Estudio del consumo e intervención desde la farmacia comunitaria para la deshabituación de psicótropos en pacientes mayores de 65 años

Resum

Introduction People older than 65 years old constitute an increasing population group due to factors such as proper nutrition, housing improvement, environmental health and developments in Medicine. Considering that this population is more sensitive to drugs effects, physiological changes inherent to aging must be taken into account when adjusting its doses. Elderly patients usually present multiple pathologies that require pharmacological treatments. The use of different drugs can provoke alterations in their metabolism, causing accumulation and overdose. Benzodiazepines (BZ) and their analogues are a pharmacological group widely used by the entire population even though they are not free of side effects such as: excessive sedation, memory loss, impaired coordination, cognitive decline and risk of fractures caused by falls. In addition, their use differs from the guidelines indicated in the patient information leaflet in terms of dosage and duration of treatment. Objectives General objective To verify the influence of pharmaceutical intervention in the improvement of standard of living in a representative sample of population older than 65 years after BZ cessation. Specific objective To analize the BZ consumption in people older than 65 years old. To check whether BZ consumption adjusts recommendations or to the contrary, it is higher. To check whether, by means of pharmaceutical intervention, it is possible to detoxify BZ-dependent patients, by testing consumption data, liver status and complications derived from its use. To analyze whether the BZ cessation improves the cognitive state of the patient and therefore their health condition. Methodology The study was carried out in a rural pharmacy in Alicante and was structured in three phases: Phase 1. Retrospective observational longitudinal analytical study on the use of BZ. Patients who used BZ were identified and invited to participate, collecting personal data, signing the informed consent, and performing the Pfeiffer test and analysis. Phase 2. Interview with the patient to report the results and invitation to participate in the cessation program. Phase 3. Referral to the primary care assistance to establish the cessation plan. Pharmacotherapeutic monitoring of the patient. Results 326 patients participated in the study, which 112 used BZ or an analogous on a regular basis (34.4%). 39.3% of the group used them as an anxiolytic, 35.7% as a hypnotic and 4.5% for both treatments. Only 11 patients agreed to participate in the cessation program (9.8%), and 3 of them achieve the withdrawal (33.3%). It obtained fewer errors in the Pfeiffer test (cognitive state) with all patients with have achieved the withdrawal, than the rest of the group. Conclusions The using time of BZ exceeds recommendations in most cases of population older than 65 years old, and BZ are used in inappropriate doses and at the same time with other drugs that can cause accumulation in body. The pharmacological effect may be greater than expected, leading to a worse the patient's state of health. The cessation of this type of drug improves the patient's cognitive state and eliminates adverse reactions derived from its use. Suitable communication with healthcare professionals can improve the effectiveness of pharmacological treatments, improving life quality of the patient.