Zeitschrift für Gerontologie und Geriatrie

, Volume 45, Issue 6, pp 473–478 | Cite as

Polypharmacy in the elderly from the clinical toxicologist perspective

  • H.J. Heppner
  • M. Christ
  • M. Gosch
  • W. Mühlberg
  • P. Bahrmann
  • T. Bertsch
  • C. Sieber
  • K. Singler
Beiträge zum Themenschwerpunkt

Abstract

Introduction

Polypharmacy is closely associated with multimorbidity in the elderly and can lead to problems and drug interactions.

Aim

This study assessed polypharmacy in the elderly, tracking inquiries to the Poison Information Centre Nuremberg (PICN) and patients needing toxicological intensive care therapy.

Methods

From 2006–2009, all PICN inquiries involving individuals > 70 years were tracked, as were cases at the Toxicological Intensive Care Unit (T-ICU) regarding adverse drug reactions (ADRs) and drug poisoning.

Results

Of 11,683 PICN calls about pharmaceuticals, 175 (1.5%) were from people > 70 years; 156 (4.8%) of 3,272 T-ICU patients were > 70 years. Calls about psychopharmaceuticals (46.9%) and analgesics (25.7%) were most frequent. Among the T-ICU patients, psychopharmaceuticals like sedatives and hypnotics were frequently involved (20.5%), as were tricyclic antidepressants (17.9%) and analgesics (29.5%). Ethanol was co-ingested by 18.3%.

Conclusion

Population-specific poison prevention strategies are needed to reduce toxic exposures. Such strategies could include pharmacist intervention, improved prescriber communication and education regarding the geriatric population, and computerized drug databases.

Keywords

Polypharmacy Elderly Clinical toxicology Poisoning Poison control centers 

Polypharmazie beim älteren Patienten aus Sicht des klinischen Toxikologen

Zusammenfassung

Einleitung

Die Polypharmazie ist auf das Engste mit der Multimorbidität beim älteren Patienten verbunden und führt häufig zu unerwünschten Problemen, Interaktionen oder Unsicherheiten aufseiten des Patienten.

Ziel

Die nachfolgende Beschreibung und Analyse soll aufzeigen, welche Bedeutung die Polypharmazie in der älteren Bevölkerungs- und Patientengruppe in Hinsicht auf Anfragen bei der Giftinformationszentrale und die intensivmedizinische Behandlungsnotwendigkeit auf der toxikologischen Intensivstation hat.

Methoden

Im Beobachtungszeitraum von 2006 bis 2009 wurden aus allen Anfragen an die Giftinformationszentrale Nürnberg die der über 70-Jährigen herausgegriffen und zeitgleich mit den stationären Behandlungsfällen der toxikologischen Intensivstation unter besonderer Berücksichtigung von unerwünschten Medikamentenwirkungen und -vergiftungen erfasst.

Ergebnisse

Es wurden 11.683 Anrufprotokolle und 3272 Patientenfälle ausgewertet. Bei den Auskünften der Giftinformationszentrale waren die Beratungssuchenden in 1,5% (n = 173) der Fälle 70–80 Jahre alt und in 1,0% (n = 119) älter als 80 Jahre. Am häufigsten waren Anfragen zu Psychopharmaka (46,9%) und Analgetika (25,7%). Bei den Intensivpatienten dominierten ebenfalls die Psychopharmaka (20,5%). Trizyklische Antidepressiva (17,9%) und Analgetika (29,5%) waren häufig vertreten. Eine zusätzliche Alkoholingestion fand sich in 18,3% der Fälle.

Schlussfolgerung

Strategien zur Vermeidung von Vergiftungen im Rahmen der Polymedikation sind ebenso von Bedeutung wie eine Verbesserung der Kommunikation unter den verordnenden Ärzten und die Anwendung strukturierter Datenbanken.

Schlüsselwörter

Polypharmazie Ältere Menschen Klinische Toxikologie Vergiftung Giftinformationszentrale 

References

  1. 1.
    Afilalo J, Karunananthan S, Eisenberg M et al (2009) Role of frailty in patients with cardiovascular disease. Am J Cardiol 103:1616–1621PubMedCrossRefGoogle Scholar
  2. 2.
    Antoniou T, Gomes T, Mamdami MM et al (2011) Trimethoprom-sulfamethoxazole induced hyperkalaemian in elderly patients reciving spironolactone: nested case-control study. BMJ 343:d5228PubMedCrossRefGoogle Scholar
  3. 3.
    Beers MH (1997) Explicit criteria for determining potentially inappropriate medication use by the elderly. Arch Intern Med 157:1531–1536PubMedCrossRefGoogle Scholar
  4. 4.
    Bennet AT, Collins KA (2001) Elderly suicide: a 10-year retrospective study. Am J Forensic Med Pathol 22:169–172CrossRefGoogle Scholar
  5. 5.
    Betteridge TM, Frampton CM, Jardine DL (2012) Polypharmacy–we make it worse! A cross-sectional study from an acute admission unit. Intern Med J 42:208–211PubMedCrossRefGoogle Scholar
  6. 6.
    Boyle N, Naganathan V, Cumming RG (2010) Medication and falls: risk and optimization. Clin Geriatr Med 26:583–605PubMedCrossRefGoogle Scholar
  7. 7.
    Budnitz DS, Lovegrove MC, Shehab N et al (2011) Emergency hospitalizations for adverse drug events in older americans. N Engl J Med 365:2002–2012PubMedCrossRefGoogle Scholar
  8. 8.
    Cahir C, Fahey T, Teeling M et al (2010) Potentially inappropriate prescribing and cost outcome of older people: a national population study. Br J Clin Pharmacol 69:543–552PubMedCrossRefGoogle Scholar
  9. 9.
    Cassidy N, Lee SK, Donegan CF, Tracey JA (2008) Poisoning in older adults: the experience of the national poisons information centre. Ir Med J 101:268–270PubMedGoogle Scholar
  10. 10.
    Ciorciaro C, Hartmann K, Kuhn M (1998) Differences in the relative incidence of adverse drug reactions in relation to age? An evaluation of the spontaneous reporting system of SANZ. Schweiz Med Wochenschr 128:254–258PubMedGoogle Scholar
  11. 11.
    Comets E, Diquet B, Legrain S et al (2012) Pharmacokinetic and pharmacodynamic varaibility of fluindione in Octogenarians. Clin Pharmacol Ther 4:777–787CrossRefGoogle Scholar
  12. 12.
    Cook R, Allcock R, Johnston M (2008) Self-poisoning: current trends and practice in a UK teaching hospital. Clin Med 8:37–40PubMedCrossRefGoogle Scholar
  13. 13.
    Dendorfer U, Mann J (2006) Drug related disorders of water and electrolyte metabolism. Internist 47:1121–1128PubMedCrossRefGoogle Scholar
  14. 14.
    Doak MW, Nixon AC, Lupton DJ et al (2009) Self-poisoning in older adults: patterns of drug ingestion and clinical outcomes. Age Ageing 38:407–411PubMedCrossRefGoogle Scholar
  15. 15.
    Dormann H, Neubert A, Criegee-Rieck M et al (2004) Readmissions and adverse drug reactions in internal medicine: the economic impact. J Intern Med 255(6):653–663PubMedCrossRefGoogle Scholar
  16. 16.
    Dovjak P, Sommeregger U, Otto R et al (2010) Polypharmazie in der Kardiologie – ein beachtliches Problem bei Synkopen, QT-Zeit-Verlängerung, Bradykardie und Tachykardie. Wien Med Wochenschr 160:264–269PubMedCrossRefGoogle Scholar
  17. 17.
    Dragonas C, Wagner JT, Heppner HJ et al (2007) The association of ABCB1 polymorphisms and elevated serum digitoxin concentrations in geriatric patients. Eur J Clin Pharmacol 16:367–372Google Scholar
  18. 18.
    Egger T, Dormann H, Ahne G et al (2003) Identification of adverse drug reactions in geriatric inpatients using a computerised drug database. Drugs Aging 20:769–776PubMedCrossRefGoogle Scholar
  19. 19.
    Fick DM, Cooper JW, Wade WE et al (2003) Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med 163:2716–2724PubMedCrossRefGoogle Scholar
  20. 20.
    Finlayson E, Maselli J, Steinmann MA et al (2011) Inappropriate medication use in older adults undergoing surgery: a national study. J Am Geriatr Soc 59:139–144CrossRefGoogle Scholar
  21. 21.
    Gandhi TK, Weingart SN, Borus J et al (2003) Adverse drug events in ambulatory care. N Engl J Med 348:1556PubMedCrossRefGoogle Scholar
  22. 22.
    Gillespie U, Alassaad A, Henrohn D et al (2009) A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older. Arch Intern Med 169:894–900PubMedCrossRefGoogle Scholar
  23. 23.
    Gosch M, Roller R (2010) Multiple drug therapy: a challange for an aging society. Wien Med Wochenschr 160:261–263PubMedCrossRefGoogle Scholar
  24. 24.
    Hadem J, Tacke F, Bruns T et al (2012) Etiologies and outcomes of acute liver failure in Germany. Clin Gastroenterol Hepatol 10:664–669PubMedCrossRefGoogle Scholar
  25. 25.
    Hartikainen S, Lönnroos E, Louhivuori K (2007) Medication as a risk factor for falls: critical systematic review. J Gerontol Med Sci 62A:1172–1181CrossRefGoogle Scholar
  26. 26.
    Heyerdahl F, Bjornas MA, Hovda KE et al (2008) Acute poisonings treated in hospitals in Oslo. A one-year prospective study (II): clinical outcome. Clin Toxicol 46:2–9CrossRefGoogle Scholar
  27. 27.
    Hicks LA, Chien YW, Taylor TH et al (2011) Outpatient antibiotic prescribing and nonsusceptible Streptococcus pneumoniae in the United States, 1996–2003. Clin Infect Dis 53:631–639PubMedCrossRefGoogle Scholar
  28. 28.
    Holt S, Schmiedl S, Thürmann PA (2010) Potenziell inadäquate Medikation für ältere Menschen: Die PRISCUS-Liste. Dtsch Arztebl Int 107:543–551PubMedGoogle Scholar
  29. 29.
    http://www.who.int/ipcs/poisons/harmonization/en/index.html. Accessed 17 May 2012Google Scholar
  30. 30.
    Huang AR, Mallet L, Rochfort CM et al (2012) Medicatiion-related falls in the elderly: causative factors and preventive strategies. Drugs Aging 29:359–376PubMedCrossRefGoogle Scholar
  31. 31.
    Juurlink DN, Mamdami MM, Lee DS et al (2004) Rates of hyperkalemia after publication of the randomized aldactone evaluation study. N Engl J Med 351:543–551PubMedCrossRefGoogle Scholar
  32. 32.
    Juurlink DN, Mamdani M, Koop A et al (2003) Drug-drug interactions among elderly patients hospitalized for drug toxicity. JAMA 289:1652–1658PubMedCrossRefGoogle Scholar
  33. 33.
    Kämmerer W, Mutschler E (1998) Arzneistoffwechselwirkungen in der Intensivmedizin. Rhein Main Druck, Mainz, GermanyGoogle Scholar
  34. 34.
    Kämmerer W (2012) Klinisch relevante pharmakokinetische Arzneimittelinteraktionen in der Intensivmedizin. Med Klin Intensivmed Notfmed 107:128–140PubMedGoogle Scholar
  35. 35.
    Krämer I, Rauber-Lüthy C, Kupferschmidt H, Krähenbühl S et al (2010) Minimal dose for severe poisoning and influencing factors in acute human clozapine intoxication: a 13-year retrospective study. Clin Neuropharmacol 33:230–234PubMedCrossRefGoogle Scholar
  36. 36.
    Lau HS, Florax C, Porsius AJ et al (2000) The completness of medication histories in medical records of patients admitted to general internal medicine wards. Br J Clin Pharmacol 49:597–603PubMedCrossRefGoogle Scholar
  37. 37.
    Mizukami F, Koide Y, Furuta K (2012) Polypharmacy with common diseases in hospitalized elderly patients. Am J Geriatr Pharmacother 10:123–128CrossRefGoogle Scholar
  38. 38.
    Modreker MK, Rentelen-Kruse W von (2009) Arzneimittel und Stürze im Alter. Internist 50:493–500PubMedCrossRefGoogle Scholar
  39. 39.
    Mühlberg W, Becher K, Heppner HJ, Wicklein S et al (2005) Acute poisoning in old and very old patients: a longitudinal retrospective study of 5883 patients in a toxicological intensive care unit. Z Gerontol Geriat 38:182–189CrossRefGoogle Scholar
  40. 40.
    Onder G, Liperoti R, Fidlova D et al (2012) Polypharamcy in nursing homes in Europe: the results from the SHELTER study. J Gerontol A Biol Sci Med Sci 67A:698–704CrossRefGoogle Scholar
  41. 41.
    Pomme E, Ficek B (2012) Management of pain in the elderly at the end of life. Drug and Aging 29:285–305CrossRefGoogle Scholar
  42. 42.
    Punywudho B, Ramsay ER, Brundage RC et al (2012) Population pharmacokinetics of carbamazepine in elderly patients. Ther Drug Monit 34:176–81CrossRefGoogle Scholar
  43. 43.
    Rammer M, Weber T, Laßing M et al (2009) Arterial Hypertension and electrolyte disturbances. J Hyperton 13:12–16CrossRefGoogle Scholar
  44. 44.
    Rogers JJ, Heard K (2007) Does age matter? Comparing case fatality rates for selected poisonings reported to U.S. poison centers. Clinical Toxicology 45:705–708PubMedCrossRefGoogle Scholar
  45. 45.
    Ruiter R, Visser LE, Rodenburg EM et al (2012) Adverse drug reaction-related hospitalizations in persons aged 55 years and over: a population-based study in The Netherlands. Drugs Aging 29:225–232PubMedCrossRefGoogle Scholar
  46. 46.
    Saad M, Harisingani R, Katinas L (2012) Impact of geriatric consultation on the number of medications in hospitalized older patients. Consult Pharm 27:42–48PubMedCrossRefGoogle Scholar
  47. 47.
    Satar S, Seydaoglu G (2005) Analysis of acute adult poisoning in a 6-year period and factors affecting the hospital stay. Adv Ther 22:137–147PubMedCrossRefGoogle Scholar
  48. 48.
    Schnurrer J, Frölich JC (2003) Incidence and prevention of lethal undisirable drug effects. Internist 44:889PubMedCrossRefGoogle Scholar
  49. 49.
    Slomski A (2012) Falls form taking multiple medications may be a risk for both young and old. JAMA 307:1127–1128PubMedCrossRefGoogle Scholar
  50. 50.
    Solomon DH, Rassen JA, Glynn RJ et al (2010) The comparative safety of analgesics in older adults with arthritis. Arch Intern Med 170:1968–1978PubMedCrossRefGoogle Scholar
  51. 51.
    Strandell J, Bate A, Hägg S et al (2009) Rhabdomyolysis a result of azithromycin and statins: an unrecognized interaction. Br J Clin Pharmacol 68:427–434PubMedCrossRefGoogle Scholar
  52. 52.
    Tinetti M, Allore H, Arauja K (2007) Modifiable impairments predict progressive disability among older persons. J Aging Health 17:239–256CrossRefGoogle Scholar
  53. 53.
    Ventura MT, Laddaga R, Cavallera P et al (2010) Adverse drug reactions as the cause of emergency department admission: focus on the elderly. Immunopharmacol Immunotoxicol 32:426–429PubMedCrossRefGoogle Scholar
  54. 54.
    Woolcott JC, Richardson KJ, Wiens MO et al (2009) Meta-analysis of the impact of nine medication classes on falls in elderly persons. Arch Intern Med 169:1952–1960PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • H.J. Heppner
    • 1
    • 2
    • 3
  • M. Christ
    • 1
  • M. Gosch
    • 4
  • W. Mühlberg
    • 5
    • 2
  • P. Bahrmann
    • 2
    • 6
  • T. Bertsch
    • 7
  • C. Sieber
    • 2
    • 6
  • K. Singler
    • 2
    • 6
  1. 1.Department of Emergency and Intensive Care MedicineKlinikum NurembergNurembergGermany
  2. 2.Institut for Biomedicine of AgingFriedrich-Alexander-University Erlangen-NurembergNurembergGermany
  3. 3.Poison Information Center NuerembergKlinikum NurembergNurembergGermany
  4. 4.Department of Geriatric MedicineLKH HochzirlHochzirlAustria
  5. 5.Department of Geriatric MedicineKlinikum Frankfurt HoechstFrankfurt a. M.Germany
  6. 6.Department of Acute Geriatric MedicineKlinikum NurembergNurembergGermany
  7. 7.Department of Clinical Chemistry, Laboratory and Transfusion MedicineKlinikum NurembergNurembergGermany

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