| Abstract | Mijenjanje fizioloških funkcija organizma starenjem, doprinosi razvoju mnogih bolesti i komorbiditeta što zahtijeva preskripciju većeg broja lijekova, a nerijetko različiti liječnici propisuju lijekove nezavisno jedan od drugog. Navedeno povećava rizik od nastanka lijek-lijek interakcija u osoba starije životne dobi. Cilj ovoga rada bio je utvrditi učestalost i kliničku značajnost interakcija lijekova u propisanoj terapiji osoba starijih od 65 godina te utvrditi povezanost klinički značajnih interakcija s njihovim kliničkim i sociodemografskim karakteristikama. Istraživanje je provedeno kao opservacijsko presječno istraživanje u razdoblju od srpnja do listopada 2019. godine u ljekarnama na području Istarske županije. Ispitanici su bile osobe starije od 65 godina koje podižu najmanje dva lijeka propisana na recept u javnim ljekarnama. Za prikupljanje podataka korišten je upitnik za ljekarne pod nazivom „Neprikladno propisivanje lijekova i dostupnost upravljanja terapijom u starijih osoba u Europi“ razvijen za potrebe Horizon 2020 EUROAGEISM projekta. Interakcije su analizirane pomoću Lexi-Comp online baze podataka. Sudjelovalo je 96 ispitanika, 67,71% žena i 32,29% muškaraca, prosječne dobi 74,9 ± 6,35 godina. Ispitanici su prosječno uzimali 6,82 ± 3,63 lijekova propisana na recept pri čemu je utvrđeno prosječno 4,43 ± 5,42 interakcija po ispitaniku. 82,29% ispitanika imalo je barem jednu lijek-lijek interakciju u propisanoj terapiji. U X interakcije najviše su stupali lijekovi s djelovanjem na koštano-mišićni sustav (najčešće nesteroidni protuupalni lijekovi) te lijekovi s djelovanjem na srce i krvožilje (najčešće antiaritmici), dok su u D interakcije najviše stupali lijekovi s djelovanjem na živčani sustav (najčešće opioidni analgetici) i lijekovi s djelovanjem na probavni sustav i mijenu tvari (najčešće antidijabetici). Utvrđena je visoka povezanost interakcija lijekova i broja lijekova propisanih na recept (p<0,001) te umjerena povezanost padova u proteklih 12 mjeseci i interakcija ljekova (p=0,008). Slaba povezanost utvrđena je za ostale varijable od interesa: broj simptoma (p=0,005), sindrom krhkosti (p=0,035), broj hospitalizacija i traženja hitne medicinske pomoći (p=0,029) te broj posjeta liječniku obiteljske medicine i liječniku specijalistu (p<0,001). Povezanost interakcija sa spolom i dobnim skupinama nije utvrđena. Rezultati ovog istraživanja potvrđuju rezultate više različitih autora o povezanosti interakcija lijekova i broja lijekova u terapiji, te ukazuju na to da su starije osobe s politerapijom rizična skupina za prisutnost interakcija lijekova i problema koje one nose. Povezanost interakcija lijekova i drugih istraženih parametara bila je slaba, a dostupna istraživanja na tu temu ne daju jednoznačne zaključke , te postoji potreba za daljnjim istraživanjima na većem uzorku ispitanika kako bi bolje razumijeli povezanost interakcija lijekova i važnih kliničkih karakteristika bolesnika starije dobi. |
| Abstract (english) | Age-related changes of the physiological functions contribute to the development of many diseases and comorbidities, which requires the prescription of a larger number of drugs. In addition, different doctors often prescribe drugs independently of each other. The risk of drug- drug interactions with the elderly is, therefore, higher. The aim of this study was to determine the prevalence and clinical significance of drug interactions in prescribed therapy of people older than 65 years, and to determine the association of clinically significant interactions with their clinical and sociodemographic factors. The study was designed as an observational cross-sectional study. It was conducted in the period from July through October 2019 in community pharmacies in the Istrian County. The respondents were individuals over the age of 65 who fill prescriptions at community pharmacies and take at least two prescription drugs. A questionnaire for data collection entitled “Inappropriate prescribing and availability of medication management services in older patients in Europe” was developed for the Horizon 2020 EUROAGEISM project. The interactions were analyzed using a Lexi-Comp online database. There were 96 participants: 67.71% women and 32.29% men, with a mean age of 74.9 ± 6.35 years. The participants took an average of 6.82 ± 3.63 prescription drugs, with an average of 4.43 ± 5.42 interactions per subject. 82.29% of participants had at least one drug-drug interaction in the prescribed therapy. Drugs with an effect on the musculoskeletal system (mostly non-steroidal anti-inflammatory drugs) and drugs with an effect on the heart and blood vessels (mostly antiarrhythmic drugs) were the most common in X interactions, while drugs with an effect on the nervous system (mostly opioids) and drugs with an effect on the digestive system and metabolism (mostly antidiabetic drugs) were the most common in D interactions. There was a high correlation between drug interactions and the number of prescription drugs (p<0.001) and a moderate correlation between falls in the past 12 months and drug interactions (p=0.008). A weak correlation was found for other variables of interest: number of symptoms (p=0.005), frailty syndrome (p=0.035), number of hospitalizations and emergency department visits (p=0.029), and number of visits to general physicians and specialist physicians (p<0.001). The association of interactions with gender and with age groups was not observed. The results of this study support the results of several different authors on the association between drug interactions and the number of drugs in therapy, and indicate that older people with polytherapy are a risk group for the presence of drug interactions and their subsequent problems. The correlation between drug interactions and other investigated parameters was weak, while available research on this topic is contradictory, and there is a need for further research on a larger sample of participants to better understand the correlation between drug interactions and important clinical characteristics of elderly patients. |
