Zusammenfassung
Vor dem Hintergrund der geriatrietypischen Multimorbidität einerseits und der besonderen Vulnerabilität des geriatrischen Patienten andererseits verdient die Multimedikation eine besondere Beachtung. Leitliniengerecht soll eine Überprüfung der Medikation nicht nur regelmäßig, sondern auch anlassbezogen und bei jedem Krankenhausaufenthalt vorgenommen werden – also auch im Kontext einer Prähabilitation. Dabei verdienen nicht nur Substanzen, die mit dem eigentlich geplanten Eingriff, der Narkose oder dem Blutungsrisiko interferieren eine Rolle, sondern jede Medikation, die die typischen Risiken für einen geriatrischen Patienten erhöhen. Dazu zählen Präparate, die eine Sturzneigung verursachen oder verstärken, ein Delir auslösen können oder aber durch pharmakologische Interaktionen die Komedikation verändern. Maßnahmen, die das Risiko minimieren können, sind die exakte Dokumentation einer Medikation, die strukturierte und komplette Informationsweitergabe, die Patienten- und Angehörigenschulung über evtl. auftretende Nebenwirkungen, ein Recall-System z. B. für etwaige Laborkontrollen und die Beachtung der Einnahmevorschriften.
Abstract
Against the background of typical geriatric multimorbidity and with the particular vulnerability of geriatric patients, polypharmacy deserves special attention. In accordance with the guidelines, medication should not only be reviewed regularly, but also on an ad hoc basis and with each hospital stay—and also in the context of prehabilitation. Thus, not only substances that interfere with the currently planned intervention, anesthesia, or risk of bleeding should be considered, but any medication that increases common risks for geriatric patients. These include drugs that cause or increase a tendency to fall, induce delirium, or alter the comedication through potential drug–drug interactions. Measures to minimize the risk include the following: exact documentation of medications, structured and complete transfer of information, patient and family training about any side effects that may occur, a recall system for possible laboratory checks, and compliance with the instructions for taking the medication.
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Wiedemann, A., Stein, J., Manseck, A. et al. Polypharmazie und Medikamentencheck im Kontext der Prähabilitation. Urologie 62, 1025–1033 (2023). https://doi.org/10.1007/s00120-023-02174-6
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DOI: https://doi.org/10.1007/s00120-023-02174-6