Palyatif Bakım Servisindeki Yaşlı Hastalarda Polifarmasi ve Uygunsuz İlaç Kullanımının Beers ve TIME-to-STOP Kriterlerine Göre Değerlendirilmesi

Abstract

Kırılgan yaşlı popülasyondaki uygunsuz ilaçları belirleyerek farkındalık oluşturup klinisyenlere yol gösterici olması açısından bu çalışma planlandı. Retrospektif dosya taraması olarak planlanan çalışmamızda 65 yaş üzeri palyatif bakım ünitesine kabul edilen hastaların başvuru esnasında kullandıkları ilaçların TIME-to-STOP ve Beers kriterlerine göre değerlendirmesi yapılarak hastalardaki uygunsuz ilaç kullanım oranı değerlendirildi. Hastanemizde yatırılarak takip ve tedavisi yapılan 65 yaş üzeri 100 hasta dahil edildi. Hastaların yatış esnasındaki tanısı, yaş ve cinsiyeti, tıbbi özgeçmişi, kronik hastalıkları, düzenli olarak kullandıkları ilaçlar hastane elektronik arşivi üzerinden tarandı. Elde edilen ilaç preparat isimleri farmakolojik gruplara ayrılarak tek tek TIME-to-STOP ve Beers kriterlerine uygunluk açısından incelendi. Polifarmasi alan hasta oranının %47 olduğu gözlendi. Beers kriterlerine göre potansiyel uygunsuz ilaç oranı %8,3 olarak saptandı. TIME-to-STOP kriterlerine göre yapılan değerlendirmede potansiyel uygunsuz ilaç oranı %11,7 bulundu. Yaşlı, kırılgan bir hasta grubunun değerlendirildiği bu çalışmada polifarmasinin potansiyel uygunsuz ilaç kullanımını arttırabileceği görüldü. Dolayısıyla kırılgan bir popülasyonu içeren yaşlı hasta grubunda polifarmasiden kaçınılmalı eğer endikasyon dahilinde ilaç reçete ediliyorsa hasta uyumunu arttırmak için muhakkak ilaç kullanımıyla ilgili eğitim verilmelidir.

Keywords

• polifarmasi
• uygunsuz ilaç
• beers kriterleri
• TIME-to-STOP
• palyatif bakım
• geriatrik hasta
• yaşlı

Evaluation of Polypharmacy and Potentially Inappropriate Drug Use in Elderly Patients in the Palliative Care Service by Beers and TIME-to-STOP Criteria

Abstract

This study was planned in order to raise awareness by identifying inappropriate drugs in the fragile elderly population and to guide clinicians. Our study as a retrospective file scan study, included 100 patients over the age of 65 who were followed up and treated in our hospital. The diagnosis, age and sex, medical history, chronic diseases, and medications they regularly use during hospitalization were scanned through the hospital electronic archive. The obtained drug preparation names were divided into pharmacological groups and examined one by one for compliance with TIME-to-STOP and Beers criteria. It was observed that the rate of patients who underwent polypharmacy was 47%. The mean number of drugs used by the patients was found to be 4,7. Potentially inappropriate drug rate was determined as 8.3% according to Beers criteria. In the evaluation made according to the TIME-to-STOP criteria, the rate of potentially inappropriate drugs was found to be 11,7%. It was observed that there was a common drug group proton pump inhibitors in both groups. In this study, which evaluated a frail elderly patient group, it was seen that polypharmacy could increase the potential inappropriate drug use. Therefore, polypharmacy should be avoided in the geriatric patient group, which includes a fragile population, and if medication is prescribed within the indication, training on drug use should be given to increase patient compliance.

Keywords

• polypharmacy
• potentially inapropriate medication
• Beers criteria
• TIME-to-STOP
• palliative care

References

1. 1. TÜİK Kurumsal. İstatistiklerle yaşlılar, 2020. Accessed 01.08.2021 https:// www.tuik.gov.tr.
2. 2. World Health Organisation. Global Health and Ageing. 2011.
3. 3. Yeşil Y, Kuyumcu ME. Polifarmasi. Klinik Gelişim 2012;25:18-23.
4. 4. Maryann M. Fulton RN. Polypharmacy in the elderly: A literature review. J Am Acad Nurse Pract 2005;17:123-32.
5. 5. Sirois C, Domingues NS, Laroche M-L, Zongo A, Lunghi C, Guénette L, et al. Polypharmacy definitions for multimorbid older adults need stronger foundations to guide research, clinical practice and public health. Pharmacy 2019;7(126):1-14.
6. 6. Yürüyen M, Tevetoğlu IÖ, Tekmen Y, Polat Ö, Arslan İ, Okuturlar Y. Palyatif bakım hastalarında klinik özellikler ve prognostik faktörler. Konuralp Medical Journal 2018;10:74-80.
7. 7. Kathleen Tschantz Unroe, Greg A. Sachs, Susan E. Hickman, Timothy E. Stump, Wanzhu Tu, Christopher M. Callahan. Hospice Use Among Nursing Home Patients. J Am Med Dir Assoc. 2013;14.
8. 8. Stockl KM, Le L, Zhang Z, Harada AS. Clinical and economic outcomes associated with potentially ınappropriate prescribing in the elderly. Am J Manag Care 2010;16:e1-10.

9. 9. Lavan AH, Gallagher P, Parsons C, O’Mahony D. STOPPFrail (Screening Tool of Older Persons Prescriptions in Frail Adults with Limited Life Expectancy). Age Ageing 2017; 46:600-7.
10. 10. 2019 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc 2019;67:674-94.
11. 11. Yang Y-X, Lewis JD, Epstein S, Metz DC. Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA 2006;296:2947-53.
12. 12. Clyne B, Smith SM, Hughes CM, Boland F, Bradley MC, Cooper JA, et al. Effectiveness of a multifaceted ıntervention for potentially ınappropriate prescribing in older patients in primary care: a cluster-randomized controlled trial (OPTI-SCRIPT Study). Ann Fam Med 2015;13:545-53.
13. 13. Demircan C, Hasanzade U. Polypharmacy and potential inappropriate drug use in the elderly admitted to the general internal medicine outpatient clinic. TJIM 2021;3(Suppl 1):46-8.
14. 14. Sostres C, Carrera-Lasfuentes P, Lanas A. Non-steroidal anti-inflammatory drug related upper gastrointestinal bleeding: types of drug use and patient profiles in real clinical practice. Curr Med Res Opin 2017;33:1815-20.
15. 15. Awad A, Hanna O. Potentially inappropriate medication use among geriatric patients in primary care setting: a cross-sectional study using the Beers, STOPP, FORTA and MAI criteria”. PLoS ONE 2019;14.
16. 16. Blanco-Reina E, Valdellós J, Aguilar-Cano L, García-Merino MR, Ocaña-Riola R, Ariza-Zafra G, et al. 2015 Beers Criteria and STOPP v2 for detecting potentially ınappropriate medication in community-dwelling older people: prevalence, profile, and risk factors. Eur J Clin Pharmacol 2019;75:1459-66.
17. 17. Mohamed MR, Ramsdale E, Loh KP, Arastu A, Xu H, Obrecht S, et al. Associations of polypharmacy and inappropriate medications with adverse outcomes in older adults with cancer: a systematic review and metaanalysis. Oncologist 2020;25:e94-e108.
18. 18. Gradalski T. Polypharmacy and Medication Errors on Admission to Palliative Care. Pol Arch Intern Med 2019;129:659-66.