RISKS AND RISK FACTORS OF ADVERSE EFFECTS OF PHARMACOTHERAPY IN GERIATRIC PATIENTS
DOI:
https://doi.org/10.11603/2312-0967.2024.2.14748Keywords:
geriatric patients, adverse effects of pharmacotherapy and their causes, risks, risk factorsAbstract
The aim of the work. Analysis of diseases in the geriatric cohort of patients, their causes, risks and risk factors contributing to the occurrence of these diseases, affecting the treatment process, as well as creating a classification of risk factors.
Materials and Methods: bibliosemantic, analytical, expert assessments, modeling.
Results and Discussion. Treatment of geriatric patients is accompanied by a number of such risks: significant level of adverse consequences of medicines use; growth of concomitant diseases; infection; increase in mortality; increasing financial costs for treatment and management of geriatric patients.
As a result of the analysis, the risk factors were divided into the following groups:
- Due to the peculiarities of the body: aging, physiological changes, pharmacokinetic and pharmacodynamic changes of drugs, decrease in resistance.
- Caused by concomitant diseases: polymorbidity, complications of the course of the main disease, reduction in the effectiveness of its treatment, chronicity of diseases.
- Caused by treatment: polypharmacy, frequent antibiotic therapy.
- Due to the peculiarities of the provision of medical care: prolongation of hospitalization, peculiarities of the provision of medical care, medical errors and medical problems.
Conclusions: Treatment of geriatric patients is accompanied by a number of risks. We propose to divide the risks of pharmacotherapy of geriatric patients into the following groups:
- increase in adverse effects of drug use;
- increase in the incidence of concomitant diseases;
- high probability of infection;
- increase in mortality;
- the growth of financial resources spent on stopping the adverse effects of treatment and management of geriatric patients.
There are risk factors contributing to the manifestation of the risks of treating geriatric patients.
We consider it expedient to divide all the mentioned risk factors of pharmacotherapy of geriatric patients into four groups according to the reason for their occurrence:
- due to the characteristics of the patient's body;
- due to concomitant diseases;
- due to treatment;
- due to the specifics of providing medical care.
References
Trivalle C, Burlaud A, Ducimetière P. Risk factors for adverse drug events in hospitalized elderly patients: A geriatric score. European Geriatric Medicine. 2011; 2(5): 284-289. Available from: https://www.sciencedirect.com/science/article/abs/pii/S1878764911001173.
Bezrukov VV, Kuprash LP. Pharmacotherapy in a geriatric clinic: Monograph. Dnipro: Zhurfond. 2020;166. Available from: http://ir.librarynmu.com/bitstream/123456789/2130/1/1.pdf.
Khaitovych MV. Polypharmacy: definition, risks, management. Original studies. 2021;2(3). Available from: http://ir.librarynmu.com/bitstream/123456789/8443/1/Polypharmacy.pdf.
Hayes BD, Klein-Schwartz W, Barrueto F. Polypharmacy and the geriatric patient. Clin. Geriatr. Med. 2007;23:37-390.
Petrovic M, van der Сammen T, Onder G. Adverse drug reaction in older people: detection and prevention. Drug Aging. 2012;29:453-462.
Tragni E, Sala F, Casula M. Elders with multiple chronic conditions: Epidemiology and drug use. GIFF. 2014;6:5-16.
Gallagher P, Lang PO, Cherubini A, Topinková E, Cruz-Jentoft A, Errasquín B.M, Mádlová P, Gasperini B, Baeyens H, Baeyens J.-P. Prevalence of potentially inappropriate prescribing in an acutely ill population of older patients admitted to six European hospitals. Eur. J. Clin. Pharmacol. 2011;67:1175-1188.
Posokhova KA, Matvieieva OV. The influence of individual characteristics of the body, pathological processes, combined use of drugs on their effectiveness. Ukrainian medical journal. 2018;4(2):14-18. Available from: http://nbuv.gov.ua/UJRN/UMCh_2018_4%282%29__5.
Polypharmacy: causes, consequences, prevention. Methodological recommendations of the State University "Institute of Dermatology and Venereology of the National Academy of Medical Sciences of Ukraine". [Internet]. Available from: https://amnu.gov.ua/polipragmaziya-prychyny-naslidky-profilaktyka-metodychni-rekomendacziyi-du-instytut-dermatologiyi-ta-venerologiyi-namn-ukrayiny/.
Gujjarlamudi HB. Polytherapy and drug interactions in elderly. J Midlife Health. 2016;7(3):105-107.
Tragni E, Sala F, Casula M. Elders with multiple chronic conditions: Epidemiology and drug use. GIFF. 2014;6:5-16.
Rengo E, Viscont C, Mosciiella S. Comorbidity in the elderly: epidemiology and clinical characteristics. J Gerontol. 2005;53(1):35-38.
ECDC. Point Prevalence Survey of Healthcare-Associated Infections and Antimicrobial Use in European Acute Care Hospitals. Available online: https://www.ecdc.europa.eu/sites/default/files/media/en/publications/Publications/healthcare-associated-infections-antimicrobial-use-PPS.pdf (accessed on 22 January 2021).
Cristina ML, Alicino C, Sartini M, Faccio V, Spagnolo AM, Bono V.D, Cassola G, De Mite A.M, Crisalli M.P, Ottria G. Epidemiology, management, and outcome of carbapenem-resistant Klebsiella pneumoniae bloodstream infections in hospitals within the same endemic metropolitan area. J Infect Public Health. 2018;11:171-177.
Cristina M, Spagnolo A, Cenderello N, Fabbri P, Sartini M, Ottria G, Orlando P. Multidrug-resistant Acinetobacter baumannii outbreak: An investigation of the possible routes of transmission. Public Health. 2013;127:386-391.
Khaitovych MV, Poliakova DS. Antimicrobial resistance and organizational issues of administration of antimicrobial drugs in Ukraine. Ukrainian Medical Journal. March 13, 2023. [Internet]. Available from: www.umj.com.ua/uk/publikatsia-239951-antimikrobna-rezistentnist-ta-organizatsijni-pitannya-administruvannya-antimikrobnih-preparativ-v-ukrayini.
Veyssier P. Antibiotic therapy in the elderly. Rev Pract. 2003;53(14):1566-1571.
Cassone M, Mody L. Colonization with Multidrug-Resistant Organisms in Nursing Homes: Scope, Importance, and Management. Curr Geriatr Rep. 2015; 4:87-95.
Cairns S, Reilly J, Stewart S, Tolson D, Godwin J, Knight P. The Prevalence of Health Care–Associated Infection in Older People in Acute Care Hospitals. Infect Control Hosp Epidemiol. 2011; 32: 763-767.
Esme M, Topeli A, Yavuz B.B, Akova M. Infections in the Elderly Critically-Ill Patients. Front Med. 2019;6:118.
Peculiarities of the use of medicines in the elderly and senile. Available from: https://compendium.com.ua/uk/clinical-guidelines-uk/cardiology-uk/section-6-uk/glava-4-osoblivosti-zastosuvannya-likarskih-zasobiv-u-pohilomu-ta-starechomu-vitsi/.
Marinosci F. Urinary tract infections in nursing home residents. G Gerontol. 2014;62:84-94.
Bedsores in bedridden patients: innovations in treatment. Magazine "District Doctor". April, 2016;52-53. Available from: https://utm.com.ua/informatsiia/korysni-statti/250-prolezhni-u-lezhachikh-khvorikh-innovatsiji-v-likuvanni.html.
Jump RLP, Crnich CJ, Mody L, Bradley SF, Nicolle LE, Yoshikawa TT. Infectious Diseases in Older Adults of Long-Term Care Facilities: Update on Approach to Diagnosis and Management. J Am Geriatr Soc. 2018;66:789-803.
Shan B, Haijar E. Polypharmacy, Adverse Drug Reaction, And Geriatric Syndrome. Clin Geriatr Med. 2012;28:173-186.
Díaz NA, Farina J, Herrera J, Ezcurra MC. Candidemia: Characteristics in elderly patients. Rev Chilena Infectol. 2020;37:288-294.
Snehyrev FH. Peculiarities of treatment of elderly people: catching up with the VI National Congress of Gerontologists and Geriatricians of Ukraine. Ukrainian Medical Journal. December 26, 2016. [Internet]. Available from: (www.umj.com.ua/uk/publikatsia-103458-osoblivosti-likuvannya-lyudej-litnogo-viku-navzdogin-vi-natsionalnomu-kongresu-gerontologiv-i-geriatriv-ukrayini.
Gallagher P, Lang PO. Cherubini A, Topinková E, Cruz-Jentoft A, Errasquín BM, Mádlová P, Gasperini B, Baeyens H, Baeyens J.-P. Prevalence of potentially inappropriate prescribing in an acutely ill population of older patients admitted to six European hospitals. Eur J Clin Pharmacol. 2011;67;1175-1188.
Side effects of drugs [Internet]. Available from: https://www.pharmencyclopedia.com.ua/article/857/pobichna-diya-likiv.
Kolesnyk M. Medical error: ethical and legal aspects. Ukrainian medical journal. November 13, 2019. Available from: https://umj.com.ua/uk/publikatsia-165368-medichna-pomilka-etichni-ta-pravovi-aspekti.
Nguen JK, Fours MM, Kotabe SE, Lo E. Polypharmacy as a risk factor for adverse drug reactions in geriatric nursing home residents. The American Journal of Geriatric Pharmacotherapy. 2006;4:36-41.
Nobili A, Licata G, Salerno F, Pasina L, Tettamanti M. Polypharmacy, length of hospital stay, and in-hospital mortality among elderly patients in internal medicine wards. The REPOSI study. European journal of clinical pharmacology. 2011;67:507-519.
Cairns S, Reilly J, Stewart S, Tolson D, Godwin J, Knight P. The Prevalence of Health Care–Associated Infection in Older People in Acute Care Hospitals. Infect Control Hosp Epidemiol. 2011; 32: 763-767.
ECDC. Most Frequently Isolated Microorganisms. Available online: https://www.ecdc.europa.eu/en/all-topics-z/healthcare-associated-infections-long-term-care-facilities/surveillance-and-disease-5 (accessed on 3 September 2020).
McGregor Jessina C, Furuno Jon P. Optimizing Research Methods Used for the Evaluation of Antimicrobial Stewardship Programs. Methodology for Evaluating Antimicrobial Stewardship Programs. CID. 2014;59(3):191. Available from: https://watermark.silverchair.com.
Katz MJ, Roghmann MC. Healthcare-associated infections in the elderly: What’s new. Curr Opin Infect Dis. 2016;29:388-393.
Mody L. Optimizing Antimicrobial Use in Nursing Homes: No Longer Optional. J Am Geriatr Soc. 2007;55:1301-1302.
van Buul LW, van der Steen JT, Veenhuizen R, Achterberg WP, Schellevis FG, Essink RT, van Benthem BH, Natsch S, Hertogh CM. Antibiotic Use and Resistance in Long Term Care Facilities. J Am Med Dir Assoc. 2012;13:568.e1–568.e13.
Martin-Loeches I, Schultz MJ, Vincent JL, Alvarez-Lerma F, Bos L.D, Solé-Violán J, Torres A, Rodriguez A. Increased incidence of co-infection in critically ill patients with influenza. Intensive Care Med. 2017;43:48-58.
Kozlovskaia A. Aspiration pneumonia: features of diagnosis and treatment. Ukrainian medical journal. March 6, 2019. [Internet]. Available from: www.umj.com.ua/uk/novyna-138719-aspiratsijna-pnevmoniya-osoblivosti-diagnostiki-ta-likuvannya.
Moro ML. Le Infezioni Ospedaliere: Prevenzione e Misure di Controllo. ANMDO. 2016. Available online: https://www.anmdo.org/wp-content/uploads/2016/10/Le-infezioni-ospedaliere-prevenzione-e-misure-di-controllo.pdf (accessed on 3 September 2020).
Infections of the urinary tract [Internet]. Available from: https://empendium.com/ua/manual/chapter/B72.V.I.
Marinosci F. Urinary tract infections in nursing home residents. G Gerontol. 2014;62;84-94.
Esposito S. Catheter-associated urinary tract infections: Epidemiology and prevention. Infez Med. 2008:3:130-143.
Mody L, Meddings J, Edson BS, McNamara SE, Trautner BW, Stone ND, Krein SL, Saint S. Enhancing Resident Safety by Preventing Healthcare-Associated Infection: A National Initiative to Reduce Catheter-Associated Urinary Tract Infections in Nursing Homes. Clin Infect Dis. 2015;61:86-94.
Cortes-Penfield NW. Trautner BW Jump RL. Urinary Tract Infection and Asymptomatic Bacteriuria in Older Adults. Infect Dis Clin N Am. 2017;31:673-688.
Marinosci F. Urinary tract infections in nursing home residents. G Gerontol. 2014;62:84-94.
Società Italiana di Gerontologia e Geriatria (SIGG). Manuale di Competenze in Geriatria. 26. Available online: https://www.sigg.it/wp-content/uploads/2018/05/Item-26_Le-piaghe-da-decubito-come-prevenirle.pdf (accessed on 3 September 2020)
Cristina ML, Spagnolo AM, Giribone L, Demartini A, Sartini M. Epidemiology and Prevention of Healthcare-Associated Infections in Geriatric Patients: A Narrative Review. Int J Environ Res Public Health. 2021;18(10):5333. DOI: 10.3390/ijerph18105333
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Pharmaceutical Review / Farmacevtičnij časopis
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The authors who publish their materials in this journal agree with the following terms:
- Authors reserve the right to authorship of their work and assign to the journal the right to first publish this work under the terms of the Creative Commons Attribution License, which allows other persons to freely distribute the published work with a mandatory reference to the authors of original work and the first publication of work in this journal
. - Authors have the right to make independent extra-exclusive work agreements in the form they are published by this journal (for example, posting work in an electronic repository of an institution or publishing as part of a monograph), provided that the link to the first publication of the work in this journal is maintained.
Journal policy allows and encourages publication of manuscripts on the Internet (for example, in institutions repositories or on personal websites), both before the publication of this manuscript and during its editorial review, as it contributes to productive scientific discussion and positively affects the efficiency and dynamics of the citation of the published work (see The Effect of Open Access).
