Geriatric Poly-Pharmacy: A Growing Epidemic. How to Prevent It?

S. Sarkar
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引用次数: 5

Abstract

Introduction: Geriatric poly-pharmacy is defined as the use of more drugs in older adults than are medically necessary. It is widely prevalent in clinical practice. The rationale for poly-pharmacy in the elderly is not clear. Objective: 1) Review the epidemiology, etiologic factors and potential consequences of geriatric poly-pharmacy; 2) Provide recommendations for prevention and reduction of geriatric polypharmacy. Methods: A review of literature for published articles in English language from online databases (Medline, EBSCO, Psychinfo, Google scholar) was conducted from 2000-2017. Results: With minor geographical variation, the prevalence of geriatric poly-pharmacy ranges from 15-80%. The trend is rising globally. Etiology is not clear. Associated factors include demographic factors (advanced age, education, geographic variation, socio-economic status, insurance), comorbidities, health status, severity of disease, treatment- refractoriness, healthcare setting (inpatient, out-patient or nursing home), cultural beliefs, physician prescribing pattern, etc. The concurrent administration and use of multiple medications increase the risk of drug interactions, potential adverse consequences, falls, fractures including morbidity and mortality in the elderly. Geriatric poly-pharmacy is also associated with cumulative toxicity, poor medication adherence and treatment non-compliance. Recommendations provided are targeted at preventing and reducing unnecessary geriatric poly-pharmacy in clinical practice. Conclusion: The growing epidemic of geriatric poly-pharmacy poses a significant public health problem. This article highlights on the strategies for preventing and reducing unnecessary prescribing of drugs in the elderly. A better understanding of physicians’ rationale for geriatric polypharmacy, patient tolerability and effectiveness of this strategy is needed to guide clinicians and to inform the development of evidence based treatment guidelines. Records searched from 2000-2017, identified through online databases (Medline, EBSCO, Psychinfo, Google Scholar).
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老年综合药房:一种日益流行的现象。如何预防?
老年多重用药被定义为老年人使用的药物多于医学上必要的药物。它在临床实践中广泛流行。老年人多重用药的理由尚不清楚。目的:1)综述老年多重用药的流行病学、病因及潜在后果;2)为预防和减少老年综合用药提供建议。方法:对在线数据库(Medline、EBSCO、Psychinfo、Google scholar) 2000-2017年发表的英文文章进行文献回顾。结果:老年人综合药房的患病率在15 ~ 80%之间,地域差异较小。这一趋势正在全球范围内上升。病因尚不清楚。相关因素包括人口因素(高龄、受教育程度、地理差异、社会经济地位、保险)、合并症、健康状况、疾病严重程度、治疗难治性、医疗环境(住院、门诊或养老院)、文化信仰、医生处方模式等。同时给药和使用多种药物增加了药物相互作用、潜在不良后果、跌倒、骨折(包括老年人发病率和死亡率)的风险。老年多重用药也与累积毒性、药物依从性差和治疗不依从性有关。提供的建议旨在预防和减少临床实践中不必要的老年多重用药。结论:老年多重药房日益流行,已成为严重的公共卫生问题。本文重点阐述了预防和减少老年人不必要用药的策略。需要更好地了解医生对老年综合用药的基本原理、患者的耐受性和该策略的有效性,以指导临床医生并为基于证据的治疗指南的制定提供信息。检索2000-2017年的记录,通过在线数据库(Medline, EBSCO, Psychinfo, Google Scholar)进行识别。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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