Alicja Klich-Rączka

The analysis of the costs of one month of ambulatory drug therapy in the group of elderly aged 80 and over following hospital discharge

Background: It is thought that at least one medication is taken by up to 60% of elderly people. What is more, in US elderly people living in the community take on average four medications, while home-care residents take averagely seven drugs a day. The above-mentioned facts, in the light of current demographic changes of the structure of population, indicate the growing cost of ambulatory drug therapy of the elderly.

Aim of the study: To analyze the costs of one month of ambulatory drug therapy in the group of elderly aged 80 and over following hospital discharge. Moreover, the relation between the number of pills and drugs taken in general, concomitant illnesses and costs of therapy were assessed.

Materials and methods: The retrospective analysis of medical documentation of 116 patients aged 80 and over was performed. The costs of therapy were calculated accordingly to the prices published in The Drug Index. Co-morbid illnesses were classified accordingly to the International Classification of Diseases (ICD-10). Analysis in the age subgroups was performed.

Results: Mean age was 85.2 ± 4.2y-rs, group consisted of 62 women and 27 men; 27 patients were excluded from further analysis. Mean number of prescribed drugs was 7.6 ± 2.9 (min.–max.: 1–16), mean number of prescribed pills was 8.8 ± 4.3 (min.–max.: 0–23). Patients in the examined group suffered from 5.8 ± 2.0 chronic diseases averagely. Mean cost of one month of ambulatory drug therapy was 135.9 ± 95.7 PLN (min.–max.: 1,96–625,9 PLN). Significant relations between the costs of ambulatory drug therapy and the number of chronic diseases (r = 0.51, p < 0.0001) as well as the number of pills (r = 0.68, p < 0.001) and drugs (r = 0.74, p < 0.001) were observed. The differences in the subgroups were observed.

Conclusions: The high co-morbidity observed in the elderly results in the need for taking a great number of drugs and consequently causes high costs of ambulatory drug therapy. When planning ambulatory treatment, it is important to analyze the patients’ and their families’ financial situation, and when necessary provide economical support.

Dementia occurs with a frequency of 10–12% in the entire geriatric population and 33–50% in people over 90 years of age. The most common cause of dementia are: Alzheimer’s disease, rarely vascular dementia, dementia with Lewy bodies, frontotemporal dementia and Parkinson’s disease with dementia. There are no medicaments to prevent dementia and effectively treat it. The treatment only slows the progression and improves the quality of life of the patient and caregiver. Taking care of a patient with dementia burdens the caregiver. As the disease progresses, care time extends even to the entire day. Over 90% of caregivers in Poland are family carers. Over 90% of patients stay in their own home until death. The cost of care is high and increases with the duration of the disease. In the case of agitated patients, the cost is higher. Institutional care is more expensive than home care. In Poland, there are no good system solutions in care for a dementia patient. Caregivers do not receive proper support from the government and subordinate units. 

Przygotowanie do wydania elektronicznego finansowane w ramach umowy 637/P-DUN/2019 ze środków Ministerstwa Nauki i Szkolnictwa Wyższego przeznaczonych na działalność upowszechniającą naukę.

Principles of health care in elderly and geriatric education. Why is geriatrics so important and why are we still lacking geriatricians?

While population is aging we are facing raising number of geriatric problems. It is obvious nowadays that if we do not start creating certain plans considering medical and social care of elderly people, the situation may get out of control.
The natural course of diseases in elderly is different to middle aged and young people. These individuals show different symptoms and social background, different prognosis and complications of the disease and of diagnostic and therapeutic medical procedures themselves. The major feature that distinguishes geriatric medicine from others is comprehensive geriatric assessment which is holistic and considers not only medical condition but also social, psychological background together with identifying aspects of functional status, nutrition, transportation and others.
It seems that the need for professionals with experience in geriatrics is growing. The most important in this area are general practitioners and geriatricians. There is also a constant need for educational effort to create society whose members are responsible for their own health.