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.
Zusammenfassung
Einleitung
Die Polypharmazie ist auf das Engste mit der Multimorbidität beim älteren Patienten verbunden und führt häufig zu unerwünschten Problemen, Interaktionen oder Unsicherheiten aufseiten des Patienten.
Ziel
Die nachfolgende Beschreibung und Analyse soll aufzeigen, welche Bedeutung die Polypharmazie in der älteren Bevölkerungs- und Patientengruppe in Hinsicht auf Anfragen bei der Giftinformationszentrale und die intensivmedizinische Behandlungsnotwendigkeit auf der toxikologischen Intensivstation hat.
Methoden
Im Beobachtungszeitraum von 2006 bis 2009 wurden aus allen Anfragen an die Giftinformationszentrale Nürnberg die der über 70-Jährigen herausgegriffen und zeitgleich mit den stationären Behandlungsfällen der toxikologischen Intensivstation unter besonderer Berücksichtigung von unerwünschten Medikamentenwirkungen und -vergiftungen erfasst.
Ergebnisse
Es wurden 11.683 Anrufprotokolle und 3272 Patientenfälle ausgewertet. Bei den Auskünften der Giftinformationszentrale waren die Beratungssuchenden in 1,5% (n = 173) der Fälle 70–80 Jahre alt und in 1,0% (n = 119) älter als 80 Jahre. Am häufigsten waren Anfragen zu Psychopharmaka (46,9%) und Analgetika (25,7%). Bei den Intensivpatienten dominierten ebenfalls die Psychopharmaka (20,5%). Trizyklische Antidepressiva (17,9%) und Analgetika (29,5%) waren häufig vertreten. Eine zusätzliche Alkoholingestion fand sich in 18,3% der Fälle.
Schlussfolgerung
Strategien zur Vermeidung von Vergiftungen im Rahmen der Polymedikation sind ebenso von Bedeutung wie eine Verbesserung der Kommunikation unter den verordnenden Ärzten und die Anwendung strukturierter Datenbanken.
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Conflict of interest
On behalf of all authors, the corresponding author states that there are no conflicts of interest. Hans Jürgen Heppner and Philipp Bahrmann are research fellows of the “Forschungskolleg Geriatrie” Robert-Bosch-Foundation, Stuttgart, Germany.
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Heppner, H., Christ, M., Gosch, M. et al. Polypharmacy in the elderly from the clinical toxicologist perspective. Z Gerontol Geriat 45, 473–478 (2012). https://doi.org/10.1007/s00391-012-0383-6
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DOI: https://doi.org/10.1007/s00391-012-0383-6