For pharmacist and researcher Jeannie Lee, PharmD, the journey to a career in geriatric care and research all began with her grandparents, to whom she was very close. Her grandmother struggled with multiple chronic conditions, and towards the end of their lives, both grandparents suffered from dementia.
After graduating from the University of Georgia, College of Pharmacy, Dr. Lee completed residency training at the VA Medical Center in Washington, DC, which highlighted geriatric care. She then worked at the Walter Reed Army Medical Center, where she conducted the ASHP Foundation-funded “Federal Study of Adherence to Medications in the Elderly (FAME) Study” and published the findings in JAMA.
She is now an associate professor at the University of Arizona Colleges of Pharmacy and Medicine and assistant head in the Department of Pharmacy Practice & Science, where she has served as clinical investigator on diverse research studies. Dr. Lee is currently working on the NIH-funded “Chronic Disease Health Beliefs, Medication Adherence, and Health Literacy (RxHL)” with UA Anthropology, and HRSA-funded “National Center for Integrative Primary Healthcare (NCIPH)” with Arizona Center of Integrative Medicine and UA Colleges of Medicine, Nursing, and Public Health. Most recently, her collaboration with UA College of Nursing, “Medication Education, Decision Support, Reminding and Monitoring (MEDSReM),” received funding from NIH.
Given all of this, it might be surprising to learn that, when she was just starting out, Dr. Lee was not dreaming about major research studies and funding from well-recognized sources such as the National Institutes of Health. Initially, she was working at Walter Reed, assisting cardiologist Dr. Allen Taylor on his clinical trial, and enjoying the interprofessional team work and caring for geriatric patients. But when reviewing her clinical notes, one thing kept grabbing her attention: medication nonadherence.
Then she read about the ASHP Foundation Federal Services Junior Investigator Research Grant. “For the first time I thought, ‘This could be my research,’” she recalls. “Dr. Taylor, who cared about patient care as much as I do, agreed to serve as my research mentor, and he was interested in going along with my idea of a medication adherence research study in older adult populations. So the Foundation grant was the first spark to my research flame, which is going strong!”
But in a country where 10,000 people a day turn 65, research is just one way in which Dr. Lee is having a tremendous positive impact on geriatric care. She is also extremely committed to training and mentoring pharmacists, pharmacy students, and other health care professionals about geriatric health care issues. “We live in the age of aging,” she says. “We know that older adults have more chronic conditions and use more medications than any other age group, but we currently don’t have enough health care professionals trained in geriatric care. The Institute of Medicine published a report in 2008 that revealed less than 1 percent of health care professionals, including physicians, nurses, and pharmacists, were trained to care for the aging population.”
Collaboration is crucial to providing the best health care for older patients, and pharmacists should push to be included on interprofessional teams caring for older adults. “Be involved and be present at the table when decisions are being made about the patient care process,” she says. “We need to bring our medication expert point of view across to the team. Sometimes we’re invited a little bit late or too late, so we really need to advocate for our profession. We are the medication experts, and anything to do with medication use and patient care should involve a pharmacist’s perspective.”
And don’t be afraid to speak up, says Dr. Lee: “Many times, I’ve been involved with a team where I am the only pharmacist, and people are really surprised to find out what I know, the different ways to ask questions, and the innovative ways to solve a problem from a pharmacist’s perspective.”
In particular, says Dr. Lee, pharmacists can improve health care for older adults in several critical areas: Polypharmacy management, chronic disease management, and care transitions. “As medication experts, no other professionals are better trained than pharmacists to deal with polypharmacy, and to be able to detect, solve, and prevent medication-related problems,” she states.
“Most chronic diseases are managed predominantly with medications, and with the knowledge about the pharmacology of aging, along with pharmacotherapeutics and pharmacokinetics, and medicinal chemistry and pharmacology, we can really impact optimal drug selection and monitoring.
“Finally, transition points are where older patients become most vulnerable to medication misadventures, so medication reconciliation and comprehensive review, and—most importantly—education, are key differences pharmacists can make. Research still shows that pharmacists are not talking to and educating patients often enough. But the studies also show that when pharmacists do educate older patients, their knowledge and outcomes improve. Such evidence should propel us to make every effort to educate our patients all the time.”
More than anything else, Dr. Lee’s dedication to collaboration and sharing her pharmacy knowledge has led to her involvement on major research projects such as “Geriatric Patient Care by U.S. Pharmacists in Healthcare Teams” and “Demonstrating Pharmacists’ Impact as Team Member on Therapeutic, Safety, Humanistic, and Economic Health Outcomes.” “It’s really about working within teams that dream the same dreams you do and really care about patient care,” she says.
It’s easy to see why she was named 2015 Geriatrician of the Year by the Arizona Geriatrics Society. “I hope that people and patients are better listened to, cared for, and valued because of my teaching, research, and service.”
For any pharmacist thinking about embarking on a research study, Dr. Lee offers this advice: “Find a great mentor who can guide you, a collaborative research team to have fun with, and never give up finding creative solutions to problems, new and old.”
And, she urges, apply for an ASHP Foundation research grant: “It is an opportunity for health-system pharmacists to explore innovative approaches to answering practice-based and patient care-realted questions. I’d like to encourage practicing pharmacists in all health care settings: Just think about a patient care-related question that always comes up and see if you can formulate an innovative solution to that question, then go for that research grant!”
The Top Three Improvements Needed in Geriatric Health care
Dr. Lee believes there are three improvements that are most necessary in health care for older adults, and pharmacists can play a vital role in all three of these areas:
- Safe medication prescribing and use. “Though I am absolutely passionate about medication adherence, we need to ensure that patients are adhering to the most optimal regimen for their conditions. The record number of medications one of my patients had in their possession is 52, and I was thankful that she was not adhering to all of those medications! Outside of prescription medications, older people use a lot of over-the-counter products or supplements, so simplifying complex regimens and de-prescribing high-risk medications is one of my priorities.”
- Person-centered care: “I believe for older patients, establishing their goals of care and focusing their preferences for treatment is more important than treating every ailment and overprescribing medications to save every organ. Older people see a lot of specialists, so overprescribing can easily occur. Cardiologists want to save the heart; nephrologists want to save the kidneys. But I think a patient’s values and wishes should be explored to support a meaningful life and end, and the focus should not be just on their organs.”
- Interprofessional and integrative health care: “Interprofessional collaboration is important in all health care practices, but especially when caring for older adults with multiple conditions. Because elders are more susceptible to adverse medication effects, drug interactions, and nonadherence, integrative approaches for non-pharmacological solutions to physical and mental health issues is wise. For example, a sleeping medication may increase a patient’s total sleep by about 15 minutes but also places them at increased risk for confusion, cognitive impairment, falls, and accidents. It would be much safer for those patients to engage in relaxation therapy, sleep hygiene, tai chi, and acupuncture–which all have supporting evidence–than going for a sleeping pill.”
Article originally published on the ASHP Foundation Website. Photo: Dr. Jeanie Lee is pictured on the far right.