Pharmakotherapie alter Patienten

Abstract

Drug therapy in seniors needs to be adapted to the capacity of the aged organism. The dosages of a high number of drugs from several classes (e.g., antibiotics, low molecular weight heparins) have to be modified according to age or reduced renal function, which is a common feature in old age. Moreover, elderly patients due to their physiological alterations exhibit an increased response to drugs having an influence on renal function: diuretics, nonsteroidal anti-inflammatory drugs, inhibitors of the renin-angiotensin-aldosterone system, and contrast media. The choice of drugs should consider their age-specific tolerability, i.e., fall-risk increasing drugs and those with strong anticholinergic side effects should be avoided. Analgesics, sedatives, and narcotics have to be selected according to the age of the patient and dosages should be adapted. Multimorbidity is often treated with polypharmacy, whereby it is not unusual that this is the cause for acute hospital admission. The necessity of all drugs prescribed has to be scrutinized and the drug burden should be reduced as clinically required.

Potentiell inadäquate Medikation bei Heimbewohnern: Eine Analyse von Risikofaktoren anhand bundesweiter GKV-Routinedaten der AOK für das Jahr 2017

“…Rund jeder vierte Heimbewohner erhielt 2017 mindestens einen PRISUS-Wirkstoff verordnet. Unerwünschte Arzneimittelereignisse und vermehrte Krankenhausaufenthalte, die in einem Zusammenhang mit der Verordnung von PRISCUS-Wirkstoffen stehen [35][36][37] können durch eine gezielte Medikamentenverordnung reduziert werden. Insbesondere regionale Unterschiede zwischen den einzelnen Bundesländern geben Anlass zu der Annahme, dass eine Reduktion der PIM-Verordnungen auf einem vergleichsweisen niedrigeren Niveau möglich ist.…”

Impact of a DSS-supported medication review on the safety of drug therapy and quality of life in patients with antithrombotic therapy

“…Especially in patients taking antithrombotics, drug interactions could cause serious unwanted side effects or, on the contrary, destroy the efficacy of drug therapy ( Schneider et al, 2018 ). In fact, bleeding risks are among the five most frequent causes of hospitalization ( Thürmann and Schmiedl, 2011 ). A recent study of elderly patients discharged from hospital showed that the prescription of multiple drugs, potentially causing DRPs, occurred in almost two-thirds of patients ( Carpenter et al, 2019 ).…”