Sarah Kidushim is a caring woman, but enough is enough. When her husband, Joseph, became argumentative and wakeful night after night, Kidushim called the doctor — in this case, Dr. Laura Mosqueda, a geriatrician and head of the University of California, Irvine Senior Health Center in Orange, Calif.
Mosqueda prescribed a meeting with Dr. Bradley Williams, a geriatric pharmacist who evaluates medications for patients and physicians at the center.
Williams looked at the prescriptions for Joseph Kidushim, who has dementia, hypertension, prostate enlargement and pain from a rotator-cuff injury and a leg amputation. Williams adjusted the medications, eliminating some and reducing others.
‘‘So now the anger comes and goes, but right now he’s doing all right," a relieved Sarah Kidushim says. "He sleeps better."
Straightening out mixed-up, overmedicated, underprescribed, contraindicated medications, vitamins and herbals is routine for Williams, professor of clinical pharmacy and clinical gerontology at the University of Southern California.
At the university, he works with a team of geriatricians and brings in USC pharmacy students for clinical and geriatric-patient experiences.
He’s one of a handful of pharmacists nationwide who will evaluate medications for individuals and provide written reports on his findings. And he’s available for private consultations.
Williams is a lifesaver, says Mosqueda:
‘‘We’ve got data to show medication issues are a common problem among older adults, and a large number of hospitalizations are due to medication issues. So it makes sense to watch medications, prevent hospitalizations and keep people healthy.’’
She talks to Williams about her prescriptions because ‘‘I can’t keep up with everything,’’ and she guides families to him when they need help getting an elder to take their pills.
As people age, they tend to take more medications, but their ability to handle them often decreases. While many pharmacies have a consulting pharmacist available, ‘‘the community pharmacist doesn’t have the time or the expertise in geriatrics to answer all the questions,’’ Williams says.
The task of advising seniors on medications is daunting. Williams estimates 90 percent of all seniors take at least one prescription drug, and most take an average of three. And that doesn’t count vitamins and herbals.
He recently spent three hours evaluating four grocery boxes of prescription and over-the-counter compounds taken by one senior.
‘‘You have to realize there are people who are afraid to take anything, and there are others who never met a medicine they didn’t like,’’ he says. ‘‘And a lot of older adults do overmedicate. There were huge advances in medicine made during their lifetimes, and they have a lot of faith in medications in general.’’
Heart, blood pressure and pain prescriptions are the most common he evaluates, Williams says. Among his challenges: Dealing with dementia patients who often don’t remember whether they have taken everything they’re supposed to.
"There is a lot of worry from the family," he says. "Doctors don’t have the time to deal with many of these questions, and that’s when we step in."
The approach impresses two of his current students, Alya Makarem, 26, and Khang Tran, 29. Both are seniors at USC. Doing the clinical rotation with Williams has sealed the future for Makarem, who hopes to be a clinical pharmacist. She works at a Longs Drugs in Laguna Woods, Calif., "and I spend at least a third of my time consulting with patients," she says. "A lot of patients don’t know what they are on. They say, ‘My doctor doesn’t have time for me,’ but we still have time and will give more time."
Tran says his interest in geriatrics is spurred by two grandparents who take several medications. "They ask me about the drugs and want my advice," he says. "So this issue is close to my heart.
"I want to help my grandparents as well as a lot of elderly persons who need our care. I want to have the time to instruct them about what they follow, to direct them to the right thing."
Tran will have no problem finding customers, Williams predicts.
An aging population is expected to push geriatric pharmacies into the mainstream.
"People have begun to realize they need more than just the cheapest pharmacy," Williams says. "They need a pharmacy — and a pharmacist — who gets involved with them as patients."