Background: COVID-19 disproportionately affects older adults, placing residents of closed-community settings, such as long-term care facilities (LTCFs), at increased risk for severe illness and death. Objective: To describe the epidemiology and healthcare resource utilization associated with acute COVID-19 in LTCFs in the United States during Omicron variant predominance. Data Sources: MEDLINE and Embase databases were searched on January 15, 2025 for full-text citations published on or after January 1, 2022. Conference abstracts from long-term care conferences in 2023 and 2024 were hand-searched. Records were included if they described acute COVID-19 in LTCFs (nursing homes, assisted living facilities, or Veterans Affairs Community Living Centers). Records were excluded if they were conducted outside the United States, published in languages other than English, focused on long COVID, did not include data from the Omicron predominance period (beginning November 1, 2021), or were clinical trials, case reports/case series, narrative reviews, editorials, or commentaries. Data Synthesis: Forty-three articles met the inclusion criteria, most of which reported COVID-19 cases (20 studies), mortality (18 studies), and/or healthcare resource utilization (11 studies). Although all studies included COVID-19 data during the Omicron period, most also included earlier periods during which other COVID-19 variants were predominant. In the United States, weekly incidence rates for COVID-19 infections and hospitalizations among nursing home residents ranged from 614 to 1338 and from 38 to 71 per 1,000 residents, respectively. Approximately 1 in 6 COVID-19 hospitalizations occurred among LTCF residents. Compared with community-dwelling individuals, mortality was 4.6-fold higher among LTCF residents. Conclusion: COVID-19 in LTCFs was associated with high rates of hospitalization and mortality among residents, including vaccinated individuals, during the study period.
Background: Sickle cell disease (SCD) is a hematologic disorder that affects approximately 100,000 Black individuals in the United States. Although extensive literature describes fall risk factors in adults 65 years and older, evidence regarding fall risk in older adults with SCD remains limited and largely anecdotal. Risk factors for falls in adults aged 50 years and older with SCD overlap with those observed in the general geriatric population aged 65 years and older. Objective: The objective of this study was to describe factors associated with increased fall risk in older patients with SCD. Data Sources: A literature search of PubMed and MEDLINE was performed using the following search terms: "sickle cell disease", "falls", "risk factors", "older adults", "management," and "prevention," as well as combinations of these terms. Data Synthesis: Fifteen studies were identified. Reduced physical functioning, dizziness/imbalance, cognitive impairment, visual deficits, vitamin D deficiency, osteoporosis, polypharmacy, and silent cerebral ischemia (SCI) were identified as risk factors for SCD-related falls. Discussion: Fall risk factors, prevention, and management strategies in patients are understudied and complex. Fall-prevention strategies used for older adults are also important for patients with SCD. Conclusion: Falls in older adults with SCD appear to reflect a convergence of neuromusculoskeletal complications, sensory deficits, cognitive vulnerability, and medication-related effects; however, the evidence base remains limited, and SCD-specific guidance is lacking. Clinicians should evaluate older adults with SCD for the aforementioned fall risk factors.
Purpose: Bloodstream infections (BSIs) require prompt, targeted antimicrobial therapy, but traditional blood culture methods may delay optimal treatment. The BIOFIRE® Blood Culture Identification 2 (BCID2) panel provides rapid pathogen identification and mayreduce time to targeted therapy. This study evaluated the impact of BCID2 implementation at a community teaching hospital. Methods: A retrospective, quasi-experimental pre/post study was conducted at a for-profit community teaching hospital in adults aged ≥18 years with BSIs. Eligible patients had bacteremia, blood cultures collected, and empiric antibiotic therapy initiated during the study periods. Exclusion criteria included pregnancy, detection of multiple pathogens in a single culture, availability of susceptibility results before the designated timeline, and discharge, transfer, or leaving against medical advice before completion of testing. The pre-implementation group included 64 patients (October-December 2023), and the postimplementation group included 60 patients (October 2024-February 2025). The primary outcome was time from blood culture collection to initiation of targeted antibiotic therapy based on final susceptibility results. Secondary outcomes included pathogen identification, empiric and total antibiotic use, and length of stay. Results: The study included 124 patients (mean age, 70.5 ± 17.3 years; 67% ≥65 years; 50% male). Blood cultures were ordered for suspected sepsis/septic shock in 58% of patients and suspected secondary bacteremia in 42%. Pathogen distribution was similar between groups, with Escherichia coli, Staphylococcus epidermidis, Enterococcus faecalis, and Staphylococcus aureus identified most frequently. BCID2 implementation significantly reduced time to optimal therapy (3.73 ± 2.01 vs. 2.02 ± 1.48 days, p<0.001) and empiric antibiotic duration (3.73 ± 2.01 vs. 2.04 ± 1.48 days, p < 0.001). Total antibiotic duration and length of stay did not differ significantly between groups. Conclusion: BCID2 implementation at a community hospital significantly shortened time to optimal therapy and reduced empiric antibiotic use among older hospitalized adults.
Background: Community-dwelling older adults often have chronic conditions and take multiple medications, leading to an increased risk of medication-related problems. The recent global pandemic further intensified challenges associated with polypharmacy, particularly among African Americans aged 65 years and older.1 Objective: This pilot study explored participant perceptions of digital health technologies used in combination with pharmacist-led telehealth medication therapy management (MTM) services to support medication management and address medication-related problems among community-dwelling older African American adults. Methods: This six-month study evaluated perceptions of technology use among older adults (≥65 years) in Houston, Texas, who were taking five or more medications and owned a smart device (smartphone, tablet, or computer). Interventions included pre- and post-surveys, use of a medication management app (Pill Reminder - All in One®), and completion of two one-hour pharmacist-led MTM sessions. Baseline pre-survey data were compared with post-survey data collected at a six-month follow-up. The Texas Southern University Institutional Review Board approved the study (U54MD007605). Results: Significant improvements were observed in self-reported medication knowledge (pre: 2.75 ± 0.64 vs post: 3.35 ± 0.55, p < 0.001) and perceived pharmacist responsiveness (pre: 3.82 ± 0.71 vs post: 4.48 ± 0.59, p < 0.001). Participation in virtual MTM increased from 15.0% at baseline to 85.0% post-intervention (p < 0.001). The proportion of participants reporting forgetting medications declined significantly from 73.8% to 44.1% (p = 0.01). Use of health technology increased from 13.6% to 67.6% following the intervention (p < 0.001). The sample population was predominately female (87.5%) and majority African American (92.5%). Conclusion: The authors conclude that digital health applications offer a promising avenue to address nonadherence and medication-related problems in community-dwelling older adults. These tools can provide flexible solutions tailored to individual patient needs, ranging from simple reminder tools to comprehensive medication management platforms.
Background: Medication adherence among older adults with cognitive impairment is a major challenge in home care and often results in frequent in-person visits for reminders or medication administration. While digital reminder tools show promise, evidence supporting their integration into routine home care practice remains limited. In publicly funded home care services, medication-related visits are resourceintensive and increasingly difficult to sustain amid workforce constraints, making the identification of safe and scalable alternatives a growing priority. Methods: A quality improvement pilot project was conducted within a publicly funded home care program in Quebec, Canada. A smart clock was implemented to deliver cognitively accessible medication reminders and enable remote confirmation of intake. The technology was integrated into existing clinical workflows through nursing assessment, structured installation, user and caregiver training, and ongoing monitoring. Descriptive quantitative measures assessed device use, substitution of in-home visits, user experience and safety, and a preliminary break-even cost analysis. Results: Forty-eight older adults received the smart clock. Thirty-five participants (72.9%) were considered successful, defined as maintaining accurate medication intake. Use of the smart clock was associated with 6,276 avoided medication-related home visits across the pilot and time savings of 39.6 minutes of home care staff time per device per day. No major medicationrelated safety events were observed. Conclusion: This pilot suggests that a clinically integrated, cognitively accessible digital intervention can support the safe substitution of medicationrelated home visits. Findings highlight the importance of interdisciplinary collaboration and implementation practices in developing sustainable technology-enabled home care models.
Background: Older adults with chronic obstructive pulmonary disease (COPD) often experience physical and cognitive changes that complicate diagnosis, medication administration, and management of multiple comorbidities. Clinical assessment is further challenged when tools are not adapted to a patient's level of care, cognitive status, or ambulatory function. The L-mMRC is a novel tool developed by consultant pharmacists in collaboration with skilled nursing facility (SNF) registered nurses. It incorporates long-term care resident self-performance codes for ambulation to provide population-specific COPD staging. Objective: To assess patient COPD ABE GOLD classification using the L-mMRC compared with the mMRC tool or COPD Assessment Test (CAT) score. Methods: This study evaluated the accuracy of the L-mMRC tool in staging COPD among patients in the SNF setting. Participants were SNF residents aged ≥ 65 years with an active COPD diagnosis. Patients with a concurrent diagnosis of asthma or those receiving hospice care were excluded. The primary outcome was the agreement of L-mMRC classifications with mMRC or CAT scores for GOLD staging. Results: Of 283 patients reviewed, 243 met inclusion criteria. The majority of participants were female (68.7%), with a mean age of 79 years. Residents were prescribed between 0 and 6 respiratory medications (mean = 1.2). The mean L-mMRC and CAT scores were 3.04 and 13.17, respectively. Conclusion: Due to the limited availability of baseline CAT and mMRC scores in patient documentation, further evaluation of baseline respiratory status by a pulmonologist or respiratory therapist is needed to validate the accuracy of the L-mMRC tool. These findings also highlight a critical gap in COPD-related care among older adults.
Alzheimer's disease (AD) is a progressive neurodegenerative disorder marked by cognitive decline and functional impairment, primarily driven by the accumulation of amyloid-beta (Aβ) plaques and tau tangles. Historically, treatments have focused on symptomatic relief; however, recent therapeutic advances have focused on disease-modifying monoclonal antibodies (mAbs), notably lecanemab and donanemab, which target Aβ pathology in early-stage AD. This review explores the clinical efficacy, safety profile, and limitations of lecanemab and donanemab, emphasizing key findings from the CLARITY-AD and TRAILBLAZER-ALZ 2 trials. In these studies, lecanemab was shown to slow cognitive decline by 27% over 18 months, while donanemab achieved a 28.9% reduction over 76 weeks, with the greatest benefits observed in patients presenting with lower baseline tau pathology.Despite these promising outcomes, challenges remain, including possible reduced efficacy in women based on subgroup analyses of trial data, racial disparities in trial representation, adverse effects such as amyloid-related imaging abnormalities (ARIA), and substantial cost and accessibility barriers. This review underscores the need for more inclusive research, personalized treatment strategies, and continued exploration of AD's complex pathology beyond amyloid clearance.
Background: This case study reviews the use of glucagon-like peptide-1 receptor agonists (GLP-1 RA) for weight management in older adults. A 69-year-old male patient discusses weight loss goals with his health care provider and seeks pharmacotherapy options in addition to lifestyle modifications. His medical history includes type 2 diabetes mellitus (T2D), coronary artery disease (CAD), prior coronary artery bypass graft, heart failure with reduced ejection fraction (HFrEF), hypertension, hyperlipidemia, and allergic rhinitis. He initiated weight loss efforts following a myocardial infarction; however, dietary and physical activity changes alone have not resulted in substantial weight reduction. Assessment: This patient is an appropriate candidate for GLP-1 RA therapy given his T2D, obesity, CAD, and a recent elevation in serum creatinine (SCr). The patient will initiate semaglutide, a medication approved for weight management with demonstrated cardiovascular benefit. The dose will be titrated to a maintenance dose of 2 mg once weekly, with ongoing monitoring of tolerability and weight loss.Given his age, there is concern for sarcopenia associated with excessive weight loss. The patient will be advised to maintain a balanced diet with an emphasis on protein intake and to engage in regular physical activity to minimize loss of muscle mass. Outcome: The patient experiences weight reduction within the first few weeks of therapy and tolerates treatment well. He has incorporated additional strength training into his exercise routine and increased his intake of vegetables and protein. The patient has insurance coverage for semaglutide due to his comorbid T2D; therefore, medication cost is not a barrier to treatment. Conclusion: When evaluating the use of GLP-1 RA agents in older adults, these agents demonstrate benefits beyond glycemic control and weight loss, including cardiovascular and renal outcomes. However, GLP-1 RA-associated weight loss may contribute to muscle loss, which is of particular concern in older adults who are at risk for frailty or falls. Patients receiving GLP-1 RA therapy should be encouraged to maintain adequate protein intake and engage in regular physical activity, particularly resistance training, to preserve muscle mass. Additionally, the high cost of GLP-1 RA agents may limit access for patients without insurance.
Antimicrobial resistance remains a leading global health threat, often exacerbated by inappropriate antibiotic use, particularly among the growing population of older adults. This commentary highlights the urgent need for geriatric-focused antimicrobial stewardship programs that balance efficacy, safety, and resistance mitigation. Age-related physiological changes, multimorbidity, and polypharmacy significantly increase the risk of antibiotic-associated adverse effects and drug interactions in older adults. Key challenges include inaccurate estimation of renal function and hypoalbuminemia, which alter antibiotic pharmacokinetics, as well as inappropriate treatment of asymptomatic bacteriuria and increased susceptibility to Clostridioides difficile infection. Clinical complexities such as prosthetic joint infections and antibiotic-induced neurotoxicity further underscore the need for individualized dosing regimens and vigilant monitoring. Certain antimicrobial classes, including fluoroquinolones, and specific agents such as trimethoprim/sulfamethoxazole and rifampin, require particular caution because of their potential for serious toxicities and drug interactions in this population. Pharmacists play a central role in optimizing antibiotic selection, dosing, and monitoring across care settings. Expanding their leadership in antimicrobial stewardship programs is critical to improving outcomes and minimizing preventable harm. Strengthening antimicrobial stewardship requires targeted policies and outcomes-driven research to identify best practices that effectively reduce adverse events. As the aging population continues to grow, it is imperative that pharmacists in geriatric and long-term care settings develop and implement robust antimicrobial stewardship programs that prioritize safety across the continuum of geriatric care.
Pharmacists are poised to play a continued, and likely expanded, pivotal role in immunization advocacy, selection, and administration. As trusted healthcare professionals, pharmacists can address hesitancy by using evidencebased communication strategies such as motivational interviewing to explore concerns, build trust, and guide patients toward informed decisions.
