In Italy, over 2 million elderly people are exposed to potentially serious drug interactions and another million take inappropriate drugs, with an increased risk of medication errors, poor therapeutic adherence, functional and cognitive deterioration, acute confusional state, behavioral disorders, food, frailty, increased risk of hospitalization and death. This is the picture traced by the 2021 OsMed (National Observatory on the use of medicines) report. gastrointestinal bleeding, almost 250,000 take two or more QT-prolonging drugs, exposing them to the risk of serious, if not fatal, arrhythmias, and over 1,300,000 take two or more drugs that cause kidney failure”, explains Micaela La Regina, medical director of I level at the Ss Risk Management (Sc Clinical Governance, Health Planning, Clinical Risk) of the ASL 5 Liguria, in an interview with Alleati per la Salute (www.alleatiperlasalute.it), portal dedicated to medical-scientific information created by Novartis .
The drugs “most often prescribed inappropriately in the elderly – says La Regina, who is also a member of the Federation of Associations of Internal Hospital Managers (Fadoi) – are: digitalis, antidepressants, calcium channel blockers and NSAIDs. And the consequence of all this it is ‘polytherapy’, the concomitant intake of five or more different drugs, a very risky condition, not always appropriate, which makes mistakes, forgetfulness or double intakes easier, interactions between drugs or between drugs and diseases, responsible for 5-15 % of all hospital admissions”.
Seniors who take multiple drugs are a veritable army. “Almost 30% of the over 65s take 10 or more active ingredients and 66.6% at least 5 – the expert points out – Italy is the European nation with the largest number of elderly people, with over 14 million citizens (approximately one in 4) who are over 65, making drug therapy management a public health concern.” Those over 65 who take at least 5 drugs “mostly take two antihypertensives – specifies La Regina – an antiplatelet and a lipid-lowering agent, because they more frequently suffer from cardiovascular disease. Those over 65 who take 8 or more drugs, on the other hand, often also suffer from diabetes mellitus and take anti-diabetic, anti-gout and anti-ulcer drugs in addition”.
“Polytherapy is due to the simultaneous presence of several chronic pathologies, a condition known as multimorbidity, which each require one or more drugs – explains La Regina – To these are added any drugs introduced to counteract the side effects of the first unrecognized drugs, drugs continued beyond necessary for inertia, self-prescription drugs, even unconventional.In addition to easily encountering errors, forgetfulness or double assumptions and interactions between drugs, among the risks of polytherapy there is the concomitant intake of drugs with anticholinergic effect, even secondary increases the likelihood of mental confusion, cognitive impairment, falls, and urine retention.” The most exposed to the risks of polypharmacy are men and women over 65, “but it must also be said that men consume more drugs than women”.
Providing correct information on this issue, however, is not just the task of the general practitioner. According to the expert, “the family doctor undoubtedly plays a central role in the management of drug therapy and in the health education of each patient, but awareness of the risks of polypharmacy and knowledge of strategies to contain them must be the property of all actors of the complex and dynamic process of pharmacotherapy”. Therefore, concludes La Regina, “specialist doctors, pharmacists, nurses, other health professionals, the patient himself, his caregiver and decision-makers in the health field who must favor by all means – scientific, technological, social – the processes of pharmacological recognition and reconciliation and descriptive”.
The complete article is available at: https://www.alleatiperlasalute.it/alla-scoperta-di/sicurezza-dei-farmaci-come-gestire-la-politerapia.