June is Alzheimer’s and Brain Awareness Month—an opportunity to learn about the impacts of Alzheimer’s disease and other dementias. Tatyana Gurvich, PharmD ’90, assistant professor of clinical pharmacy at the USC School of Pharmacy and assistant adjunct professor in the department of family medicine at the University of California, Irvine (UCI), School of Medicine, talks about her work as a board-certified geriatric pharmacist at UCI Health SeniorHealth Center, using telehealth to care for older patients during the COVID-19 pandemic, and the unique role geriatric pharmacists play in the care of older adults.
You earned your PharmD from USC School of Pharmacy and completed a geriatric pharmacology residency at USC at Rancho Los Amigos Medical Center. Can you share more about when and how you became interested in geriatric pharmacy?
I became interested in geriatric pharmacy as a PharmD student when I took an elective course on geriatrics that was taught by Dr. Brad Williams, former professor of clinical pharmacy and clinical gerontology at the USC School of Pharmacy. I enjoyed his class so much that I eventually enrolled in a geriatric pharmacology residency after I graduated.
My residency at Rancho was state of the art—a multi-disciplinary program where you work alongside geriatricians, neuropsychologists, social workers, dieticians, and occupational and physical therapists. I enjoyed working in a collaborative setting and establishing lifelong relationships with many of my colleagues at Rancho.
For more than a decade, you have served as a board-certified geriatric pharmacist and clinical preceptor at the UCI Health SeniorHealth Center. Can you tell us more about your work at the Center and what is unique about it? As a preceptor, what lessons do you aim to impart to pharmacy students and residents? Likewise, when you train medical students, what do you want them to know about the role of a pharmacist?
When I started working at the UCI Health SeniorHealth Center, a lot of work had to be done to get the facility running. Since the beginning, I have been involved in establishing a practice site at the Center where we provide care for older adults and screen them for diabetes, hypertension, high cholesterol, psychiatric disorders, cognitive impairments and more. I have also mentored pharmacy and medical students ever since I started working at UCI. I always remind students that the field of geriatrics requires a team effort and cannot be practiced alone.
Another thing about geriatrics is that it is a very nuanced field—the clinical practice guidelines students learn in school must be rejiggered and adjusted a bit for each patient. It is always important to note that not all older patients have the same needs.
What topics do you cover in your PHRD 655: Geriatric Pharmacy class? How do you prepare students who want to want to pursue a path in geriatric pharmacy? Given there is a national shortage of geriatricians, how can pharmacists help fill the care gaps for older patients?
My class is a year-long elective with a combination of second and third-year pharmacy students with little to no experience in geriatrics. The class is not solely focused on medications for older adults—it is unique and heavily centered on the psychosocial aspects of being an older adult and the barriers they face when getting access to medical care.
Pharmacists can help fill the care gaps for older patients in many ways. I believe every physician and geriatrician who manages older adults must have a pharmacist on their staff. Geriatric pharmacists are experts at figuring out medication problems. If a geriatrician is not on-site, it is important to have pharmacists who are well trained and know how to assess a situation.
How did the COVID-19 pandemic impact your ability to provide care for older patients?
During the COVID-19 pandemic, I continued to provide care for patients and train students as we were all adapting to telehealth. The USC Geriatric Workforce Enhancement Program (GWEP) continued to operate during that time and it was both a challenging and rewarding experience. GWEP is supported by a three-year, $2.5 million grant from the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS), that develops a comprehensive interprofessional geriatric primary care-based assessment and training program with an emphasis on interprofessional training and team-based care. The program involves a diverse group of students and faculty from various schools at USC with different types of expertise in their fields.
The stay-at-home orders for everyone over 65 years old complicated things. The grant made it possible for low-income patients to receive cell phones to communicate with us, however, we would sometimes find ourselves teaching our patients about telehealth so they could use Zoom, FaceTime, text messages and other applications to virtually meet with us and discuss their health needs. We also made sure to work together to tackle language barriers by pairing patients with students who spoke their native language.
What are some of the specific medication-related challenges that Alzheimer’s and dementia patients and caregivers often face? How do you help patients and caregivers navigate the disease?
The first challenge is that there is no cure for Alzheimer’s disease. It is a progressive illness that eventually gets worse and cognitive function declines; however, medication can slow down the progression of the disease. It is important to review the patient’s entire medication list (prescriptions, over-the-counter medications, and supplements) to ensure that none of them cause cognitive decline or confusion.
My role as a geriatric pharmacist is to explain to the patient and caregiver what to look for and what to expect from the medications. The best you can hope for these medications is that cognitive function remains stable for a long period of time. It is crucial to develop an effective medication plan for the patient while also considering their overall health.
As a geriatric pharmacist, what is the most rewarding aspect of your work?
The most rewarding aspect of my job is seeing my patients enjoy their lives in the most robust way possible because of something I did that benefited their health. The goal for all geriatricians and geriatric pharmacists is to help their patients age well and maintain function.
What else would you like for people to know about the field of geriatric pharmacy? What is your hope for the future?
I think what is happening worldwide is that the older adult population is growing. Patients are living longer, and we will have more geriatric patients around us. Any pharmacist who graduates from pharmacy school needs to know more about geriatric care. I want all pharmacists to become geriatric experts.