Pharmacists Play Important Role in Age-Friendly and Long-Term Care

The landscape of long-term care (LTC) is undergoing a paradigm shift, moving away from a historically cost-driven model toward a clinical framework centered on patient safety, tolerability, and age-friendly principles.

For the modern pharmacist, whether practicing in a community setting, a health system, or a skilled nursing facility, the lessons from the front lines of LTC offer a blueprint for professional evolution.

A recent expert panel featuring Chad Worz, PharmD, BCGP, FASCP, chief executive of the American Society of Consultant Pharmacists (ASCP), Rob Leffler, BSPharm, BCGP, FASCP, vice president of clinical services for Synchrony Pharmacy, Anna Meyer, PharmD, pharmacy manager of clinical services for Avera Long-Term Care Pharmacy, and Jessica Androff, PharmD, BCGA, FASCP, president of operations for Consonus Healthcare, detailed how pharmacists can transition from cost managers to clinical shepherds by leveraging new drug pricing policies, specialized formulations, and robust immunization programs.

"This shift allows us as clinicians and practitioners to prioritize, recommend, and present the best options for patients,” Worz said. “These would be the drugs that you probably confidently pick for your parents or your family, and they're designed to get the best outcomes."

Prioritizing Clinical Superiority Over Cost

Historically, pharmacists and prescribers were often tethered to the lowest-cost medication options due to restrictive Medicare D formularies and high out-of-pocket costs for patients. However, Worz noted that recent drug pricing updates—including a $2,000 annual out-of-pocket cap for Medicare patients—have removed significant financial barriers.

"This shift allows us as clinicians and practitioners to prioritize, recommend, and present the best options for patients," Worz stated.

By moving away from older, less effective, and potentially dangerous alternatives, pharmacists can now focus on the "best possible results.” Worz emphasized that pharmacists should adopt the mentality of choosing medications they would "confidently pick for [their] parents or [their] family.”

Eliminating the Anticholinergic Burden

One of the most immediate roles for the pharmacist in LTC is the reduction of anticholinergic burden.

"I hate anticholinergic drugs,” Leffler said. “We’re really putting patients at significant risk for cognitive decline.”

Leffler highlighted the use of comprehensive medication regimen reviews (MRR) and tools like the BEERS Criteria to identify high-risk medications like oxybutynin, which is commonly used for overactive bladder but carries a heavy cognitive cost. He advocated for switching patients to beta-3 agonists like mirabegron (Myrbetriq) or vibegron (Gemtesa), which offer better tolerability profiles and fewer adverse effects.

Importantly, Leffler pointed out that this clinical improvement is also a business win for the pharmacy. Although older drugs like oxybutynin are cheap, they offer razor-thin margins and poor patient outcomes. In contrast, newer, safer medications often yield higher dispensing margins while simultaneously reducing the risk of expensive adverse events like falls and hospitalizations.

Evolving Management of Neuropsychiatric Care

The panel also addressed the evolving management of serious mental illness and neuropsychiatric symptoms in older adults. Worz described the historical use of first-generation antipsychotics as "shotgun therapy," defined as powerful drugs that hit the intended target but also caused significant collateral damage through adverse effects like sedation, orthostatic hypotension, and extrapyramidal symptoms.

As the population in nursing homes becomes more sophisticated with complex diagnoses like Parkinson disease psychosis or dementia with agitation, pharmacists must advocate for targeted, more "rifle-like" medications. This precision ensures that patients are not simply sedated but rather treated with evidence-based therapies that improve their quality of life.

Specialized Formulations and the Dysphagia Crisis

A critical but often overlooked role for the pharmacist is ensuring that the formulation matches the patient's physical needs. Androff noted that 50% to 60% of nursing home residents experience swallowing difficulties known as dysphagia.

Androff warned that the common practice of crushing tablets can be detrimental, altering pharmacokinetics and leading to inconsistent dosing.

"Treatment must account for tolerability," Androff said, advocating for the use of sprinkle capsules, liquids, and dissolvable films.

For example, using a metoprolol succinate extended-release sprinkle capsule ensures the drug's release profile remains intact, unlike a crushed tablet, which could cause bradycardia or a fall.

Beyond clinical safety, these formulations improve nursing efficiency. Crushing tablets is time-consuming and risks bitter taste and dose loss. By recommending specialized formulations, pharmacists become really good partners to facility staff while improving medication adherence, according to Androff.

Pharmacists as Vaccine Champions

Finally, the panel highlighted the pharmacist's role as a leader in preventative care through immunization. Meyer shared that incorporating vaccine assessments into admission MRRs can significantly boost uptake.

Meyer pointed out that although national COVID-19 vaccine uptake in nursing homes was roughly 30%, facilities with strong pharmacy partners saw rates as high as 90%.

"Having a pharmacy involved... it works," Meyer stated, noting that pharmacists can personalize recommendations to help families overcome vaccine fatigue.

From a sustainability standpoint, Meyer detailed how a mid-sized LTC pharmacy could generate $100,000 in annual net revenue by optimizing their vaccine programs, particularly by selecting higher-margin, clinically superior products like high-dose flu shots or conjugate pneumococcal vaccines.

Conclusion

The role of the pharmacist in 2026 is defined by intentionality. By focusing on de-prescribing, targeted therapies, and specialized delivery methods, pharmacists ensure that every resident gets the right drug for them to optimize the best results.

“Age-friendly pharmacy isn't about adding work. It's about aligning what matters to patients with what is clinically appropriate and operationally sustainable,” Meyer said. “When we get the right drug for the right patient at the right time, everyone wins—the resident, the facility, and the pharmacy.”