Abstract
Older patients frequently experience the coexistence of multiple diseases. The conventional single-discipline diagnostic and treatment model is insufficient to comprehensively address all concurrent conditions, thereby necessitating a multi-disciplinary collaborative approach. The Geriatric Interdisciplinary Team represents an innovative diagnostic and treatment paradigm tailored for older patients, with clinical pharmacists serving as integral members of this team. This article presents a case report of the application of Geriatric Interdisciplinary Team, involving the participation of a clinical pharmacist, aiming to provide practical insights and experiences of this model for clinical pharmacists.
1 Introduction
With the accelerated aging process of the human population, changes in lifestyle, enhancements in socioeconomic conditions, and progressions in medical diagnostic technologies, the incidence rates of Multimorbidity have shown a significant upward trend. Globally, multiple chronic conditions and the resulting polypharmacy have become major public health challenges in aging societies. A systematic review and meta-analysis covering 54 countries revealed that over half of adult aged 60 and above suffer from multiple comorbidities (1). Moreover, long-term polypharmacy is significantly associated with a 30% increased risk of mortality and a 61% elevated risk of hospitalization (2). The traditional single-discipline treatment model cannot offer systematic diagnosis and treatment for this vulnerable population, so the Geriatric Interdisciplinary Team (GIT) has become the main treatment model for older patients in developed countries.
Currently, GIT in China is still in the initial trial stage and has only been used in a few general hospitals (3). In China, more than 50% of older patients concurrently suffer from three or more chronic diseases (4). Meanwhile, the rate of polypharmacy is as high as 70.8%, and the average daily intake of medications reaches 8.6 types (5). This frequently poses risks such as repeated medication usage, drug interactions, and heightened risks of adverse reactions, which in turn elevates medical costs and impacts clinical outcomes. To better address the health issues of olderly patients with comorbidities, our hospital has established the GIT. This article focuses on the perspective of clinical pharmacists’ participation in the practice of the geriatric multidisciplinary team, adopting a patient-centered approach. By optimizing medication regimens and implementing personalized medication monitoring, the safety of medication use is ensured, thereby minimizing drug interactions to the greatest extent.
The GIT at our center is primarily composed of geriatricians, nurses, rehabilitation physicians, nutritionists, clinical pharmacists, and psychiatrists. The workflow proceeds as follows: Initially, geriatricians conduct comprehensive geriatric assessments to screen patients requiring GIT meetings. Subsequently, the team convenes where the geriatrician presents the medical history, followed by a joint bedside evaluation of the patient. The team then returns to the meeting room to discuss the patient’s clinical progress and optimize treatment plans. Clinical pharmacists are responsible for reporting pharmaceutical care records during hospitalization, identifying risk points in current medication regimens, and ultimately reviewing and consolidating medication-related risks from each specialty’s finalized treatment plans. Throughout this process, the team maintains effective information sharing and collaborative mechanisms (Figure 1).
Figure 1
The workflow of GIT.
2 Case description
A 79-year-old male patient, with a height of 172 cm and weight of 60 kg, had a 27-year history of coronary heart disease (CHD). He underwent coronary angiography and interventional therapy 27 years ago, 13 years ago, and 3 months ago, with a total of 3 stents implanted in the left anterior descending artery and left circumflex artery to date. He was on medication, with no recent recurrence of chest pain. Four days prior, he developed chest tightness, shortness of breath, and fatigue after climbing stairs, without chest pain or profuse sweating. Symptoms relieved after ~1 min of rest, and he was admitted to our hospital on March 1, 2025. He had no history of hypertension, but a 1-year history of arrhythmia with frequent premature ventricular contractions; 5-month history of mild-to-moderate aortic stenosis; and 7-month history of organizing pneumonia (on oral methylprednisolone). Elevated blood glucose was detected half a month ago, for which acarbose was prescribed. Past history also included atherosclerotic occlusive disease of bilateral anterior tibial arteries and osteopenia of bilateral hip joints.
On admission examination: crackles were auscultated in the lower lung fields; pulsation range was normal, heart rhythm regular, with no pathological murmurs in valve auscultation areas. Chest CT scan revealed ground-glass opacities in the left upper lung lobe, bilateral interstitial lung lesions, localized bilateral emphysema, and slightly enlarged mediastinal lymph nodes. Laboratory results: granulocyte count 7.15 × 109/L, serum albumin 39.7 g/L, C-reactive protein 53.80 mg/L, procalcitonin 0.106 ng/mL, serum interleukin-6 (IL-6) 22.00 pg./mL; other tests were unremarkable.
Upon admission, medication reconciliation was performed for the patient. The patient’s medication orders and dosages remained consistent before and after admission, with no special adjustments made. We held a git meeting on March 5th and conducted a multidisciplinary joint ward round.
Admission diagnoses: organizing pneumonia with infection; stable CHD; post-coronary angiography and stent implantation; arrhythmia with frequent ventricular premature contractions; mild-to-moderate aortic stenosis; bilateral anterior tibial artery atherosclerotic occlusive disease; bilateral hip osteopenia.
Post-admission comprehensive assessment showed: mild dependence on activities of daily living; Geriatric Frailty Screening (FRAIL) Scale: 4 points, marked frailty; reduced calf circumference (left 34.5 cm, right 32.5 cm); Appendicular Skeletal Muscle Index (ASMI) 7.02; decreased 6-meter walk speed; abnormal time for five chair rises; normal grip strength; high fall risk; and at risk of malnutrition.
According to the American Geriatrics Society (AGS) (6) and the National Institute for Health and Care Excellence (NICE) (7), The guidelines for the diagnosis and treatment of comorbidities in older patients focus more on the patients treatment experience and preferences, aiming to improve disease symptoms and prevent complications from chronic diseases. Therefore, the key points discussed by the GIT team include: addressing the causes of shortness of breath; further optimizing nutritional and rehabilitation plans; actively intervening due to family reports of anxiety and pessimism; evaluating medication risks for patients taking multiple medications, simplifying prescriptions, and improving compliance.
Opinions of GIT members: ① Endocrinology Consultation Opinion: The patient presented with polydipsia, polyphagia, and polyuria, diagnosed with diabetes. Postprandial blood glucose elevated after taking methylprednisolone tablets. It was recommended to continue the current regimen of acarbose tablets (0.1 g chewed with lunch and dinner) for glycemic control, with regular blood glucose monitoring. If glycemic control was suboptimal, repaglinide tablets could be added for immediate oral administration before meals if necessary. Subsequently, the patient’s blood glucose was well-controlled without additional hypoglycemic agents. ② Rehabilitation Consultation Opinion: The patient was in the acute stage of the disease with unstable oxygen saturation; thus, rehabilitation exercises were not recommended temporarily. ③ Nutrition Consultation Opinion: The patient was advised to adhere to a low-carbohydrate, low-GI (glycemic index) diet with high-quality protein supplementation. During hospitalization, the patient’s weight remained stable, and serum albumin levels showed an upward trend. ④ Respiratory Consultation Opinion: Elevated blood glucose was detected half a month prior, prompting a reduction in methylprednisolone dosage from 12 mg/d to 8 mg/d. The current shortness of breath was attributed to intolerance to the reduced hormone dosage. It was advised to monitor oxygen saturation, adjust methylprednisolone back to 12 mg/d, and routinely recheck inflammatory markers. The patient’s shortness of breath improved thereafter. ⑤ Psychiatric Consultation Opinion: The patient was attentive to their condition and, due to personality traits, exhibited mild illness anxiety. No medication intervention was needed temporarily; family members were advised to provide necessary support and encouragement to help the patient maintain a positive attitude. ⑥ Clinical Pharmacist Intervention: Details of the patient’s medications and interventions are presented in Table 1.
Table 1
| Purpose of medication | Name of drug | Dosage and administration | Frequency of administration | Adjust recommendations | Adjust the results |
|---|---|---|---|---|---|
| Liver protection | Glutathione tablets | 0.4 g | tid | Block up | Discontinue glutathione tablets and continue to use polyene phosphatidylcholine capsules |
| Polyene phosphatidylcholine capsules | 456 mg | tid | |||
| Organized pneumonia | Methylprednisolone tablets | 12 mg | qd | Monitor blood sugar and be alert for gastrointestinal ulcers and osteoporosis | The patients’ blood sugar was stable, and no new adverse reactions were reported |
| Stable coronary heart disease | Isosorbide mononitrate sustained release tablets | 40 mg | qd | Continue to apply | Continue to apply |
| Metoprolol succinate sustained release tablets | 23.75 mg | qd | There are many interactions and it is recommended to switch to another drug | Switch to Bisoprolol fumarate tablets | |
| Arrhythmia | Propafenone hydrochloride tablets | 150 mg | tid | Continue to apply | Continue to apply |
| Diltiazem sustained release capsules (II) | 90 mg | qd | |||
| Antiplatelet | Ticagrelor tablets | 60 mg | bid | Continue to apply | Continue to apply |
| Reduce blood lipids, stabilize plaques | Rosuvastatin calcium tablets | 10 mg | qd | Monitor creatine kinase and transaminase | Creatine kinase and transaminase were normal |
| Ezetimibe tablets | 10 mg | qd | |||
| Lower blood sugar | Acarbose tablets | 100 mg | bid | Continue to apply and monitor blood sugar | The patients’ blood sugar was stable |
| Anti-infection | Moxifloxacin hydrochloride injection | 0.4 g | qd | Monitor blood sugar and electrocardiogram | The patients’ blood sugar was stable and the electrocardiogram was normal |
| Supplement nutrients | Compound amino acid capsules | 1 pill | bid | Continue application with a break from moxifloxacin | Continue application with a break from moxifloxacin |
| Multivitamin tablets | 1 tablet | qd | |||
| Protect the stomach | Rebamipide Tablets | 100 mg | tid | Continue to apply | Continue to apply |
| Pantoprazole Enteric-Coated Tablets | 40 mg | qd | Discontinue medication after regular course of treatment | No new stomach discomfort | |
| Bilateral hip osteopenia | Vitamin D3 Soft Capsules | 1,000 IU | qd | Monitor the level of 25-hydroxyvitamin D | The 25-hydroxyvitamin D level is normal |
Detailed information of patients medication and intervention.
3 Discussion
On the Rationality Evaluation of Medical Orders: The clinical pharmacist meticulously reviews all medications utilized by the patient post-admission, assessing their appropriateness, dosage, contraindications, and potential for drug interactions. Based on the patient’s admission test results, which indicated normal liver function, the administration of glutathione tablets and polyene phosphatidylcholine capsules is deemed off-label. For the management of chronic gastritis, the patient was prescribed pantoprazole enteric-coated tablets, also an off-label usage. It is advisable to discontinue these medications following standardized treatment protocols.
Polypharmacy Assessment: The patient exhibits multiple comorbidities and encounters challenges related to polypharmacy, which heightens concerns regarding the potential for inappropriate medication use (referred to as potentially inappropriate medication, PIM) among older patients due to the concurrent use of numerous medications. Clinical pharmacists conducted an evaluation of PIMs in older patients by employing the 2023 American Geriatrics Society (AGS) Beers Criteria (8), the Chinese older patients Potential Inappropriate Medication Use Judgment Standard (9), and relevant drug labels. PIM assessment results: (1) PIMs to be Avoided in the older patients: Proton pump inhibitors (PPIs) elevate the risk of Clostridium difficile infection, pneumonia, gastrointestinal malignancies, bone loss, and fractures in older patients, and should not be administered for more than 8 weeks. Research indicates that the concurrent use of oral corticosteroids and PPIs heightens the risk of osteoporotic fractures by 1.6 times (10). In this case, the patient has a history of PPI use spanning 1 year and is currently taking glucocorticoids, thereby increasing the risk of fractures; it is advisable to discontinue PPIs. (2) Medications that should be used with caution in the older: as ticagrelor elevates the risk of major bleeding in older adults, particularly those aged 75 years or older. An analysis from a Chinese cardiovascular disease quality improvement project study revealed that among patients aged 75 years or older with acute coronary syndrome who underwent ticagrelor treatment, the risk of significant intra-hospital bleeding rose by 45% (11). Given that the patient is 79 years old, ticagrelor should be used with utmost caution. (3) Potential drug interactions to be avoided in older patients: The combination of rosuvastatin and ezetimibe can increase the risk of muscle damage and elevate transaminase levels. When diltiazem is used in combination with ticagrelor, ticagrelor is mainly metabolized by CYP3A4, while diltiazem is an inhibitor of CYP3A4. Therefore, the combination of the two will increase the blood concentration of ticagrelor, leading to an increase in the risk of bleeding. When diltiazem is used in combination with metoprolol, diltiazem is a calcium channel blocker. When used in combination with beta-blockers, it has an additive inhibitory effect on atrioventricular conduction and sinoatrial function. There have been case reports of significant bradycardia when beta-blockers are used in combination with calcium channel blockers (12, 13); Propranolol and metoprolol used together, where metoprolol is metabolized via CYP2D6, and propranolol acts as an CYP2D6 inhibitor, can increase the blood concentration of metoprolol by 2 to 5 times. It also has β receptor blocking effects; it is recommended to switch to bisoprolol to reduce interactions; Diltiazem and methylprednisolone used together, where methylprednisolone is primarily metabolized via CYP3A4, and diltiazem is an inhibitor of CYP3A4, combined use can increase the risk of cardiac suppression; In non-diabetic individuals, the incidence of hyperglycemia after receiving medium to high doses of glucocorticoids exceeds 28–45% (14); In addition, patients who used both hypoglycemic drugs (acarbose) and moxifloxacin were reported to have impaired blood glucose, especially prone to hypoglycemia (15); The combination of mosaisacin and metoprolol increases the effect of prolongation of QT interval. There have been many reports of QT interval prolongation caused by mosaisacin, and it causes torsades de pointes in high-risk patients (16); The combination of moxifloxacin with multivitamins can significantly affect its absorption, leading to lower than expected blood levels of moxifloxacin. There are no inappropriate drugs with drug-disease or drug-syndrome interactions; there are no drugs that should be avoided or reduced in dose due to decreased renal function in the older.
Individualized adjustment: Based on the patients preference, the liver protection drug was continued in the absence of abnormal liver function. After communication and discussion with the psychiatrist, the patient finally agreed to stop using glutathione tablets and continue using polyene phosphatidylcholine capsules. The patients liver and kidney function were normal and there were no contraindications for related drugs.
3.1 Security assessment
No drug-related discomfort was observed during hospitalization.
3.2 Intervention outcomes
Throughout the intervention, patient-centered, multidisciplinary collaboration enabled individualized diagnosis and treatment for the elderly patient. Clinical pharmacists performed prescription reconciliation on physicians’ orders and assisted in monitoring drug-related adverse reactions and interactions, ensuring the safety and efficacy of medication use. Following intervention by our hospital’s geriatric multidisciplinary integrated team, no adverse events such as falls occurred during hospitalization. The patient had stable blood glucose and blood pressure, improved shortness of breath, a 1 kg weight gain, and enhanced nutritional status. At 1-month follow-up, the patient maintained stable blood pressure and glucose, normal liver and kidney function, and a normal serum albumin level. Anxiety symptoms improved, medication adherence was enhanced, and family support was high.
While GIT care has become an established model in some Western countries, it has not been widely adopted in China. This limited implementation arises from challenges within China’s resource-constrained healthcare system: First, the lack of long-term multicenter studies on GIT in China leaves the sustained benefits for older adults unclear. Second, overburdened medical teams, facing growing workloads, must selectively enroll patients in GIT. This project has adapted the GIT model through localization strategies, featuring a standing multidisciplinary expert team that holds biweekly GIT meetings. Prior to these meetings, clinical teams share patient materials with expert groups, allowing specialists to review cases and anticipated treatment goals in advance. A key innovation is the integration of embedded clinical pharmacists. Within GIT, pharmacists act not only as “medication experts” but also as standardization drivers: they establish standards for core processes such as medication assessment, regimen optimization, and adverse reaction monitoring, providing a basis for formulating national guidelines. Through rational medication interventions, they reduce medical waste, demonstrating the cost-effectiveness of GIT medication management and enhancing hospital efficiency under the Diagnosis Related Groups (DRG)/Diagnosis-Intervention Packet (DIP) payment systems and pharmaceutical zero-markup reforms. Additionally, pharmacists optimize physicians’ treatment plans by addressing drug interactions, dosage form suitability, and adherence. Currently, most domestic and international GIT case reports are physician-led, whereas this case, from the perspective of clinical pharmacists, focuses on medication adjustment and full-course patient monitoring. Through the full participation of clinical pharmacists in multidisciplinary ward rounds, medication optimization efficiency has been improved. This further underscores the unique value of this study in terms of localized practice, the deepened role of pharmacists, and cost-effectiveness.
3.3 Novelty
This study provides new insights into how pharmacist-led interventions enhance medication safety, improve cost efficiency, and optimize clinical outcomes in geriatric patients. The study not only established a pharmaceutical hierarchical care standard tailored to the characteristics of older patients, but also incorporated evidence-based references including the 2023 Beers Criteria and the Chinese criteria for potentially inappropriate medications in older adults.
3.4 Scientific significance
Our findings contribute to the growing body of evidence supporting pharmacists’ role in polypharmacy management, to provide standardized protocols for pharmacists in implementing polypharmacy management in GIT, with potential implications for clinical practice and healthcare policy.
Statements
Data availability statement
The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.
Ethics statement
The studies involving humans were approved by the Medical Research Ethics Committee of the First Affiliated Hospital of China Medical University. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article. Written informed consent was obtained from the participant/patient(s) for the publication of this case report.
Author contributions
J-WG: Writing – review & editing. HZ: Writing – original draft. WT: Writing – review & editing. SC: Writing – review & editing, Writing – original draft.
Funding
The author(s) declare that no financial support was received for the research and/or publication of this article.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Generative AI statement
The authors declare that no Gen AI was used in the creation of this manuscript.
Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.
Publisher’s note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
References
1.
Chowdhury SR Chandra Das D Sunna TC Beyene J Hossain A . Global and regional prevalence of multimorbidity in the adult population in community settings: a systematic review and meta-analysis. EClinicalMedicine. (2023) 57:101860. doi: 10.1016/j.eclinm.2023.101860
2.
Costanzo S Di Castelnuovo A Panzera T De Curtis A Falciglia S Persichillo M et al . Polypharmacy in older adults: the Hazard of hospitalization and mortality is mediated by potentially inappropriate prescriptions, findings from the Moli-sani study. Int J Public Health. (2024) 69:1607682. doi: 10.3389/ijph.2024.1607682
3.
Gao C Yu P . Progress of multidisciplinary integrated team working mode in geriatric medicine. Chin J Geriatr. (2020) 39:3. doi: 10.3760/cma.j.issn.0254-9026.2020.02.026
4.
Zhu Y Jin P . Expert consensus on standard operating procedures for outpatient services for polypharmacy in the elderly. Chin J Geriatr. (2024) 43:1382–91. doi: 10.3760/cma.j.issn.0254-9026.2024.11.002
5.
Shen J Gao N Zheng B . Expert consensus on the evaluation and management of polypharmacy in elderly Homo sapiens in China. Chin J Geriatr. (2024) 43:269–78. doi: 10.3760/cma.j.issn.0254-9026.2024.03.002
6.
AGS Expert Panel on Multimorbidity in Older Adults . Guiding principles for the care of older adults with multimorbidity: an approach for clinicians: American Geriatrics Society expert panel on the Care of Older Adults with multimorbidity. J Am Geriatr Soc. (2012) 60:E1–E25. doi: 10.1111/j.1532-5415.2012.04188.x
7.
Kernick D Chew-Graham CA O'Flynn N . Clinical assessment and management of multimorbidity: NICE guideline. Br J Gen Pract. (2017) 67:235–6. doi: 10.3399/bjgp17X690857
8.
The AGS Beers Criteria® Panel . American Geriatrics Society 2023 updated AGS beers criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. (2023) 71:2052–81. doi: 10.1111/jgs.18372
9.
GRDUB-CAGR, CSG, GMCCPA, AAAD-CPS and DID-CPS . The judgment criteria for potential inappropriate medication in Chinese elderly was developed to optimize drug use in older adults. Adverse Drug React. (2017) J.020 (001):2–8. doi: 10.3760/cma.j.issn.1008-5734.2018.01.002
10.
Abtahi S Driessen JHM Burden AM Souverein PC van den Bergh JP van Staa TP et al . Concomitant use of oral glucocorticoids and proton pump inhibitorsand risk of osteoporotic fractures among patients with rheumatoid arthritis: a population-based cohort study. Ann Rheum Dis. (2021) 80:423–31. doi: 10.1136/annrheumdis-2020-218758
11.
Yang N Liu J Liu J Hao Y Smith JSC Huo Y et al . In-hospital outcomes of ticagrelor versus clopidogrel in patients 75 years or older with acute coronary syndrome: findings from the improving Care for Cardiovascular Disease in China (CCC)-acute coronary syndrome project. Age Ageing. (2022) 51:afac231. doi: 10.1093/ageing/afac231
12.
Arai R Fukamachi D Monden M Akutsu N Murata N Okumura Y . Bradycardia shock caused by the combined use of Carteolol eye drops and verapamil in an elderly patient with atrial fibrillation and chronic kidney disease. Intern Med. (2021) 60:79–83. doi: 10.2169/internalmedicine.5598-20
13.
Takeuchi S Kotani Y Tsujimoto T . Hypotension induced by the concomitant use of a calcium-channel blocker and clarithromycin. BMJ Case Rep. (2017) 2017:bcr2016218388. doi: 10.1136/bcr-2016-218388
14.
CMDA-EMPB and NCRC-MD . Consensus on blood glucose management during corticosteroid therapy for COVID-19. Chin J Diabetes. (2023) 15:123–7. doi: 10.3760/cma.j.cn115791-20230117-00022
15.
Juhl CR Burgdorf J Knudsen C Lubberding AF Veedfald S Isaksen JL et al . A randomized, double-blind, crossover study of the effect of the fluoroquinolone moxifloxacin on glucose levels and insulin sensitivity in young men and women. Diabetes Obes Metab. (2023) 25:98–109. doi: 10.1111/dom.14851
16.
Khan F Ismail M Khan Q Ali Z . Moxifloxacin-induced QT interval prolongation and torsades de pointes: a narrative review. Expert Opin Drug Saf. (2018) 17:1029–39. doi: 10.1080/14740338.2018.1520837
Summary
Keywords
Geriatric Interdisciplinary Team, clinical pharmacists, polypharmacy, case report, individualized treatment
Citation
Guo J-W, Zhao H, Tian W and Cai S (2025) Risk assessment and management of polypharmacy in the Geriatric Interdisciplinary Team: a case report. Front. Med. 12:1650502. doi: 10.3389/fmed.2025.1650502
Received
20 June 2025
Accepted
09 September 2025
Published
26 September 2025
Volume
12 - 2025
Edited by
Amin Gasmi, Francophone Society of Nutritherapy and Applied Nutrigenetics, France, France
Reviewed by
Amaury Durand, Centre Hospitalier Intercommunal de la Baie de Somme, France
Sudeep Mathew George, All India Institute of Medical Sciences, India
Updates
Copyright
© 2025 Guo, Zhao, Tian and Cai.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Shuang Cai, caishuang@zgydyy.wecom.workWen Tian, wtian56@cmu.edu.cn
†These authors have contributed equally to this work and share senior authorship
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.