The elderly often take many medicines, but not infrequently some of them continue to be taken even when they are no longer needed
A drug is not, and does not have to be, forever: a “coupon” of the therapies is needed at least once a year to assess whether they are still necessary, especially if the elderly follow them. The experts of the Italian Society of Gerontology and Geriatricswho have just presented the new guidelines for the management of polytherapy in over 65swhere it often happens that the cardiologist, the diabetologist, the family doctor prescribe a medicine which then remains in the daily habits for life.
Dangerous interactions
Over the years the result is a “heap” of drugs that are often counterproductivenot only because the more you take, the more likely you are to forget someone fundamental or to make mistakes with doses and times: geriatricians estimate that at least two million elderly people are exposed to drug interactions potentially very serious, while another million take drugs inappropriately and thus have a greater risk of hospitalizations, side effects, even mortality. “75 percent of those over 60 take 5 or more drugshowever, often the therapies are protracted without there being any more indication, “he says Francesco Landi, chairman Sigg. “They remain as a kind of ritual obligation, due to a therapeutic inertia that must be fought: you have to prescribe better to prescribe less“.
Periodic review
It means, as the new guidelines underline, that the doctor must give each new medicine after making sure that it is compatible with those already taken and only if it is necessary and really effective in controlling symptoms and complications. The patient for his part can and must ask for the periodic review of the drugs, which the geriatricians believe can decrease the risk of adverse events by 20 per cent and lead to the removal every time at least one drug that is no longer appropriate or that is a therapeutic duplicate: “At least once a year and whenever there are variations in the clinical conditions, the therapy should be re-evaluated as a whole, trying to simplify and optimize it by reducing or by stopping medicines that no longer have an indication, “he specifies Graziano Onderdirector of the Department of Cardiovascular, Endocrinometabolic Diseases and Aging of the Istituto Superiore di Sanità.
Medicines taken “out of habit”
What are the drugs that most often continue to be taken “out of habit”? “For example proton pump inhibitors, i.e. antacids: they are often taken without a clear indication of use but if used in the long term they can have side effects, such as an increased risk of fractures; or statins for cholesterol, not recommended in those with a limited life expectancy, “he replies Alessandra Marengoni, geriatrician and co-author of the guidelines. Identifying the priorities of care and summarizing the different therapies is the responsibility of the healthcare provider, but elderly patients and their families can do a lot: in the meantime, it is good not to be afraid of giving up a medicineif your doctor recommends it.
It is almost always possible to eliminate at least one drug without health consequences: a study conducted on particularly fragile patients in Assisted Health Residences for example it has shown that it is possible to remove psychotropic drugs such as benzodiazepines or antidepressants reducing by 21 percent the number of patients exposed to severe interactions; a survey of elderly people cared for by the general practitioner has shown that revision of therapies can reduce by up to 17 percent incorrect use of antacids and other drugs, decreasing the risk of interactions by 10 percent and increasing adherence to essential care by up to 30 percent. In short, we must not fear that we will no longer be treated well or sufficiently if we eliminate a drug, quite the contrary.
The vademecum
In order not to be mistaken, a brief vademecum drawn up by geriatricians can also help: “First rule, have a list and a precise scheme of the therapies followed, including supplements and herbal products, making sure to keep your doctor up to date with any changes in treatment, ”advises Landi. «So, it is useful cor involve a family member or caregiverespecially for those patients who have memory difficulties and risk administration errors. Yes to daily and weekly dispensers so as not to repeat the intake several times or, on the contrary, forget the pills, possibly also with the help of alarms on the mobile phone. In some cases, finallyappropriate advice to change the lifestylefrom the correct diet to constant physical activity, to the ban on smoking, can at least partially make the intake of a certain medicine superfluous ».
February 23, 2022 (change February 23, 2022 | 19:59)
© REPRODUCTION RESERVED
#Medicines #elderly #real #benefit