TIME kriterleri ile belirlenen uygunsuz ilaç kullanımı ve kırılganlık arasındaki ilişki

Amaç: Çalışmamızın amacı kırılganlık ile çoklu ilaç kullanımı, Potansiyel Uygunsuz İlaç Kullanımı (PUİK) ve Potansiyel Reçete İhmali (PRİ) ilişkisini değerlendirmektedir. Gereç ve Yöntem: Geriatri polikliniğine 1 Ekim 2021 ve 1 Nisan 2022 ayaktan başvuran 65 yaş ve üzeri hastalar retrospektif değerlendirildi. Hastaların demografik verileri, kullandıkları ilaçların etken maddeleri, komorbid hastalıkları ve Klinik Kırılganlık Skalası (KKS) skoru kayıt edildi. KKS skoruna göre hastalar kırılgan ve kırılgan olmayan olarak ikiye ayrıldı. Turkish Inappropriate Medication use in the Elderly (TIME) to STOP kriterleri PUİK değerlendirmek için, TIME to START ise PRİ’yi belirlemek için kullanıldı. Bulgular: Hastaların ortalama yaşı 75,9±8,7 olup, hastaların %63,1 kadın idi. Hastaların kullandığı ortanca ilaç sayısı 7 (0-17) iken, katılımcıların %79,6’sında polifarmasi mevcuttu. Kırılgan hastaların %69,5 (n=42)’ inde polifarmasi mevcut olup, kırılgan olmayan hastalarda bu oran %22,5 (n=18) idi. Kırılgan hastalarda oral beslenme ürünü, 3-hidroksi-3-metil-glutaril-KoA reduktaz inhibitörleri ve demans tedavisi reçete ihmali oranı anlamlı olarak normal popülasyondan daha fazla idi. Proton pompa inhibitörleri, antipsikotikler, asetilsalisilik asit ve betahistinin uygunsuz kullanım oranı kırılgan hastalarda, kırılgan olmayan hastalardan daha fazla idi. Sonuç: Polifarmasi, PRİ ve PUİK hastalarda değerlendirilirken kırılganlık göz önünde bulundurulmalıdır ve her ülkenin farklı reçeteleme alışkanlığı olmasından dolayı ülkemize özel olan TIME kriterlerinin kullanımı önemli bir avantaj sağlayabilir.

Inappropriate drug use determined by TIME criteria and the relation with frailty

Purpose: This study aims to evaluate the relationship between frailty and polypharmacy, Polypharmacy, Potentially Inappropriate Medication (PIM) and Potential Prescription Omission (PPO) Materials and Methods: Patients aged 65 years and older who applied to the geriatrics outpatient clinic on October 1, 2021 and April 1, 2022 were evaluated retrospectively. Demographic data of the patients, active ingredients of the drugs they used, comorbid diseases and Clinical Frailty Scale (CFS) score were recorded. Patients were divided into two groups as frail and non-frail according to the CFS score. Turkish Inappropriate Medication use in the Elderly (TIME) to STOP criteria were used to evaluate PIMs, and TIME to START was used to determine PPOs. Results: The mean age of 143 patients was 75.9±8.7 years, and of the patietns, 63.1% were female. While the median number of drugs used by the patients was 7 (0-17), 79.6% of the participants had polypharmacy. Polypharmacy was present in 69.5% (n=42) of frail patients, and this rate was 22.5% (n=18) in non-frail patients. The rate of PPOs of oral nutrition products, 3-hydroxy-3-methyl-glutaryl-CoA reductase inhibitors and dementia treatment in frail patients was significantly higher non-frail ones. The rate of inappropriate use of proton pump inhibitors, antipsychotics, acetylsalicylic acid, and betahistine was higher in frail patients than in non-frail patients. Conclusion: Frailty should be considered when evaluating patients with polypharmacy, PRI and PUIK, and the use of TIME criteria, which are specific to our country, may provide an essential advantage since each country has different prescribing habits.

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