Vnitřní lékařství blok 1 - funkční diagnostika, pracovní lékařství a geriatrie

POLYMORBIDITY


DEFINITION OF MULTIMORBIDITY
  • Presence ≥ 2-4 chron. dg. = definition
  • Functional limitations, cognitive disorders
  • Interaction between diagnoses
  • Interactions between their treatments

MORBIDITY OF THE ELDERLY
  • The elderly population is very heterogeneous in terms of health.
  • ↑ morbidity, ↑ occurrence of chronic and degenerative diseases
  • higher incidence of acute deterioration and decompensation
  • The most common diseases of older age: cardiovascular diseases,  musculoskeletal, metabolic, GIT and respiratory diseases.

ATYPICAL PRESENTATION OF THE DISEASES IN OLD AGE
  • Symptoms typical for a certain dg. are often   missing.
  • On the contrary, changes in behavior and   functional abilities are present
  • Failure to establish the correct dg. with atypical   symptomatology can lead to incorrect dg. and   incorrect therapy

CLINICAL PICTURE OF DISEASES IN OLD AGE
  • The actual symptomatology of the underlying disease tends to be inconspicuous.
  • Non-specific and universal manifestations of brain activity decompensation dominate.
  • The senior's brain is usually the first organ to react to changes.

POLYPHARMACY - CHARACTERISTICS
  • Taking ≥ 5 medications
  • Extreme polyph. ≥ 10 different drugs
  • Especially for people ≥ 85 years old.
  • Therapeutic window with increasing age ↓
  • ↓compliance, ↑interindividual variability of effect   and ↑ risk of drug interactions and ADRs

Polypharmacy and occurrence of ADR s
POLYPHARMACY - CONSEQUENCES
  • An independent risk factor for ADR’s
  • ↑ hospitalization
  • ↑ risks of placement in NH
  • Hypoglycemia
  • Falls and fractures
  • Pneumonia 
  • Malnourishement
  • Death

REDUCTION OF POLYPHARMACY
  • ↑ probability of adherence to medication
  • This is the cause of 20% ADR’s
  • ↓ Costs

REDUCTION OF POLYPHARMACY
Multimorbidity
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MULTIMORBIDITY
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