{"id":749,"date":"2026-01-20T16:11:11","date_gmt":"2026-01-20T13:11:11","guid":{"rendered":"https:\/\/tatd.org.tr\/geriatri\/?p=749"},"modified":"2026-01-20T16:22:09","modified_gmt":"2026-01-20T13:22:09","slug":"yaslilarda-polifarmasi-ve-ilac-yonetimi","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/geriatri\/genel\/yaslilarda-polifarmasi-ve-ilac-yonetimi\/","title":{"rendered":"Ya\u015fl\u0131larda Polifarmasi ve \u0130la\u00e7 Y\u00f6netimi"},"content":{"rendered":"\n

Yazar: Dr. Kudret Selki<\/strong> \u00a0Edit\u00f6r:\u00a0Prof. Dr. \u00d6zg\u00fcr Karc\u0131o\u011flu<\/strong><\/p>\n\n\n\n

*Ocak 2025\u2019de yaz\u0131lan bu blog yaz\u0131s\u0131 teknik sorunlar nedeni ile Ocak 2026\u2019da yay\u0131nlanm\u0131\u015ft\u0131r.<\/p>\n\n\n\n

Acil servis bir\u00e7ok \u00f6zellikli hasta grubunun u\u011frak kap\u0131s\u0131d\u0131r. Son y\u0131llarda t\u0131bbi bak\u0131m\u0131n iyile\u015fmesiyle bu \u00f6zellikli gruplardan bir tanesi \u00f6n plana \u00e7\u0131kmaktad\u0131r. Bu grup, geriatrik yani ya\u015fl\u0131 hastalard\u0131r.\u00a0 Nas\u0131l ki \u00e7ocuklar eri\u015fkinlerin k\u00fc\u00e7\u00fclt\u00fclm\u00fc\u015f\u00fc de\u011fildir, tan\u0131-tedavi y\u00f6ntemleri kendine ait \u00f6zellikli bir gruptur, ya\u015fl\u0131lar da eri\u015fkinlerin b\u00fcy\u00fclt\u00fclm\u00fc\u015f\u00fc de\u011fildir. Ya\u015fl\u0131 hasta deyince de akl\u0131m\u0131za ilk olarak \u00e7ok say\u0131da komorbidite, dolay\u0131s\u0131yla polifarmasi gelir. Polifarmasi nedir, potansiyel uygunsuz ila\u00e7 (PIM) kullan\u0131m\u0131 nedir, hangi kriterlerle tan\u0131mlan\u0131r, hangi noktalara dikkat etmek gerekir gibi sorulara yan\u0131t bulman\u0131z i\u00e7in bu yaz\u0131y\u0131 sizlere sunuyorum.<\/p>\n\n\n\n

Polifarmasi Nedir?<\/strong><\/p>\n\n\n\n

Polifarmasi 20. y\u00fczy\u0131ldan beri \u00e7ok say\u0131da ila\u00e7 kullan\u0131m\u0131 olarak tan\u0131mlanan bir terimdir (1). Tan\u0131m\u0131 hakk\u0131nda net bir g\u00f6r\u00fc\u015f birli\u011fi bulunmamaktad\u0131r. En az 240 g\u00fcn s\u00fcreyle 2 ve daha fazla ila\u00e7 kullan\u0131m\u0131 (2), 4 ve daha fazla ila\u00e7 kullan\u0131m\u0131 (3), 5 ve daha fazla ila\u00e7 kullan\u0131m\u0131 (4) gibi bir\u00e7ok tan\u0131mlama mevcuttur. Net bir kesme de\u011feri bulunmamas\u0131 nedeniyle \u2018\u2019hastan\u0131n ihtiyac\u0131 oldu\u011fundan fazla miktarda ila\u00e7 kullanmas\u0131\u2019\u2019 olarak tan\u0131mlamak do\u011fru olacakt\u0131r. Ayr\u0131ca polifarmasi dendi\u011finde yaln\u0131zca hekimin re\u00e7ete etti\u011fi ila\u00e7lar de\u011fil, kom\u015fu tavsiyesi ila\u00e7lar, tezgah \u00fcst\u00fc ila\u00e7lar ve bitkisel takviyeler de ak\u0131lda bulundurulmal\u0131d\u0131r.<\/p>\n\n\n\n

\u00dclkemizde ve D\u00fcnyada Ya\u015fl\u0131 N\u00fcfus<\/strong><\/p>\n\n\n\n

Ya\u015fl\u0131 n\u00fcfus olarak kabul edilen 65 ya\u015f ve \u00fczeri pop\u00fclasyon, 2018 T\u00fcrkiye \u0130statistik Kurumu (T\u00dc\u0130K) verilerine g\u00f6re, 7 milyon 186 bin 204 ki\u015fi iken son be\u015f y\u0131lda %21,4 artarak 2023 y\u0131l\u0131nda 8 milyon 722 bin 806 ki\u015fi oldu. Ya\u015fl\u0131 n\u00fcfusun toplam n\u00fcfus i\u00e7indeki oran\u0131 ise 2018 y\u0131l\u0131nda %8,8 iken, 2023 y\u0131l\u0131nda %10,2’ye y\u00fckseldi. N\u00fcfus projeksiyonlar\u0131na g\u00f6re ya\u015fl\u0131 n\u00fcfus oran\u0131n\u0131n 2030 y\u0131l\u0131nda %12,9, 2040 y\u0131l\u0131nda %16,3, 2060 y\u0131l\u0131nda %22,6 ve 2080 y\u0131l\u0131nda %25,6 olaca\u011f\u0131 \u00f6ng\u00f6r\u00fcl\u00fcyor. \u00d6l\u00fcm nedeni istatistiklerine g\u00f6re, 2022 y\u0131l\u0131nda \u00f6len ya\u015fl\u0131lar\u0131n %39,1’i dola\u015f\u0131m sistemi hastal\u0131klar\u0131 nedeniyle hayat\u0131n\u0131 kaybetti. Bu hastal\u0131\u011f\u0131 ikinci s\u0131rada %15,5 ile solunum sistemi hastal\u0131klar\u0131, \u00fc\u00e7\u00fcnc\u00fc s\u0131rada %12,7 ile maligniteler takip etti (\u015eekil-1) (5). 2020 D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (WHO) verilerine g\u00f6re d\u00fcnyadaki 60 ya\u015f \u00fcst\u00fc pop\u00fclasyon 1 milyar iken 2030 y\u0131l\u0131nda 1.4 milyara \u00e7\u0131kmas\u0131 beklenmektedir. 2050 y\u0131l\u0131na kadar ise bu n\u00fcfusun iki kat\u0131na \u00e7\u0131karak 2,1 milyar olmas\u0131 beklenmektedir. 2020-2050 y\u0131llar\u0131 aras\u0131nda 80 ya\u015f \u00fcst\u00fc n\u00fcfusun ise 3 kat\u0131na \u00e7\u0131karak 426 milyona ula\u015fmas\u0131 beklenmektedir (6). Bu veriler bizlere d\u00fcnyadaki ya\u015fl\u0131 n\u00fcfusun h\u0131zla artt\u0131\u011f\u0131n\u0131 ve artmaya devam edece\u011fini g\u00f6steriyor. Bu da bizler i\u00e7in acil servis yo\u011funlu\u011funu artt\u0131raca\u011f\u0131ndan \u00f6nem arz ediyor. Avustralya\u2019da yap\u0131lan bir \u00e7al\u0131\u015fmada 2050 y\u0131l\u0131ndaki acil servis ba\u015fvurular\u0131, 65-84 ya\u015f grubunda 2010\u2019a g\u00f6re %242’sine, \u226585 ya\u015flar\u0131ndaki ki\u015filerde %411’ine bir art\u0131\u015f oldu\u011fu ortaya koyulmu\u015ftur. Orta d\u00fczeyde n\u00fcfus art\u0131\u015f\u0131 senaryosunda \u226585 ya\u015f\u0131ndaki ki\u015filerin ba\u015fvurular\u0131 2020’de %150’ye, 2030’da %236’ya, 2040’ta %402’ye ve 2050’de %574’e y\u00fckselmi\u015ftir (7).\u200b <\/sup>T\u00fcrkiye\u2019de ya\u015fl\u0131 hastalar\u0131n acil servis ba\u015fvurular\u0131n\u0131n kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131 bir \u00e7al\u0131\u015fmada \u00e7ok ya\u015fl\u0131 n\u00fcfusun (90 ya\u015f \u00fcst\u00fc) oran\u0131 %3,9\u2019dur. Ayn\u0131 \u00e7al\u0131\u015fmada ya\u015fl\u0131 (65-89 ya\u015f) ve \u00e7ok ya\u015fl\u0131 n\u00fcfusun 30 g\u00fcnl\u00fck mortaliteleri k\u0131yasland\u0131\u011f\u0131nda %2\u2019ye kar\u015f\u0131n %5,8 oran\u0131 tespit edilmi\u015f. Yani ya\u015f artt\u0131k\u00e7a mortalite de artm\u0131\u015f (8). Yine T\u00fcrkiye\u2019de yap\u0131lan bir \u00e7al\u0131\u015fmada 65 ya\u015f \u00fcst\u00fc hastalar\u0131n %88\u2019inin y\u0131lda 4-7 kere, %12\u2019sinin ise y\u0131lda 7\u2019den daha fazla acil servis ba\u015fvurusu oldu\u011fu tespit edilmi\u015f. Ayn\u0131 \u00e7al\u0131\u015fmada 74 g\u00fcn i\u00e7inde 4 ve daha fazla acil servis ba\u015fvurusu olan ya\u015fl\u0131 hastalar\u0131n mortalite riskinin 4 kat artt\u0131\u011f\u0131 g\u00f6r\u00fclm\u00fc\u015f (9).  Yani ya\u015fl\u0131 n\u00fcfus t\u00fcm d\u00fcnyada oldu\u011fu gibi \u00fclkemizde de h\u0131zla artmakta, dolay\u0131s\u0131yla geriatrik pop\u00fclasyon \u00fczerine d\u00fc\u015f\u00fclmesi gereken bir grup olarak dikkat \u00e7ekmektedir. Bu hastalar\u0131n eri\u015fkin pop\u00fclasyona g\u00f6re acil servis ba\u015fvuru say\u0131s\u0131n\u0131n ve mortalitelerinin daha fazla oldu\u011fu g\u00f6z \u00f6n\u00fcne al\u0131nd\u0131\u011f\u0131nda acillerin ya\u015fl\u0131 hasta y\u00fck\u00fcn\u00fc en \u00f6n cephede s\u0131rtlayan yerler oldu\u011fu g\u00f6ze \u00e7arpmaktad\u0131r.<\/p>\n\n\n\n

\"\"<\/figure>\n\n\n\n

\u015eekil-1. <\/strong>2022 Y\u0131l\u0131nda T\u00fcrkiye\u2019de Ger\u00e7ekle\u015fem \u00d6l\u00fcm Nedenleri ve Cinsiyetlere G\u00f6re Da\u011f\u0131l\u0131m\u0131<\/p>\n\n\n\n

Ya\u015fl\u0131larda Polifarmasi<\/strong><\/p>\n\n\n\n

\u0130leri ya\u015f bir\u00e7ok t\u0131bbi durum gibi polifarmasi i\u00e7in de en yayg\u0131n risk fakt\u00f6r\u00fcd\u00fcr. Acil serviste anamnez al\u0131rken, ya\u015fl\u0131 bir hastan\u0131n yak\u0131n\u0131n\u0131n bir eczane po\u015feti dolusu ilac\u0131 deske d\u00f6kmesi bu yaz\u0131y\u0131 okuyan kimseye yabanc\u0131 gelmeyecektir. OPERAM (Optimizing Therapy to Prevent Avoidable Hospital Admissions in Multimorbid Older Adults – \u00c7oklu Morbiditeye Sahip Ya\u015fl\u0131 Yeti\u015fkinlerde \u00d6nlenebilir Hastane Yat\u0131\u015f\u0131n\u0131 \u00d6nlemek \u0130\u00e7in Tedaviyi Optimize Etme), randomize kontroll\u00fc bir \u00e7al\u0131\u015fma, polifarmasi ve \u00e7oklu morbiditeye sahip ya\u015fl\u0131 yeti\u015fkinlerde ila\u00e7la ili\u015fkili hastane yat\u0131\u015flar\u0131 \u00fczerinde ila\u00e7 tedavisini optimize etmenin etkisini incelemek i\u00e7in y\u00fcr\u00fct\u00fclm\u00fc\u015ft\u00fcr. \u00c7al\u0131\u015fma, hastaneye yat\u0131r\u0131lan polifarmasi olan ya\u015fl\u0131 yeti\u015fkinlerde uygunsuz re\u00e7etelemenin yayg\u0131n oldu\u011fu ve farmakoterapiyi optimize etmenin yat\u0131\u015f oranlar\u0131n\u0131 azaltabilece\u011fi sonucuna varm\u0131\u015ft\u0131r (10). 2023 y\u0131l\u0131nda yap\u0131lan bir \u00e7al\u0131\u015fmada ila\u00e7-ila\u00e7 ve ila\u00e7-hastal\u0131k etkile\u015fimlerini tespit etmenin \u00f6n\u00fcndeki en b\u00fcy\u00fck engelin zaman oldu\u011funda yola \u00e7\u0131k\u0131larak yapay zeka destekli bir web sitesi geli\u015ftirilmi\u015ftir ve PIM\u2019lerin %75,3\u2019\u00fc tespit edilmi\u015ftir. Bunu, hekimlerin ortalama s\u00fcresi olan 2278 saniyeye kar\u015f\u0131l\u0131k 33,8 saniyeye indirdi\u011fi, yani bu s\u00fcreyi 60 kat h\u0131zland\u0131rd\u0131\u011f\u0131 sonucuna var\u0131lm\u0131\u015ft\u0131r (11). Bir di\u011fer \u00e7al\u0131\u015fmada 3 ve daha fazla ila\u00e7 kullanan hastalar\u0131n, 3\u2019ten az ila\u00e7 kullananlara g\u00f6re 1 y\u0131l i\u00e7inde demans g\u00f6r\u00fclme riskinin 6 kat daha fazla oldu\u011fu bildirilmi\u015ftir (12).<\/p>\n\n\n\n

1991\u2019de Mark Beers, ya\u015fl\u0131 hastalarda \u00e7ok say\u0131da ila\u00e7 kullan\u0131m\u0131n\u0131n olas\u0131 yan etkilerini \u00f6n g\u00f6rmek, do\u011fru ila\u00e7 d\u00fczenleme stratejileri ile yan etki, ila\u00e7-ila\u00e7 etkile\u015fimlerini en aza indirmek i\u00e7in Beers Kriterleri\u2019ni tan\u0131mlam\u0131\u015ft\u0131r. 2023\u2019te bu kriterlerin en g\u00fcncel hali Amerikan Geriatri Derne\u011fi taraf\u0131nca yay\u0131mland\u0131 (13). Yine 2023 y\u0131l\u0131nda ya\u015fl\u0131 hastalarda uygunsuz ila\u00e7 kullan\u0131m\u0131 i\u00e7in ilki 2008 y\u0131l\u0131nda yay\u0131mlanan STOPP (Screening Tool of Older Person’s Prescriptions – Ya\u015fl\u0131 \u0130nsanlar\u0131n Re\u00e7etelerini Tarama Arac\u0131) \/ START (Screening Tool to Alert Doctors to the Right Treatment – Doktorlar\u0131 Do\u011fru Tedavi Konusunda Uyaracak Tan\u0131 Arac\u0131) kriterleri-Versiyon 3 yay\u0131mland\u0131. \u00d6nceki versiyonu 114 kriterden olu\u015fan bu sistem 190 kritere geni\u015fletildi (14).<\/p>\n\n\n\n

Beers Kriterleri-2023 <\/strong>(13)<\/strong> <\/strong>(Tablolar T\u00fcrk\u00e7ele\u015ftirilmi\u015f ve sadele\u015ftirilmi\u015ftir. Orijinal hallerine tablo alt\u0131ndaki referanslar\u0131ndan ula\u015fabilirsiniz.)<\/strong><\/p>\n\n\n\n

\u0130la\u00e7lar be\u015f kategoriye ayr\u0131lm\u0131\u015ft\u0131r:<\/p>\n\n\n\n