Öz
Aim: It is aimed to evaluate the effects of malnutrition and polypharmacy on the risk of falling, which is an important cause of morbidity and mortality in patients with dementia.
Material Methods: This cross-sectional study includes early stage dementia patients who were followed for at least one year in the dementia outpatient clinic. As a criterion for polypharmacy, patients using more than five drugs were determined and drug types were divided into subgroups. The patients' Morse Drop Scale (MDS) and Mini Nutritional Assessment Scale (MNA) were filled in, and their Body Mass Index (BMI) was calculated.
Results: A total of 240 dementia patients (150 women) were included in the study. Patients with Alzheimer's Dementia (AD), Frontotemporal Dementia (FTD), Dementia with Lewy Bodies (LBD) and Vascular Dementia (VD) were studied. It has been observed that malnutrition and polypharmacy increase the risk of falling, and the highest risk was found in the psychotropic drug group. It has been observed that the use of a single antipsychotic increases the risk of falling more than the combination of antipsychotics and antidepressants, and this is associated with high doses of antipsychotics.
Conclusion: When malnutrition is combined with polypharmacy and especially psychopolypharmacy, it significantly increases the risk of falls and related morbidity and mortality. It is necessary to monitor malnutrition at frequent intervals and use psychotropic drugs in as small amounts as possible, for short periods and for limited indications.
Anahtar Kelimeler
Kaynakça
- 1.Eckstrom E, Vincenzo JL, Casey CM et al. American Geriatrics Society response to the World Falls Guidelines. J Am Geriatr Soc. 2024;72(6):1669-1686. doi: 10.1111/jgs.18734.
- 2.Kukreja S, Kalra G, Shah N, Shrivastava A. Polypharmacy in psychiatry: a review. Mens Sana Monogr. 2013;11(1):82-99.
- 3.Kato-Narita EM, Radanovic M. Characteristics of falls in mild and moderate Alzheimer’s disease. Dement Neuropsychol. 2009;3(4):337-343.
- 4.McKhann GM, Knopman DS, Chertkow H, et al. The diagnosis of dementia due to Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement. 2011;7(3):263-269.
- 5.Rascovsky K, Hodges JR, Knopman D, et al. Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia. Brain. 2011;134(9):2456-2477.
- 6.Sachdev P, Kalaria R, O’Brien J, et al. Diagnostic criteria for vascular cognitive disorders: a VASCOG statement. Alzheimer Dis Assoc Disord. 2014;28(3):206-218.
- 7.McKeith IG, Boeve BF, Dickson DW, et al. Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium. Neurology. 2017;89(1):88-100.
- 8.Morse JM. Development of a Scale to Identify the Fall-Prone Patient. Can J Aging. 1985;4(2):17-24.
- 9.Demir NY, İntepeler ŞS. Morse Düşme Ölçeğinin Türkçe’ye Uyarlanması ve Duyarlılık-Seçicilik Düzeyinin Belirlenmesi. Ege Üniversitesi Hemşirelik Fakültesi Dergisi. 2012;28(1):1-7.
- 10.Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF). J Gerontol A Biol Sci Med Sci. 2001;56(6):366–372.
- 11.Kaiser MJ, Bauer JM, Ramsch C, et al. Validation of the Mini Nutritional Assessment short-form (MNA-SF): a practical tool for identification of nutritional status. J Nutr Health Aging. 2009;13(9):782-788.
- 12.Ferner RE, Aronson JK. Communicating information about drug safety. BMJ. 2006;333(7559):143-145.
- 13.Davis DW, Hanson J, Chapman C, et al. High-level psychotropic polypharmacy: a retrospective comparison of children in foster care to their peers on Medicaid. BMC Psychiatry. 2021;21(1):303.
- 14. Mukadam N, Walters FJ, Valsh S et al.Changes in prevalence and incidence of dementia and risk factors for dementia: an analysis from cohort studies. Lancet Public Health. 2024; 9(7): 443 - 460.
- 15. Shaw FE. Falls in cognitive impairment and dementia. Clin Geriatr Med. 2002;18(2):159-173.
- 16.Eriksson S, Gustafson Y, Lundin-Olsson L. Risk factors for falls in people with and without a diagnose of dementia living in residential care facilities: a prospective study. Arch Gerontol Geriatr. 2008;46(3):293-306.
- 17.Allan LM, Ballard CG, Rowan EN, Kenny RA. Incidence and prediction of falls in dementia: a prospective study in older people. PLoS One. 2009;4(5):5521.
- 18.Stalenhoef PA, Diederiks JP, Knottnerus JA, Kester AD, Crebolder HF. A risk model for the prediction of recurrent falls in community-dwelling elderly: a prospective cohort study. J Clin Epidemiol. 2002;55(11):1088-1094.
- 19.Vassallo M, Mallela SK, Williams A, Kwan J, Allen S, Sharma JC. Fall risk factors in elderly patients with cognitive impairment on rehabilitation wards. Geriatr Gerontol Int. 2009;9(1):41-46.
- 20. Mitchell SL, Teno JM, Kiely DK, Shaffer ML, The clinical course of advanced dementia. N Engl J Med. 2009;361(16):1529-1538.
- 21.Dodds WJ, Stewart ET, Logemann JA. Physiology and radiology of the normal oral and pharyngeal phases of swallowing. AJR Am J Roentgenol. 1990;154(5):953-963.
- 22.Butler RN. Population aging and health. BMJ. 1997;315(7115):1082-1084.
- 23.Doty RL, Shaman P, Applebaum SL, Giberson R, Siksorski L, Rosenberg L. Smell identification ability: changes with age. Science. 1984;226(4681):1441-1443.
- 24.Zuliani G, Ranzini M, Guerra G, et al. Plasma cytokines profile in older subjects with late onset Alzheimer’s disease or vascular dementia. J Psychiatr Res. 2007;41(8):686-693.
- 25.Ousset PJ, Nourhashemi F, Reynish E, Vellas B. Nutritional status is associated with disease progression in very mild Alzheimer disease. Alzheimer Dis Assoc Disord. 2008;22(1):66-71.
- 26.Ball LE, Desbrow B, Leveritt MD. Experiences and nutrition support strategies in dementia care: Lessons from family carers. Nutr Diet. 2015;72(1):22-29.
- 27.Hanson LC, Ersek M, Lin FC, Carey TS. Outcomes of feeding problems in advanced dementia in a nursing home population. J Am Geriatr Soc. 2013;61(10):1692-1697.
- 28.Chapman IM. Weight loss in older persons. Med Clin North Am. 2011;95(3):579-593.
- 29.Agarwal E, Miller M, Yaxley A, Isenring E. Malnutrition in the elderly: A narrative review. Maturitas. 2013;76(4):296-302.
- 30.Dhalwani NN, Fahami R, Sathanapally H, Seidu S, Davies MJ, Khunti K. Association between polypharmacy and falls in older adults: A longitudinal study from England. BMJ Open. 2017;7(10).
- 31.Milos V, Bondesson Å, Magnusson M, Jakobsson U, Westerlund T, Midlöv P. Fall risk-increasing drugs and falls: A cross-sectional study among elderly patients in primary care. BMC Geriatr. 2014;14:40.
- 32.Sturm G, Mair A, Stampfer R, Untner E, Schaffer S. Prevalence and impact of fall-risk-increasing drugs, polypharmacy, and drug-drug interactions in robust versus frail hospitalized falls patients: A prospective cohort study. BMC Geriatr. 2014;14:40.
- 33.Fiske M, Moen A, Mdala I, Straand J. Malnutrition and Polypharmacy in Older Adult Patients Receiving Home Care Nursing Services: A Cross-sectional Study. J Am Med Dir Assoc. 2024 Mar;25(3):526-531. 2021; 30: 96-106.
Öz
Amaç: Demans hastalarında morbidite ve mortalitenin önemli bir nedeni olan düşme riski üzerine beslenme yetersizliği ve çoklu ilaç kullanımının etkilerini değerlendirme amaçlanmaktadır.
Materyal Metodlar: Bu kesitsel çalışma, demans polikliniğinde en az bir yıldır takip edilen erken evre demans hastalarını kapsamaktadır. Polifarmasi ölçütü olarak beşten fazla ilaç kullanan hastalar belirlenmiş ve ilaç tipleri alt gruplara ayrılmıştır. Hastaların Morse Düşme Ölçeği (MDÖ) ve Mini Nutrisyonel Değerlendirme Ölçeği (mini nutritional assessment-MNA) uygulandı.
Bulgular: Çalışmaya toplamda 240 demans hastası (150 kadın) dahil edilmiştir. Alzheimer Demans (AD), Frontotemporal Demans (FTD), Lewy Cisimcikli Demans (LBD) ve Vasküler Demans (VD) olan hastalar incelenmiştir. Malnütrisyon ve polifarmasinin düşme riskini artırdığı gözlemlenmiş, en yüksek risk psikotrop ilaç grubunda bulunmuştur. Tek antipsikotik kullanımının antipsikotik ve antidepresan birlikteliğine göre düşme riskini daha çok arttırığı gözlenmiş olup, bu durum yüksek antipsikotik dozları ile ilişkilendirilmiştir.
Sonuç: Malnütrisyon polifarmasi ve özellikle psikopolifarmasi ile bir araya geldiğinde düşme ve buna bağlı morbidite ve mortaliteyi ciddi oranda arttırmaktadır. Sık aralıklarla malnütrisyon takibinin yapılması ve olabildiğince az miktarda, kısa sürelerde ve kısıtlı endikasyonlarda psikotropik ilaçların kullanılması gereklidir.
Anahtar Kelimeler
Etik Beyan
etik kurul alınmıştır.
Destekleyen Kurum
destekleyen kurum yoktur.
Kaynakça
- 1.Eckstrom E, Vincenzo JL, Casey CM et al. American Geriatrics Society response to the World Falls Guidelines. J Am Geriatr Soc. 2024;72(6):1669-1686. doi: 10.1111/jgs.18734.
- 2.Kukreja S, Kalra G, Shah N, Shrivastava A. Polypharmacy in psychiatry: a review. Mens Sana Monogr. 2013;11(1):82-99.
- 3.Kato-Narita EM, Radanovic M. Characteristics of falls in mild and moderate Alzheimer’s disease. Dement Neuropsychol. 2009;3(4):337-343.
- 4.McKhann GM, Knopman DS, Chertkow H, et al. The diagnosis of dementia due to Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement. 2011;7(3):263-269.
- 5.Rascovsky K, Hodges JR, Knopman D, et al. Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia. Brain. 2011;134(9):2456-2477.
- 6.Sachdev P, Kalaria R, O’Brien J, et al. Diagnostic criteria for vascular cognitive disorders: a VASCOG statement. Alzheimer Dis Assoc Disord. 2014;28(3):206-218.
- 7.McKeith IG, Boeve BF, Dickson DW, et al. Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium. Neurology. 2017;89(1):88-100.
- 8.Morse JM. Development of a Scale to Identify the Fall-Prone Patient. Can J Aging. 1985;4(2):17-24.
- 9.Demir NY, İntepeler ŞS. Morse Düşme Ölçeğinin Türkçe’ye Uyarlanması ve Duyarlılık-Seçicilik Düzeyinin Belirlenmesi. Ege Üniversitesi Hemşirelik Fakültesi Dergisi. 2012;28(1):1-7.
- 10.Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF). J Gerontol A Biol Sci Med Sci. 2001;56(6):366–372.
- 11.Kaiser MJ, Bauer JM, Ramsch C, et al. Validation of the Mini Nutritional Assessment short-form (MNA-SF): a practical tool for identification of nutritional status. J Nutr Health Aging. 2009;13(9):782-788.
- 12.Ferner RE, Aronson JK. Communicating information about drug safety. BMJ. 2006;333(7559):143-145.
- 13.Davis DW, Hanson J, Chapman C, et al. High-level psychotropic polypharmacy: a retrospective comparison of children in foster care to their peers on Medicaid. BMC Psychiatry. 2021;21(1):303.
- 14. Mukadam N, Walters FJ, Valsh S et al.Changes in prevalence and incidence of dementia and risk factors for dementia: an analysis from cohort studies. Lancet Public Health. 2024; 9(7): 443 - 460.
- 15. Shaw FE. Falls in cognitive impairment and dementia. Clin Geriatr Med. 2002;18(2):159-173.
- 16.Eriksson S, Gustafson Y, Lundin-Olsson L. Risk factors for falls in people with and without a diagnose of dementia living in residential care facilities: a prospective study. Arch Gerontol Geriatr. 2008;46(3):293-306.
- 17.Allan LM, Ballard CG, Rowan EN, Kenny RA. Incidence and prediction of falls in dementia: a prospective study in older people. PLoS One. 2009;4(5):5521.
- 18.Stalenhoef PA, Diederiks JP, Knottnerus JA, Kester AD, Crebolder HF. A risk model for the prediction of recurrent falls in community-dwelling elderly: a prospective cohort study. J Clin Epidemiol. 2002;55(11):1088-1094.
- 19.Vassallo M, Mallela SK, Williams A, Kwan J, Allen S, Sharma JC. Fall risk factors in elderly patients with cognitive impairment on rehabilitation wards. Geriatr Gerontol Int. 2009;9(1):41-46.
- 20. Mitchell SL, Teno JM, Kiely DK, Shaffer ML, The clinical course of advanced dementia. N Engl J Med. 2009;361(16):1529-1538.
- 21.Dodds WJ, Stewart ET, Logemann JA. Physiology and radiology of the normal oral and pharyngeal phases of swallowing. AJR Am J Roentgenol. 1990;154(5):953-963.
- 22.Butler RN. Population aging and health. BMJ. 1997;315(7115):1082-1084.
- 23.Doty RL, Shaman P, Applebaum SL, Giberson R, Siksorski L, Rosenberg L. Smell identification ability: changes with age. Science. 1984;226(4681):1441-1443.
- 24.Zuliani G, Ranzini M, Guerra G, et al. Plasma cytokines profile in older subjects with late onset Alzheimer’s disease or vascular dementia. J Psychiatr Res. 2007;41(8):686-693.
- 25.Ousset PJ, Nourhashemi F, Reynish E, Vellas B. Nutritional status is associated with disease progression in very mild Alzheimer disease. Alzheimer Dis Assoc Disord. 2008;22(1):66-71.
- 26.Ball LE, Desbrow B, Leveritt MD. Experiences and nutrition support strategies in dementia care: Lessons from family carers. Nutr Diet. 2015;72(1):22-29.
- 27.Hanson LC, Ersek M, Lin FC, Carey TS. Outcomes of feeding problems in advanced dementia in a nursing home population. J Am Geriatr Soc. 2013;61(10):1692-1697.
- 28.Chapman IM. Weight loss in older persons. Med Clin North Am. 2011;95(3):579-593.
- 29.Agarwal E, Miller M, Yaxley A, Isenring E. Malnutrition in the elderly: A narrative review. Maturitas. 2013;76(4):296-302.
- 30.Dhalwani NN, Fahami R, Sathanapally H, Seidu S, Davies MJ, Khunti K. Association between polypharmacy and falls in older adults: A longitudinal study from England. BMJ Open. 2017;7(10).
- 31.Milos V, Bondesson Å, Magnusson M, Jakobsson U, Westerlund T, Midlöv P. Fall risk-increasing drugs and falls: A cross-sectional study among elderly patients in primary care. BMC Geriatr. 2014;14:40.
- 32.Sturm G, Mair A, Stampfer R, Untner E, Schaffer S. Prevalence and impact of fall-risk-increasing drugs, polypharmacy, and drug-drug interactions in robust versus frail hospitalized falls patients: A prospective cohort study. BMC Geriatr. 2014;14:40.
- 33.Fiske M, Moen A, Mdala I, Straand J. Malnutrition and Polypharmacy in Older Adult Patients Receiving Home Care Nursing Services: A Cross-sectional Study. J Am Med Dir Assoc. 2024 Mar;25(3):526-531. 2021; 30: 96-106.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Klinik Tıp Bilimleri (Diğer) |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 29 Nisan 2025 |
| Gönderilme Tarihi | 18 Eylül 2024 |
| Kabul Tarihi | 10 Mart 2025 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 17 Sayı: 1 |
