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Prävention unerwünschter Arzneimittelwirkungen bei älteren Patienten

Prevention of adverse drug reactions in older patients

  • BEITRAG ZUM THEMENSCHWERPUNKT
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Zeitschrift für Gerontologie und Geriatrie Aims and scope Submit manuscript

Zusammenfassung

Unerwünschte Arzneimittelwirkungen (UAW) gehören zu den bedeutendsten Therapie assoziierten unerwünschten Ereignissen überhaupt und ziehen eine beträchtliche Morbidität und Mortalität nach sich. Dies betrifft besonders ältere Patienten im Rahmen von Multimorbidität und Polypharmazie, auch wenn das kalendarische Alter kein unabhängiger Risikofaktor für das Eintreten von UAW ist. Besonders häufig in dieser Altersklasse auftretende und klinisch bedeutsame UAW sind das delirante Syndrom und Sturzereignisse. Die vorliegende Übersicht bietet einen Überblick über die zugrundeliegenden Mechanismen und Aspekte und entwickelt daraus Möglichkeiten für eine Prävention dieser Ereignisse. Dazu zählen pharmakokinetische und -genetische Aspekte, pharmakodynamische Aspekte und Faktoren, welche die Compliance des Patienten beeinflussen. Ein beträchtlicher Anteil der auftretenden UAW lässt sich durch umsichtige Indikationstellung und Monitoring der Therapie sowie effektiven Einsatz Compliancefördernder Maßnahmen vermeiden. Dies bedarf in der Regel eines individualisierten Ansatzes, da funktionelle Defizite oft eine erfolgreiche Pharmakotherapie behindern und ihrerseits Risikofaktoren für das Auftreten von Therapiefehlern und UAW sind. Hierzu zählen insbesondere kognitive Defizite und Visuseinschränkungen sowie Einbußen im Bereich der manuellen Feinmotorik. Hier kann der Einsatz von Instrumenten des geriatrischen Assessments helfen, diese Defizite zu erkennen und qualitativ wie auch quantitativ zu bewerten. Ein weiterer bedeutender Aspekt ist das Erfassen der Nierenfunktion, da eine signifikante Einschränkung derselben bei älteren Patienten oft nicht erkannt wird und eine UAW im Rahmen einer Medikamentenakkumulation begünstigen kann. Dieser wichtige pharmakokinetische Aspekt kann im klinischen Alltag nicht exakt bestimmt werden. Aber mit Hilfe geeigneter Schätzformeln sollte stets eine annähernde Bestimmung durchgeführt werden.

Abstract

Adverse drug reactions are among the most common adverse events and a significant cause of preventable morbidity and mortality. As multimorbidity and polypharmacy are frequent in this population, the elderly are at special risk for adverse drug events, although the calendarian age has not been proved as independent risk factor in this context. In particular falls and delirium are clinically significant and typical adverse drug events in the elderly. In this review mechanisms and factors which determine adverse drug re actions are described, and possible strategies for an effective prevention are given. This covers pharmacokinetic, pharmacogenetic and pharmacodynamik aspects as well as factors influencing individual adherence to drug therapy. A significant portion of adverse drug reaction may be prevented by a thorough indication and prudent monitoring of pharmacotherapy. Also adherence to pharmacotherapy may be improved by tailored and individual means referring to the patient‘s needs and expectancies. In the elderly functional limitations such as reduced cognitive abilities, reduced visual acuity and impaired dexterity determine an ineffective pharmacotherapy and medication errors. Hereby these functional limitations are significant predictors of adverse drug events in the context of self-management of pharmacotherapy. Testing of functional abilities as provided in the geriatric assessment is helpful to identify these factors. Among altered pharmacokinetic factors in the elderly, reduced renal function is most important to avoid overdosage. Although a precise measurement of renal function is not possible in a bed-side manner, an estimation of actual renal function utilizing estimation-formulas should always take place.

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  1. Universität Heidelberg, Medizinische Fakultät Mannheim, IV. Medizinische Klinik, Schwerpunkt Geriatrie und Zentrum für Gerontopharmakologie, Universitätsklinikum Mannheim, 68135, Mannheim, Germany

    H. Burkhardt & R. Gladisch

  2. Universität Heidelberg, Medizinische Fakultät Mannheim, Klinische Pharmakologie und Zentrum für Gerontopharmakologie, Universitätsklinikum Mannheim, 68135, Mannheim, Germany

    M. Wehling

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Burkhardt, H., Wehling, M. & Gladisch, R. Prävention unerwünschter Arzneimittelwirkungen bei älteren Patienten. Z Gerontol Geriat 40, 241–254 (2007). https://doi.org/10.1007/s00391-007-0468-9

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