Eficacia de la deprescripción de benzodiacepinas en la reducción de caídas en pacientes polimedicados de edad avanzada

Abstract

La polimedicación se trata de una circunstancia muy frecuente en la actualidad, siendo especialmente predominante en la población de edad avanzada. El uso concomitante de múltiples fármacos aumenta el riesgo de interacciones y de aparición de efectos secundarios por lo que la deprescripción supone un importante desafío clínico. Actualmente las benzodiacepinas pertenecen a una de las familias de fármacos más prescritos en pacientes de edad avanzada, suponiendo tratamientos que se prologan en el tiempo pudiendo generar la aparición de efectos adversos. Al tratarse de fármacos de uso común, y a la considerable morbimortalidad que pueden ocasionar, es de gran interés científico llevar a cabo investigaciones que aporten nueva información y evidencia científica sobre factores secundarios relacionados con el uso de benzodiacepinas y que pueda guiar en una prescripción apropiada a los profesionales sanitarios. El presente estudio, se trata de un ensayo clínico aleatorizado que tiene como objetivo principal evaluar la reducción de la proporción de pacientes mayores de 65 años polimedicados que sufren caídas en 6 meses tras la deprescripción adecuada de benzodiacepinas, para ello se seleccionará a aquellos pacientes adscritos al centro de salud de Totana Sur que cumplan los criterios de inclusión y que quieran participar en la investigación. La asignación en grupo control/ intervención se llevará a cabo de forma aleatoria, se precisan 114 sujetos en cada grupo para detectar una diferencia del 14% entre las dos proporciones, se ha aceptado un error alfa del 5% y se asume un error beta del 20%. Será necesaria la formación de los investigadores participantes para una adecuada deprescripción y posterior seguimiento de los pacientes. Tras la recogida de los datos y para responder al objetivo principal del estudio, teniendo en cuenta como variable respuesta la proporción de pacientes que presentan caídas, se utilizaría prueba χ2 (Chi-cuadrado). Polypharmacy is currently a very common circumstance being especially predominant in the elderly population. The concomitant use of multiple drugs increases the risk of interactions and the appearance of side effects. Deprescription represents an important clinical challenge since it must be linked to a prudent and strategic prescription considering the objective of the pharmacological treatment. Benzodiazepines is one of the most prescribed classes of drugs on elderly patients, assuming that these treatments prolonged over time, can generate the appearence of adverse side effects such as drowsiness, memory problems and increased risk of falls. As these are drugs of common use, and can cause considerable morbidity and mortality, it is of great interest to carry out a research that provides new information and scientific evidence related to the use of benzodiazepines and which can be used as guideline to the professionals for an appropriate prescription. The current study presents the theoretical framework of a randomized clinical trial with the main objective to evaluate the reduction in the proportion of polymedicated patients over 65 years who suffer falls in 6 months after adequate deprescription of benzodiazepines. For this purpose, patients assigned to the Totana Sur Health Center who meet the inclusion criteria and want to participate in the research will be selected. The assignment to each control / intervention group will be done randomly. A training of all participating researchers will be required for an adequate prescription and follow- up of the patients. After collecting all data, and in order to respond to the main objective of the study, taking into consideration the proportion of patients with falls, the response variable, the test χ2 (Chi-square) will be used.

Polypharmacy is currently a very common circumstance being especially predominant in the elderly population. The concomitant use of multiple drugs increases the risk of interactions and the appearance of side effects. Deprescription represents an important clinical challenge since it must be linked to a prudent and strategic prescription considering the objective of the pharmacological treatment. Benzodiazepines is one of the most prescribed classes of drugs on elderly patients, assuming that these treatments prolonged over time, can generate the appearence of adverse side effects such as drowsiness, memory problems and increased risk of falls. As these are drugs of common use, and can cause considerable morbidity and mortality, it is of great interest to carry out a research that provides new information and scientific evidence related to the use of benzodiazepines and which can be used as guideline to the professionals for an appropriate prescription. The current study presents the theoretical framework of a randomized clinical trial with the main objective to evaluate the reduction in the proportion of polymedicated patients over 65 years who suffer falls in 6 months after adequate deprescription of benzodiazepines. For this purpose, patients assigned to the Totana Sur Health Center who meet the inclusion criteria and want to participate in the research will be selected. The assignment to each control / intervention group will be done randomly. A training of all participating researchers will be required for an adequate prescription and follow- up of the patients. After collecting all data, and in order to respond to the main objective of the study, taking into consideration the proportion of patients with falls, the response variable, the test χ2 (Chi-square) will be used.