IL PUNTO DI VISTA DEL GERIATRA The geriatrician's point of view La presa in carico e la gestione dell'anziano complesso: punti di vista Management of older adults with multiple chronic conditions: points of view Keywords Polypharmacy Elderly Comprehensive geriatric assessment adverse drug reactions

Punti Di Vista Giornale Italiano, Di
2014 Farmacoeconomia e Farmacoutilizzazione   unpublished
Polypharmacy is a problem of growing interest in geriatrics, since drug consumption has risen in recent years, particularly among people aged over 65. The process leading to polypharmacy involves a longer life expectancy, co-morbidity and the implementation of evidence-based clinical practice guidelines (CPG). Polypharmacy carries important negative consequences, however, such as a higher risk of adverse drug reactions and a decline in their efficacy due to reduced compliance. Comprehensive
more » ... atric assessment (CGa) is a multidimensional process that has long prevailed as the best approach to the management of the clinical complexity characteristic of older patients. Being composed of an interdisciplinary team, it can explore multiple domains and hence provide a global assessment of the elderly patient. CGa has proved effective in reducing the number of prescriptions and daily drug doses for patients as a result of unnecessary or inappropriate medications being discontinued. CGa also demonstrated the ability to optimize the treatment by increasing the number of drugs taken in some cases because it identified under-treated diseases. CGa should help clinicians to identify diseases that take priority for treatment in order to achieve better pharmacological treatments for elderly patients. The patient's prognosis should also be considered in the treatment prioritization process. The most appropriate medication regimen should combine existing evidence-based CPG with data gathered from CGa, including social and economic considerations. Furthermore, for prescriptions to remain appropriate, the elderly should periodically undergo medication review for as long as they risk developing multiple co-morbidities. Introduzione La polifarmacoterapia è un problema di crescente interesse in ambito geriatrico, sia dal punto di vista clinico che di economia sanitaria. Negli ultimi anni, il consumo di farmaci sta progressivamente aumentando in tutto il mondo e sta coinvolgendo so-prattutto le persone ultrasessantacinquenni [1]. Ciò è conseguenza dell'allungamento della spettanza di vita e, a cascata, del numero di comorbilità e dei pazienti con Corrispondenza: Giuseppe Sergi,