Saratoga (N.Y.) Hospital’s pharmacy has become the first hospital-based inpatient pharmacy in the country to earn Age-Friendly Pharmacy Recognition from the American Society of Consultant Pharmacists — the result of a process that started with a much smaller question: What could the pharmacy add to a hospitalwide age-friendly initiative already three to four years in the making?
“We were thinking, OK, what can the pharmacy do?” said Mike Vanderwerken, RPh, director of pharmacy at Saratoga Hospital. “Is there anything out there that’s more pharmacy specific — something that we can do that would help the program, but also help ourselves?”
The recognition, launched this year, was developed by the association with the John A. Hartford Foundation and the Peter Lamy Center on Drug Therapy and Aging and is built around the 4Ms Framework — What Matters, Medication, Mentation and Mobility. It was initially aimed at consultant pharmacists working in nursing homes and long-term care.
The clinical backbone of Saratoga’s program predates the recognition itself. In recent years, CMS introduced guidance — not yet a requirement, though Mr. Vanderwerken expects it eventually will be — directing hospitals to review medications for potentially inappropriate use in patients 65 and older throughout their hospital stay.
But not every facility has interpreted that guidance the same way, Mr. Vanderwerken said.
“Some are very generic in meeting the potential requirement as simplistically as possible — a blanket statement saying they’ve reviewed it, whether or not they really have,” he said. “I’m not trying to be disparaging to other facilities, but whether they’ve actually done anything or they’re just meeting the requirement, we took it a little bit more to heart.”
In practice, decentralized pharmacists assigned to specific units review a new patient’s medication list within about 24 hours of admission — longer over a weekend — using reporting tools to flag potentially inappropriate medications rather than reviewing every chart manually. When a flagged medication looks safe to stop or reduce, the pharmacist contacts the prescriber directly.
Some interventions are straightforward: discontinuing antihistamines or “Z-drug” sleep aids such as zolpidem, both linked to falls in older adults. Others are more complex. Benzodiazepines taken as needed by patients with chronic use require a taper, a process that rarely fits neatly inside a hospital stay focused on an unrelated diagnosis.
“That becomes more challenging, and that’s like our next step — how do we make sure that continues,” Mr. Vanderwerken said.
The review does not stop at admission. Every 10 days a patient remains hospitalized, pharmacists repeat the process to catch anything that slipped through or has not yet been addressed. The goal, Mr. Vanderwerken said, is straightforward: help patients recover faster, avoid falls and delirium and get discharged sooner — reducing their risk of returning to the hospital and improving their quality of life.
Earning the recognition required at least half of Saratoga’s pharmacists to complete an additional age-friendly training course through the association — a threshold the pharmacy met easily, Mr. Vanderwerken said. The bigger lift was elsewhere.
“It’s a fair amount of work to do it right, and they’re already at a point where they have a lot of stuff to do,” Mr. Vanderwerken said. “It’s definitely much more of a multidisciplinary thing than just the pharmacy saying, ‘Hey, don’t take these.’ You have to have buy-in from the physicians, from the nurses, from the entire hospital.”
Saratoga rolled the program out gradually, starting with a narrow set of medications to avoid overwhelming staff and giving prescribers time to adjust to the requests. The hospital’s multiyear head start on age-friendly work — including standing age-friendly committees and workgroups — meant the underlying concept was not new to pharmacists, even if the added workload was.
For other health systems considering the same path, Mr. Vanderwerken has some advice.
“Look at the low-hanging fruit of these med orders first, to kind of get things going,” he said. Discontinuing a nighttime Benadryl or Ambien order is a fast win that builds momentum with prescribers. Benzodiazepine tapers and other complex cases can come later, once the workflow is established.
Leaning on the EHR helped, too. Rather than manually reviewing every patient’s medication list, pharmacists use reporting and decision-support tools to identify flagged medications, then document interventions through progress notes and Epic’s Interventions tool so pharmacists across shifts are not duplicating work.
Saratoga is part of an affiliation of hospitals, some of which are earlier in their own age-friendly journeys. Mr. Vanderwerken pointed to the hospital’s geriatrician — described as “a huge advocate” who helps educate peers on why the work matters — as a key factor in the program’s success.
“You can’t be an age-friendly pharmacy without an age-friendly facility and age-friendly advocates,” Mr. Vanderwerken said. “We’re lucky here because we have that great team.”
