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Yaşlılarda çoklu ilaç kullanımının değerlendirilmesi

Yıl 2019, Cilt: 29 Sayı: 2, 55 - 59, 01.03.2019

Songül Ünüvar Hacer Bayrak Göknur Aktay

Öz

Amaç: Çoklu ilaç kullanımı, polifarmasi olarak ta adlandırılmaktadır. Hastanın aynı anda veya belli aralıklarla, çoğu zaman endikasyon olmadan birden fazla ilacı bir arada kullanmasıdır. Polifarmasi en sık, birden fazla kronik hastalığın bir arada görüldüğü yaşlı hastalarda gözlenmektedir. Yaşlı hastalarda polifarmasiye bağlı en önemli sorun ise ilaç uyuncunun sağlanamamasıdır. Çalışmamızda bir grup yaşlı hastada çoklu ilaç kullanımı sonrasında ilaç uyuncu değerlendirilmiştir.Gereç ve Yöntem: Çalışma 55 yaş üstü, 70 hasta ile yürütülmüştür. Hastalarla yüz yüze görüşülerek çoklu ilaç kullanımları değerlendirilmiştir. Bulgular: İlaç uyuncu ve eğitim düzeyi arasında bir ilişki bulunmamıştır. Kadınların ilaçları doğru kullanım oranı, erkeklerden daha fazla bulunmuştur. Yaşlıların %19'unun alternatif tedavileri tercih ettikleri, geleneksel ve alternatif tedaviyi birlikte uygulayanların ise %22.9 olduğu bulunmuştur. Katılımcıların % 1.4'ünün hekim önerisi dışında ilaç kullandığı bulunmuştur.Sonuç: Yaşlanma süreci, tüm organ sistemlerini etkileyen yapısal ve fonksiyonel değişikliklerle karakterize, homeostatik kapasitenin azalmasına neden olan bir süreçtir. Vücut kompozisyonundaki değişiklikler, hepatik ve böbrek fonksiyonlarını etkileyerek yağda çözünen ilaçların dağılım hacminde artış ve suda çözünen ilaçların klerensinde azalmayla sonuçlanmaktadır. İlaçların plazma yarılanma ömrü genel olarak artmaktadır. Yaşlanmaya bağlı farmakokinetik ve farmakodinamik değişikliklerin terapötik rejimler üzerindeki etkisini iyi anlamak, tedavi etkinliğini artıracaktır

Anahtar Kelimeler

Yaşlılık ilaç uyuncu polifarmasi ilaç farmakokinetiği

Kaynakça

  • Navaratnarajah A, Jackson SHD. The physiology of ageing. Medicine 2017; 45: 6-10.
  • Mortazavi SS, Shati M, Keshtkar A, Malakouti SK, Bazargan M, Assari S. Defining polypharmacy in the elderly: a syste- matic review protocol. BMJ Open 2016; 6: e010989.
  • Duerden M, Avery T, Payne R. Polypharmacy and Medici- nes Optimisation: Making it Safe and Sound. first ed., The King’s Fund, UK 2013.
  • Riker GI, Setter SM. Polypharmacy in older adults at home: what it is and what to do about it--implications for home healthcare and hospice. Home Healthc Nurse 2012; 30(8): 474-85.
  • Veehof L, Stewart R, Haaijer-Ruskamp F, Jong BM. The development of polypharmacy. A longitudinal study. Fam Pract 2000; 17: 261-7.
  • Santos TR, Lima DM, Nakatani AY, Pereira LV, Leal GS, Amaral RG. Medicine use by the elderly in Goiania, Mi- dwestern Brazil. Rev Saude Publica 2013; 47: 94-103.
  • Secoli SR. Polypharmacy: interaction and adverse reactions in the use of drugs by elderly people. Rev Bras Enferm 2010; 63: 136-40.
  • Administration on Aging of the United State Department of Health and Human Services. A profile of older Americans: 2010.https://www.acl.gov/sites/default/files/Aging%20 and%20Disability%20in%20America/2016-Profile.pdf. (accessed September 20, 2017).
  • Türkiye İstatistik Kurumu. http://www.tuik.gov.tr/PreHa- berBultenleri.do?id=24644. (accessed September 20, 2017).
  • Corsonello A, Pedone C, Incalzi RA. Age-related pharma- cokinetic and pharmacodynamic changes and related risk of adverse drug reactions. Curr Med Chem 2010; 17: 571- 84.
  • Public Health and Aging: Trends in Aging-United States and Worldwide. JAMA 2003; 289: 1371-3.
  • Stewart RB, Cooper JW. Polypharmacy in the aged. Practi- cal solutions. Drugs Aging 1994; 4: 449-61.
  • Arslan Ş, Atalay A, Gökçe-Kutsal Y. Drug use in older peop- le. J Am Geriatr Soc 2002; 50: 1163-8.
  • Gökçe Kutsal Y. Yaşlılarda çoklu ilaç kullanımı (Polyphar- macy in elderly). Turk J Geriatr 2006; Özel Sayı: 37-44.
  • Cankurtaran M, Yavuz BB, Halil M, Arıogul S. Polyphar- macy in elderly: Does evidence based medicine brings more drug useage? 3rd European Geriatrics congress. J Nutrition Health Aging 2004; 8: 280.
  • Nguyen J, Fouts M, Kotabe SE, Lo E. Polypharmacy as a risk factor for adverse drug reactions in geriatric nursing home residents. Am J Geriat Pharmacother 2006; 4: 36-41.
  • Linjakumpu T, Hartikainen S, Klaukka T, Veijola J, Kive- la SL, Isoaho R. Use of medications and polypharmacy are increasing among the elderly. J Clin Epidemiol 2002; 55: 809-17.
  • Larsen P, Martin J. Polypharmacy and elderly patients. As- sociation of operating room nurses. AORN J 1999; 69: 619- 27.
  • Frazier S. Health outcomes and polypharmacy in elderly ındividuals. J Gerontol Nurs 2005; 31: 4-11.
  • Shah BM, Hajjar ER. Polypharmacy, adverse drug reacti- ons, and geriatric syndromes. Clin Geriatr Med 2012; 28: 173-86.
  • Zed PJ, Abu-Laban RB, Balen RM, Loewen PS, Hohl CM, Brubacher JR, et al. Incidence, severity and preventability of medication-related visits to the emergency department: a prospective study. CMAJ 2008; 178: 1563-9.
  • Akan P, Erdinçler D, Tezcan V, Beğer T. Yaşlıda ilaç kullanı- mı. Türk Geriatri Dergisi 1999; 2: 33-8.
  • Arslan Ş, Atalay A, Gökçe-Kutsal Y. Yaşlılarda ilaç tüketimi. Turkish Journal of Geriatrics 2000; 3: 56-60.
  • Şahin G,Baydar T. Use of drugs among older persons. In: Troisi J,Gökçe Kutsal Y (Eds) Aging in Turkey: Internatio- nal Institute on Ageing and Hacettepe University Research Center of Geriatrics SciencesGEBAM,Vertas Pres, Mal- ta,2006,pp:55-84.
  • Lavan AH, Gallagher P. Predicting risk of adverse drug re- actions in older adults. Ther Adv Drug Saf 2016; 7: 11-22.

Yıl 2019, Cilt: 29 Sayı: 2, 55 - 59, 01.03.2019

Songül Ünüvar Hacer Bayrak Göknur Aktay

Öz

Objective: Multiple drug use is also called as polypharmacy. The use of more than one drug by the patient at the same time or at certain intervals, often without indication. Polypharmacy is most often seen in elderly patients with multiple chronic illnesses. The most important problem related to polypharmacy in elderly patients is the inability to obtain drug compliance. In our study, drug compliance was assessed after multiple drug use in a group of elderly patients.Material and Methods: The study was conducted with 70 patients over 55 years of age. Multiple drug use was assessed by face-to-face interviews with the patients.Results: No relationship was found between drug compliance and education level. Women's correct medication rate was found higher than men. It was found that 19% of the elderly preferred alternative treatment and 22.9% of those who applied traditional and alternative treatment together. 1.4% of the participants were found to use drugs other than the physician's recommendation.Conclusion: The aging process is characterized by structural and functional changes affecting all organ systems and is a process that causes the reduction of homeostatic capacity. Changes in body composition affect hepatic and renal function, resulting in an increase in the volume of distribution of lipid-soluble drugs and a decrease in the clearance of water-soluble drugs. The plasma half-life of drugs is generally increased. Well-understood of the effect of aging-related pharmacokinetic and pharmacodynamic changes on therapeutic regimens will increase the efficacy of treatment

Anahtar Kelimeler

Aging drug compliance polypharmacy drug pharmacokinetics

Kaynakça

  • Navaratnarajah A, Jackson SHD. The physiology of ageing. Medicine 2017; 45: 6-10.
  • Mortazavi SS, Shati M, Keshtkar A, Malakouti SK, Bazargan M, Assari S. Defining polypharmacy in the elderly: a syste- matic review protocol. BMJ Open 2016; 6: e010989.
  • Duerden M, Avery T, Payne R. Polypharmacy and Medici- nes Optimisation: Making it Safe and Sound. first ed., The King’s Fund, UK 2013.
  • Riker GI, Setter SM. Polypharmacy in older adults at home: what it is and what to do about it--implications for home healthcare and hospice. Home Healthc Nurse 2012; 30(8): 474-85.
  • Veehof L, Stewart R, Haaijer-Ruskamp F, Jong BM. The development of polypharmacy. A longitudinal study. Fam Pract 2000; 17: 261-7.
  • Santos TR, Lima DM, Nakatani AY, Pereira LV, Leal GS, Amaral RG. Medicine use by the elderly in Goiania, Mi- dwestern Brazil. Rev Saude Publica 2013; 47: 94-103.
  • Secoli SR. Polypharmacy: interaction and adverse reactions in the use of drugs by elderly people. Rev Bras Enferm 2010; 63: 136-40.
  • Administration on Aging of the United State Department of Health and Human Services. A profile of older Americans: 2010.https://www.acl.gov/sites/default/files/Aging%20 and%20Disability%20in%20America/2016-Profile.pdf. (accessed September 20, 2017).
  • Türkiye İstatistik Kurumu. http://www.tuik.gov.tr/PreHa- berBultenleri.do?id=24644. (accessed September 20, 2017).
  • Corsonello A, Pedone C, Incalzi RA. Age-related pharma- cokinetic and pharmacodynamic changes and related risk of adverse drug reactions. Curr Med Chem 2010; 17: 571- 84.
  • Public Health and Aging: Trends in Aging-United States and Worldwide. JAMA 2003; 289: 1371-3.
  • Stewart RB, Cooper JW. Polypharmacy in the aged. Practi- cal solutions. Drugs Aging 1994; 4: 449-61.
  • Arslan Ş, Atalay A, Gökçe-Kutsal Y. Drug use in older peop- le. J Am Geriatr Soc 2002; 50: 1163-8.
  • Gökçe Kutsal Y. Yaşlılarda çoklu ilaç kullanımı (Polyphar- macy in elderly). Turk J Geriatr 2006; Özel Sayı: 37-44.
  • Cankurtaran M, Yavuz BB, Halil M, Arıogul S. Polyphar- macy in elderly: Does evidence based medicine brings more drug useage? 3rd European Geriatrics congress. J Nutrition Health Aging 2004; 8: 280.
  • Nguyen J, Fouts M, Kotabe SE, Lo E. Polypharmacy as a risk factor for adverse drug reactions in geriatric nursing home residents. Am J Geriat Pharmacother 2006; 4: 36-41.
  • Linjakumpu T, Hartikainen S, Klaukka T, Veijola J, Kive- la SL, Isoaho R. Use of medications and polypharmacy are increasing among the elderly. J Clin Epidemiol 2002; 55: 809-17.
  • Larsen P, Martin J. Polypharmacy and elderly patients. As- sociation of operating room nurses. AORN J 1999; 69: 619- 27.
  • Frazier S. Health outcomes and polypharmacy in elderly ındividuals. J Gerontol Nurs 2005; 31: 4-11.
  • Shah BM, Hajjar ER. Polypharmacy, adverse drug reacti- ons, and geriatric syndromes. Clin Geriatr Med 2012; 28: 173-86.
  • Zed PJ, Abu-Laban RB, Balen RM, Loewen PS, Hohl CM, Brubacher JR, et al. Incidence, severity and preventability of medication-related visits to the emergency department: a prospective study. CMAJ 2008; 178: 1563-9.
  • Akan P, Erdinçler D, Tezcan V, Beğer T. Yaşlıda ilaç kullanı- mı. Türk Geriatri Dergisi 1999; 2: 33-8.
  • Arslan Ş, Atalay A, Gökçe-Kutsal Y. Yaşlılarda ilaç tüketimi. Turkish Journal of Geriatrics 2000; 3: 56-60.
  • Şahin G,Baydar T. Use of drugs among older persons. In: Troisi J,Gökçe Kutsal Y (Eds) Aging in Turkey: Internatio- nal Institute on Ageing and Hacettepe University Research Center of Geriatrics SciencesGEBAM,Vertas Pres, Mal- ta,2006,pp:55-84.
  • Lavan AH, Gallagher P. Predicting risk of adverse drug re- actions in older adults. Ther Adv Drug Saf 2016; 7: 11-22.
Toplam 25 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Original Article
Yazarlar

Songül Ünüvar Bu kişi benim

Hacer Bayrak Bu kişi benim

Göknur Aktay Bu kişi benim

Yayımlanma Tarihi 1 Mart 2019
Yayımlandığı Sayı Yıl 2019 Cilt: 29 Sayı: 2

Kaynak Göster

Vancouver Ünüvar S, Bayrak H, Aktay G. Yaşlılarda çoklu ilaç kullanımının değerlendirilmesi. Genel Tıp Derg. 2019;29(2):55-9.

Genel Tıp Dergisi Creative Commons Atıf-GayriTicari 4.0 Uluslararası Lisansı (CC BY NC) ile lisanslanmıştır.