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Polypharmacy in seniors

Polypharmacy: What is it?

Polypharmacy is a prescription drug excessive. The elderly are primarily concerned, as evidenced by the length of orders: often more than six medications per patient. This polypharmacy seems a legitimate response to the increasing number of pathologies observed with age. But an older patient is more susceptible to adverse drug reactions and drug interactions. Polypharmacy represents a risk of accidents called "iatrogenic" (caused by medical or paramedical care).

To treat hypertension, for example, it is not uncommon to prescribe two distinct molecules in a fixed combination, so little flexible, for greater efficiency. In addition, there are drugs to treat diseases associated with cholesterol, diabetes, hyperlipidemia. What increase the risk of accidents due to overloading of the organism in different molecules, too many and not always compatible!

What are the legal and health issues?

Almost half of the drugs are consumed by people over 60 years, and prevention of adverse drug reactions is a health priority.

According to a report by the CNAM (May 2006), 42% of people have experienced adverse reactions to drugs. To prescribe better (HAS) taking into account the excess treatment, inappropriate prescribing, but also the shortcomings of treatment in some cases (use of antidepressants in the elderly suicidal), the Agency for the Safety of Health Products, proposed in July 2005 three measures to reach a consensus on the requirements for the elderly, a systematic re-treatment after 80 years at annual consultations, while encouraging all institutions in contact with the patient to adhere to this approach.

As stated in the law of 9 August 2004, is to achieve a reduction in the frequency of inappropriate prescribing and adverse events in the elderly.

These traces, APNET advocates a déprescription decreasing the need prescriptions.
The National Academy of Medicine has published a list of recommendations to governments, institutions and prescribers to improve the care of elderly patients.

Mechanisms polypharmacy

The ESPS survey 2002, as previous studies showed that the rate of drug consumers increases significantly when health deteriorates.

The order often grows with the requirements of the various successive doctors who treat elderly patients. Often nobody pays attention to all the drugs side effects add up, especially as kidney function and liver function deteriorate with age. Paradoxically it is advantageous when the drugs are too numerous, the older person does not take his good treatment most often she forgets or refuses to take them. This is a double error vanishes, without making the patient well-being, but with a considerable cost to payers.

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What are the risks?

Before economic (cost prohibitive inappropriate treatment), the major risk is the risk iatrogenic. In mild cases, it leads either to discontinuation of the drug is responsible for the adjustment of the treatment it leads in severe cases hospitalization (128,000 cases) and in extreme instances to a declaration of pharmacovigilance .

Undertook the responsibility of the prescriber who has not cared to reassess the appropriateness of prescribed treatments, possibly in the pharmacist, but also the patient who, in turn, may have added to his unacknowledged self-medication prescription.

How is the polypharmacy?

Ingesting too much medication promotes loss of appetite and digestive discomfort. The person will eat less because you absorb its treatment and that her appetite away!

The most common effects of interaction between many drugs are dizziness (responsible for falls), irritability, allergies, digestive disorders, bleeding, fever, dehydration, falls, confusional state and degradation general condition.

Some examples of associations that poor household: aspirin and anticoagulants (risk of haemorrhage that motivate 17,000 hospitalizations / year), analgesic (ibuprofen) and antihypertensive (voltage drop).
What is the doctor?

Alteration unexplained health of an elderly person is still on the trail of a possible drug cause. The doctor evaluates the benefits and risks of each treatment: for example, need to treat a hypertensive risk because a stroke. The doctor chooses the essential requirements and attempts to remove the comfort medications, but it is not always well accepted: painkillers attack the kidney and liver, but they make life more pleasant, or simply livable!

To discharge the order on the question of the merits of treatment after 70 years, we prioritize the priorities with the patient, then very gradually reduce the dose to avoid potential rebound effects, especially with psychotropic . You should know adopt non-pharmacological solutions to sleep disorders, for example, if the order is too long massage, soft music, physical activity sufficient daylight.

Can be dispensed with diuretics beneficial however, if the risk of urinary incontinence compromises treatment monitoring.

Ideally, any new prescription drug in the elderly is associated with the revaluation of other treatments. It should begin treatment with a reduced dose may be revised upward based on its efficacy and tolerability. It is important to set a time limit for treatment, which allows to evaluate its effectiveness at regular intervals and identify potential problems.

What should I be wary?

The multiplicity of actors medical revolve around the elderly complicates management. Avoid the proliferation of players, refer the patient to a specialist able to harmonize aging treatments to avoid the risk of error.

Poor compliance is a requirement is rarely completely absorbed. Do not blame the drugs are not taken! Consideration should be given to lapses of memory fails, the difficulties to read the instructions and confusion between the two drugs.

Finally, we must not demonize drugs that make great services they only require a very high reflection and very close monitoring in the elderly.

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