiatric Disorders (anxiety, bipolar, depression, schizophrenia, sleep disorders, substance abuse/misuse, PTSD) • Respiratory (Asthma, COPD, cough/cold/allergy) • Non-Therapeutic Issues (ethics, economics/insurance/Medicare, cultural competencies, continuum of care, wellness/health promotion, health literacy, adherence, interprofessional team) Practice Opportunities • Journal Club (on geriatric topic, medication, or population) • SOAP/Progress notes/Documentation • In-services to Providers/Staff • Interprofessional Participation (Med safety meeting, interdisciplinary rounds, P&T meetings) • Transitions of Care (medication reconciliation, admission/discharge counseling)

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16 GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION POST-GRADUATE YEAR – 2 GERIATRICS

GERIATRIC PHARMACOTHERAPY RESIDENCY The resident should be able to facilitate the following activities: • Introduction to Geriatrics and Geriatric Syndromes o Introduction to Geriatrics (epidemiology, biology of aging, pharmacokinetics, pharmacodynamics, elder abuse) o Introduction to Geriatric Syndromes (falls/gait problems, weakness/frailty, dizziness/syncope, functional/ cognitive decline, sensory deficit, appetite/weight loss/malnutrition/dysphagia, medication-induced disease, polypharmacy) o Explicit Criteria for Prescribing (Beers Criteria, START/STOPP) • Cardiology (ACS, arrhythmias, cardiomyopathy, CAD, CHF, hyperlipidemia, hypertension, PAD) o CVA (accurate history needed including medications) o Hyperlipidemia (new guidelines do not include aged >75, statin benefits vs risk) o Hypertension (relaxed BP goal, hypotension) • Dermatology (psoriasis, other common skin disorders) • Head, Eyes, Ears, Nose, and Throat (glaucoma, Macular degeneration, hearing loss, dysphagia) • Endocrine (adrenal disorders, diabetes mellitus, disorders of hypothalamus, sexual/erectile dysfunction, hormone therapy, thyroid disease) o Diabetes (relaxed A1c goal, hypoglycemia) o Thyroid disease (Sub-clinical hyper/hypothyroidism) • Gastrointestinal Disorders o Bowel-related Issues (constipation, diarrhea, fecal incontinence) o (diverticular disease, GERD/PUD, non-hepatitis hepatic disorders, inflammatory bowel disease, irritable bowel disease, nausea/vomiting, pancreatitis) • Hematology/Oncology (anemia, disorders of hemostasis/platelets/WBC, cancers) • Infectious Disease (HIV/AIDS, bone/joint infection, endocarditis, genitourinary, GI infection, herpes zoster, hepatitis, influenza, meningitis, nosocomial infections, ophthalmic infection, pneumonia, STIs, skin/soft tissue infection, tuberculosis, respiratory infections) o STIs (common in older adults  unprotected sex) • Musculoskeletal and Inflammatory Disorders o Osteoarthritis o Osteoporosis (Paget’s Disease, Vitamin D/PTH disorders) o (gout/hyperuricemia, rheumatoid arthritis, systemic inflammatory disease) • Neurology o Dementia (Alzheimer’s disease, vascular-dementia, Lewy Body dementia, other) . Dementia (Cognitive function tests, cognitive impairment) o Parkinson’s disease / Movement Disorders o (pain, CVA/TIA, headache/migraine, MS, neuropathies, seizures, traumatic brain injury, fluid/electrolytes) • Nephrology o Chronic Kidney Disease / End-Stage Renal Disease o (acid-base disorders, acute renal failure) • Psychiatry o Delirium o (anxiety, bipolar, depression, schizophrenia, sleep disorders, substance abuse/misuse) o Depression (slower onset of action of SSRIs and higher incidence of uncommon adverse effects, geriatric depression scale) • Respiratory (Asthma, COPD, cough/cold/allergy) • Urology (bladder outlet obstruction, urinary incontinence)

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GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION 17 Practice Opportunities • Journal Club & Older Adult Education on Outcomes (converting journal club to layperson terms) • Comprehensive MTM • Verbal Geriatric Assessment (pain scale, Geriatric Depression Scale, memory scales) • Physical Geriatric Assessment (Inhaler technique, glucometer) • Outreach (Brown Bag assessment, Fall-Risk, Assessment) • SOAP/Progress notes/Documentation • In-services to Providers/Staff • Interprofessional Participation (medication safety meetings, interdisciplinary rounds, P&T meetings) • Transitions of Care (medication reconciliation, admission/discharge counseling) • Complete geriatric related research project/MUE/DUE and manuscript for publication • Attend national pharmacy and geriatric meetings (American Society of Consultant Pharmacists [ASCP], American Geriatrics Society [AGS], American • Society of Health-System Pharmacists [ASHP], American Association of Colleges of Pharmacy, Gerontological Society of America [GSA]) • Visit pharmacy organization headquarters (ASCP) • Become an active member in state and national pharmacy committees and/or geriatric societies • Network/Collaborate with experts in geriatrics • Teach at local pharmacy school (lectures, small group discussion, seminar, labs) ASHP’s Educational Outcomes, Goals, and Objectives in PGY-2 Geriatrics Residency • Serve as an authoritative resource on the optimal use of medications used with geriatric patients • Optimize the continuum-of-care of geriatric patients; recognizing diseases, disorders, syndromes, and psychosocial needs unique to this population; by providing evidence-based, patient-centered therapy as an integral part of an interdisciplinary team. • Manage and improve medication-use systems across the continuum of care for geriatric patients • Demonstrate leadership and practice management skills • Demonstrate excellence in the provision of training and educational activities for health care professionals, health care professionals in training, and the public • Contribute to the body of geriatric pharmacotherapy knowledge

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18 GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION POST-GRADUATE YEAR-2 NON GERIATRICS SPECIALTIES ASHP PGY2 Competency Areas SPECIALTY TOPIC DISCUSSIONS PRACTICE OPPORTUNITIES Ambulatory Care Geriatric Communication/ Sensory Loss Elective rotations in the Cardiac and Endocrine Goal adjustment following: Assisted Living OTC geriatric considerations Facilities, Retirement ADL/iADLs and quality of life goals Communities, Adult Day Medicare- Part B and D Cares, PACE Facilities Medication adherence aids Cardiology Blood pressure goals in older adults Development of treatment Orthostatic Hypotension protocols for older adults ISH Statin risk vs benefit in patients >75 years old Futility of primary prevention Stroke aftercare Clinical Pharmacogenomics Geriatric Pharmacokinetic and Pharmacodynamic changes on genomic outcomes Critical Care Non-verbal pain assessment Delirium Out of hospital directives Emergency Medicine Transition to/from a nursing home or rehab facility GEMS Non-verbal pain assessment Prescribing Cascades Altered disease presentation in older adults Elder Abuse Health System Medicare Create or assess need for a Administration and Coordination of care with nursing homes, rehab geriatric service Leadership facilities, or home health agencies Role justification of a BCGP Adherence packaging Infectious Disease STIs in older adults Atypical infectious presentation of older adults Herpes zoster Informatics Shared medication information systems with Integration of anticholinergic common older adult systems scores in Clinical Decision Long term care systems Support (CDS) Nursing home automation Development of tools to Adherence automation identify prescribing cascades Internal Medicine Relaxed goals/targets in older adults Provide education to a stroke Prevention of delirium support group or other Anticholinergic burden geriatric prevalent disease Non-verbal pain assessment Functional Incontinence Dose de-escalation Anticholinergic burden assessment Investigational Drugs and Advocate for older adult involvement in clinical Research trials Advocate for nursing home patients to be in clinical trials Medication- Use Safety and Prescribing cascades Create or assess need for a Policy Coordination of care with nursing homes, rehab geriatric service facilities, or home health agencies Role justification of a BCGP Anticholinergic assessment Neurology End of Life care Geriatric Depression

Return to Table of Contents GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION 19 Nutrition Support Dysphagia in dementia Strategic use of ‘sweet’ in older adults Oncology Routine screening appropriateness in older adults Pain Management and Scheduled therapy needs in dementia Palliative Care Elder abuse through pain medicine denial NSAID dangers in older adults Pharmacotherapy Relaxed goals/targets in older adults Provide education to a stroke Prevention of delirium support group or other Anticholinergic burden geriatric prevalent disease Non-verbal pain assessment Functional Incontinence Dose de-escalation Anticholinergic burden assessment Pharmacy Outcomes and Analytics in a nursing home Partnership with ASCP Healthcare Analytics Tools, guidelines or measures to maximize Long term care pharmacy appropriateness in older adults such as Beers PBMs criteria, fall risk assessment, anticholinergic assessment, and deprescribing Population Health Ageism Geriatric focused project Management and Data Tools, guidelines or measures to maximize Analytics appropriateness in older adults such as Beers criteria, fall risk assessment, anticholinergic assessment, and deprescribing Nursing home federal regulations Psychiatric Dementia related behaviors Geripsych units or clinics PK/PD impact on psychiatric medications Projects to improve antipsychotic utilization in older adults

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20 GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION BOARD CERTIFIED GERIATRIC PHARMACOTHERAPY SPECIALIST (BCGP)

GERIATRICS ROTATION Facilitate the following: Topic Discussions • Introduction to Geriatrics (epidemiology, biology of aging, pharmacokinetics, pharmacodynamics, elder abuse) • Introduction to Geriatric Syndrome (falls/gait, weakness/frailty, dizziness/syncope, functional/cognitive decline, sensory deficit, appetite/weight loss/malnutrition/dysphagia, medication-induced disease, polypharmacy) • Bowel-related Issues (constipation, diarrhea, fecal incontinence) • Chronic Kidney Disease / End-Stage Renal Disease • Delirium • Dementia (Alzheimer’s disease, vascular-dementia, Lewy Body dementia, other) • Ophthalmology (glaucoma/Macular degeneration) • Osteoarthritis • Osteoporosis (Paget’s Disease, Vitamin D/PTH disorders) • Parkinson’s disease / Movement Disorders • Urology (bladder outlet obstruction, urinary incontinence) Topic Discussions •Depression (slower onset of action of SSRIs, geriatric depression scale) • Diabetes (relaxed A1c goal, hypoglycemia) • CVA (accurate history needed included medications) • Hyperlipidemia (new guidelines do not include aged >75) • Hypertension (relaxed BP goal, hypotension) • STIs (common in older adults  unprotected sex) • Thyroid disease (Sub-clinical hyper/hypothyroidism) Practice Opportunities Practice Opportunities • Comprehensive MTM • Verbal Geriatric Assessment (Pain scale, Geriatric Depression Scale, Memory Scales) • Physical Geriatric Assessment (Inhaler technique, glucometer) • Outreach (Brown Bag assessment, Fall-Risk, Assessment) • In-services to Providers/Staff • Interprofessional Participation (Med safety meeting, interdisciplinary rounds, P&T meetings) • Transitions of Care (medication reconciliation, admission/discharge counseling) • Adherence (assessment, counseling, practice – Medication Planner Fill/Consumption using candy, http:// www.mymedschedule.com/) • Complete geriatric related research project/MUE/DUE and manuscript for publication • Attend national pharmacy and geriatric meetings (American Society of Consultant Pharmacists (ASCP), American Geriatric Society, American Society of Health-System Pharmacists (ASHP), American Association of Colleges of Pharmacy, Gerontological Society of America) • Become an active member in state and national pharmacy committees • Network/Collaborate with experts in geriatrics • Teach at local pharmacy school (lectures, small group discussion, seminar, labs)

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GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION 21 ADVANCED/SPECIALTY TRAINING FOR THE GERIATRIC SPECIALIST The advanced geriatric pharmacist may be interested in expanding their clinical expertise in focused areas through continuing education programs, additional certifications, leadership experiences, and additional training. Below is a not an all-inclusive list of programs but could be a starting point for continuing professional development.

ADDITIONAL BOARD CERTIFICATIONS THROUGH THE BOARD OF PHARMACY SPECIALTIES (BPS):

Based on data from BPS from 2016-2019, many BCGP have dual or triple certification in pharmacotherapy, ambulatory care, psychiatry, critical care, nutrition support, and oncology among others. Certificate programs: • Pharmacogenomics (ACCP, ASHP) • Medication reconciliation (ASHP) • Medication therapy management (APhA) • Medication safety (ASHP) • Nutrition support (ASHP) • Pharmacy informatics (ASHP) • Pain management (ASHP) • Diabetes management (ASHP) • Anticoagulation (ASHP) • Cardiovascular disease risk management (APhA) • Patient-centered diabetes care (APhA) • Health care fraud investigator (National Health Care Anti-Fraud Association) • Health data analyst (American Health Information Management Association) • American College of Sports Medicine • Specialty pharmaceuticals (SPCB, NASP) • Using Evidence to Advance your Practice (APhA) • Advanced Preceptor Training (APhA) • Advanced Clinical Pharmacy Practice (University of Arizona) • Antimicrobial stewardship, long-term care or acute care (SIDP)

BECOME A CERTIFIED EDUCATOR IN: • Pain (CPE) • Diabetes (CDE) • Anticoagulation specialist (CACP)

PROFESSIONAL DESIGNATIONS: • Fellowship (national and local organizations)

LEADERSHIP: • Leadership institute (APhA) • Tideswell-AGS-ADGAP Emerging Leaders in Aging (AGS)

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22 GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION ABBREVIATIONS A1C: Glycated Hemoglobin ACPE: Accreditation Council for Pharmacy Education ACS: Acute Coronary Syndrome ADL: Activities of Daily Living AIDS: Acquired Immunodeficiency Syndrome ALS: Amyotrophic Lateral Sclerosis APPE: Advanced Pharmacy Practice Experience ASCP: American Society of Consultant Pharmacists ASHP: American Society of Health-System Pharmacists BCACP: Board Certified Ambulatory Care Pharmacists BCPS: Board Certified Pharmacotherapy Specialist BP: Blood Pressure CAD: Coronary Artery Disease CAPE: Center for the Advancement of Pharmaceutical Education CDC: Centers for Disease Control and Prevention CGP: Certified Geriatric Pharmacist CHF: Congestive Heart Failure COPD: Chronic Obstructive Pulmonary Disease CVA: Cerebrovascular Accident DUE: Drug Use Evaluation FRAX: Fracture Risk Assessment Tool GERD: Gastroesophageal Reflux Disease GI: Gastrointestinal HEENT: Head, Eyes, Ears, Nose and Throat HIV: Human Immunodeficiency Virus IADL: Instrument Activities of Daily Living IBD: Inflammatory Bowel Disease IPPE: Introductory Pharmacy Practice Experience MS: Multiple Sclerosis MTM: Medication Therapy Management MUE: Medication Use Evaluation N/V: Nausea/Vomiting PAD: Peripheral Artery Disease PEG: Percutaneous Endoscropic Gastronomy PGY1: Postgraduate Year One PGY2: Postgraduate Year Two P&T: Pharmacy and Therapeutics PTH: Parathyroid Hormone PTSD: Post Traumatic Stress Disorder PUD: Peptic Ulcer Disease SOAP: Subjective Objective Assessment Plan SSRI: Selective Serotonin Reuptake Inhibitor STI: Sexually Transmitted Infection START: Screening Tool to Alert doctors to the Right Treatment STOPP: Screening Tool of Older People’s potentially inappropriate Prescriptions TIA: Transient Ischemic Attack URI: Upper Respiratory Infection WBC: White Blood Cell

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GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION 23 RESOURCES

GENERAL RESOURCES

American Society of Consultant Pharmacists Practice Resource Center

ASCP-NCOA Falls Risk Reduction Toolkit

Anastasia E, Estus E. Living in an Older Adult Community: A Pharmacy Student’s Experience. The Consultant Pharmacist. 2013;28(12):762-769. doi:10.4140/TCP.n.2013.762.

CDC: STEADI – Older Adult Fall Prevention

Chen AMH, Plake KS, Yehle KS, Kiersma ME. Impact of the Geriatric Medication Game on Pharmacy Students’ Attitudes Toward Older Adults. Am J Pharm Educ. 2011;75(8):158. doi:10.5688/ajpe758158.

Delafuente JC. Pharmacokinetic and Pharmacodynamic Alterations in the Geriatric Patient. The Consultant Pharmacist. 2008;23(4):324-334. doi:10.4140/tcp.n.2008.324.

Flynn BL. What It Is Like to Be a Long-Term Care Resident: A Personal Perspective. The Consultant Pharmacist. 2005;20(7):610-614. doi:10.4140/tcp.n.2005.610.

Hutchison LC, O’Brien CE. Changes in Pharmacokinetics and Pharmacodynamics in the Elderly Patient. Journal of Pharmacy Practice. 2007;20(1):4-12. doi:10.1177/0897190007304657.

Hutchison LC, Sleeper RB, American Society of Health-System Pharmacists, eds. Fundamentals of Geriatric Pharmacotherapy: An Evidenced-Based Approach. Second edition. American Society of Health-System Pharmacists; 2015.

Joint Commission of Pharmacy Practitioners. Pharmacists’ Patient Care Process. May 29, 2014.

Lee JK, Slack MK, Martin J, Ehrman C, Chisholm-Burns M. Geriatric Patient Care by U.S. Pharmacists in Healthcare Teams: Systematic Review and Meta-Analyses. J Am Geriatr Soc. 2013;61(7):1119-1127. doi:10.1111/jgs.12323.

Martin CM, McSpadden CS. Changes in the State Operations Manual: Implications for Consultant Pharmacy Practice. The Consultant Pharmacist. 2006;21(12):948-961. doi:10.4140/tcp.n.2006.948.

Porter R, Kaplan J, Lynn R. Geriatrics. In: Merck Manual Professional Version. Merck & Co., 2020.

Reuben DB, Herr KA, Pacala JT, Pollock BG, Potter JF, Semla TP. Geriatrics At Your Fingertips. 22nd ed. American Geriatrics Society; 2020.

Rudolph JL, Salow MJ, Angelini MC, McGlinchey RE. The Anticholinergic Risk Scale and Anticholinergic Adverse Effects in Older Persons. Arch Intern Med. 2008;168(5):508-513. doi:10.1001/archinternmed.2007.106.

Sleeper RB. Common Geriatric Syndromes and Special Problems. The Consultant Pharmacist. 2009;24(6):447-462. doi:10.4140/TCP.n.2009.051.

The Senior Care Pharmacist (née The Consultant Pharmacist) is the peer-reviewed journal of the American Society of Consultant Pharmacists (ASCP) and offers relevant information relating to geriatric education and senior-care pharmacist practice based information. It provides case studies that can be used as examples and discussion topics. The journal is dedicated to the medication therapy needs of older adults.

The American Journal of Pharmaceutical Education (AJPE) is the official scholarly publication of the American Association of Colleges of Pharmacy(AACP). This journal features articles that support all areas of pharmaceutical education.

Useful Position Statements/Practice Guidelines/General Background for Geriatrics

POSITION STATEMENTS ASCP Policy Statements and Guidelines. American Society of Consultant Pharmacists. Hypertension Guidelines

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24 GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION HYPERTENSION GUIDELINES

James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507-520. doi:10.1001/jama.2013.284427.

Stone NJ, Robinson J, Liechtenstein HA, et al. 2013 ACC/AHA guidelines on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2013. Available here.

DIABETES GUIDELINES

American Diabetes Association. Older Adults: standards of medical care in diabetes – 2020. Diabetes Care. 2020;43(suppl 1):S152 – S162.

POTENTIALLY INAPPROPRIATE MEDICATIONS

American Geriatrics Society. Updated Beers’ criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2019;67(4):674-94.

O’Mahony D, O’sullivan D, Byrne S, O’connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing. 2014;1-6.

GENERAL BACKGROUND FOR GERIATRICS

AGS Choosing Wisely Workgroup. American Geriatrics Society identifies five things that healthcare providers and patients should question. J Am Geriatr Soc. 2013;61:622-631.

AGS Choosing Wisely Workgroup. American Geriatrics Society identifies another five things that healthcare providers and patients should question. J Am Geriatr Soc. 2014. DOI:10.111/jgs.12770.

American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. Patient-Centered Care for Older Adults with Multiple Chronic Conditions: A Stepwise Approach from the American Geriatrics Society American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. J Am Geriatr Soc. 2012;60(10):1957-1968. doi: 10.1111/j.1532- 5415.2012.04187.x.

Elder Care Interprofessional Provider Sheets. Arizona Center on Aging.

Holmes HM, Hayley DC, Alexander GC, Sachs GA. Reconsidering medication appropriateness for patients late in life. Arch Intern Med. 2006;166:605-9.

Steinman MA, Hanlon JT. Managing medications in clinically complex elders: There’s got to be a happy medium. JAMA. 2010;304(14):1592-1601.

TeamSTEPPS®. Agency for Healthcare Research and Quality.

Top 10 Particularly Dangerous Drug Interactions in Long-Term Care. The Society for Post-Acute and Long-Term Care Medicine.

Health Communication Skills and Interprofessional Care Resources

CULTURE AND HEALTH COMMUNICATION SKILLS

Agness-Whittaker C, Macedo L. Aging, culture, and health communication: exploring personal cultural health beliefs and strategies to facilitate cross-cultural communication with older adults. MedEdPORTAL Publications doi. org/10.15766/mep_2374-8265.10374

Centers for Disease Control and Prevention. Health Literacy: Older Adults.

Centers for Disease Control and Prevention. Improving Health Literacy for Older Adults: Expert Panel Report 2009. Atlanta: U.S. Department of Health and Human Services; 2009.

Gerontologic Society of America. Communicating with Older Adults Publication Series Video

Publication: Communicating with Older Adults Return to Table of Contents

GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION 25 International Council on Active Aging. ICAA’s Guidelines for effective communication with older adults.

Kleinman A, Benson P. Anthropology in the Clinic: The Problem of Cultural Competency and How to Fix It. PLoS Med. 2006;3(10): e294. https://doi.org/10.1371/journal.pmed.0030294

Levin SJ, Like RC, Gottlieb JE. ETHNIC: A Framework for Culturally Competent Clinical Practice. In Appendix: Useful Clinical Interviewing Mnemonics. Patient Care. 2000;34(9): 188-189.

National Institute on Aging. Tips with improving communication with older adults.

Stanford Geriatric Education Center. Center on Ethnogeriatrics, the study of health care for elders from diverse populations.

Talerico KA. Enhancing communication with older adults. Overcoming elderspeak. J Psychosocial Nurs. 2005;43(5): 12-16.

INTERPROFESSIONAL CARE

Interprofessional Education Collaborative.

Solberg LB, Solberg LM, Carter CS. Geriatric Care Boot Camp: an interprofessional education program for healthcare professionals. J Am Geriatr Soc. 2015;63:997-1001.

World Health Organization. Framework for Action on Interprofessional Education & Collaborative Practice.

CURRICULUM/PRECEPTING RESOURCES

American Geriatrics Society Resources, Publications and Tools

ASCP Practice Resource Center

Blaszczyk AT, Mahan RJ, McCarrell J, Sleeper RB. The use of a polypharmacy simulation exercise for increasing empathy in pharmacy students. Am J Pharm Ed. 2018;82(3):Article 6238.

CDC Tools for Cross-Cultural Communication and Language Access

Stanford School of Medicine Ethnogeriatrics

Geriatric Emergency Department Guidelines

AHRQ Health Literacy Universal Precautions Toolkit

Interprofessional Collaborator Assessment Rubric (ICAR)

Interprofessional education collaborative (IPEC) Core competencies for interprofessional Collaborative Practice: 2016 Update

Mangoni AA, Jackson SH. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol. 2004;57(1):6-14. doi:10.1046/j.1365-2125.2003.02007.x

MedEdPortal: Repository of Evidence-Based Teaching Activities for Health Profession Trainees Covering a Wide Range of Direct Patient Care Skills and Professional Competencies in Geriatrics and Other Specialty Areas

Partnership for Health in Aging Workgroup on Interdisciplinary Team Training in Geriatrics. Position statement on interdisciplinary team training in geriatrics: an essential component of quality health care for older adults. J Am Geriatr Soc. 2014;62(5):961-965. doi:10.1111/jgs.12822

Partnership for Health In Aging Multidisciplinary Competencies in the Care of Older Adults at The Completion of the Entry-Level Health Professional Degree

Think Cultural Health: Resources for cross-cultural communication in the healthcare setting

Try This: Series Assessment Tools for Best Practices to care for older adults

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26 GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION RESIDENCY RESOURCES

ASHP Residency Information.

Educational Outcomes, Goals, and Objectives for Postgraduate Year Two (PGY2) Pharmacy Residencies in Geriatrics.

ASCP Geriatric Residencies.

ASCP Tips and Tricks for Residency/Fellowship Interviews. https://www.ascp.com/page/careerdevelopment

GERIATRIC APPE/ELECTIVE RESOURCES

Augustine J, Shah A, Makadia N, Shah A, Lee JK. Knowledge, Attitudes, and Beliefs Regarding Geriatric Care among Student Pharmacists. Currents Pharm Teach Learn. 2014 (6):226– 232.

Bouwmeester C. The PACE Program: home-based long-term care. Consult Pharm. 2012;1:24-30.

Estus EL, Hume AL, Owens NJ. Innovations in teaching: Pharmacotherapy in geriatrics: Improving student perception and knowledge through an active learning course model. Am J Pharm Educ. 2010; 74(3): Article 38.

Gilligan AM, Loui JA, Mezdo A, Patel N, Lee JK. Geriatric Quality-of-Life: A comparison of active older individuals and pharmacy student perceptions. Am J Pharm Educ. 2014 Feb 12;78(1):10. doi: 10.5688/ajpe78110.

Pinheiro SO, White HK, Burh GT, Elbert-Avila K, Cohen HJ, Heflin MT. Advancing Geriatrics Education Through a Faculty Development Program for Geriatrics-Oriented Clinician Educators. J Am Geriatr Soc. 2015;63(12):2580-2587. doi: 10.1111/jgs.13824.

OUTREACH RESOURCES

California Association of Physician Groups. Innovations in senior outreach. 2018. Available here.

MTM RESOURCES

AphA MTM Central. American Pharmacist Association.

ASCP Medication Therapy Management Services (Member Log on Required): American Society for Consultant Pharmacists.

CAREER RESOURCES

American Society of Consultant Pharmacists (ASCP). Resources.

American Geriatrics Society (AGS). Geriatrics Healthcare Professionals. Training for Geriatric Pharmacists.

Professional Development/Geriatric Certification Resources

American Society of Health-Systems Pharmacists. Traineeships.

ASHP Clinical Leadership Development. Traineeships.

Board of Pharmacy Specialties. Geriatric Pharmacy (BCGP). Available here:

Certifications for Pharmacists. Available here

Deprescribing/ Online Deprescribing Networks/Tools

ABIM Foundation. Choosing Wisely.

Bjerre LM, Farrell B, Hogel M, et al. Deprescribing antipsychotics for behavioural and psychological symptoms of dementia and insomnia: Evidence-based clinical practice guideline. Can Fam Physician. 2018;64(1):17-27.

By the 2019 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2019;67(4):674-694. doi:10.1111/jgs.15767

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GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION 27 Deprescribing.Org

Farrell B, Black C, Thompson W, et al. Deprescribing antihyperglycemic agents in older persons: Evidence-based clinical practice guideline. Can Fam Physician. 2017;63(11):832-843.

Farrell B, Pottie K, Thompson W, et al. Deprescribing proton pump inhibitors: Evidence-based clinical practice guideline. Can Fam Physician. 2017;63(5):354-364.

Gokula M, Holmes HM. Tools to reduce polypharmacy. Clin Geriatr Med. 2012;28(2):323-341. doi:10.1016/j. cger.2012.01.011

Hanlon JT, Semla TP, Schmader KE. Alternative Medications for Medications in the Use of High-Risk Medications in the Elderly and Potentially Harmful Drug-Disease Interactions in the Elderly Quality Measures. J Am Geriatr Soc. 2015;63(12):e8-e18. doi:10.1111/jgs.13807.

Jansen J, Naganathan V, Carter SM, et al. Too much medicine in older people? Deprescribing through shared decision making. BMJ. 2016;353:i2893. doi:10.1136/bmj.i2893

Kuhn-Thiel AM, Weiß C, Wehling M; FORTA authors/expert panel members. Consensus validation of the FORTA (Fit fOR The Aged) List: a clinical tool for increasing the appropriateness of pharmacotherapy in the elderly. Drugs Aging. 2014;31(2):131-140. doi:10.1007/s40266-013-0146-0

Lown Institute

McLeod PJ, Huang AR, Tamblyn RM, Gayton DC. Defining inappropriate practices in prescribing for elderly people: a national consensus panel. CMAJ. 1997;156(3):385-391.

Medstopper: Canada

Primary Health: Tasmania. Deprescribing Resources.

Scott IA, Hilmer SN, Reeve E, et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med. 2015;175(5):827-834. doi:10.1001/jamainternmed.2015.0324

University of Maryland Optimizing medication management during the COVID-19 Pandemic: Implementation Guide for Post-Acute and Long-Term Care Complete guide available here

PHARMACOGENOMICS

Clinical Pharmacogenetics Implementation Consortium

PharmGKB

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28 GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION Appendix A: Crosswalk with ACPE Section I: Education Outcomes The Accreditation Council for Pharmacy Education is responsible for the accreditation of professional- level pharmacy degree programs, as well as continuing-education programs for pharmacists. The ACPE outcomes are the foundation of the curriculum of each school of pharmacy.

ACPE Outcome ASCP’s Geriatric Pharmacy Curriculum Guide 1.1. Foundational Knowledge I.B.2. Describe the biology of aging and discuss common theories The graduate must be able to of aging. develop, integrate, and apply I.B.3. Discuss the physiologic changes of aging and how they knowledge from the impact the pharmacokinetic, pharmacodynamic and therapeutic foundational sciences (i.e., use of medications. biomedical, pharmaceutical, II.D.2. Evaluate the appropriateness of standards of practice or social/behavioral/administrative, treatment guidelines for an older adult patient. and clinical sciences) to evaluate II.D.4. Apply principles of pharmacokinetic and pharmacodynamic the scientific literature, explain changes associated with aging to the design of the drug action, solve therapeutic pharmacotherapy regimen. problems, and advance III.A.1. Identify reputable sources of information for the care of an population health and patient- older adult patient. centered care. III.A.4. Evaluate and apply evidence from primary literature as it pertains to the care of older adult patients. III.A.5. Evaluate the relevancy of clinical practice guidelines, standards of care and quality measures related to geriatric care. 2.1. Patient-centered care I.D.1. Communicate drug and adherence information to older The graduate must be able to patients, their care partners and the interprofessional team. provide patient-centered care as I.D.3. Demonstrate proficiency to interview and counsel older the medication expert (collect adults with varying degrees of health literacy, cognitive function, and interpret evidence, and communication abilities. prioritize, formulate I.F.3. Conduct a comprehensive medication review to minimize assessments and the impact of drug-related falls. recommendations, implement, II.B.1. Recognize the atypical clinical presentation and progression monitor and adjust plans, and of common diseases found in older adults. document activities). II.B.2. Identify symptoms of drug-induced diseases and geriatric syndromes. II.C.1. Identify basic cognitive, functional, physical and safety assessments for common diseases in the older adult population. II.C.2. Demonstrate the ability to conduct basic cognitive, functional, physical and safety assessments for common diseases in the older adult population. II.C.4. Apply knowledge of geriatric syndromes and medication- related problems when interpreting assessment results. II.C.5. Obtain and interpret a comprehensive medication history in relation to an older adult’s current health status. II.C.6. Assess a medication regimen for medication-related problems (e.g., polypharmacy, non-adherence, drug interactions, adverse drug events, underuse, and potentially inappropriate prescribing). II.C.7. Appropriately recommend laboratory monitoring and interpret laboratory results for an older adult patient. Return to Table of Contents GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION 29 II.C.10. Develop a problem list and prioritize care based upon severity of illness, patient preference, quality of life, and time to benefit. II.C.12 .Identify when appropriate to recommend deprescribing in an older adult. II.D.1. Define therapeutic goals incorporating patient-specific principles (e.g., age, functionality, patient preference, pharmacogenomics, cultural). II.D.3. Determine therapeutic options and the risk/benefit to the patient (e.g., no treatment, non-pharmacologic interventions, non-prescription medications, complementary and alternative medicine, and prescription medications). II.D.4. Apply principles of pharmacokinetic and pharmacodynamic changes associated with aging to the design of the pharmacotherapy regimen. II.D.6. Resolve and/or prevent medication-related problems in a given older adult patient. II.E.1. Develop and implement an older adult patient-specific monitoring plan. II.E.2. Revise therapeutic plans based upon changes in patient status. II.G.1. Document rationale, actions, and outcomes from medication therapies for the healthcare team. II.G.2. Write an action plan for use by the patient/care partner. III.A.4. Evaluate and apply evidence from primary literature as it pertains to the care of older adult patients. 2.2. Medication use systems I.E.1. Define the continuum of care available to older adults such management as community resources, home care, formal and informal care The graduate must be able to partnerships, assisted living facilities, nursing facilities, sub-acute manage patient healthcare care facilities, hospice care, and hospitals. needs using human, financial, I.E.3. Facilitate medication reconciliation to improve transitions technological, and physical across the continuum of care and reduce readmissions. resources to optimize the safety II.G.3. Perform and document comprehensive medication and efficacy of medication use reconciliation across the continuum of care. systems. II.G.4. Acknowledge different systems for documentation and tracking of intervention data which can generate evidence of care. III.A.2. Evaluate medication utilization at the system level to ensure safe and effective drug therapy. III.A.3. Utilize a documentation system to evaluate outcomes of pharmacist intervention. 2.3. Health and wellness I.B.4. Educate an individual on factors to consider when The graduate must be able to evaluating an intervention to slow the aging process. design prevention, intervention, I.C.1. Describe the interrelationship between social determinants and educational strategies for of health and aging (e.g., family, cultural, community, housing, individuals and communities to access to care, policy issues). manage chronic disease and I.C.2. Recognize signs and symptoms of substance and medication improve health and wellness. misuse/abuse in older adults. Return to Table of Contents 30 GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION I.C.3. Identify and manage the social issues of medication use for an individual patient’s therapy. I.C.4. Describe the interrelationship between an older adult and their formal and informal care partners. I.C.5. Recognize available resources and develop strategies to support older adults and care partners. I.C.9. Define elder abuse/neglect (e.g., physical, psychological, and financial). I.C.10. Recognize and report the signs of elder abuse/neglect. I.C.12. Consider financial/reimbursement issues (e.g., formularies, insurance coverage) when making therapeutic recommendations. I.C.13. Value and appreciate ethnic, racial and cultural differences in the older adult. I.C.14. Recognize differences in healthcare beliefs which may exist between patients and healthcare professionals. I.C.16. Discuss the concept of ageism and how it may impact the treatment of patients I.D.2. Recognize the prevalence of limited health literacy in the older adult population. I.E.2. Participate in interprofessional decision making regarding appropriate levels of care for individual patients. I.F.1. Describe and advocate for health care initiatives related to wellness and health promotion (e.g., nutrition, physical activity, medication adherence, immunizations, and health screenings). I.F.2. Counsel an older adult on the utility of health screenings and preventive measures. I.F.3. Conduct a comprehensive medication review to minimize the impact of drug-related falls. II.C.3. Assess social and cultural determinants of health outcomes. III.B.3. Respect the roles and responsibilities of the pharmacist and other healthcare professionals within the interprofessional team. 2.4. Population-based care I.A.1. Define the demographic, economic and medical The graduate must be able to characteristics of older adults (e.g., gender, ethnicity, geographic, describe how population-based socioeconomic, multi-morbidity, disability, and medication use care influences patient-centered patterns). care and influences the I.A.2. Recognize the heterogeneity of the older adult population development of practice I.B.1. Recognize the spectrum of aging from healthy aging to guidelines and evidence-based frailty. best practices. I.C.7. Promote patient-centered decision making and care. I.C.13. Value and appreciate ethnic, racial and cultural differences in the older adult. I.D.2. Recognize the prevalence of limited health literacy in the older adult population. I.E.4. Discuss the philosophy and practice of hospice/palliative care. I.E.5. Incorporate life expectancy and end-of-life issues in the decision-making of appropriate use of medications. Return to Table of Contents GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION 31 II.A. Describe incidence and prevalence of diseases in the older adult population III.A.5. Evaluate the relevancy of clinical practice guidelines, standards of care and quality measures related to geriatric care. III.D.1. Develop, implement and assess formulary management/protocols as they pertain to the care of the older adult patient. 3.1. Problem Solving I.C.15. Demonstrate the ability to assess personal misconceptions, The graduate must be able to generalities and stereotypes which may impact the care of an identify problems; explore and ethnically, racially and culturally diverse patient population. prioritize potential strategies; I.D.2. Recognize the prevalence of limited health literacy in the and design, implement, and older adult population. evaluate a viable solution. I.D.4. Recognize barriers to effective communication (e.g., cognitive, sensory, cultural, and language). II.C.6. Assess a medication regimen for medication-related problems (e.g., polypharmacy, non-adherence, drug interactions, adverse drug events, underuse, and potentially inappropriate prescribing). II.C.8. Identify and recognize potential functional barriers to the older adult patient (e.g., transportation, housing, economics, and social support structure). II.C.9. Identify potential environmental causes of decline in activities of daily living (ADL), instrumental activities of daily living (IADL), and cognitive function. II.C.12 .Identify when appropriate to recommend deprescribing in an older adult. II.D.7. Optimize a medication regimen to minimize polypharmacy, prescribing cascades, and anticholinergic burden. II.E.1. Develop and implement an older adult patient-specific monitoring plan II.E.2. Revise therapeutic plans based upon changes in patient status. 3.2. Educator I.B.4. Educate an individual on factors to consider when The graduate must be able to evaluating an intervention to slow the aging process. educate all audiences by I.D.1. Communicate drug and adherence information to older determining the most effective patients, their care partners and the interprofessional team. and enduring ways to impart I.D.3. Demonstrate proficiency to interview and counsel older information and assess adults with varying degrees of health literacy, cognitive function, understanding. and communication abilities. I.D.4. Recognize barriers to effective communication (e.g., cognitive, sensory, cultural, and language). I.F.1. Describe and advocate for health care initiatives related to wellness and health promotion (e.g., nutrition, physical activity, medication adherence, immunizations, and health screenings). I.F.2. Counsel an older adult on the utility of health screenings and preventive measures. II.F.1. Utilize educational material appropriate to the specific patient/care partner. Return to Table of Contents 32 GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION II.F.2. Ensure understanding of medication use and its role in the overall treatment plan. II.F.4. Assist the patient/care partner in identifying, procuring, and utilizing adherence strategies and devices. II.F.5. Educate interprofessional team members regarding geriatric-specific pharmacotherapy principles. 3.3. Patient Advocacy I.C.7. Promote patient-centered decision making and care. The graduate must be able to I.C.8. Describe advanced directives, living wills and the role of a represent the patients’ best power of attorney interest. I.C.10. Recognize and report the signs of elder abuse/neglect. I.C.11. Describe the options for coverage and benefits older adults may utilize (e.g., Medicare, Medicaid and supplemental coverage). I.C.12. Consider financial/reimbursement issues (e.g., formularies, insuranceI.F.1. Describe coverage and advocate) when m foraking health therapeutic care initiatives recommendations. relative to wellness and health promotion (e.g., nutrition, physical activity, medication adherence, immunizations, and health screenings). II.C.11. Identify patients who need referrals to other health and non-health professionals. II.C.12 .Identify when appropriate to recommend deprescribing in an older adult. II.F.4. Assist the patient/care partner in identifying, procuring, and utilizing adherence strategies and devices. III.C.4. Promote advocacy for geriatric patient care and the pharmacy profession. 3.4. Interprofessional I.C.7. Promote patient-centered decision making and care. collaboration I.D.1. Communicate drug and adherence information to older The graduate must be able to patients, their care partners and the interprofessional team. actively participate and engage I.E.2. Participate in interprofessional decision making regarding as a healthcare team member by appropriate levels of care for individual patients. demonstrating mutual respect, II.C.11. Identify patients who need referrals to other health and understanding, and values to non-health professionals. meet patient care needs. II.F.5. Educate interprofessional team members regarding geriatric-specific pharmacotherapy principles. III.B.2. Recognize emerging opportunities for geriatric practice. III.B.3. Respect the roles and responsibilities of the pharmacist and other healthcare professionals within the interprofessional team. III.C.5. Demonstrate decision making skills when implementing care for older adults to improve outcomes and quality measures. 3.5. Cultural sensitivity I.A.1. Define the demographic, economic and medical The graduate must be able to characteristics of older adults (e.g., gender, ethnicity, geographic, recognize social determinants of socioeconomic, multi-morbidity, disability, and medication use health to diminish disparities patterns). and inequities in access to I.C.1. Describe the interrelationship between social determinants quality care. of health and aging (e.g., family, cultural, community, housing, access to care, policy issues). I.C.13. Value and appreciate ethnic, racial and cultural differences in the older adult.

Return to Table of Contents GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION 33 I.C.14. Recognize differences in healthcare beliefs which may exist between patients and healthcare professionals. I.C.15. Demonstrate the ability to assess personal misconceptions, generalities and stereotypes which may impact the care of an ethnically, racially and culturally diverse patient population. I.C.16. Discuss the concept of ageism and how it may impact the treatment of patients. I.D.2. Recognize the prevalence of limited health literacy in the older adult population. I.D.3. Demonstrate proficiency to interview and counsel older adults with varying degrees of health literacy, cognitive function, and communication abilities. I.D.4. Recognize barriers to effective communication (e.g., cognitive, sensory, cultural, and language). II.C.3. Assess social and cultural determinants of health outcomes. II.F.2. Ensure understanding of medication use and its role in the overall treatment plan. 3.6. Communication I.D.1. Communicate drug and adherence information to older The graduate must be able to patients, their care partners and the interprofessional team. effectively communicate I.D.3. Demonstrate proficiency to interview and counsel older verbally and nonverbally when adults with varying degrees of health literacy, cognitive function, interacting with an individual, and communication abilities. groups, and organization. I.F.2. Counsel an older adult on the utility of health screenings and preventive measures. I.F.3. Conduct a medication review to minimize the impact of drug-related falls. II.C.2. Demonstrate the ability to conduct basic cognitive, functional, physical and safety assessments for common diseases in the older adult population. II.C.5. Obtain and interpret a comprehensive medication history in relation to an older adult’s current health status. II.F.2. Ensure understanding of medication use and its role in the overall treatment plan. II.F.5. Educate interprofessional team members regarding geriatric-specific pharmacotherapy principles. II.G.1. Document rationale, actions, and outcomes from medication therapies for the healthcare team II.G.3. Perform and document comprehensive medication reconciliation across the continuum of care. II.G.4. Acknowledge different systems for documentation and tracking of intervention data which can generate evidence of care. III.A.3. Utilize a documentation system to evaluate outcomes of pharmacist intervention. 4.1. Self-awareness I.C.14. Recognize differences in healthcare beliefs which may exist The graduate must be able to between patients and healthcare professionals. examine and reflect on personal I.C.15. Demonstrate the ability to assess personal misconceptions, knowledge, skills, abilities, generalities and stereotypes which may impact the care of an beliefs, biases, motivation, and ethnically, racially and culturally diverse patient population. Return to Table of Contents 34 GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION emotions that could enhance or I.D.4. Recognize barriers to effective communication (e.g., limit personal and professional cognitive, sensory, cultural, and language). growth. III.C.3. Develop strategies for keeping up-to-date on regulatory changes and their impact on geriatric care 4.2. Leadership I.E.2. Participate in interprofessional decision making regarding The graduate must be able to appropriate levels of care for individual patients. demonstrate responsibility for III.B.3. Respect the roles and responsibilities of the pharmacist and creating and achieving shared other healthcare professionals within the interprofessional team. goals, regardless of position. III.C.5. Demonstrate decision making skills when implementing care for older adults to improve outcomes and quality measures. 4.3. Innovation and III.B.1. Identify existing and emerging models of practice in Entrepreneurship geriatric care. The graduate must be able to III.B.2. Recognize emerging opportunities for geriatric practice. engage in innovative activities by III.C.1. Identify agencies and organizations integral in the using creative thinking to development and enforcement of geriatric public policy. envision better ways of III.C.4. Promote advocacy for geriatric patient care and the accomplishing professional pharmacy profession. goals. III.D.2. Demonstrate knowledge of sources and processes of compensation for geriatric pharmacy services. 4.4. Professionalism I.C.6. Recognize ethical dilemmas through a systematic decision- The graduate must be able to making process based on clearly articulated ethical theories and exhibit behaviors and values that principles (e.g., self-determination, autonomy, justice in the are consistent with the trust distribution of resources). given to the profession by I.C.13. Value and appreciate ethnic, racial and cultural differences patients, other healthcare in the older adult. providers, and society. I.C.15. Demonstrate the ability to assess personal misconceptions, generalities and stereotypes which may impact the care of an ethnically, racially and culturally diverse patient population. III.B.4. Discuss board certifications available for pharmacists providing geriatric care (e.g., BCGP, CDE, other advanced training) III.C.2. Identify and adhere to site-specific regulations for geriatric care Reference: Accreditation standards and key element for the professional program in pharmacy leading to the doctor of pharmacy degree, 2016, Accreditation Council for Pharmacy Education, https://www.acpe- accredit.org/pdf/Standards2016FINAL.pdf

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GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION 35 Appendix B: Crosswalk with Core Competencies for Interprofessional Collaborative Practice.

In 2009, six national associations of schools of health professions formed a collaborative to promote and encourage constituent efforts that would advance substantive interprofessional learning experiences. The goal was, and remains, to help prepare future health professionals for enhanced team-based care of patients and improved population health outcomes. The collaborative, representing dentistry, nursing, medicine, osteopathic medicine, pharmacy, and public health, convened an expert panel of representatives from each of the six IPEC sponsor professions to create core competencies for interprofessional collaborative practice, to guide curriculum development across health professions schools. The competencies and implementation recommendations subsequently published in the 2011 Core Competencies for Interprofessional Collaborative Practice have been broadly disseminated.

In 2016 the IPEC Board aims to: reaffirm the original competencies, ground the competency model firmly under the singular domain of Interprofessional Collaboration, and broaden the competencies to better integrate population health approaches across the health and partner professions so as to enhance collaboration for improving both individual care and population health outcomes.

Core Competencies for Interprofessional ASCP’s Geriatric Pharmacy Curriculum Guide Collaborative Practice: 2016 Update Values/Ethics for Interprofessional Practice I.C.7. Promote person-centered decision making and care. Work with individuals of other professions to maintain a climate of mutual respect and shared I.C.13. Value and appreciate ethnic, racial and values. cultural differences in the older adult population.

I.C.14. Recognize differences in healthcare beliefs which may exist between patients and healthcare professionals.

1.C.15 Demonstrate the ability to assess personal misconceptions, generalities and stereotypes which may impact the care of an ethnically, racially and culturally diverse patient population

Roles/Responsibilities I.E.2. Participate in interprofessional decision making regarding appropriate levels of care for Use the knowledge of one’s own role and those of individual patients. other professions to appropriately assess and address the health care needs of patients and to II.C.11. Identify patients who need referrals to promote and advance the health of populations. other health and non-health professionals.

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36 GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION II.F.5. Educate interprofessional team members regarding geriatric-specific pharmacotherapy principles.

III.B.3. Respect the roles and responsibilities of the pharmacist and other healthcare professionals within the interprofessional team.

Interprofessional Communication I.C.4. Describe the interrelationship between an older adult and their formal and informal Communicate with patients, families, communities, caregivers. and professionals in health and other fields in a responsive and responsible manner that supports a I.C.5. Recognize available resources and team approach to the promotion and maintenance develop strategies to support older adults and of health and the prevention and treatment of caregivers. disease. I.D.1. Communicate drug and adherence information to older patients, their caregivers and the interprofessional team.

II.G.1. Document rationale, actions, and outcomes from medication therapies for the healthcare team.

Teams and Teamwork III.B.3. Respect the roles and responsibilities of the pharmacist and other healthcare Apply relationship-building values and the professionals within the interprofessional team. principles of team dynamics to perform effectively in different team roles to plan, deliver, and evaluate patient/population- centered care and population health programs and policies that are safe, timely, efficient, effective, and equitable. Reference: Interprofessional Education Collaborative. (2016). Core competencies for interprofessional collaborative practice: 2016 update. Washington, DC: Interprofessional Education Collaborative. https://nebula.wsimg.com/2f68a39520b03336b41038c370497473?AccessKeyId=DC06780E69ED19E2 B3A5&disposition=0&alloworigin=1

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GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION 37 Appendix C: Crosswalk with the Curricular Framework: Core Competencies in Multicultural Geriatric Care (2004) The Curricular Framework: Core Competencies in Multicultural Geriatric Care was created with recommendations from the University of California Academic Geriatric Resource Program and the Ethnogeriatrics Committee of the American Geriatrics Society. The objective was to develop cultural competencies for geriatric faculty for all healthcare disciplines. The competencies focus on preparing healthcare professionals to work effectively in cross-cultural situations.

Core Competencies in Multicultural Geriatric Care ASCP’s Geriatric Pharmacy Curriculum Guide Attitudes I.C.13. Value and appreciate ethnic, racial and Assess awareness of personal beliefs before cultural differences in the older adult population. interacting with others. I.C.14. Recognize differences in healthcare beliefs which may exist between patients and healthcare professionals. I.C.15. Demonstrate the ability to assess personal misconceptions, generalities and stereotypes which may impact the care of an ethnically, racially and culturally diverse patient population. Knowledge I.A.1. Define the demographic, economic and Use data to influence attitudes and improve medical characteristics of older adults (e.g., healthcare outcomes. gender, ethnicity, geographic, socioeconomic, multi-morbidity, disability, and medication use patterns). I.C.16. Discuss the concept of ageism and how it may impact the treatment of patients. I.D.4. Recognize barriers to effective communication (e.g., cognitive, sensory, cultural, and language). II.C.8. Identify and recognize potential functional barriers to the older adult patient (e.g., transportation, housing, economics, and social support structure). II.D.1. Define therapeutic goals incorporating patient-specific principles (e.g., age, functionality, patient preference, pharmacogenomics, cultural). Skills II.C.3. Assess social and cultural determinants of Demonstrate competency in understanding health outcomes. cultural needs by applying attitudes and knowledge when working with patients. References: Xakellis G, Brangman SA, Hinton WL, et al. Curricular framework: core competencies in multicultural geriatric care. J Am Geriatr Soc. 2004;52(1):137-42. American Psychological Association, Committee on Aging. (2009). Multicultural Competency in Geropsychology. Washington, DC: American Psychological Association. Betancourt JR. Cultural competency: providing quality care to diverse populations. Consult Pharm 2006;21(12):988-95.

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38 GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION Appendix D: Crosswalk with Partnership with Health in Aging Multidisciplinary Competencies in the Care of Older Adults at the Completion of the Entry-level Health Professional Degree (2010)

The Partnership for Health in Aging, originally convened by the American Geriatrics Society, is a coalition of more than 30 health professions organizations involved in the care of older adults. As one of its first actions, the Partnership for Health in Aging developed a statement of educational core competencies unique to the care of older adults that are relevant to all health professions. The competencies are applicable to all health professions at the completion of the entry-level degree program.

Partnership with Health in Aging ASCP’s Curriculum Guide Multidisciplinary Competencies in the Care of Older Adults at the Completion of the Entry-level Health Professional Degree

Domain #1: Health Promotion & Safety 1.Advocate to older adults and their I.F.1. Describe and advocate health care initiatives caregivers interventions and behaviors related to wellness and health promotion (e.g., nutrition, that promote physical and mental health, physical activity, medication adherence, immunizations, nutrition, function, safety, social and health screenings). interactions, independence, and quality I.F.2. Counsel an older adult on the utility of health of life. screenings and preventive measures. II.C.11. Identify patients who need referrals to other health and non-health professionals or services. 2. Identify and inform older adults and I.F.1. Describe and advocate health care initiatives their caregivers about evidence-based related to wellness and health promotion (e.g., nutrition, approaches to screening, immunizations, physical activity, medication adherence, immunizations, health promotion, and disease and health screenings). prevention. I.F.2. Counsel an older adult on the utility of health screenings and preventive measures. 3.Assess specific risks and barriers to I.C.2. Recognize signs of substance and medication older adult safety, including falls, elder misuse/abuse in older adults. mistreatment, and other risks in I.C.9. Define elder abuse/neglect (e.g., physical, community, home, and care psychological, and financial). environments. I.C.10. Recognize and report the signs of elder abuse/neglect. I.F.3. Conduct a comprehensive medication review to minimize the impact of drug-related falls. II.C.1. Identify basic cognitive, functional physical and safety assessments for common diseases in the older adult population. II.C.2. Demonstrate the ability to conduct basic cognitive, functional, physical and safety assessments for common diseases in the older adult population II.C.3. Assess social and cultural determinants of health outcomes.

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GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION 39 II.C.4. Apply knowledge of geriatric syndromes and medication-related problems when interpreting assessment results. II.C.8. Identify and recognize potential functional barriers to the older aduly patient (e.g., transportation, housing, economics, and social support structure). II.C.9. Identify potential environmental causes of decline in activities of daily living (ADL), instrumental activities of daily living (IADL), and cognitive function. 4. Recognize the principles and practices I.A.2. Recognize the heterogeneity of the older adult of safe, appropriate, and effective population medication use in older adults. I.B.4. Educate an individual on factors to consider when evaluating an intervention to slow the aging process II.C.6. Assess a medication regimen for medication- related problems (e.g., polypharmacy, non-adherence, drug interactions, adverse drug event, underuse, potentially inappropriate prescribing) II.D.4. Apply principles of pharmacokinetic and pharmacodynamic changes associated with aging to the design of the pharmacotherapy regimen. II.D.5. Design and recommend age/person specific regimen including medication, dose, dosage form, dosing interval, and route of administration. II.D.6. Resolve and/or prevent medication-related problems in a given older adult patient. 5. Apply knowledge of the indications and I.C.7. Promote person-centered decision making and care contraindications for, risks of, and II.C.6. Assess a medication regimen for medication- alternatives to the use of physical and related problems (e.g., polypharmacy, non-adherence, pharmacological restraints with older drug interactions, adverse drug event, underuse, adults. potentially inappropriate prescribing) II.D.6. Resolve and/or prevent medication-related problems in a given older adult patient. Domain #2: Evaluation and Assessment 1. Define the purpose and components of II.C.1. Identify basic cognitive, functional, physical and an interdisciplinary, comprehensive safety assessments for common diseases in the older geriatric assessment and the roles adult population. individual disciplines play in conducting II.C.2. Demonstrate the ability to conduct basic cognitive, and interpreting a comprehensive functional, physical and safety assessments for common geriatric assessment diseases in the geriatric population II.C.3. Assess social and cultural determinants of health outcomes. II.C.6. Assess a medication regimen for medication- related problems (e.g., polypharmacy, non-adherence, drug interactions, adverse drug event, underuse, potentially inappropriate prescribing) 2. Apply knowledge of the biological, I.B.2. Describe the biology of aging and discuss common physical, cognitive, psychological, and theories of aging. Return to Table of Contents 40 GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION social changes commonly associated with I.B.3. Discuss the physiologic changes of aging and how aging. they impact the pharmacokinetic, pharmacodynamic and therapeutic use of medications. I.C.1. Describe the interrelationship between social issues and aging (e.g., family, cultural, community, housing, access to care, policy issues). II.C.9. Identify potential environmental causes of decline in activities of daily living (ADL), instrumental activities of daily living (IADL), and cognitive function. 3. Choose, administer, and interpret a II.C.1. Identify basic cognitive, functional physical and validated and reliable tool/instrument safety assessments for common diseases in the older appropriate for use with a given older adult population. adult to assess: a) cognition, b) mood, c) II.C.2. Demonstrate the ability to conduct basic cognitive, physical function, d) nutrition, and e) functional, physical and safety assessments for common pain. diseases in the older adult population 4. Demonstrate knowledge of the signs II.B.2. Identify symptoms of drug-induced disease and and symptoms of delirium and whom to geriatric syndromes notify if an older adult exhibits these II.C.1. Identify basic cognitive, functional physical and signs and symptoms. safety assessments for common diseases in the older adult population. II.C.2. Demonstrate the ability to conduct basic cognitive, functional, physical and safety assessments for common diseases in the older adult population. II.C.6. Assess a medication regimen for medication- related problems (e.g., polypharmacy, non-adherence, drug interactions, adverse drug event, underuse, potentially inappropriate prescribing) II.C.11. Identify patients who need referrals to other health and non-health professionals or services. II.D.6. Resolve and/or prevent medication-related problems in a given older adult patient. 5. Develop verbal and nonverbal I.D.2. Recognize the prevalence of limited health communication strategies to overcome literacy in the older adult population. potential sensory, language, and cognitive I.D.3 Demonstrate proficiency to interview and counsel limitations in older adults. older adults with varying degrees of health literacy, cognitive function, and communication abilities. Domain #3: Care Planning and Coordination Across the Care Spectrum (Including End-of- Life Care) 1. Develop treatment plans based on best I.C.7. Promote patient-centered decision making and evidence and on person-centered and care. directed care goals. II.D.2. Evaluate the appropriateness of standards of practice or treatment guidelines for an older adult patient. III.A.4. Evaluate and apply evidence from primary literature as it pertains to the care of older adults. III.A.5. Evaluate the relevancy of clinical practice guidelines, standards of care and quality measures related to geriatric care. Return to Table of Contents GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION 41 2. Evaluate clinical situations where I.C.7. Promote patient-centered decision making and standard treatment recommendations, care. based on best evidence, should be I.C.13. Value and appreciate ethnic, racial and cultural modified with regard to older adults’ differences in the older adult population preferences and treatment/care goals, I.D.1. Communicate drug and adherence information to life expectancy, co- morbid conditions, older patients, their caregivers and the interprofessional and/or functional status. team. I.E.5. Incorporate life expectancy and end-of-life issues in the decision-making of appropriate use of medications. II.C.10. Develop a problem list and prioritize care based upon severity of illness, patient preference, quality of life, and time to benefit. III.A.5. Evaluate the relevancy of clinical practice guidelines, standards of care and quality measures related to geriatric care. 3. Develop advanced care plans based on I.C.7. Promote patient-centered decision making and older adults’ preferences and care. treatment/care goals, and their physical, II.D.1. Define therapeutic goals incorporating person- psychological, social, and spiritual needs. specific principles (e.g., age, functionality, patient preference, pharmacogenomics, cultural). 4. Recognize the need for continuity of I.E.1. Define the continuum of care available to older treatment and communication across the adults such as community resources, home care, formal spectrum of services and during and informal care giverships, assisted living facilities, transitions between care settings, nursing facilities, sub- acute care facilities, hospice care, utilizing information technology where and hospitals. appropriate and available. I.E.2. Participate in interprofessional decision making regarding appropriate levels of care for individual patients. I.E.3. Facilitate medication reconciliation to improve transitions across the continuum of care. II.G.3. Perform and document comprehensive medication reconciliation across the continuum of care Domain #4: Interdisciplinary and Team Care 1. Distinguish among, refer to, and/or II.C.11. Identify patients who need referrals to other consult with any of the multiple health and non-health professionals or services. healthcare professionals who work with II.F.5. Educate interprofessional team members regarding older adults, to achieve positive geriatric-specific pharmacotherapy principles. outcomes. III.B.3. Understand the roles and responsibilities of the pharmacist and other healthcare professionals within the interprofessional team. 2. Communicate and collaborate with I.C.4. Describe the interrelationship between an older older adults, their caregivers, healthcare adult and their formal and informal care partners. professionals, and direct-care workers to I.C.14. Recognize differences in healthcare beliefs which incorporate discipline-specific information may exist between patients and healthcare professionals into overall team care planning and I.C.15. Demonstrate the ability to assess personal implementation. misconceptions, generalities and stereotypes which may impact the care of an ethnically, racially and culturally diverse patient population Return to Table of Contents 42 GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION I.E.2. Participate in interprofessional decision making regarding appropriate levels of care for individual patients. II.G.1. Document rationale, actions, and outcomes from medication therapies for the healthcare team. Domain #5: Caregiver Support 1. Assess caregiver knowledge and II.B.1. Recognize the atypical clinical presentation and expectations of the impact of advanced progression of common diseases found in older adults. age and disease on health needs, risks, II.F.2. Ensure understanding of medication use and its role and the unique manifestations and in the overall treatment plan. treatment of health conditions. 2. Assist caregivers to identify, access, and I.C.4. Describe the interrelationship between an older utilize specialized products, professional adult and their formal and informal care partners. services, and support groups that can II.F.4. Assist the patient/caregiver in identifying, assist with care-giving responsibilities and procuring, and utilizing adherence strategies and devices. reduce caregiver burden. 3. Know how to access and explain the II.F.1. Utilize educational material appropriate to the availability and effectiveness of resources specific patient/caregiver. for older adults and caregivers that help II.F.2. Ensure understanding of medication use and its them meet personal goals, maximize role in the overall treatment plan. function, maintain independence, and live II.F.3. Educate patient/caregiver regarding potential in their preferred and/or least restrictive problems with patient care management and environment. administration of medications. 4. Evaluate the continued II.E.2. Revise therapeutic plans based upon changes in appropriateness of care plans and patient status. services based on older adults’ and caregivers’ changes in age, health status, and function; assist caregivers in altering plans and actions as needed. Domain #6: Healthcare Systems and Benefits 1. Serve as an advocate for older adults III.C.4. Promote advocacy for geriatric patient care and and caregivers within various healthcare the pharmacy profession. systems and settings. 2. Know how to access, and share with I.C.11. Describe the options for coverage and benefits older adults and their caregivers, older adults may utilize (e.g., Medicare, Medicaid and information about the healthcare supplemental coverage). benefits of programs such as Medicare, I.C.12. Consider financial/reimbursement issues (e.g., Medicaid, Veterans’ services, Social formularies, insurance coverage) when making Security, and other public programs. therapeutic recommendations. 3. Provide information to older adults and I.E.1. Define the continuum of care available to older their caregivers about the continuum of adults such as community resources, home care, formal long-term care services and supports – and informal care giverships, assisted living facilities, such as community resources, home nursing facilities, sub- acute care facilities, hospice care, care, assisted living facilities, hospitals, and hospitals. nursing facilities, sub-acute care facilities, III.A.1. Identify reputable sources of information for the and hospice care. care of an older adult patient. Reference: Citation: Partnership for Health in Aging (2010). Multidisciplinary Competencies in the Care of Older Adults at the Completion of the Entry-level Health Professional Degree. http://www.americangeriatrics.org/files/documents/health_care_pros/PHA_Multidisc_Competencies.pdf. Return to Table of Contents GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION 43 Appendix E: Crosswalk with Pharmacists’ Patient Care Process

https://jcpp.net/wp-content/uploads/2016/03/PatientCareProcess-with-supporting-organizations.pdf

The following was created by The Joint Commission of Pharmacy Practitioners (JCPP).The pharmacists’ patient care process (PPCP) “encompasses a contemporary and comprehensive approach to patient- centered care that is delivered in collaboration with other members of the health care team.” The JCPP developed the process after examining the literature pertaining to pharmaceutical care and medication therapy management.

ASCP Geriatric Curriculum Guide Competencies Mapped to the PPCP: PPCP Patient-Centered Care I.C.7. Promote person-centered decision making and care. I.C.13. Value and appreciate ethnic, racial and cultural differences in the older adult. II.D.1. Define therapeutic goals incorporating patient-specific principles (e.g., age, functionality, patient preference, pharmacogenomics, cultural). II.D.3. Determine therapeutic options and the risk/benefit to the patient (e.g., no treatment, non-pharmacologic interventions, non- prescription medications, complementary and alternative medicine, and prescription medications).

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44 GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION Collect I.C.3. Identify and manage the social issues of medication use for an older adult’s therapy. I.D.2. Recognize the prevalence of limited health literacy in the older adult population. I.D.3. Demonstrate proficiency to interview and counsel older adults with varying degrees of health literacy, cognitive function, and communication abilities. I.F.3. Conduct a medication review to minimize the impact of drug- related falls. II.B.1. Recognize the atypical clinical presentation and progression of common diseases found in older adults. II.B.2. Identify symptoms of drug-induced diseases and geriatric syndromes. II.C.2. Demonstrate the ability to conduct basic cognitive, functional, physical and safety assessments for common disease in the older adult population. II.C.5. Obtain and interpret a comprehensive medication history in relation to an older adult’s current health status. Assess I.C.2. Recognize signs and symptoms of substance and medication misuse/abuse in older adults. I.C.10. Recognize and report the signs of elder abuse/neglect. I.C.12. Consider financial/reimbursement issues (e.g, formularies, insurance coverage) when making therapeutic recommendations. I.C.15. Demonstrate the ability to assess personal misconceptions, generalities and stereotypes which may impact the care of an ethnically, racially and culturally diverse patient population. I.F.3. Conduct a medication review to minimize the impact of drug- related falls. I.E.5. Incorporate life expectancy and end-of-life issues in the decision- making of appropriate use of medications. II.B.1. Recognize the atypical clinical presentation and progression of common diseases found in older adults. II.B.2. Identify symptoms of drug-induced diseases and geriatric syndromes. II.C.3. Assess social and cultural determinants of health outcomes. II.C.4. Apply knowledge of geriatric syndromes and medication-related problems when interpreting assessment results. II.C.5. Obtain and interpret a comprehensive medication history in relation to an older adult’s current health status. II.C.6. Assess a medication regimen for medication-related problems. (e.g., polypharmacy, non-adherence, drug interactions, adverse drug event, underuse, potentially inappropriate prescribing). II.C.7. Appropriately recommend laboratory monitoring and interpret laboratory results for an older adult patient. II.C.9. Identify potential environmental causes of decline in ADL (activities of daily living), IADL (independent activities of daily living) and cognitive function. Return to Table of Contents GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION 45 II.C.10. Develop a problem list and prioritize care based upon severity of illness, patient preference, quality of life, and time to benefit. II.C.11. Identify patients who need referrals to other health and non- health professionals or services. II.C.12. Identify when appropriate to recommend deprescribing in an older adult patient. II.D.1. Define therapeutic goals incorporating patient-specific principles (e.g., age, functionality, patient preference, pharmacogenomics, cultural). II.D.3. Determine therapeutic options and the risk/benefit to the patient (e.g., no treatment, non-pharmacologic interventions, non- prescription medications, complementary and alternative medicine, and prescription medications). III.A.1. Identify reputable sources of information for the care of an older adult patient. III.A.2. Evaluate medication utilization at the system level to ensure safe and effective drug therapy. III.A.4. Evaluate and apply evidence from primary literature as it pertains to the care of older adult patients. III.A.5. Evaluate the relevancy of clinical practice guidelines, standards of care and quality measures related to geriatric care. III.D.1. Develop, implement and assess formulary management/protocols as they pertain to the care of the older adult patient. III.D.2. Demonstrate knowledge of sources and processes of compensation for geriatric pharmacy services. Plan I.C.12. Consider financial/reimbursement issues (e.g, formularies, insurance coverage) when making therapeutic recommendations. I.E.5. Incorporate life expectancy and end-of-life issues in the decision- making of appropriate use of medications. II.C.7. Appropriately recommend and interpret laboratory results for an older adult patient. II.D.1. Define therapeutic goals incorporating patient-specific principles (e.g., age, functionality, patient preference, pharmacogenomics, cultural). II.D.4. Apply principles of pharmacokinetic and pharmacodynamic changes associated with aging to the design of the pharmacotherapy regimen. II.D.5. Design and recommend age/person specific regimen including medication, dose, dosage form, dosing interval, and route of administration. II.D.6. Resolve and/or prevent medication-related problems in a given older adult patient. II.D.7. Optimize a medication regimen to minimize polypharmacy, prescribing cascades, and anticholinergic burden. II.E.1. Develop and implement an older adult person-specific monitoring plan. Return to Table of Contents 46 GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION Implement I.C.3. Identify and manage the social issues of medication use for an older adult’s therapy. I.C.10. Recognize and report the signs of elder abuse/neglect. I.D.3. Demonstrate proficiency to interview and counsel older adults with varying degrees of health literacy, cognitive function, and communication abilities. I.F.2. Counsel an older adult patient on the utility of health screenings and preventive measures. I.F.3. Conduct a comprehensive medication review to minimize the impact of drug-related falls. II.C.2. Demonstrate the ability to conduct basic cognitive, functional, physical and safety assessments for common disease in the older adult population. II.D.6. Resolve and/or prevent medication-related problems in a given older adult patient. II.E.1. Develop and implement an older adult person-specific monitoring plan. II.F.1. Utilize educational material appropriate to the specific patient/caregiver. II.F.2. Ensure understanding of medication use and its role in the overall treatment plan. II.F.3. Educate patient/caregiver regarding potential problems with patient care management and administration of medications. II.F.4. Assist the patient/caregiver in identifying, procuring, and utilizing adherence strategies and devices. II.F.5. Educate interprofessional team members regarding geriatric- specific pharmacotherapy principles. II.G.2. Write an action plan for use by the patient/caregiver. III.C.4. Promote advocacy for geriatric patient care and the pharmacy profession. III.C.5. Demonstrate decision making skills when implementing care for older adults to improve outcomes and quality measures. III.D.1. Develop, implement and assess formulary management/protocols as they pertain to the care of the older adult patient. Follow-up: Monitor and I.D.5. Discuss the physiologic changes of aging and how they impact Evaluate the pharmacokinetic, pharmacodynamics and therapeutic use of medications. II.C.7. Appropriately recommend and interpret laboratory results for an older adult patient. II.E.1. Develop and implement an older adult person-specific monitoring plan. II.E.2. Revise therapeutic plans based upon changes in patient status. Collaborate, Communicate I.D.1. Communicate drug and adherence information to older patients, and Document their caregivers and the interprofessional team. I.D.4. Recognize barriers to effective communication (e.g., cognitive, sensory, cultural, and language). Return to Table of Contents GERIATRIC CURRICULUM GUIDE ­— FOURTH EDITION 47 II.F.5. Educate interprofessional team members regarding geriatric- specific pharmacotherapy principles. II.G.1. Document rationale, actions, and outcomes from medication therapies for the healthcare team. II.G.2. Write an action plan for use by the patient/caregiver. II.G.3. Perform and document comprehensive medication reconciliation across the continuum of care. II.G.4. Acknowledge different systems for documentation and tracking of intervention data which can generate evidence of care. II.F.5. Educate interprofessional team members regarding geriatric- specific pharmacotherapy principles. II.G.1. Document rationale, actions, and outcomes from medication therapies for the healthcare team. II.G.2. Write an action plan for use by the patient/caregiver. II.G.3. Perform and document comprehensive medication reconciliation across the continuum of care. II.G.4. Acknowledge different systems for documentation and tracking of intervention data which can generate evidence of care. III.A.3. Utilize a documentation system to evaluate outcomes of pharmacist intervention. III.B.1. Identify existing and emerging models of practice in geriatric care. III.B.2. Recognize emerging opportunities for geriatric practice. III.B.3. Respect the roles and responsibilities of the pharmacist and other healthcare professionals within the interprofessional team. III.B.4. Discuss board certifications available for pharmacists providing geriatric care (e.g., BCGP, CDE, other advanced training). III.C.1. Identify agencies and organizations integral in the development and enforcement of geriatric public policy. III.C.2. Identify and adhere to site-specific regulations for geriatric care. III.C.3. Develop strategies for keeping up-to-date on regulatory changes and their impact on geriatric care. Citation: Joint Commission of Pharmacy Practitioners. Pharmacists’ Patient Care Process. May 29, 2014. Available at: https://jcpp.net/wp-content/uploads/2016/03/PatientCareProcess-with- supporting-organizations.pdf.

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