Elderly patient receiving pharmacist care in a hospital setting

Is Your Hospital Stay Making You Healthier? How Pharmacists are Key to Elderly Care

Nico Varela in Health & Wellness November 2025 • 5 min read.

"Uncover how hospital pharmacists are revolutionizing elderly inpatient care, reducing medication risks, and improving health outcomes."

As global fertility rates decline and life expectancy increases, the world's elderly population is rapidly growing. This demographic shift brings advancements in medical and pharmaceutical technologies, leading to greater use of healthcare services and medications for chronic and degenerative diseases. By 2025, Brazil is projected to have the sixth-largest elderly population globally, highlighting the urgent need for optimized healthcare strategies.

However, the natural physiological changes that come with aging can significantly impact how medications are processed by the body. This can result in exaggerated or inappropriate responses to medication, or even a complete lack of therapeutic benefit. This has raised widespread concern about the appropriate use of medication in older patients, making it a critical area of focus for healthcare professionals.

One of the key strategies for improving medication use in the elderly is to focus on reducing adverse drug events (ADEs), which can range from unnecessary drug use and inappropriate drug choices to a lack of long-term therapy reassessment. To tackle this, many guides and resources have been developed to help clinicians choose the best therapeutic options. Among these, the Beers List is the most frequently used tool for identifying potentially inappropriate medications for older adults.

The Pharmacist's Role: Reducing Medication Risks in Hospitals

Elderly patient receiving pharmacist care in a hospital setting

Adverse drug events are a significant concern in healthcare, particularly among hospitalized patients. According to research, 1% of all hospital admissions are caused by drug-drug interactions (DDIs), accounting for 16% of all hospital admissions due to adverse drug reactions (ADRs). In the United States, these ADRs lead to increased hospital costs, estimated at around $4,700 per admission, totaling $2 billion annually.

Given these alarming statistics, a study was conducted to assess the impact of hospital admission on improving pharmacotherapy among elderly inpatients. The study focused on potential drug interactions (pDDI), major pDDIs, and the use of potentially inappropriate medications (PIMs) at hospital admission, during hospitalization, and at discharge. The goal was to determine whether hospital admission provides an opportunity to enhance pharmacotherapy for elderly patients in a university hospital with a clinical pharmacist.

Study Design: A prospective cohort study was conducted, utilizing medical records of patients admitted to an internal medicine ward.
Data Collection: All admissions and prescriptions were monitored from March to August 2006.
Identification of Risks: Micromedex® DrugReax® and Beers Criteria 2015 were used to identify pDDI, major pDDI, and PIMs.
Analysis: Admission and discharge prescriptions were compared to assess changes in medication profiles.

The study revealed several significant changes between admission and discharge prescriptions. There was an increase in the proportion of patients using antithrombotic agents (76 vs. 144) and lipid-modifying agents (58 vs. 81). Additionally, there was a rise in the use of drugs for acid-related disorders (99 vs. 152), particularly omeprazole (61 vs. 87). Conversely, there was a decrease in the number of patients prescribed psycholeptics (73 vs. 32) and diazepam (54 vs. 13). Furthermore, the study observed a reduction in the proportion of patients exposed to polypharmacy (16.1% vs. 10.1%), at least one pDDI (44.5% vs. 32.8%), major pDDI (19.9% vs. 12.2%), or PIM (85.8% vs. 51.9%).

The Impact of Clinical Pharmacists on Patient Safety

The study concludes that admission to a hospital ward with a clinical pharmacist is associated with a significant reduction in the number of elderly inpatients exposed to polypharmacy, pDDIs, major pDDIs, and PIMs. This highlights the crucial role of clinical pharmacists in improving medication safety and ensuring better health outcomes for elderly patients. The presence of a clinical pharmacist provides an invaluable opportunity to optimize medication regimens, reduce potential risks, and enhance the overall quality of care for older adults during their hospital stay.

About this Article -

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This article is based on research published under:

DOI-LINK: 10.1590/s1984-82502016000300005, Alternate LINK

Title: Does Hospital Admission Provide An Opportunity For Improving Pharmacotherapy Among Elderly Inpatients?

Subject: General Pharmacology, Toxicology and Pharmaceutics

Journal: Brazilian Journal of Pharmaceutical Sciences

Publisher: FapUNIFESP (SciELO)

Authors: Daniela Oliveira De Melo, Sílvia Storpirtis, Eliane Ribeiro

Published: 2016-09-01

Everything You Need To Know

What are adverse drug events (ADEs), and how does the Beers List help reduce medication risks for the elderly?

Adverse drug events (ADEs) are a big problem for older people, especially in hospitals. They include things like taking drugs that aren't needed, choosing the wrong drugs, or not checking if a medicine is still the right one to use over time. Guides like the Beers List help doctors and pharmacists pick safer medicines for older adults by pointing out drugs that might not be the best choice for them.

How did the study assess the impact of hospital admission on improving medication therapy among elderly inpatients, and what specific tools were used?

The study looked at elderly patients in a hospital. It tracked their medicines when they were admitted, while they were in the hospital, and when they were discharged. The goal was to see if being in the hospital, with a clinical pharmacist involved, could help improve how these patients used their medications. They specifically looked for potential drug interactions (pDDIs), major pDDIs, and potentially inappropriate medications (PIMs) using tools like Micromedex® DrugReax® and the Beers Criteria 2015.

What significant changes in medication profiles were observed between hospital admission and discharge in the study, and what do these changes suggest?

The study found several medication changes during hospitalization. More patients were prescribed antithrombotic and lipid-modifying agents. Also, there was an increase in medications for acid-related disorders, like omeprazole. On the other hand, fewer patients were prescribed psycholeptics and diazepam. Overall, the study showed that fewer patients were exposed to polypharmacy, potential drug interactions (pDDIs), major potential drug interactions, or potentially inappropriate medications (PIMs) when a clinical pharmacist was involved.

What role does a clinical pharmacist play in improving patient safety, and how does their involvement affect elderly inpatients' exposure to potentially harmful medications?

A clinical pharmacist plays a crucial role in improving patient safety, especially for the elderly. By carefully reviewing medications, they can reduce the risks associated with polypharmacy, potential drug interactions (pDDIs), major potential drug interactions, and potentially inappropriate medications (PIMs). This ensures that older patients receive the most appropriate and safe medication therapy, leading to better health outcomes during and after their hospital stay. This highlights their role in optimizing medication regimens and improving the overall quality of care for older adults.

The study shows an increase in certain medication prescriptions during hospitalization. What are the implications of these changes, and how should healthcare providers ensure patient safety in light of these adjustments?

The study mentioned that, from admission to discharge, there was a notable increase in the prescription of antithrombotic agents, lipid-modifying agents, and drugs for acid-related disorders like Omeprazole. This suggests a focus on managing conditions like cardiovascular issues and acid reflux more aggressively during the hospital stay. However, it's important to ensure that these changes are appropriate for each patient, considering their overall health and other medications they are taking, to avoid potential adverse drug events (ADEs).