The risk of ADRs increases with the number of drugs taken
[5]. Older people have a higher prevalence of comorbidities,
and only a few decades after the first pharmaceutical
discoveries many elderly now use a substantial and still
increasing number of drugs on a regular basis [6].
There is some recent evidence that controlled
medication discontinuation can improve the
subjective quality of life in the elderly [8, 9].
Paese
N.
Setting
%PI
Germania
USA
USA
Europa
Olanda
Italy
USA
Francia
Francia
73665
397
8139
2707
119218
849325
493971
30683
35259
Comm
NH Fra
Medic.
Home c
Comm
Comm
Hosp
Comm
Comm
22.0
18.3
91.8
7.8
19.8
14.3
18.0
49-38HS
25.4* 19.7
53.5
Irlanda
Irlanda Nord1
Norvegia (>70)
Spagna
732 LTC
166108 Comm
445900 Comm
100 NH
* 33.5% to 19.3% from 1995 to 2004
63.7
42.9
34
34.8
79
95
M
28.5
F
Farmaco
Criteri
24.8
Antidepressivi
Gastroent
Analgesici
Pentossifillina
LA BZD
Doxazosina
Sedativi
Analgesici
Pentossifill
Anticoliner.
LA BZD
Ppi
BZD
PPI
LA BZD
PPI-NO CaD
Psicotropi
PRISCUS
MAI>=1
Beers 97
Beers 97/03, McLoad
Beers 03
Beers 03
Beers 03
Beers 97 French update
French PIM
OR=2
30.9
59.5
STOPP
Beers 03
STOPP
NORGEP
STOPP START
Ausralian System
D Fialova et al, JAMA, 2005
B Bongue et al: Pharmacoepidemiology and Drug Safety, 2009; 18: 1125–1133
Reazioni avverse di potenziale importanza nell'anziano:
1. Ipomagnesemia
2. Riduzione assorbimento del calcio carbonato
3. Infezioni respiratorie
4. Diarrea da Cl.difficile
5. Poliposi gastrica
6. Gastrite atrofica in soggetti H. Pylori
Conclusions: Our data verifies that practitioners
routinely start general medical in-patients on acid
suppression without an appropriate indication.
Many of these prescriptions are continued at
discharge for no apparent reason, leading to their
long-term misuse.
DA Zinc et al, Aliment Pharmacol Ther, 2005
Overuse of acid suppression therapy in hospitalized patients.
Gupta R, Garg P, Kottoor R, Munoz JC, Jamal MM, Lambiase LR, Vega KJ.
RESULTS: Seventy percent of patients were started on AST on admission. Of these, 73%were
unnecessary. Stress ulcers prophylaxis in low risk patients or the concomitant use of ulcerogenic
drugs motivated initiation of therapy most frequently. Sixty nine percent of patients started on
inappropriate AST were discharged on the same regimen. Admitting diagnosis, age of patient, length
of stay, or concomitant use of ulcerogenic drugs did not predict continuation of unnecessary AST at
discharge.
CONCLUSION: AST is overused in hospitalized patients. This primarily occurred in low risk patients
and was compounded by continuation at discharge. This significantly increases cost to the health car
system and the risk of drug interactions.
South Med J. 2010 Mar;103(3):207-11.
Drugs and Aging, 2012
Deprescribing medication in very elderly
patients with multimorbidity: the view of
Dutch GPs. A qualitative study
J Schuling et al. BMC Family Practice 2012, 13:56
AA VV G Ital Farmacol Clin, 2012, 26, 4:359-368
Drugs Aging. 2012 Aug 1;29(8):659-67
CASO CLINICO sulla prescrizione di farmaci nell'anziano - 2
CASO CLINICO sulla prescrizione di farmaci nell'anziano - 3
CASO CLINICO sulla prescrizione di farmaci nell'anziano - 4
AUSTRALIA
GERIATRI GENOVA (N=22)
Drug
□ pravastatina
□ setralina
□ digossina
□ oxazepam
□ gliclazide
□ spironolattone
□ donepezil
□ alendronato
□ omeprazolo
□ CaCO3
□ Movicol®
□ carbidopa-benserazide
□ Perindopril
n (%)
19 (86.4)
17 (77.3)
14 (63.6)
13 (59.1)
12 (54.5)
12 (54.5)
12 (54.5)
12 (54.5)
12 (54.5)
10 (45.5)
9 (40.9)
7 (31.8)
7 (31.8)
AUSTRALIA
GERIATRI GENOVA (N=22)
Drug
(+23%)
(+25%)
(+27%)
(+52%)
(+50%)
(+23%)
(+38%)
(+25%)
(+18%)
(+22%)
(+37%)
(0 %)
(0 %)
□ pravastatina
□ setralina
□ digossina
□ oxazepam
□ gliclazide
□ spironolattone
□ donepezil
□ alendronato
□ omeprazolo
□ CaCO3
□ Movicol®
□ carbidopa-benserazide
□ Perindopril
n (%)
19 (86.4)
17 (77.3)
14 (63.6)
13 (59.1)
12 (54.5)
12 (54.5)
12 (54.5)
12 (54.5)
12 (54.5)
10 (45.5)
9 (40.9)
7 (31.8)
7 (31.8)
FARMACI CON IL MAGGIORE CONSENSO
AUSTRALIA
GERIATRI GENOVA
CARVEDILOLO
COLECALCIFEROLO
FUROSEMIDE
DIGOSSINA
PERINDOPRIL
OMEPRAZOLO
CARVEDILOLO
COLECALCIFEROLO
FUROSEMIDE
PERINDOPRIL
ISOSORBIDE
CARBIDOPA/BENSER
Geriatri ospedalieri vs geriatri territoriali
H
T
Farmaci da sospendere
(i 7 vizi capitali)
Numero medio sosp.:
Totale 7.3
H
7.3
T
7.3
Pravastatina
Gliclazide
Setralina
Alendronato
Digossina
Spironolatt.
Omeprazolo
(93.3)
(73.3)
(73.3)
(73.3)
(66.7)
(53.3)
(46.7)
Oxazepam
(100)
Sertralina
(85.7)
Pravastatina (71.4)
Omeprazolo (71.4)
Movicol
(71.4)
Spironolattone(57.1)
Digossina
(57.1)
Farmaci da confermare
(i magnifici 7)
Totale 7.2
H
7.3
T
7.0
Carvedilolo
Colecalcifer
Furosemide
Perindopril
Isosorbide
Movicol
Carbid/Bens
(100)
(93.3)
(93.3)
(53.3)
(46.7)
(46.7)
(40.0)
Perindopril (85.7)
Carvedilolo (71.4)
Furosemide (57.1)
Isosorbide
(57.1)
Warfarin
(57.1)
Carbid/Bens (57.1)
Colecalciferolo(42.9)
I dubbi amletici
Parac/Cod
Isosorbide
Oxazepam
(60.0)
(46.7)
(46.7)
Donepezil
(71.4)
Spironolattone(42.9)
Warfarin
(42.9)
Tecniche Sale e Pepe
SALE (in zucca)
Semplificare
Avversi (eventi)
Lista di farmaci
Evidenze di efficacia
PEPE
Personalizzare
Educare
Pazienza (tempo disponibile)
Effetti da interazione
Bhavik M. Shah,, Emily R. Hajjar, Clin Geriatr Med 28 (2012) 173–186