Several international investigations reveal that half of the elderly take one or more drugs that are not necessary. Well because they do not have enough therapeutic value, they are no longer appropriate for their age (for example, keeping the cholesterol pill in an 80-year-old person increases mortality), or at some point they were prescribed and they have not been abandoned. Leocadio Rodríguez Mañas, head of Geriatrics at the Getafe Hospital, met with a man who had been taking antibiotics for three years. "And then there's what the patient thinks are not medicines, like anti-inflammatories or tranquilizers," he says.
"You have to prescribe the drugs you need," adds José Antonio Serra, head of Geriatrics at the Gregorio Marañón Hospital in Madrid. Ramón Orueta, family doctor, member of the drug use working group of SemFYC, like his colleagues, talks about therapeutic adaptation. "Each specialist prescribes for the disease that diagnoses," says geriatrician Serra, "without taking into account that the patient suffers from other ailments and takes drugs that can interact. And the older and more medication, the more risk. "
Polypharmacy in adults involves risks well studied by science: higher probability of adverse events (up to 88% increase in risk, it being estimated that one in 10 emergencies is due to the effects of medications (especially if taking anticoagulants, diuretics , anticonvulsants, benzodiazepines or remedies for diabetes), interactions between drugs, and between these and the disease that is suffered Taking a cocktail of medicines can cause reduced ability to perform daily tasks, urinary incontinence and nutrition problems, increased mortality, delusions, dizziness or falls, the latter grouped under the name of geriatric syndrome.
two. Carmen is still very depressed. He does not recover his appetite. The daughter removed the opioid patch and replaced it with acetaminophen (which she was already taking) and nolotil.
The head of Pharmacy at the Clinical Hospital of Madrid, José Manuel Martínez Sesmero, says: "You have to ask yourself, does this medicine provide anything to the patient? Does it improve the quality of life? "We must assess which medicines are essential and which ones can be withdrawn due to their scarce therapeutic value or because they can cause new ailments. "It is the iatrogenic cascade," says geriatrician Rodriguez Mañas, "a medication is prescribed, this causes side effects and instead of withdrawing it, another drug is added to treat the symptoms that the first one gives". Geriatricians, like family doctors, recommend that medication and new symptoms be reviewed at each visit to the primary care doctor. There are tools that value the effectiveness and safety of drugs; STOPP / START, Beers, Good Geriatric-Palliative Algorithm. Whenever possible, and with the complicity of the patient, you have to take pills.
But is it done? "Little. Not in a systematic way, "replies Rodríguez Mañas. The situation of family doctors does not help either. "We are saturated and there is not enough time for prescription consultations or for many other things," says Miguel Ángel Hernández, coordinator of the SemFYC drug work group.
3. Carmen and Menchu go to the health center. The young doctor who takes care of them is new. Examine both the elderly woman and her clinical analyzes and bulging electronic prescription. Check that you have low blood pressure, so remove the pill. Suppress medications against cholesterol and an antidepressant. Advises you to go to a day center. Note that you are deficient in vitamin D and prescribed. In total, six medications.
Two weeks later, Carmen, her white hair in pajamas, gets up to greet her nimbly. She has not obeyed the doctor regarding the day center and does not sleep too well. "But it's going much better," says Menchu without his mother, a little deaf, hear.
The mother twists the gesture and keeps saying that this is not life. He complains about everything: the right-wing politicians who appear on the television in front of him, his head, his son-in-law, his dead sisters. The daughter scolds her: "Mom, if you're much better!" "Yes, but …"
Aging transforms the therapeutic paradigm. The physiology of a person of 40 years is not the same as that of someone who is twice his age. Most clinical trials of medications exclude people over 65, so little is known about how they behave in an aging body. The geriatricians recommend that the doses be adjusted according to "renal function, weight variations, possible interactions" and also the concentration in blood.
The more pills are prescribed, complicating the routine of handling the pillbox, the worse. One out of every three adults (35%) does not take the medication or not as it has been prescribed. The geriatrician José Antonio Serra says that most of the time in the consultation he goes to find out what his patients consume and how. The family doctor Ramón Orueta applies complicity. "If you ask them if they take the pills well, they will answer yes, to please you. So I tell them that there are people who have had problems with the medication and that it happens to them too. " Then they tell the truth. One trick is to ask them to put all the medicines in a bag and take them to the office.
In the elderly, in addition to overtreatment, there is poor treatment and undertreatment. It says the geriatrician Leocadio Rodríguez Mañas, who usually finds, for example, depressed patients with ineffective treatments. "They were prescribed an initial dose that is only the beginning of the therapy and then needs to be reviewed. It was not checked if the symptoms subsided. And they continue with a pill that does not do anything to them. "
His colleague Serra is faced with many elderly without vitamin D, essential to alleviate osteoporosis. It is a population that is less exposed to the sun, essential for the synthesis of this molecule so necessary to combat the dreaded fractures and muscle weakness. Half of the elderly usually have low vitamin, something that needs to be corrected.