Skip to main content
SpringerLink
Log in

Polypharmacy in the elderly from the clinical toxicologist perspective

Polypharmazie beim älteren Patienten aus Sicht des klinischen Toxikologen

  • Beiträge zum Themenschwerpunkt
  • Published:
Zeitschrift für Gerontologie und Geriatrie Aims and scope Submit manuscript

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.

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Afilalo J, Karunananthan S, Eisenberg M et al (2009) Role of frailty in patients with cardiovascular disease. Am J Cardiol 103:1616–1621

    Article  PubMed  Google Scholar 

  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:d5228

    Article  PubMed  Google Scholar 

  3. Beers MH (1997) Explicit criteria for determining potentially inappropriate medication use by the elderly. Arch Intern Med 157:1531–1536

    Article  PubMed  CAS  Google Scholar 

  4. Bennet AT, Collins KA (2001) Elderly suicide: a 10-year retrospective study. Am J Forensic Med Pathol 22:169–172

    Article  Google Scholar 

  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 42:208–211

    Article  PubMed  CAS  Google Scholar 

  6. Boyle N, Naganathan V, Cumming RG (2010) Medication and falls: risk and optimization. Clin Geriatr Med 26:583–605

    Article  PubMed  Google Scholar 

  7. Budnitz DS, Lovegrove MC, Shehab N et al (2011) Emergency hospitalizations for adverse drug events in older americans. N Engl J Med 365:2002–2012

    Article  PubMed  CAS  Google Scholar 

  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 69:543–552

    Article  PubMed  Google Scholar 

  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 101:268–270

    PubMed  CAS  Google Scholar 

  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 128:254–258

    PubMed  CAS  Google Scholar 

  11. Comets E, Diquet B, Legrain S et al (2012) Pharmacokinetic and pharmacodynamic varaibility of fluindione in Octogenarians. Clin Pharmacol Ther 4:777–787

    Article  Google Scholar 

  12. Cook R, Allcock R, Johnston M (2008) Self-poisoning: current trends and practice in a UK teaching hospital. Clin Med 8:37–40

    Article  PubMed  Google Scholar 

  13. Dendorfer U, Mann J (2006) Drug related disorders of water and electrolyte metabolism. Internist 47:1121–1128

    Article  PubMed  CAS  Google Scholar 

  14. Doak MW, Nixon AC, Lupton DJ et al (2009) Self-poisoning in older adults: patterns of drug ingestion and clinical outcomes. Age Ageing 38:407–411

    Article  PubMed  Google Scholar 

  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):653–663

    Article  PubMed  CAS  Google Scholar 

  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 160:264–269

    Article  PubMed  Google Scholar 

  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 16:367–372

    Google Scholar 

  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 20:769–776

    Article  PubMed  CAS  Google Scholar 

  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 163:2716–2724

    Article  PubMed  Google Scholar 

  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 59:139–144

    Article  Google Scholar 

  21. Gandhi TK, Weingart SN, Borus J et al (2003) Adverse drug events in ambulatory care. N Engl J Med 348:1556

    Article  PubMed  Google Scholar 

  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 169:894–900

    Article  PubMed  Google Scholar 

  23. Gosch M, Roller R (2010) Multiple drug therapy: a challange for an aging society. Wien Med Wochenschr 160:261–263

    Article  PubMed  Google Scholar 

  24. Hadem J, Tacke F, Bruns T et al (2012) Etiologies and outcomes of acute liver failure in Germany. Clin Gastroenterol Hepatol 10:664–669

    Article  PubMed  Google Scholar 

  25. Hartikainen S, Lönnroos E, Louhivuori K (2007) Medication as a risk factor for falls: critical systematic review. J Gerontol Med Sci 62A:1172–1181

    Article  Google Scholar 

  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 46:2–9

    Article  Google Scholar 

  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 53:631–639

    Article  PubMed  Google Scholar 

  28. Holt S, Schmiedl S, Thürmann PA (2010) Potenziell inadäquate Medikation für ältere Menschen: Die PRISCUS-Liste. Dtsch Arztebl Int 107:543–551

    PubMed  Google Scholar 

  29. http://www.who.int/ipcs/poisons/harmonization/en/index.html. Accessed 17 May 2012

  30. Huang AR, Mallet L, Rochfort CM et al (2012) Medicatiion-related falls in the elderly: causative factors and preventive strategies. Drugs Aging 29:359–376

    Article  PubMed  CAS  Google Scholar 

  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 351:543–551

    Article  PubMed  CAS  Google Scholar 

  32. Juurlink DN, Mamdani M, Koop A et al (2003) Drug-drug interactions among elderly patients hospitalized for drug toxicity. JAMA 289:1652–1658

    Article  PubMed  CAS  Google Scholar 

  33. Kämmerer W, Mutschler E (1998) Arzneistoffwechselwirkungen in der Intensivmedizin. Rhein Main Druck, Mainz, Germany

  34. Kämmerer W (2012) Klinisch relevante pharmakokinetische Arzneimittelinteraktionen in der Intensivmedizin. Med Klin Intensivmed Notfmed 107:128–140

    PubMed  Google Scholar 

  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 33:230–234

    Article  PubMed  Google Scholar 

  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 49:597–603

    Article  PubMed  CAS  Google Scholar 

  37. Mizukami F, Koide Y, Furuta K (2012) Polypharmacy with common diseases in hospitalized elderly patients. Am J Geriatr Pharmacother 10:123–128

    Article  Google Scholar 

  38. Modreker MK, Rentelen-Kruse W von (2009) Arzneimittel und Stürze im Alter. Internist 50:493–500

    Article  PubMed  CAS  Google Scholar 

  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 38:182–189

    Article  Google Scholar 

  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:698–704

    Article  Google Scholar 

  41. Pomme E, Ficek B (2012) Management of pain in the elderly at the end of life. Drug and Aging 29:285–305

    Article  Google Scholar 

  42. Punywudho B, Ramsay ER, Brundage RC et al (2012) Population pharmacokinetics of carbamazepine in elderly patients. Ther Drug Monit 34:176–81

    Article  Google Scholar 

  43. Rammer M, Weber T, Laßing M et al (2009) Arterial Hypertension and electrolyte disturbances. J Hyperton 13:12–16

    Article  Google Scholar 

  44. Rogers JJ, Heard K (2007) Does age matter? Comparing case fatality rates for selected poisonings reported to U.S. poison centers. Clinical Toxicology 45:705–708

    Article  PubMed  Google Scholar 

  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 29:225–232

    Article  PubMed  Google Scholar 

  46. Saad M, Harisingani R, Katinas L (2012) Impact of geriatric consultation on the number of medications in hospitalized older patients. Consult Pharm 27:42–48

    Article  PubMed  Google Scholar 

  47. Satar S, Seydaoglu G (2005) Analysis of acute adult poisoning in a 6-year period and factors affecting the hospital stay. Adv Ther 22:137–147

    Article  PubMed  Google Scholar 

  48. Schnurrer J, Frölich JC (2003) Incidence and prevention of lethal undisirable drug effects. Internist 44:889

    Article  PubMed  CAS  Google Scholar 

  49. Slomski A (2012) Falls form taking multiple medications may be a risk for both young and old. JAMA 307:1127–1128

    Article  PubMed  CAS  Google Scholar 

  50. Solomon DH, Rassen JA, Glynn RJ et al (2010) The comparative safety of analgesics in older adults with arthritis. Arch Intern Med 170:1968–1978

    Article  PubMed  Google Scholar 

  51. Strandell J, Bate A, Hägg S et al (2009) Rhabdomyolysis a result of azithromycin and statins: an unrecognized interaction. Br J Clin Pharmacol 68:427–434

    Article  PubMed  CAS  Google Scholar 

  52. Tinetti M, Allore H, Arauja K (2007) Modifiable impairments predict progressive disability among older persons. J Aging Health 17:239–256

    Article  Google Scholar 

  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 32:426–429

    Article  PubMed  Google Scholar 

  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 169:1952–1960

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest. Hans Jürgen Heppner and Philipp Bahrmann are research fellows of the “Forschungskolleg Geriatrie” Robert-Bosch-Foundation, Stuttgart, Germany.

Author information

Authors and Affiliations

  1. Department of Emergency and Intensive Care Medicine, Klinikum Nuremberg, Prof.-E.-Nathan-Str. 1, 90419, Nuremberg, Germany

    H.J. Heppner MD, MHBA & M. Christ MD

  2. Institut for Biomedicine of Aging, Friedrich-Alexander-University Erlangen-Nuremberg, Heimerichstr. 58, 90419, Nuremberg, Germany

    H.J. Heppner MD, MHBA, W. Mühlberg MD, P. Bahrmann MD, C. Sieber MD & K. Singler MD

  3. Poison Information Center Nueremberg, Klinikum Nuremberg, Nuremberg, Germany

    H.J. Heppner MD, MHBA

  4. Department of Geriatric Medicine, LKH Hochzirl, 6170, Hochzirl, Austria

    M. Gosch MD

  5. Department of Geriatric Medicine, Klinikum Frankfurt Hoechst, Gotenstr. 6–8, 65929, Frankfurt a. M., Germany

    W. Mühlberg MD

  6. Department of Acute Geriatric Medicine, Klinikum Nuremberg, Nuremberg, Germany

    P. Bahrmann MD, C. Sieber MD & K. Singler MD

  7. Department of Clinical Chemistry, Laboratory and Transfusion Medicine, Klinikum Nuremberg, Nuremberg, Germany

    T. Bertsch MD

Authors
  1. H.J. Heppner MD, MHBA
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Christ MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Gosch MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. W. Mühlberg MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. Bahrmann MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. T. Bertsch MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. C. Sieber MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. K. Singler MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H.J. Heppner MD, MHBA.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Heppner, H., Christ, M., Gosch, M. et al. Polypharmacy in the elderly from the clinical toxicologist perspective. Z Gerontol Geriat 45, 473–478 (2012). https://doi.org/10.1007/s00391-012-0383-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00391-012-0383-6

Keywords

Schlüsselwörter

Search

Navigation