Asunto(s)
Traumatismos de la Rodilla/patología , Rodilla/patología , Neoplasias Pulmonares/patología , Neumonía/patología , Anciano , Antibacterianos/uso terapéutico , Antineoplásicos/uso terapéutico , Clorhidrato de Erlotinib , Resultado Fatal , Humanos , Rodilla/microbiología , Traumatismos de la Rodilla/etiología , Traumatismos de la Rodilla/microbiología , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/mortalidad , Masculino , Neumonía/tratamiento farmacológico , Neumonía/microbiología , Quinazolinas/uso terapéuticoRESUMEN
INTRODUCTION: At present, 7.2% of the population in Singapore is in the geriatric age group, which will increase to 18.4% in the year 2030. The frailest segment of the geriatric population live in nursing homes. They suffer from multiple co-morbidities requiring multiple medication use. Polypharmacy and inappropriate medication use have been considered as quality indicators for nursing home care. As no data of these indicators are available in Singapore, this study was planned to assess the prevalence of polypharmacy and inappropriate medication use in Singapore nursing homes. MATERIALS AND METHODS: A total of 454 residents in the geriatric age group residing in 3 randomly selected nursing homes were involved in the study. Case notes were reviewed for demographic information, clinical history and medication use. The data were analysed for polypharmacy (5 or more medication orders) and inappropriate medication use (based on established criteria). RESULTS: Residents were on an average of 5.32 medications. Polypharmacy and inappropriate medication use were seen in 266 (58.6%) and 318 (70.0%) residents, respectively. There was significant association between polypharmacy and inappropriate medication use [P < 0.001, chi2 = 82.56 at 95% confidence interval (CI)]. The most common medication-related problems were the use of medication without proper indication (n = 302), significant potential for adverse drug reactions (n = 281) and drug interactions (n = 141). CONCLUSION: The prevalence of polypharmacy and inappropriate medication use is high in Singapore nursing homes. Current practice of medication use in the nursing homes may lead to significant adverse drug reactions and drug interactions. A multidisciplinary approach involving geriatricians, nursing home physicians, nurses and pharmacists may potentially reduce polypharmacy and inappropriate medication use in Singapore nursing homes.
Asunto(s)
Utilización de Medicamentos/normas , Mal Uso de los Servicios de Salud/estadística & datos numéricos , Casas de Salud/normas , Polifarmacia , Pautas de la Práctica en Medicina/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Comorbilidad , Quimioterapia/normas , Quimioterapia/estadística & datos numéricos , Utilización de Medicamentos/estadística & datos numéricos , Femenino , Humanos , Cuidados a Largo Plazo , Masculino , Casas de Salud/estadística & datos numéricos , Estudios Retrospectivos , SingapurRESUMEN
Parkinson's disease is characterised by a variable combination of tremor, rigidity, bradykinesia and impaired righting reflexes. The cumulative life-time risk is one in 40. Levodopa remains the single most effective treatment in older patients, and the minimum dose to achieve maximum functional benefit should be employed. When fluctuations occur, controlled release preparations and selegiline can improve function. Oral dopamine agonists have a role but the combined side effect profile with levodopa should be monitored. COMT inhibitors have recently become available. Subcutaneous apomorphine can be helpful when "on-off" phenomena are marked. The concept of neuroprotection continues to be debated. Surgery is an option for fitter older people but neurotransplantation remains essentially a research tool.