Elderly people are the group of people who are the most exposed to multiple medications at the same time. As with senescence the body experiences physiological changes, treatment should be adapted to minimize adverse effects. In polypharmacy, potential drug-drug interactions are more common, but they do not necessarily have to be clinically expressed. The aim of the study was to determine the type and proportion of potentially inappropriate medications in the case of the elderly and the frequency and type of potential drug-drug interactions in the retirement home Postojna. The study included elderly patients who received at least 5 medications for systemic therapy, either during the regular therapy or when necessary. The therapy data was obtained from the retirement home’s doctor's medical documentation on the selected day at the beginning of 2017. The PRISCUS list was used to identify PIM and the Lexicomp database was used to identify the potential drug-drug interactions. Most of the elderly are subjected to polypharmacy and the median of medications is 9. The number of prescribed drugs decreases with age. The most frequently prescribed drugs are from the group N according to the ATC classification (38.6% of all medications), where the most represented are psycholeptics (39.6%) and analgesics (29.9%). In the second place is Group A (20.4% of all medications), followed by Group C (19.8% of all medications). Among the most common active ingredients are pantoprazole, acetylsalicylic acid and lactulose for regular therapy, and paracetamol, alone or in combination with tramadol, for therapy when necessary. Half of the elderly receive at least one PIM. As PIM we identified 15 active substances that werw prescribed in 88 cases. The most common are benzodiazepines, followed by zolpidem and neuroleptics. We found that potential drug-drug interactions occur in almost 75% cases. We identified 281 examples of D interactions, which were formed by 55 active substances and 54 cases of X interactions formed by 11 active ingredients. 59 active ingredients did not enter into interactions D or X. Most interactions form active substances that act on the CNS, while safe agents without interaction are paracetamol, lactulose and cholecalciferol. In a conversation with a home physician, we found that most PIM are prescribed by specialists and that the incidence of adverse effects due to PIM is very low in doctor’s opinion. Caregivers have been receiving the majority of prescribed medicines for many years.
|