Öz
Multidrug use in the Elderly Patients with Multimorbidity: A Great Problem in Family Medicine The elderly population is gradually increasing in our country and worldwide. Disease burden of the elderly population seems to arise from chronic diseases. Number of medications used daily also increases due to increasing multimorbidity and comorbidities. Multidrug use (polypharmacy) is a gradually increasing problem worldwide. Improper multidrug prescription and the habit of drug use increase drug-related morbidity and mortality risk. In addition, negative drug interactions and adverse effects of drugs lead to severe costs for social security agencies and insurance companies. Specialization makes polypharmacy management difficult. In our country, family physicians have had a great role in management of chronic diseases and arrangement of medications particularly after introduction of family medicine practice in primary care. One of the important role of family physicians is taking measures not only to prolong the life span but also quality of life of the patients. In this paper, it was aimed to emphasize that polypharmacy and its negative effects increase in the elderly and family physicians should be aware of this issue.
Anahtar Kelimeler
Kaynakça
- Türk İstatistik Kurumu. İstatistiklerle yaşlılar 20 20 Mart 2013 http://www.tuik.gov.tr/PreHaberBultenleri.do?id= 13466
- Budnitz DS, Lovegrove MC, Shehab N, Richards CL: Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med 2011;365(21):2002-12.
- Eckardt R, Steinhagen-Thiessen E, Kämpfe S, Buchmann N. Polypharmazie und Arzneimitteltherapiesicherheit im Alter. Zeitschrift für Gerontologie und Geriatrie 2013:1-9.
- Kruse W, Rampmaier J, Frauenrath-Volkers C et al. Drug-prescribing patterns in old age. A study of the impact of hospitalization on drug prescriptions and follow-up survey in patients 75 years and older. Eur J Clin Pharmacol 1991;41(5):441-7.
- Nair BR. Evidence based medicine for older people: available, accessible, acceptable, adaptable? Australasian Journal on Ageing 2002;2:58-60.
- Ältere Patienten erhalten häufig ungeeignete Arzneimittel. Wissenschaftliches Institut der AOK (WidO). Dezember 2, 20 http://www.wido.de/meldung_archiv+M5a5d2db4 ddc.html Rottlaender D, Scherner M, Schneider T, et al. Multimedikation, Compliance und Zusatzmedikation bei Patienten mit kardiovaskulären Erkrankungen. Deutsche Medizinische Wochenschrift 2007;132:139-44.
- Dişcigil G, Tekinç N, Anadol Z, Bozkaya AO. Toplum içinde yaşayan ve bakımevinde kalan yaşlılarda polifarmasi. Turk J Geriatr 2006;9:117
- Junius-Walker U, Theile G, Hummers-Pradier E. Prevalence and predictors of polypharmacy among older primary care patients in Germany. Fam Pract 2007;24(1):14-9.
- Davies EC, Green CF, Taylor S et al. Adverse drug reactions in hospital in-patients: a prospective analysis of 3695 patient-episodes. PLoS One 2009;4(2):1-7.
- 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.
- Morandi A, Bellelli G, Vasilevskis EE, Turco R, Guerini F, Torpilliesi T et al. Predictors of rehospitalization among elderly patients admitted to a rehabilitation hospital: the role of polypharmacy, functional status, and length of stay. J Am Med Dir Assoc 2013;14(10):761-7.
- Lopez-Picazo JJ, Ruiz JC, Sanchez JF, Ariza A, Aguilera B, Lazaro D, et al. Prevalence and typology of potential drug interactions occurring in primary care patients. Eur J Gen Pract 2010;16(2):92-9.
- Bjerrum L, Gonzalez Lopez-Valcarcel B, Petersen G. Risk factors for potential drug interactions in general practice. Eur J Gen Pract 2008;14(1):23-9. Linjakumpu T, Hartikainen S, Klaukka T, Veijola J, Kivela SL, Isoaho R. Use of medications and polypharmacy are increasing among the elderly. J Clin Epidemiol 2002;55: 809-17.
- Marx G, Püsche K, Ahrens D. Polypharmacy: a dilemma in primary care? Results of group discussions with general practitioners. Gesundheitswesen 2009;71(6):339-48.
- Barker KN, Flynn EA, Pepper GA, Bates DW, Mikeal RL. Medication errors observed in 36 health care facilities. Arch Intern Med 2002;162(16):189790
- Weingart SN, Cleary A, Seger A, Eng TK, Saadeh M, Gross A, Shulman LN. Medication reconciliation in ambulatory oncology. Jt Comm J Qual Patient Saf 2007;33(12):750-7.
- Pronovost P, Weast B, Schwarz M et al. Medication reconciliation: a practical tool to reduce the risk of medication errors. J Crit Care 2003;18(4):201-5.
- Schneeweiss S, Hasford J, Göttler M, Hoffmann A, Riethling AK, Avorn J. Admissions caused by adverse drug events to internal medicine and emergency departments in hospitals: a longitudinal population-based study. Eur J Clin Pharmacol 2002;58(4):285-91.
- Lagnaoui R, Moore N, Fach J, Longy-Boursier M, Bégaud B. Adverse drug reactions in a department of systemic diseases-oriented internal medicine: prevalence, incidence, direct costs and avoidability. Eur J Clin Pharmacol 2000;56(2):181-6.
- Akici A, Kalaca S, Ugurlu MU, Karaalp A, Cali S, Oktay S Impact of a short postgraduate course in rational pharmacotherapy for general practitioners. Br J Clin Pharmacol 2004;57(3):310
- Topinkova E, Baeyens JP, Michel JP, Lang PO. Evidence-based strategies for the optimization of pharmacotherapy in older people. Drugs Aging 2012;29(6):477-94.
- Siegmund S, Nicola. Polypharmakotherapie im Alter: Weniger Medikamente sind oft mehr. Dtsch Arztebl 2012;109(9):418-421
- Sevilay N. Aile Hekimliğinde Komorbidite ve Multimorbiditeyi Anlamak. TJFMPC 2013; 7:35-39.
- Dawes M: Co-morbidity: we need a guideline for each patient not a guideline for each disease. Fam Pract 2010;27(1):2
- Gallagher P, Ryan C, Byrne S, Kennedy J, O'Mahony D. STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. Int J Clin Pharmacol Ther 2008;46(2):72
- Onar E, Kapucu S. Yaşlılarda Çoklu İlaç Kullanımı: Polifarmasi. Akat Geriatri 2011;3:22-28
- Akıcı A. Akılcı İlaç Kullanımı İlkeleri Doğrultusunda Yaşlılarda Reçete Yazma ve Türkiye’de Yaşlılarda İlaç Kullanımımın Boyutları. Turk J Geriatr 2006 Özel Sayı:19 - 27
Öz
Multimorbiditesi Olan Yaşlı Hastalarda Çoklu İlaç Kullanımı: Aile Hekimliğinde Önemli Bir Problem Ülkemizde ve dünyada yaşlı nüfus giderek artmaktadır. Yaşlı nüfusun hastalık yükünün kronik hastalıklara bağlı olduğu görülmektedir. Yaşlı nüfusta artan multimorbidite ve komorbiditeleri nedeni ile kullanılan günlük ilaç sayısı da artış göstermektedir. Çoklu ilaç kullanımı (polifarmasi) dünyada giderek artan bir sorun olarak karşımıza çıkmaktadır. Uygunsuz çoklu ilaç reçetelenmesi ve kullanım alışkanlıkları, ilaçlara bağlı morbidite ve mortalite riskini artırmaktadır. Ayrıca olumsuz ilaç etkileşimleri ve ilaç yan etkileri sosyal güvelik kuruluşları ve sigorta şirketlerine ciddi maliyet oluşturmaktadır. Mesleki anlamda branşlaşma çoklu ilaç yönetimini giderek zorlaştırmaktadır. Ülkemizde Aile Hekimliği Uygulamasına geçilmesi ile kronik hastalıkların yönetimi ve ilaçların düzenlenmesinde aile hekimlerine bu nedenle büyük görevler düşmektedir. Aile Hekimlerinin önemli bir görevi toplumun yaşam süresi ile birlikte yaşam kalitesini de arttıracak tedbirlerin alınmasıdır. Bu yazıda çoklu ilaç kullanımının yaşlılık döneminde arttığının ve yaşlılar üzerinde olumsuz etkileri olduğunun vurgulanması, hastayı takip ve tedavi eden aile hekimlerinin bu konuda daha duyarlı hale getirilmesi amaçlanmıştır.
Anahtar Kelimeler
Kaynakça
- Türk İstatistik Kurumu. İstatistiklerle yaşlılar 20 20 Mart 2013 http://www.tuik.gov.tr/PreHaberBultenleri.do?id= 13466
- Budnitz DS, Lovegrove MC, Shehab N, Richards CL: Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med 2011;365(21):2002-12.
- Eckardt R, Steinhagen-Thiessen E, Kämpfe S, Buchmann N. Polypharmazie und Arzneimitteltherapiesicherheit im Alter. Zeitschrift für Gerontologie und Geriatrie 2013:1-9.
- Kruse W, Rampmaier J, Frauenrath-Volkers C et al. Drug-prescribing patterns in old age. A study of the impact of hospitalization on drug prescriptions and follow-up survey in patients 75 years and older. Eur J Clin Pharmacol 1991;41(5):441-7.
- Nair BR. Evidence based medicine for older people: available, accessible, acceptable, adaptable? Australasian Journal on Ageing 2002;2:58-60.
- Ältere Patienten erhalten häufig ungeeignete Arzneimittel. Wissenschaftliches Institut der AOK (WidO). Dezember 2, 20 http://www.wido.de/meldung_archiv+M5a5d2db4 ddc.html Rottlaender D, Scherner M, Schneider T, et al. Multimedikation, Compliance und Zusatzmedikation bei Patienten mit kardiovaskulären Erkrankungen. Deutsche Medizinische Wochenschrift 2007;132:139-44.
- Dişcigil G, Tekinç N, Anadol Z, Bozkaya AO. Toplum içinde yaşayan ve bakımevinde kalan yaşlılarda polifarmasi. Turk J Geriatr 2006;9:117
- Junius-Walker U, Theile G, Hummers-Pradier E. Prevalence and predictors of polypharmacy among older primary care patients in Germany. Fam Pract 2007;24(1):14-9.
- Davies EC, Green CF, Taylor S et al. Adverse drug reactions in hospital in-patients: a prospective analysis of 3695 patient-episodes. PLoS One 2009;4(2):1-7.
- 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.
- Morandi A, Bellelli G, Vasilevskis EE, Turco R, Guerini F, Torpilliesi T et al. Predictors of rehospitalization among elderly patients admitted to a rehabilitation hospital: the role of polypharmacy, functional status, and length of stay. J Am Med Dir Assoc 2013;14(10):761-7.
- Lopez-Picazo JJ, Ruiz JC, Sanchez JF, Ariza A, Aguilera B, Lazaro D, et al. Prevalence and typology of potential drug interactions occurring in primary care patients. Eur J Gen Pract 2010;16(2):92-9.
- Bjerrum L, Gonzalez Lopez-Valcarcel B, Petersen G. Risk factors for potential drug interactions in general practice. Eur J Gen Pract 2008;14(1):23-9. Linjakumpu T, Hartikainen S, Klaukka T, Veijola J, Kivela SL, Isoaho R. Use of medications and polypharmacy are increasing among the elderly. J Clin Epidemiol 2002;55: 809-17.
- Marx G, Püsche K, Ahrens D. Polypharmacy: a dilemma in primary care? Results of group discussions with general practitioners. Gesundheitswesen 2009;71(6):339-48.
- Barker KN, Flynn EA, Pepper GA, Bates DW, Mikeal RL. Medication errors observed in 36 health care facilities. Arch Intern Med 2002;162(16):189790
- Weingart SN, Cleary A, Seger A, Eng TK, Saadeh M, Gross A, Shulman LN. Medication reconciliation in ambulatory oncology. Jt Comm J Qual Patient Saf 2007;33(12):750-7.
- Pronovost P, Weast B, Schwarz M et al. Medication reconciliation: a practical tool to reduce the risk of medication errors. J Crit Care 2003;18(4):201-5.
- Schneeweiss S, Hasford J, Göttler M, Hoffmann A, Riethling AK, Avorn J. Admissions caused by adverse drug events to internal medicine and emergency departments in hospitals: a longitudinal population-based study. Eur J Clin Pharmacol 2002;58(4):285-91.
- Lagnaoui R, Moore N, Fach J, Longy-Boursier M, Bégaud B. Adverse drug reactions in a department of systemic diseases-oriented internal medicine: prevalence, incidence, direct costs and avoidability. Eur J Clin Pharmacol 2000;56(2):181-6.
- Akici A, Kalaca S, Ugurlu MU, Karaalp A, Cali S, Oktay S Impact of a short postgraduate course in rational pharmacotherapy for general practitioners. Br J Clin Pharmacol 2004;57(3):310
- Topinkova E, Baeyens JP, Michel JP, Lang PO. Evidence-based strategies for the optimization of pharmacotherapy in older people. Drugs Aging 2012;29(6):477-94.
- Siegmund S, Nicola. Polypharmakotherapie im Alter: Weniger Medikamente sind oft mehr. Dtsch Arztebl 2012;109(9):418-421
- Sevilay N. Aile Hekimliğinde Komorbidite ve Multimorbiditeyi Anlamak. TJFMPC 2013; 7:35-39.
- Dawes M: Co-morbidity: we need a guideline for each patient not a guideline for each disease. Fam Pract 2010;27(1):2
- Gallagher P, Ryan C, Byrne S, Kennedy J, O'Mahony D. STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. Int J Clin Pharmacol Ther 2008;46(2):72
- Onar E, Kapucu S. Yaşlılarda Çoklu İlaç Kullanımı: Polifarmasi. Akat Geriatri 2011;3:22-28
- Akıcı A. Akılcı İlaç Kullanımı İlkeleri Doğrultusunda Yaşlılarda Reçete Yazma ve Türkiye’de Yaşlılarda İlaç Kullanımımın Boyutları. Turk J Geriatr 2006 Özel Sayı:19 - 27
Ayrıntılar
| Bölüm | Orijinal Makaleler |
|---|---|
| Yazarlar | |
| Yayımlanma Tarihi | 1 Mart 2014 |
| Gönderilme Tarihi | 1 Ağustos 2014 |
| Yayımlandığı Sayı | Yıl 2014 Cilt: 8 Sayı: 1 |
Cited By
Sağlığın ve birinci basamak bakımın anlaşılmasına ve geliştirilmesine katkıda bulunacak yeni bilgilere sahip yazarların İngilizce veya Türkçe makaleleri memnuniyetle karşılanmaktadır.