The risk of ADRs increases with the number of drugs taken [5]. Older people have a higher prevalence of comorbidities, and only a few decades after the first pharmaceutical discoveries many elderly now use a substantial and still increasing number of drugs on a regular basis [6]. There is some recent evidence that controlled medication discontinuation can improve the subjective quality of life in the elderly [8, 9].

Paese N. Setting %PI M F Farmaco Criteri

Germania 73665 Comm 22.0 18.3 24.8 Antidepressivi PRISCUSUSA 397 NH Fra 91.8 Gastroent MAI>=1USA 8139 Medic. 7.8 OR=2 Analgesici Beers 97Europa 2707 Home c 19.8 Pentossifillina Beers 97/03, McLoadOlanda 119218 Comm 14.3 LA BZD Beers 03Italy 849325 Comm 18.0 Doxazosina Beers 03USA 493971 Hosp 49-38HS Sedativi Beers 03Francia 30683 Comm 25.4* 19.7 30.9 Analgesici Beers 97 French updateFrancia 35259 Comm 53.5 Pentossifill French PIM

Anticoliner.LA BZD

Irlanda 732 LTC 63.7 Ppi STOPP42.9 BZD Beers 03

Irlanda Nord1 166108 Comm 34 PPI STOPPNorvegia (>70) 445900 Comm 34.8 28.5 59.5 LA BZD NORGEPSpagna 100 NH 79 PPI-NO CaD STOPP START

95 Psicotropi Ausralian System

* 33.5% to 19.3% from 1995 to 2004

D Fialova et al, JAMA, 2005

B Bongue et al: Pharmacoepidemiology and Drug Safety, 2009; 18: 1125–1133

Reazioni avverse di potenziale importanza nell'anziano:

1. Ipomagnesemia2. Riduzione assorbimento del calcio carbonato3. Infezioni respiratorie4. Diarrea da Cl.difficile5. Poliposi gastrica6. Gastrite atrofica in soggetti H. Pylori

DA Zinc et al, Aliment Pharmacol Ther, 2005

Conclusions: Our data verifies that practitioners routinely start general medical in-patients on acid suppression without an appropriate indication. Many of these prescriptions are continued at discharge for no apparent reason, leading to their long-term misuse.

O veruse o f acid supp ression therapy in hosp italiz ed p atients.

G u pta R , G a rg P , K ottoor R , M u n oz J C , J a m a l M M , L a m bia se L R , V ega K J .

RESULTS: Seventy percent of patients were started on AST on admission. Of these, 73% were unnecessary. Stress ulcers prophylaxis in low risk patients or the concomitant use of ulcerogenic drugs motivated initiation of therapy most frequently. Sixty nine percent of patients started on inappropriate AST were discharged on the same regimen. Admitting diagnosis, age of patient, length of stay, or concomitant use of ulcerogenic drugs did not predict continuation of unnecessary AST at discharge.CONCLUSION: AST is overused in hospitalized patients. This primarily occurred in low risk patients and was compounded by continuation at discharge. This significantly increases cost to the health care system and the risk of drug interactions.

S ou th M ed J . 2 0 1 0 M a r;1 0 3 (3 ) :2 0 7 - 1 1 .

Drugs and Aging, 2012

Deprescribing medication in very elderly patients with multimorbidity: the view of Dutch GPs. A qualitative studyJ Schuling et al. BMC Family Practice 2012, 13:56

AA VV G Ital Farmacol Clin, 2012, 26, 4:359-368

Drugs Aging. 2012 Aug 1;29(8):659-67

CASO CLINICO sulla prescrizione di farmaci nell'anziano - 2

CASO CLINICO sulla prescrizione di farmaci nell'anziano - 3

CASO CLINICO sulla prescrizione di farmaci nell'anziano - 4

GERIATRI GENOVA (N=22)AUSTRALIA

Drug n (%)

□ pravastatina 19 (86.4) □ setralina 17 (77.3) □ digossina 14 (63.6) □ oxazepam 13 (59.1) □ gliclazide 12 (54.5) □ spironolattone 12 (54.5) □ donepezil 12 (54.5) □ alendronato 12 (54.5) □ omeprazolo 12 (54.5) □ CaCO3 10 (45.5) □ Movicol® 9 (40.9) □ carbidopa-benserazide 7 (31.8) □ Perindopril 7 (31.8)

(+23%)(+25%)

(+27%)

(+52%)

(+50%)

(+23%)

(+38%)

(+25%)

(+18%)

(+22%)

(+37%)(0 %)

(0 %)

AUSTRALIA

Drug n (%)

□ pravastatina 19 (86.4) □ setralina 17 (77.3) □ digossina 14 (63.6) □ oxazepam 13 (59.1) □ gliclazide 12 (54.5) □ spironolattone 12 (54.5) □ donepezil 12 (54.5) □ alendronato 12 (54.5) □ omeprazolo 12 (54.5) □ CaCO3 10 (45.5) □ Movicol® 9 (40.9) □ carbidopa-benserazide 7 (31.8) □ Perindopril 7 (31.8)

GERIATRI GENOVA (N=22)

FARMACI CON IL MAGGIORE CONSENSO

AUSTRALIA

CARVEDILOLOCOLECALCIFEROLOFUROSEMIDEDIGOSSINAPERINDOPRILOMEPRAZOLO

GERIATRI GENOVA

CARVEDILOLOCOLECALCIFEROLOFUROSEMIDEPERINDOPRILISOSORBIDECARBIDOPA/BENSER

Geriatri ospedalieri vs geriatri territoriali

Farmaci da sospendere Pravastatina (93.3) Oxazepam (100)(i 7 vizi capitali) Gliclazide (73.3) Sertralina (85.7)Numero medio sosp.: Setralina (73.3) Pravastatina(71.4)

Totale 7.3 Alendronato (73.3) Omeprazolo (71.4)H 7.3 Digossina (66.7) Movicol (71.4)T 7.3 Spironolatt. (53.3) Spironolattone(57.1)

Omeprazolo (46.7) Digossina (57.1)

Farmaci da confermare Carvedilolo (100) Perindopril (85.7)(i magnifici 7) Colecalcifer (93.3) Carvedilolo (71.4)

Totale7.2 Furosemide (93.3) Furosemide (57.1)H 7.3 Perindopril (53.3) Isosorbide (57.1)T 7.0 Isosorbide (46.7) Warfarin (57.1)

Movicol (46.7) Carbid/Bens (57.1)Carbid/Bens (40.0) Colecalciferolo(42.9)

I dubbi amletici Parac/Cod (60.0) Donepezil (71.4)Isosorbide (46.7) Spironolattone(42.9)Oxazepam (46.7) Warfarin (42.9)

H T

Tecniche Sale e Pepe

SALE (in zucca)

SemplificareAvversi (eventi)Lista di farmaciEvidenze di efficacia

PEPE

Personalizzare

Educare

Pazienza (tempo disponibile)

Effetti da interazione

Bhavik M. Shah,, Emily R. Hajjar, Clin Geriatr Med 28 (2012) 173–186