El uso de fármacos conlleva innegables beneficios en las personas mayores, pero no está exento de efectos indeseables. La deprescripción es el proceso de revisión sistemática de la medicación con el ...objetivo de lograr la mejor relación riesgo-beneficio en base a la mejor evidencia disponible. Este proceso es especialmente importante en mayores polimedicados, sobretratados, frágiles, con enfermedades terminales y en el final de la vida.
La deprescripción debe hacerse de forma escalonada, estableciendo un seguimiento estrecho por si aparecen problemas tras la retirada. En la toma de decisiones es muy importante contar con la opinión del paciente y de los cuidadores, valorando los objetivos del tratamiento según la situación clínica, funcional y social del enfermo.
Existen múltiples herramientas para facilitar a los clínicos la tarea de seleccionar qué fármacos deprescribir (criterios Beers, STOPP-START…). Los grupos farmacológicos más susceptibles de intervención son: antihipertensivos, antidiabéticos, estatinas, benzodiacepinas, antidepresivos, anticolinérgicos, anticolinesterásicos y neurolépticos.
The use of drugs has undeniable benefits to the elderly, but it is not exempt from undesirable effects. Deprescription is the process of systematic medication review with the target of achieving the best risk-benefit ratio based on the best available evidence. This process is especially important for polymedicated elderly patients as well as those overtreated, frail, terminally ill and at the end of life.
The deprescription must be done in stages, establishing a close follow-up in case problems appear after withdrawal. In the decision-making process, it is very important to consider the patient and caregivers opinion, assessing the objectives of the treatment according to the clinical, functional and social situation of the patient.
There are multiple tools to make it easier for clinicians to select which drugs to deprescribe (Beers criteria, STOPP-START…). The most susceptible to intervention pharmacological groups are: antihypertensives, antidiabetics, statins, benzodiazepines, antidepressants, anticholinergics, anticholinesterase agents, and neuroleptics.
Actividades preventivas en el mayor. Actualización PAPPS 2022 Acosta Benito, Miguel Ángel; García Pliego, Rosa Ana; Baena Díez, José Miguel ...
Atención primaria,
October 2022, 2022-10-00, 20221001, 2022-10-01, Letnik:
54, Številka:
Suppl 1
Journal Article
Recenzirano
Odprti dostop
En este artículo se examina la última evidencia disponible sobre las actividades preventivas en la persona mayor, incluyendo los trastornos de sueño, el ejercicio físico, la deprescripción, los ...trastornos cognitivos y las demencias, la nutrición, el aislamiento social y la fragilidad.
This article examines the latest available evidence on preventive activities in the elderly, including sleep disorders, physical exercise, deprescription, cognitive disorders and dementias, nutrition, social isolation and frailty.
PAPPS update on older people 2022 Acosta Benito, Miguel Ángel; García Pliego, Rosa Ana; Baena Díez, José Miguel ...
Atención primaria,
10/2022, Letnik:
54 Suppl 1
Journal Article
Recenzirano
Odprti dostop
This article examines the latest available evidence on preventive activities in the elderly, including sleep disorders, physical exercise, deprescription, cognitive disorders and dementias, ...nutrition, social isolation and frailty.
PAPPS update on older people 2022 Acosta Benito, Miguel Ángel; García Pliego, Rosa Ana; Baena Díez, José Miguel ...
Atención primaria,
10/2022, Letnik:
54 Suppl 1
Journal Article
The aims of this study were to determine the crude age-and sex-adjusted prevalence rates of diabetes mellitus (DM), type 1 DM (DM1) and type 2 DM (DM2), and to compare the relationship with ...cardiovascular risk factors, cardiovascular diseases, chronic kidney disease and metabolic diseases among populations with and without DM.
SIMETAP-DM is a cross-sectional observational study conducted in a primary care setting, with a random population-based sample of 10,579 adults. Response rate: 66%. The diagnoses of DM, DM1 and DM2 were based on clinical and biochemical criteria and/or the checking of these diagnoses in medical records. The crude and age- and sex-adjusted prevalence rates (standardised with the Spanish population) were calculated.
The crude prevalence rates of DM1, DM2 and DM were 0.87% (95% confidence interval 95% CI: 0.67–1.13), 14.7% (95% CI: 13.9–15.6) and 15.6% (95% CI: 14.7–16.5), respectively. The age- and sex-adjusted prevalence rates of DM1, DM2 and DM were 1.0% (1.3% for men and 0.7% for women), 11.5% (13.6% for men and 9.7% for women) and 12.5% (14.9% for men and 10.5% for women), respectively. The prevalence of DM in the population ≥70 years was double (30.3% 95% CI: 28.0–32.7) that of the population between 40 and 69 years old (15.3% 95% CI: 14.1–16.5%). Hypertension, peripheral arterial disease, increased weight-to-height ratio, albuminuria, coronary heart disease, atherogenic dyslipidaemia and hypercholesterolaemia were associated with DM.
In a Spanish primary care setting, the age-adjusted prevalences of DM1, DM2 and DM in the adult population were 1.0, 11.5 and 12.5%, respectively. A third of the population over 70 years old suffered from DM.
Los objetivos del estudio fueron determinar las tasas de prevalencia crudas y ajustadas por edad y sexo de diabetes mellitus (DM), DM tipo-1 (DM1), y DM tipo-2 (DM2), y comparar la asociación de factores de riesgo cardiovascular, enfermedades cardiovasculares, enfermedad renal crónica, y enfermedades metabólicas entre las poblaciones con y sin DM.
SIMETAP-DM es un estudio observacional transversal realizado en atención primaria, con una muestra aleatoria de base poblacional de 10.579 adultos. Tasa de respuesta: 66%. Los diagnósticos de DM, DM1 y DM2 se basaron en criterios clínicos y bioquímicos y/o en la comprobación de estos diagnósticos en las historias clínicas. Se determinaron las prevalencias crudas y ajustadas por edad y sexo (estandarizadas con la población española).
Las prevalencias crudas de DM1, DM2, y DM fueron 0,87% (intervalo confianza 95% IC: 0,67–1,13%), 14.7% (IC: 13,9–15,6%), y 15.6% (IC: 14,7–16,5%), respectivamente. Las prevalencias ajustadas por edad y sexo de DM1, DM2, y DM fueron 1.0% (1.3% hombres; 0.7% mujeres), 11.5% (13.6% hombres; 9.7% mujeres), y 12.5% (14.9% hombres; 10.5% mujeres), respectivamente. La prevalencia de DM en la población ≥70 años era el doble (30.3% IC: 28,0–32,7%) que en la población entre 40 y 69 años (15.3% IC: 14,1–16,5%). La hipertensión arterial, enfermedad arterial periférica, índice cintura-talla aumentado, albuminuria, enfermedad coronaria, dislipidemia aterogénica y la hipercolesterolemia se asociaban con la DM.
En el ámbito de la atención primaria española, las prevalencias ajustadas por edad de DM1, DM2 y DM en la población adulta fueron 1.0%, 11.5% y 12.5%, respectivamente. Un tercio de la población mayor de 70 años padecía DM.
With the advancement of knowledge in relation to the physiopathogenesis of atopic dermatitis (AD), several new therapeutic forms have been developed. There are also new guidelines for self-care. On ...the other hand, there is still an underdiagnosis of AD in Mexico. Thus, the need was seen to develop a national guide, with a broad base among the different medical groups that care for patients with AD. The Atopic Dermatitis Guidelines for Mexico (GUIDAMEX) was developed with the ADAPTE methodology, with the endorsement and participation of ten national medical societies, from physicians in Primary Healthcare to allergists and dermatologists. Throughout the manuscript, key clinical questions are answered that lead to recommendations and suggestions for the diagnosis of AD (including differential diagnosis with immunodeficiency syndromes), the recognition of comorbidities and complications, non-pharmacological treatment including therapeutic education, treatment of flares and maintenance therapy. The latter encompasses general measures to avoid triggering factors, first-line treatment focussed on repair of the skin barrier, second-line treatment (topical proactive therapy), and third-line phototherapy or systemic treatment, including dupilumab and JAK inhibitors.
