LA PRESCRIZIONE DEI FARMACI E LE CONDIZIONI DI SALUTE DEI 'GRANDI ANZIANI'. STUDIO LONGITUDINALE NELLA U.S.S.L. TORINO I

Since the beginning of the eighties, the Pharmaceutical Service of the USSL Torino I has been trying to create a multidisciplinary group dealing with some high priority health problems. At first, drug prescribing in the whole population was studied, then high risk groups never studied in depth, such as the elderly, pregnant women and children, were considered. It is well established that elderly people are the heaviest consumers of drugs and that many simultaneously take multiple medications. Polipharmacy may have negative consequences such as increased risk of adverse drug reactions and unwanted drug interactions, diminished patient compliance and increase health care costs. Although most drugs are prescribed and/or monitored by the General Practitioner (GP), others are unreported by the GP either because of inaccurate drug history taking or because the information is not easily obtainable from the patient. An important issue in reducing the probability of taking unreported drugs is the identification and characterisation of the main predictors of this behaviour. Only a few studies have tackled this question in the elderly. This study was conducted in the USSL Torino I from November 1990 to March 1991. The objective of the present study, conducted in a random sample of a very old (≥ 75 years old) community dwelling population, living in Turin (Italy), was to analyse the association between socio-demographic and clinical characteristics and the use of an reported drugs. Our study shows that 40% of very old people take at least one drug unreported by the GP. The major predictors of taking unreported drugs are poor education and presence of depressive symptoms. 'Younger' age (75-79 years), living alone and cognitive impairment are other possible predictors, which did not reach significance because of the low number of subjects. Benzodiazepines represent the main class of unreported drugs (26%). What is clear is that drug history represents a crucial point in the global assessment of a patient, especially if very old. GPs should adopt a more active and specific approach in taking drug history and not limit themselves to a general question or to record the first answer of the patients. This is particularly important with very old, depressed, and poorly educated patients, and possibly when the subject show a cognitive impairment or is living alone. Cognitive impairment in very old people comes out as an outstanding problem: diagnosis by the GP is poor, prescription of useless drugs is very frequent, patient assessment is incomplete. Interventions pointing only to a reduction of prescription of 'cerebroactives' are scientifically justified but possibly lack in persuasion power. Instead, if we provide them with the opportunity of a better overall assessment, with means for diagnosing more precisely and the possibility of initiating a rational caring programme, we could improve the patients situation deal with the GPs feeling of helplessness, and give more strength to the request of a stricter drug policy.