Der Internist

, Volume 50, Issue 12, pp 1415–1424 | Cite as

Arzneimitteltherapie im Alter

Wo liegen die Probleme? Was soll man tun, was muss man lassen?
Arzneimitteltherapie

Zusammenfassung

Der Arzneimittelgebrauch steigt im höheren Lebensalter parallel zur Krankheitslast (Multimorbidität) deutlich an. Ältere Menschen haben häufigere und schwerere unerwünschte Arzneimittelwirkungen als jüngere. Unabdingbar für eine sichere Medikation ist die Beachtung von physiologischen Veränderungen im Alter und ihrer Bedeutung für Pharmakokinetik und Pharmakodynamik sowie eine kritische Indikationsstellung mit klar definierten, am individuellen Gesamtkonzept orientierten Zielen. Wichtig ist die Durchführung von geriatrischen Assessments, die u. a. die Aktivitäten des täglichen Lebens, den Grad der Selbständigkeit in der Versorgung, den kognitiven Status, die soziale Situation, den Hilfebedarf sowie den Ernährungszustand erfassen. Das kalendarische Alter eines Patienten ist dagegen ein eher untergeordnetes Maß für medikamentöse Therapieentscheidungen. Praktische Hilfen (Dispensiersysteme, Hilfe bei visuellen, taktilen oder kognitiven Einschränkungen etc.) können Adhärenz und Sicherheit und damit den Therapieerfolg verbessern. Erkennen und Vermeiden von unerwünschten Arzneimittelwirkungen könnte die bedeutendste Einzelmaßnahme bei den potenziell reversiblen Leiden des Alters sein. Listen mit im Alter ungeeigneten Arzneimitteln sind wegen ihrer kategorischen Empfehlungen nur bedingt zielführend. Wünschenswert wäre eine stärkere Beachtung patientenseitiger Faktoren, um risikoträchtige Medikationen zu vermeiden.

Schlüsselwörter

Pharmakotherapie Ältere Patienten Multimorbidität Geriatrie Unerwünschte Arzneimittelwirkungen 

Drug therapy in the elderly

What are the problems? What are the dos and don’ts?

Abstract

With increasing age a clear increase in drug use exists in parallel with the age-related burden of disease. Elderly subjects have more frequent and more severe adverse drug reactions. Often polypharmacy causes a cascade which leads to the prescription of additional drugs to treat adverse drug reactions. To ensure safe medications, consideration of physiological changes and their relevance for pharmacodynamics and pharmacokinetics is necessary, as are critical prescription decisions with clearly defined individual therapeutic targets. Geriatric assessments should be performed more often. They comprise assessments of activities of daily living, the degree of autonomy and self-sufficiency, cognitive and nutritional status. Chronological age is only a minor criterion for prescription decisions. Practical help (dispensing devices, help when visual, tactile or cognitive impairments are present) will be able to improve adherence and thus safety and efficacy of drugs. Recognizing and preventing adverse drug reactions is probably the single most reversible affliction of geriatric medicine. Lists with potentially inappropriate medications (PIM) in the elderly are rather unsuitable due to their categorical character. Better consideration of patient-related factors and defining “potentially inappropriate patients (PIP)” seems preferable for preventing the prescription of risk-entailing medications.

Keywords

Drug therapy Elderly patients Multimorbidity Geriatrics Adverse drug reactions 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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Copyright information

© Springer Medizin Verlag 2009

Authors and Affiliations

  1. 1.Geriatrie Charité Universitätsmedizin Berlin und Evangelisches Geriatriezentrum Berlin gGmbHBerlinDeutschland

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