Keche Yogendra Narayanrao, Gaikwad Nitin R, Wasnik Preetam N, Siddiqui Sabah, Nagpure Keshao, Dhaneria Suryaprakash
Department of Pharmacology, All India Institute of Medical Sciences Raipur, Chhattisgarh, India.
Department of General Medicine, All India Institute of Medical Sciences Raipur, Chhattisgarh, India.
J Family Med Prim Care. 2022 Nov;11(11):7064-7071. doi: 10.4103/jfmpc.jfmpc_733_22. Epub 2022 Dec 16.
Polypharmacy and inappropriate prescribing are risk factors for adverse clinical outcomes in older people. Screening tools can identify potential medicine-related patient safety incidents for the elderly on multiple medicines and with chronic diseases.
In this prospective observational study, details of demography, diagnosis, history of constipation/peptic ulcer disease, over-the-counter medications, and clinical and laboratory findings were noted. Information obtained was reviewed and analyzed with the help of STOPP/START and Beers 2019 criteria. At 1 month follow-up, improvement was assessed with the help of a structured questionnaire.
As per the criteria, modification in drugs was recommended for 213 drugs; it was actually performed for 27.73% and 48.71% drugs as per Beers and STOPP/START criteria, respectively. Glimepiride was replaced with short-acting sulfonylureas because of hypoglycemia, and angiotensin receptor blockers were stopped because of hyperkalemia as per Beers criteria. Statins were started in 19 patients by START criteria. Overall general health improvement was observed at 1 month, but an increase in anxiety, tension, worry, depressed feel, and insomnia was observed in initial days of the coronavirus disease 2019 pandemic.
In view of polypharmacy in the prescriptions, the combination of prescribing criteria need to be considered while prescribing medications to the elderly to get optimum therapeutic benefits and improvement in the quality of life. The quality of primary care of the elderly can also be improved by use of screening tools such as STOPP/START and Beers criteria by a primary/family physician. Prescription evaluation by a trained pharmacologist/physician for possible drug/food/disease interactions and for therapy modification can be incorporated for routine geriatric care at a tertiary care center. .
多重用药和不适当处方是老年人不良临床结局的危险因素。筛查工具可以识别服用多种药物且患有慢性病的老年人潜在的与药物相关的患者安全事件。
在这项前瞻性观察研究中，记录了人口统计学、诊断、便秘/消化性溃疡病史、非处方药以及临床和实验室检查结果的详细信息。借助STOPP/START和2019年版《Beers标准》对获得的信息进行审查和分析。在1个月的随访中，借助结构化问卷评估改善情况。
根据标准，建议对213种药物进行调整；按照《Beers标准》和STOPP/START标准，实际分别对27.73%和48.71%的药物进行了调整。由于低血糖，用短效磺脲类药物替代了格列美脲；按照《Beers标准》，因高钾血症停用了血管紧张素受体阻滞剂。根据START标准，19例患者开始使用他汀类药物。在1个月时观察到总体健康状况有所改善，但在2019年冠状病毒病大流行的初期，焦虑、紧张、担忧、抑郁情绪和失眠有所增加。
鉴于处方中的多重用药情况，在给老年人开处方时需要考虑多种处方标准的结合，以获得最佳治疗效果并改善生活质量。初级/家庭医生使用STOPP/START和《Beers标准》等筛查工具也可以提高老年人的初级保健质量。在三级医疗中心的常规老年护理中，可以纳入由训练有素的药理学家/医生进行的处方评估，以检查可能的药物/食物/疾病相互作用并进行治疗调整。
