Polypharmacy viewed not only through the prism of multi-morbidity, but also as an independent geriatric syndrome
Authors:
Pavel Weber; Hana Meluzínová; Dana Prudius; Katarína Bielaková
Authors‘ workplace:
Klinika interní, geriatrie a praktického lékařství LF MU a FN Brno, pracoviště Bohunice
Published in:
Vnitř Lék 2016; 62(Suppl 3): 135-139
Category:
Reviews
Overview
Polypharmacy is common in the elderly, especially in the late age (over 75 years). Usually it is closely related to the geriatric multi-morbidity. The authors highlight the medication used in the anticipated positive and potential negative potential. While physicians often must make difficult trade-offs between the guidelines on one hand and complicated multi-morbidity, on the other hand, while trying to avoid polypharmacy (≥ 5 drugs), especially excessive polypharmacy (≥ 10 drugs). Multimorbid elderly patients who are treated in accordance with guidelines typically use large amounts of medicaments. This polypharmacy increases the risk of adverse drug reactions and drug interactions. The authors point out the pitfalls of performance of large clinical studies and EBM on one side and the daily clinical practice at the risk of their indiscriminate application, albeit with good intentions to improve the health of seniors.
Key words:
evidence based medicine – geriatrisation of medicine – multi–morbidity – old age – polypharmacy – prescription – randomized clinical trials
Sources
1. Evans DC, Cook CH, Christy JM et al. Comorbidity-polypharmacy scoring facilitates outcome prediction in older trauma patients. J Am Geriatr Soc 2012; 60(8): 1465–1470. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1532–5415.2012.04075.x>.
2. Moen J, Antonov K, Larsson CA et al. Factors associated with multiple medication use in different age groups. Ann Pharmacother 2009; 43(12): 1978–1985. Dostupné z DOI: <http://dx.doi.org/10.1345/aph.1M354>.
3. Hovstadius B, Astrand B, Petersson G. Assessment of regional variation in polypharmacy. Pharmacoepidemiol Drug Saf 2010; 19(4): 375–383. Dostupné z DOI: <http://dx.doi.org/10.1002/pds.1921>.
4. Morley JE, Caplan G, Cesari M. International Survey of Nursing Home Research Priorities. JAMDA 2014; 15(5): 309–312. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jamda.2014.03.003>.
5. Bushardt RL, Massey EB, Simpson TW et al. Polypharmacy: misleading, but manageable. Clin Interv Aging 2008; 3(2): 383–389.
6. Nechba RB, Moncif El M‘barki Kadiric, Mounia Bennani-Ziatnid et al. Difficulty in managing polypharmacy in the elderly: Case report and review of the literature. Journal of Clinical Gerontology and Geriatrics 2015; 6(1): 30–33. Dostupné z WWW: <http://www.e-jcgg.com/article/S2210–8335(14)00062–8/pdf>.
7. 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(10): E1-E25. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1532–5415.2012.04188.x>.
8. Weber P, Prudius D, Meluzínová H. Geriatrická multimorbidita – jeden z klíčových problémů současné medicíny. Vnitř Lék 2015; 61(12): 1042–1048.
9. Gómez C, Vega-Quiroga S, Bermejo-Pareja F et al. Polypharmacy in the Elderly: A Marker of Increased Risk of Mortality in a Population-Based Prospective Study (NEDICES). Gerontology 2015; 61(4): 301–309. Dostupné z DOI: <http://dx.doi.org/10.1159/000365328>.
10. Werder S, Preskorn S. Managing polypharmacy: Walking the fine line between help and harm. Current Psychiatry.2003; 2(2): 24–36. Dostupné z WWW: www.currentpsychiatry.com/UserInputInfo.asp?AID=601&PID=0.
11. Koper D, Kamenski G, Flamm M et al. Frequency of medication errors in primary care patients with polypharmacy. Fam Pract 2013; 30(3): 313–319. Dostupné z DOI: <http://dx.doi.org/10.1093/fampra/cms070>.
12. Bronskill SE, Gill SS, Paterson JM et al. Exploring variation in rates of polypharmacy across long term care homes. J Am Med Dir Assoc 2012; 13: 309.e15–21. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jamda.2011.07.00>.
13. Jódar-Sánchez F, Malet-Larrea A, Martín JJ et al. Cost-utility analysis of a medication review with follow-up service for older adults with polypharmacy in community pharmacies in Spain: the conSIGUE program. Pharmacoeconomics 2015; 33(6): 599–610. Dostupné z DOI: <http://dx.doi.org/10.1007/s40273–015–0270–2>.
14. Wrobel N. Demografieinduzierte Multi-Morbidität – Komplexleistung Im DRG-Vergütungssystem. Recht Und Politik Im Gesundheitswesen 2008; 14(1): 7–10.
15. Onder G, Liperoti R, Fialova D et al. SHELTER Project. Polypharmacy in nursing home in Europe: results from the SHELTER study. J Gerontol A Biol Sci Med Sci 2012; 67(6): 698–704. Dostupné z DOI: <http://dx.doi.org/10.1093/gerona/glr233>.
16. Garfinkel D, Mangin D. Feasibility study of a systematic approach for discontinuation of multiple medications in older adults: addressing polypharmacy. Arch Intern Med 2010; 170(18): 1648–1654. Dostupné z DOI: <http://dx.doi.org/10.1001/archinternmed.2010.355>.
17. Zrubáková K, Krajčík Š et al. Farmakoterapie v geriatrii. Grada: Praha 2016. ISBN 978–80–247–5229–7.
18. Kalvach Z, Holmerová I. Geriatrická farmakoterapie. Současná klinická praxe 2008; 7(1): 34–40.
19. Topinková E. Jak zlepšit adherenci k lékovemu režimu u klinicky komplexních polymorbidnich seniorů? Vnitř Lék 2013; 59(9): 760–763.
20. Fried TR, Tinetti ME, Iannone L et al. Health outcome prioritization as a tool for decision making among older persons with multiple chronic conditions. Arch Intern Med 2011; 171(20): 1854–1856. Dostupné z DOI: <http://dx.doi.org/10.1001/archinternmed.2011>.
21. Rai Gurcharan S, Mulley GP (eds). Elderly medicine: a training guide. 2nd ed. Churchill Livingstone: Edinburgh 2007. ISBN 978–0443103025
22. Gokce Kutsal Y, Barak A, Atalay A et al. Polypharmacy in the elderly: a multicenter study. J Am Med Dir Assoc 2009; 10(7): 486–490. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jamda.2009.03.018>.
23. Jadad AR, To MJ, Emara M et al. Consideration of multiple chronic diseases in randomized controlled trials. JAMA 2011; 306(24): 2670–2672. Dostupné z DOI: <http://dx.doi.org/10.1001/jama.2011.1886>.
24. Zulman DM, Sussman JB, Chen X et al. Examining the evidence: a systematic review of the inclusion and analysis of older adults in randomized controlled trials. J Gen Intern Med 2011; 26(7): 783–790. Dostupné z DOI: <http://dx.doi.org/10.1007/s11606–010–1629-x>.
25. Cassel CHK, Leipzig R, Cohen HJ et al. (eds). Geriatric medicine: an evidence-based approach paperback softcover reprint of the origina 4th ed 2003. Springer: New York 2013. ISBN 978–1475778373.
26. Lally F, Roffe Ch (ed). Geriatric Medicine: an evidence-based approach Paperback. Oxford University Press: London 2014. ISBN 978–0199689644.
27. Suchopár J, Prokes M. Polypragmazie a lékové interakce. Vnitř Lék 2011; 57(9): 755–759.
28. Pathy MS John, Finucane P (eds). Geriatric Medicine: Problems and Practice paperback. Springer: New York 2014. ISBN 978–1447116486.
29. Patterson SM, Hughes C, Kerse N et al. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev 2012; 16(5): CD008165. Dostupné z DOI: <http://dx.doi.org/10.1002/14651858.CD008165.pub2>.
30. Boyd CM, Darer J, Boult C et al. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA 2005, 294(6): 716–724.
31. Matějovská Kubešová H, Weber P, Meluzínová H et al. Senioři a kardiovaskulární medikace. Vnitř Lék 2011; 57(6): 561–570.
32. Morley JE, Vellas B, van Kan GA et al. Frailty consensus: a call to action. J Am Med Dir Assoc 2013; 14(6): 392–397. Dostupné z DOI: <http://dx.doi.org/.1016/j.jamda.2013.03.022>.
33. Gallagher P, Ryan C, Byrne S et al. Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START): Validation and application to hospitalised elderly patients. Age Ageing 2008; 37: 56.
34. Gallagher P, O‘Mahony D. STOPP (Screening Tool of Older Persons‘ potentially inappropriate Prescriptions): application to acutely ill elderly patients and comparison with Beers‘ criteria. Age Ageing 2008; 37(6): 673–679.
35. Williams B, Chang A, Landefeld C et al (eds). Current Diagnosis and Treatment: Geriatrics. 2nd ed.McGraw-Hill Education/Medical 2014. ISBN 978–0071792080.
36. Jorgensen T, Johansson S, Kennerfalk A et al. Prescription drug use, diagnoses, and healthcare utilization among the elderly. Ann Pharmacother 2001; 35(9): 1004–1009.
37. Steinman MA, Handler SM, Gurwitz JH et al. Beyond the prescription: medication monitoring and adverse drug events in older adults. J Am Geriatr Soc 2011; 59(8): 1513–1520. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1532–5415.2011.03500.x>.
38. Olsson IN, Runnamo R, Engfeldt P. Drug treatment in the elderly: an intervention in primary care to enhance prescription quality and quality of life. Scand J Prim Health Care 2012; 30(1): 3–9. Dostupné z DOI: <http://dx.doi.org/10.3109/02813432.2011.629149>.
39. Manias E, Kusljic S, Berry C et al. Use of the Screening Tool of Older Person‘s Prescriptions (STOPP) in older people admitted to an Australian hospital. Australas J Ageing 2015; 34(1): 15–20. Dostupné z DOI: <http://dx.doi.org/10.1111/ajag.12054>.
40. Payne RA, Avery AJ. Polypharmacy: one of the greatest prescribing challenges in general practice. Br J Gen Pract 2011; 61(583): 83–84. Dostupné z DOI: <http://dx.doi.org/10.3399/bjgp11X556146>.
41. Blanco-Reina E, Ariza-Zafra G, Ocaña-Riola R et al. Optimizing elderly pharmacotherapy: polypharmacy vs. undertreatment. Are these two concepts related? Eur J Clin Pharmacol 2015; 71(2): 199–207. Dostupné z DOI: <http://dx.doi.org/10.1007/s00228–014–1780–0>.
42. Scott IA, Gray LC, Martin JH et al. Minimizing inappropriate medications in older populations: a 10-step conceptual framework. Am J Med 2012; 125(6): 529–537. Dostupné z DOI: <http://dx.doi.org/10.1016/j.amjmed.2011.09.021>.
43. Hovstadius B, Petersson G, Hellström L et al. Trends in inappropriate drug therapy prescription in the elderly in Sweden from 2006 to 2013: assessment using national indicators. Drugs Aging 2014; 31(5): 379–386. Dostupné z DOI: <http://dx.doi.org/10.1007/s40266–014–0165–5>.
44. Cahir C, Fahey T, Teeling M et al. Potentially inappropriate prescribing and cost outcomes for older people: a national population study. Br J Clin Pharmacol 2010; 69(5): 543–552. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1365–2125.2010.03628.x>.
45. [American Geriatrics Society 2012 Beers Criteria Update Expert Panel]. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2012; 60(4): 616–631. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1532–5415.2012.03923.x>.
46. Fialová D, Topinková E, Ballóková A et al. Expertní konsenzus ČR 2012 v oblasti léčiv a lékových postupů potenciálně nevhodných ve stáří. Klin Farmakol Farm 2013; 27(1): 18–28.
Labels
Diabetology Endocrinology Internal medicineArticle was published in
Internal Medicine
2016 Issue Suppl 3
Most read in this issue
- Congenital Adrenal Hyperplasia in Adults
- Multiple Endocrine Neoplasia I (Wermer‘s Syndrome), Forms of Clinical Manifestation, 5 Case Studies
- Vitamin D and autoimmune thyroid diseases
- Central Thyroid Disorders