POLİFARMASİ İLE İLİŞKİLİ İLAÇ ETKİLEŞİMLERİNİN VE KIRILGANLIĞIN ÖNGÖRÜLMESİ VE TESPİTİ : GERİATRİ
Yıl 2024,
Cilt: 4 Sayı: 11, 156 - 163, 24.10.2024
Sema Ketenci
,
Nazife Gökçe Akpınar
Öz
Giriş ve Amaç: Kırılganlık son yıllarda önemi giderek artan bir durumdur. Çalışmanın amacı, yaşlı yetişkinlerde polifarmasinin neden olduğu ilaç-ilaç etkileşimleri ile kırılganlık arasındaki bağlantıyı araştırmaktır.
Yöntemler: Ocak 2022 ile Haziran 2022 tarihleri arasında aile hekimliği bölümüne başvuran 180 yaşlı yetişkin çalışmaya dahil edildi. Aile hekimliği polikliniğine başvuran 65 yaş üstü kişiler çalışmaya dahil edildi.
Bulgular: Polifarmasi ilişkili ilaç-ilaç etkileşimi olan bireylerde en yaygın komorbiditeler hipertansiyon (%71,6), diyabet (%31,1) ve artroz (%19,4) olup, antihipertansif ilaçlar tüm etkileşim sınıflarında en fazla etkileşime sahipti. Çalışmaya dahil edilen 180 hastanın 130'unda (%72,2) polifarmasi ilişkili ilaç-ilaç etkileşimi saptanmıştır.
Sonuçlar: Çalışmada, polifarmasi ile ilişkili ilaç-ilaç etkileşimi olan 65 yaş ve üzeri hastalarda kırılganlık skoru yaş, komorbiditeler ve ilaç sayısına göre istatistiksel olarak anlamlı derecede daha kötü bulunmuştur.
Etik Beyan
Declarations
Ethical Approval
This research complies with all relevant national regulations, institutional policies, and the principles of the Declaration of Helsinki, and Istanbul Atlas University Ethics Committee (approval number: E-22686390-050.01.04-10991) and Kocaeli Governorship, Provincial Health Directorate Scientific Research Studies Health Facility (approval number: E-65530689-799). The rights of all participants were protected and written informed consent was obtained prior to the procedures according to the Declaration of Helsinki.
Teşekkür
We thanks for Republic of Turkey Ministry of Health and Gebze Family Health Centre.
Kaynakça
- Bowie, M. W., & Slattum, P. W. (2007). Pharmacodynamics in older adults: a review. The American journal of geriatric pharmacotherapy, 5(3), 263–303. https://doi.org/10.1016/j.amjopharm.2007.10.001
- Clegg, Andrew, et al. "Frailty in 65 years and older people." The Lancet 381.9868 (2013): 752-762.
- Merchant, R. A., Chen, M. Z., Tan, L. W. L., Lim, M. Y., Ho, H. K., & van Dam, R. M. (2017). Singapore Healthy Older People Everyday (HOPE) Study: Prevalence of Frailty and Associated Factors in Older Adults. Journal of the American Medical Directors Association, 18(8), 734.e9–734.e14. https://doi.org/10.1016/j.jamda.2017.04.020
- Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in 65 years and older people. Lancet 2013;381:752-62. Available from: 10.1016/S0140-6736(12)62167-9
- Gnjidic D, Hilmer SN, Blyth FM, Naganathan V, Cumming RG, Handelsman DJ, et al. High risk prescribing and incidence of frailty among older community-dwelling men. Clin Pharmacol Ther 2012;91:521-8.
- Bouillon, K., Kivimaki, M., Hamer, M., Sabia, S., Fransson, E. I., Singh-Manoux, A., Gale, C. R., & Batty, G. D. (2013). Measures of frailty in population-based studies: an overview. BMC geriatrics, 13, 64. https://doi.org/10.1186/1471-2318-13-64
- Morley JE, Malmstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging. 2012;16(7):601–608. doi: 10.1007/s12603-012-0084-2.
- Randles, M. A., O'Mahony, D., & Gallagher, P. F. (2022). Frailty and Potentially Inappropriate Prescribing in Older People with Polypharmacy: A Bi-Directional Relationship?. Drugs & aging, 39(8), 597–606. https://doi.org/10.1007/s40266-022-00952-
- World Health Organization. World Report on Ageing and Health [Internet]. Geneva; 2015. Available from: http://www.who.int/life-course/publications/2015-ageing-report/en/. Accessed May 19, 2017.
- Coelho T, Paúl C, Gobbens RJJ, et al. Determinants of frailty: the added value of assessing medication. Front Aging Neurosci 2015;7:1-8.
- Poudel A, Hubbard RE, Nissen L, et al. Frailty: a key indicator to minimize inappropriate medication in older people. QJM 2013;106:969-75.
- Herr M, Robine J-M, Pinot J, et al. Polypharmacy and frailty: prevalence, relationship, and impact on mortality in a French sample of 2350 old people. Pharmacoepidemiol Drug Saf 2015;24:637-46.
- Multifaceted 65 years and older Assessment and Follow-up Guide Ministry of Health, Ankara, 2019. https://hsgm.saglik.gov.tr/depo/birimler/kronik-hastaliklar-engelli-db/hastaliklar/Yasli_Sagligi/rehberler/Cok_Yonlu_Yasli_Izlem_Klavuzu_2021.pdf Accessed: December 2021.
- Disease Management Platform Project User Manual, Republic of Turkey Ministry of Health,2021,https://hsgm.saglik.gov.tr/depo/birimler/kronikhastaliklarengellidb/haberler/HYP_Haber/4HYPKilavuzu_gncel.pdf Accessed: December 2021.
- Herr M, Robine J-M, Pinot J, et al. Polypharmacy and frailty: prevalence, relationship, and impact on mortality in a French sample of 2350 old people. Pharmacoepidemiol Drug Saf 2015;24:637-46.
- Rolland Y, Morley JE. Frailty and polypharmacy. J Nutr Health Aging 2016;20:645-6.
- Schoufour JD, Echteld MA, Bastiaanse LP, Evenhuis HM. The use of a frailty index to predict adverse health outcomes (falls, fractures, hospitalization, medication use, comorbid conditions) in people with intellectual disabilities. Res Dev Disabil 2015;38:39-47.
- Gnjidic D, Hilmer SN, Blyth FM, et al. Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes. J Clin Epidemiol 2012;65:989-95.
- Yuki A, Otsuka R, Tange C, et al. Polypharmacy is associated with frailty in Japanese community-dwelling older adults. Geriatr Gerontol Int 2018;18:1497-500.
- Rawle MJ, Richards M, Davis D, Kuh D. The prevalence and determinants of polypharmacy at age 69: A British birth cohort study. BMC Geriatr 2018;18:1-12.
- Herr M, Robine J-M, Pinot J, et al. Polypharmacy and frailty: prevalence, relationship, and impact on mortality in a French sample of 2350 old people. Pharmacoepidemiol Drug Saf 2015;24:637-46.
- Arslan, M., Keskin Arslan, E., Koç, E. M., Sözmen, M. K., & Kaplan, Y. C. (2020). The relationship between frailty and drug use and polypharmacy in persons 65 years of age and older. Med Bull Haseki, 58, 33-41.
- O’Connor MN, Gallagher P, O’Mahony D. Inappropriate prescribing: criteria, detection, and prevention. Drugs Aging 2012;29: 437–52.
- Cullinan S, Fleming A, O’Mahony D et al. Doctors’ perspectives on the barriers to appropriate prescribing in older hospitalized patients: a qualitative study. Br J Clin Pharmacol 2015;79: 860–9.
PREDICTING AND DETECTING POLYPHARMACY-RELATED DRUG INTERACTIONS AND FRAILTY : GERIATRICS
Yıl 2024,
Cilt: 4 Sayı: 11, 156 - 163, 24.10.2024
Sema Ketenci
,
Nazife Gökçe Akpınar
Öz
Background: Frailty is a situation that has become increasingly important in recent years. The study's objective was to investigate the connection between frailty and drug-drug interactions brought on by polypharmacy in older adults.
Methods: 180 older adults admitted from the family practice medicine department between January 2022 to June 2022 were included. People over the age of 65 who applied to the family medicine outpatient clinic were included in the study.
Results: The most prevalent comorbidities were hypertension (71.6%), diabetes (31.1%), and arthrosis (19.4%) in individuals with polypharmacy-related drug-drug interactions, antihypertensive medicines had the most interactions across all interaction classes. Polypharmacy-related drug-drug interactions were found in 130 (72.2%) of 180 patients included in the study.
Conclusions: In the study, the frailty score was found to be statistically significantly worse in the 65 years and older with polypharmacy-related drug-drug interactions, according to age, comorbidities, and the number of drugs.
Kaynakça
- Bowie, M. W., & Slattum, P. W. (2007). Pharmacodynamics in older adults: a review. The American journal of geriatric pharmacotherapy, 5(3), 263–303. https://doi.org/10.1016/j.amjopharm.2007.10.001
- Clegg, Andrew, et al. "Frailty in 65 years and older people." The Lancet 381.9868 (2013): 752-762.
- Merchant, R. A., Chen, M. Z., Tan, L. W. L., Lim, M. Y., Ho, H. K., & van Dam, R. M. (2017). Singapore Healthy Older People Everyday (HOPE) Study: Prevalence of Frailty and Associated Factors in Older Adults. Journal of the American Medical Directors Association, 18(8), 734.e9–734.e14. https://doi.org/10.1016/j.jamda.2017.04.020
- Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in 65 years and older people. Lancet 2013;381:752-62. Available from: 10.1016/S0140-6736(12)62167-9
- Gnjidic D, Hilmer SN, Blyth FM, Naganathan V, Cumming RG, Handelsman DJ, et al. High risk prescribing and incidence of frailty among older community-dwelling men. Clin Pharmacol Ther 2012;91:521-8.
- Bouillon, K., Kivimaki, M., Hamer, M., Sabia, S., Fransson, E. I., Singh-Manoux, A., Gale, C. R., & Batty, G. D. (2013). Measures of frailty in population-based studies: an overview. BMC geriatrics, 13, 64. https://doi.org/10.1186/1471-2318-13-64
- Morley JE, Malmstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging. 2012;16(7):601–608. doi: 10.1007/s12603-012-0084-2.
- Randles, M. A., O'Mahony, D., & Gallagher, P. F. (2022). Frailty and Potentially Inappropriate Prescribing in Older People with Polypharmacy: A Bi-Directional Relationship?. Drugs & aging, 39(8), 597–606. https://doi.org/10.1007/s40266-022-00952-
- World Health Organization. World Report on Ageing and Health [Internet]. Geneva; 2015. Available from: http://www.who.int/life-course/publications/2015-ageing-report/en/. Accessed May 19, 2017.
- Coelho T, Paúl C, Gobbens RJJ, et al. Determinants of frailty: the added value of assessing medication. Front Aging Neurosci 2015;7:1-8.
- Poudel A, Hubbard RE, Nissen L, et al. Frailty: a key indicator to minimize inappropriate medication in older people. QJM 2013;106:969-75.
- Herr M, Robine J-M, Pinot J, et al. Polypharmacy and frailty: prevalence, relationship, and impact on mortality in a French sample of 2350 old people. Pharmacoepidemiol Drug Saf 2015;24:637-46.
- Multifaceted 65 years and older Assessment and Follow-up Guide Ministry of Health, Ankara, 2019. https://hsgm.saglik.gov.tr/depo/birimler/kronik-hastaliklar-engelli-db/hastaliklar/Yasli_Sagligi/rehberler/Cok_Yonlu_Yasli_Izlem_Klavuzu_2021.pdf Accessed: December 2021.
- Disease Management Platform Project User Manual, Republic of Turkey Ministry of Health,2021,https://hsgm.saglik.gov.tr/depo/birimler/kronikhastaliklarengellidb/haberler/HYP_Haber/4HYPKilavuzu_gncel.pdf Accessed: December 2021.
- Herr M, Robine J-M, Pinot J, et al. Polypharmacy and frailty: prevalence, relationship, and impact on mortality in a French sample of 2350 old people. Pharmacoepidemiol Drug Saf 2015;24:637-46.
- Rolland Y, Morley JE. Frailty and polypharmacy. J Nutr Health Aging 2016;20:645-6.
- Schoufour JD, Echteld MA, Bastiaanse LP, Evenhuis HM. The use of a frailty index to predict adverse health outcomes (falls, fractures, hospitalization, medication use, comorbid conditions) in people with intellectual disabilities. Res Dev Disabil 2015;38:39-47.
- Gnjidic D, Hilmer SN, Blyth FM, et al. Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes. J Clin Epidemiol 2012;65:989-95.
- Yuki A, Otsuka R, Tange C, et al. Polypharmacy is associated with frailty in Japanese community-dwelling older adults. Geriatr Gerontol Int 2018;18:1497-500.
- Rawle MJ, Richards M, Davis D, Kuh D. The prevalence and determinants of polypharmacy at age 69: A British birth cohort study. BMC Geriatr 2018;18:1-12.
- Herr M, Robine J-M, Pinot J, et al. Polypharmacy and frailty: prevalence, relationship, and impact on mortality in a French sample of 2350 old people. Pharmacoepidemiol Drug Saf 2015;24:637-46.
- Arslan, M., Keskin Arslan, E., Koç, E. M., Sözmen, M. K., & Kaplan, Y. C. (2020). The relationship between frailty and drug use and polypharmacy in persons 65 years of age and older. Med Bull Haseki, 58, 33-41.
- O’Connor MN, Gallagher P, O’Mahony D. Inappropriate prescribing: criteria, detection, and prevention. Drugs Aging 2012;29: 437–52.
- Cullinan S, Fleming A, O’Mahony D et al. Doctors’ perspectives on the barriers to appropriate prescribing in older hospitalized patients: a qualitative study. Br J Clin Pharmacol 2015;79: 860–9.