Medikamentennachweise bei bayerischen Altenheimbewohnern – eine rechtsmedizinische Analyse. Erste Ergebnisse aus Screeninguntersuchungen an Urinproben

Krüger, J.; Groth, O.; Fels, H.; Graw, M.; Musshoff, F.; Roider, G.; Schöpfer, J. und Gleich, S. (2019): Medikamentennachweise bei bayerischen Altenheimbewohnern – eine rechtsmedizinische Analyse. Erste Ergebnisse aus Screeninguntersuchungen an Urinproben. In: Rechtsmedizin, Bd. 29, Nr. 2: S. 117-124

Abstract

IntroductionPolypharmacy, together with its associated risks for those concerned is aknown phenomenon in older patients. Furthermore, it is currently under discussion that the use of psychotropic drugs in residential nursing homes may significantly contribute to freedom-restraining measures (FRM). In this context an interdisciplinary study was conducted to address questions related to this subject.MethodsThe study included all residents of old age and nursing homes who died between 2013 and 2015 and were subsequently the subject of an autopsy at the Institute of Forensic Medicine in Munich. None of these cases harbored the suspicion of adrug overdose. Records from the state prosecutor's office for each case as well as the macromorphological findings obtained during the autopsies were considered for data analysis. Urine samples were collected during the postmortem examinations and qualitatively analyzed for the presence of alarge number of drugs and drugs of abuse by means of liquid chromatography coupled to time-of-flight mass spectrometry. The statistics software SPSS (IBM, version23) was applied for a descriptive analysis of the data obtained.ResultsAltogether 98 deceased residents of old age and nursing homes were included in the present study. Data obtained from the screening results of 95 of these cases showed that antipsychotic drugs (47.4%), antidepressants (30.5%), opioid analgesics (28.4%) and hypnotics/sedatives (20.0%) were among the top ten most frequently detected drug classes. The results showed that several deceased from the investigated group simultaneously received acombination of centrally active drugs. So-called PRISCUS substances could be detected in 25% of cases.DiscussionThe results obtained during this study provide initial data on the spectrum of drugs that could be detected in deceased residents of old age and nursing homes. The number of substances detected is comparable to the prescription data obtained from health insurances. This retrospective study showed that older individuals simultaneously received ahigh number of centrally active prescription drugs. This poses an increased risk for both drug interactions and side effects, particularly for this vulnerable patient group. The combinations of drugs detected in the deceased persons in some cases did not appear to correspond to the guidelines of specialist societies. There were indications for the simultaneous prescription of several opioid analgesics or hypnotic drugs. The prescription rate for PRISCUS drugs in the study collective was twice as high as the general German population of the same age living in their own home. Future studies with toxicological results obtained from blood and hair samples from the investigated group as well as the analysis of the available drug regimens are envisaged and will be published at alater stage.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 0937-9819
• Sprache: Deutsch