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Suchttherapie 2014; 15(03): 113-117
DOI: 10.1055/s-0034-1384557
Schwerpunktthema
© Georg Thieme Verlag KG Stuttgart · New York

Probleme älterer Patienten in Substitutionsbehandlung

Problems of Older Patients on Opioid Maintenance Treatment
K. M. Dürsteler-MacFarland
1   Universitäre Psychiatrische Kliniken Basel
,
M. Herdener
2   Psychiatrische Universitätsklinik Zürich
,
M. Vogel
1   Universitäre Psychiatrische Kliniken Basel
› Author Affiliations
Further Information

Publication History

Publication Date:
12 August 2014 (online)

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Zusammenfassung

Aufgrund der Wirksamkeit von Substitutionsbehandlungen zeichnet sich zukünftig eine deutliche Zunahme von älteren Patienten ab. Viele Substitutionspatienten scheinen infolge ihres langjährigen Drogenkonsums und der damit assoziierten Risiken „vorgealtert“ und häufig leiden sie bereits frühzeitig an Mobilitätseinschränkungen und altersbedingten chronischen Erkrankungen. Dazu gesellen sich bei vielen von ihnen psychische Störungen, die das Problem der Polypharmazie verschärfen. Neurokognitive Funktionseinbußen, die erhebliche Auswirkungen auf die Compliance und die Behandlungsplanung haben können, treten in dieser Population auch häufig früh auf. Alterungsbedingte physiologische Veränderungen beeinflussen zudem die Wirkung von Medikamenten, was pharmakotherapeutisch zu berücksichtigen ist. Bislang mangelt es an Studien zum Gesundheitszustand und zur bedürfnisgerechten Behandlung älterer Substitutionspatienten, und vielerorts bestehen noch Mängel und Widerstände im Versorgungssystem. Dennoch sind ältere Substitutionspa­tienten wie alle anderen Personen ihrem Alter und ihren gesundheitlichen Problemen entsprechend zu behandeln, und das Substitut sollte vorbehaltlos als Medikament für ihr Wohlbefinden betrachtet werden.

Abstract

The population of older maintenance patients continues to grow rapidly, which is largely due to the effectiveness of opioid maintenance treatment. Many of them have aged prematurely as a result of their drug use history and associated risk factors, and they often suffer early from reduced mobility and age-related chronic diseases. A high proportion of them have co-occurring mental conditions which aggravates the issue of polypharmacy. Neurocognitive functions in this population may also be impaired at an early age, which may compromise compliance and have implications for treatment planning. Furthermore, aging induces physiological changes that affect drug action which must be considered in pharmacotherapy. However, research addressing the health problems and the treatment needs of older maintenance patients is still sparse. And, within the health care system there are many shortcomings and resistance. However, older maintenance patients should be accorded treatment appropriate to their age and health problems, just like any other patients – meaning opioids should be considered as a medication for the well-being of these patients without any undue restrictions.

Schlüsselwörter

Alterung - altersbedingte Erkrankungen - neurokognitive Einbußen - Polypharmazie - physiologische ­Veränderungen

Key words

aging - age-related diseases - neurocognitive impairment - polypharmacy - physiological changes
 

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