Yaşlı Hastalarda İlaç Kullanımı
Özet
Dünya genelinde hızla artan yaşlı nüfus, beraberinde çoklu kronik hastalıkları, geriatrik sendromları ve bunların doğal bir sonucu olan çoklu ilaç kullanımını (polifarmasi) getirmektedir. Yaşlanma ile değişen fizyolojik yapı; organ fonksiyonlarındaki azalmalar ve vücut kompozisyonundaki değişimler nedeniyle farmakokinetik ve farmakodinamik parametreleri doğrudan etkilemektedir. Bu sebeple yaşlı hastalarda olası toksisiteleri ve advers etkileri önlemek amacıyla ilaç tedavilerine mutlaka "düşük dozda başla ve yavaş artır" ilkesiyle yaklaşılmalıdır. Uygunsuz reçeteleme ve ilaç yan etkilerinin yeni bir hastalık semptomu gibi algılanıp yeni ilaçların eklenmesiyle büyüyen reçeteleme kaskadı; yaşlılarda düşme, deliryum, demans, inkontinans ve malnütrisyon gibi ciddi klinik tablolarla ilişkilendirilmektedir. Bu riskleri en aza indirmek için Beers, STOPP/START ve Türkiye popülasyonuna özgü TIME kriterleri gibi rehberlerden ve klinik eczacılık hizmetlerinden yararlanılması büyük önem taşımaktadır. Özellikle yoğun bakım ünitelerinde yatan kırılgan yaşlı hastalarda morbidite ve mortaliteyi artıran en kritik faktörlerden biri deliryumdur. Deliryum riskini azaltmak ve süreci doğru yönetmek adına, riskli ilaçların (benzodiazepinler, antikolinerjikler vb.) kullanımından kaçınılmalı; hafif sedasyon, erken mobilizasyon ve aile katılımını içeren kanıta dayalı ABCDEF bütüncül bakım paketleri doğrultusunda bireyselleştirilmiş, yakın takipli tedavi planları uygulanmalıdır.
The rapidly increasing elderly population worldwide brings along multiple chronic diseases, geriatric syndromes, and consequently, polypharmacy. The physiological changes that occur with aging directly affect pharmacokinetic and pharmacodynamic parameters due to declines in organ functions and alterations in body composition. Therefore, to prevent potential toxicities and adverse effects in elderly patients, pharmacotherapy must be approached with the principle of "start low and go slow". Inappropriate prescribing and the prescribing cascade—which occurs when drug adverse effects are misinterpreted as a new medical condition, leading to the initiation of additional medications—are closely associated with severe clinical conditions in older adults, such as falls, delirium, dementia, incontinence, and malnutrition. To minimize these risks, utilizing guidelines such as Beers, STOPP/START, and the Turkish-specific TIME criteria, alongside clinical pharmacy services, is of paramount importance. Particularly for frail elderly patients in intensive care units, delirium represents one of the most critical factors increasing morbidity and mortality. To reduce delirium risk and manage the process accurately, the use of high-risk drugs (e.g., benzodiazepines, anticholinergics) should be avoided, and individualized, closely monitored treatment plans must be implemented in line with evidence-based holistic ABCDEF care bundles that encompass light sedation, early mobilization, and family engagement.
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https://www.ailevecalisma.gov.tr/media/45354/yasli-nufus-demografik-degisimi-2020.pdf
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