García Pliego Rosa Ana, Baena Díez José Miguel, Herreros Herreros Yolanda, Acosta Benito Miguel Ángel
Medicina de Familia, Centro de Salud Dr. Aguilar, Cubas de la Sagra, Madrid, España; Grupo de Atención al Mayor de la Sociedad Madrileña de Medicina Familiar y Comunitaria, Madrid, España; Grupo del Mayor del PAPPS de la Sociedad Española de Medicina Familiar y Comunitaria, España.
Medicina de Familia, Centro de Salud La Marina, Barcelona, España; Grupo de Atención al Mayor de la Sociedad Madrileña de Medicina Familiar y Comunitaria, Madrid, España; Grup de la Gent Gran de la Societat Catalana de Medicina Familiar i Comunitària, Barcelona, España.
Aten Primaria. 2022 Aug;54(8):102367. doi: 10.1016/j.aprim.2022.102367. Epub 2022 May 30.
The use of drugs has undeniable benefits to the elderly, but it is not exempt from undesirable effects. Deprescription is the process of systematic medication review with the target of achieving the best risk-benefit ratio based on the best available evidence. This process is especially important for polymedicated elderly patients as well as those overtreated, frail, terminally ill and at the end of life. The deprescription must be done in stages, establishing a close follow-up in case problems appear after withdrawal. In the decision-making process, it is very important to consider the patient and caregivers opinion, assessing the objectives of the treatment according to the clinical, functional and social situation of the patient. There are multiple tools to make it easier for clinicians to select which drugs to deprescribe (Beers criteria, STOPP-START…). The most susceptible to intervention pharmacological groups are: antihypertensives, antidiabetics, statins, benzodiazepines, antidepressants, anticholinergics, anticholinesterase agents, and neuroleptics.
药物的使用对老年人有不可否认的益处,但也难免会有不良影响。减药是一个系统的药物审查过程,目标是根据现有最佳证据实现最佳风险效益比。这个过程对于使用多种药物的老年患者以及那些过度治疗、体弱、晚期和临终患者尤为重要。减药必须分阶段进行,在停药后出现问题时要建立密切随访。在决策过程中,考虑患者和护理人员的意见非常重要,要根据患者的临床、功能和社会状况评估治疗目标。有多种工具可帮助临床医生更轻松地选择哪些药物需要减用(如Beers标准、STOPP-START……)。最容易受到干预的药物类别有:抗高血压药、抗糖尿病药、他汀类药物、苯二氮䓬类药物、抗抑郁药、抗胆碱能药、抗胆碱酯酶药和抗精神病药。