Background Hip fracture is a major public health problem with a high incidence and prevalence in people over 65 years old. This group of patients presents changes in body composition and organ function, an important situation of co-morbidity; and they are usually polymedicated, which implies a greater chance of drug-related problems. All of that should be taken into account in the pharmaceutical care.
Purpose To analyse the pharmacological treatment of elderly patients experiencing a hip fracture, focusing on geriatric dosage adjustments, in order to improve pharmaceutical care in this group of patients.
Materials and methods A prospective pilot study was performed over two months [August–October, 2013] with patients admitted to a tertiary hospital with a hip fracture. These variables were recorded for each patient: sex, age, length of hospital stay, neuropsychiatric problems, residential status, actual diseases and renal function. Drug treatment was recorded from the pharmacy database (Silicon).
Drugs were classified in seven different groups: No adjustment required (N), Adjustment required for renal function condition (AR), Adjustment required for elderly condition not related to renal function (AG), Adjustment required for both elderly and renal function (AB), Precaution in elderly patients (P), Not enough information in geriatric population (NI), and Inappropriate based on Beer’s criteria (I).
In a second phase, a pharmacist experienced in the geriatric population reviewed all of the prescriptions on every patient and determined if drugs that needed dosage adjustment were adjusted or not.
Results Forty hip fracture patients were included in the study, 75% women and 25% men, with a mean age of 85 years (73–102). 47.5% of the patients lived at home and 20% were institutionalised. The average number of current illnesses was 6 (1–13); 15% of the patients had neuropsychiatric problems. On average they stayed 16 days in the hospital (7–28), and received 14 drugs (6–20). About renal function, 7.5% of the patients presented a creatinine clearance below 30 ml/min, and 35% presented one between 30–60 ml/min.
We analysed 553 prescriptions, which included 117 drugs and were classified in seven different groups: N: 46 drugs (39%), AR: 26 drugs (22%), AG: 9 drugs (8%), AB: 4 drugs (3%), P: 19 drugs (16%), NI: 9 drugs (8%) and I: 4 drugs (3%).
On average, a dosage adjustment had been made on 84% of the drugs that needed it.
In 3 patients a dosage adjustment had been made made on fewer than the 40% of the drugs that needed it and 29 patients had an 80–100% correct adjustment.
Conclusions Dosage adjustment or precaution was required in the 53% of the drugs prescribed and 42% of them needed adjustment according to renal function.
The dose had been adjusted correctly in 84% of those drugs in average on each patient. Only a few patients had had 40% or fewer of their drug doses adjusted, and almost a third of the total number of patients had had 80–100% of their drug doses adjusted for their renal function.
It’s necessary to include the role of the pharmacist in the multidisciplinary team in elderly patients experiencing hip fracture in order to adjust the pharmacological treatment appropriately and avoid potential drug-related problems.
No conflict of interest.
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