RESUMO
Polypharmacy increases the risk of unbearable side effects, drug-drug interactions, and hospitalizations in geriatric patients. The iatrogenic risk of inadequate management of antidepressants is very important in this population. Therefore, primary care physicians and geriatricians have the responsibility of the optimization of antidepressants prescriptions. Our work is a literature review of the European and the international guidelines regarding the management of antidepressants. We reviewed the PubMed database and Google scholar for articles and reviews from 2015. We also screened relevant articles for more references and searched the web for available European guidelines relevant to our topic. We divided our findings into four main inquiries that are Indication, effectiveness, tolerability, and iatrogenic risks. Poor or absence of effectiveness should lead to a readjustment of the treatment plan. In case of unbearable side effects, antidepressants should be stopped, and alternative non-pharmacological therapies should be proposed. Doctors should look out for drug-drug interaction risks in this population and constantly adjust the prescription. Prescription of antidepressants is not always evidence based which leads to heavy iatrogenic consequences. We suggest a simple 4-questions-algorithm that aims to remind doctors of the basics of good practice and helps in the process of deprescribing an antidepressant in older adults.
RESUMO
The risks of iatrogenic medication related adverse events are high among older patients. Assessing prescriptions is critical to prevent overusing, underusing, or misusing medications. The aim of this study is to evaluate the prescription reassessment in older patients hospitalized in long-term care unit. Among the 30 patients (M age = 83 years, woman 66%), polymedication was present, patients taking 5 to 18 drugs (mean 11 drugs). The length of stay varied from 92 days to 4.5 years (mean 564 ± 430 days). The prescription reassessment of the patients hospitalized in our long-term care unit varied from 1 to 125 days with a mean of 16 days. Plan the prescription reassessment could reduce the iatrogenic medication in weakened patients.
RESUMO
PURPOSE: We evaluated the use of the PPI treatment by physicians in older adults hospitalized in a long-term care unit. METHODS: We included 40 patients aged 65 years or older with a lansoprazole prescription hospitalized in long-term care unit from January 2018 to January 2022. Patient characteristics, gastroduodenal history, dose of lansoprazole, indication, days of prescription, and number of medications were collected from electronic patient records. RESULTS: The mean age of patients was 84.2 ± 9.3. Patients were taking between 5 and 24 (mean = 12.7, SD = 4.4) medications overall with 15 patients taking low dose of aspirin (75 mg daily) and 8 patients taking an antiplatelet. Most patients (82.5%) received once-daily lansoprazole treatment, 55% of whom took a dose of 15 mg. Five patients were treated with the maximum dose of lansoprazole 30 mg twice daily. Only seven patients had an appropriate indication. The minimum of treatment time was 3 days and the maximum was 1198 days; moreover, 24 patients (60%) were still in treatment. CONCLUSION: Few PPI prescriptions had an indication in the patient's electronic record. Prescriptions were ongoing with no date of discontinuation or re-evaluation.
AIM: To evaluate the lansoprazole prescription in older adults hospitalized in long-term care unit. FINDINGS: In our study population of 65 years or more, the prevalence of appropriate prescription was 17.5% with mean of medications at 12.7 (SD = 4.4). The treatment time was ranging from 3 to 1198 days with 24 patients (60%) still in treatment. MESSAGE: Regular reassessment and the implementation of PPI prescription recommendations were still not routinely used in clinical practice.
