A Pharmacist’s Role in Addressing the Burden of OAB Among Older Adults

Chad Worz, PharmD, BCGP, chief executive, ASCP, discusses the prevalence of polypharmacy among older adults with overactive bladder and the role pharmacists play in the care team to reduce the burden.

This interview is part of the series,"Navigating Clinical Challenges, Improving Care for Patients With Overactive Bladder."

Read the full transcript:

Welcome back to PopHealth Perspectives, a conversation with the Population Health Learning Network, where we combine expert commentary and exclusive insight into key issues in population health management and more.

In this episode, we discussed the prevalence of polypharmacy among older adults with overactive bladder and the role pharmacists play in the care team to reduce the burden. Dr Worz?

Hi, I'm Chad Worz. I'm a pharmacist. I've been a long-term care pharmacist for over 20 years. I'm a PharmD and a board-certified geriatric pharmacist. I am the chief executive of the American Society of Consultant Pharmacists, which services 5000 pharmacists and pharmacies across the country in the long-term care space.

Great, thank you. My first question—older adult populations are experiencing increasing rates of polypharmacy and anticholinergic burden, particularly those with overactive bladder or urinary incontinence. Can you discuss the risks these present for this patient population?

Absolutely. I think overactive bladder is, first of all, one of the most common issues that affects our older adult population and it's something that crosses the different activities of their daily life. Worrying about where a bathroom is or having an accident is probably one of the scariest things that I think people can think about.

In terms of being able to treat it and have options, it's something that is very patient motivating. People want to be able to manage their condition and manage it in a way that gives them their freedom back. It's particularly important that we apply medications and treatments to them that fit their particular age group and their particular individual characteristics.

I think if we look at the past and some of the agents that we've used in the past, they've created some problems for this population. They are not agents that work well with aging people. They cause some side effects that can be problematic for older adults. Some of the newer medications don't have that. They're a different class and they don't carry some of the anticholinergic properties, some of the risk for falls, some of the fogginess that can occur with some of the anticholinergic drugs. They're ultimately better choices and when you're dealing with older adults, that's really the key factor.

You've got an older adult predominantly on multiple medications, a polypharmacy situation, so it's important to tease out which medications are going to work well with their other medications and which medications are going to work well with their particular body, at its particular age. I think sometimes we lose sight of that.

Thank you. So my next question, you actually touched on a bit, but if you want to expand upon it, what is uniquely challenging about caring for the growing older adult population?

Well, the older adult population is challenging. I think that most of us probably feel like we are 20 years younger than we are, on an average basis. So I think when you think about medications, some people that have been on medications for a long time, feel like, "Oh, I've been on this drug for a long time at this particular dose. It's always worked for me." But they're not taking note of the fact that their body has changed. Their metabolism has changed. Their kidney function has changed over time.

We must be cognizant and make adjustments to medications. As people get older, sometimes that's not intuitive and sometimes people don't understand those facets of growing old. Sometimes it means that we've got to change medications to one that isn't quite as caustic to an older body than a younger body.

And again, I think intuitively most of us don't think in those terms, but we have to think in those terms, when we're treating older adults to keep them safe.

What current initiatives exist to reduce polypharmacy and inappropriate medication use in post-acute and long-term care settings?

I think appropriately as health care professionals look at the aging population, we have 57 million people over the age of 65 today. In seven years—by 2030—we're going to have 77 million people. That's 20 million more people in that age group over the age of 65.

So the challenge is making sure that we stay up to date on the current ways that we manage and help people that are in that age group, because we're going to be dealing with a lot of individuals with polypharmacy issues, with comorbidities, with conditions that require medications.

We have to get better at making sure that we put the right drug regimen together for that person and that takes a degree of skill. It takes a degree of knowledge about, again, the aging body and about the medications that are available.

Thank you. What role can pharmacists play in reducing these burdens and improving outcomes?

Well, certainly as a pharmacist and as a board-certified geriatric pharmacist, I think we play a central role. Pharmacists are particularly skilled with looking at somebody's medication profile and finding ways to make it more efficient and make it safer, while not sacrificing the benefits or even amplifying the benefits that those medications are providing.

I think pharmacists today are different, maybe, than the general perception. Pharmacists are looking at ways of reducing medication burden, which oftentimes is finding a medication that's a culprit in creating side effects that require additional medications. A good pharmacist that understands the individual that they're taking care of and the medications that they're on, can probably help reduce the burden of medications by picking ones that are safer, that don't cause as many side effects and ultimately are better for that patient's quality of life. So I think pharmacists are particularly tooled and skilled to really help as this population ages.

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