{"id":1900,"date":"2023-06-05T14:04:33","date_gmt":"2023-06-05T14:04:33","guid":{"rendered":"https:\/\/blogchicchezvous.com\/?p=1900"},"modified":"2023-07-11T17:29:59","modified_gmt":"2023-07-11T17:29:59","slug":"polymedication-chez-les-aines","status":"publish","type":"post","link":"https:\/\/blogchicchezvous.com\/en\/2023\/06\/05\/polymedication-chez-les-aines\/","title":{"rendered":"Polymedication in seniors"},"content":{"rendered":"\n[et_pb_section fb_built=\u00a0\u00bb1″ _builder_version=\u00a0\u00bb4.21.0″ _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_row _builder_version=\u00a0\u00bb4.21.0″ _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_column type=\u00a0\u00bb4_4″ _builder_version=\u00a0\u00bb4.21.0″ _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_text _builder_version=\u00a0\u00bb4.21.0″ _module_preset=\u00a0\u00bbdefault\u00a0\u00bb text_text_color=\u00a0\u00bb#000000″ text_font_size=\u00a0\u00bb19px\u00a0\u00bb header_text_color=\u00a0\u00bb#003344″ hover_enabled=\u00a0\u00bb0″ global_colors_info=\u00a0\u00bb{}\u00a0\u00bb sticky_enabled=\u00a0\u00bb0″]

Femme de 79 ans souffrant de 5 maladies chroniques, soit l\u2019hypertension art\u00e9rielle, le diab\u00e8te de type 2, l\u2019ost\u00e9oporose, l\u2019arthrose et une maladie pulmonaire. Sur la base des recommandations de bonnes pratiques, cette patiente re\u00e7oit 12 m\u00e9dicaments diff\u00e9rents. <\/em><\/p>\n

 <\/p>\n

Chez le sujet \u00e2g\u00e9, de nombreuses pathologies telles que celles pr\u00e9cit\u00e9es justifient l\u2019association de plusieurs m\u00e9dicaments pour un traitement optimal. Ces associations ont permis d\u2019am\u00e9liorer le pronostic de maladies qui autrefois \u00e9taient associ\u00e9es \u00e0 une mortalit\u00e9 pr\u00e9matur\u00e9e.<\/p>\n

 <\/p>\n

Or, la polym\u00e9dication chez les a\u00een\u00e9s est-elle toujours n\u00e9cessaire, voire s\u00e9curitaire ?<\/p>\n

 <\/p>\n

Nous verrons dans cet article que ce n\u2019est pas toujours le cas.<\/p>\n

 <\/p>\n

Nous verrons que la polypharmacie est un probl\u00e8me de sant\u00e9 publique reconnu et bien document\u00e9. Citons le cas des \u00c9tats-Unis, o\u00f9 30% des hospitalisations de personnes \u00e2g\u00e9es sont reli\u00e9es \u00e0 la consommation de m\u00e9dicaments et \u00e0 leurs effets ind\u00e9sirables.<\/p>\n

 <\/p>\n

La polym\u00e9dication est un ph\u00e9nom\u00e8ne en croissance, qui s\u2019explique notamment par l\u2019augmentation des maladies chroniques et l\u2019allongement de l\u2019esp\u00e9rance de vie.<\/p>\n

 <\/p>\n

 <\/p>\n

Qu\u2019est-ce que la polym\u00e9dication ?<\/strong><\/h1>\n

 <\/p>\n

D\u2019un point de vue quantitatif, la polym\u00e9dication correspond \u00e0 la prise simultan\u00e9e de 3 m\u00e9dicaments ou plus. D\u2019autres auteurs consid\u00e8rent que c\u2019est la prise simultan\u00e9e de 5 m\u00e9dicaments ou plus.<\/p>\n

 <\/p>\n

D\u2019un point de vue qualitatif, la polym\u00e9dication est l\u2019usage de m\u00e9dicaments inappropri\u00e9s ou qui ne sont pas cliniquement indiqu\u00e9s.<\/p>\n

 <\/p>\n

 <\/p>\n

Les types de polym\u00e9dication<\/strong><\/h1>\n

\u00a0<\/strong><\/p>\n

1) La polym\u00e9dication simultan\u00e9e\u00a0: c\u2019est le nombre moyen de m\u00e9dicaments pris un jour donn\u00e9.<\/p>\n

 <\/p>\n

2) La polym\u00e9dication cumulative\u00a0: c\u2019est la somme de tous les m\u00e9dicaments administr\u00e9s au cours d\u2019une p\u00e9riode donn\u00e9e, le plus souvent 3 mois.<\/p>\n

 <\/p>\n

3) La polym\u00e9dication continue\u00a0: ce sont les m\u00e9dicaments pris de fa\u00e7on prolong\u00e9e et r\u00e9guli\u00e8re.<\/p>\n

 <\/p>\n

 <\/p>\n

La nature de la polym\u00e9dication<\/strong><\/h1>\n

\u00a0<\/strong><\/p>\n

D\u2019apr\u00e8s la litt\u00e9rature, les maladies les plus fr\u00e9quemment responsables de consultations (et donc faisant l\u2019objet de prescriptions) concernent les appareils cardio-vasculaires, le syst\u00e8me nerveux central, les pathologies digestives et le syst\u00e8me ost\u00e9o-articulaire.<\/p>\n

\u00a0<\/strong><\/p>\n

\"\"\u00a0<\/strong><\/p>\n

 <\/p>\n

Les circonstances favorisant la polym\u00e9dication<\/strong><\/h1>\n

\u00a0<\/strong><\/p>\n

Certaines circonstances favorisent la polym\u00e9dication. Par exemple, une personne \u00e2g\u00e9e qui consulte plusieurs m\u00e9decins et obtient autant d\u2019ordonnances sans informer le prescripteur de ce qui lui a d\u00e9j\u00e0 \u00e9t\u00e9 prescrit. Ou encore une personne \u00e2g\u00e9e qui fait affaire avec diff\u00e9rentes pharmacies communautaires qui ne partagent pas leurs dossiers pharmaceutiques. L\u2019autom\u00e9dication, qui est le fait de prendre des m\u00e9dicaments sans prescription du m\u00e9decin, peut aussi favoriser la polym\u00e9dication.<\/p>\n

 <\/p>\n

 <\/p>\n

La polym\u00e9dication en CHSLD<\/strong><\/h1>\n

\u00a0<\/strong><\/p>\n

D\u2019autre part, il est bien connu que la polym\u00e9dication est fr\u00e9quente chez les a\u00een\u00e9s en CHSLD. Ceux-ci consomment en moyenne 14 m\u00e9dicaments. Cette situation est d\u2019autant plus pr\u00e9occupante qu\u2019il s\u2019agit d\u2019une population fragile, tant en ce qui concerne les effets secondaires des m\u00e9dicaments qu\u2019en raison des changements physiologiques chez ces patients qui r\u00e9duisent l\u2019\u00e9limination des m\u00e9dicaments et en augmente ainsi la toxicit\u00e9.<\/p>\n

 <\/p>\n

 <\/p>\n

Les cons\u00e9quences de la polypharmacie<\/strong><\/h1>\n

\u00a0<\/strong><\/p>\n

Il est bien \u00e9tabli que la polym\u00e9dication peut alt\u00e9rer la qualit\u00e9 de vie des personnes \u00e2g\u00e9es en pr\u00e9cipitant un d\u00e9clin fonctionnel. Elle est clairement associ\u00e9e \u00e0 un risque augment\u00e9 d\u2019effets ind\u00e9sirables, de surdosages, d\u2019interactions m\u00e9dicamenteuses et d\u2019erreurs de prise. Elle peut entra\u00eener une diminution de la compliance th\u00e9rapeutique.<\/p>\n

 <\/p>\n

\"\"<\/p>\n

 <\/p>\n

La polypharmacie est \u00e9galement associ\u00e9e \u00e0 une pr\u00e9valence augment\u00e9e de chutes et de fractures f\u00e9morales chez les a\u00een\u00e9s. Relevons le fait que la prise d\u2019antid\u00e9presseurs, de benzodiaz\u00e9pines et de diur\u00e9tiques est souvent en cause dans les chutes chez les personnes \u00e2g\u00e9es.<\/p>\n

 <\/p>\n

\"\"<\/p>\n

 <\/p>\n

Associ\u00e9e aux changements physiologiques du vieillissement, la polym\u00e9dication augmente le risque de morbidit\u00e9 et m\u00eame de mortalit\u00e9.<\/p>\n

 <\/p>\n

 <\/p>\n

Les co\u00fbts \u00e9conomiques <\/strong><\/h1>\n

\u00a0<\/strong><\/p>\n

Non seulement la polym\u00e9dication impacte la vie du patient, mais elle engendre aussi des co\u00fbts \u00e9conomiques. En effet, les hospitalisations occasionn\u00e9es par les effets ind\u00e9sirables des m\u00e9dicaments contribuent \u00e0 augmenter les d\u00e9penses et diminuent l\u2019efficience des soins.<\/p>\n

 <\/p>\n

 <\/p>\n

Pistes pour am\u00e9liorer la prescription<\/strong><\/h1>\n

\u00a0<\/strong><\/p>\n

Les crit\u00e8res MAI (Medication Appropriateness Index) permettent de se questionner sur l\u2019indication, la justesse, les modalit\u00e9s, le dosage, les interactions entre les m\u00e9dicaments, la pr\u00e9sence de double prescription de m\u00eame que la dur\u00e9e d\u2019un traitement.<\/p>\n

 <\/p>\n

En second lieu, l\u2019utilisation d\u2019un syst\u00e8me informatique d\u2019aide \u00e0 la prescription peut permettre l\u2019am\u00e9lioration de la qualit\u00e9 de la prescription en signalant les interactions dangereuses et les dosages inappropri\u00e9s.<\/p>\n

 <\/p>\n

En troisi\u00e8me lieu, la prise en charge par une \u00e9quipe multidisciplinaire de g\u00e9riatrie est aussi l\u2019occasion de revoir l\u2019ensemble du traitement du patient.<\/p>\n

 <\/p>\n

Enfin, la pr\u00e9sence au sein de l\u2019\u00e9quipe multidisciplinaire d\u2019un pharmacien clinicien apporte une valeur ajout\u00e9e aux autres mesures cit\u00e9es ci-haut.<\/p>\n

 <\/p>\n

 <\/p>\n

Conclusion<\/strong><\/h1>\n

\u00a0<\/strong><\/p>\n

La polym\u00e9dication est la prise de plusieurs m\u00e9dicaments et on la mesure de trois fa\u00e7ons diff\u00e9rentes. Les consultations multiples et l\u2019autom\u00e9dication peuvent favoriser la polypharmacie. Celle-ci entra\u00eene de nombreuses cons\u00e9quences n\u00e9fastes au niveau individuel (ex. d\u00e9clin fonctionnel, effets ind\u00e9sirables, interactions m\u00e9dicamenteuses, chutes, etc.) et au niveau \u00e9conomique.<\/p>\n

 <\/p>\n

Nous avons vu aussi des pistes pour am\u00e9liorer la prescription telles que les crit\u00e8res MAI ou un syst\u00e8me informatique d\u2019aide \u00e0 la prescription.<\/p>\n

 <\/p>\n

Il peut \u00eatre judicieux \u00e9galement de rechercher des alternatives aux prescriptions m\u00e9dicamenteuses (ex. nutrition).<\/p>\n

 <\/p>\n

Dans la m\u00eame veine, on est en droit de se questionner \u00e0 savoir \u00ab Faut-il tout traiter, tout le temps et jusqu\u2019\u00e0 quand ? \u00bb<\/p>\n

 <\/p>\n

Il est donc \u00e0 souhaiter que les m\u00e9decins et les pharmaciens en viennent \u00e0 d\u00e9prescrire les m\u00e9dicaments jug\u00e9s non appropri\u00e9s, tout en faisant \u00e9quipe avec les patients \u00e2g\u00e9s.<\/p>\n

 <\/p>\n

 <\/p>\n

 <\/p>\n

 <\/p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]\n","protected":false},"excerpt":{"rendered":"

Femme de 79 ans souffrant de 5 maladies chroniques, soit l\u2019hypertension art\u00e9rielle, le diab\u00e8te de type 2, l\u2019ost\u00e9oporose, l\u2019arthrose et une maladie pulmonaire. Sur la base des recommandations de bonnes pratiques, cette patiente re\u00e7oit 12 m\u00e9dicaments diff\u00e9rents.   Chez le sujet \u00e2g\u00e9, de nombreuses pathologies telles que celles pr\u00e9cit\u00e9es justifient l\u2019association de plusieurs m\u00e9dicaments pour […]<\/p>\n","protected":false},"author":1,"featured_media":1906,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"categories":[18],"tags":[],"class_list":["post-1900","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-vieillissement"],"yoast_head":"\nPolym\u00e9dication chez les a\u00een\u00e9s - Blogue Chic chez vous<\/title>\n<meta name=\"description\" content=\"La polym\u00e9dication chez les a\u00een\u00e9s, qui est un probl\u00e8me de sant\u00e9 publique reconnu, n'est pas toujours n\u00e9cessaire ni s\u00e9curitaire.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogchicchezvous.com\/en\/2023\/06\/05\/polymedication-chez-les-aines\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Polym\u00e9dication chez les a\u00een\u00e9s - 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