Identificación de prescripciones potencialmente inapropiadas asociadas al ingreso a los servicios de urgencias de adultos mayores

Resumen El envejecimiento comprende un amplio conjunto de procesos biológicos, psicológicos y sociales, que tienen como consecuencia un deterioro funcional que afecta la salud y calidad de vida de las personas, que se traduce en enfermedades y dificultades para realizar actividades, muchas de estas enfermedades suelen ser crónicas por lo que se observa un mayor uso de medicamentos, puede favorecer el riesgo de presentar reacciones adversas, interacciones entre fármacos y polifarmacia; por lo tanto la prescripción de medicamentos debe considerar todos los efectos que se pudieran tener, sin embargo es frecuente que se detecte la prescripción inapropiada (PI) en adultos mayores, que incluye medicamentos que no debieran ser prescritos por el riesgo que representan, las cuales se pueden detectar mediante herramientas creadas para disminuirlas y prevenir a los médicos sobre el uso de medicamentos en adultos mayores; tal es el caso de los criterios STOPP/START, los cuales ayudan a identificar las prescripciones potencialmente inapropiadas (PPI) y omitidas (PPO) para prevenir efectos adversos, resultados negativos a la medicación y disminuir la polifarmacia. El objetivo de este estudio fue analizar las PI en adultos mayores de 65 años que ingresen al servicio de urgencias del Hospital Regional de Alta Especialidad Centenario de la Revolución Mexicana del ISSSTE en el estado de Morelos. Se realizó revisión de los expedientes y notas médicas, y entrevistas a los pacientes para detectar PPI de acuerdo a los criterios STOPP/START además de evaluar los factores de riesgo que pudieran estar asociados a la presencia de la PPI.

Abstract Aging comprises a wide set of biological, psychological and social processes, which have as a consequence, a functional deterioration that affects the health and quality of life of people, which translates into diseases and difficulties in carrying out activities, many of these diseases are usually chronic, for which a greater use of medications is observed, which will also increase the risk of presenting adverse reactions, interactions between drugs and polypharmacy; therefore, the prescription of drugs must consider all the effects that may be had, however there is commonly inappropriate prescription (IP) in older adults that includes drugs that should not be prescribed due to the risk they represent, however they can be detected by tools created to reduce them and warn doctors about the use of drugs in older adults; such is the case of the STOPP/START criteria, which help to identify potentially inappropriate (PIP) and omitted (PPO) prescriptions (those that the patient does need but are not in their pharmacotherapy) to prevent adverse effects, negative results to medication and decrease polypharmacy. In this study, we sought to analize PIP in older adults, in the emergency service of the Hospital Regional de Alta Especialidad Centenario de la Revolución Mexicana of the ISSSTE in the state of Morelos, where a review of the records and medical notes was made, as well as interviews with patients to detect PIP with STOPP / START criteria and the risk factors that could be associated with the presence of PIP; In the results, it was possible to identify 48% of the population had at least one PIP, of which 55% were prior to hospital admission and 45% during hospital stay; from the sociodemographic data, the mean age was 76.5 (SD ± 7.72) and 67% of the patients were female, during their stay they received an average of 7.01 (SD +3.07) drugs, and the most commonly used were omeprazole, ceftriaxone and lysine clonixinate. It was possible to identify and analyze PPIs in the population of adults over 65 years of age or older who entered the emergency service of the ISSSTE in Morelos, finding a high prevalence of these and a low PPO rate, also sulfonylureas were identified as factors related to favoring admission to the hospital service in the elderly (p = 0.007).