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Zeitschrift für Gerontologie und Geriatrie

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01.08.2012 | Beiträge zum Themenschwerpunkt

Polypharmacy in the elderly from the clinical toxicologist perspective

verfasst von: H.J. Heppner, MD, MHBA, M. Christ, MD, M. Gosch, MD, W. Mühlberg, MD, P. Bahrmann, MD, T. Bertsch, MD, C. Sieber, MD, K. Singler, MD

Erschienen in: Zeitschrift für Gerontologie und Geriatrie | Ausgabe 6/2012

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Abstract

Introduction

Polypharmacy is closely associated with multimorbidity in the elderly and can lead to problems and drug interactions.

Aim

This study assessed polypharmacy in the elderly, tracking inquiries to the Poison Information Centre Nuremberg (PICN) and patients needing toxicological intensive care therapy.

Methods

From 2006–2009, all PICN inquiries involving individuals > 70 years were tracked, as were cases at the Toxicological Intensive Care Unit (T-ICU) regarding adverse drug reactions (ADRs) and drug poisoning.

Results

Of 11,683 PICN calls about pharmaceuticals, 175 (1.5%) were from people > 70 years; 156 (4.8%) of 3,272 T-ICU patients were > 70 years. Calls about psychopharmaceuticals (46.9%) and analgesics (25.7%) were most frequent. Among the T-ICU patients, psychopharmaceuticals like sedatives and hypnotics were frequently involved (20.5%), as were tricyclic antidepressants (17.9%) and analgesics (29.5%). Ethanol was co-ingested by 18.3%.

Conclusion

Population-specific poison prevention strategies are needed to reduce toxic exposures. Such strategies could include pharmacist intervention, improved prescriber communication and education regarding the geriatric population, and computerized drug databases.

Vorheriger Artikel Tools in polypharmacy

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Afilalo J, Karunananthan S, Eisenberg M et al (2009) Role of frailty in patients with cardiovascular disease. Am J Cardiol 103:1616–1621PubMedCrossRef

Antoniou T, Gomes T, Mamdami MM et al (2011) Trimethoprom-sulfamethoxazole induced hyperkalaemian in elderly patients reciving spironolactone: nested case-control study. BMJ 343:d5228PubMedCrossRef

Beers MH (1997) Explicit criteria for determining potentially inappropriate medication use by the elderly. Arch Intern Med 157:1531–1536PubMedCrossRef

Bennet AT, Collins KA (2001) Elderly suicide: a 10-year retrospective study. Am J Forensic Med Pathol 22:169–172CrossRef

Betteridge TM, Frampton CM, Jardine DL (2012) Polypharmacy–we make it worse! A cross-sectional study from an acute admission unit. Intern Med J 42:208–211PubMedCrossRef

Boyle N, Naganathan V, Cumming RG (2010) Medication and falls: risk and optimization. Clin Geriatr Med 26:583–605PubMedCrossRef

Budnitz DS, Lovegrove MC, Shehab N et al (2011) Emergency hospitalizations for adverse drug events in older americans. N Engl J Med 365:2002–2012PubMedCrossRef

Cahir C, Fahey T, Teeling M et al (2010) Potentially inappropriate prescribing and cost outcome of older people: a national population study. Br J Clin Pharmacol 69:543–552PubMedCrossRef

Cassidy N, Lee SK, Donegan CF, Tracey JA (2008) Poisoning in older adults: the experience of the national poisons information centre. Ir Med J 101:268–270PubMed

10.

Ciorciaro C, Hartmann K, Kuhn M (1998) Differences in the relative incidence of adverse drug reactions in relation to age? An evaluation of the spontaneous reporting system of SANZ. Schweiz Med Wochenschr 128:254–258PubMed

11.

Comets E, Diquet B, Legrain S et al (2012) Pharmacokinetic and pharmacodynamic varaibility of fluindione in Octogenarians. Clin Pharmacol Ther 4:777–787CrossRef

12.

Cook R, Allcock R, Johnston M (2008) Self-poisoning: current trends and practice in a UK teaching hospital. Clin Med 8:37–40PubMedCrossRef

13.

Dendorfer U, Mann J (2006) Drug related disorders of water and electrolyte metabolism. Internist 47:1121–1128PubMedCrossRef

14.

Doak MW, Nixon AC, Lupton DJ et al (2009) Self-poisoning in older adults: patterns of drug ingestion and clinical outcomes. Age Ageing 38:407–411PubMedCrossRef

15.

Dormann H, Neubert A, Criegee-Rieck M et al (2004) Readmissions and adverse drug reactions in internal medicine: the economic impact. J Intern Med 255(6):653–663PubMedCrossRef

16.

Dovjak P, Sommeregger U, Otto R et al (2010) Polypharmazie in der Kardiologie – ein beachtliches Problem bei Synkopen, QT-Zeit-Verlängerung, Bradykardie und Tachykardie. Wien Med Wochenschr 160:264–269PubMedCrossRef

17.

Dragonas C, Wagner JT, Heppner HJ et al (2007) The association of ABCB1 polymorphisms and elevated serum digitoxin concentrations in geriatric patients. Eur J Clin Pharmacol 16:367–372

18.

Egger T, Dormann H, Ahne G et al (2003) Identification of adverse drug reactions in geriatric inpatients using a computerised drug database. Drugs Aging 20:769–776PubMedCrossRef

19.

Fick DM, Cooper JW, Wade WE et al (2003) Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med 163:2716–2724PubMedCrossRef

20.

Finlayson E, Maselli J, Steinmann MA et al (2011) Inappropriate medication use in older adults undergoing surgery: a national study. J Am Geriatr Soc 59:139–144CrossRef

21.

Gandhi TK, Weingart SN, Borus J et al (2003) Adverse drug events in ambulatory care. N Engl J Med 348:1556PubMedCrossRef

22.

Gillespie U, Alassaad A, Henrohn D et al (2009) A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older. Arch Intern Med 169:894–900PubMedCrossRef

23.

Gosch M, Roller R (2010) Multiple drug therapy: a challange for an aging society. Wien Med Wochenschr 160:261–263PubMedCrossRef

24.

Hadem J, Tacke F, Bruns T et al (2012) Etiologies and outcomes of acute liver failure in Germany. Clin Gastroenterol Hepatol 10:664–669PubMedCrossRef

25.

Hartikainen S, Lönnroos E, Louhivuori K (2007) Medication as a risk factor for falls: critical systematic review. J Gerontol Med Sci 62A:1172–1181CrossRef

26.

Heyerdahl F, Bjornas MA, Hovda KE et al (2008) Acute poisonings treated in hospitals in Oslo. A one-year prospective study (II): clinical outcome. Clin Toxicol 46:2–9CrossRef

27.

Hicks LA, Chien YW, Taylor TH et al (2011) Outpatient antibiotic prescribing and nonsusceptible Streptococcus pneumoniae in the United States, 1996–2003. Clin Infect Dis 53:631–639PubMedCrossRef

28.

Holt S, Schmiedl S, Thürmann PA (2010) Potenziell inadäquate Medikation für ältere Menschen: Die PRISCUS-Liste. Dtsch Arztebl Int 107:543–551PubMed

29.

http://www.who.int/ipcs/poisons/harmonization/en/index.html. Accessed 17 May 2012

30.

Huang AR, Mallet L, Rochfort CM et al (2012) Medicatiion-related falls in the elderly: causative factors and preventive strategies. Drugs Aging 29:359–376PubMedCrossRef

31.

Juurlink DN, Mamdami MM, Lee DS et al (2004) Rates of hyperkalemia after publication of the randomized aldactone evaluation study. N Engl J Med 351:543–551PubMedCrossRef

32.

Juurlink DN, Mamdani M, Koop A et al (2003) Drug-drug interactions among elderly patients hospitalized for drug toxicity. JAMA 289:1652–1658PubMedCrossRef

33.

Kämmerer W, Mutschler E (1998) Arzneistoffwechselwirkungen in der Intensivmedizin. Rhein Main Druck, Mainz, Germany

34.

Kämmerer W (2012) Klinisch relevante pharmakokinetische Arzneimittelinteraktionen in der Intensivmedizin. Med Klin Intensivmed Notfmed 107:128–140PubMed

35.

Krämer I, Rauber-Lüthy C, Kupferschmidt H, Krähenbühl S et al (2010) Minimal dose for severe poisoning and influencing factors in acute human clozapine intoxication: a 13-year retrospective study. Clin Neuropharmacol 33:230–234PubMedCrossRef

36.

Lau HS, Florax C, Porsius AJ et al (2000) The completness of medication histories in medical records of patients admitted to general internal medicine wards. Br J Clin Pharmacol 49:597–603PubMedCrossRef

37.

Mizukami F, Koide Y, Furuta K (2012) Polypharmacy with common diseases in hospitalized elderly patients. Am J Geriatr Pharmacother 10:123–128CrossRef

38.

Modreker MK, Rentelen-Kruse W von (2009) Arzneimittel und Stürze im Alter. Internist 50:493–500PubMedCrossRef

39.

Mühlberg W, Becher K, Heppner HJ, Wicklein S et al (2005) Acute poisoning in old and very old patients: a longitudinal retrospective study of 5883 patients in a toxicological intensive care unit. Z Gerontol Geriat 38:182–189CrossRef

40.

Onder G, Liperoti R, Fidlova D et al (2012) Polypharamcy in nursing homes in Europe: the results from the SHELTER study. J Gerontol A Biol Sci Med Sci 67A:698–704CrossRef

41.

Pomme E, Ficek B (2012) Management of pain in the elderly at the end of life. Drug and Aging 29:285–305CrossRef

42.

Punywudho B, Ramsay ER, Brundage RC et al (2012) Population pharmacokinetics of carbamazepine in elderly patients. Ther Drug Monit 34:176–81CrossRef

43.

Rammer M, Weber T, Laßing M et al (2009) Arterial Hypertension and electrolyte disturbances. J Hyperton 13:12–16CrossRef

44.

Rogers JJ, Heard K (2007) Does age matter? Comparing case fatality rates for selected poisonings reported to U.S. poison centers. Clinical Toxicology 45:705–708PubMedCrossRef

45.

Ruiter R, Visser LE, Rodenburg EM et al (2012) Adverse drug reaction-related hospitalizations in persons aged 55 years and over: a population-based study in The Netherlands. Drugs Aging 29:225–232PubMedCrossRef

46.

Saad M, Harisingani R, Katinas L (2012) Impact of geriatric consultation on the number of medications in hospitalized older patients. Consult Pharm 27:42–48PubMedCrossRef

47.

Satar S, Seydaoglu G (2005) Analysis of acute adult poisoning in a 6-year period and factors affecting the hospital stay. Adv Ther 22:137–147PubMedCrossRef

48.

Schnurrer J, Frölich JC (2003) Incidence and prevention of lethal undisirable drug effects. Internist 44:889PubMedCrossRef

49.

Slomski A (2012) Falls form taking multiple medications may be a risk for both young and old. JAMA 307:1127–1128PubMedCrossRef

50.

Solomon DH, Rassen JA, Glynn RJ et al (2010) The comparative safety of analgesics in older adults with arthritis. Arch Intern Med 170:1968–1978PubMedCrossRef

51.

Strandell J, Bate A, Hägg S et al (2009) Rhabdomyolysis a result of azithromycin and statins: an unrecognized interaction. Br J Clin Pharmacol 68:427–434PubMedCrossRef

52.

Tinetti M, Allore H, Arauja K (2007) Modifiable impairments predict progressive disability among older persons. J Aging Health 17:239–256CrossRef

53.

Ventura MT, Laddaga R, Cavallera P et al (2010) Adverse drug reactions as the cause of emergency department admission: focus on the elderly. Immunopharmacol Immunotoxicol 32:426–429PubMedCrossRef

54.

Woolcott JC, Richardson KJ, Wiens MO et al (2009) Meta-analysis of the impact of nine medication classes on falls in elderly persons. Arch Intern Med 169:1952–1960PubMedCrossRef

Titel: Polypharmacy in the elderly from the clinical toxicologist perspective
verfasst von: H.J. Heppner, MD, MHBA
M. Christ, MD
M. Gosch, MD
W. Mühlberg, MD
P. Bahrmann, MD
T. Bertsch, MD
C. Sieber, MD
K. Singler, MD
Publikationsdatum: 01.08.2012
Verlag: Springer-Verlag
Erschienen in: Zeitschrift für Gerontologie und Geriatrie / Ausgabe 6/2012
Print ISSN: 0948-6704
Elektronische ISSN: 1435-1269
DOI: https://doi.org/10.1007/s00391-012-0383-6

Springerpflege

Abstract

Introduction

Aim

Methods

Results

Conclusion

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