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Benson Lam is one of the few hospital pharmacists in Canada dedicated to geriatric pharmacy.
There are days when Benson Lam wishes he had a mentor.
But as one of the few pharmacists working in a Canadian hospital geriatrics department, Lam is more poised to one day become a professional adviser in his field than find someone to help him nurture his own career.
“Being such a relatively new position among pharmacists altogether, it’s been a challenge to find evidence-based approaches to care and quality improvement initiatives,” Lam says.
So just how unique is geriatric pharmacy in a hospital? Throughout Canada, there are 50 hospital pharmacists assigned to inpatient geriatric care, according to a 2020-21 poll by the Canadian Society of Hospital Pharmacists.
However, they may not be dedicated entirely to a Geriatrics department, like Lam is as the pharmacist heading up Niagara Health’s Geriatrics Pharmacist Consult Service, launched last August. Older adults may be part of other hospital pharmacists’ patient rosters, “but not many are focused on geriatric patients themselves.”
That means Lam doesn’t have a blueprint to follow. So it’s up to him to develop and tailor the role to meet the needs of patients and the organization, attesting to Niagara Health’s emphasis on providing safe, high-quality care to the population it serves.
Among large urban areas in Canada, Niagara has one of the highest proportions of people 85 and older. Those 65 and up account for 60 per cent of the population growth in the region.
“The field of geriatrics, especially for pharmacy in Canada, is more up and coming than I expected but it’s an exciting opportunity to lead and build up this field for our region,” Lam says. “The Geriatrics team has helped guide me in the right approach to have the best impact on the hospital. Our program will play a crucial role in the next 20 years as our population will continue to age and grow every year.”
As it does, so, too, will the need for diligent monitoring of prescriptions for older adults when they come into the hospital.
Lam is the ideal person for the job, though it took others to help him realize it.
Growing up in Scarborough, he was determined to become a forensic scientist. Lam even began laying the groundwork for such a career when he enrolled in biochemistry at McMaster University. Then his dad was diagnosed with Type 2 diabetes.
Because of a language barrier between his father and care team, Lam had to talk to his dad in detail about the medication he was prescribed and what to expect from the treatment. He dug deeper and researched side effects and progression of the disease.
“I find it gratifying to optimize care. What I find rewarding in geriatric pharmacy is looking at whether the medications are still useful, and should we be adjusting these medications or stopping them?”
That attention to detail and ability to share his knowledge so well with his dad, along with his track record helping fellow biochem students, was enough for two friends studying pharmacy to convince Lam to pursue his Doctor of Pharmacy at the University of Toronto.
“They realized by the way I focused on studying and using that information to teach others what I know, that translated well into learning about medications, interactions, how they’re dosed and teaching that to patients,” Lam recalls. “For a pharmacist, it’s being able to focus on the details of medications, assessing medications and teaching those to others, whether nurses, physicians, patients or other healthcare professionals.”
Homing in on geriatric pharmacy as his specialty and becoming board-certified in the field in 2017 only promised to keep his job interesting.
“I thought about it logically. Young, healthy adults aren’t on a lot of medications. While there is a role for pharmacists there, it’s not all-encompassing,” Lam says. “But as people get older, they get more diseases and need more medications, but the sensitivity to medications increases, so the role of a pharmacist becomes more impactful.”
There was no geriatrics pharmacist position at Niagara Health when he was hired in 2019, but it didn’t take Lam long to carve his niche here. He was approached by the Geriatrics Program to create a geriatric management order set, including delirium. After working on that, he was tapped for the new geriatrics pharmacist position to work on a dedicated geriatrics pharmacist consultation service.
Through the Geriatrics Pharmacist Consult Service, which is available Monday to Friday, Lam provides medication consultation services related to polypharmacy, deprescribing, falls risk delirium, Parkinsonian symptoms and behaviour management related to dementia. His focus is on polypharmacy, assessing whether patients are on more medications than they need or if their prescriptions are causing more harm than good, and deprescribing medication in consultation with physicians, physician assistants, nurse practitioners, patients and their caregivers.
“There are a lot of guidelines where if people have a disease, these are the medications they need to be prescribed but there’s no focus on when to stop the medications,” he says. “A lot of older adults are more vulnerable to issues with medications because they don’t always have the capacity to advocate for themselves. I try to give them that voice on the pharmacy side.
“I find it gratifying to optimize care,” he adds. “What I find rewarding in geriatric pharmacy is looking at whether the medications are still useful and should we be adjusting these medications or stopping them?”
Just like one day, Lam will find it rewarding to teach others about geriatric pharmacy as the leader he is in his field.
“I hope to identify how the profession of pharmacy can make the most impact for the older adult population and teach that to other pharmacists at Niagara Health or teach it to other pharmacy students.”
