The Pharmacist's Role in Age-Friendly Mobility

Background The patient is an 85-year-old resident of a skilled nursing facility (SNF) who sustained a hip fracture resulting from a fall. This injury required hip surgery and subsequent admission to a rehabilitation facility for a short-term stay. Her past medical history includes hypertension, type 2 diabetes mellitus, osteoporosis, and depression. Assessment The consultant pharmacist and physical therapist (PT) collaborate to assess the resident's functional abilities, mobility, gait, medications, and mentation using principles of Age-Friendly care. Screening for pain, mobility, frailty, and fall risk are performed to develop a comprehensive care plan for her rehabilitation. The speech-language pathologist (SLP) and occupational therapist (OT) assess and identify restrictions in range of motion, which are addressed through targeted exercises aimed at improving strength, stability, and cognitive function. The pharmacist evaluates the risks and benefits of each medication and, applying the Beers Criteria®, recommends deprescribing those with anticholinergic properties. Outcomes The pharmacist, PT, OT, and SLP components of the comprehensive care plan are implemented and monitored. The resident becomes stronger, more stable, cognitively alert, and better able to participate in her rehabilitation on a daily basis. Despite being frail and at high risk for falls upon admission, the resident undergoes rehabilitation through physical, occupational, and speech-language exercises that improve her gait, strength, and endurance, enhance stability during transitions, and reduce her fall risk. The pharmacist collaborates with the resident's physician to discontinue anticholinergic medications without compromising pain management or sleep quality. Instead of doxepin, a highly anticholinergic antidepressant, the resident is effectively transitioned to escitalopram, resulting in a stable mood. By optimizing her medications, the risk of cognitive decline is mitigated; the resident is able to think more clearly and exhibits less confusion. Conclusion Caring for residents with impaired function and mobility requires a comprehensive assessment and the application of the 4Ms: What Matters, Medication, Mobility, and Mentation. When pharmacists collaborate with other care providers during assessment and care planning, coordinated and successful outcomes can be achieved. Although the resident primarily presented with mobility issues, her case illustrates the interplay of all 4Ms and underscores the importance of a collaborative approach. This patient, whose main concern was mobility, required interventions to optimize medications and address mentation through the treatment of depression, all while maintaining a focus on what matters most to her as an individual.