Poly-pharmacy and Adverse Drug Reactions in the Elderly：聚药和老年人药物不良反应.ppt

* * * * But, as a recent report by the WHO has identified between one third and a half of medicines prescribed for long-term illness are not taken as directed. If we assume that the prescription was appropriate then this level of non-adherence is a concern for those, receiving, providing or funding care because it not only entails a waste of resources but also a missed opportunity for therapeutic benefit and health gain. * * * * * * Three recent reports: Estimated that between 30 -50% medicines prescribed for long term illnesses are not taken as directed If prescription was appropriate then this represents a loss for patients, healthcare providers and pharma industries Effective interventions are elusive (Haynes, et al. 1996, 2003 - series of Cochrane reviews of efficacy of adherence interventions) Non-adherence to medicines 1World Health Organization Report 2003. 2Horne et al. Concordance, adherence and compliance in medicine taking. NIHR SDO 2006. 3NICE. Medicines concordance adherence:involving adults and carers in decisions about prescribed medicines 2008/9 UNINTENTIONAL Non-adherence INTENTIONAL Non-adherence Capacity resources Practical barriers Motivational Beliefs/preferences Perceptual barriers Perceptions Practicalities Model of Adherence Horne R, Weinman et al Concordance, Adherence and Compliance in Medicine Taking: A conceptual map and research priorities (2006). National Institute for Health Research Service Delivery and Organisation RD, London, Patient Medicine Adverse Drug Reaction Poly- Pharmacy Cognitive impairment adherence Environment Pharmaco- genetics Altered Drug Handling Altered Drug Response Physiological Decline Co-morbidities Recovery, Hospitalisation Disability Death ADRs and Age Incidence of ADR increases with age Elderly receive more medicines Incidence of ADR increases the more prescribed medicines taken (exponentially?) Grymonpre et al (1988) – study 50 yrs ADR rates – 5% for 1 or 2 medicines Increa