Ovrednotenje ambulantnega predpisovanja zdravil s tveganjem za padce pri starejših odraslih v Sloveniji

Mravljak Krajner, Anita (author), Kos, Mitja (mentor), Jazbar, Janja (co-mentor)

Padci predstavljajo pomemben javnozdravstveni problem pri starejših odraslih, starih nad 65 let. Ker padci pogosto vodijo do poškodb in z njimi povezane zmanjšane kakovosti življenja, invalidnosti in smrtnosti, je treba pravočasno prepoznati dejavnike tveganja. Zdravila so tako eden izmed pomembnih dejavnikov tveganja za padce in poznanih je že kar nekaj učinkovin, ki povečajo to tveganje. Namen te farmakoepidemiološke študije je bil ovrednotiti ambulantno predpisovanje učinkovin s tveganjem za padce pri starejših odraslih, starih nad 65 let, v Sloveniji v letu 2018. Podatke o izdanih receptih smo pridobili iz anonimizirane evidence Zavoda za zdravstveno zavarovanje Slovenije o izdanih zdravilih na recept iz leta 2018. Seznam učinkovin, ki povečajo tveganje za padce, je bil oblikovan na podlagi objavljenih metaanaliz, ki so bile ločeno objavljene za kardiovaskularne, psihotropne in ostale učinkovine. Število starejših odraslih z vsaj enim receptom v letu 2018 je bilo 395.216, kar predstavlja 91,1 % celotne slovenske populacije starejših odraslih. Ti so prejeli 837.201 (9,7 %) receptov z učinkovino, ki dokazano poveča tveganje za padce. Celokupno število starejših odraslih z vsaj eno učinkovino, ki dokazano poveča tveganje za padce, je bilo 165.224, kar predstavlja več kot 40 % populacije v študiji. Prevalenca je bila večja pri ženskah in starejših starostnih skupinah. Med ženskami je bila prevalenca 44,5 %, med moškimi pa 30,3 %. Med starostnimi skupinami je bila prevalenca med 65 in 74 let 29,0 %, med 75 in 84 let 44,0 % in nad 85 let 60,4 %. Med posameznimi skupinami učinkovin, ki dokazano povečajo tveganje za padce, je bila prevalenca naslednja: kardiovaskularne učinkovine 14,1 %, psihotropne učinkovine 28,8 % in ostale učinkovine 5,2 %. Med kardiovaskularnimi učinkovinami sta bila najpogosteje in edina predpisana furosemid in torasemid. Med najpogosteje predpisanimi psihotropnimi učinkovinami so bili kvetiapin, alprazolam, bromazepam, escitalopram in sertralin. Najpogosteje predpisane učinkovine med ostalimi učinkovinami pa so bile pregabalin, levetiracetam, karbamazepin, lamotrigin in valprojska kislina. Zdravila so eden izmed pomembnih dejavnikov tveganja za padce. Kljub temu da je/da bi bil umik takšnih zdravil učinkovit ukrep za preprečevanje padcev, je treba pri tem upoštevati vse koristi in tveganja za posameznega bolnika, da zagotovimo učinkovito in varno zdravljenje ter s tem tudi boljšo kakovost življenja starejših odraslih oseb.

• Language: Slovenian
• Keywords: starejši odrasli, padec, kardiovaskularne učinkovine, psihotropne učinkovine, ostale učinkovine
• Work type: Master's thesis/paper
• Organization: FFA - Faculty of Pharmacy
• Year: 2020
• PID: 20.500.12556/RUL-114767
• Publication date in RUL: 07.03.2020

Secondary language

• Language: English
• Title: Evaluation of ambulatory prescribed medicines with an increased risk for falls among older adults in Slovenia

Abstract

Falls represent an important public health issue with elderly people, aged 65 or more. As falls often lead to injuries and the associated reduced quality of life, disabilities and higher mortality rate, risk factors need to be identified in a timely manner. Drugs are one of the important risk factors for falls and there are quite a number of active ingredients known to increase this risk. The purpose of this phramacoepidemiological study was to evaluate the prevalence and characteristics of fall risk increasing drugs among outpatients aged 65 or more in Slovenia in 2018. The data on dispensedprescriptions was obtained from anonymised records of the Health insurance institute of Slovenia regarding prescription drugs dispensed in 2018. The list of drugs that increase the risk of falls was formed on the basis of meta-analyses, which were published separately for cardiovascular drugs, psychotropic drugs and other drugs. The number of elderly people with at least one prescription in 2018 was 395,216, representing 91.1 % of the total Slovenian population of elderly people. They received 837,201 (9.7 %) prescriptions with at least one fall risk increasing drug. The total number of elderly people with fall risk increasing drugs was 165,224, representing more than 40 % of the study population. The prevalence was higher in women and older age groups. Namely, the gender prevalence was 44.5 % among women and 30.3 % among men, while the age group prevalence was 29.0 % for ages 65–74, 44.0 % for ages 75–84 and 60.4 % for ages 85 and more. Among the individual groups of fall risk increasing drugs, the prevalence was as follows: cardiovascular drugs (14.1 %), psychotropic drugs (28.8 %) and other drugs (5.2 %). Among the cardiovascular drugs, furosemide and torasemide were the only ones prescribed, and as such, also the most common. The most commonly prescribed psychotropic drugs were quetiapine, alprazolam, bromazepam, escitalopram and sertraline. The most commonly prescribed active substancesamong other drugs were pregabalin, levetiracetam, carbamazepine, lamotrigine and valproic acid. Although withdrawal of such medicines is an effective measure to prevent falls, all benefits and risks to the individual patient must be taken into account in order to ensure effective and safe treatment and thus a better quality of life for older adults.

• Keywords: elderly people, falls, cardiovascular drugs, psychotropic drugs, other drugs