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| Year : 2015 | Volume
: 61
| Issue : 1 | Page : 57-58 |
Combining pharmacological treatments in geriatric population: Weighing the balance
R Bhad1, N Hazari2
1 Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
2 Department of Psychiatry, Seth GS Medical College and King Edward Memorial (KEM) Hospital, Mumbai, Maharashtra, India
| Date of Web Publication | 15-Dec-2014 |
Correspondence Address:
Dr. R Bhad
Department of Psychiatry, All India Institute of Medical Sciences, New Delhi
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0022-3859.147061
How to cite this article:
Bhad R, Hazari N. Combining pharmacological treatments in geriatric population: Weighing the balance. J Postgrad Med 2015;61:57-8 |
Sir,
Apropos, the paper by Wisler et al., titled "Pre-injury neuro-psychiatric medication use, alone or in combination with cardiac medications, may affect outcomes in trauma patients," [1] we appreciate that the author has discussed a clinically significant issue concerning polypharmacy in older patients. Notably, with the increasing age of longevity of the population, clinicians are bound to see many older patients on polypharmacy for various medical comorbidities. However, the conclusion drawn from the study that those patients who were on combination of neuropsychiatric medications and cardiac medications are likely to have increase in-hospital mortality needs to be understood in the correct context. We think this observation holds true for not only these two groups of medications, but also for any two groups of medications, which has been observed in studies on polypharmacy outcomes in elderly patients. [2],[3] It would be discriminatory to blame use of neuro-psychiatric medication for increase in inpatient mortality in this particular group of patients. Moreover, there is no control group to know the treatment outcome in use Vis à Vis non-use group for this group of medications. As psychiatric illnesses are themselves associated with increased risk of intentional as well as unintentional injuries, if left untreated, neuropsychiatric medications do have roles in prevention of injuries and hence overall morbidity. [4],[5]
Additionally, the patients who were receiving multiple neuropsychiatric medications may have been suffering from severe mental illnesses which were uncontrolled and the underlying illness itself may have increased the morbidity and mortality. [6] In that case, the culprit is not the neuropsychiatric medications but the underlying neuropsychiatric condition. Similarly, the role of underlying cardiovascular condition is also crucial which could have contributed to the greater morbidity. Also, the dangerous side effects of neuropsychiatric drugs like neuroleptic malignant syndrome (prevalence rate 0.07% to 2.2%) and serotonin syndrome are rare, and it is unlikely that such rare side effects contributed in increase mortality of the patients. [7],[8]
Finally, the clinicians should not hesitate in using neuropsychiatric medications in old age due to fear of increase morbidity and mortality. The standard approach of "start low-go slow" should be used while prescribing neuropsychiatric medications to older patients. [9] Neuropsychiatric conditions are the cause of significant morbidity in elderly and appropriate management keeping in mind other co-morbidities and drug interactions is a must to improve prognosis and quality of life.
| :: References | |  |
| 1. | Wisler JR, Springer AN, Hateley K, Mo XM, Evans DC, Cook CH, et al. Pre-injury neuro-psychiatric medication use, alone or in combination with cardiac medications, may affect outcomes in trauma patients. J Postgrad Med 2014;60:366-71.  [ PUBMED]  |
| 2. | Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf 2014;13:57-65. |
| 3. | Sganga F, Landi F, Ruggiero C, Corsonello A, Vetrano DL, Lattanzio F, et al. Polypharmacy and health outcomes among older adults discharged from hospital: Results from the CRIME study. Geriatr Gerontol Int 2014. [Epub ahead of print]. |
| 4. | O'Donnell ML, Creamer M, Elliott P, Bryant R, McFarlane A, Silove D. Prior trauma and psychiatric history as risk factors for intentional and unintentional injury in Australia. J Trauma 2009;66:470-6. |
| 5. | van der Westhuizen C, Wyatt G, Williams JK, Stein DJ, Sorsdahl K. Prevalence and predictors of mental disorders in intentionally and unintentionally injured emergency center patients. J Nerv Ment Dis 2014;202:638-46. |
| 6. | Almeida OP, Hankey GJ, Yeap BB, Golledge J, Norman PE, Flicker L. Mortality among people with severe mental disorders who reach old age: A longitudinal study of a community-representative sample of 37892 men. PloS One 2014;9:e111882. |
| 7. | Adnet P, Lestavel P, Krivosic-Horber R. Neuroleptic malignant syndrome. Br J Anaesth 2000;85:129-35. |
| 8. | Iqbal MM, Basil MJ, Kaplan J, Iqbal MT. Overview of serotonin syndrome. Ann Clin Psychiatry 2012;24:310-8. |
| 9. | Wollmer MA, Müller-Spahn F. Psychopharmacotherapy of the elderly. Ther Umsch 2009;66:459-65. |
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