CLINICAL INVESTIGATIONS Geriatric Patient Care by U.S. Pharmacists in Healthcare Teams: Systematic Review and Meta-Analyses Jeannie K. Lee, PharmD,* Marion K. Slack, PhD,* Jennifer Martin, MA, † Clara Ehrman, BS,* and Marie Chisholm-Burns, PharmD, MPH ‡ OBJECTIVES: To conduct a systematic review and meta- analyses to examine the effects of pharmacists’ care on geriatric patient-oriented health outcomes in the United States (U.S.). DESIGN: Studies examining U.S. pharmacists’ patient care services from inception of the databases through July 2012 were searched. The databases searched include PubMed/ MEDLINE, Ovid/MEDLINE, ABI/INFORM, Health Busi- ness Fulltext Elite, Academic Search Complete, Interna- tional Pharmaceutical Abstracts, PsycINFO, Cochrane Database, and ClinicalTrials.gov. Studies reporting phar- macists’ intervention for geriatric patients, comparison groups, and patient-oriented outcomes were assessed. Dual review for inclusion and data extraction were performed. SETTING: University of Arizona College of Pharmacy. MEASUREMENTS: Study and participant characteristics, pharmacist intervention, and outcomes with data for meta- analyses were collected. A forest plot was constructed to obtain a pooled standardized mean difference using a ran- dom effects model. RESULTS: One hundred fifty-two articles were reviewed, with 20 resulting studies included in the final meta-analy- ses. Study sample size ranged from 36 to 4,218, with mean age of subjects being 65 and older. The studies were most frequently conducted in ambulatory care clinics, followed by inpatient settings; the majority focused on multiple dis- eases and conditions. Pharmacist activities varied widely, with technical interventions used most often. Favorable results were found in all outcome categories, and meta- analyses conducted for therapeutic, safety, hospitalization, and adherence were significant (P < .001), favoring phar- macist care over comparison. Some identifiable variability existed between included studies. CONCLUSION: Pharmacist intervention has favorable effects on therapeutic, safety, hospitalization, and adher- ence outcomes in older adults. Pharmacists should be involved in team-based care of older adults. J Am Geriatr Soc 2013. Key words: pharmacists; older adults; direct patient care; systematic review; meta-analysis T he United States is aging along with the rest of the world, especially now that the baby boomers are turn- ing 65 and growing older, meaning that the patient popu- lation is aging and that an increasing number of older adults require polypharmacy management for their chronic conditions. Polypharmacy means using multiple medica- tions concurrently, which is common in older individuals, with more than one-third using five to nine medications and 12% using 10 or more. 1 Adverse drug effects occur in high rates in the United States (>4.5 million each year) and frequently affect older adults in primary care and long- term care settings; many are preventable. 2,3 Older adults are particularly vulnerable to experiencing adverse drug reactions or events when potentially inappropriate medica- tions, as defined according to the Beers Criteria, are used. 4–6 High healthcare costs in older adults stem from use of the inappropriate medications—$7.2 billion in 2000/01 healthcare expenditures. 7 In 2008, the Institute of Medicine (IOM) released Retooling for an Aging America: Building the Health Care Workforce emphasizing the need to enhance geriatric com- petencies in healthcare providers who will care for the growing older populations. 8 The report also stressed the need to improve and disseminate effective geriatric care models, including interprofessional team care. 8 The IOM has also recognized the critical value of pharmacist knowl- edge and services in medication management and safety and their effect on quality patient care through collabora- tive practice. 9–11 Pharmacists’ medication use expertise and roles as members of healthcare teams are crucial for From the *Pharmacy Practice and Science, College of Pharmacy, University of Arizona, † Information Services, Arizona Health Sciences Library, University of Arizona, Tucson, Arizona; and ‡ College of Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee. Address correspondence to Jeannie K. Lee, Pharmacy Practice and Science, College of Pharmacy, University of Arizona, 1295 N. Martin Ave, PO Box 210202, Tucson, AZ 85721. E-mail: jlee@pharmacy.arizona.edu DOI: 10.1111/jgs.12323 JAGS 2013 © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society 0002-8614/13/$15.00