Polypharmazie als Risiko: eine rechtsmedizinische Untersuchung verstorbener Altenheimbewohner

Gleich, S.; Skopp, G.; Fels, H.; Wiedfeld, C.; Mußhoff, F.; Graw, M. und Schäöffer, B. (2020): Polypharmazie als Risiko: eine rechtsmedizinische Untersuchung verstorbener Altenheimbewohner. In: Rechtsmedizin, Bd. 31, Nr. 2: S. 91-100

Abstract

Background: In Germany 25% of people in need of care are cared for in nursing homes;they are predominantly multimorbid and suffer from dementia. Multimorbidity is the main cause of polypharmacy. The probability of possible interactions greatly increases with the number of prescribed drugs. In addition, in very old people slower drug degradation can lead to accumulation of active substances with increased risks of adverse drug events. Methods The study included all residents of nursing homes who died between 2013 and 2015 with no suspicion of drug overdose and where an autopsy was carried out at the Institute of Forensic Medicine in Munich. Chemical toxicological tests for drugs and narcotics were carried out in an accredited forensic toxicology laboratory by means of liquid chromatography in combination with high-resolution mass spectrometry for screening and by liquid chromatography/tandem mass spectrometry for blood samples. The mediQ(TM) database and drug manufacturers' technical information were analyzed to determine whether contraindications existed for the combined prescriptions. Finally, a comparison with the current medication plans was carried out. The evaluation of the data was performed descriptively with the statistics program SPSS (IBM, version 23) Results: Polypharmacy was present in 52% of cases. Cardiovascular drugs and nonopioid analgesics were detected most frequently, followed by antipsychotics, antidepressants, opioid analgesics and hypnotics/sedatives. On average, two centrally acting drugs were identified per case. In 81% of the cases there were potential interactions for the identified substance pairs. The most frequent relevant interaction was a QTc time extension. For 70% of the drug pairs with highly relevant interaction risks, existing absolute contraindications to simultaneous prescription or dispensing were not considered. Conclusion Risks for drug interactions were detected in over 80% of the collective. In a high percentage drug pairs were found, the combination of which was contraindicated. Antipsychotics and antidepressants were the most frequent drug classes with the potentially greatest risk for undesirable drug effects. Citalopram was most frequently represented in the absolute contraindications for combinations with other drugs and low-potency neuroleptics most frequently in the relative contraindications. From a legal point of view it is critical that nonprescribed drugs were detected in contraindicated combinations. This can have both criminal and civil law consequences for those responsible.

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