Comprehensive geriatric assessment against older polypharmacy

Polypharmacy in Spain has become in a public health problem. Data from the Ministry of Health reveal that about three out of ten people over 65 years of age they take more than five pills on a recurring basis, a figure that shoots up to 44.7% in the 85 to 94 age group.

Now, the problem lies not only in the number, but also in the fact that, in many cases, not all the active ingredients are always needed. This phenomenon is known as inappropriate polypharmacy and health authorities attribute it to factors as diverse as cascade prescription To mitigate side effects of drugs, lack of periodic review, the self-medication, he use of alternative remedies, the Fattention ragmentation wave Fhigh longitudinality.

Given this reality, Nicolás Velillaclinical member of the Spanish Society of Geriatrics and Gerontology (SEGG), warns 65YMÁS that we are not facing a simple error of diagnosis, but against what is called the “perfect storm.”

According to the expert, this situation is the result of “an aging population with chronic pathologies, clinical guidelines that only know how to look at diseases separately and a health system where on many occasions each specialist attends to his or her area without making a global assessment.”

“Eternal” treatments

Specifically, Velilla explains that the inertia of the system leads to certain treatments, such as gastric protectors or anxiolytics, become “eternal” without anyone questioning them.

And it is ironic, the geriatrician points out, that while there is an excess of protectors or statins, Sometimes patients fall short on drugs needed to treat dementia or thyroid.

Risks

This cocktail of active ingredients that many older people ingest daily is not harmless to health. Velilla points out that the risk is not only the quantity, but how that mixture affects to a fragile body, often being the direct cause of falls, bleeding or confusion (delirium) that end up in the emergency services.

Some dangers, which are confirmed by the Ministry of Health itself, where they assure that inadequate polypharmacy is related to “a 91% increase in hospital admissions due to adverse events, 60% in functional deterioration and 26% in adverse reactions”.

The “deprescription”

Thus, the general consensus is that the solution is not to stop treating patients systematically, but for “deprescribing” applying clinical logic. And to achieve this, Velilla understands that it is essential to establish mandatory periodic reviews, especially when patients They cross the barrier of 75 or 80 years.

In these cases, it must be evaluated whether the preventive treatments really will provide short-term benefitssince obsessive control of tension or glucose in very fragile patients can be counterproductive and cause falls or hypoglycemia.

On the other hand, although the expert welcomes the Health proposals aimed at prescribing in a more rational way, he warns of a fundamental barrier: lack of time. “Reviewing the medication of a complex patient is not done in five minutes,” he says, adding that without time or training in deprescribing, the proposals could remain good intentions.

Towards a Comprehensive Geriatric Assessment

To tackle this problem, which also represents an enormous economic challenge and whose rationalization could save 500 million euros as stipulated in the draft of the new Medicines Lawthe geriatrician proposes a paradigm shift.

The current model of “organ specialist” It is totally inefficient for a 90-year-old patient with seven different diseases, he argues, since the heart and kidney cannot be treated as if they were not part of the same body.

Therefore, it defends the implementation of a Comprehensive Geriatric Assessment. “This means prioritizing the patient’s quality of life and autonomy over what the manual dictates for a specific disease. Primary Care must be empowered to act as an orchestra conductor. At the end of the day, success should not be measured by how many diagnoses we have treated, but by how we have adjusted the treatment to the reality of that person,” he concludes.