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PSAP 2025 Book 2 (Geriatrics)

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The management of effective pharmacotherapy for older adults requires a nuanced understanding of age-related physiologic changes, multimorbidity, and polypharmacy to optimize outcomes while minimizing the risks of medications. Geriatrics, the latest release in ACCP’s popular Pharmacotherapy Self-Assessment Program (PSAP), provides evidence-based strategies and clinical insights to enhance medication management across diverse care settings. The target audience for PSAP 2025 Book 2 (Geriatrics) includes geriatric pharmacotherapy specialists and advanced-level clinical pharmacists providing care for older adults with common health conditions associated with aging, especially as it relates to goals of care and end-of-life care considerations.

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Geriatrics contains eight learning activities offering a total of 16.0 available continuing pharmacy education (CPE) credits. Each learning activity may be taken individually for CPE credit. The book content was developed under the leadership of Mary Barna Bridgeman, Pharm.D., FCCP, BCPS, BCGP, Clinical Professor, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey and Internal Medicine Clinical Specialist, Robert Wood Johnson University Hospital, New Brunswick, New Jersey.

Continuing education activities in PSAP cover the most recent published data (past 3–5 years) on a specific therapeutic area or patient-care problem. Learning content is provided as an electronic book (interactive PDF) with high-level updates in up to three formats, as appropriate to the topic:

Traditional chapters review the latest published evidence on a therapeutic or practice-related topic
Case series deliver learning content in sections, with each section bookended by a sample case and its explained answer
Recorded webcasts provide learning content as a PowerPoint presentation, accessed as an MP4 file as well as a PDF of slides and transcribed narrative

Every PSAP release comes in two full-color online formats: (1) interactive PDFs you can save to your desktop or print; and (2) an e-media version you can view on an e-reader, tablet, iOS or Android smart phone. Learning elements are also provided in audio form (MP3 files) as the popular PSAP Audio Companion. For an additional fee, a limited number of one-color softbound print books can be added to these formats and shipped to your address.

All PSAP chapters are fully referenced, with clickable hyperlinks to literature compilers such as PubMed. Other links provide ready access to clinical practice guidelines, official recommendations, and patient assessment tools. Graphic features focus on pivotal studies, patient care scenarios, and take-home points that can be readily integrated into clinical practice.

Publisher: ACCP, 200 pages, May 2025; ISBN-13s: 978-1-964074-18-4 (print); 978-1-964074-19-1 (eBook)

Release Date: May 15, 2025
BCPS Deadline: November 14, 2025

ACPE Deadline: May 15, 2028

MORE PRODUCTS IN THIS SERIES

Chapter: Osteoporosis

Osteoporosis is a pervasive skeletal disorder characterized by decreased bone density and structural deterioration of bone tissue, predisposing individuals to bone fragility and fractures. The disease is a major public health concern because of its prevalence, affecting an estimated 500 million people globally, contributing to significant morbidity, mortality, and health care costs (International Osteoporosis Foundation [IOF] 2023). In the United States, an estimated 10 million people older than 50 years have osteoporosis, about 2 million of whom are men (Healthy People 2030 2025).

Chapter: Parkinson's Disease

Parkinson disease (PD) is a progressive neurodegenerative disorder most commonly known for its characteristic motor symptoms (eg, tremor, rigidity, and bradykinesia) and complex pharmacologic management. With almost 1 million people living with PD in the United States and an estimated 10 million people worldwide, PD is the second most common neurodegenerative disorder (Hayes 2019). The median age of diagnosis is 60 years, with men diagnosed 1.5 times more often and about 2 years earlier than women (Marras 2018; Haaxma 2007). Although the exact pathology of PD is unknown, current theories include inflammation, mitochondrial dysfunction, oxidative stress, and abnormal protein handling leading to neuronal loss and decreased dopamine in the substantia nigra. Lewy bodies and eosinophilic cytoplasmic inclusion bodies containing α-synuclein are also common in patients with PD, which can contribute to nonmotor manifestations of PD such as cognitive impairment, hallucinations, and declining executive function (Hayes 2019; Kouli 2018).

Chapter: Gout

Gout is a form of inflammatory arthritis caused by the accumulation of uric acid crystals, known as monosodium urate (MSU) crystals, in the joints. Uric acid serves no known physiologic purpose and is the final metabolic product of purine breakdown, a process that occurs in the liver. Purines are nitrogen-containing compounds found in the DNA and RNA of cells, as well as in many foods such as red meats, seafood, and certain alcoholic beverages. Normally, uric acid is eliminated primarily through the kidneys, with a smaller proportion excreted through the GI tract. Under typical physiologic conditions, normal serum uric acid (SUA) concentrations are 2 to 6.5 mg/dL in women and 3.5 to 7.2 mg/dL in men. Hyperuricemia refers to the condition in which uric acid concentrations increase above these thresholds. Hyperuricemia may develop because of increased production of uric acid, decreased excretion of uric acid, or a combination of both.

Chapter: Osteoarthritis

Osteoarthritis (OA) is the most common form of arthritis and affects about 33 million adults in the United States. Downstream effects of OA can lead to cartilage, bone, and joint tissue wearing away and can negatively impact activities of daily living and quality of life (QoL) (CDC 2024). Given the large population of people with OA, pharmacists should be prepared to counsel patients on strategies to prevent disease onset and to recommend pharmacologic and nonpharmacologic options for management of OA. Although the available pharmacologic treatment options for OA do not reduce disease progression, these medications can reduce symptom burden. These treatment options are used in an older adult population that experiences physiological changes affecting the pharmacokinetic or pharmacodynamic drug profiles. Pharmacists must be aware of where to find practice resources and how to use medications safely, as well as how to stay current on the most safe and effective drug and nonpharmacologic treatment options.

Recorded Webcast: Deprescribing in the Older Adult

Deprescribing, which we will discuss today, is a process that is appropriate for any age group or population. Good prescribing involves deprescribing. However, for this lecture I will be specifically discussing how to approach deprescribing in the Older Adult.

Chapter: Palliative and End-of-Life Care

When an individual is diagnosed with a life-limiting or terminal disease, there is often a desire to shift the focus of care goals from quantity of life to quality of life. Depending on estimated life expectancy, two models of care are designed to make this transition possible. The terms palliative care and hospice care are often used interchangeably by all people involved, including patients, caregivers, and health care providers. Unfortunately, this approach may limit the use of both services based on a misconception of hospice as being for patients who are actively dying. The core difference between the two services is that hospice is specifically for those with a predicted life expectancy of less than 6 months, whereas palliative care can be provided to any patient with a life-limiting illness, regardless of prognosis. In a qualitative study aimed to discern what older adults know about hospice, the service is often described as providing comfort, supportive care, medical care, and pain support, with an emphasis on family. The primary misconception was that hospice occurs in the hospital or away from home (Brereton 2022).

Chapter: Immunizations in Older Adults

As a result of the Baby Boom generation (birth year 1946 to 1964), the United States is faced with a growing population of older adults. In 2023, 17.5% of the US population was older than 65 years (US Census Bureau 2023). Because of age-related changes in the immune system, known as immunosenescence, older adults have increased susceptibility to infection and are at higher risk for infection-related complications, including hospitalization and death, compared with the general population. A growing number of vaccine recommendations are targeted towards preventing infection-related morbidity and mortality in older adults. This chapter provides an overview of the etiology, available vaccine products, and recommendations for vaccination in older adults for the following vaccine-preventable diseases: influenza, coronavirus disease 2019 (COVID-19), respiratory syncytial virus (RSV), Streptococcus pneumoniae, herpes zoster (HZ), and hepatitis B virus (HBV).

Chapter: Transitions of Care

The WHO defines a care transition as points where patients move to or return from a location where they contact a health care professional to receive care (WHO 2016). The American Geriatrics Society definition of care transitions expands on the WHO definition to include patient movement between different levels of care within the same location (Coleman 2003). A care transition differs from a handoff in that it involves a change in the patient's location or care team, whereas a handoff occurs within the same location with providers exchanging standardized information based on clinical responsibilities (for example, during a nursing shift change). Care in the context of transition for the older adult requires pharmacists to have not only a deep knowledge of chronic care management but also an understanding of patient goals, means of engaging patients and caregivers with education, and familiarity with multiple logistical arrangements related to diverse care locations.

*Content Matter Expert

Faculty

	Marissa Salvo, Pharm.D., FCCP, BCACP Associate Clinical Professor University of Connecticut School of Pharmacy
	Christina Polomoff, Pharm.D., BCACP, BCGP University of Connecticut

Reviewers

Mary L. Wagner, Pharm.D.
Associate Professor Rutgers

Carol Heunisch, Pharm.D., BCCP, BCPS
NorthShore University HealthSystem

Diane Gutgsell, Pharm.D., BCPS, BC-ADM

Faculty

Jessica A. Bente, Pharm.D., BCGP, BCPS
Geriatrics Clinical Pharmacy Specialist
PGY2 Geriatric Pharmacy Residency Program Director
Saint Barnabas Medical Center
Livingston, New Jersey

Reviewers

Laura Meyer, Pharm.D., BCPS
Clinical Assistant Professor University of Illinois at Chicago College of Pharmacy

Michelle Maynard, Pharm.D., BCPS
Clinical Pharmacist Froedtert & the Medical College of Wisconsin Neurosciences Clinic

Megan Farrell, BCPS

Faculty

	M. Thomas Bateman, Jr., Pharm.D., BCACP Pharmacist Ernest Mario School of Pharmacy at Rutgers, The State University of New Jersey
	Caitlin McCarthy, Pharm.D., BCPP Clinical Assistant Professor, Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, the State University of New Jersey, New Brunswick, New Jersey

Reviewers

Tasha Woodall, Pharm.D., BCGP
Co-Director, MAHEC Center for Healthy Aging Mountain Area Health Education Center

Alifiya Hyderi, Pharm.D., MBA, BCPS

Faculty

Ryan C. Costantino, Pharm.D., BCGP, BCPS
Pharmacist US Army

Reviewers

Chanel Whittaker, Pharm.D.
Associate Professor University of Maryland School of Pharmacy

AHMAD EL OUWEINI, BCPS

Jennifer A. Szwak, Pharm.D., FCCP, BCPS
Clinical Pharmacy Specialist - Internal Medicine The Johns Hopkins Hospital

Faculty

Rebecca Mahan, Pharm.D., BCGP
Assistant Professor of Pharmacy Practice, Geriatrics Division TTUHSC SOP

Reviewers

Nicole Genovese, BCGP

Kala Squires, Pharm.D., BCPS

Jessica B. Emshoff, Pharm.D., BCGP, BCPS
Pharmacotherapy Specialist Palliative Care Northeast Ohio Medical University, University Hospitals Portage Medical Center

Faculty

Kaitlyn Rivard, BCIDP

Reviewers

Michael R. Brodeur, Pharm.D.

Josh Mosteller

Thomas S. Achey, Pharm.D., BCPS
Manager, Inpatient Pharmacy Services MUSC Health University Medical Center

Faculty

Julie B. Cooper, Pharm.D., BCCP, BCPS
Associate Professor High Point University School of Pharmacy

Reviewers

Maria Shin, Pharm.D., BCGP, BCPS
Clinical Pharmacy Specialist in Internal Medicine Robley Rex Louisville Veterans Affairs Medical Center

Hailey P. Soni, Pharm.D., BCPS
Clinical Pharmacist University of Illinois Chicago - College of Pharmacy

Ashley Heil, Pharm.D., BCOP, BCPS
Hematology/Oncology Clinical Pharmacist Specialist, Avera McKennan Hospital & University Health Center

The American College of Clinical Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

The American College of Clinical Pharmacy is approved by BPS as a provider for the recertification of BCPS.

BPS is an autonomous division of the American Pharmacists Association. To maintain its strict, independent standards for certification, BPS does NOT endorse or provide review information, preparatory courses, or study guides for board certification examinations. BPS, through its specialty councils, is responsible for specialty examination content, administration, scoring, and all other aspects of its certification programs. BPS is totally separate and distinct from ACCP. For information about BPS specialty recertification the BPS recertification process, go to: www.bpsweb.org/

To receive recertification credit, posttests must be submitted prior to the recertification posttest deadline (see above). Only completed tests are eligible for credit; no partial or incomplete tests will be processed. You may complete one or all available posttests for credit.

The passing point to earn recertification credit is based on an expert analysis of the assessment items in each posttest. Any posttest submitted before the recertification test deadline that meets this passing point will earn recertification credits. These credits will be assigned as of the date of test submission and reported within 48 hours to BPS. For statements of recertification credit, visit www.bpsweb.org.

In accordance with BPS guidelines concerning remediation for products launched in 2024 and after, posttests that do not reach the passing point for recertification credit will generate a second-chance test option. This test will automatically appear in the learner’s My Account page and will have assessment items presented in a different order. To qualify for recertification credit, the second-chance test must be submitted before the recertification deadline stated above.

The ACCP Recertification Dashboard is a free online tool that can track recertification credits as they are earned through ACCP and schedule new opportunities for credits from upcoming ACCP professional development programs. Questions regarding the number of hours required for recertification should be directed to BPS at www.bpsweb.org.

Target Audience: BCPS

Chapter: Osteoporosis Activity Number: 0217-0000-25-065-H01-P Contact Hour(s): 2.50 Activity Type: Application BasedLearning Objectives 1. Evaluate risk factors for osteoporosis and recommend prevention strategies. 2. Distinguish differences among guideline recommendations for screening and treatment of osteoporosis in men and women. 3. Assess pharmacotherapy options for osteoporosis prevention and treatment in both men and women. 4. Develop a patient-specific osteoporosis treatment plan, including appropriate monitoring to assess safety and efficacy.
Chapter: Parkinson's Disease Activity Number: 0217-0000-25-066-H01-P Contact Hour(s): 2.00 Activity Type: Application BasedLearning Objectives 1. Classify patient signs and symptoms consistent with Parkinson disease (PD). 2. Design a therapeutic treatment plan for managing motor and nonmotor symptoms of PD. 3. Assess the role of complementary and alternative medicine in PD. 4. Evaluate the impact of care transitions on patients with PD. 5. Distinguish new treatment modalities for PD.
Chapter: Gout Activity Number: 0217-0000-25-067-H01-P Contact Hour(s): 1.50 Activity Type: Application BasedLearning Objectives 1. Assess a patient profile for gout and gout-related complications. 2. Develop lifestyle modification plans to aid patients in managing gout. 3. Design treatment plans for the acute management of a gout flare. 4. Assess a patient profile to initiate or adjust urate-lowering therapy for the chronic management of gout. 5. Create monitoring parameters to evaluate the efficacy of a pharmacotherapy regimen for gout management.
Chapter: Osteoarthritis Activity Number: 0217-0000-25-068-H01-P Contact Hour(s): 2.00 Activity Type: Application BasedLearning Objectives 1. Apply recommendations for the treatment of osteoarthritis (OA) current guidelines based on strength of evidence. 2. Devise an appropriate, patient-specific, nonpharmacologic treatment plan for the management of OA. 3. Design a pharmacologic treatment plan in accordance with current practice guidelines for an older adult with OA. 4. Develop recommendations to mitigate potential harm associated with OA treatment in older adults. 5. Evaluate the potential place in OA treatment of complementary, integrative, and emerging treatment options based on the available evidence.
Recorded Webcast: Deprescribing in the Older Adult Activity Number: 0217-0000-25-069-H01-P Contact Hour(s): 2.00 Activity Type: Application BasedLearning Objectives 1. Apply the tenets and process for deprescribing a medication to a case involving an older adult with multimorbidity. 2. Distinguish myths associated with deprescribing that can affect outcomes. 3. Given a clinical scenario, develop appropriate communication strategies to address patient and caregiver concerns about medication deprescribing. 4. Design a plan for deprescribing for an older adult with multimorbidity.
Chapter: Palliative and End-of-Life Care Activity Number: 0217-0000-25-070-H01-P Contact Hour(s): 1.50 Activity Type: Application BasedLearning Objectives 1. Distinguish between the eligibility for and services offered by palliative and hospice care. 2. Develop person-centered care goals for an individual in regard to end-of-life. 3. Analyze treatment considerations for management of symptoms addressed in palliative and hospice care. 4. Devise a care plan for an individual receiving palliative or hospice care that maximizes quality of life. 5. Recommend support mechanisms for all individuals involved in end-of-life care, including the patient, family/caregivers and health care professionals.
Chapter: Immunizations in Older Adults Activity Number: 0217-0000-25-071-H01-P Contact Hour(s): 2.00 Activity Type: Application BasedLearning Objectives 1. Evaluate older patients for the etiology, epidemiology, risk factors, and complications of common vaccine-preventable diseases. 2. Account for the impact of aging on vaccine response when recommending immunizations for older adults. 3. Analyze the safety and effectiveness of vaccines indicated for older adults to prevent influenza, respiratory syncytial virus, pneumococcal disease, and shingles. 4. Design an immunization regimen for an older adult based on age and comorbid conditions. 5. Resolve barriers to immunization for older adults.
Chapter: Transitions of Care Activity Number: 0217-0000-25-072-H01-P Contact Hour(s): 2.50 Activity Type: Application BasedLearning Objectives 1. Analyze an older adult’s care transition between different care contexts on the basis of evidence-based principles of safety and person-centered care. 2. Distinguish the different systems of care affecting care transitions for older adults. 3. Evaluate community-based systems of care to support care transitions for older adults. 4. Evaluate the type and impact of pharmacist-driven interventions on care transition outcomes across practice settings. 5. Develop pharmacologic and nonpharmacologic therapy plans to mitigate the risk of medication-related harm at care transition.

Disclosures

The American College of Clinical Pharmacy does not solicit or accept external commercial/financial support for its continuing pharmacy education activities. No commercial/financial support has been solicited or accepted for this activity.

Sample_Chapter.pdf

PSAP 2025 Book 2 (Geriatrics)