gms | German Medical Science

Background: Sail ahoy: Demography and prognoses, polypharmacy with falls and fractures, renal failure, and cognitive dysfunction up to dementia should direct physicians and other health care professionals as well as managers in pharmaceutical industry, healthcare politics and health economics to a rational holistic view of the situation and rethink preventative approach.

We are en route cooperatively. Who does assume the responsibility for the mismanagement of the geriatric sailing ship?

Materials and methods: Analysis of risks resulting from “higher-level structures” apart from the individual patient to define the challenge of preventative sails: based on evidence from >14,500 own medication reviews (synopsis internal medicine and clinical pharmacology) of patients stranded in traumatology and intensive care units and from performing interprofessional educational workshops on the risks in gerontopharmacology/polypharmacy in the ambulatory setting. From these broad insights severe grievances are obvious and pointed out that seem to be co-responsible for the misery in gerontopharmacology to a preventable extent.

Results: As a preventative contribution eight important sails should be hoisted:

• Sail 1: Pharmaceutical studies with new drugs finally should include the most consuming elderly patient group.
• Sail 2: Clinical studies on drugs should always be designed with focus on additionally secondary endpoints as manifestation of cognitive dysfunction and impairment and falls etc. in both acute and longterm follow-up.
• Sail 3: The pronounced subspecialisation within physicians requires an interdisciplinary co-responsibility of clinical pharmacolgy in the drug related patient care.
• Sail 4: Unfortunately “guideline-appropriate therapy” is almost never expertised for geriatric patients with multimorbidity. This might result in false safety-mindedness esp. in combining several of them resulting in most severe risks in an individual geriatric patient.
• Sail 5: Physicians, nurses, pharmacists and students must be sensitised and informed adequately concerning most important problems in gerontopharmacology/polypharmacy and start networking and communication on the individual manifestation of unwarranted drug effects observed.
• Sail 6: The new electronic health smart card and medication list should indicate updated renal function.
• Sail 7: Trading drug names must always indicate the name of the pharmaceutical substance primarily.
• Sail 8: Laboratory blood tests for drug-related risks must be guaranteed to family physicians in the budget by the Federal Association of Statutory Health Insurance Physicians (KBV).

Conclusion: “Higher-level structure” responsibility in drug safety: Preferably all, at least most sails already would presumably guarantee a distinct and more powerful implementation of a preventive approach for a change of the course with regard to safer ageing. Sail ahoy! in shallow and safe waters for the elderly people reducing risks from polypharmcy with inherent expected health economic benefit.