Kronik subdural hematom tanılı geriatrik hastalarda potansiyel uygunsuz ilaç kullanımı, düşme ve komorbiditeler
Abstract
Amaç: Kronik subdural hematom insidansı, geriatrik yaş grubunda yılda 2-4/100000’dir. Kronik subdural hematom tanılı geriatrik hastalarda, Beers 2019 kriterlerine göre potansiyel uygunsuz ilaç kullanımı ile düşme ve Charlson komorbidite indeksi arasındaki ilişkiyi araştırmayı amaçladık
Gereç ve Yöntem: İzmir Katip Çelebi Üniversitesi Hastanesi Beyin ve Sinir Cerrahisi bölümünde son 5 yılda kronik subdural hematom tanısıyla yatan 69 hastanın tıbbi kayıtları yerel fakülte etik kurulunun izniyle retrospektif olarak toplandı. Veriler uygun istatistiksel yöntem kullanılarak SPSSv18 programıyla analiz edildi.
Bulgular: Hastaların yaş ortalaması 78,43 ± 7,51 yıl, ortalama Charlson komorbidite indeksi 5,87 ± 2,97 puandı. Düşme olayları 69 kronik subdural hematom vakasının 59’undan (%85,5) sorumluydu. Beers 2019 kriterlerine göre potansiyel uygunsuz ilaç kullanımı 20 hastada (%29) saptandı. Uygunsuz ilaçlar en çok kardiyovasküler sistem sınıfı (%14,5) ve antitrombosit / antikoagulan sınıfa (%14,5) aitti. Hastalar potansiyel uygunsuz ilaç kullanımının olup olmamasına göre iki gruba ayrıldığında, Charlson komorbidite indeksi ilk grupta daha yüksek saptandı (p <0,05). Hastalar düşen ve düşmeyenler olarak iki gruba ayrıldığında, Charlson komorbidite indeksi, demans prevalansı, hastanede yatış süresi, ilaç sayısı, potansiyel uygunsuz ilaç kullanımı, serebrovasküler infarkt ve hemipleji varlığı her iki grupta istatistiksel olarak farklı saptanmadı (p >0,05). Charlson komorbidite indeksi ve kullanılan ilaç sayısı arasında önemli istatistiksel ilişki saptandı (p = 0,001).
Sonuç: Retrospektif çalışmamızda düşme, Charlson komorbidite indeksi ve potansiyel uygunsuz ilaç kullanımı arasında önemli bir ilişki saptayamadık. Küçük çalışma grubu, retrospektif kayıtların güvenilmez oluşu, çalışma popülasyonun görece sağlıklı karakteristiğe sahip oluşu kafa karıştırıcı sonuçlara katkıda bulunmuş olabilir.
Keywords
Kronik subdural hematom geriatrics fall comorbidity inappropriate medication Beers criteria.
References
- Kudo H, Kuwamura K, Izawa I, Sawa H, Tamaki N. Chronic subdural hematoma in elderly people: present status on Awaji Island and epidemiological prospect. Neurol Med Chir 1992; 32 (4): 207-9.
- Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40 (5): 373-83.
- Pasquetti P, Apicella L, Mangone G. Pathogenesis and treatment of falls in elderly Clin Cases Miner Bone Metab 2014; 11 (3): 222-5.
- Nam YS, Han JS, Kim JY ,Bae WK, Lee K. Prescription of potentially inappropriate medication in Korean older adults based on 2012 Beers Criteria: a cross-sectional population based study. BMC Geriatr 2016; 16: 118.
- Harrison SL, Kouladjian L, Crotty D. Costs of potentially inappropriate medication use in residential aged care facilities BMC Geriatr 2018; 18: 9
- Price SD, Holman CD, Sanfilippo FM, Emery JD. Association between potentially inappropriate medications from the Beers criteria and the risk of unplanned hospitalization in elderly patients. Ann Pharmacother 2014; 48 (1): 6–16.
- Song Y, Wang Z, Wang LLD, Zhang J. The level of circulating endothelial progenitor cells may be associated with the occurrence and recurrence of chronic subdural hematoma. Clinics (Sao Paulo) 2013; 68 (8): 1084-8.
- Adhiyaman V, Asghar M, Ganeshram K, Bhowmick B Chronic subdural haematoma in the elderly Postgrad Med J 2002; 78 (916): 71-5.
- Fick DM, Semla TP, Steinman M, et al. American Geriatrics Society 2019 Updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2019; 67 (4): 674-94.
- Wang H, Zhang M, Zheng H et al. The effects of antithrombotic drugs on the recurrence and mortality in patients with chronic subdural hematoma: A meta-analysis. Medicine (Baltimore) 2019; 98 (1):13972.
- Tinetti M.E, Han L, Lee DS. Antihypertensive medications and serious fall injuries in a nationally representative sample of older adults. JAMA Intern Med 2014; 174 (4): 588-95.
- Guha D, Coyne S, Macdonald RL. Timing of the resumption of antithrombotic agents following surgical evacuation of chronic subdural hematomas: a retrospective cohort study. J Neurosurg 2016; 124: 750–9.
- Aspegren OP, Astrand R, Lundgren MI, Romner B. Anticoagulation therapy a risk factor for the development of chronic subdural hematoma. Clin Neurol Neurosurg 2013; 115: 981–4.
- Baraniskin A, Steffens C, Harders A, Schmiegel W, Schroers R, Spangenberg P. Impact of pre-hospital antithrombotic medication on the outcome of chronic and acute subdural hematoma. J Neurol Surg A Cent Eur Neurosurg 2014; 75: 31-6.
- Honda Y, Sorimachi T, Momose H, Takizawa K, Inokuchi S, Matsumae M. Chronic subdural haematoma associated with disturbance of consciousness: significance of acute-on-chronic subdural haematoma. Neurol Res 2015; 37: 985-92.
- Ohba S, Kinoshita Y, Nakagawa T, Murakami H. The risk factors for recurrence of chronic subdural hematoma. Neurosurg Rev 2013; 36: 145-50.
- Chon KH, Lee JM, Koh EJ, Choi HY. Independent predictors for recurrence of chronic subdural hematoma. Acta Neurochir 2012; 154: 1541-8. 18. Theou O, Squires E, Mallery K, et al. What do we know about frailty in the acute care setting? A scoping review BMC Geriatr 2018; 18: 139.
- Theou O, Squires E, Mallery K, et al. What do we know about frailty in the acute care setting? A scoping review BMC Geriatr 2018; 18: 139.
Potentially inappropriate medication usage, fall and comorbidities in geriatric patients diagnosed with chronic subdural hematoma
Abstract
Aim: The annual incidence of chronic subdural hematoma is 2-4/100000 in geriatric population. We aimed to investigate relationship between potentially inappropriate medication usage according to Beers 2019 criteria, fall and Charlson comorbidity index in geriatric patients diagnosed with chronic subdural hematoma.
Materials and Methods: We retrospectively collected medical records of 69 geriatric patients diagnosed with chronic subdural hematoma and hospitalized for the last 5 years in neurosurgery department of Izmir Katip Çelebi University Hospital with the permission of local ethical committee of medical faculty. Data was recorded and analyzed with appropriate method by using SPSS v18.
Results: Mean age was 78.43 ± 7.51 years, mean Charlson comorbidity index was 5.87 ± 2.97. Falling events were responsible for 59 (85.5%) out of 69 chronic subdural hematoma cases. Potentially inappropriate medication usage according to Beers 2019 criteria was found in 20 (29%) patients. Inappropriate medications belonged to cardiovascular system (14.5%) class and antiplatelet/anticoagulant (14.5%) class mostly. When group was divided into two groups as patients who used potentially inappropriate medication or not, Charlson comorbidity index was found to be higher in the first group. (p <0.05) When group was divided into two groups as patients who fall or not, no correlation was found in Charlson comorbidity index, dementia prevalence, hospitalization duration, number of medications, potentially inappropriate medication, cerebrovascular infarct and hemiplegia prevalence between these groups (p >0.05). Charlson comorbidity index and number of medications showed significant correlation (p = 0.001).
Conclusion: We could not reach a significant correlation between fall, Charlson comorbidity index and potentially inappropriate medication usage in our retrospective study. Small study population size, unreliable medical records and relatively healthy characteristics of population may contribute to crossing results.
Keywords
Chronic subdural hematoma geriatrics fall comorbidity inappropriate medication Beers criteria
References
- Kudo H, Kuwamura K, Izawa I, Sawa H, Tamaki N. Chronic subdural hematoma in elderly people: present status on Awaji Island and epidemiological prospect. Neurol Med Chir 1992; 32 (4): 207-9.
- Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40 (5): 373-83.
- Pasquetti P, Apicella L, Mangone G. Pathogenesis and treatment of falls in elderly Clin Cases Miner Bone Metab 2014; 11 (3): 222-5.
- Nam YS, Han JS, Kim JY ,Bae WK, Lee K. Prescription of potentially inappropriate medication in Korean older adults based on 2012 Beers Criteria: a cross-sectional population based study. BMC Geriatr 2016; 16: 118.
- Harrison SL, Kouladjian L, Crotty D. Costs of potentially inappropriate medication use in residential aged care facilities BMC Geriatr 2018; 18: 9
- Price SD, Holman CD, Sanfilippo FM, Emery JD. Association between potentially inappropriate medications from the Beers criteria and the risk of unplanned hospitalization in elderly patients. Ann Pharmacother 2014; 48 (1): 6–16.
- Song Y, Wang Z, Wang LLD, Zhang J. The level of circulating endothelial progenitor cells may be associated with the occurrence and recurrence of chronic subdural hematoma. Clinics (Sao Paulo) 2013; 68 (8): 1084-8.
- Adhiyaman V, Asghar M, Ganeshram K, Bhowmick B Chronic subdural haematoma in the elderly Postgrad Med J 2002; 78 (916): 71-5.
- Fick DM, Semla TP, Steinman M, et al. American Geriatrics Society 2019 Updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2019; 67 (4): 674-94.
- Wang H, Zhang M, Zheng H et al. The effects of antithrombotic drugs on the recurrence and mortality in patients with chronic subdural hematoma: A meta-analysis. Medicine (Baltimore) 2019; 98 (1):13972.
- Tinetti M.E, Han L, Lee DS. Antihypertensive medications and serious fall injuries in a nationally representative sample of older adults. JAMA Intern Med 2014; 174 (4): 588-95.
- Guha D, Coyne S, Macdonald RL. Timing of the resumption of antithrombotic agents following surgical evacuation of chronic subdural hematomas: a retrospective cohort study. J Neurosurg 2016; 124: 750–9.
- Aspegren OP, Astrand R, Lundgren MI, Romner B. Anticoagulation therapy a risk factor for the development of chronic subdural hematoma. Clin Neurol Neurosurg 2013; 115: 981–4.
- Baraniskin A, Steffens C, Harders A, Schmiegel W, Schroers R, Spangenberg P. Impact of pre-hospital antithrombotic medication on the outcome of chronic and acute subdural hematoma. J Neurol Surg A Cent Eur Neurosurg 2014; 75: 31-6.
- Honda Y, Sorimachi T, Momose H, Takizawa K, Inokuchi S, Matsumae M. Chronic subdural haematoma associated with disturbance of consciousness: significance of acute-on-chronic subdural haematoma. Neurol Res 2015; 37: 985-92.
- Ohba S, Kinoshita Y, Nakagawa T, Murakami H. The risk factors for recurrence of chronic subdural hematoma. Neurosurg Rev 2013; 36: 145-50.
- Chon KH, Lee JM, Koh EJ, Choi HY. Independent predictors for recurrence of chronic subdural hematoma. Acta Neurochir 2012; 154: 1541-8. 18. Theou O, Squires E, Mallery K, et al. What do we know about frailty in the acute care setting? A scoping review BMC Geriatr 2018; 18: 139.
- Theou O, Squires E, Mallery K, et al. What do we know about frailty in the acute care setting? A scoping review BMC Geriatr 2018; 18: 139.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | April 19, 2021 |
| Submission Date | January 18, 2021 |
| Published in Issue | Year 2021 |